Alcohol Review

Alcohol understanding for all

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Lancet experts recommend alcohol price controls to combat dementia

Alcohol price controls should be among the steps used to reduce high alcohol consumption to prevent or delay two out of five dementia cases, says a new report from a Lancet commission.

The report also suggests “increased awareness of levels and risks of [alcohol] overconsumption” among 13 recommendations to reduce the risk or delay onset of dementia. A parallel study estimates £4bn ($5bn) annual savings in England.

“Healthy lifestyles that involve regular exercise, not smoking, cognitive activity in midlife… and avoiding excess alcohol can not only lower dementia risk but may also push back dementia onset,” said lead author Professor Gill Livingston of University College London.

“Overall, reduction of excessive alcohol or sustained light drinking is associated with a lower dementia risk than is excessive alcohol. A lack of clear evidence exists that not drinking alcohol increases the risk of dementia,” the report says.

Vision loss and high cholesterol were also added to 12 potentially modifiable risk factors identified in the previous iteration of the report in 2020. ■

The personal story conundrum

As someone writing about alcohol I am often asked to tell my own story. I find it very difficult to know how to respond.

It is not that I don’t have one. I do. I even wrote it down once. But it is never the right moment to tell it.

Lived experiences make a huge contribution to the discussion around alcohol, giving us the insider perspectives we need.

The openness of Labour MPs Jonathan Ashcroft, Liam Byrne and Caroline Flint has had an enormous positive impact.

At the same time adding one’s own tale into the mix can, in some circumstances, have significant drawbacks.

Not being the story
Journalists of all kinds typically avoid talking about themselves because it obscures the broader stories they try to tell.

We would hardly tolerate a political journalist book-ending each piece with an update on which way they were leaning.

Like them, I typically cover stories involving many thousands of other people, not just me. I am just a tiny drop in this ocean.

Alcohol is odd too. There is no perfect amount of personal experience of it that make us more credible when talking about it.

Too much and some will think we are probably shaped by it. Too little and they will wonder if we can possibly know the subject.

Suffice it to say, I hope, I am somewhere in the middle, like most people, neither unaffected nor the most affected.

Researching my book shed new light my experiences, making me see them afresh, and of myself as part of a vast continuum.

This motivates me to listen to other people, and try to explore the research with imagination, empathy and critical thought.

Striking a balance
Hearing stories and ideas beyond our own experiences is a vital part in assembling the jigsaw puzzle of alcohol understanding.

That said, we can also often have good reason to keep our own experiences to ourselves. And we have every right to.

We all share things in some circumstances and not others, and the same is true here. It is up to us.

It was a decision I agonised over. While I could see some positives, I could also see downsides. Would it add or subtract value?

I concluded that telling my own story comes second to uncovering and telling stories beyond myself.

Journalists are by no means the only ones with circumstances not always wholly suited to telling their own stories.

So, if there is a story I would tell about my own alcohol experience in the hope it helps others, it is this one. ■

Alcohol and beyond with Alison Canavan

Supermodel, wellness guru and single mum Alison Canavan shares how her problematic relationship with alcohol intertwined with stellar international success and her longstanding Buddhist practice. She shares what she learned and what she has carried into her new alcohol-free life in LA. ■

Try out some alcohol policies at home

Policies and individual choices are normally seen as completely separate, but in reality they merge. So why not ring in the New Year by road-testing some effective alcohol strategies at home?

We all set some rules, or policies, for our homes, for example. Few let outdoor shoes go beyond a certain threshold. Weaponry, road vehicles, fire, smoke and harmful chemicals also typically have their perimeters.

These are not prohibitions. They are regulations. By crossing borders we can have access to all of the things verboten in some places. Out there is a target-shooting, tanker driver who only smokes when scrubbed up, unarmed on the veranda.

The regulatory systems of our private lives often operate on the basis of unwritten policies picked up from parents, partners, and common sense. They offer an easy way to keep a safe, livable and inexpensive environment. 

These policies are typically adopted and applied without any democratic mandate. But we will also, sometimes, decide to set new policies, often through a process of thought, negotiation and compromise.

So why not consider adding evidence-based alcohol policies to the mix. We might take, for instance, government policies reckoned to curb harm at a population level as a starting point: increase the price, and reduce availability and marketing.

A few calculations might allow us to set a minimum unit price. This we might do by identifying products which are below it. Or we might levy a alcohol per unit “tax”, setting aside revenue for household running costs and infrastructure.

Implementation of these might be complicated. Perhaps an easier option would be reducing alcohol availability. We might bar keeping alcohol at home; Or to limit the stockpile; Or not put what we have in the fridge; Or, maybe, not to buy online. 

Limiting home availability would have a knock-on effect. It bumps up the price of alcohol at home, imposing on inhabitants the cost of leaving the house to buy it. This also gives us a chance for second thoughts. 

Reducing marketing exposure is trickier, because alcohol advertising targets us without our consent. But we can reduce it, by putting alcohol brands out of sight at home. We can also filter some online ads. And we can try to avoid alcohol retail.

Harmful levels of drinking are best addressed with the aid of medical advice. But making our own environments less alcohol loaded makes low-risk drinking the easy option. And home drinking is the source of the bulk of alcohol harm.

We all set and live by policies to create environments which are safe and best serve our needs. We need politicians to do this for us in environments we share. ■

THC and CBD use during pregnancy, adolescence and other periods of rapid development

by Hilary A. Marusak, Wayne State University

Marijuana use by the mother can affect a baby’s brain development.
John Fedele/Tetraimages via Getty Images

Cannabis is a widely used psychoactive drug worldwide, and its popularity is growing: The U.S. market for recreational cannabis sales could surpass US$72 billion by 2023.

As of early 2023, 21 U.S. states and the District of Columbia have legalized cannabis for recreational use for people age 21 and up, while 39 states plus the District of Columbia have legalized it for medical use.

The growing wave of legalization and the dramatic increase in cannabis potency over the past two decades have raised concerns among scientists and public health experts about the potential health effects of cannabis use during pregnancy and other vulnerable periods of development, such as the teen years.

I am a developmental neuroscientist specializing in studying what’s known as the endocannabinoid system. This is an evolutionarily ancient system found in humans and other vertebrates that produces natural cannabinoids such as THC and CBD.

Cannabis and its constituents interact with the body’s endocannabinoid system to product their effects. THC and CBD are the most commonly known cannabis extracts and can be synthesized in a lab. My lab also studies the risks versus potential therapeutic value of cannabis and cannabinoids.

People often assume there’s no risk when using cannabis or cannabinoids during vulnerable periods of life, but they’re basing that on little to no data. Our research and that of others suggests that cannabis use during pregnancy and adolescence can present myriad health risks the public should be aware of.

Data shows that many people who use cannabis continue to do so during pregnancy. But there are health risks.

Cannabis use during pregnancy
More and more pregnant people are using cannabis today compared with a decade ago, with some studies showing that nearly 1 in 4 pregnant adolescents report that they use cannabis.

Many cannabis-using people may have not known they were pregnant and stopped using when they found out. Others report using cannabis for its touted ability to ease pregnancy-related symptoms, like nausea and anxiety. However, studies do not yet confirm those health claims. What’s more, the potential harms are often downplayed by pro-cannabis marketing and messaging by dispensaries, advocacy groups and even midwives or doulas.

In addition, physicians and other health care providers often are not knowledgeable enough or don’t feel well equipped to discuss the potential risks and benefits of cannabis with their patients, including during pregnancy.

While research shows that most people who are pregnant perceive little to no risk in using cannabis during pregnancy, the data show there is clear cause for concern. Indeed, a growing number of studies link prenatal cannabis exposure to greater risk of preterm birth, lower birth weight and psychiatric and behavioral problems in children. These include, for example, difficulties with attention, thought, social problems, anxiety and depression.

Cannabis and the developing brain
When cannabis is inhaled, consumed orally or taken in through other routes, it can easily cross through the placenta and deposit in the fetal brain, disrupting brain development.

A recent study from my lab, led by medical student Mohammed Faraj, found that cannabis use during pregnancy can shape the developing brain in ways that are detectable even a decade later.

We used data from the National Institutes of Health Adolescent Brain Cognitive Development Study, which is the largest long-term study of brain development and child and adolescent health in the U.S. It has followed more than 10,000 children and their families from age 9-10 over a 10-year period.

Through that analysis, we linked prenatal cannabis exposure to alterations in functional brain networks in 9- and 10-year-old children. In particular, prenatal cannabis exposure appeared to disrupt the communication between brain networks involved in attentional control, which may explain why children who were exposed to cannabis in utero may develop difficulties with attention or other behavioral issues or mental disorders as they develop.

While alcohol abuse has steadily declined among adolescents since 2000 in the U.S., cannabis use shows the opposite pattern: It increased by 245% during that same period.

Data reported in 2022 from the Monitoring the Future survey of over 50,000 students in the U.S. found that nearly one-third of 12th grade students reported using cannabis in the past year, including cannabis vaping. Yet only about 1 in 4 12th grade students perceive great harm in using cannabis regularly. This suggests that many teens use cannabis, but very few consider it to have potential negative effects.

 

High-potency, concentrated forms of cannabis extracts have far higher levels of THC than the pot of earlier decades.

Cannabis use during adolescence
Research shows that the adolescent brain is primed to engage in high-risk behaviors such as experimenting with cannabis and other substances. Unfortunately, owing to ongoing brain development, the adolescent brain is also particularly susceptible to the effects of cannabis and other substances. Indeed, many neuroscientists now agree that the brain continues to develop well into the second and even third decade of life.

In line with this vulnerability, research shows that, relative to those who did not use cannabis during adolescence, those who started using it during adolescence are at increased risk of developing depression, suicidal ideation, psychosis and reductions in IQ during adolescence and adulthood. Neuroimaging studies also show residual effects of adolescent cannabis use on brain functioning, even later during adulthood.

Reading beyond the label
Despite common misconceptions that cannabis is “all natural” and safe to use during pregnancy or adolescence, the data suggests there are real risks. In fact, in 2019, the U.S. surgeon general issued an advisory against the use of cannabis during pregnancy and adolescence, stating that “no amount … is known to be safe.”

Cannabis may be harmful to the developing brain because it disrupts the developing endocannabinoid system, which plays a critical role in shaping brain development from conception and into adulthood. This includes neural circuits involved in learning, memory, decision-making and emotion regulation.

While much of this research has focused on cannabis use, there is also other research that comes to similar conclusions for THC and CBD in other forms. In fact, although CBD is widely available as an unregulated supplement, we researchers know almost nothing about its effects on the developing brain. Of note, these harms apply not only to smoking, but also to ingesting, vaping or other ways of consuming cannabis or its extracts.

In my view, it’s important that consumers know these risks and recognize that not everything claimed in a label is backed by science. So before you pick up that edible or vape pen for stress, anxiety, or sleep or pain control, it’s important to talk to a health care provider about potential risks – especially if you are or could be pregnant or are a teen or young adult

 

Marijuana use by the mother can affect a baby’s brain development.
John Fedele/Tetraimages via Getty Images

Hilary A. Marusak, Wayne State University

Cannabis is a widely used psychoactive drug worldwide, and its popularity is growing: The U.S. market for recreational cannabis sales could surpass US$72 billion by 2023.

As of early 2023, 21 U.S. states and the District of Columbia have legalized cannabis for recreational use for people age 21 and up, while 39 states plus the District of Columbia have legalized it for medical use.

The growing wave of legalization and the dramatic increase in cannabis potency over the past two decades have raised concerns among scientists and public health experts about the potential health effects of cannabis use during pregnancy and other vulnerable periods of development, such as the teen years.

I am a developmental neuroscientist specializing in studying what’s known as the endocannabinoid system. This is an evolutionarily ancient system found in humans and other vertebrates that produces natural cannabinoids such as THC and CBD.

Cannabis and its constituents interact with the body’s endocannabinoid system to product their effects. THC and CBD are the most commonly known cannabis extracts and can be synthesized in a lab. My lab also studies the risks versus potential therapeutic value of cannabis and cannabinoids.

People often assume there’s no risk when using cannabis or cannabinoids during vulnerable periods of life, but they’re basing that on little to no data. Our research and that of others suggests that cannabis use during pregnancy and adolescence can present myriad health risks the public should be aware of.

Data shows that many people who use cannabis continue to do so during pregnancy. But there are health risks.

Cannabis use during pregnancy
More and more pregnant people are using cannabis today compared with a decade ago, with some studies showing that nearly 1 in 4 pregnant adolescents report that they use cannabis.

Many cannabis-using people may have not known they were pregnant and stopped using when they found out. Others report using cannabis for its touted ability to ease pregnancy-related symptoms, like nausea and anxiety. However, studies do not yet confirm those health claims. What’s more, the potential harms are often downplayed by pro-cannabis marketing and messaging by dispensaries, advocacy groups and even midwives or doulas.

In addition, physicians and other health care providers often are not knowledgeable enough or don’t feel well equipped to discuss the potential risks and benefits of cannabis with their patients, including during pregnancy.

While research shows that most people who are pregnant perceive little to no risk in using cannabis during pregnancy, the data show there is clear cause for concern. Indeed, a growing number of studies link prenatal cannabis exposure to greater risk of preterm birth, lower birth weight and psychiatric and behavioral problems in children. These include, for example, difficulties with attention, thought, social problems, anxiety and depression.

Cannabis and the developing brain
When cannabis is inhaled, consumed orally or taken in through other routes, it can easily cross through the placenta and deposit in the fetal brain, disrupting brain development.

A recent study from my lab, led by medical student Mohammed Faraj, found that cannabis use during pregnancy can shape the developing brain in ways that are detectable even a decade later.

We used data from the National Institutes of Health Adolescent Brain Cognitive Development Study, which is the largest long-term study of brain development and child and adolescent health in the U.S. It has followed more than 10,000 children and their families from age 9-10 over a 10-year period.

Through that analysis, we linked prenatal cannabis exposure to alterations in functional brain networks in 9- and 10-year-old children. In particular, prenatal cannabis exposure appeared to disrupt the communication between brain networks involved in attentional control, which may explain why children who were exposed to cannabis in utero may develop difficulties with attention or other behavioral issues or mental disorders as they develop.

While alcohol abuse has steadily declined among adolescents since 2000 in the U.S., cannabis use shows the opposite pattern: It increased by 245% during that same period.

Data reported in 2022 from the Monitoring the Future survey of over 50,000 students in the U.S. found that nearly one-third of 12th grade students reported using cannabis in the past year, including cannabis vaping. Yet only about 1 in 4 12th grade students perceive great harm in using cannabis regularly. This suggests that many teens use cannabis, but very few consider it to have potential negative effects.

 

High-potency, concentrated forms of cannabis extracts have far higher levels of THC than the pot of earlier decades.

Cannabis use during adolescence
Research shows that the adolescent brain is primed to engage in high-risk behaviors such as experimenting with cannabis and other substances. Unfortunately, owing to ongoing brain development, the adolescent brain is also particularly susceptible to the effects of cannabis and other substances. Indeed, many neuroscientists now agree that the brain continues to develop well into the second and even third decade of life.

In line with this vulnerability, research shows that, relative to those who did not use cannabis during adolescence, those who started using it during adolescence are at increased risk of developing depression, suicidal ideation, psychosis and reductions in IQ during adolescence and adulthood. Neuroimaging studies also show residual effects of adolescent cannabis use on brain functioning, even later during adulthood.

Reading beyond the label
Despite common misconceptions that cannabis is “all natural” and safe to use during pregnancy or adolescence, the data suggests there are real risks. In fact, in 2019, the U.S. surgeon general issued an advisory against the use of cannabis during pregnancy and adolescence, stating that “no amount … is known to be safe.”

Cannabis may be harmful to the developing brain because it disrupts the developing endocannabinoid system, which plays a critical role in shaping brain development from conception and into adulthood. This includes neural circuits involved in learning, memory, decision-making and emotion regulation.

While much of this research has focused on cannabis use, there is also other research that comes to similar conclusions for THC and CBD in other forms. In fact, although CBD is widely available as an unregulated supplement, we researchers know almost nothing about its effects on the developing brain. Of note, these harms apply not only to smoking, but also to ingesting, vaping or other ways of consuming cannabis or its extracts.

In my view, it’s important that consumers know these risks and recognize that not everything claimed in a label is backed by science. So before you pick up that edible or vape pen for stress, anxiety, or sleep or pain control, it’s important to talk to a health care provider about potential risks – especially if you are or could be pregnant or are a teen or young adult. ■The Conversation

Note: Hilary A. Marusak, Assistant Professor of Psychiatry and Behavioral Neurosciences, Wayne State University This article is republished from The Conversation under a Creative Commons license. Read the original article.