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Plenary Speakers

Plenary Lecture 1

Vladimir Poznyak

Monday, September 10, 9:00-9:45

Alcohol policy development and research:
A complex interface

Vladimir Poznyak
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

Vladimir Poznyak is a Coordinator of Management of Substance Abuse unit at the World Health Organization (WHO) in Geneva, and in this capacity he is responsible for coordination of normative, advocacy, research and country support activities on alcohol, drugs and addictive behaviors in WHO headquarters. A medical doctor and psychiatrist by professional background, Dr Poznyak received his PhD from All-Union Center of Medical and Biological Problems of Addiction Medicine in Moscow, Russian Federation, and his research at that time was focused on gender differences in alcohol dependence. Dr Poznyak has been at the forefront of the WHO Secretariat’s work on development and implementation of the WHO Global strategy to reduce the harmful use of alcohol and on addressing public health dimensions of the world drug problem. In recent years Dr Poznyak coordinated the work on 11th revision of the International Classification of Diseases (ICD) for disorders due to substance use and addictive behaviors.

Psychoactive, toxic and dependence-producing properties of alcohol are well documented, and recent research findings expand the list of health conditions with causal relationship to alcohol consumption. In spite of around 3 million deaths attributable worldwide to alcohol every year and around 250 million people affected by alcohol use disorders, effective alcohol control policies lack strong support in many societies and jurisdictions. The WHO Global strategy to reduce the harmful use of alcohol is the only global non-binding policy framework on alcohol that was negotiated and agreed at the intergovernmental level. The recent global policy developments, including Sustainable Development Goals 2030 with special health target on substance abuse and strategies for prevention and control of Noncommunicable Diseases (NCDs) create new opportunities for effective alcohol control. Research findings on effectiveness and cost-effectiveness of policy options prompted development of “best buy” concept that includes feasible policies and interventions with an average cost-effectiveness ration of ≤ 1$ 100/DALY. For reducing the harmful use of alcohol these policy options include increase in excise taxes and prices of alcoholic beverages, reduction in physical availability of retailed alcohol and comprehensive restrictions or bans on alcohol advertising. Screening and brief interventions (SBI) for hazardous and harmful drinking has good cost-effectiveness ratio, but their implementation in health systems is limited. The 11th revision of the International Classification of Diseases, released in June 2018, is expected to facilitate implementation of alcohol-focused interventions in health services. The global data on implementation of alcohol policy options indicate that research efforts do not necessarily translate into science-based policy developments, and factors influencing the complex interface between research and alcohol policy development will be discussed in the presentation.

Plenary Lecture 2

Markus A. Heilig

Tuesday, September 11, 8:15-9:00

ISBRA Tabakoff Award Lecture
Developing neuroscience based treatments for alcohol addiction - Challenges and prospects

Markus A. Heilig
Center for Social and Affective Neuroscience, Sweden

Markus Heilig received his MD and PhD from Lund University, Sweden, 1986 and 1989, resp, and was a post-doc at The Scripps Research Institute, LaJolla, CA 1990 - 1992. Upon returning to Sweden and completing clinical training in psychiatry, he served at the Karolinska Institute, Stockholm, Sweden, in various clinical and academic leadership capacities until 2004. Between 2004 – 2015, he was the chief of intramural clinical and translational research at the US National Inst on Alcohol Abuse and Alcoholism. In 2015, he was recruited back to Sweden as the founding director of the Center for Social and Affective Neuroscience at Linköping Univ, in a joint initiative of the Swedish Research Council, the University and the Region.

Heilig's research is centered on regulation of negative effect, as it applies to affective, anxiety and addictive disorders. He has published more than 250 peer reviewed papers, including in leading journals such as Science, Lancet, PNAS and others. His work has been cited >10000 times, resulting in an H-index of about 60. Current efforts in the Heilig lab are focused on identifying novel mechanisms for pharmacotherapy of addiction, and developing these from preclinical target discovery and validation to early human proof-of-concept trials. Currently pursued targets include systems involved in stress- and negative effect such as neurokinins, nociceptin, glutamate and cannabinoids. Recently, his laboratory has expanded the scope of its research incorporate the neurobiology of choosing between alcohol and natural rewards, and how social factors influence these behaviors.

Neurobiological research on addictive disorders has grown exponentially in the past two decades. It has also become increasingly sophisticated in its ability to identify neural circuits and molecular mechanisms behind drug seeking and taking. These advances have fueled hopes that novel, neuroscience based treatments would emerge and transform treatment of alcohol addiction. That hope has not yet materialized. Existing medications for alcohol addiction provide proof-of-principle for pharmacological treatment of this disorder, but their discovery precedes the neuroscience revolution, and they have not been adopted broadly enough to transform clinical practice.
This talk will review the ups, downs and new ups over two decades of translational work attempting to identify and target novel mechanisms for treatment of alcohol addiction. The first theme will discuss the limitations of focusing on brain reward mechanisms as therapeutic targets, and review our work on reprogramming of the transcriptome within key brain structures as a mechanism behind long-term neuroadaptations that fundamentally change the incentives behind alcohol seeking. The second theme will discuss the limitations of studying drug seeking in isolation. It will introduce the critical importance of studying alcohol seeking in the context of availability of natural rewards, and of individual vulnerability. Implications for medications development will be discussed.

Plenary Lecture 3

Jurgen Rehm

Tuesday, September 11, 9:00-9:45

Burden of disease caused by alcohol and alcohol use disorders – What do we know and where do we go?

Jurgen Rehm
Centre for Addiction and Mental Health, Toronto, Canada

Jürgen Rehm, Ph.D., has been appointed the Inaugural Chair for Addiction Policy at the Dalla Lana School of Public Health of the University of Toronto (Canada). In addition, he holds positions at the Centre for Addiction and Mental Health as Senior Director of the Institute for Mental Health Policy Research, and at the Institute for Clinical Psychology and Psychotherapy of the Technical University Dresden (Germany). Dr. Rehm has published more than 900 peer-reviewed journal articles in substance use research; and is listed among the Thompson Reuters/Clarivate most highly cited in his field (top 1% with respect to impact as measured by citations). He has been awarded the Jellinek and the European Addiction Research Awards.

Alcohol use has long been known to be a major risk factor for burden of disease and injury. The newest global and regional estimates of alcohol-attributable burden of disease as measured in deaths, years of life lost and disability adjusted life years will be presented, with emphasis on alcohol-attributable infectious disease, gastrointestinal disease and injuries.

The contribution of heavy drinking occasions and liver disease in the etiology of alcohol-attributable disease burden will be highlighted, as well as the interaction with between alcohol use and socioeconomic status and poverty. As a specific example of the latter, we will highlight the contribution of alcohol to the current stagnation of life expectancy in the USA.

Plenary Lecture 4

Yoshiyuki Takei

Tuesday, September 11, 13:50-14:35

Liver parenchymal cells and sinusoidal cells: Cell sociology in alcoholic liver disease

Yoshiyuki Takei
Department of Gastroenterology, Mie University School of Medicine, Japan

Yoshiyuki Takei, MD, PhD is Vice President of Mie University and Professor and Chairman of the Department of Gastroenterology, Mie University Graduate School of Medicine. Following his training as a hepatology specialist at the First Department of Medicine, Osaka University and the University of North Carolina at Chapel Hill (mentor: Late Prof. Ronald G Thurman), his translational and clinical investigations have focused on alcoholic liver disease and non-alcoholic fatty liver disease with special interest in the interaction and crosstalk between hepatocytes and non-parenchymal cells. He has published more than 300 peer-reviewed articles in respected international journals.
He is a long-time member of the ISBRA and was the Vice Chairman of the Local Organizing Committee of the ISBRA Congress in 2012. He has also served on the boards of the ISBRA and the Japan Society of Hepatology.

Since the direct hepatotoxicity of ethanol was demonstrated by Charles Lieber almost half a century ago, significant progress has been made in research on the mechanism of alcohol liver disease (ALD). Consequently, the mechanism of ALD is considered to be diverse and multifaceted. In the late 1980s, it was proposed that alcohol is not only the direct toxicant to liver parenchymal cells, but also targets a variety of liver sinusoidal cells including Kupffer cells, stellate cells and sinusoidal endothelial cells (SECs). This hypothesis led to the general theory that alcohol-induced liver damage is a result of multiple, complex parallel processes. Ethanol-induced factors that communicate stress signals between hepatocytes and non-parenchymal cells initiate and perpetuate the pathological processes responsible for liver damage and disease progression to alcoholic hepatitis and cirrhosis. For example, at high concentrations, ethanol evokes endothelin-1 expression in SECs and causes contraction of the hepatic sinusoid leading to disturbed hepatic microcirculation. Moreover, ethanol increases gut-derived endotoxins (pathogen-associated molecular patterns), leading to the activation of Kupffer cells, culminating in the overproduction of toxic mediators such as tumor necrosis factor-α. Thus, interaction and crosstalk between hepatocytes and non-parenchymal cells appear to be crucial to the pathogenesis of ALD.

Plenary Lecture 5

Reinout W. Wiers

Wednesday, September 12, 9:00-9:45

On the Use of Cognitive Training in the Treatment of Alcohol Use Disorders

Reinout W. Wiers
Professor of Developmental Psychopathology, Addiction Development and Psychopathology (ADAPT) Lab; Chair of Developmental Psychology, Faculteitshoogleraar FMG UvA; and Department of Psychology, Universiteit van Amsterdam, the Netherlands

Professor Reinout W. Wiers is professor of developmental psychopathology and distinguished faculty professor at the University of Amsterdam (UvA). He is senior editor of the journal Addiction, and on the editorial board of several other journals of addiction and clinical psychology. Wiers is internationally known for his work on implicit cognition and addiction. He received the prestigious VIDI (2002) and VICI (2008) research grants from the Dutch National Science Foundation (N.W.O.), for research on assessing and changing implicit cognitive processes in addiction. He also received several other grants from national and international funding agencies. His 2011 Psychological Science paper on changing the approach-bias for alcohol in alcohol-dependent papers with clinical effects is in the top 1% of most cited papers of that year in psychology and psychiatry. Wiers published over 250 international papers and book chapters, and his current Hirsch-index is 45 (web of science) or 65, google scholar, see:

Alcohol Use Disorders (AUDs) are typically treated with psychosocial treatments and/or medication. However, there is a third category of interventions to consider: varieties of Cognitive Training (CT). Two types of CT can be distinguished: those in which general abilities are trained (e.g. working memory training) and those in which initial motivational reactions to alcohol are targeted, so called cognitive biases (Cognitive Bias Modification, CBM). I will review the state of affairs in both. Training of general abilities takes a long time, but does show promise for a subgroup of patients. CBM has shown to increase one-year abstinence in several large clinical trials, with effect sizes similar to medication for alcohol (NNT=12). It is also becoming clear for which individuals CBM shows most promise as an add-on treatment (those with a strong cue-reactivity and/or impulsivity), and we are beginning to understand the neurocognitive mechanisms underlying training effects (e.g., reduced cue-reactivity). CT shows modest but reliable effects as add-on to regular psychosocial treatment, but does not appear to work in the absence of psychosocial treatment, nor in the absence of motivation to change (e.g. in proof-of-principle studies in students). Finally, I will sketch ways forward, such as combining training with neurostimulation.

Plenary Lecture 6

Vijay A. Ramchandani

Wednesday, September 12, 13:50-14:35

Alcohol Pharmacodynamics and Neurofunctional Domains underlying Alcohol Use Disorder

Vijay A. Ramchandani
Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA

Vijay Ramchandani, Ph.D., is a Clinical Investigator and Chief of the Section on Human Psychopharmacology in the intramural research program of the National Institute on Alcohol Abuse and Alcoholism, one of the National Institutes of Health, in Bethesda, MD. Dr. Ramchandani obtained his undergraduate degree in Pharmaceutical Sciences from Bombay University in India in 1990, and his Ph.D. in Pharmaceutical Sciences from Virginia Commonwealth University, Richmond, VA in 1996. From 1996 to 2002, he worked at the Alcohol Research Center at Indiana University School of Medicine, Indianapolis, IN, first as a Research Associate and then as an Assistant Scientist and Part-time Assistant Professor. In 2003, Dr. Ramchandani joined NIAAA as a Staff Scientist in the Laboratory of Clinical and Translational Studies, and started his independent research program in 2010. Dr. Ramchandani also serves as the Deputy Training Director for the NIAAA intramural program.
Dr. Ramchandani’s research is focused on characterizing the clinical pharmacology of alcohol in humans using behavioral, neuroendocrine, psychophysiological and functional imaging measures, and the relationship between alcohol response and risk factors, both genetic and environmental, for alcohol use disorders. He is also conducting studies to develop human laboratory paradigms to screen novel potential pharmacotherapies for alcohol use disorders, in terms of their ability to alter the motivation, consumption and pharmacodynamics of alcohol in high-risk drinkers.

Alcohol use disorder has a tremendous negative individual and global impact, and there is an urgent need to understand its etiology as well as to advance treatment for this devastating illness. Research on the clinical pharmacology of alcohol is necessary to explain how variability in alcohol response affects the risk of developing this disorder. Furthermore, an improved understanding of the genetic, environmental, and neurobiological factors that affect alcohol response could lead to the development of novel treatments.
Dr. Ramchandani’s presentation will focus on research advances in characterization of the pharmacological effects of alcohol in humans across the neurofunctional domains of incentive salience, negative affect, and executive dysfunction that are critical to the cycle of addiction. He will include examples of his own human laboratory research that utilizes novel intravenous alcohol administration paradigms to provide a platform of highly controlled alcohol exposure, combined with a range of pharmacodynamic measures, in individuals across the spectrum of alcohol consumption and risk. These studies provide important insights into the relationship between alcohol pharmacodynamics and risk of alcohol problems, and facilitate the identification and screening of potential targets for treatment of alcohol use disorder.