Almost half of active-duty military members in the United States — 47 percent — were binge-drinkers in 2008, up from 35 percent a decade earlier. Rates of heavy drinking also rose during that period, according to a 2012 by the Institute of Medicine. But many in the military avoid seeking help for alcohol abuse, fearing disciplinary action or other repercussions, and few soldiers are referred for evaluation or treatment.

“If you’re in the military and you seek substance abuse treatment, your commanding officer is notified and it goes on your medical record and your military record. That’s a huge barrier,” said , director of the at the 91̽�� School of Social Work.

Not surprisingly, there is little research on what type of treatment is most effective for active-duty military members. To shed new insight on that question and remove obstacles to seeking treatment, Walker and a team of researchers tested a telephone-based intervention geared specifically to military members struggling with alcohol abuse — with promising results.

The , published online Oct. 13 in October in the , found that participants in the telephone intervention significantly reduced their drinking over time, had lower rates of alcohol dependence and were more likely to seek treatment.

The trial involved 242 military members at Joint Base Lewis-McChord in western Washington, who were recruited through advertisements and informational booths at military events. All met the criteria for alcohol use disorder, though none were enrolled in treatment programs.

Participants had an initial interview by phone to assess their daily and monthly alcohol consumption. They were also asked a series of questions about the consequences of their drinking — for example, whether it had impacted their physical training or interfered with their ability to fulfill their duties.

Then participants were randomized to a treatment or control group. The control group received educational information about alcohol and other drug use, while the treatment group got a one-hour personalized intervention session over the phone that used “motivational interviewing,” a goal-oriented approach intended to help people make positive behavioral changes.

“The intervention really connects their behavior with their values and goals and wants for themselves,” Walker said. “It’s a safe place to talk confidentially and freely with someone on the other end who is compassionate and non-judgmental.”

The counselors also asked participants about their alcohol consumption versus that of their peers, to gauge whether excessive drinking was in part spurred by normative perceptions about alcohol use in the military.

“The army has a culture of drinking, so there’s a heightened sense among soldiers that their peers are drinking more than they actually are,” said , project director for the study and a 91̽��doctoral student in social work.

“When those perceptions are corrected, it can have a strong effect, as heavy-drinking soldiers often reduce their intake to more typical levels.”

Follow-up interviews were conducted three and six months after the sessions and showed significant decreases in both drinking rates and alcohol dependence. Intervention group participants went from drinking 32 drinks weekly on average to 14 drinks weekly after six months, and their rates of alcohol dependence dropped from 83 to 22 percent. Alcohol dependence also decreased in the control group, from 83 to 35 percent.

“Those are pretty dramatic reductions in drinking, particularly for one session with a counselor,” Walker said. “That was really encouraging.”

Participants increasingly sought treatment over time; by the six-month follow-up, nearly one-third of soldiers in both groups had made some move toward seeking treatment, such as discussing substance abuse concerns with an army chaplain or making an appointment for treatment intake. While the intervention led to more dramatic decreases in drinking, providing educational information may be enough to prompt some to take a first step toward making a change, the researchers said.

Walker and Walton attribute the intervention’s success to its convenience and confidentiality. Participants could enroll without fear of their superiors finding out — recruitment materials made it clear that military command was not involved — and could schedule the phone calls at their convenience.

“Some did the session on their lunch breaks or in the garage while their family was in the house,” Walker said. “They didn’t have to walk into a building that says ‘army substance abuse program.’ It was private and a low-burden intervention.”

And though the military offers substance abuse programs, Walker said, many soldiers avoid seeking help and are not referred to treatment until their problems reach a crisis point.

“People who get into army substance abuse programs are often mandated to go or have gotten into trouble,” she said. “That leaves out a huge proportion of the population who are struggling and not doing well.”

That reality and the protracted conflicts in Iraq and Afghanistan, Walker said, have intensified the need for additional options to help soldiers grappling with substance abuse and other problems. Telephone-based counseling, she said, is a cost-effective way to encourage military members to seek help confidentially, without the barriers of more traditional approaches.

“This intervention has the potential to be used for soldiers and military personnel worldwide. It would really help fill the gap in service provision that is currently available to soldiers.”

Co-authors are Clayton Neighbors, professor of psychology at the University of Houston ; , a 91̽��professor of psychiatry and behavioral sciences; Lyungai Mbilinyi, research social scientist at RTI International; Jolee Darnell, program manager of the Army Substance Abuse Program; Lindsey Rodriguez, an assistant professor at the University of South Florida, St. Petersburg; and , professor emeritus at the 91̽��School of Social Work. The study was funded by the U.S. Department of Defense.

For more information or a copy of the study, contact Walker at ddwalker@uw.edu or 206-543-7511.

A 91̽�� team of researchers sought to address those questions in the context of evolving marijuana policies in the United States. Their , published online Dec. 21 in the journal Alcoholism: Clinical & Experimental Research, highlight the difficulties of gauging the impact of a formerly illicit drug as it moves into the mainstream.

Recreational marijuana use is now legal in four states and medical marijuana in 23 states. Research on legalization policies has focused largely on how they impact marijuana access and use. But the 91̽��team wanted to know how legalization affects the use of alcohol, by far the nation’s drug.

The majority of adults in the U.S. imbibe to varying degrees, and alcohol abuse is the third leading preventable cause of death nationwide. Drinking accounts for almost one-third of driving fatalities annually, and excessive alcohol use cost in 2006 alone.

“We chose to focus on alcohol because even relatively small changes in alcohol consumption could have profound implications for public health, safety and related costs,” said lead author , a researcher in the UW’s .

The researchers sought to determine whether legalizing marijuana led to it becoming a substitute for alcohol or tended to increase consumption of both substances. If it was the former, they reasoned, that could greatly reduce the costs of healthcare, traffic accidents and lower workplace productivity related to excessive drinking.

But if legalized marijuana resulted in increased use of both drugs, costs to society could increase dramatically, particularly since those who use both substances tend to use them . Those who use both substances simultaneously are twice as likely to drive drunk and face social troubles such as drunken brawls and relationship problems, a recent found.

Drawing on previous studies, the researchers hypothesized that legalization of marijuana could result in either substitution or complementary effects. Marijuana and alcohol both provide users with similar “reward and sedation” effects, the researchers noted, which could prompt users to substitute one for the other. But blood levels of THC, the chemical responsible for most of marijuana’s pleasurable psychological effects, increase with simultaneous alcohol use — so the quest for a better high might lead people to use both substances.

The researchers reviewed more than 750 studies on marijuana and alcohol use and focused on 15 that specifically addressed the links between marijuana policies and drinking. They looked at how decriminalized marijuana, medical marijuana and recreational marijuana impacted alcohol use.

The findings of those studies fluctuated widely, depending on the demographic and the type and frequency of alcohol and marijuana use. One study, for example, found that states where marijuana is decriminalized had more emergency room visits related to marijuana and fewer visits linked to alcohol and other drugs. Some studies found that high school seniors in states where pot was decriminalized tended to drink less, while other research found that college students who used pot also drank more.

Findings around medical marijuana also varied. One study reported that states with medical marijuana dispensaries had higher rates of both marijuana and alcohol use, as well as higher admissions into alcohol treatment facilities. But while states with medical marijuana had fewer alcohol-related fatalities overall, those with dispensaries saw more of those deaths.

Other research found that while legalized medical marijuana wasn’t associated with any increases in underage drinking, it was linked with more binge drinking and simultaneous use of pot and alcohol among adults.

The issue is particularly complicated in Washington state, which legalized recreational marijuana use in 2012 after privatizing liquor sales the previous year. As a result, the uptick in alcohol sales made it difficult to isolate the impacts of legalized marijuana on drinking from the change in alcohol policy.

The researchers concluded that there’s evidence of marijuana and alcohol being both substitutes and complements. Given the rapidly evolving landscape of marijuana policy, they say further study will be important to understand how changes in marijuana laws impact the use of alcohol and other drugs.

In particular, Guttmannová said, future studies should address specific dimensions of marijuana policies, timing of policy change and implementation, and different aspects of marijuana and alcohol use, such as age of users and whether they are episodic or regular consumers.

“This is a complicated issue and requires a nuanced approach,” she said. “We were hoping to have more clear-cut answers at the end of our research. But you know what? This is the science of human behavior, and it’s messy, and that’s OK.”

Co-authors at the 91̽��Center for the Study of Health and Risk Behaviors are Associate Director , professor of psychiatry , assistant professor of psychiatry , and research assistant professor . Other co-authors are 91̽��School of Social Work lecturer and investigator and Social Development Research Group investigator .

The research was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.

Turn your head and cough…into the phone?

You may soon hold diagnostic tests in the palm of your hand. Several 91̽��inventors are designing mobile applications that can perform a variety of tests, and then send the results to your physician. One, for example, alerts your physician of orange skin tones in your newborn. This color change can indicate high bilirubin levels. Jaundice in infants is easy to treat, but dangerous if undetected. ��Another app helps people with irritable bowel syndrome track the gut-wrenching effects of certain foods in their diet.

Learn about these and other medical apps being developed at the UW:

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Anti-craving drug and counseling lower alcohol harm in homeless, without sobriety demands

Chronically homeless, alcohol-dependent individuals might benefit from a new intervention that does not require them to stop or even reduce drinking, according to the results of a preliminary study in Seattle.

Participants in the 12-week pilot program received monthly injections of an anti-craving medication, extended-release naltrexone. They also met regularly with study physicians to set their own goals for treatment and to learn to be safer in their use of alcohol.

“Abstinence-based alcohol treatment has not been effective for or desirable to many homeless people with alcohol dependence ,” said Susan Collins of the 91̽��Department of Psychiatry and Behavioral Sciences. She is the lead researcher on a published report in the journal Substance Abuse.

Read more in HSNewsBeat:

Attention, finally for overlooked elderly with chronic disabilities

American society has lavished attention for decades on the expansive “boomer” population – its dreams, careers, families, habits, midlife crises and now its retirement. Many millions of research dollars have been spent divining strategies for the vast group’s “healthy aging.”

​An important group in this aging generation has been overlooked : those with a long-term physical disability.

A 91̽��rehabilitation medicine expert has received a five-year grant to promote healthy aging among people with long-term neuromuscular problems, specifically multiple sclerosis, muscular dystrophy, spinal cord injury and post-polio syndrome.

See how wellness can be enhanced for older adults with chronic disabilities:

According to information issued by the National Institutes of Health, “The National Science and Technology Council was commissioned by President Clinton in 1996 to recreate the award program to honor and support the extraordinary achievements of the finest scientists and engineers, who, while early in their research careers, show exceptional potential for leadership at the frontiers of scientific knowledge… The Presidential Award is considered to be one of the highest honors bestowed on scientists and engineering beginning their independent careers.”

Clark was recognized for his studies on the neurobiology of motivated behavior. He conducts such research to explore important public health concerns. His Presidential Early Career Award will support his investigations of the neural mechanisms of risk preference following adolescent alcohol use.

People often have their first experiences drinking alcohol as teenagers, and some do so during binges. Clark’s research project summary notes that these episodes can sometimes be the start of problem drinking, and have been associated with impaired decision-making. He also noted that studies in animal models of teen drinking suggest that alcohol exposure during this time of life can produce long-term difficulties in assessing risk when making choices.

“Adolescence is a critical period of maturation,” Clark wrote, “where brain development may be disrupted by alcohol use.” Clark plans to test several hypotheses on how teenage drinking might influence risk preference. Specifically, he added, chronic alcohol exposure during adolescence might alter the mesolimbic dopamine system, which has been linked to reward processing.

“An early age of onset of alcohol use appears to be linked to a vulnerability to drug abuse problems in adulthood,” Clark said. “We would like to understand how exposure in the teen years might lead to chronic alcoholism in adults.”

Clark earned a Ph.D. in psychology in 2006 from the UW, and the next year took a position as a postdoctoral fellow with Paul Phillips in the 91̽��Department of Psychiatry and Behavioral Sciences. Now on the 91̽��medical school faculty, he is part of the Center for Drug Addiction Research.

He is the 11^th faculty member at 91̽��Medicine to receive a Presidential Early Career Award for Scientists and Engineers since the program started.

91̽�� professor of social work and colleagues studied whether anti-alcohol policies in public and private schools in Washington state and Australia’s Victoria state were effective for eighth- and ninth-graders.

What they found was that each school’s particular policy mattered less than the students’ perceived enforcement of it. So, even if a school had a suspension or expulsion policy, if students felt the school didn’t enforce it then they were more likely to drink on campus. But, even if a school’s policy was less harsh – such as requiring counseling – students were less likely to drink at school if they believed school officials would enforce it.

“Whatever your school policy is, lax enforcement is related to more drinking,” Catalano said.

The study was published recently in the journal .

The results were similar in Washington, where the legal drinking age is 21 and schools tend to have a zero-tolerance approach, and Victoria, Australia, where the legal drinking age is 18 and policies are more about minimizing harm.

In the study, 44 percent of Victoria eighth-graders and 22 percent of Washington eighth-graders reported drinking alcohol. Victoria students also reported higher rates of binge drinking and alcohol-related harms.

Apart from perceptions about enforcement, harmful behaviors in both states were reduced when students believed policy violators would likely be counseled by a teacher on the dangers of alcohol use, rather than expelled or suspended.

“Schools should focus on zero tolerance and abstinence in primary and early middle school, but sometime between middle school and high school they have to blend in zero tolerance with harm minimization,” said Catalano, director of the Social Development Research Group at the 91̽�� and principal investigator for the International Youth Development Study. “By the time they get into high school they need new strategies.”

Those strategies could include talking to a teacher or being referred to treatment. The likelihood of binge drinking was reduced if students received an abstinence alcohol message or a harm minimization message, and if they believed teachers would talk to them about the dangers of alcohol. Catalano said such remediation policies are an important predictor of less alcohol use among ninth-graders.

He said the study shows harsh punishment for drinking on school grounds, such as calling the police or expelling the student, doesn’t inhibit alcohol use on campus. Instead, long-term negative impacts of expulsion mean students feel disconnected from school and may subsequently drink more. Calling the police, which gives the student a police record, appears to make things even worse.

“What we’ve seen in other studies from this sample is suspension policies actually worsen the behavior problem,” Catalano said. “What that says to me is, although you want policies and you want enforcement of policies, there are other ways of responding than suspension, expulsion and calling the police: Getting a student to talk to a teacher about how alcohol might be harmful, or a session with the school counselor.”

The study was funded by the , , and Victorian Government’s Operational Infrastructure Support Program. Co-authors are Todd Herrenkohl of the UW, lead author Tracy Evans-Whipp and Stephanie Plenty of in Victoria, Australia, and John Toumbourou of in Australia.

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For more information, contact Catalano at 206-543-6382, or catalano@uw.edu.