Alcohol and Health: TABLECONTENTS of CONTENTS

TABLE OF Alcohol and Health: TABLECONTENTS OF CONTENTS Current Evidence NOV-DEC 2006 ALCOHOL AND HEALTH OUTCOMES Alcohol and Health Outcomes Does Inflammation Influence Alcohol’s Cardiovascular Does Inflammation Influence Alcohol’s Cardiovascular Effects? Effects?, 1 Light-to-moderate alcohol use can reduce women had an outcome event. cardiovascular mortality in some popula- Long-Term Mortality in People tions. To investigate whether this protective Comments: This interesting research is con- Treated for Alcoholism, 1 effect is influenced by inflammation, re- sistent with prior studies that show researchers assessed alcohol use and inflamma- duced all-cause mortality and cardiac events tory markers (C-reactive protein and inter- in adults who drink light-to-moderate Moderate Drinking Impairs the Ability to See, 2 leukin-6) in 2487 adults, aged 70–79 years, amounts. Although the study found no rela- without heart disease at study entry. Over a tionship between C-reactive protein levels, mean 5.6 years of follow-up, 397 deaths and alcohol use, and outcomes, it did find a Alcohol and Cancer Worldwide, 3 383 cardiac events (myocardial infarction, lower risk in light-to-moderate drinking angina, or heart failure) occurred. men with high (but not low) interleukin-6 levels. To better understand the interaction Alcohol-Attributable Mortality and Morbidity in Canada, 3 • In adjusted analyses, the risks of all- of inflammation, alcohol, and cardiovascular cause mortality and incident cardiac health, further research on this topic events were lower in light-to-moderate should include different populations, such Prescription Drug Misuse Is drinkers* than in never or occasional as people with chronic inflammatory condi- More Common in Drinkers, 3 drinkers** (hazard ratios [HRs] 0.7 for tions, women, and racial minorities. Kevin L. Kraemer, MD, MSc all-cause mortality and 0.7 for cardiac Alcohol Outlets Increase Hospi- events). talizations for Assault, 4 • Risks were also reduced in light-to- *Drank 1–7 standard drinks per week moderate drinking men with above- **Drank never or <1 drink per week median, but not lower, levels of interleukin-6 (HRs 0.5 for all-cause mortality Reference: Maraldi C, et al. Impact of inflammation on the relationship among ASSESSMENTS/INTERVENTIONS and 0.5 for cardiac events). • C-reactive protein levels did not affect alcohol consumption, mortality, and cardiac events: the Health, Aging, and Body the association between drinking and Primary Care Clinicians Lack risk among men. Composition Study. Arch Intern Med. 2006;166(14):1490–1497. Comfort and Skills in Discussing • The effect of inflammatory markers was Alcohol Use, 4 not assessed in women because too few Do Doctors’ Drinking Habits Affect Management of Patients’ Alcohol Problems?, 5 Long-Term Mortality in People Treated for Alcoholism Few studies have assessed the long-term ment and 61 years at death. B Vitamins Are Efficacious for mortality of a group of people with alcohol- Alcoholic Polyneuropathy, 5 ism who received treatment at the same • During follow-up, 449 subjects died. program. Researchers in this study tracked, The overall case-fatality rate was 0.057 Study Does Not Confirm Brief for over 33 years, state and national death deaths per person-year. Intervention’s Efficacy, 6 records of 500 people with alcoholism who • Cancer and lung-related death rates had been admitted to a comprehensive, were lower than expected in the early community-based alcohol treatment pro- years of follow-up and higher than ex- gram in San Antonio. Most subjects were pected in the later years. white, male, unemployed, and unmarried; (continued on page 2) they had a mean age of 47 years at enroll- Alcohol and Health: Current Evidence is a project of the Boston Medical Center, supported by the National Institute on Alcohol Abuse and Alcoholism, and produced in cooperation with the Boston University Schools of Medicine and Public Health. PAGE 2 Long-Term Mortality (continued from page 1) Editorial Board • Conversely, death rates of liver currence of liver disease and lifestyle- disease and “lifestyle-related” related deaths, and some differences Editor causes (accidents, car crashes, among ethnic/racial groups. The author Richard Saitz, MD, MPH, FASAM, FACP homicide, suicide, overdose, and acknowledges that findings from this Professor of Medicine & Epidemiology AIDS) were higher than expected in group of urban poor will likely differ Associate Director, Youth Alcohol Prevention Center the early years of follow-up and from findings in other populations with Director, Clinical Addiction Research & Education Unit lower than expected in the later alcoholism. However, the study illus- Section of General Internal Medicine years. trates that treatment providers should Boston Medical Center • Ethnic and racial differences in mor- understand the mortality risks for their Boston University Schools of Medicine & Public Health tality included (1) longer survival patients and incorporate appropriate linkages to medical care and other ser- among whites than blacks and His- panics, and (2) greater than ex- vices. Co-Editor pected frequency of deaths from Kevin L. Kraemer, MD, MSc R. Curtis Ellison, MD liver disease and lifestyle causes in Professor of Medicine & Public Health Hispanics than in blacks and whites. Chief, Section of Preventive Medicine & Epidemiology Reference: Costello, RM. Long-term Evans Department of Medicine mortality from alcoholism: a descriptive Director, Institute on Lifestyle & Health Comments: This long-term follow-up of Boston University School of Medicine people with alcoholism admitted to the analysis. J Stud Alcohol. 2006;67(5):694– same treatment program indicates a 699. relatively high mortality rate, early oc- Associate Editors Joseph Conigliaro, MD, MPH, FACP Director, Program for Quality, Safety and Patient Rights University of Kentucky Medical Center Moderate Drinking Impairs the Ability to See Peter D. Friedmann, MD, MPH Drinking alcohol clearly impairs the abil- less likely than those who received Associate Professor of Medicine & Community Health ity to drive. To determine whether this placebo to notice the gorilla (18% Division of General Internal Medicine impairment is partly due to inattentional vs. 46%, respectively). Rhode Island Hospital blindness—the inability to detect unex- • Telling subjects the content of their Brown Medical School pected but visually-salient objects— beverages did not affect results researchers conducted a randomized (30% who were told they received Kevin L. Kraemer, MD, MSc study of 46 adults, aged 21–35 years, alcohol and 33% who were told Associate Professor of Medicine & Health Policy & who were not heavy drinkers. they received placebo noticed the Management gorilla). Director, General Internal Medicine Fellowship Program Subjects received either alcohol or tonic Division of General Internal Medicine (placebo). Some were accurately told Comments: This study suggests that inat- University of Pittsburgh Schools of Medicine & Public which beverage they received, while tentional blindness is more common Health others were misinformed. The amounts when people drink than when they ab- of alcohol administered were enough to Jeffrey H. Samet, MD, MA, MPH stain. This is particularly concerning achieve a blood alcohol level of 0.04. Professor of Medicine & Public Health given that subjects who received alcohol Chief, Section of General Internal Medicine in this study had a blood alcohol level Boston Medical Center After consuming the beverage, each that was half the legal driving limit in Boston University Schools of Medicine & Public Health subject watched a video of teams pass- most states. The public should be in- ing a basketball back and forth. Subjects formed that even low-level drinking were asked how many times a particular before driving is risky. Managing Editor team passed the ball and whether they Rosanne Guerriero, MPH noticed the person in a gorilla costume Rosanne T. Guerriero, MPH Richard Saitz MD, MPH who briefly appeared in the video. Boston Medical Center Boston University Schools of Medicine & Public Health Reference: Clifasefi SL, et al. Blind drunk: • Only 33% of subjects noticed the the effects of alcohol on inattentional “gorilla.” blindness. Appl Cognit Psychol. • Subjects who received alcohol were 2006;20(5):697–704. Alcohol and Health: Current Evidence, Nov-Dec 2006 PAGE 3 Alcohol and Cancer Worldwide Alcohol use can increase the risk of various cancers. In- • The majority of cancer cases attributable to alcohol vestigators in this study estimated the number of cancer in men were of the upper digestive tract (oral cavity, cases and deaths attributable to alcohol drinking world- pharynx, and esophagus), while the majority in wide in 2002. They used data on drinking prevalence from women were of the breast. the World Health Organization and relative risks of various cancers (oral cavity, pharynx, esophagus, liver, colon, Comments: There are always problems trying to aggre- rectum, larynx, and female breast) from recent meta- and gate global data from many sources. A key concern is the pooled analyses. lack of information on the health habits and drinking pat- terns of the individuals who developed cancer. Knowing • Worldwide, 389,100 cases of and 232,900 deaths this information can help provide much more precise from cancer were attributable to alcohol. These fig- estimates of alcohol’s effects on cancer than can these ures represent 3.6% of all cancer cases (5.2% in men, global estimates derived from limited data. 1.7% in women) and 3.5% of all cancer deaths (5.1% R. Curtis Ellison, MD in men, 1.3% in women), respectively. • The proportion of alcohol-attributable cancers was Reference: Boffetta P, et al. The burden of cancer particularly high (approximately 9%) among men in attributable to alcohol drinking. Int J Cancer. Central and Eastern Europe. 2006;119(4):884–887. Alcohol-Attributable Mortality and Morbidity in Canada Researchers in this study aimed to show the impact of for men) was associated with 25% of the deaths caused alcohol use on chronic diseases in Canada. They linked by alcohol and 85% of the deaths prevented by alcohol.

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