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New Study Reveals Sharp Spike in Alcohol Use Disorders
Written by Anne Fletcher
From the latest version of the largest and most ambitious survey ever done on alcohol, drug, and co-occurring psychiatric disorders – called the National Epidemiologic Survey on Alcohol and Related Conditions, or NESARC-III – a new study published in JAMA Psychiatry reports that nearly 30% of adults in the United States have had an alcohol use disorder (AUD) at some time in their lives. However, only a small percentage seek professional treatment or other help – for instance, from Alcoholics Anonymous. The study also reveals a significant increase in AUDs over the last decade.
How the Study Was Conducted
For NESARC-III, in 2012-2013 more than 36,000 people from all walks of life were asked in face-to-face interviews a battery of questions about their present and past alcohol, drug, and tobacco problems; use of addiction treatment services; and psychiatric disorders. Because NESARC participants are a large representative group of people selected at random, findings from the survey can be generalized.
…more than 36,000 people from all walks of life were asked in face-to-face interviews a battery of questions about their present and past alcohol, drug, and tobacco problems; use of addiction treatment services; and psychiatric disorders. -Anne Fletcher The first NESARC study was conducted in 2001-2002, when the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) was used to assess alcohol and drug problems. DSM-IV divided alcohol and drug disorders into two distinct categories – abuse and dependence, with different criteria for each.
The DSM-5, released in 2013, integrates abuse and dependence into a single disorder – substance use disorder, generally speaking, and according to specific drugs, such as alcohol use disorder and cocaine use disorder. The DSM-5 then categorizes the disorder according to the number of any of 11 criteria a person meets – mild use disorders are defined by 2 to 3 criteria, moderate by 4 to 5, and severe by 6 or more. Criteria include failure to meet work, social, or family obligations because of substance use; continued use despite persistent negative consequences; tolerance (needing more chemical to get the desired effect); regularly taking a substance in larger amounts or over a longer time than intended; devoting a lot of time to getting, using, or recovering from the effects of a substance; withdrawal (physical or mental symptoms if the drug is abruptly stopped); craving; and several others.
The JAMA Psychiatry study, led by the National Institutes on Alcohol Abuse and Alcoholism's (NIAAA) Bridget Grant, Ph.D., was designed not only to study prevalence of alcohol use disorders (and related drug and mental health problems) using the newer DSM-5 criteria but also to apply the old DSM-IV criteria to participants' responses (a way of comparing apples to apples) to see if people are experiencing more or fewer alcohol use disorders over the decade between the first NESARC and NESARC-III.
Using the newer DSM-V criteria, Grant and colleagues found that about 14% of adults met AUD criteria during the previous year, while 29% met AUD criteria at some time in their lives. Lifetime prevalences of mild, moderate, and severe AUDs were 8.6%, 6.6%, and about 14%, respectively. In general, men, Native Americans, and lower income people were more likely to have AUDs.
Compiling the Available Information
Certainly, finding that nearly 30% of Americans report having an AUD at some time in their lives is striking. But results from comparisons with past research, as well as other findings from the new study, offer even more cause for concern…
Alarmingly, when the researchers applied the same diagnostic criteria (DSM-IV) to both the older and newer NESARC groups (the apples to apples comparison), they found that the percentage of people with AUDs has gone up markedly. Specifically, NESARC participants studied in 2001-2002 reported recent (past-year) and lifetime rates of AUDs of about 9% and 30%, respectively. In contrast, past-year and lifetime AUD rates for those studied in 2012-2013 jumped to nearly 13% and 44%, respectively. Grant and her colleagues suspect that this may reflect increases in heavy alcohol drinking during that period. (They cite other research documenting how much heavy drinking has increased in both men and women over the same decade.)
While some experts expressed concern that the DSM-V would result in more people being unnecessarily diagnosed with an alcohol use disorder – and perhaps coerced to go to treatment or 12-step groups – a study from earlier this year involving the NESARC-III subjects showed that, while past-year prevalence of alcohol use disorders were higher when applying the DSM-5 criteria than when applying DSM-IV criteria, lifetime prevalences were lower under DSM-5.
Findings in young adults are particularly alarming. "Especially striking," say the researchers, is the 7% past-year rate of severe AUDs among 18- to 29-year-olds (about 27% had any AUD), suggesting an urgent need for more effective prevention and intervention efforts among young adults. They note that the average age of onset of an AUD was about 24 for severe AUDs. (People younger than 18 were not included in NESARC.)
Not surprisingly, certain psychiatric problems and AUDs were found to go hand-in-hand. Significant associations were found between recent and lifetime AUD and major depressive disorder, specific phobia, bipolar I disorder, as well as antisocial, borderline personality disorders, and other substance use disorders across all levels of AUD severity. (Other psychiatric problems, such as PTSD and generalized anxiety disorder were associated with lifetime AUD as well.) The researchers statistical analyses suggests that common causal factors underlie co-occurring AUDs and certain mental health disorders, which may help to identify risk factors.
Finally, the study revealed that the vast majority of people with alcohol use disorders don't seek treatment or other help – only about 20% of individuals with an AUD do so at some point in their lives. The most common source of help was from 12-step groups, although aid from health practitioners ranked high for those who sought help in the past year, as did rehabs, outpatient clinics, and health care professionals for those who had ever had an AUD.
In the NESARC-III, the mean age at first treatment of DSM-5 AUD was 29.4 years, representing a 3-year lag between the average age at onset (26.2 years) and treatment, suggesting that there's likely a critical time when individuals might receive some low-intensity help before it "gets really bad." The researchers briefly address a form of such treatment called brief intervention, but it's not widely available. Unfortunately, few treatment resources are available for people with mild and for many with moderate AUDs.
…prior NESARC findings show that participation in 12-step groups increases the likelihood of recovery. However, much of formal addiction treatment has not been found to be effective as it's administered in the U.S.. -Anne Fletcher
Grant and her colleagues also refer to "a large body of literature" that supports the effectiveness of treatment (no reference given) and prior NESARC research shows that participation in 12-step groups increases the likelihood of recovery. However, much of formal addiction treatment has not been found to be effective as it's administered in the U.S., as my findings from Inside Rehab revealed. The groundbreaking 2012 National Center on Addiction and Substance Abuse at Columbia (CASA Columbia) report on the state of addiction treatment titled "Addiction Medicine: Closing the Gap Between Science and Practice" concluded that "the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care" and that "only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works."
As for the study, the NESARC researchers refer to supporting 12-step participation, although it found a strong positive impact of recent help-seeking that included 12-step participation, it's worth noting that the majority of individuals who achieved recovery did not access any form of treatment or 12-step participation.
If we want to see fewer substance use disorders out there and, when they do occur, want them to be more effectively resolved, it's high time we get away from the "party lines." Refreshingly, in an article by the Associated Press, George Koob, Ph.D., director of NIAAA, was quoted as saying, "There's a lore that there's only Alcoholics Anonymous out there, and that's not true."
Special acknowledgment goes to Dan Kivlahan, Ph.D., substance use disorder researcher extraordinaire with Seattle VA Medical Center and the University of Washington for his help with this article.
Image Courtesy of Pixabay.com


I thought I'd share my version of a classic buttercream. This buttercream is perfect for most cakes with it's fluffy and smooth texture. Some say it reminds them of icecream, in that factor you can't go wrong.
A recipe is just a template to work with so remember to tweak the recipe to your liking and needed consistency. Press play below to watch the Youtube Tutorial.
Makes enough for one 6" cake or two dozen cupcakes.
Place butter into mixing bowl and begin to whisk on low speed gradually bringing it up to medium. Whip for two minutes. Scrape up any butter that may be stuck to the bottom of the bowl and continue to whip again for one minute.
Add the shortening to the butter and whip on medium speed. Your butter should start to have a creamier consistency and be paler in color. Continue to whisk for two minutes.
Measure out the confectioners sugar in a bowl and set aside. Turn the mixer off completely and add half of the confectioners sugar to the bowl. Begin to whisk in the sugar using the lowest setting. When all of the sugar has been incorporated, turn the mixer off once again and add the remaining sugar. Mix on the lowest setting for one minute.
When all of the sugar is incorporated, use the rubber spatula to scrape down the sides and bottom of the bowl. Begin to whip the frosting starting on low speed and gradually working to medium high. At this stage the frosting should go from clumpy to smooth in texture. Allow frosting to whip for five minutes on medium speed.
Scrape down the sides of the bowl one last time and add the salt and vanilla. Continue to whip for three minutes to dissolve the salt. By now the frosting should be a pale yellow and have almost doubled in volume. Take time to test the consistency. For a stiffer frosting add a 1/2 C more of the confectioners sugar. For a thinner frosting add milk 1 tsp. at a time.
*Try adding fresh lemon zest for a lemon frosting.
*The frosting takes on flavors and colors very well. Play around with extracts for a flavor that you can call your own.
What did I do with my frosting?


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How Free Mobile Games Like Pokemon Go Make Singaporeans Spend
July 13, 2016 |Posted by Ryan Ong | Save Money
Every hobby is expensive in its own way, and the release of Pokemon Go in Singapore might burn a major hole in your pocket.
Free apps are harmless to the wallet right? Sure, on the surface. But the reality is, "pay to play" is a factor that can ramp up costs.
After all, mobile gaming is a multi-billion dollar industry, and titles like Pokemon Go have ways to make money off its fans. Here's how mobile games cunningly empty out your bank account:
Playing "Free" Games Involve Jaw-Droppingly Large Sums of Money
How much money is really involved in a free game? Well, consider one of the typical (not even the most popular) free games, the Game of War.
You've probably seen this advertised in cinemas or on YouTube – the ad campaign features Kate Upton, and cost about S$53 million to produce. To put it into perspective, a 99-year leasehold bungalow in Sentosa Cove costs around S$23 million; less than half the price of those video clips.
Can they possibly recover that cost? Yes, because there are people who spend something like S$12,000 on the game (that's a single user). Remember, the game is theoretically free.
But what about a popular free game, like Candy Crush? Well, we know for a fact that Candy Crush makes around S$11.6 million. Per day.
Now these are games that have been made in the West. Japanese made mobile games, like Pokemon Go, are even more aggressive in getting you to buy. They start you off with few resources, and want you to make big purchases right away.
The earning potential of Pokemon Go is so significant, Nintendo shares rose 24 per cent in one hour when the game was launched. In dollars, this adds approximately $10.7 billion to Nintendo's value.
Free games, in short, are a huge business. And they make you spend money in a number of ways:
1. The Skinner Box Effect
The Skinner Box refers to a famous science experiment, in which rats in a box are encouraged to push a button for a food pellet. Yes, that's literally how game designers see you, and it's sadly accurate for most of us.
You can read the entire description from a Microsoft game developer, but we'll summarise for you: levelling up.
Every time you perform an activity repeatedly, you level up. With each level, the amount of times you must repeat an activity increases before you get the next reward.
You may recognise this as being a perfect description of subscription-based games, such as Diablo and World of Warcraft. But free mobile games do it too.
When you are tapping away like crazy on Farmville, what else do you think you're doing?
You are being psychologically driven to repeat a particular motion, and spend more and more time on the game. And the longer you spend on the game, the more likely you are to give in to temptation, and buy power-ups, level-ups, etc.
Part of the reason you end up spending on free games is the way they lure you back again and again, giving them endless amounts of time to tempt you.
2. One-Hand Gaming
The phenomenon known as "one-hand gaming" just means mobile games are accessible everywhere. Unlike a game that requires a console or computer, a mobile game is almost always on hand. It is ready, at every single moment of weakness, to sell you an in-game purchase.
You may also be distracted while playing the game (e.g. waiting for your bus and playing). This peripheral attention causes you to let your guard down and make in-game purchase without even thinking.
It can be likened to the way you snack when talking or watching TV: your hand keeps reaching out, and you're barely conscious of how much you're eating. By the time you look down the whole packet of chips is finished.
3. Payment is Easy
Payments are made through credit cards and can be done with a single tap. The less effort you use to pay, the more likely you are to buy. When you need to pull the actual money out of your wallet or write a cheque, you tend to at least pause and reconsider.
Several taps of a S$0.99 purchase later, you could end up facing amounts that range into the hundreds or even thousands. In at least one case in Singapore, that amount came to S$15,000.
4. Wait Times Build Craving
The longer you wait for a reward, the bigger the high you get from it. Think of how when you're starving, almost anything tastes good.
This is why free mobile games often impose long waiting periods when you are "out of energy" or need to wait for things to be built.
They also know that at some point, you will get impatient and "buy" time by shortening the wait.
5. Sunk Cost Fallacy
Why don't people quit once they realise they've spent thousands? Well the answer is because they've spent thousands.
Most people are hesitant to stop playing when they've already made such a large investment in the game. The only solution then is to keep playing, and invest even more in it.
The invested money is just a small part of it. With games like Pokemon Go, time is a factor too: if you've spent hours climbing fences and going into people's houses to "catch 'em all", then you're not likely to quit after a whole year of effort.
You see where this going: the entire game becomes a black hole, into which your money and time disappear, and the more time and money you sink into it, the more you get sucked in.
Does That Mean You Shouldn't Play?
Every hobby is expensive in its own way, and we're not going to dictate what you should or shouldn't do for fun.
But we will say this:
Implement a strict budget for your game, and stick to it. If you feel it's getting out of control, don't subscribe to the sunk cost fallacy. Take a deep breath and delete it. After a few days away from it, we assure you any lingering regrets will vanish.
7 Creative Ways to Save Money This Weekend
4 Subtle Ways Your Friends Make You Spend More

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It's that time of year again, when New York slowly but surely starts to turn the corner into spring, and we start preparing for the epic cocktail festival that is the Manhattan Cocktail Classic. Tickets went on sale last week, and we suggest you move fast if you want to secure your spot at the various events since they tend to sell out. Here are our top picks for what to check out – including our own super-fabulous seminar-carnival with St. George Spirits and Middle Branch.
Awesome Local Distillery Experience – Check out Owney's Rum Soaked Distillery Tour hosted by Bridget Firtle, distiller extraordinaire and Brooklyn native. She makes molasses-based, white rum in Bushwick – delicious AND local! Saturday, May 10, 3-5pm, Bushwick, $50 gets you lots of rummy cocktails + Roberta's pizza. Get tickets here.
Fun Cocktail Learning – Before heading out to Brooklyn to visit Owney's, hone your cocktail knowledge and tasting skills with our interactive seminar featuring the delicious & versatile products of St. George Spirits. Learn how our minds perceive taste & smell, and how bartenders & distillers use these concepts to craft the perfect beverage. Then, test your knowledge at our cocktail carnival and compete for fun prizes! Saturday, May 10, 1-3pm, Middle Branch, 154 East 33rd Street. $60 includes spirit tastings, cocktails, snacks & fun. Get tickets here.
DIY Enthusiast – If you love experimenting with your home bar, then the High West barrel aged cocktail workshop is the place for you. High West Distillery makes phenomenal products, and their distiller will be on hand to share his knowledge & expertise. You also get VIP access to a walk-around tasting event at Astor Wine & Spirits. Saturday, May 10, 5:30-7pm, Astor Center. Tickets are $115.
Swig 'n' Swine – The ultimate pork and punch party hosted by the Bon Vivants at Union Pool (PSA: not actually a pool) in Brooklyn. The cost of admission is the purchase of a $30 t-shirt, all of which goes to fund charitable works. More info & RSVP here. Sunday, May 11, 12-5pm, Union Pool in Williamsburg.
Discover off the beaten path spirits – One of our most favorite annual events, the Indie Spirits Expo offers a unique chance to taste craft spirits from small producers all over the world. Tuesday, May 13 at the Penn Club in Midtown. Tickets are $50 and there are two sessions, 5-7pm and 7-9pm.
For the Chocoholic – Our friends over at The Cocktail Guru are hosting a decadent Mother's Day afternoon of booze and chocolates at American Whiskey. A great mom-friendly event if you're looking to kill two birds with one stone. Sunday, May 11 3-5pm at American Whiskey at 247 W. 30th St. between 7th and 8th Ave., NYC. Tickets are $45.


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Comunities in Tune
The Bandstand Marathon
Cultural Olympiad and London Festival
Superact
Bandstands
2012 Cultural Olympiad and London Festival
The UK bid for the 2012 Olympic and Paralympic games promised that London's 2012 programme would champion culture and education alongside sport, with a Cultural Olympiad to inspire young people and celebrate the country's diversity across the UK. The Cultural Olympiad was launched in 2008 as a four-year, UK-wide programme, developed by and for communities, especially young people, with special programmes to celebrate Deaf and disabled artists, the UK's diverse creative industries, heritage and natural environments, as well as icons including William Shakespeare.
The finale of the Cultural Olympiad was the London 2012 Festival, a curated UK-wide festival showcasing the best of the Cultural Olympiad with works from leading British and international artists.
The UK already had a good reputation for cultural programming before the Cultural Olympiad and Festival, so raising the bar was a challenge. The difference was seen mostly in the scale and diversity of the programme, the championing of 'new' work with an emphasis on values, themes and the development of new partnerships within and across sectors.
The 2012 programme had a broad range of activities across a wide geographical area with artists of diverse types and nationalities. Of the almost 118,000 activities over the Olympiad, 29 per cent (33,631) took place in the 12-week London 2012 Festival period.
The programme's commitment to engagement and active participation resulted in 52 per cent of all activities including sessions for education, training or taking part. Some regions matched London for the number of sessions of education they held. Whilst there are a lot of art forms, many involved outdoor activities, bringing art into unusual places.
The London 2012 Festival projects were generally classic artforms, with projects often involving high profile artists in theatre, led by the World Shakespeare Festival, the visual arts, music and dance. Dance was also dominant, with a flagship mass participation project, Big Dance. All the competing Olympic nations were represented at the BT River of Music, being free concerts across London and a week of poetry translation at the Southbank Centre in Poetry Parnassus. The Festival also celebrated film and comedy with new commissions, new productions and premiers as well as new partnerships and new ways of working, many of which would not have happened without the Cultural Olympia or would have taken on a different form. The festival also offered free participation opportunities for local communities with a programme on a geographical scale unmatched by any previous UK cultural event.
In contrast, the general Cultural Olympiad was dominated by combined arts and had many more museum and heritage projects and community-led events including sport, health and education. In total the Cultural Olympiad created 5,370 new artistic works or commissions, ranging from films, fanfares and carnival floats to costumes, plays, graphic murals and more.
An additional promise was a legacy for those who participated, with many of the new partnerships, festivals and commissions continuing beyond 2012, to include the Glasgow 2014 Commonwealth Games and the Rio 2016 Olympic and Paralympic Games which both premiered at the London 2012 Festival.
The scale and the ambition of some of the projects enabled them to flourish beyond 2012, particularly festivals, employment and training programmes and touring productions, but also projects covering the full breadth of the Cultural Olympiad.
For the UK cultural sector, the evidence after the close of the festival was that people were motivated to continue extending their engagement in culture as a result of their London 2012 experiences. This motivation was higher for people that took part in the Cultural Olympiad and the London 2012 Festival.
The Cultural Olympiad and post-Olympiad activity also raised the profile of the UK's culture, opening up iconic locations across the country, to reach new tourist markets with more than half the projects planning to continue after the event.
The London 2012 Festival promised 'once-in-a-lifetime' commissions, with a commitment to serving communities throughout the UK in partnership with local, national and international partners.
Using the Olympic and Paralympic Movements' values and themes for inspiration resulted in many commissions. The most famous included a commission to Richard Long to present work alongside the Olympic cycling race in Box Hill Road River. Also used in a commission was Arthur's Seat in Edinburgh, used as the grounds for a live piece of public art created using 120 endurance runners in Speed of Light. The Cultural Olympiad also saw the production of new films responding to the Games, such as BAFTA winner The Swimmer by Lynne Ramsay and Deborah Warner and Fiona Shaw's Olympic Truce inspired Peace Camp. The collaboration of the Mayor of London with large scale pop-up commissioned celebrations of London included Piccadilly Circus Circus and Elizabeth Streb's One Extraordinary Day and the world premiere of Mittwoch aus Licht by Birmingham Opera Company.
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Drove to Chandler yesterday for a photo shoot at the Route 66 Interpretive Center in the beautifully restored WPA armory.
Also shot the 1930 Phillips 66 station on Highway 18, being restored to original bright colors. Then to Perkins to locate the WPA outhouse at the Frank Eaton (Pistol Pete) house and found some interesting railroad history objects.