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Welcome to SHAAP’s (Scottish Health Action on Alcohol Problems) weekly media monitoring service.

07 September 2016

#MUPsaveslives

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This briefing aims to provide a ‘snap shot’ of latest news on alcohol and health policy. The inclusion of an article in the briefing should not imply that SHAAP approves or condones the content.

SHAAP provides a coordinated, coherent and authoritative medical and clinical voice on the need to reduce the impact of alcohol related harm on the health and wellbeing of the people in Scotland. SHAAP was set up by the Scottish Medical Royal Colleges, through their Scottish Intercollegiate Group (SIGA) and is governed by an Executive Committee made up of members of the Royal Colleges.

534 people die from alcohol abuse in Lanarkshire, shock figures reveal

A total of 534 people have died from alcohol-related illnesses in Lanarkshire over the past three years, the Wishaw Press can reveal.

Shock new data shows that number of adults who died from abusing booze shot up by 11 per cent in the county over two years.

Last year there were 186 deaths from alcohol-related illnesses compared to 181 in 2014 and 167 in 2013.

Over the three-year period, 160 people died at Wishaw General Hospital, 12 more than 148 deaths at Monklands in Airdrie and 45 more than the 115 East Kilbride’s Hairmyres Hospital.

That means that one person every week was recorded as a death from a booze-related illness at Wishaw General every week.

The highest year for deaths at the hospital over the period was 2014 where 59 people died, three more than last year’s total of 56 and 15 more of 2013 total of 45.

Tory Central Scotland MSP Graham Simpson said the figures were shocking and called for action to tackle the nation’s addiction with booze.

“Every single one is a personal and family tragedy,” he added.

“It shows that we must continue our efforts to tackle alcohol addiction in Lanarkshire and throughout Scotland.”

Wishaw MSP Clare Adamson said alcohol abuse continues to be a major cause of health and social problems in Scotland.

She said: “The Scottish Parliament have passed The Alcohol (Minimum Pricing) (Scotland) Act 2012, which unfortunately has yet to be implemented due to legal challenge by the Scottish Whisky Association. When enacted however, recent research has predicted that by year twenty of the legislation, alcohol-related deaths will fall 120 per year, and alcohol-related hospital admissions by 2000 per year.

“Minimum Pricing is a start. Alongside this legislation, Scotland must look at its cultural relationship with alcohol and properly educate future generations on the true impact of alcohol abuse on families, services and wider society.’

Our special investigation shows that 16,413 patients were discharged from accident and emergency or inpatients were alcohol was mentioned in the discharge for diagnoses over the three-year period.

Of the 16,413, 4327 had attended A&E and 12086 were inpatients at the county’s three hospitals.

Over the three-year period, 5677 people had attended Wishaw General with alcohol-related problems, 1470 had been discharged at the hospital’s A&E and 4207 were inpatients there.

The figures for Monklands Hospital were the highest in Lanarkshire with 6042 recorded. This consisted of 2173 discharged at A&E and 3869 as a hospital inpatient.

Hairmyres recorded the lowest of the county’s three hospital with a a total figure of 4094.

A total of 684 at Hairmyres Hospital’s A&E and 4010 as the hospital’s inpatient,

Lanarkshire Alcohol and Drug Partnership (LADP) undertake the work of tackling drug and alcohol issues.

Their multi-agency strategic planning group are made up partners including NHS Lanarkshire, North and South Lanarkshire Councils, Police Scotland, Scottish Fire and Rescue, the Crown Prosecution Service and the voluntary sector.

The remit of the LADP is to safeguard and promote the interests of children, young people and families affected by substance misuse, reduce the level of alcohol and drug related harm at a community level and support individuals with alcohol and/or drug problems by providing a recovery-oriented system of care in Lanarkshire.

A NHS Lanarkshire spokesman said that over the last decade the three-year average shows alcohol-related deaths in Lanarkshire have fallen from 201 between 2003/2005 to 178 between 2013/2015.

Dr Adam Brodie, NHS Lanarkshire’s clinical director for addictions, said: “The best way to address alcohol-related illnesses is of course prevention which is a major focus of the LADP work such as the work it does with young people, diversionary schemes, and young
adults.

“Evidence shows this focus can help prevent alcohol issues/addictions emerging.”

Source: Daily Record, 7th September
 

Captain Morgan TV ad scuppered for implying alcohol can boost confidence

A TV ad for Captain Morgan rum featuring a raucous boat party has been banned for implying alcohol can make you more confident.

The TV ad featured a party on a sailing ship with a fun-loving man who has the face of the Captain Morgan pirate logo that adorns the rum’s bottles superimposed over his own.

The man is seen dancing with friends to Chic’s Le Freak, upending a sofa and swinging on a rope from deck to deck with text saying “Captain the dance floor”, “Captain the night” and “Put your Captain face on”.

The ad ended with a shot of the Captain Morgan product range and the line “Live like the Captain”.

The Advertising Standards Authority received complaints from Alcohol Concern and a member of the public that the TV ad was irresponsible because it implied that drinking alcohol could contribute to an individual’s popularity or confidence.

Diageo, which owns the rum brand, said the ad shows enjoying a night with friends and “taking charge of a night out and staying in control”.

It said the use of the Captain Morgan face image on the main character did not symbolise alcohol consumption and no booze was shown in the party scenes at all.

The ASA said that viewers would equate the brand and the character with the rum brand.

“Viewers were therefore likely to understand that the central figure’s behaviour resulted from his consumption of Captain Morgan rum,” said the ASA.

“We considered that the use of ‘captain’ as a verb to mean being in charge or in control carried connotations of enhanced confidence, dominance, and ability to lead others.

“In that context we considered that the phrases … would be understood by consumers as invitations to achieve a confident, uninhibited attitude through consuming Captain Morgan rum.”

The ASA said that while the main character was not shown drinking “we considered that the superimposed Captain Morgan face implied that he ha

d already consumed the product and thus linked his confident behaviour to this consumption.”

The ASA banned the ad under rules relating to responsible alcohol advertising.

“We concluded that the ad implied that drinking alcohol could enhance personal qualities and was therefore irresponsible,” the ASA said.

Source: The Guardian, 31st August
 

More evidence that TV ads may influence kids' drinking

The more advertising kids see for particular brands of alcohol, the more they consume of those brands, according to a new study.

The research, published in the September issue of the Journal of Studies on Alcohol and Drugs, adds to evidence linking alcohol advertising to underage drinking. And it suggests that TV ads really do influence the amount of alcohol kids drink.

Past studies have found that underage drinkers often have a preference for the brands of alcohol they see advertised.

"But critics could say, sure, ads influence the brands underage drinkers choose, but not whether they drink, or how much they drink in total," said Timothy Naimi, M.D., M.P.H., lead researcher on the new study and an associate professor of community health sciences at Boston University School of Public Health.

However, he said his team's findings counter that argument: The more exposure kids had to brand-specific alcohol ads on TV, the greater the total amount they consumed of those brands, even after adjusting for consumption of all non-advertised brands. This adjustment is important, says Naimi, because it takes into account the fact that those who watch more television may tend to drink more.

The findings are based on a national sample of 1,031 13- to 20-year-olds who said they'd had alcohol in the past month. They were asked whether, in the past month, they'd watched any of 20 popular TV shows that featured alcohol commercials. They also reported on their consumption of the 61 brands in those commercials.

The researchers measured youths' ad exposure in what they term "adstock units." On average, underage drinkers who'd seen zero units had about 14 drinks per month; that rose to about 33 per month by the time they'd seen 300 adstock units. Drinking levels shot up among kids exposed to more than 300 units, reaching 200-plus drinks in the past month.

As it stands, Naimi pointed out, alcohol advertising is self-regulated by the industry. Manufacturers have guidelines saying that ads should be limited to media that have a mostly adult audience, for instance. But alcohol companies don't always follow their own guidelines, and there is no penalty for violations.

Nonetheless, the current study is not the first to show that under-21 audiences are seeing plenty of alcohol ads, despite the industry's own regulations.

For parents, Naimi said, the findings may offer extra motivation to curb kids' time in front of the TV, particularly for programming with alcohol advertising. In general, experts recommend that children and teenagers spend a limited amount of time each day in front of a "screen" -- whether a TV, computer, or phone. The point, in part, is to free more time for healthier activities, such as exercising and reading.

"This could be yet another reason to limit screen time," Naimi said.

Source: Eurek Alert, 7th September
 

Heavy drinking frequently causes liver inflammation and injury, and fatty acids (FAs) involved in pro- and anti-inflammatory responses could play a critical role in these processes. This study evaluated heavy drinking and changes in levels of omega-6 (ω-6, pro-inflammatory) and omega-3 (ω-3, anti-inflammatory) FAs in alcohol dependent (AD) patients who showed no clinical signs of liver injury.

Researchers assigned 114 heavy drinking AD patients recruited from an AD treatment program to one of two groups based on the levels of a specific liver enzyme, alanine aminotransferase -- ALT, elevated levels of which reflect liver injury. The patients were aged 21-65 years and showed no signs of liver injury. Patient group one (34 males, 24 females) had normal levels of ALT and patient group two (40 males, 16 females) had mildly elevated ALT levels.

Results indicated that changes in the ω-3 and ω-6 FA levels and the ω-6:ω-3 ratio reflected a pro-inflammatory shift in patients with elevated ALT -- mild liver injury. At comparable levels of alcohol consumption, women in the study showed greater liver injury than men. The authors speculated that women may be at greater risk of developing alcoholic liver disease than men, even when consuming less alcohol.

Source: Science Daily, 2nd September
 

YouTube videos glamourise alcohol, encourage binge drinking: study

YouTube music videos that involve alcohol often glamorise drinking, objectify women and use sexual imagery or lyrics - encouraging teens to binge drink and abuse alcohol, a new UK study has found.

The research is an extension of previous work which found that teenagers in the UK were heavily exposed to images of alcohol and tobacco in YouTube music, effectively glamorising the habits and promoting underage drinking and smoking.

Scientists from the University of Nottingham specifically studied the portrayal of alcohol content in popular YouTube music videos, analysing song lyrics and visual imagery in 49 UK Top 40 videos previously found to contain alcohol content.

They found that content involving alcohol was also linked to sexualised imagery or lyrics and the objectification of women, and that alcohol was linked to personal image, lifestyle and sociability.

Some videos also showed encouragement of excessive drinking including those with branded alcohol, with no negative consequences to the drinker shown.

"Among young people particularly binge drinking is also linked to criminal behaviour, unprotected sex, progression to illegal drug use and is a risk factor for alcohol dependence in later life," Joanne Cranwell, from the University of Nottingham.

"We know that alcohol imagery and references in advertising, films, TV and music videos are a risk factor for uptake of drinking in young people but we wanted to pin down the exact extent," said Cranwell.

The study of top music charts found that the overt use of celebrity endorsement or brand ambassadors of alcohol products in music videos contravenes voluntary codes of practice in the alcohol industry.

The study was published in the International Journal of Behavioural Medicine.

Source: First Post, 7th September



Targetting 'addicition switch' may help combat alcoholism

"Alcoholics are missing 'vital chemical in their brain' that helps control addiction," the Daily Express reports.

Research carried out on rats suggests that low levels of the PRDM2 enzyme could trigger self-destructive addictive behaviour associated with alcohol dependency; leading people to continue to drink even though it is causing them physical and mental stress.

The studies showed that levels of this enzyme were lower in brain cells of the frontal lobe in rats that had previously been made dependent on alcohol, through being made to inhale alcohol vapour. These rats showed signs of addiction such as increased drinking of alcohol, even when it was mixed with bitter quinine, and seeking alcohol when stressed by being given electric shocks.

The researchers then found that rats which had not been exposed to alcohol vapour showed similar behaviour, after being treated to prevent them from producing PRDM2. They say this shows that the enzyme is important in controlling impulsive behaviour, which is difficult for people with alcohol addiction.

The obvious caveats about extrapolating animal research to humans apply.

The lead researcher said he hoped the findings would lead to medicines that can help people recover from alcoholism.

Current treatment options for alcohol dependency include talking therapies, group therapy, and medication that can help relieve cravings and prevent relapses.

To keep your risk of alcohol-related harm low, the NHS recommends not regularly drinking more than 14 units of alcohol a week.

If you are worried about your alcohol consumption, speak to your GP to find out more about treatment options.

What are enzymes?

Enzymes are molecules, usually proteins, that are involved in accelerating chemical reactions inside the body. For example, enzymes play a vital role in helping the body digest food.

Where did the story come from?

The study was carried out by researchers from Linköping University in Sweden, University of Miami Miller School of Medicine, National Institute on Alcohol Abuse and Alcoholism, and the University of Georgia, all in the US. It was funded by the National Institute on Alcohol Abuse and Alcoholism, the Swedish Research Council and United States Department of Defense.

The study was published in the peer-reviewed journal Molecular Psychiatry on an open-access basis so it is free to read online.

The Times says that cancer drugs "could help alcoholics give up drink." This claim seems to be based on interviews with researchers, rather than anything in the study, which did not look at any medicines that might reverse the effects of the enzyme found to be lower in alcohol-dependent rats. The headline could raise hopes that a treatment for alcoholism is closer than it actually is.

The Daily Express fails to make it clear in its report that there is no direct evidence from this study that lack of PRDM2 is responsible for alcoholism in humans. This may be because the researchers' press release was headed: "People with alcohol dependency lack important enzyme," and doesn't mention animal research until the seventh paragraph.

What kind of research was this?

This was a series of animal experiments on rats in a laboratory, including manipulation of genes responsible for producing the enzyme PRDM2. These types of studies are helpful to understand molecular pathways behind diseases like alcoholism, but they do not investigate cures. Also, findings that apply to animals do not always translate to humans.

What did the research involve?

Researchers did a series of experiments involving rats that had been exposed to breathing alcohol vapour for 14 hours a day over seven weeks. This makes them "dependent" on alcohol. The researchers studied their behaviour in a series of behavioural experiments, including seeing whether they continued to drink alcohol when it was mixed with bitter-tasting quinine.

The researchers examined brain tissue cells for production of enzymes including PRDM2 and carried out DNA sequencing to examine the function of nerve cells affected by these enzymes. They used DNA analysis and cell chemistry techniques to look at expression of PRDM2 and behavioural experiments to examine the effects of changing this enzyme expression. They then carried out behavioural experiments on rats that had not been exposed to alcohol vapour, but which had been genetically manipulated not to produce PRDM2.

The behaviour of these rats was compared to rats with normal PRDM2 expression.

The researchers wanted to understand the role of different enzymes, and whether specific enzymes could be identified that affected alcohol addiction or produced behaviour similar to that shown by rats dependent on alcohol.

What were the basic results?

Researchers found that rats with alcohol dependency, as shown by their behaviour, had lower levels of the enzyme PRDM2 produced in their prefrontal cortex cells, weeks after they had stopped receiving alcohol.

In the second series of experiments, rats engineered not to produce PRDM2 showed similar behavioural signs of alcohol dependency, despite not having been exposed to alcohol vapour. Compared to rats with normal PRDM2 production, they were likely to drink more alcohol, to drink compulsively despite the bitter quinine taste, and to drink alcohol in response to electric shock stress. They were no more likely than normal rats to drink more sugar solution, suggesting that the effects of PRDM2 were specific to alcohol.

How did the researchers interpret the results?

In their paper, the researchers said "these observations suggest that long-term repression of PRDM2 is a key epigenetic mechanism contributing to a cluster of behaviours thought to be at the core of alcohol addiction." Epigenetics is the way in which genes are switched on and off, in response to external stimuli including enzymes.

They concluded that this gave a "strong rationale to explore PRDM2 or some of its downstream targets as candidate targets for novel alcoholism medications." They say that reversing the changes seen in alcoholism where the cells stop producing PRDM2 might "promote a transition back to a preaddicted state."

Conclusion

It seems likely that many factors influence why some people become addicted to alcohol and not simply a single enzyme. This new study shows that a change in enzyme production by brain cells of rats who have been forcibly exposed to alcohol vapour may be part of the process by which animals become dependent on alcohol. But despite the claims in the press release, this study does not prove anything about human brain cells, enzymes or alcohol addiction.

One researcher expressed the hope that his findings would "do away with the stigmatisation of alcoholism," by showing that it has a biochemical basis. While this is a laudable aim, the research published today does not show that the same mechanisms operational in rat brains operate in human brains. We do not know whether PRDM2 expression is the key to developing alcohol addiction for humans, even if animal research suggests it may be.

The findings open up possibilities for future research in humans, and may even one day lead to new drugs to reverse people's dependency on alcohol. That is still a way off, however, and much more research needs to be done before new drugs are likely to be available.

If you are worried you may have a problem with alcohol, talk to your GP or find out more about getting help with our information on alcohol support.

Source: NHS Choices, 31st August

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