Information about the Research


STUDY INFORMATION

Why Is This Study Important?


Adolescence in general is a high-risk period for starting alcohol use and for high-risk drinking. The highest rates of alcohol dependence (see below for definition) are seen in people ages 18–24, yet the brain consequences of adolescent alcohol involvement, if any, have received limited attention. Many college students experience a rapid increase in heavy drinking over a relatively short time period2. It is unclear how such use affects cognition as individuals transition into young adult responsibilities, and affect normal brain maturing processes such as white matter myelination and synaptic pruning that are known to continue into a person's twenties3-5. Although not enough evidence exists to make firm conclusions, available research on the consequences of drinking suggests that underage and college-age drinkers may be at greater risk of toxic effects on the ability to think clearly and effectively. In adults, continued alcohol consumption at very high levels has long-term effects (over many years) on brain volume and brain function. However, nobody knows if these effects are more or less marked over the short term in the still-maturing adolescent brain. Some researchers have argued that because the adolescent brain is still not fully developed, it has more plasticity and can more easily recover from circumstances (like alcohol toxicity) that may be more damaging to the adult brain. This is the case for head injury- younger people recover faster and to a greater extent than adults. Other researchers have argued exactly the opposite; that is because the adolescent brain is not yet fully developed it is more vulnerable to such damage. The jury is still out.

What Are Some of the Questions We Are Trying to Answer?


• Can heavy drinking in college affect brain structure and function in a way that impacts thinking ability or affects college grades?
• If this is the case, is it related to overall amount of alcohol consumed, or more to alcohol consumption patterns, such as binging or experiencing alcohol blackouts?
• Many students seem to drink heavily in college, but only a minority of them to go on to have alcohol problems after finishing college. Why is this, and is there any way to identify ahead of time the people who will be longer-term problem drinkers?
• Are all adolescents affected equally by alcohol in terms of possible effects on brain and risk for later alcohol abuse, or are some more or less vulnerable than others?
• If some people are really more vulnerable to unintended bad effects, is it possible to identify them in advance?


Facts about Drinking Alcohol in College

Drinking is Widespread and often heavy.  College students drink significantly more than their non-college same age same-sex peers.  As many of you have known, the legal drinking age is in dispute. Recently a coordinated effort was made by several college presidents to lower the drinking age to 18 from 21.
 

Obviously, drinking starts for many people before college. Alcohol remains the drug of choice for many adolescents8, who begin alcohol use at earlier ages than in the past9. In 2000, 32% of high school seniors reported being drunk in the past month and 26% reported using another recreational drug10,11. Of 14-18 year-old high school students, just under 10% met criteria for alcohol use disorders12,13. These numbers increase as students enter college and often move away from home.
 

Once students enter college, drinking patterns change. College drinkers consume more alcohol than non-college peers14. The major period for beginning alcohol use is mostly over by the end of the teenage years15, and the window of risk for becoming dependent (see definitions below) on alcohol peaks by age 18-19 (NIAAA on Epidemiology of Dependence16).
 

About a third of American youths aged 12–20 report past-month use of alcohol17-19. About 20% are binge (heavy episodic) drinkers (defined by NHSDA as consuming 5 or more alcoholic beverages on the same occasion on at least 1 day in the past 30 days) and 6% are heavy drinkers (defined by NHSDA as consuming >5 drinks on the same occasion on at least 5 different days in the past 30). These prevalence estimates are much lower than those of many surveys and are probably underestimates10. Almost 50% of high school students are current drinkers and approximately 60% of these drinkers binge. Several aspects of college life, including “jock culture,” fraternity initiations, tailgate parties, “Power Hour” and “21 for 21” drinking bouts glamorize very heavy drinking8. Games such as beer pong and equipment like beer bongs also encourage heavy alcohol consumption.

Moderate drinking can be enjoyable.

Alcohol consumption seems to be an essential part of most civilizations and attempts to prohibit alcohol have often met with failure. Cultures where drinking is allowed, draw distinctions between moderate social drinking, drinking to intoxication and problem drinking which we will discuss below.

Alcohol Consumption May Have Adverse Cognitive Effects.


Thinking ability and academic achievement are impacted by heavy alcohol use in college. In a survey of >14,000 students at 4-year colleges, 31% and 62% of occasional and frequent binge drinkers respectively reported missing a class (vs. 9% of non-binge drinkers); while 26% and 46% respectively, reported falling behind in schoolwork (vs. 10% of non-binge drinkers)38. Teens with alcohol use disorders have high rates of sleep disturbance39 and disrupted sleep–wake cycles, impairing school performance40. Problem drinkers are more likely to drop out of college. Impaired cognitive development may continue to affect individuals even after they have entered adulthood41.

Heavy Drinking in College Can Be Associated with Other Major Problems, Now and Later


Problems resulting from drinking in college, as explained below include date rape, motor vehicle accidents, and fights20,5. Acute health and safety consequences of adolescent alcohol use include alcohol poisoning21, which leads to a series of deaths each year, motor vehicle crashes22, risky sexual behaviors23,24, drowning25, and other drug use10,26. Alcohol may play a role in >50% of traumatic brain injuries in adolescents27. In 1998, >1400 college students aged 18–24 years died as a result of alcohol-related injuries, including car crashes. Additionally, >500,000 college students were injured while under the influence of alcohol and >600,000 were assaulted by another student who had been drinking28. Legal problems are especially associated with binge (heavy episodic) drinking. Depression is commonly co-occurring with alcohol dependence and abuse and increases suicide risk, which is significantly elevated in teenaged heavy drinkers29-33.
 

Several adverse long-term outcomes are predicted by adolescent problem drinking, including problem drinking in early adulthood and later in life34,35. By young adulthood, early-starting alcohol use is associated with a greater chance of having employment problems, other substance use, and be¬havioral problems36.
 

College binge drinkers are more likely to experience one or more alcohol-related problems while in college37. In addition, college binge drinking patterns pose significant risk factors for alcohol dependence and abuse 10 years after the initial interview, plus evidence of academic attrition, early departure from college, and less favorable labor market outcomes-i.e. lower-paid jobs37.

What Do We Mean by Alcohol "Abuse" and "Dependence"


In alcohol abuse, school job performance may suffer either from after-effects of drinking (being hung over) or from actual intoxication at school. Child care or household responsibilities may be neglected and alcohol-related absences occur from school. The person may use alcohol in physically hazardous circumstances, such as driving an automobile or operating machinery while drunk. Legal difficulties may arise because of alcohol use such as arrests for intoxicated behavior or DWI’s. Finally, individuals with alcohol abuse may continue to consume alcohol despite the knowledge that continue to consumption poses significant social or interpersonal problems for them, e.g. violent arguments with boyfriend/girlfriend when intoxicated, child abuse, friends and family members refuse to talk to them due to alcohol problems.

Alcohol dependence refers to people who meet criteria for substance abuse, but who also have actual physical dependence on alcohol, indicated by evidence of tolerance or withdrawal symptoms. Tolerance refers to needing to consume increasingly higher doses of alcohol to feel any effects from it. Alcohol withdrawal is characterized when somebody develops withdrawal symptoms, usually 12 hours or so after stopping or cutting back on alcohol use following prolonged heavy use. This commonly occurs after a nights sleep. Typical withdrawal symptoms include severe “shakes” e.g. hand tremors, sweating a lot, high pulse rate, inability to sleep, nausea or vomiting and occasionally hallucinations or seizures. Withdrawal from alcohol is often unpleasant and intense so that individuals with alcohol dependence may continue to drink alcohol despite adverse consequences, in order to avoid or relieve their withdrawal symptoms. Only about 5% of people with alcohol dependence ever experience especially severe complications of withdrawal such as delirium or major seizures. Once a pattern of compulsive use develops, individuals with alcohol dependence may devote substantial periods of time to obtaining and consuming alcoholic drinks. These individuals often then continue to use alcohol despite evidence of psychological or physical unpleasant consequences such as serious depression, memory blackouts, liver disease etc.
Information adapted from American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV). Washington, D.C.: APA

Trivia Section: A History of Alcohol, (much condensed) from Wikipedia;


Brewing dates from the beginning of civilization in ancient Egypt and alcoholic beverages were very important at that time. Symbolic of this is the fact that while many gods were local or familial, Osiris was worshiped throughout the entire country. The Egyptians believed that this important god invented beer, a beverage that was considered a necessity of life; it was brewed in the home "on an everyday basis."…….The ancient Egyptians made at least 17 types of beer and at least 24 varieties of wine. Alcoholic beverages were used for pleasure, nutrition, medicine, ritual, remuneration and funerary purposes. The latter involved storing the beverages in tombs of the deceased for their use in the after-life.
 

Numerous accounts of the period stressed the importance of moderation, and these norms were both secular and religious. While Egyptians did not generally appear to define drunkenness as a problem, they warned against taverns (which were often houses of prostitution) and excessive drinking. After reviewing extensive evidence regarding the widespread but generally moderate use of alcoholic beverage, the nutritional biochemist and historian William J. Darby makes a most important observation: all these accounts are warped by the fact that moderate users "were overshadowed by their more boisterous counterparts who added 'color' to history." Thus, the intemperate use of alcohol throughout history receives a disproportionate amount of attention. Those who abuse alcohol cause problems, draw attention to themselves, are highly visible and cause legislation to be enacted. The vast majority of drinkers, who neither experience nor cause difficulties, are not noteworthy. Consequently, observers and writers largely ignore moderation.


Drinking in America


Alcoholic beverages played an important role in Colonial America from the very beginning. The Puritans brought more beer than water on the Mayflower as they departed for the New World. While this may seem strange for Puritans viewed from the modern context, it should be understood that drinking wine and beer at that time was safer than water - which was usually taken from sources used to dispose of sewerage and garbage. Their experience showed them that it was safer to drink alcohol than the typically polluted water in Europe. Alcohol was also an effective analgesic, provided energy necessary for hard work, and generally enhanced the quality of life.


For hundreds of years their English ancestors had consumed beer and ale. Both in England and in the New World, people of both sexes and all ages typically drank beer with their meals. Because importing a continuing supply of beer was expensive, the early settlers brewed their own. However, it was difficult to make the beer they were accustomed to because wild yeasts caused problems in fermentation and resulted in a bitter, unappetizing brew. Although wild hops grew in New England, hop seeds were ordered from England in order to cultivate an adequate supply for traditional beer. In the meantime, the colonists improvised a beer made from red and black spruce twigs boiled in water, as well as a ginger beer.


Beer was designated “X”, “XX”, or “XXX” according to its alcohol content. The colonists also learned to make a wide variety of wine from fruits. They additionally made wine from such products as flowers, herbs, and even oak leaves. Early on, French vine-growers were brought to the New World to teach settlers how to cultivate grapes. Colonists adhered to the traditional belief that distilled spirits were aqua vitae, or water of life. However, rum was not commonly available until after 1650, when it was imported from the Caribbean. The cost of rum dropped after the colonists began importing molasses and cane sugar directly and distilled their own. By 1657, a rum distillery was operating in Boston. It was highly successful and within a generation the production of rum became colonial New England's largest and most prosperous industry. Almost every important town from Massachusetts to the Carolinas had a rum distillery to meet the local demand, which had increased dramatically. Rum was often enjoyed in mixed drinks, including flip. This was a popular winter beverage made of rum and beer sweetened with sugar and warmed by plunging a red-hot fireplace poker into the serving mug. Alcohol was viewed positively while its abuse was condemned. Increase Mather (d. 1723) expressed the common view in a sermon against drunkenness: "Drink is in itself a good creature of God, and to be received with thankfulness, but the abuse of drink is from Satan; the wine is from God, but the drunkard is from the Devil."
Thanks Wikipedia.

FAQ's


1.What is Involved if I Participate in BARCS ?

You will be asked to come to the study area at your college as a subject, hear about what’s involved in the study and sign an Informed Consent. The Informed Consent is a document that explains all the procedures of the study and is provided to help you decide if you want to participate. The procedures involved in the study include interviews, paper and pencil and computer testing, an MRI, and giving saliva for DNA. All information obtained from the procedures is kept confidential and will only be used for research purposes.


The interview consists of a private session in which a member of the study staff asks you questions about your background, health and family history in a private interview room.This takes ~30-45 min.  You are paid $15 per hour for your participation


At a separate time, you and other participating students are tested on laptops in groups of several people by a member of the study staff, where computer tests consisting of a series of memory, concentration, and motor function tasks are given  in a private testing room with a member of the study staff, and take approximately one hour. This testing is repeated at 2 years after your initial session. You are paid $15 per hour for your participation.


DNA for the study is gathered by taking a saliva sample. The genetic testing done on the DNA will be used to show whether certain genes have a role in alcohol use. Your name will not be on the sample, and the results of the testing will not be used for any diagnostic purpose and will not be added to your medical record. We will use your DNA to study differences in genes between individuals and to identify genes influencing behavior and characteristics of brain structure and function. Your DNA will be kept in a research DNA bank indefinitely as a reference.DNA samples are NOT labeled with any personal identifying information, only with a randomized study number.

Monthly Website Session.

All BARCS participants log on to a specially protected, password protected website once a month for 2 years, for a brief period of time (~40 min the first month and ~20 min/month subsequently), to report on their alcohol consumption and some other data over the prior month. You are paid $5 per session, but entered into a monthly prize drawing, where one of the participants wins $150 each month.

MRI

Some of the students who complete the cognitive testing part of the study, and who are interested in the MRI, will be invited to come to the Olin Center for MRI testing at a later date, usually in the month after first testing.


Magnetic resonance imaging (MRI) is a technique in which a large magnet and radio waves are used to create pictures of your brain. You cannot do the MRI if you are pregnant or have certain types of metal in your body, and the research staff will make collect enough information about possible metal objects before this session. A urine sample may also be required to document that test performance is free from the influence of drugs/alcohol.) Some brief additional testing (computer tasks) are also given. This entire session takes ~ 2 hours.  You are paid $15/hr for participation.

2. What procedures are carried out during all parts of the study?

All procedures are painless and consist of the following:

Clinical Interviews: Conversations with members of the research staff to gather background information.
Neuropsychological Testing: Simple tests of memory and attention.

Neurological Examination: An evaluation of how brain and nerves are working by testing mental, sensory, motor, and reflex function.

Laboratory Tests: A small sample of saliva will be analyzed to study the genetic component.

Neuroimaging: (some participants only) Several safe, non-invasive, non-radioactive brain MRI scans will be administered. A structural scan maps the brain’s anatomy during rest and several functional scans (fMRI) map the brain’s activity while performing tasks.

3. Will I be compensated?

Every participant will receive payment for completing each part of the study. There is no charge for any test.

4. How do I enroll?

There are Study Co-ordinators at CCSU, Trinity and at the Institute of Living. You can contact the coordinator at the your college. The study coordinators can both answer questions about what is involved in if you want to participate in BARCS, and also make arrangements for your study participation.  You can also submit your information using this form.

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Hartford Hospital, Institue of Living, Olin Neuropsychiatry Research Center