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Fiala J, Sochor O, Klimusová H, Homolka M. Alcohol Consumption in Population Aged 25-65 Years Living in the Metropolis of South Moravia, Czech Republic. Cent Eur J Public Health 2017; 25:191-199. [PMID: 29022677 DOI: 10.21101/cejph.a4481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/02/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate alcohol consumption in a representative sample of the population of the city of Brno, as part of research on cardiovascular risk factors. METHODS Cross-sectional survey on a sample of 2,160 randomly selected residents 35-65 years old was carried out. For the invited volunteers who became a part of the investigation, alcohol consumption was determined in a controlled, face to face interview structured in accordance with a special questionnaire form. The frequency of alcohol consumption during the previous year was determined, in more detail during the last month (including quantification using "units of alcohol", their normal and maximum level of drinking, and any association between alcohol consumption and meals), and during the last week in the form of a complete, beverage specified and quantified 7-day recall period. Typical patterns of alcohol consumption were explored by the means of cluster analysis. RESULTS During the past 12 months, 90.0% of the men and 79.0% of the women had consumed alcohol, the rest can be considered abstinent. The most commonly reported frequency was 2-4 times per week (35.6% of the men), or 1-3 times per month (22.8% of the women). Daily or almost daily consumption was reported by 24.8% of the men and 12.8% of the women. The number of units of alcohol consumed usually on one occasion amounts to an average of 3.88±4.80 for the men and 2.25±1.39 for the women, but the amount most often cited by both sexes was 2 drinks (36.4% of the men and 40.4% of the women). The largest amount consumed on any occasion during the last 30 days was 5 or more units in 69.3% of the men, and in 33.9% of the women it was 4 or more units (this amount of alcohol leads to a blood alcohol concentration (BAC) of 0.08, the border of drunkenness). In 19.9% of the men and 7.5% of the women, this border was exceeded more than 5 times in the past month. Only 14.7% of the men and 10.3% of the women reported that the majority of their alcohol consumption occurs with food; on the contrary, 64.3% of the men and 77.6% of the women drinkers drink it either always without food or only rarely with it. During the past week, 81.6% of the men and 63.4% of the women drank alcohol (p<0.001, chi-square). The average value of consumption for one man was 11.57±11.91 doses, and for one woman 4.68±6.38 doses per week (p<0.001, t-test). A total of 17.8% of the men exceeded the limit of 21 doses per week, and 7.4% of the women exceeded 14 doses/week. After converting the weekly consumption into the number of units of alcohol per week expressed in litres per year, the total average consumption was 5.01±6.36 litres; for the men 7.26±7.62 litres and for the women 3.02±4.08 litres of pure alcohol per person annually. Consumption during the week was not uniform (p<0.001, ANOVA), with the highest occurring on Saturday, followed by Friday. The men mostly drank beer (62.9% of the total volume of alcohol), the women wine (68.6%). The cluster analysis identified 5 clusters of respondents, based on a set of alcohol consumption variables, as follows: very heavy drinking (1.6% of the respondents who drink alcohol); heavy drinking (8.8%); binge drinking (6.3%); moderate drinking (31.1%); and occasional drinking (52.3%). CONCLUSIONS The results show a relatively high consumption of alcohol in the examined group. The recommended weekly limits were exceeded by only a small portion, but that consumption had a binge character. Conversion into a form allowing comparison with conventional national statistics shows a significantly lower consumption than these reported statements. Overall, men consume significantly more alcohol than women.
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Affiliation(s)
- Jindřich Fiala
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Ondřej Sochor
- International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Helena Klimusová
- Institute of Psychology, Faculty of Arts, Masaryk University, Brno, Czech Republic
| | - Martin Homolka
- International Clinical Research Centre, St. Anne's University Hospital Brno, Brno, Czech Republic
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Melón LC, Nolan ZT, Colar D, Moore EM, Boehm SL. Activation of extrasynaptic δ-GABA A receptors globally or within the posterior-VTA has estrous-dependent effects on consumption of alcohol and estrous-independent effects on locomotion. Horm Behav 2017; 95:65-75. [PMID: 28765080 PMCID: PMC5623082 DOI: 10.1016/j.yhbeh.2017.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/21/2022]
Abstract
Recent reports support higher than expected rates of binge alcohol consumption among women and girls. Unfortunately, few studies have assessed the mechanisms underlying this pattern of intake in females. Studies in males suggest that alcohol concentrations relevant to the beginning stages of binge intoxication may selectively target tonic GABAergic inhibition mediated by GABAA receptor subtypes expressing the δ-subunit protein (δ-GABAARs). Indeed, administration of agonists that interact with these δ-GABAARs prior to alcohol access can abolish binge drinking behavior in male mice. These δ-GABAARs have also been shown to exhibit estrous-dependent plasticity in regions relevant to drug taking behavior, like the hippocampus and periaqueductal gray. The present experiments were designed to determine whether the estrous cycle would alter binge drinking, or our ability to modulate this pattern of alcohol use with THIP, an agonist with high selectivity and efficacy at δ-GABAARs. Using the Drinking-in-the-Dark (DID) binge-drinking model, regularly cycling female mice were given 2h of daily access to alcohol (20%v/v). Vaginal cytology or vaginal impedance was assessed after drinking sessions to track estrous status. There was no fluctuation in binge drinking associated with the estrous cycle. Both Intra-posterior-VTA administration of THIP and systemic administration of the drug was also associated with an estrous cycle dependent reduction in drinking behavior. Pre-treatment with finasteride to inhibit synthesis of 5α-reduced neurosteroids did not disrupt THIP's effects. Analysis of δ-subunit mRNA from posterior-VTA enriched tissue samples revealed that expression of this GABAA receptor subunit is elevated during diestrus in this region. Taken together, these studies demonstrate that δGABAARs in the VTA are an important target for binge drinking in females and confirm that the estrous cycle is an important moderator of the pharmacology of this GABAA receptor subtype.
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Affiliation(s)
- Laverne C Melón
- Addiction Neuroscience, Department of Psychology, Indiana University/Purdue University-Indianapolis, Indianapolis, IN 46202, USA; Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, USA
| | | | - Delphine Colar
- Addiction Neuroscience, Department of Psychology, Indiana University/Purdue University-Indianapolis, Indianapolis, IN 46202, USA
| | - Eileen M Moore
- Center for Behavioral Teratology, Department of Psychology, San Diego State University, San Diego, CA 92120, USA
| | - Stephen L Boehm
- Addiction Neuroscience, Department of Psychology, Indiana University/Purdue University-Indianapolis, Indianapolis, IN 46202, USA.
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Åberg F, Helenius-Hietala J, Puukka P, Jula A. Binge drinking and the risk of liver events: A population-based cohort study. Liver Int 2017; 37:1373-1381. [PMID: 28276137 DOI: 10.1111/liv.13408] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/26/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Binge drinking or heavy episodic drinking is increasingly prevalent, but the health effects are incompletely understood. We investigated whether binge drinking increases the risk for liver disease above and beyond the risk due to average alcohol consumption. METHODS 6366 subjects without baseline liver disease who participated in the Finnish population-based Health 2000 Study (2000-2001), a nationally representative cohort. Follow-up data from national registers until 2013 were analysed for liver-related admissions, mortality and liver cancer. Binge drinking (≥5 drinks per occasion, standard drink 12 g ethanol) was categorised as weekly, monthly, or as less often or none. Multiple confounders were considered. RESULTS Eighty-four subjects developed decompensated liver disease. Binge drinking frequency showed a direct association with liver-disease risk after adjustment for average daily alcohol intake and age. After adjustment, the hazard ratios (HRs) for weekly and monthly binge drinking were 3.45 (P=.001) and 2.26 (P=.007) and were higher after excluding regular heavy drinkers. The HR for weekly binging was 6.82 (P=.02) in women; 2.34 (P=.03) in men; and 4.29 (P=.001) in subjects with the metabolic syndrome. Weekly binge drinking and the metabolic syndrome produced supra-additive increases in the risk of decompensated liver disease. Weekly, and to a lesser extent monthly, binging retained significance in sequential multivariate models that additionally adjusted for beverage preference and lifestyle, metabolic, and socioeconomic factors. CONCLUSIONS Binge drinking is associated with an increased risk for liver disease independently of average alcohol intake and confounders. The rising prevalence of binge drinking and the metabolic syndrome is particularly concerning.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Jaana Helenius-Hietala
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Pauli Puukka
- Department of Health, National Institute for Health and Welfare, Turku, Finland
| | - Antti Jula
- Department of Health, National Institute for Health and Welfare, Turku, Finland
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Grant BF, Chou SP, Saha TD, Pickering RP, Kerridge BT, Ruan WJ, Huang B, Jung J, Zhang H, Fan A, Hasin DS. Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. JAMA Psychiatry 2017; 74:911-923. [PMID: 28793133 PMCID: PMC5710229 DOI: 10.1001/jamapsychiatry.2017.2161] [Citation(s) in RCA: 905] [Impact Index Per Article: 129.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Lack of current and comprehensive trend data derived from a uniform, reliable, and valid source on alcohol use, high-risk drinking, and DSM-IV alcohol use disorder (AUD) represents a major gap in public health information. OBJECTIVE To present nationally representative data on changes in the prevalences of 12-month alcohol use, 12-month high-risk drinking, 12-month DSM-IV AUD, 12-month DSM-IV AUD among 12-month alcohol users, and 12-month DSM-IV AUD among 12-month high-risk drinkers between 2001-2002 and 2012-2013. DESIGN, SETTING, AND PARTICIPANTS The study data were derived from face-to-face interviews conducted in 2 nationally representative surveys of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions, with data collected from April 2001 to June 2002, and the National Epidemiologic Survey on Alcohol and Related Conditions III, with data collected from April 2012 to June 2013. Data were analyzed in November and December 2016. MAIN OUTCOMES AND MEASURES Twelve-month alcohol use, high-risk drinking, and DSM-IV AUD. RESULTS The study sample included 43 093 participants in the National Epidemiologic Survey on Alcohol and Related Conditions and 36 309 participants in the National Epidemiologic Survey on Alcohol and Related Conditions III. Between 2001-2002 and 2012-2013, 12-month alcohol use, high-risk drinking, and DSM-IV AUD increased by 11.2%, 29.9%, and 49.4%, respectively, with alcohol use increasing from 65.4% (95% CI, 64.3%-66.6%) to 72.7% (95% CI, 71.4%-73.9%), high-risk drinking increasing from 9.7% (95% CI, 9.3%-10.2%) to 12.6% (95% CI, 12.0%-13.2%), and DSM-IV AUD increasing from 8.5% (95% CI, 8.0%-8.9%) to 12.7% (95% CI, 12.1%-13.3%). With few exceptions, increases in alcohol use, high-risk drinking, and DSM-IV AUD between 2001-2002 and 2012-2013 were also statistically significant across sociodemographic subgroups. Increases in all of these outcomes were greatest among women, older adults, racial/ethnic minorities, and individuals with lower educational level and family income. Increases were also seen for the total sample and most sociodemographic subgroups for the prevalences of 12-month DSM-IV AUD among 12-month alcohol users from 12.9% (95% CI, 12.3%-17.5%) to 17.5% (95% CI, 16.7%-18.3%) and 12-month DSM-IV AUD among 12-month high-risk drinkers from 46.5% (95% CI, 44.3%-48.7%) to 54.5% (95% CI, 52.7%-56.4%). CONCLUSIONS AND RELEVANCE Increases in alcohol use, high-risk drinking, and DSM-IV AUD in the US population and among subgroups, especially women, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged, constitute a public health crisis. Taken together, these findings portend increases in many chronic comorbidities in which alcohol use has a substantial role.
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Affiliation(s)
- Bridget F. Grant
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - S. Patricia Chou
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Tulshi D. Saha
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Roger P. Pickering
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | | | - W. June Ruan
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Boji Huang
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Jeesun Jung
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Haitao Zhang
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Amy Fan
- Epidemiology and Biometry Branch, National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Deborah S. Hasin
- New York State Psychiatric Institute, New York,Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York
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Jadhav KS, Magistretti PJ, Halfon O, Augsburger M, Boutrel B. A preclinical model for identifying rats at risk of alcohol use disorder. Sci Rep 2017; 7:9454. [PMID: 28842608 PMCID: PMC5572732 DOI: 10.1038/s41598-017-09801-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/28/2017] [Indexed: 01/02/2023] Open
Abstract
Alcohol use is one of the world's leading causes of death and disease, although only a small proportion of individuals develop persistent alcohol use disorder (AUD). The identification of vulnerable individuals prior to their chronic intoxication remains of highest importance. We propose here to adapt current methodologies for identifying rats at risk of losing control over alcohol intake by modeling diagnostic criteria for AUD: inability to abstain during a signaled period of reward unavailability, increased motivation assessed in a progressive effortful task and persistent alcohol intake despite aversive foot shocks. Factor analysis showed that these three addiction criteria loaded on one underlying construct indicating that they represent a latent construct of addiction trait. Further, not only vulnerable rats displayed higher ethanol consumption, and higher preference for ethanol over sweetened solutions, but they also exhibited pre-existing higher anxiety as compared to resilient rats. In conclusion, the present preclinical model confirms that development of an addiction trait not only requires prolonged exposure to alcohol, but also depends on endophenotype like anxiety that predispose a minority of individuals to lose control over alcohol consumption.
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Affiliation(s)
- Kshitij S Jadhav
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierre J Magistretti
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- Brain Mind Institute, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Olivier Halfon
- Division of Adolescent and Child Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc Augsburger
- Toxicology and Forensic Chemistry Unit, University Center of Legal Medicine, Lausanne, Geneva, Switzerland
| | - Benjamin Boutrel
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
- Division of Adolescent and Child Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
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56
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Paolillo EW, Gongvatana A, Umlauf A, Letendre SL, Moore DJ. At-Risk Alcohol Use is Associated with Antiretroviral Treatment Nonadherence Among Adults Living with HIV/AIDS. Alcohol Clin Exp Res 2017; 41:1518-1525. [PMID: 28679147 PMCID: PMC5564671 DOI: 10.1111/acer.13433] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 06/07/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Alcohol use is a risk factor for nonadherence to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA); however, differences in ART adherence across levels of alcohol use are unclear. This study examined whether "at-risk" alcohol use, defined by National Institute of Alcohol Abuse and Alcoholism guidelines, was associated with ART nonadherence among PLWHA. METHODS Participants were 535 HIV-infected adults enrolled in studies at the HIV Neurobehavioral Research Program. ART nonadherence was identified by either self-reported missed dose or plasma viral load detectability (≥50 copies/ml). Potential covariates for multivariable logistic regression included demographics, depression, and substance use disorders. RESULTS Using a stepwise model selection procedure, we found that at-risk alcohol use (OR = 0.64; p = 0.032) and low education (OR = 1.09 per 1 year increase in education; p = 0.009) significantly predict lower ART adherence. CONCLUSIONS A greater focus on the treatment of at-risk alcohol use may improve ART adherence among HIV-infected persons.
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Affiliation(s)
- Emily W. Paolillo
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Assawin Gongvatana
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, California
| | - Anya Umlauf
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, California
| | - Scott L. Letendre
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, California
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, San Diego, California
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Kuntsche E, Kuntsche S, Thrul J, Gmel G. Binge drinking: Health impact, prevalence, correlates and interventions. Psychol Health 2017; 32:976-1017. [PMID: 28513195 DOI: 10.1080/08870446.2017.1325889] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Binge drinking (also called heavy episodic drinking, risky single-occasion drinking etc.) is a major public health problem. This paper provides an overview of recently published evidence concerning the definition and measurement, prevalence rates, health impact, demographic and psychosocial correlates of, and interventions for, binge drinking. DESIGN Narrative review. RESULTS Mostly occurring among young people at weekends, binge drinking increases the risk of both acute (e.g. injuries) and long-term negative consequences (e.g. alcohol disorders). Binge drinkers tend to be extrovert, impulsive and sensation-seeking. Stress, anxiety, traumatic events and depression are also related to binge drinking. Both alcohol-related behaviour of parents and general parenting (e.g. parenting styles, monitoring) are also important. Other major risk factors for binge drinking are frequently spending time with friends who drink, and the drinking norms observed in the wider social environment (e.g. school, community, culture). Emergency departments, birthday parties, fraternities and the workplace serve as settings for interventions; these are increasingly delivered via digital and mobile technology. There is evidence of small-sized effects across approaches (brief interventions, personalised normative feedback, protective behavioural strategies etc.) and populations. CONCLUSION A more consistent terminology, investigating multi-level influences and identifying the most effective intervention components are challenges for future research.
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Affiliation(s)
- Emmanuel Kuntsche
- a Addiction Switzerland, Research Department , Lausanne , Switzerland.,b Behavioural Science Institute , Radboud University , Nijmegen , The Netherlands.,c Institute of Psychology , Eötvös Loránd University , Budapest , Hungary
| | - Sandra Kuntsche
- a Addiction Switzerland, Research Department , Lausanne , Switzerland
| | - Johannes Thrul
- d Center for Tobacco Control Research and Education , University of California , San Francisco , CA , USA
| | - Gerhard Gmel
- a Addiction Switzerland, Research Department , Lausanne , Switzerland.,e Alcohol Treatment Centre , Lausanne University Hospital , Lausanne , Switzerland
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A Phase 2, Double-Blind, Placebo-Controlled Randomized Trial Assessing the Efficacy of ABT-436, a Novel V1b Receptor Antagonist, for Alcohol Dependence. Neuropsychopharmacology 2017; 42:1012-1023. [PMID: 27658483 PMCID: PMC5506792 DOI: 10.1038/npp.2016.214] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/30/2016] [Accepted: 09/08/2016] [Indexed: 12/20/2022]
Abstract
Alcohol use disorder has been linked to dysregulation of the brain stress systems, producing a negative emotional state leading to chronic relapsing behavior. Vasopressin receptors appear to have a regulatory role in stress, anxiety, and alcohol. This study evaluated the novel compound, ABT-436, a V1b receptor antagonist, in alcohol-dependent participants in a 12-week clinical trial. Men and women (n=150) who met criteria for DSM-IV alcohol dependence were recruited across four sites. Participants received double-blind ABT-436 or placebo, and a computerized behavioral intervention. ABT-436 was titrated to 800 mg/day during weeks 2-12. Although the primary outcome, percentage of heavy drinking days, was lower in participants receiving ABT-436 compared with placebo, this difference was not statistically significant (31.3 vs 37.6, respectively; p=0.172; d=0.20). However, participants receiving ABT-436 had significantly greater percentage of days abstinent than those receiving placebo (51.2 vs 41.6, respectively; p=0.037; d=0.31). No significant differences were found between treatment groups on any other measures of drinking, alcohol craving, or alcohol-related consequences. Smokers receiving ABT-436 smoked significantly fewer cigarettes per week than those receiving placebo (p=0.046). ABT-436 was well tolerated, with diarrhea (mild-to-moderate severity) being the most common side effect. In subgroup analyses, participants with relatively higher baseline levels of stress responded better to ABT-436 than placebo on select drinking outcomes, suggesting there may be value in testing medications targeting the vasopressin receptor in high stress, alcohol-dependent patients.
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Askgaard G, Leon DA, Kjaer MS, Deleuran T, Gerds TA, Tolstrup JS. Risk for alcoholic liver cirrhosis after an initial hospital contact with alcohol problems: A nationwide prospective cohort study. Hepatology 2017; 65:929-937. [PMID: 27862159 DOI: 10.1002/hep.28943] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/15/2016] [Accepted: 11/02/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Alcoholic liver cirrhosis is usually preceded by many years of heavy drinking, in which cessation in drinking could prevent the disease. Alcohol problems are not consistently managed in hospital patients. We followed all Danish patients with an initial hospital contact with alcohol problems (intoxication, harmful use, or dependence) during 1998-2002 for alcoholic liver cirrhosis development (n = 36,044). In this registry-based cohort, we identified predictors of the absolute risk for alcoholic liver cirrhosis. Incidence rate ratios (IRRs) were estimated as the incidence rate of alcoholic liver cirrhosis in these patients relative to the general population. Age and alcohol diagnosis were significant predictors of alcoholic liver cirrhosis risk in men and women, whereas civil status, education, and type of hospital care were not. In men, the 15-year absolute risk was 0.7% (95% confidence interval [CI], 0.4, 0.8) for 20-29 years, 5.5% (95% CI, 4.9, 6.2) for 30-39 years, 9.8% (95% CI, 9.0, 11) for 40-49 years, 8.9% (95% CI, 8.1, 9.8) for 50-59 years, 6.2% (95% CI, 5.1, 7.2) for 60-69 years, and 2.5% (95% CI, 1.7, 3.3) for 70-84 years. According to alcohol diagnosis in men, the 15-year absolute risk was 2.6% (95% CI, 2.3, 2.9) for intoxication, 7.7% (95% CI, 6.4, 7.9) for harmful use, and 8.8% (95% CI, 8.2, 9.4) for dependence. The IRR for alcoholic liver cirrhosis in the cohort relative to the general population was 11 (95% CI, 10, 12) in men and 18 (95% CI, 15, 21) in women. CONCLUSION Hospital patients with alcohol problems had a much greater risk for alcoholic liver cirrhosis compared to the general population. The risk was particularly increased for patients 40-59 years and for patients diagnosed with harmful use or dependence. (Hepatology 2017;65:929-937).
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Affiliation(s)
- Gro Askgaard
- Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - David A Leon
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Sciences, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Department of Community Medicine, UiT Arctic University of Norway, Tromsø, Norway
| | - Mette S Kjaer
- Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Deleuran
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Härkönen J, Aalto M, Suvisaari J, Lintonen T, Mäki-Opas T, Peña S, Mäkelä P. Predictors of Persistence of Risky Drinking in Adults: An 11-Year Follow-Up Study. Eur Addict Res 2017; 23:231-237. [PMID: 28982095 DOI: 10.1159/000481347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 09/06/2017] [Indexed: 01/12/2023]
Abstract
AIM To examine the long-term predictors of persistence of risky drinking in a baseline group of risky drinkers in whom alcohol use disorder had not been diagnosed. METHODS The data was derived from a representative sample of the Finnish adult population aged 30 years or more, surveyed at 2 time points in the years 2000 (n = 5,726) and 2011 (n = 3,848, 67.2% of the baseline sample). Risky drinking was defined using BSQF-measurement (for men, 21 standard UK drinks or more per week; for women 14+ drinks) and not having alcohol abuse or alcohol dependence. The sample of risky drinkers in baseline comprised 642 persons, of whom 380 (59.2%) people provided follow-up data. Multivariable logistic regression models were estimated to identify determinants of persistence of risky drinking. RESULTS The rate for persistence of risky drinking was 48.7%. Persistence was predicted by daily smoking, low physical activity, and male gender, whereas higher age and later onset of drinking predicted cessation of risky drinking. Daily smoking remained an independent predictor after adjusting for other risk factors. CONCLUSIONS Health behaviour predicts the persistence of risky drinking in a study population of adults aged 30 and over. These factors should be taken into account when assessing the long-term prognosis on risky drinking.
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Affiliation(s)
- Janne Härkönen
- The National Institute for Health and Welfare (THL), Helsinki, Finland
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Klepper S, Odenwald M, Rockstroh B. Risikowahrnehmung und Alkoholabhängigkeit. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2016. [DOI: 10.1024/0939-5911/a000457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Zielsetzung: Alkoholabhängige Personen (AP) zeigen riskanten Alkoholkonsum trotz des Wissens um dessen objektive Risiken. Um die Bedeutung des Konstrukts Risikowahrnehmung für diese Diskrepanz zu überprüfen, wurde die „accuracy“ Hypothese und der „optimistic bias“ bei Alkoholabhängigkeit untersucht. Methodik: Zur Hypothesenprüfung wurden vier Dimensionen alkoholbezogener Risikowahrnehmung bei 73 stationär behandelten AP und 75 Kontrollpersonen (KP) anhand eines neu entwickelten deutschsprachigen Fragebogens verglichen und mit Alkoholkonsum in Beziehung gesetzt. Ergebnisse: AP schätzten im Vergleich zu KP eigene Risiken als höher ein und bewerteten diese als bedrohlicher. Trotz realistischer Wahrnehmung tendierten sie zu optimistischer Unterschätzung der eigenen Risiken. Wahrgenommene Vulnerabilität und Peer Vulnerabilität klärten neben der Diagnose Varianz im Konsum (AP: vor Behandlungsbeginn) auf. Der positive Zusammenhang zwischen Konsumverhalten und affektiver Bewertung von Risiken zeigte sich nur bei AP. Schlussfolgerungen: Die „accuracy“ Hypothese wurde bestätigt und konnte die realistische Wahrnehmung der Alkoholrisiken bei AP erklären. Gleichzeitig zeigten AP einen „optimistic bias“, welcher zu fortdauernd riskantem Trinken beitragen könnte. Das Konstrukt Risikowahrnehmung bietet Hypothesen für längsschnittliche Therapiestudien an, durch die weiterer Erkenntnisgewinn zu erwarten ist.
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Ricci E, Al Beitawi S, Cipriani S, Candiani M, Chiaffarino F, Viganò P, Noli S, Parazzini F. Semen quality and alcohol intake: a systematic review and meta-analysis. Reprod Biomed Online 2016; 34:38-47. [PMID: 28029592 DOI: 10.1016/j.rbmo.2016.09.012] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 02/03/2023]
Abstract
Alcohol consumption is widespread in the Western world. Some studies have suggested a negative association between alcohol intake and semen quality although others have not confirmed this. MEDLINE and Embase were searched using 'alcohol intake' OR 'alcohol consumption' OR 'alcohol drinking' OR 'lifestyle' combined with 'semen quality' OR 'sperm quality' OR 'sperm volume' OR 'sperm concentration' OR 'sperm motility' for full-length observational articles, published in English. Reference lists of retrieved articles were searched for other pertinent studies. Main outcome measures were sperm parameters, if provided as means (standard deviation or standard error) or as medians (interquartile range). Fifteen cross-sectional studies were included, with 16,395 men enrolled. Main results showed that alcohol intake has a detrimental effect on semen volume (pooled estimate for no/low alcohol consumption 0.25 ml, 95% CI, 0.07 to 0.42) and normal morphology (1.87%, 95% CI, 0.86 to 2.88%). The difference was more marked when comparing occasional versus daily consumers, rather than never versus occasional, suggesting a moderate consumption did not adversely affect semen parameters. Hence, studies evaluating the effect of changes on semen parameters on the reproductive outcomes are needed in advance of providing recommendations regarding alcohol intake other than the advice to avoid heavy alcohol drinking.
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Affiliation(s)
- Elena Ricci
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Suha Al Beitawi
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sonia Cipriani
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Massimo Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Chiaffarino
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefania Noli
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Fabio Parazzini
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Miquel L, Gual A, Vela E, Lligoña A, Bustins M, Colom J, Rehm J. Alcohol Consumption and Inpatient Health Service Utilization in a Cohort of Patients With Alcohol Dependence After 20 Years of Follow-up. Alcohol Alcohol 2016; 52:227-233. [DOI: 10.1093/alcalc/agw075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
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Dodge T, Clarke P, Dwan R. The Relationship Between Physical Activity and Alcohol Use Among Adults in the United States. Am J Health Promot 2016; 31:97-108. [PMID: 27630108 DOI: 10.1177/0890117116664710] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To synthesize published literature that has tested the relationship between physical activity and alcohol use. DATA SOURCE A systematic review of literature published between January 2005 and May 2015 was conducted by searching the databases: PsychInfo, Medline, and Pubmed. STUDY INCLUSION AND EXCLUSION CRITERIA Inclusion criteria: must have tested for the relationship between physical activity and alcohol use; used adult samples within the United States. EXCLUSION CRITERIA utilized samples from outside the United States, adolescents, or alcohol dependent and heavy drinkers. DATA EXTRACTION Data were extracted from studies that achieved a quality score of 4 or greater. The following information was recorded for each study: sample characteristics, the variable that served as the predictor, study design, covariates included in analyses, and the direction/nature of the relationship. DATA SYNTHESIS The search captured 1036 unique articles, 16 of which were included in the final systematic review. RESULTS Nearly 88% of the studies with college students and 75% of studies with nonstudent adults reported a positive relationship between physical activity and alcohol use. CONCLUSION Research published in the past decade implies a positive relationship between physical activity and alcohol use. Findings have important implications for the design of health promotion programs targeting physical activity and alcohol use.
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Affiliation(s)
- Tonya Dodge
- 1 Department of Psychology, George Washington University, Washington, DC, USA
| | - Paige Clarke
- 1 Department of Psychology, George Washington University, Washington, DC, USA
| | - Rita Dwan
- 1 Department of Psychology, George Washington University, Washington, DC, USA
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Justice AC, McGinnis KA, Tate JP, Braithwaite RS, Bryant KJ, Cook RL, Edelman EJ, Fiellin LE, Freiberg MS, Gordon AJ, Kraemer KL, Marshall BD, Williams EC, Fiellin DA. Risk of mortality and physiologic injury evident with lower alcohol exposure among HIV infected compared with uninfected men. Drug Alcohol Depend 2016; 161:95-103. [PMID: 26861883 PMCID: PMC4792710 DOI: 10.1016/j.drugalcdep.2016.01.017] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND HIV infected (HIV+) individuals may be more susceptible to alcohol-related harm than uninfected individuals. METHODS We analyzed data on HIV+ and uninfected individuals in the Veterans Aging Cohort Study (VACS) with an Alcohol Use Disorders Identification Test-Consumption AUDIT-C score from 2008 to 2012. We used Cox proportional hazards models to examine the association between alcohol exposure and mortality through July, 2014; and linear regression models to assess the association between alcohol exposure and physiologic injury based on VACS Index Scores. Models were adjusted for age, race/ethnicity, smoking, and hepatitis C infection. RESULTS The sample included 18,145 HIV+ and 42,228 uninfected individuals. Among HIV+ individuals, 76% had undetectable HIV-1 RNA (<500 copies/ml). The threshold for an association of alcohol use with mortality and physiologic injury differed by HIV status. Among HIV+ individuals, AUDIT-C score ≥4 (hazard ratio [HR] 1.25, 95% CI 1.09-1.44) and ≥30 drinks per month (HR, 1.30, 95% CI 1.14-1.50) were associated with increased risk of mortality. Among uninfected individuals, AUDIT-C score ≥5 (HR, 1.19, 95% CI 1.07-1.32) and ≥70 drinks per month (HR 1.13, 95% CI 1.00-1.28) were associated with increased risk. Similarly, AUDIT-C threshold scores of 5-7 were associated with physiologic injury among HIV+ individuals (beta 0.47, 95% CI 0.22, 0.73) and a score of 8 or more was associated with injury in uninfected (beta 0.29, 95% CI 0.16, 0.42) individuals. CONCLUSIONS Despite antiretroviral therapy, HIV+ individuals experienced increased mortality and physiologic injury at lower levels of alcohol use compared with uninfected individuals. Alcohol consumption limits should be lower among HIV+ individuals.
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Affiliation(s)
- Amy C. Justice
- Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA,Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA,Corresponding author at: VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue, Building 35a Room 2-212 (11-ACSLG), West Haven, CT 06516, Tel.: 203.932.5711 x3541, Fax: 203.937.4926
| | - Kathleen A. McGinnis
- VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, Pennsylvania, 15240, USA
| | - Janet P. Tate
- Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA,Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA
| | - R. Scott Braithwaite
- Department of Population Health New York University School of Medicine, 227 East 30 street, New York, NY 10016, USA
| | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism, 5635 Fishers Lane, MSC 9304, Bethesda, MD 20892-9304, USA
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, PO Box 100231, Gainesville, FL, USA
| | - E. Jennifer Edelman
- Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA,Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA
| | - Lynn E. Fiellin
- Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA
| | - Matthew S. Freiberg
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA,Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, 2525 West End Avenue, Nashville, TN, USA
| | - Adam J. Gordon
- VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, Pennsylvania, 15240, USA,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Suite 600, 230 McKee Place, Pittsburgh, Pennsylvania, 15213, USA
| | - Kevin L. Kraemer
- VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, Pennsylvania, 15240, USA,Division of General Internal Medicine, University of Pittsburgh School of Medicine, Suite 600, 230 McKee Place, Pittsburgh, Pennsylvania, 15213, USA
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA, 02912
| | - Emily C. Williams
- University of Washington School of Public Health, 325 Ninth Avenue, Box 359762, Seattle, WA, USA
| | - David A. Fiellin
- Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA,Department of Internal Medicine, and the Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University 367 Cedar Street, New Haven, Connecticut, 06510, USA
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Berglund KJ, Svensson I, Berggren U, Balldin J, Fahlke C. Is There a Need for Congruent Treatment Goals Between Alcohol-Dependent Patients and Caregivers? Alcohol Clin Exp Res 2016; 40:874-9. [PMID: 26972058 DOI: 10.1111/acer.13003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol-dependent patients have different treatment goals when entering treatment. Furthermore, different treatment settings advocate different treatment goals. Earlier studies have pointed out that treatment goal is important for treatment outcome, both in the treatment setting as well as in the patients themselves. However, to our knowledge, no study has so far investigated the interaction between patient's goal and the goal of the treatment setting. The aim of the study was therefore to study the interaction between these 2 factors on treatment outcome. METHODS Patients' (n = 201) goals from 2 treatment settings-one that had an abstinence-oriented goal and one with a low-risk drinking goal-were investigated. The patients were followed up 2.5 years after treatment entry and effectiveness of congruent treatment goals on treatment outcome was investigated. RESULTS There was no significant association between congruent goals and treatment outcomes (p = 0.060). However, when comparing the effectiveness of congruent treatment goal between the 2 treatment settings, the abstinence-oriented treatment setting was significantly more effective (p < 0.01). CONCLUSIONS The major finding was that there appeared to be no association between congruence itself and treatment outcome. On the other hand, we found that the treatment outcome was more successful if the patient as well as the treatment setting had abstinence as a goal (i.e., congruent goals of abstinence).
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Affiliation(s)
| | - Ida Svensson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Berggren
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jan Balldin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Claudia Fahlke
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals. BMC Public Health 2016; 16:111. [PMID: 26888538 PMCID: PMC4758164 DOI: 10.1186/s12889-016-2766-x] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/21/2016] [Indexed: 02/05/2023] Open
Abstract
Background Internationally, studies show that similar levels of alcohol consumption in deprived communities (vs. more affluent) result in higher levels of alcohol-related ill health. Hypotheses to explain this alcohol harm paradox include deprived drinkers: suffering greater combined health challenges (e.g. smoking, obesity) which exacerbate effects of alcohol harms; exhibiting more harmful consumption patterns (e.g. bingeing); having a history of more harmful consumption; and disproportionately under-reporting consumption. We use a bespoke national survey to assess each of these hypotheses. Methods A national telephone survey designed to test this alcohol harm paradox was undertaken (May 2013 to April 2014) with English adults (n = 6015). Deprivation was assigned by area of residence. Questions examined factors including: current and historic drinking patterns; combined health challenges (smoking, diet, exercise and body mass); and under-reported consumption (enhanced questioning on atypical/special occasion drinking). For each factor, analyses examined differences between deprived and more affluent individuals controlled for total alcohol consumption. Results Independent of total consumption, deprived drinkers were more likely to smoke, be overweight and report poor diet and exercise. Consequently, deprived increased risk drinkers (male >168–400 g, female >112–280 g alcohol/week) were >10 times more likely than non-deprived counterparts to drink in a behavioural syndrome combining smoking, excess weight and poor diet/exercise. Differences by deprivation were significant but less marked in higher risk drinkers (male >400 g, female >280 g alcohol/week). Current binge drinking was associated with deprivation independently of total consumption and a history of bingeing was also associated with deprivation in lower and increased risk drinkers. Conclusions Deprived increased/higher drinkers are more likely than affluent counterparts to consume alcohol as part of a suite of health challenging behaviours including smoking, excess weight and poor diet/exercise. Together these can have multiplicative effects on risks of wholly (e.g. alcoholic liver disease) and partly (e.g. cancers) alcohol-related conditions. More binge drinking in deprived individuals will also increase risks of injury and heart disease despite total alcohol consumption not differing from affluent counterparts. Public health messages on how smoking, poor diet/exercise and bingeing escalate health risks associated with alcohol are needed, especially in deprived communities, as their absence will contribute to health inequalities.
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Abstract
BACKGROUND Hazardous alcohol use in psychiatric patients may increase the risk of the development of a substance use disorder and negatively affect the course of the psychiatric disorder. AIMS To investigate the prevalence of hazardous alcohol and drug use in a Swedish psychiatric outpatient population with particular focus on hazardous alcohol consumption and assess relationships of hazardous alcohol use to sex, age and psychiatric diagnosis. METHODS General psychiatric outpatients, n = 1,679, completed a self-rating Alcohol Use Disorders Identification Test (AUDIT). RESULTS Hazardous or harmful alcohol habits occurred among 22% of all women and 30% of all men with higher prevalence among younger patients. Nine percent of all women and 22 % of all men reported binge drinking. Binge drinking was more frequent in younger subjects. Women with a personality disorder diagnosis had a higher frequency of at risk drinking. Apart from that, psychiatric diagnosis was unrelated to rate of hazardous drinking. CONCLUSIONS Hazardous alcohol use was common in this psychiatric outpatient population. With regard to possible risks related to drinking in psychiatric patients, alcohol habits should be assessed as a part of good clinical practice.
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Affiliation(s)
- Sophia Eberhard
- Department of Clinical Science, Division of Psychiatry, University Hospital Lund , Lund , Sweden
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69
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Goulding E. Alcohol Use and Management. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Gender differences in the developmental trajectories of multiple substance use and the effect of nicotine and marijuana use on heavy drinking in a high-risk sample. Addict Behav 2015; 50:6-12. [PMID: 26093058 DOI: 10.1016/j.addbeh.2015.06.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/13/2015] [Accepted: 06/04/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Heavy drinking is highly comorbid with nicotine and marijuana use among young adults. Yet, our knowledge about the longitudinal effects of nicotine and marijuana use (including onset timing and quantity/frequency) on heavy drinking and whether the effects vary by gender is very limited. This study aims to characterize gender-specific developmental trajectories of multiple substance use and to examine gender differences in the effects of nicotine and marijuana use on heavy drinking. METHODS We conducted secondary analysis on 8 waves of data from 850 high-risk youth who were recruited as ninth graders with low GPA in an economically disadvantaged school district in the Midwest and were followed up annually to young adulthood. Onset ages and quantity/frequency of multiple substance use were assessed by a self-report questionnaire at each wave. The time-varying effect model and linear mixed model were adopted for statistical analysis. RESULTS Males' levels of heavy drinking, nicotine use, and marijuana use tended to grow persistently from adolescence to emerging adulthood. Females, on the other hand, only gradually increased their nicotine use across time while maintaining low levels of heavy drinking and marijuana use. Controlling for the early onset status of alcohol use, early onset statuses of nicotine use and marijuana use both added additional risk for heavy drinking; late onset marijuana users were also at higher risk for heavy drinking than nonusers of marijuana. Controlling for substance use onset statuses, higher quantity/frequency of nicotine and marijuana use both contributed to more involvement in heavy drinking. We also found that the effect of nicotine use quantity on heavy drinking was greater among males. CONCLUSIONS Our study demonstrates the longitudinal effects of onset timing and quantity/frequency of nicotine and marijuana use on heavy drinking. Our analysis of gender differences also identifies female youth's nicotine use and male youth's co-use of nicotine and alcohol as two important areas for future prevention and intervention work.
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Baggio S, Dupuis M, Iglesias K, Daeppen JB. Independent and combined associations of risky single-occasion drinking and drinking volume with alcohol use disorder: Evidence from a sample of young Swiss men. Drug Alcohol Depend 2015. [PMID: 26210735 DOI: 10.1016/j.drugalcdep.2015.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risky single-occasion drinking (RSOD) is a prevalent and potentially harmful alcohol use pattern associated with increased alcohol use disorder (AUD). However, RSOD is commonly associated with a higher level of alcohol intake, and most studies have not controlled for drinking volume (DV). Thus, it is unclear whether the findings provide information about RSOD or DV. This study sought to investigate the independent and combined effects of RSOD and DV on AUD. METHODS Data were collected in the longitudinal Cohort Study on Substance Use Risk Factors (C-SURF) among 5598 young Swiss male alcohol users in their early twenties. Assessment included DV, RSOD, and AUD at two time points. Generalized linear models for binomial distributions provided evidence regarding associations of DV, RSOD, and their interaction. RESULTS DV, RSOD, and their interaction were significantly related to the number of AUD criteria. The slope of the interaction was steeper for non/rare RSOD than for frequent RSOD. CONCLUSIONS RSOD appears to be a harmful pattern of drinking, associated with increased AUD and it moderated the relationship between DV and AUD. This study highlighted the importance of taking drinking patterns into account, for both research and public health planning, since RSO drinkers constitute a vulnerable subgroup for AUD.
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Affiliation(s)
- Stéphanie Baggio
- Life Course and Social Inequality Research Centre, University of Lausanne, Geopolis Building, CH-1015 Lausanne, Switzerland.
| | - Marc Dupuis
- Institute of Psychology, University of Lausanne, Geopolis Building, CH-1015 Lausanne, Switzerland.
| | - Katia Iglesias
- Centre for the Understanding of Social Processes, University of Neuchâtel, Faubourg de l'Hôpital 27, CH-2000 Neuchâtel, Switzerland.
| | - Jean-Bernard Daeppen
- Alcohol Treatment Centre, Lausanne University Hospital CHUV, Av. Beaumont 21 bis, Pavillon 2, CH-1011 Lausanne, Switzerland.
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Abstract
More than one in four American adults consume alcohol in quantities exceeding recommended limits. One in 12 have an alcohol use disorder marked by harmful consequences. Both types of alcohol misuse contribute to acute injury and chronic disease, making alcohol the third largest cause of preventable death in the United States. Alcohol misuse alters the management of common conditions from insomnia to anemia. Primary care providers should screen adult patients to identify the full spectrum of alcohol misuse. A range of effective treatments are available - from brief counselling interventions and mutual help groups to medications and behavioral therapies.
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Affiliation(s)
- Douglas Berger
- General Medicine Service, VA Puget Sound, Seattle, WA 98108, USA; Department of Medicine, University of Washington, Seattle, WA 98101, USA.
| | - Katharine A Bradley
- Department of Medicine, University of Washington, Seattle, WA 98101, USA; Department of Health Services, University of Washington, Seattle, WA 98101, USA; Group Health Research Institute, Seattle, WA, USA; VA Health Services Research & Development (HSR&D) and Center of Excellence in Substance Abuse Treatment and Education (CESATE), Seattle, WA, USA
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Lammers J, Goossens F, Conrod P, Engels R, Wiers RW, Kleinjan M. Effectiveness of a selective intervention program targeting personality risk factors for alcohol misuse among young adolescents: results of a cluster randomized controlled trial. Addiction 2015; 110:1101-9. [PMID: 25892544 DOI: 10.1111/add.12952] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/27/2014] [Accepted: 03/30/2015] [Indexed: 11/28/2022]
Abstract
AIM The effectiveness of Preventure was tested on drinking behaviour of young adolescents in secondary education in the Netherlands. DESIGN A cluster randomized controlled trial was carried out, with participants assigned randomly to a two-session coping skills intervention or a control no-intervention condition. SETTING Fifteen secondary schools throughout the Netherlands; seven schools in the intervention and eight schools in the control condition. PARTICIPANTS A total of 699 adolescents aged 13-15 years participated, 343 allocated to the intervention and 356 to the control condition, with drinking experience and elevated scores in either negative thinking, anxiety sensitivity, impulsivity or sensation-seeking. INTERVENTION AND COMPARATOR Preventure is a selective school-based alcohol prevention programme targeting personality risk factors. The comparator was a no-intervention control. MEASUREMENTS The effects of the intervention on the primary outcome past-month binge drinking, and the secondary outcomes binge drinking frequency, alcohol use, alcohol frequency and problem drinking, were examined. The primary analyses of interest were intervention main effects at 12 months post-intervention. In addition, intervention effects on the linear development of binge drinking using a latent-growth curve approach were examined. FINDINGS Binge drinking rates were not significantly different between the intervention (42.9%) and control group (49.2%) at 12 months follow-up [odds ratio (OR) = 1.05, confidence interval (CI) = 0.99, 1.11]. Intention-to-treat analyses revealed no significant intervention effects on alcohol use (53.9 versus 61.5%; OR = 0.99, CI = 0.86, 1.14) and problem drinking (37.0 versus 44.7%; OR = 1.03, CI = 0.92, 1.10) at 12 months follow-up. The post-hoc latent-growth analyses revealed significant effects on the development of binge drinking (β = -0.16, P = 0.05), and binge drinking frequency (β = -0.14, P = 0.05). CONCLUSION The alcohol prevention programme, Preventure, appears to have little or no effect on overall prevalence of binge drinking in adolescents in the Netherlands but may reduce the development of binge drinking over time.
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Affiliation(s)
- Jeroen Lammers
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Ferry Goossens
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Patricia Conrod
- Department of Psychological Medicine and Psychiatry, Section of Addiction, Kings College London, University of London, UK
| | - Rutger Engels
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Behavioural Science Institute, Radboud University, The Netherlands
| | - Reinout W Wiers
- Addiction, Development and Psychopathology (ADAPT) Laboratory, Department of Psychology, University of Amsterdam, The Netherlands
| | - Marloes Kleinjan
- Behavioural Science Institute, Radboud University, The Netherlands
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Åhlin J, Hallgren M, Öjehagen A, Källmén H, Forsell Y. Adults with mild to moderate depression exhibit more alcohol related problems compared to the general adult population: a cross sectional study. BMC Public Health 2015; 15:542. [PMID: 26051511 PMCID: PMC4459061 DOI: 10.1186/s12889-015-1837-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 05/13/2015] [Indexed: 12/12/2022] Open
Abstract
Background Alcohol use has been shown to interfere with treatment for depression, but consumption habits are not routinely screened in primary care. To date, few studies have compared the alcohol consumption habits of patients with depression to the general population. The purpose of this study was to compare alcohol habits in adults diagnosed with depression in primary care to the general adult population in Sweden. Methods Nine hundred fourty six patients diagnosed with mild to moderate depression, without a primary substance use disorder, in primary care settings located across Sweden completed the Alcohol Use Disorders Identification Test (AUDIT). Consumptions habits and alcohol related problems in the depressed sample were compared to those in the general adult population (n = 663). Analyses were stratified by gender and age. Results Ratings of alcohol problems and measures of hazardous drinking and binge drinking were significantly higher among patients seeking treatment for depression in primary care compared to the general population. Male patients scored higher on the AUDIT total and AUDIT-C (consumption) subscale than men in the general population. Compared to younger adults (aged 17–27) older depressed adults (aged 28–50 and 51–71) exhibited higher rates of consumption and problems related to alcohol. Conclusions Compared to the general adult population, consumption and problems related to alcohol use were substantially higher among patients with mild to moderate depression in primary care. Routine screening of alcohol use in primary care is recommended for patients presenting with depression.
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Affiliation(s)
- Julia Åhlin
- Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
| | - Mats Hallgren
- Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
| | - Agneta Öjehagen
- Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden.
| | - Håkan Källmén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. .,STAD, Centre for Psychiatry research, Stockholm, Sweden.
| | - Yvonne Forsell
- Department of Public Health Sciences, Section for Epidemiology and Public Health Intervention Research (EPHIR), Karolinska Institutet, Stockholm, Sweden.
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Mahmood JI, Grotmol KS, Tesli M, Vaglum P, Tyssen R. Risk Factors Measured During Medical School for Later Hazardous Drinking: A 10-year, Longitudinal, Nationwide Study (NORDOC). Alcohol Alcohol 2015; 51:71-6. [DOI: 10.1093/alcalc/agv059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/19/2015] [Indexed: 11/12/2022] Open
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Barkley-Levenson AM, Crabbe JC. Distinct ethanol drinking microstructures in two replicate lines of mice selected for drinking to intoxication. GENES, BRAIN, AND BEHAVIOR 2015; 14:398-410. [PMID: 25981501 PMCID: PMC4749147 DOI: 10.1111/gbb.12225] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/01/2015] [Accepted: 05/13/2015] [Indexed: 02/01/2023]
Abstract
The High Drinking in the Dark (HDID) mice have been selectively bred for reaching high blood ethanol concentrations (BECs) following the limited access Drinking in the Dark (DID) test. We have shown previously that mice from the first HDID replicate line (HDID-1) drink in larger, but not longer, ethanol drinking bouts than the low-drinking HS/Npt control mice when consuming modest amounts in the DID test. Here, we assessed drinking microstructure in HDID-1 mice during binge-like levels of ethanol intake using a lickometer system. Mice from both HDID replicates (HDID-1 and -2) and HS mice were also given three DID tests (single-bottle ethanol, two-bottle choice and single-bottle saccharin) using a continuously recording BioDAQ system to determine whether there are selection-dependent changes in drinking microstructure. Larger ethanol bout size in the HDID-1 mice than the HS mice was found to be due to a larger lick volume in these mice. HDID-1 and HDID-2 mice were also seen to have different drinking microstructures that both resulted in high intake and high BECs. The HDID-1 mice drank in larger ethanol bouts than HS, whereas HDID-2 mice drank in more frequent bouts. This pattern was also seen in two-bottle choice DID. The HDID-2 mice had a high bout frequency for all fluid types tested, whereas the large bout size phenotype of the HDID-1 mice was specific to alcohol. These findings suggest that selection for drinking to intoxication has resulted in two distinct drinking microstructures, both of which lead to high BECs and high ethanol intake.
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Affiliation(s)
- A M Barkley-Levenson
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
- Portland Alcohol Research Center, VA Medical Center, Portland, OR, USA
| | - J C Crabbe
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
- Portland Alcohol Research Center, VA Medical Center, Portland, OR, USA
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77
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Toll BA, Martino S, O'Malley SS, Fucito LM, McKee SA, Kahler CW, Rojewski AM, Mahoney MC, Wu R, Celestino P, Seshadri S, Koutsky J, Hyland A, Cummings KM. A randomized trial for hazardous drinking and smoking cessation for callers to a quitline. J Consult Clin Psychol 2015; 83:445-54. [PMID: 25419583 PMCID: PMC5996380 DOI: 10.1037/a0038183] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study evaluated whether tobacco quitline telephone coaches can be trained to counsel hazardous-drinking smokers to improve smoking cessation success and to limit or abstain from alcohol use. METHOD Smokers (N = 1,948) who called the New York State Smokers' Quitline and reported hazardous drinking (exceeding sex-specific weekly limits [14 drinks for men, 7 drinks for women] or meeting/exceeding daily drinking limits [5 drinks for men, 4 drinks for women] at least once in the past year) were randomized to receive either brief motivational counseling to limit or abstain from alcohol plus an alcohol reduction booklet added to standard care (Alcohol + Tobacco Counseling; ATC), or only smoking cessation counseling plus a smoking cessation booklet added to standard care (Tobacco-Only Counseling; TOC). RESULTS Acceptable coach adherence was achieved. The intention-to-treat (ITT) analysis showed that ATC was associated with a significantly higher rate of smoking abstinence at 7-month follow-up (13.5%) compared with TOC (10.3%; p = .03). The respondent analysis (ATC= 26.2%; TOC = 20.4%) paralleled the ITT findings. When controlling for treatment condition, participants who did not report any heavy drinking were significantly more likely to quit smoking than those who reported any heavy drinking (OR = 1.87, 95% CI [1.29, 2.71]; p = .001). CONCLUSIONS A brief alcohol intervention plus standard care via a telephone quitline resulted in significantly higher smoking cessation rates for hazardous-drinking callers. Given that quitline coaches were trained to provide the intervention with acceptable adherence, the potential to extend this intervention for wide-scale implementation and impact is promising.
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Affiliation(s)
| | - Steve Martino
- Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare Center
| | | | | | | | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavior and Social Sciences, Brown University School of Public Health
| | | | | | | | - Paula Celestino
- Department of Health Behavior, Roswell Park Cancer Institute
| | | | - James Koutsky
- Department of Health Behavior, Roswell Park Cancer Institute
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
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Askgaard G, Grønbæk M, Kjær MS, Tjønneland A, Tolstrup JS. Alcohol drinking pattern and risk of alcoholic liver cirrhosis: a prospective cohort study. J Hepatol 2015; 62:1061-7. [PMID: 25634330 DOI: 10.1016/j.jhep.2014.12.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/09/2014] [Accepted: 12/03/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Alcohol is the main contributing factor of alcoholic cirrhosis, but less is known about the significance of drinking pattern. METHODS We investigated the risk of alcoholic cirrhosis among 55,917 participants (aged 50-64 years) in the Danish Cancer, Diet, and Health study (1993-2011). Baseline information on alcohol intake, drinking pattern, and confounders was obtained from a questionnaire. Follow-up information came from national registers. We calculated hazard ratios (HRs) for alcoholic cirrhosis in relation to drinking frequency, lifetime alcohol amount, and beverage type. RESULTS We observed 257 and 85 incident cases of alcoholic cirrhosis among men and women, respectively, none among lifetime abstainers. In men, HR for alcoholic cirrhosis among daily drinkers was 3.65 (95% CI: 2.39; 5.55) compared to drinking 2-4 days/week. Alcohol amount in recent age periods (40-49 and 50-59 years) was associated with an increased risk, whereas the amount in 20-29 and 30-39 years was not. In men drinking 14-28 drinks/week, HR was 7.47 (95% CI: 1.68; 33.12), 3.12 (95% CI: 1.53; 6.39), and 1.69 (95% CI: 0.79; 3.65) in drinkers of little (<1% of weekly amount), some (1-15%), and mostly wine (50-100%), compared to drinking <14 drinks/week. In general, results were similar for women. CONCLUSIONS In men, daily drinking was associated with an increased risk of alcoholic cirrhosis. Recent alcohol consumption rather than earlier in life was associated with risk of alcoholic cirrhosis. Compared to beer and liquor, wine might be associated with a lower risk of alcoholic cirrhosis.
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Affiliation(s)
- Gro Askgaard
- Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen DK-2100, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen DK-1353, Denmark.
| | - Morten Grønbæk
- National Institute of Public Health, University of Southern Denmark, Copenhagen DK-1353, Denmark
| | - Mette S Kjær
- Department of Hepatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen DK-2100, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen DK-2100, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen DK-1353, Denmark
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Rehm J, Roerecke M. Patterns of drinking and liver cirrhosis - what do we know and where do we go? J Hepatol 2015; 62:1000-1. [PMID: 25646887 DOI: 10.1016/j.jhep.2015.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/24/2015] [Accepted: 01/27/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada; Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - Michael Roerecke
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada
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80
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Kim K, Kim JS. The association between alcohol consumption patterns and health-related quality of life in a nationally representative sample of South Korean adults. PLoS One 2015; 10:e0119245. [PMID: 25786249 PMCID: PMC4365041 DOI: 10.1371/journal.pone.0119245] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/19/2015] [Indexed: 11/24/2022] Open
Abstract
This study examined the relationship between alcohol consumption and health-related quality of life (HRQOL) in a nationally representative sample of middle-aged to older South Koreans. Data collected from 3,408 men and 3,361 women aged ≥ 40 years were obtained from the 2010 and 2011 Korea National Health and Nutrition Examination Survey. Based on the World Health Organization guidelines, the participants were categorized into zones I (0–7), II (8–15), III (16–19), or IV (20–40) according to their Alcohol Use Disorders Identification Test (AUDIT) scores, with a higher zone indicating a higher level of alcohol consumption. Data collected from the AUDIT and EuroQol 5-Dimension (EQ-5D) test were subjected to multiple regression analysis in order to examine the relationship between alcohol consumption patterns and health-related quality of life, and to identify intersex and interzone differences. Significant intersex differences were found for the mean total AUDIT and EQ-5D scores and the proportion of participants rating their pain/discomfort and impairment in mobility and usual activities as “moderate” or “severe” (p < 0.001). The analysis of the EQ-5D scores by alcohol consumption pattern and sex suggested the existence of an inverted U-shaped relationship between the total AUDIT and EQ-5D scores. The HRQOL of moderate alcohol drinkers was higher than that of non-drinkers and heavy drinkers. The results of this study will be valuable in designing appropriate interventions to increase the HRQOL impaired by the harmful use of alcohol, in comparing HRQOL among different countries, and in implementing alcohol-related health projects.
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Affiliation(s)
- KyungHee Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Ji-Su Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
- * E-mail:
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81
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Saalfield J, Spear L. Consequences of repeated ethanol exposure during early or late adolescence on conditioned taste aversions in rats. Dev Cogn Neurosci 2015; 16:174-182. [PMID: 25698309 PMCID: PMC4512940 DOI: 10.1016/j.dcn.2015.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/05/2015] [Accepted: 01/17/2015] [Indexed: 12/24/2022] Open
Abstract
Adolescent Intermittent Ethanol (AIE) resulted in attenuated CTA in adulthood. AIE in late adolescence resulted in greater CTA attenuation 2 days post-exposure. All AIE animals were equally insensitive when tested 3 weeks post-exposure. No metabolic tolerance was noted following AIE. AIE results in a decreased sensitivity to aversive effects of ethanol in adulthood.
Alcohol use is prevalent during adolescence, yet little is known about possible long-lasting consequences. Recent evidence suggests that adolescents are less sensitive than adults to ethanol's aversive effects, an insensitivity that may be retained into adulthood after repeated adolescent ethanol exposure. This study assessed whether intermittent ethanol exposure during early or late adolescence (early-AIE or late-AIE, respectively) would affect ethanol conditioned taste aversions 2 days (CTA1) and >3 weeks (CTA2) post-exposure using supersaccharin and saline as conditioning stimuli (CS), respectively. Pair-housed male Sprague-Dawley rats received 4 g/kg i.g. ethanol (25%) or water every 48 h from postnatal day (P) 25–45 (early AIE) or P45-65 (late AIE), or were left non-manipulated (NM). During conditioning, 30 min home cage access to the CS was followed by 0, 1, 1.5, 2 or 2.5 g/kg ethanol i.p., with testing 2 days later. Attenuated CTA relative to controls was seen among early and late AIE animals at both CTA1 and CTA2, an effect particularly pronounced at CTA1 after late AIE. Thus, adolescent exposure to ethanol was found to induce an insensitivity to ethanol CTA seen soon after exposure and lasting into adulthood, and evident with ethanol exposures not only early but also later in adolescence.
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Affiliation(s)
- Jessica Saalfield
- Binghamton University, Psychology Department, P.O. Box 6000, Binghamton, NY 13902, United States.
| | - Linda Spear
- Binghamton University, Psychology Department, P.O. Box 6000, Binghamton, NY 13902, United States
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Chavez LJ, Ornelas IJ, Lyles CR, Williams EC. Racial/ethnic workplace discrimination: association with tobacco and alcohol use. Am J Prev Med 2015; 48:42-9. [PMID: 25441232 PMCID: PMC4274219 DOI: 10.1016/j.amepre.2014.08.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/22/2014] [Accepted: 08/12/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Experiences of discrimination are associated with tobacco and alcohol use, and work is a common setting where individuals experience racial/ethnic discrimination. Few studies have evaluated the association between workplace discrimination and these behaviors, and none have described associations across race/ethnicity. PURPOSE To examine the association between workplace discrimination and tobacco and alcohol use in a large, multistate sample of U.S. adult respondents to the Behavioral Risk Factor Surveillance System survey Reactions to Race Module (2004-2010). METHODS Multivariable logistic regression analyses evaluated cross-sectional associations between self-reported workplace discrimination and tobacco (current and daily smoking) and alcohol use (any and heavy use, and binge drinking) among all participants and stratified by race/ethnicity, adjusting for relevant covariates. Data were analyzed in 2013. RESULTS Among respondents, 70,080 completed the workplace discrimination measure. Discrimination was more common among black non-Hispanic (21%), Hispanic (12%), and other race respondents (11%) than white non-Hispanics (4%) (p<0.001). In the total sample, discrimination was associated with current smoking (risk ratio [RR]=1.32, 95% CI=1.19, 1.47), daily smoking (RR=1.41, 95% CI=1.24, 1.61), and heavy drinking (RR=1.11, 95% CI=1.01, 1.22), but not binge or any drinking. Among Hispanics, workplace discrimination was associated with increased heavy and binge drinking, but not any alcohol use or smoking. Workplace discrimination among black non-Hispanics and white Non-Hispanics was associated with increased current and daily smoking, but not alcohol outcomes. CONCLUSIONS Workplace discrimination is common, associated with smoking and alcohol use, and merits further policy attention, given the impact of these behaviors on morbidity and mortality.
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Affiliation(s)
- Laura J Chavez
- Department of Health Services, School of Public Health, University of Washington; Veterans Affairs (VA) Puget Sound Health Services Research & Development, VA Health Care Systems, Seattle, Washington.
| | - India J Ornelas
- Department of Health Services, School of Public Health, University of Washington
| | - Courtney R Lyles
- Division of General Internal Medicine, San Francisco General Hospital; Center for Vulnerable Populations, San Francisco, California
| | - Emily C Williams
- Department of Health Services, School of Public Health, University of Washington; Veterans Affairs (VA) Puget Sound Health Services Research & Development, VA Health Care Systems, Seattle, Washington
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83
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Fiala J, Sochor O. Methodology for Measurement of Alcohol Consumption in Epidemiological Studies of Risk Factors of Non-Communicable Diseases and the Kardiovize 2030 Project. ACTA ACUST UNITED AC 2014. [DOI: 10.21101/hygiena.a1288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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84
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Falk DE, Litten RZ, Anton RF, Kranzler HR, Johnson BA. Cumulative proportion of responders analysis (CPRA) as a tool to assess treatment outcome in alcohol clinical trials. J Stud Alcohol Drugs 2014; 75:335-46. [PMID: 24650828 DOI: 10.15288/jsad.2014.75.335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Several definitions of treatment response have been proposed for alcohol clinical trials (e.g., abstinence and no heavy drinking). However, each of these outcomes allows only one definition of successful response. In contrast, the cumulative proportion of responders analysis (CPRA) includes all of the possible drinking response cutoff points, providing a more complete picture of the therapeutic effects of a treatment. CPRA has been used to examine the efficacy of analgesics but not alcohol pharmacotherapy. To demonstrate its potential utility, we conducted CPRA in two large alcohol treatment trials: the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) trial (naltrexone) and a multisite topiramate trial. CPRA was used to demonstrate the efficacy of naltrexone and topiramate on continuous measures of in-treatment drinking-heavy drinking days and drinks per day-and their reductions from pretreatment. METHOD All possible cutoff points were portrayed for each measure. We provide graphs to illustrate the effects of the active medications compared with placebo and examined them statistically over a number of salient drinking outcomes to evaluate their efficacy. RESULTS Treatment group responder curves were not parallel across the entire range of cutoff points; rather, they separated only at lower levels of drinking. In general, effect sizes increased by 0.10-0.15 when going from the lowest drinking level cutoff (i.e., abstinence and no heavy drinking) to the cutoff associated with the maximal treatment effect. CONCLUSIONS CPRA may be useful in designing subsequent trials and helping to illustrate for treatment providers the likelihood of treatment success given various definitions of a positive response.
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Affiliation(s)
- Daniel E Falk
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Raye Z Litten
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania and Veterans Integrated Service Network 4, Mental Illness Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Bankole A Johnson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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Jensen TK, Gottschau M, Madsen JOB, Andersson AM, Lassen TH, Skakkebæk NE, Swan SH, Priskorn L, Juul A, Jørgensen N. Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men. BMJ Open 2014; 4:e005462. [PMID: 25277121 PMCID: PMC4185337 DOI: 10.1136/bmjopen-2014-005462] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Study associations between three measures of alcohol consumption (recent, typical/habitual, binging), semen quality and serum reproductive hormones. DESIGN Cross-sectional population based study. SETTING AND PARTICIPANTS 1221 young Danish men, aged 18-28 years were recruited when they attended a compulsory medical examination to determine their fitness for military service from 2008 to 2012. Total alcohol consumption: (1) in the week preceding (habitual/typical) the visit (recent alcohol intake), (2) in a typical week and (3) frequency of 'binge drinking' (consuming more than 5 units/day)) in the past 30 days was estimated. MAIN OUTCOME MEASURES Semen quality (volume, sperm concentration, total sperm count, and percentages of motile and morphologically normal spermatozoa) and serum concentration of reproductive hormones (follicle-stimulating hormone, luteinising hormone, testosterone, sex hormone binding globulin, oestradiol, free testosterone and inhibin B). RESULTS Sperm concentration, total sperm count and percentage of spermatozoa with normal morphology were negatively associated with increasing habitual alcohol intake. This association was observed in men reporting at least 5 units in a typical week but was most pronounced for men with a typical intake of more than 25 units/week. Men with a typical weekly intake above 40 units had a 33% (95% CI 11% to 59%) reduction in sperm concentration compared to men with an intake of 1-5 units/week. A significant increase in serum free testosterone with increasing alcohol consumption the week preceding the visit was found. Binging was not independently associated with semen quality. CONCLUSIONS Our study suggests that even modest habitual alcohol consumption of more than 5 units per week had adverse effects on semen quality although most pronounced associations were seen in men who consumed more than 25 units per week. Alcohol consumption was also linked to changes in testosterone and SHBG levels. Young men should be advised to avoid habitual alcohol intake.
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Affiliation(s)
- Tina Kold Jensen
- Department of Environmental Medicine, University of Southern Denmark, Copenhagen, Denmark
- The Faculty of Medical and Health Sciences, University Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mads Gottschau
- Department of Environmental Medicine, University of Southern Denmark, Copenhagen, Denmark
| | - Jens Otto Broby Madsen
- Department of Environmental Medicine, University of Southern Denmark, Copenhagen, Denmark
| | - Anne-Maria Andersson
- The Faculty of Medical and Health Sciences, University Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Tina Harmer Lassen
- The Faculty of Medical and Health Sciences, University Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels E Skakkebæk
- The Faculty of Medical and Health Sciences, University Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Shanna H Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lærke Priskorn
- Department of Environmental Medicine, University of Southern Denmark, Copenhagen, Denmark
| | - Anders Juul
- The Faculty of Medical and Health Sciences, University Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niels Jørgensen
- The Faculty of Medical and Health Sciences, University Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Alcohol drinking patterns and differences in alcohol-related harm: a population-based study of the United States. BIOMED RESEARCH INTERNATIONAL 2014; 2014:853410. [PMID: 25057502 PMCID: PMC4095708 DOI: 10.1155/2014/853410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/22/2014] [Accepted: 05/14/2014] [Indexed: 11/29/2022]
Abstract
Alcohol use and associated alcohol-related harm (ARH) are a prevalent and important public health problem, with alcohol representing about 4% of the global burden of disease. A discussion of ARH secondary to alcohol consumption necessitates a consideration of the amount of alcohol consumed and the drinking pattern. This study examined the association between alcohol drinking patterns and self-reported ARH. Pearson chi-square test (χ2) and logistic regression analyses were used on data from the National Comorbidity Survey Replication (NCS-R). The NCS-R is a cross-sectional nationally representative sample. Data was obtained by face-to-face interviews from 9282 adults aged ≥18 years in the full sample, and 5,692 respondents in a subsample of the full sample. Results presented as odds ratio (OR) and 95% confidence intervals (95% CI). Alcohol drinking patterns (frequency of drinking, and drinks per occasion) were associated with increased risks of self-reported ARH; binge or “risky” drinking was strongly predictive of ARH than other categories of drinks per occasion or frequency of drinking; and men had significantly higher likelihood of ARH in relation to frequency of drinking and drinks per occasion. Findings provide evidence for public health practitioners to target alcohol prevention strategies at the entire population of drinkers.
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Thompson K, Stockwell T, Leadbeater B, Homel J. Association among different measures of alcohol use across adolescence and emerging adulthood. Addiction 2014; 109:894-903. [PMID: 24467265 PMCID: PMC4905750 DOI: 10.1111/add.12499] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/18/2013] [Accepted: 01/16/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS The use of alterative alcohol indices in developmental research may generate conflicting findings in the literature. This study examined the longitudinal associations among four indices of alcohol involvement from ages 15 to 25 years and examined their concurrent associations with alcohol-related problems in emerging adulthood. DESIGN Data are from the Victoria Healthy Youth Survey, a five-wave multi-cohort study conducted biennially in Victoria, Canada between 2003 and 2011. SETTING AND PARTICIPANTS This study included a subsample of 637 randomly recruited Canadian adolescents, aged 15-25 years. MEASUREMENTS Four indices of alcohol use were compared using multivariate piecewise growth modeling: frequency, usual quantity, heavy episodic drinking and volume. FINDINGS All indices increased on average from ages 15 to 21, peaked at approximately age 21, and gradually declined from ages 21 to 25. Levels of use at age 21 were highly correlated across indices (r = 0.63-0.94, P < 0.001), but correlations among rates of change varied between pairs of indices. Heavy episodic drinking and volume had the strongest correlations over time (r = 0.64-0.81, P < 0.001) and accounted for the greatest variance in alcohol use disorder symptoms (R(2) = 0.35) and social and health consequences (R(2) = 16) in emerging adulthood. Frequency and quantity had the weakest associations during adolescence (r = 0.49, P = 0.001) and were uncorrelated during emerging adulthood (r = 0.23, P = 0.09). CONCLUSIONS Among Canadian youth aged 15-25 years, measures of heavy episodic drinking and volume are the most strongly correlated over time and account for greater variance in alcohol-related problems in emerging adulthood than either frequency or quantity alone.
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Affiliation(s)
- Kara Thompson
- Centre for Addiction Research of British Columbia, Department of Psychology, University of Victoria, Victoria, BC, Canada
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Spear LP, Swartzwelder HS. Adolescent alcohol exposure and persistence of adolescent-typical phenotypes into adulthood: a mini-review. Neurosci Biobehav Rev 2014; 45:1-8. [PMID: 24813805 DOI: 10.1016/j.neubiorev.2014.04.012] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/28/2014] [Accepted: 04/30/2014] [Indexed: 12/17/2022]
Abstract
Alcohol use is typically initiated during adolescence, which, along with young adulthood, is a vulnerable period for the onset of high-risk drinking and alcohol abuse. Given across-species commonalities in certain fundamental neurobehavioral characteristics of adolescence, studies in laboratory animals such as the rat have proved useful to assess persisting consequences of repeated alcohol exposure. Despite limited research to date, reports of long-lasting effects of adolescent ethanol exposure are emerging, along with certain common themes. One repeated finding is that adolescent exposure to ethanol sometimes results in the persistence of adolescent-typical phenotypes into adulthood. Instances of adolescent-like persistence have been seen in terms of baseline behavioral, cognitive, electrophysiological and neuroanatomical characteristics, along with the retention of adolescent-typical sensitivities to acute ethanol challenge. These effects are generally not observed after comparable ethanol exposure in adulthood. Persistence of adolescent-typical phenotypes is not always evident, and may be related to regionally specific ethanol influences on the interplay between CNS excitation and inhibition critical for the timing of neuroplasticity.
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Affiliation(s)
- Linda Patia Spear
- Developmental Exposure Alcohol Research Center (DEARC), Department of Psychology, Binghamton University, Binghamton, NY 13902-6000, United States.
| | - H Scott Swartzwelder
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Neurobiology Research Laboratory, VA Medical Center, Durham, NC 27705, United States
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Kranzler HR, Covault J, Feinn R, Armeli S, Tennen H, Arias AJ, Gelernter J, Pond T, Oncken C, Kampman KM. Topiramate treatment for heavy drinkers: moderation by a GRIK1 polymorphism. Am J Psychiatry 2014; 171:445-52. [PMID: 24525690 PMCID: PMC3997125 DOI: 10.1176/appi.ajp.2013.13081014] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Topiramate has been shown to reduce drinking and heavy drinking in individuals with alcohol dependence whose goal was to stop drinking. The authors evaluated the efficacy and tolerability of topiramate in heavy drinkers whose treatment goal was to reduce drinking to safe levels. METHOD A total of 138 individuals (62.3% men) were randomly assigned to receive 12 weeks of treatment with topiramate (N=67), at a maximal daily dose of 200 mg, or matching placebo (N=71). Both groups received brief counseling to reduce drinking and increase abstinent days. It was hypothesized that topiramate-treated patients would be better able to achieve these goals, and it was predicted that based on prior research, the effects would be moderated by a single nucleotide polymorphism (rs2832407) in GRIK1, encoding the kainate GluK1 receptor subunit. RESULTS The rate of treatment completion was 84.9% and equal by treatment group. Topiramate treatment significantly reduced heavy drinking days and increased abstinent days relative to placebo. Patients receiving topiramate also had lower concentrations of the liver enzyme γ-glutamyl transpeptidase and lower scores on a measure of alcohol-related problems than the placebo group. In a European American subsample (N=122), topiramate's effect on heavy drinking days was significantly greater than that for placebo only in rs2832407 C-allele homozygotes. CONCLUSIONS These findings support the use of topiramate at a daily dose of 200 mg to reduce heavy drinking in problem drinkers. The moderator effect of rs2832407, if validated, would facilitate the identification of heavy drinkers who are likely to respond well to topiramate treatment and provide an important personalized treatment option. The pharmacogenetic findings also implicate the kainate receptor in the mechanism of topiramate's effects on heavy drinking.
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Affiliation(s)
- Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and VISN4 MIRECC, Philadelphia VAMC, Philadelphia, PA 19104
| | - Jonathan Covault
- Alcohol Research Center, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030
| | - Richard Feinn
- Frank Netter School of Medicine, Quinnipiac University, Hamden, CT 06518
| | - Stephen Armeli
- Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ 07666
| | - Howard Tennen
- Alcohol Research Center, Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030
- Department of Community Medicine and Healthcare, University of Connecticut School of Medicine, Farmington, CT 06030
| | - Albert J. Arias
- Department of Psychiatry, Yale University School of Medicine, New Haven CT and VA Connecticut, West Haven, CT 06516
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, New Haven CT and VA Connecticut, West Haven, CT 06516
| | - Timothy Pond
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and VISN4 MIRECC, Philadelphia VAMC, Philadelphia, PA 19104
| | - Cheryl Oncken
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT 06030
| | - Kyle M. Kampman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and VISN4 MIRECC, Philadelphia VAMC, Philadelphia, PA 19104
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Roerecke M, Rehm J. Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis. Int J Epidemiol 2014; 43:906-19. [DOI: 10.1093/ije/dyu018] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Shield KD, Rehm J, Rehm MX, Gmel G, Drummond C. The potential impact of increased treatment rates for alcohol dependence in the United Kingdom in 2004. BMC Health Serv Res 2014; 14:53. [PMID: 24499391 PMCID: PMC3923387 DOI: 10.1186/1472-6963-14-53] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 01/07/2014] [Indexed: 12/27/2022] Open
Abstract
Background Alcohol consumption has been linked to a considerable burden of disease in the United Kingdom (UK), with most of this burden due to heavy drinking and Alcohol Dependence (AD). However, AD is undertreated in the UK, with only 8% of those individuals with AD being treated in England and only 6% of those individuals with AD being treated in Scotland. Thus, the objective of this paper is to quantify the deaths that would have been avoided in the UK in 2004 if the treatment rate for AD had been increased. Methods Data on the prevalence of AD, alcohol consumption, and mortality were obtained from the Adult Psychiatric Morbidity Survey, the Global Information System on Alcohol and Health, and the 2004 Global Burden of Disease study respectively. Data on the effectiveness of pharmacological treatment and Motivational Interviewing/Cognitive Behavioural Therapy were obtained from Cochrane reviews and meta-analyses. Simulations were used to model the number of deaths under different treatment scenarios. Sensitivity analyses were performed to model the effects of Brief Interventions and to examine the effect of using AD prevalence data obtained from the National Institute for Health and Clinical Excellence. Results In the UK, 320 female and 1,385 male deaths would have been avoided if treatment coverage of pharmacological treatment had been increased to 20%. This decrease in the number of deaths represents 7.9% of all alcohol-attributable deaths (7.0% of all alcohol-attributable deaths for women and 8.1% of all alcohol-attributable deaths for men). If we used lower AD prevalence rates obtained from the National Institute for Health and Clinical Excellence, then treatment coverage of pharmacological treatment in hospitals for 20% of the population with AD would have resulted in the avoidance of 529 deaths in 2004 (99 deaths avoided for women and 430 deaths avoided for men). Conclusions Increasing AD treatment in the UK would have led to a large number of deaths being avoided in 2004. Increased AD treatment rates not only impact mortality but also impact upon the large burden of disability and morbidity attributable to AD, as well as the associated social and economic burdens.
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Affiliation(s)
- Kevin D Shield
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada.
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Delaney KE, Lee AK, Lapham GT, Rubinsky AD, Chavez LJ, Bradley KA. Inconsistencies between alcohol screening results based on AUDIT-C scores and reported drinking on the AUDIT-C questions: prevalence in two US national samples. Addict Sci Clin Pract 2014; 9:2. [PMID: 24468406 PMCID: PMC3946205 DOI: 10.1186/1940-0640-9-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/23/2013] [Indexed: 12/02/2022] Open
Abstract
Background The AUDIT-C is an extensively validated screen for unhealthy alcohol use (i.e. drinking above recommended limits or alcohol use disorder), which consists of three questions about alcohol consumption. AUDIT-C scores ≥4 points for men and ≥3 for women are considered positive screens based on US validation studies that compared the AUDIT-C to “gold standard” measures of unhealthy alcohol use from independent, detailed interviews. However, results of screening—positive or negative based on AUDIT-C scores—can be inconsistent with reported drinking on the AUDIT-C questions. For example, individuals can screen positive based on the AUDIT-C score while reporting drinking below US recommended limits on the same AUDIT-C. Alternatively, they can screen negative based on the AUDIT-C score while reporting drinking above US recommended limits. Such inconsistencies could complicate interpretation of screening results, but it is unclear how often they occur in practice. Methods This study used AUDIT-C data from respondents who reported past-year drinking on one of two national US surveys: a general population survey (N = 26,610) and a Veterans Health Administration (VA) outpatient survey (N = 467,416). Gender-stratified analyses estimated the prevalence of AUDIT-C screen results—positive or negative screens based on the AUDIT-C score—that were inconsistent with reported drinking (above or below US recommended limits) on the same AUDIT-C. Results Among men who reported drinking, 13.8% and 21.1% of US general population and VA samples, respectively, had screening results based on AUDIT-C scores (positive or negative) that were inconsistent with reported drinking on the AUDIT-C questions (above or below US recommended limits). Among women who reported drinking, 18.3% and 20.7% of US general population and VA samples, respectively, had screening results that were inconsistent with reported drinking. Limitations This study did not include an independent interview gold standard for unhealthy alcohol use and therefore cannot address how often observed inconsistencies represent false positive or negative screens. Conclusions Up to 21% of people who drink alcohol had alcohol screening results based on the AUDIT-C score that were inconsistent with reported drinking on the same AUDIT-C. This needs to be addressed when training clinicians to use the AUDIT-C.
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Affiliation(s)
| | | | | | | | | | - Katharine A Bradley
- VA HSR&D Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle WA, USA.
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Kisic-Tepavcevic D, Gazibara T, Popovic A, Trajkovic G, Pekmezovic T. The impact of alcohol on health-related quality of life in Belgrade University students. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 39:130-5. [PMID: 23421572 DOI: 10.3109/00952990.2012.746348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to assess alcohol drinking patterns and its influence on health-related quality of life (HRQoL) among the Belgrade University students. METHODS Between April and June, 2009, 1624 students were enrolled in the cross-sectional study. All participants in the study completed the questionnaire that comprised demographic data, as well as information referring to education, social status, lifetime residence, and habits. HRQoL was assessed by using SF-36 questionnaire and general depressive status by Beck Depression Inventory (BDI). RESULTS The occurrence of getting drunk on a yearly level had a statistically significant correlation with both SF-36 composite scores (ρ = -.048, p = .049 for Physical Composite Score (PCS), ρ = -.053, p = .038 for Mental Composite Score (MCS)) and the total score (ρ= -.057, p = .025). Those who were never getting drunk had statistically significantly higher scores for Social functioning and Mental health SF-36 as well as for MCS compared to students who were getting drunk on monthly and weekly basis. After adjustment for multiple testing, Social functioning domain and MCS remained statistically significant. The final models of hierarchical regression analysis demonstrated that gender, place of residence during high schooling, type of faculty, depression, chronic conditions, and alcohol consumption accounted 15.2% of the variance in PCS and 17.7% of the variance in MCS. CONCLUSION Information regarding drinking patterns and its influence on HRQoL in the Belgrade University students can help public health professionals, university administration, and local health care providers in developing appropriate prevention and treatment strategies.
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Rehm J, Rehm M, Shield KD, Gmel G, Frick U, Mann K. Reduzierung alkoholbedingter Mortalität durch Behandlung der Alkoholabhängigkeit. SUCHT-ZEITSCHRIFT FUR WISSENSCHAFT UND PRAXIS 2014. [DOI: 10.1024/0939-5911.a000299] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fragestellung: Ziel dieser Studie ist es, die von riskantem Trinken und von Alkoholabhängigkeit in Deutschland verursachte Krankheitslast zu quantifizieren. Weiterhin sollen die erwartbaren Auswirkungen eines verbesserten Zugangs von Alkoholabhängigen zu effektiven Therapien auf die alkoholbedingte Sterblichkeit abgeschätzt werden. Methodik: Die Krankheitslast wurde anhand von „Attributable Fractions“ berechnet, die den durch die jeweilige Exposition bedingten Anteil an den Todesfällen einer umfassenden Liste von durch Alkohol verursachten Krankheiten beziffern. Mögliche Auswirkungen eines verbesserten Zugangs zu Behandlungen wurden berechnet durch modellgemäße Veränderungen in der Zusammensetzung der trinkenden Bevölkerung. Alle Modelle legten das Jahr 2004 und die Bevölkerung zwischen 15 und 64 Jahren zugrunde, d. h. ausschließlich vorzeitige Todesfälle wurden berücksichtigt. Ergebnisse: Riskantes Trinken ist bei Frauen für rund 58 % und bei Männern für rund 71 % aller vorzeitigen alkoholbedingten Todesfälle ursächlich. Die entsprechenden Anteile der mit riskantem Trinken stark überlappenden Kategorie der Alkoholabhängigkeit liegen bei 40 % (Frauen) und 68 % (Männer). Eine Erhöhung der gegenwärtigen Behandlungsquote auf 40 % aller Alkoholabhängigen zeitigte eine Verringerung um bis zu 13,1 % bei den männlichen und 10,7 % bei den weiblichen alkoholbedingten Todesfällen innerhalb eines Jahres, eine Erhöhung auf 20 % war mit einer Verringerung um bis zu 6.5 % bei den männlichen und 5.3 % bei den weiblichen alkoholbedingten Todesfällen verbunden. Schlussfolgerungen: Durch einen verbesserten Zugang besonders der abhängig Erkrankten zu effektiven therapeutischen Interventionen könnte ein bedeutsamer Teil der alkoholbedingten Krankheitslast vermindert werden.
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Affiliation(s)
- Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Deutschland
- Centre for Addiction and Mental Health (CAMH), Toronto, Kanada
- Institute of Medical Science, University of Toronto, Kanada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Kanada
- Department of Psychiatry, University of Toronto, Kanada
| | - Maximilien Rehm
- Faculty of Arts and Sciences/Politics and Governance, Ryerson University, Toronto, Kanada
| | - Kevin D. Shield
- Centre for Addiction and Mental Health (CAMH), Toronto, Kanada
- Institute of Medical Science, University of Toronto, Kanada
| | - Gerrit Gmel
- Centre for Addiction and Mental Health (CAMH), Toronto, Kanada
| | - Ulrich Frick
- Klinik & Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg, Deutschland
- Fachhochschule Kärnten, Bereich Gesundheit & Soziales, Österreich
| | - Karl Mann
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
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Perspectives on the neuroscience of alcohol from the National Institute on Alcohol Abuse and Alcoholism. HANDBOOK OF CLINICAL NEUROLOGY 2014; 125:15-29. [PMID: 25307566 DOI: 10.1016/b978-0-444-62619-6.00002-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mounting evidence over the last 40 years clearly indicates that alcoholism (alcohol dependence) is a disorder of the brain. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has taken significant steps to advance research into the neuroscience of alcohol. The Division of Neuroscience and Behavior (DNB) was formed within NIAAA in 2002 to oversee, fund, and direct all research areas that examine the effects of alcohol on the brain, the genetic underpinnings of alcohol dependence, the neuroadaptations resulting from excessive alcohol consumption, advanced behavioral models of the various stages of the addiction cycle, and preclinical medications development. This research portfolio has produced important discoveries in the etiology, treatment, and prevention of alcohol abuse and dependence. Several of these salient discoveries are highlighted and future areas of neuroscience research on alcohol are presented.
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Beier M, D'Orio V, Spat J, Shuman M, Foley FW. Alcohol and substance use in multiple sclerosis. J Neurol Sci 2013; 338:122-7. [PMID: 24411661 DOI: 10.1016/j.jns.2013.12.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 12/03/2013] [Accepted: 12/17/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Few studies have examined the prevalence of alcohol and drug use in individuals with multiple sclerosis (MS). The current study sought to examine the prevalence and associated demographic, disease-related, and psychological correlates of substance use in an East Coast United States outpatient MS sample. METHODS 157 individuals with MS completed questionnaires prior to, during or after their visit with an MS neurologist. These questionnaires included: the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), CAGE, CAGE-Adapted to Include Drugs (CAGE-AID), Patient Health Questionnaire-9 item (PHQ-9), Beck Depression Inventory-Second Edition (BDI-II) and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). RESULTS On the AUDIT-C, 40% of individuals with MS met or exceeded the cutoff for excessive alcohol use. They were more highly educated and younger than non-drinkers. Utilizing the CAGE, 6% of the sample met criteria for a lifetime history of excessive alcohol use and men endorsed higher rates of alcohol use than women. Only a small portion of the sample endorsed a history of drug use (CAGE-AID, 4%). Drug use was associated with greater disability and depression symptoms, but lower self-reported anxiety. CONCLUSIONS Current alcohol use was prevalent in this sample, and excessive use was associated with men, younger age, and more education. Reported drug use was minimal and associated with greater disability, more self-reported depression, but fewer anxiety symptoms.
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Affiliation(s)
- Meghan Beier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Box 359612, 325 9th Ave., Seattle, WA 98104, United States.
| | - Vanessa D'Orio
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10468, United States; Multiple Sclerosis Center of Holy Name Medical Center, 718 Teaneck Rd., Teaneck, NJ 07666, United States
| | - Jessica Spat
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10468, United States; Multiple Sclerosis Center of Holy Name Medical Center, 718 Teaneck Rd., Teaneck, NJ 07666, United States
| | - Melissa Shuman
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10468, United States; Multiple Sclerosis Center of Holy Name Medical Center, 718 Teaneck Rd., Teaneck, NJ 07666, United States
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University, 1300 Morris Park Ave., Bronx, NY 10468, United States; Multiple Sclerosis Center of Holy Name Medical Center, 718 Teaneck Rd., Teaneck, NJ 07666, United States
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Rossow I, Bogstrand ST, Ekeberg Ø, Normann PT. Associations between heavy episodic drinking and alcohol related injuries: a case control study. BMC Public Health 2013; 13:1076. [PMID: 24228707 PMCID: PMC4225769 DOI: 10.1186/1471-2458-13-1076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries. METHODS We applied a case - control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately. RESULTS An increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox. CONCLUSION There is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group.
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Affiliation(s)
- Ingeborg Rossow
- Norwegian Institute for Alcohol and Drug Research, POB 565 Sentrum, Oslo N-0105, Norway.
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Abstract
In 1994, the US Food and Drug Administration approved the μ-opioid receptor antagonist naltrexone to treat alcohol dependence. However, treatments requiring daily administration, such as naltrexone, are inconsistently adhered to in substance abusing populations, and constant medication exposure can increase risk of adverse outcomes, e.g., hepatotoxicity. This has fostered a 'targeted' or 'as needed' approach to opioid receptor antagonist treatment, in which medications are used only in anticipation of or during high-risk situations, including times of intense cravings. Initial studies of the ability of targeted naltrexone to reduce drinking-related outcomes were conducted in problem drinkers and have been extended into larger, multi-site, placebo-controlled investigations with positive results. Another μ-opioid receptor antagonist, nalmefene, has been studied on an 'as-needed' basis to reduce heavy drinking in alcohol-dependent individuals. These studies include three large multi-site trials in Europe of up to 1 year in duration, and serve as the basis for the recent approval of nalmefene by the European Medicines Agency as an 'as-needed' adjunctive treatment for alcohol dependence. We review potential moderators of opioid receptor antagonist treatment response including subjective assessments, objective clinical measures and genetic variants. In sum, the targeted or 'as-needed' approach to treatment with opioid antagonists is an efficacious harm-reduction strategy for problem drinking and alcohol dependence.
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Jiang H, Livingston M, Room R, Dietze P, Norström T, Kerr WC. Alcohol consumption and liver disease in Australia: a time series analysis of the period 1935-2006. Alcohol Alcohol 2013; 49:363-8. [PMID: 24052533 DOI: 10.1093/alcalc/agt143] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS The aim of the study was to examine for Australia whether the link between population alcohol consumption and liver disease mortality varies over time, using 71 years of data. METHODS Overall and gender-specific rates of liver disease mortality were analysed in relation to total alcohol consumption as well as for different beverage types by using autoregressive integrated moving average (ARIMA) time series methods. Separate models were developed for the entire time period and for two sub-periods (1935-1975, 1976-2006). RESULTS A 1-l increase in adult per capita consumption of pure alcohol led to a rise of ∼10% in overall liver disease mortality rates and a 11 and 9% increase in female and male liver disease mortality, respectively. The strength of the relationship between per capita consumption and liver disease mortality diminished over time. Spirits consumption was found to be the main driving factor in liver mortality rates between 1935 and 1975, while beer consumption was found to be the most significant predictor in liver diseases in the last three decades. In a comparative perspective, the effect of per capita alcohol consumption on liver disease in Australia is similar to the USA, Southern and Eastern Europe countries, but weaker than in Canada and western European countries. CONCLUSION An increase in per capita alcohol consumption in Australia is likely to lead to an increase in liver disease. Changes in the most important beverage over the study period suggest substantial shifts in drinking patterns and preferences among the heaviest Australian drinkers.
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Affiliation(s)
- Heng Jiang
- Corresponding author: Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, 54 Gertrude Street, Fitzroy, VIC 3065, Australia.
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Rehm J, Marmet S, Anderson P, Gual A, Kraus L, Nutt DJ, Room R, Samokhvalov AV, Scafato E, Trapencieris M, Wiers RW, Gmel G. Defining Substance Use Disorders: Do We Really Need More Than Heavy Use? Alcohol Alcohol 2013; 48:633-40. [DOI: 10.1093/alcalc/agt127] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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