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Aims To understand service users' views and experiences of alcohol relapse prevention medication, views of a telephone behavioural modification intervention delivered by pharmacists and the use of Contingency Management (CM) to support acamprosate adherence following assisted alcohol withdrawal. Methods Four focus groups were conducted within four alcohol treatment and recovery groups across England (UK), with service users with lived experience of alcohol dependence (26 participants). Semi-structured topic guide was used to explore participants' views and experiences of alcohol relapse prevention medication, a telephone behavioural modification medication intervention delivered by pharmacists, and the use of CM to support acamprosate adherence. These were audio-recorded, transcribed verbatim and thematically analysed inductively and deductively. Results Four themes were identified: concerns about support and availability of alcohol relapse prevention medication; lack of knowledge and understanding about acamprosate treatment; positive perceptions of acamprosate adherence telephone support from pharmacists; and negative perceptions of CM to support acamprosate adherence. There were misunderstandings about acamprosate's mode of action and strong negative beliefs about CM. However, most were positive about pharmacists' new role to support acamprosate adherence. Conclusion This study highlighted challenges service users face to commence alcohol relapse prevention medication. It appears service users could benefit from a pharmacist-led telephone intervention to improve understanding about acamprosate medication, particularly, if delivered in an engaging and motivating way.

Alcohol-Related Brain Damage: Challenges and Opportunities Colin Drummond National Addiction Centre, Institute of Psychiatry, King's College London, UK Alcohol is a toxic and dependence-producing substance that can damage most organs in the body, and is implicated in more than 60 different diseases (Oforei-Adjei et al. , 2007). Alcohol is now the third leading cause of ill health in Europe (Rehm et al. , 2009). In the UK, alcohol-related morbidity and mortality have been increasing over the last 30 years, and alcohol-related hospital admissions now exceed 1 million per annum in England (North West Public Health Observatory, 2011). The brain is particularly sensitive to the toxic effects of alcohol either directly, particularly in the foetus and young people, or in the context of malnutrition and thiamine deficiency leading to Wernicke–Korsakoff syndrome; or following repeated episodes of alcohol withdrawal. The precise mechanisms of alcohol-related brain damage (ARBD) remain to be fully understood and several papers in this series describe the limits of knowledge. However, enough is already known to make a significant impact on the prevalence of ARBD through relatively inexpensive preventive strategies. Yet, such preventive strategies are poorly implemented in the UK. Why is this the case? First, there has been a lack of training and clear guidance to clinicians on preventing and managing alcohol problems, including ARBD. This has resulted in low levels of identification and intervention of patients at risk of alcohol-related complications in medical and psychiatric care (Barnaby et al. , 2003; Cheeta et al. , 2008). The recently published suite of NICE guidance on alcohol-use disorders aims to improve detection, prevention and management (NICE, 2010a, b, 2011). However, effective implementation will require a significant investment in staff training to raise awareness, knowledge and skills. Secondly, there is the issue of stigma. Patients who misuse alcohol face stigma and opprobrium, …

Aims: Ethyl glucuronide (EtG) in hair is a proposed biomarker for alcohol consumption. This study compares hair EtG concentrations with self-reported alcohol consumption data, in individuals with a range of alcohol use. Methods: Hair was collected from 100 participants with a range of alcohol use. Participants completed an Alcohol Use Disorders Identification Test C questionnaire to record alcohol consumption. Participants were categorized into one of the four groups: tee-totallers (consuming 0 units a week), lower-risk drinkers (1-21 units a week), increasing-risk drinkers' consuming (22-50 units a week) and high-risk drinkers (over 50 units a week). Hair from the proximal 3 cm was analysed for EtG using gas chromatography-mass spectrometry/mass spectrometry. Results: EtG was detected in 29 out of 100 hair samples. Based on the Society of Hair Testing (SOHT) threshold of 30 pg/mg EtG, the hair test identified alcohol consumption in 57.9% of high-risk drinkers, 45.5% of increasing-risk drinkers and only 9.8% of lower-risk drinkers. EtG sensitivity was highest for high-risk drinkers (consuming more than 50 units a week), identified to be 0.52 using a 30 pg/mg threshold and 0.58 using a 45 pg/mg threshold. A positive result is highly likely to indicate any drinking (positive predictive value, 1.00). A negative result does not provide good evidence for abstinence (negative predictive value, 0.23). Conclusions: EtG has been identified to be a low sensitivity marker that cannot be used quantitatively to determine alcohol exposure. EtG can be used qualitatively to indicate alcohol consumption with a positive result providing strong evidence for an individual drinking within the past 3 months. Language: en

Aims: to assess the attentional bias for alcohol-related information in adolescents with ( n = 15), and without ( n = 15), a parental history of alcohol dependence. Methods: participants completed questionnaires assessing depression, weekly alcohol consumption, anxiety, and concerns about alcohol consumption and undertook subliminal and supraliminal computerized Stroop tasks using colour-words, alcohol-related words, and control words. Results: adolescents with alcohol-dependent parents showed supraliminal interference for alcohol-related words. The magnitude of this interference was correlated with higher trait and state anxiety, and lower levels of weekly alcohol consumption. No interference was found on the subliminal alcohol Stroop task. Conclusions: while it is likely that this attentional bias for alcohol-related cues reflects the concerns regarding parental drinking, it is also possible that this might underlie the increased risk of future alcohol dependence in the children of alcohol-dependent parents. ( Received 2 June 2005; first review notified 7 July 2005; accepted in revised form 16 March 2006)

Alcohol dependence is a brain disease with a progressive, and relapsing, course. Alcohol is directly and indirectly affecting many neurochemical brain systems, leading to dysregulations for example in the brain opioid systems. Functional neuroimaging allows studying individuals with alcohol dependence directly and has contributed greatly …

Alcohol dependence damages the brain through a multiplicity of factors including thiamine deficiency, liver disease, head injury, and repeated episodes of withdrawal. Alcohol withdrawal is a potential opportunity for reducing damage as it is the main point of contact between doctors and patients. Pre-clinical models of alcohol dependence demonstrate activation of microglia, brain-resident macrophages, and expression of cytokines both …

Neuroimaging has played a key role in providing evidence about the neuropharmacology of alcoholism. This talk will focus on use of positron emission tomography (PET) and fMRI to characterize key neurotransmitter systems involved in mediating alcohol's effects on the brain eg the GABA- benzodiazepine receptor (GBzR), the opioid receptor …