Concurrent binge drinking and depression among Canadian youth: prevalence, patterns, and suicidality

Depression among medical students in Tunisia: Prevalence and associated factors

BACKGROUND

Medical school is known for its lengthy process, which is both physically and emotionally draining. Students' mental balance would shrink as they progress in their medical training. A systematic review and meta-analysis reported that the prevalence of depressive symptoms among medical students remained relatively constant at 27.2%.

AIM

To assess the prevalence of depressive symptoms among Tunisian medical students and evaluate its associated factors.

METHODS

This is a descriptive cross-sectional study that was carried out in the second semester of the academic year 2017/2018, between April 2018 and July 2018 among 1138 medical students. Data were collected using a socio-demographic questionnaire and the Beck Depression Inventory-II (BDI-II).

RESULTS

Sixty-four percent (n = 728) of the participants had depressive symptoms, of which 266 (23.4%) met the criteria for mild, 271 (23.8%) for moderate, and 191 (16.8%) for severe depressive symptoms. Female gender, low socio-economic level, smoking habits and history of mental disorder, performing leisure and physical activities, satisfaction toward a career choice, and happiness perception were the main prognostic factors for depression among medical students. Although academic grades may not be considered a prognostic factor, final-year students appeared to be less depressive than their colleagues.

CONCLUSION

These findings give insight into mental health issues and comorbidities among Tunisian medical students. It is a hopeful request for decision-makers and academic authorities to set serious measures and draw effective interventions to minimize the currency of psychological distress among this subpopulation.

Tell me how you feel, I will tell you what you look at: Impact of mood and craving on alcohol attentional bias in binge drinking

BACKGROUND

Alcohol-related attentional bias (AB) is thought to play a key role in the emergence and maintenance of excessive alcohol use. Recent models suggest that AB, classically considered as a permanent feature in alcohol use disorders, is rather modulated by temporary motivational states.

AIMS

We explored the influence of current mood and craving on AB in binge drinking, through a mood induction procedure combined with eye-tracking measures of AB.

METHODS

In Experiment 1, we measured AB (visual probe task with eye-tracking measures) among binge drinkers (n = 48) and light drinkers (n = 32) following positive, negative and neutral mood inductions. Participants reported subjective craving and mood before/after induction. In Experiment 2, we measured AB among the same binge drinkers compared with 29 moderate drinkers following alcohol-related negative, non-alcohol-related negative and neutral mood inductions.

RESULTS

In Experiment 1, induced negative mood and group positively predicted subjective craving, which was positively associated with AB. We found no effect of induced positive mood nor a direct mood-AB association. In Experiment 2, the relationships AB presented with both induced negative mood and group were again mediated by craving. Inducing alcohol-related negative mood did not modify the mood-craving association.

CONCLUSIONS

Alcohol-related AB is not a stable binge drinking characteristic but rather varies according to transient motivational (i.e., craving) and emotional (i.e., negative mood) states. This study provides important insights to better understand AB in subclinical populations and emphasizes the importance of considering motivational and affective states as intercorrelated, to offer multiple ways to reduce excessive alcohol use.

Associations between binge drinking experience, depressive mood, and suicidality in adolescents: Based on the 2021 Korea Youth Risk Behavior Web-based Survey

BACKGROUND

This study aimed to investigate the associations between binge drinking experience (BDE), depressive mood, and suicidality among Korean adolescents.

METHODS

We analyzed the 17th population-based and cross-sectional data from the Korean Youth Risk Behavior Web-based Survey. Multiple logistic regression analysis was performed to compare BDE, depressive mood, and suicidality by sex.

RESULTS

In 54,848 adolescents, the prevalence of BDE was 5.3 % in boys and 4.4 % in girls. The prevalence of suicidal ideation, plans, and attempts among girls was 7.8 %, 2.4 %, and 1.4 %, respectively. The prevalence of suicide attempts among girls with both BDE and depressive moods was higher than that among boys. Boys with both BDE and depressive mood had 12.60 times and 14.50 times higher adjusted odds ratio (aOR) of suicide ideation and plan, respectively, compared with the non-drinking/non-depressed group. Girls with both BDE and depressive mood had 22.06 times higher aOR of suicide attempts than the non-drinking/non-depressed group.

LIMITATIONS

The study has few limitations including the use of self-report questionnaires, participants' response bias, and lack of diagnosis by mental health professionals.

CONCLUSIONS

These findings represent the prevalence of suicidality among South Korean adolescents with BDE or depressive mood. Since adolescents with both BDE and depressive mood showed particularly high suicidality, it is necessary to establish mental health services, such as proper prevention strategies and targeted interventions.

Is There an Association between Being a Victim of Physical Violence by Intimate Partner and Binge Drinking in Men and Women? Secondary Analysis of a National Study, Peru 2020

The relationship between being a victim of physical violence by an intimate partner and binge drinking (BD) is a poorly explored line of research, especially in men. To determine the association between being a victim of physical violence by an intimate partner and BD in men and women in Peru in 2020, a secondary analytical cross-sectional study was conducted using the Demographic Health Survey. BD was categorized according to the Center of Disease Control definition for men and women, based on the type and amount of alcoholic beverage ingested. Physical violence was based the report of being hit with any part of the body or an object, by their intimate partner. To identify the association, a multivariable general linear model of the family and link log Poisson was used. The results were presented as prevalence ratios (PRs). In the adjusted models stratified by sex, a 90% greater likelihood of BD was found in male victims and an 80% higher probability among female victims (PRa 1.9, 95%CI 1.3;2.7, p < 0.001 vs. PRa 1.8, CI95% 1.1; 2.8, p = 0.013, respectively). An association was found between physical violence by an intimate partner and BD in the Peruvian population older than 15 years, in both men and women.

The social determinants of substance use associated with deaths of despair: Individual risks and population impacts

As the incidence of deaths from external causes including poisonings, suicide, and alcohol-related liver disease, increases in countries such as the United States and Canada, a better understanding of the fundamental social determinants of the substance use underlying these so-called "deaths of despair", at the population level, is needed. Using data from the nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles) (N = 30,729), the independent associations between age, sex, marital status, immigrant status, race/ethnicity, education, income, rurality, affective health and the use of illicit substances, opioids (without distinction for prescription status), problematic levels of alcohol, and combined past-year use (≥2) of substances, were explored using multivariate logistic regression, marginal risk, and population attributable fraction estimation, with propensity score-adjusted sensitivity analyses. Males, those who were under 29 years, without a partner, born in Canada, White, or had an affective disorder reported both higher use of individual substances and multiple substances in the past year. Social determinants appear to explain a substantial proportion of substance use patterns overall. Between 10% and 45% of illicit substance, problematic alcohol, and polysubstance use prevalence was attributable to non-partnered marital status, non-immigrant status, and White race/ethnicity. Of opioid use prevalence, 25% was attributable to White race/ethnicity, 13% to affective disorder status and 4% to lower-income. Though not all substance use will result in substance-related morbidity or mortality, these findings highlight the role of social determinants in shaping the intermediary behavioural outcomes that shape population-level risk of "deaths of despair".

Social determinants of ethno-racial inequalities in substance use: a decomposition of national survey data

BACKGROUND

Similar to the US, mortality due to suicide and the use of opioids, alcohol, and other substances (so-called "Deaths of Despair"), is rising in Canada and has been disproportionately observed among Whites compared to other racial and ethnic groups. This study aimed to assess the determinants of the ethno-racial differences in the use of substances that underlie these deaths.

METHODS

Using nationally representative data from the Canadian Community Health Survey (2003, 2015-2016, 2018 cycles), a decomposition analysis was performed to estimate the contribution of psychosocial determinants, including age, sex, marital status, immigration, education, income, rurality, and affective health on inequalities between White and non-White populations in illicit substance, opioid, and problematic alcohol use and combined use (≥ 2) of substances.

RESULTS

Overall, White respondents reported higher levels (by 5% to 10%) of substance use than non-White peers. Over 30% of the ethno-racial inequalities in illicit substance, problematic alcohol, and polysubstance use are explained by the protective role of immigration among those who are not White, whose low levels of substance use lower the prevalence in the non-White population overall. Among those born in Canada, no ethno-racial differences in substance use were observed.

CONCLUSION

Social determinants, particularly immigrant status, explain a substantial proportion of ethno-racial inequalities in substance use in Canada. The jump in substance use between racialized populations who immigrated to Canada and those Canadian-born highlights the importance of exploring within-group variability in deaths of despair risk and considering how intersecting forces including systemic racism shape substance use patterns across generations.

The role of substance use coping in linking depression and alcohol use from late adolescence through early adulthood

Although theoretical models highlight the role of coping motivations in promoting co-development of depression and alcohol use, few longitudinal studies have examined such processes across early adulthood. The current study examined the role of coping in the association between depression and alcohol use across late adolescence and early adulthood. A control sample of adolescents (N = 498) from a longitudinal prevention trial completed the Brief Symptom Inventory, Life Events Coping Inventory, and a self-report survey on alcohol use at ages 17, 22, and 23, as well as the Composite International Diagnostic Interview at age 28-30. Path analyses integrated self-report and diagnostic measures. Although gender differences were observed in mean levels of depression, alcohol use, and the use of substances to cope, we did not find gender differences in structural relations across these domains over time. Substance use coping served as an intervening pathway in the association between alcohol use and depression both at the symptom level from age 17 to 23, and in predicting longer term diagnostic outcomes at ages 28-30. Depressive symptoms in early adulthood were indirectly related to major depressive disorder (MDD) through two independent paths, including the stability of depressive symptoms over time, and through the influence of depression on increasing the tendency to use substances to cope with stress. Our results underscore that coping effects provide unique predictive power across developmental transitions, over and above the stability of depressive symptoms and alcohol use, underscoring coping motives as a promising intervention target that may prevent co-occurring depression and substance use. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cigarette use and binge drinking among Korean adolescents: examining the moderating role of multicultural status

Cigarette is usually used conjointly with alcohol however its impact may vary with how much alcohol is being consumed. Besides the general use of alcohol, this study specifically focused on identifying the association between cigarette use and binge drinking of Korean adolescents. Furthermore, it aims to testify whether the multicultural status plays a moderating role in this relationship, and to discover other problem behavior theory constructs that may be associated with binge drinking of the Korean adolescents. Using the nationally representative data from the 2018 Korea Youth Health Risk Survey, 60,040 students were selected to perform chi-square, t-test, and hierarchical multiple regression. There was a strong association between cigarette use and binge drinking, and multicultural status had the moderating effect in this relationship. More specifically, adolescents from the multicultural families had higher levels of cigarette use and binge drinking than the non-multicultural adolescents. Besides these main findings, covariates such as suicidal ideation, sexual intercourse, e-cigarette use, and harmful experiences from the alcohol use of others were found to be the additional significant factors of Korean adolescents' binge drinking. Based on these findings, author suggests for the combined interventions for alcohol and tobacco, and raise awareness on the possible health disparities that could occur between multicultural families and non-multicultural families in South Korea.

What is binge drinking? Insights from a network perspective

This study aimed to delineate the specific characteristics of binge drinking habits by capitalizing on data-driven network analysis. Such an approach allowed us to consider binge drinking as a network system of interacting elements, thus identifying the key variables involved in this phenomenon. A total of 1,455 university students with excessive drinking habits were included in this study. We assessed the most critical features of binge drinking (i.e., the consumption of more than six alcohol units per occasion, drunkenness frequency, consumption speed), together with alcohol use and more general alcohol-related components of dysfunction and harm. All variables were considered in the network analysis. Centrality analysis identified drunkenness frequency as the most influential variable in the entire network. Community detection analysis showed three distinct subnetworks related to alcohol use, drunkenness, and dysfunction/harm components. Drunkenness frequency and blackout occurrence emerged as core bridge items in the binge drinking network. Drunkenness is recognized as the hallmark feature of binge drinking.

The Mediated Moderation Model of Depressive Symptoms, Alcohol Use, and Consequences: The Protective Role of Executive Function

Heavy episodic drinking (HED) and negative drinking consequences represent prevalent and serious health concerns for college students. Depressive symptoms may elevate students' risk for engaging in HED and experiencing negative consequences, but levels of risk may vary by executive function (EF) capabilities. Growing evidence suggests that EF deficits are associated with comorbid depressive symptoms and alcohol misuse. Nevertheless, little is known about unique and shared risks that depressive symptoms and EF may interactively pose for HED and negative drinking consequences. Methods: To address these gaps, the study assessed depressive symptoms, multiple domains of EF via multimethod approach, HED, and negative drinking consequences in a sample of 446 undergraduate students. Mediated moderation models were conducted to examine associations between depressive symptoms and alcohol use behaviors and modulating roles of EF. Results: Depressive symptoms, poor planning, and self-reported executive dysfunction were significantly associated with HED and negative drinking consequences. HED mediated the effect of depressive symptoms and executive dysfunction on negative consequences. A significant interaction indicated that better EF (i.e. low or average self-reported executive dysfunction) may buffer the risk depressive symptoms present for negative drinking consequences. Conclusions: The current findings suggest that among college students, risk and resilience factors for HED and negative drinking consequences may vary. Effective EF capabilities may be especially helpful for reducing students' risk for more serious drinking consequences.

Patterns of behavioral risk factors for non-communicable diseases in Vietnam: A narrative scoping review

This review describes both magnitude and patterns of major behavioral risk factors for NCDs. Positive changes in tobacco use were identified, though this is far to meet the established expectation. Harmful alcohol consumption was reported, especially for males. Only small proportion of the population consumed an adequate amount of fruits and vegetables daily. Average salt intake was approximately doubled, in comparison to WHO's recommendations. Physical activity has shifted gradually negatively, but future trends are unpredictable. An organized surveillance system should be developed initially with adequate tools and public resources to maintain and ensure sustainability over time.

Prospective relationships between youth assets, negative life events, and binge drinking in a longitudinal cohort of the youth

PURPOSE

The purpose of this study was to investigate whether individual, family, and community assets can 1) protect youth from binge drinking in the face of negative life events and 2) modify the relationship between negative life events and binge drinking.

METHODS

Data from waves 2-5 of the Youth Asset Study were analyzed. Generalized estimating equations were used to assess the relationship between negative life events, assets, and binge drinking. Multiplicative and additive interaction between negative life events and assets was evaluated.

RESULTS

When included in the same model as negative life events, individual, family, and community assets had a graded, protective relationship with binge drinking, with strongest protection for those with the greatest number of assets. For example, youth with 3 [adjusted odds ratio (AOR):0.78, 95% confidence interval (CI): 0.65-0.93], 4 [AOR: 0.60, 95% CI: 0.49-0.73], 5 [AOR: 0.53, 95% CI: 0.41-0.69], and 6 [AOR: 0.42, 95% CI: 0.28-0.63] assets within the community domain had a significantly lower odds of binge drinking than youth with 0-2 community assets. No significant interactions were observed.

CONCLUSIONS

The findings suggest that while youth who are exposed to negative life events are at risk for binge drinking, building assets across individual, family, and community domains can have a protective influence.

Craving is everything: An eye-tracking exploration of attentional bias in binge drinking

BACKGROUND

Attentional bias towards alcohol-related stimuli is a core characteristic of severe alcohol use disorders (AUD), directly linked to clinical variables (e.g. alcohol consumption, relapse). Nevertheless, the extent of this bias in subclinical populations remains poorly documented. This is particularly true for binge drinking, an alcohol consumption pattern highly prevalent in youth, characterised by an alternation between excessive intakes and withdrawal periods.

AIMS

We used eye-tracking to: (a) measure attentional bias in binge drinking, (b) determine its time course by dissociating early/late processing stages, (c) clarify its specificity for alcohol-related stimuli compared to other appetitive stimulations and (d) explore its modulation by current craving intensity.

METHODS

Binge drinkers (n=42) and matched controls (n=43) performed a visual probe task, requiring visual targets preceded by pairs of pictures to be processed, with three conditions (i.e. alcohol vs. soft drink, alcohol vs. high-calorie food, high-calorie food vs. low-calorie food).

RESULTS

No group difference was observed for early processing (i.e. first area of interest visited). Dwell times highlighted a bias towards soft drinks and healthy food among controls, without any global bias towards alcohol in binge drinkers. Centrally, a comparison of binge drinkers with low versus high current craving intensity indicated that binge drinking was associated with a bias towards alcohol and high-calorie food only in the presence of a high craving towards these stimuli.

CONCLUSION

Attentional bias towards alcohol reported in severe AUD is only found in binge drinkers in the presence of high craving and is generalised to other appetitive cues.

Untangling Influences in the Longitudinal Relationship Between Depressive Symptoms and Drinking Frequency in High School

PURPOSE

In young people, alcohol consumption and depressive symptoms are related, but the temporal ordering of the relationship is an open question. Previous studies have not disaggregated influences of interindividual and intraindividual components affecting the relationship. We investigated whether a reciprocal relationship between frequency of alcohol use and depressive symptoms exists in the general population of adolescents after removing interindividual influences.

METHODS

A total of 1,293 Canadian adolescents provided data on depressive symptoms and frequency of alcohol use every 3 months from grade 7 to 11 (1999-2005) for a total of 20 cycles. We used latent curve models with structured residuals, which disaggregate interindividual and intraindividual components to assess the directionality of the relationship.

RESULTS

Both drinking frequency and depressive symptoms increased linearly and quadratically over time, with significant interindividual variation around the origin and rate of change. Intercepts and slopes for drinking frequency and depressive symptoms differed by sex and age. After controlling for sex, age, maternal education, sensation seeking, impulsivity and clustering by school, a significant positive association was observed between depressive symptoms and drinking frequency 3 months later (.032 [.004, .060]; p = .024), but no association was observed between drinking frequency and subsequent depressive symptoms (.011 [-.006 to .029]; p = .193).

CONCLUSIONS

Our data provide longitudinal evidence that changes in depressive symptoms exceeding one's "normal" level predict increases in drinking frequency. This suggests that teaching youth to recognize and cope with mood changes would be worthwhile.

Factors associated with alcohol use disorder: the role of depression, anxiety, stress, alexithymia and work fatigue- a population study in Lebanon

Background

International research showed that common mental disorders such as depression, anxiety, social anxiety, stress, alexithymia and having insecure attachment styles are risk factors for alcohol use disorder (AUD). Our objective was to study the factors associated withAUD in a sample of the Lebanese population.

Methods

During the period lasting from November 2017 to March 2018, a sample of 789 Lebanese participants agreed to contribute to a cross-sectional study (53.23% males). Alcohol use disorder was assessed using the Alcohol Use Disorder Identification Test (AUDIT).

Results

A high risk of AUD was associated with higher alexithymia (ORa = 1.030; CI 1.009–1.051), depression (ORa = 1.076; CI 1.050–1.103) and suicidal ideation (ORa = 1.253; CI 1.026–1.531) in a significant manner. In opposition, a higher number of kids (ORa = 0.863; CI 0.752–0.991), being a female (ORa = 0.460; CI 0.305–0.694) and higher emotional management (ORa = 0.962; CI 0.937–0.988) were significantly associated with lower AUD risk.

A cluster analysis derived three mutually exclusive clusters. Cluster 1 formed 45.4% of the sample and assembled people with psychological difficulties (work fatigue and high stress, high emotional work fatigue and low emotional intelligence, low self-esteem, high social phobia, high alexithymia); Cluster 2 formed 34.4% of the sample and assembled people with high wellbeing (low suicidal ideation, low emotional work fatigue, depression and anxiety, high emotional intelligence, high self-esteem and low social phobia); whereas cluster 3 formed 20.2% of the sample and represented people with mental dysfunction (high anxiety and depression, high suicidal ideation, low self-esteem and high social phobia, low emotional intelligence, high emotional work fatigue). People with psychological difficulties (cluster 1) (Beta = 5.547; CI 4.430–6.663), and people in distress (cluster 3) (Beta = 7.455; CI 5.945–8.965) were associated with higher AUDIT scores than those with high wellbeing (cluster 2).

Conclusion

AUD seems to be influenced by several factors among the Lebanese population, including alexithymia, stress, anxiety and work fatigue. Healthcare professionals should spread awareness to reduce the prevalence of these factors.

Prevalence of binge drinking and its association with mental health conditions and quality of life in Singapore

AIMS

Although heavy alcohol consumption has been linked to a myriad of adverse health problems, there is a paucity of population-based studies in Asian countries. The aims of this study were to determine the past-year prevalence of binge drinking in Singapore and its associations with socio-demographic factors, mental health conditions and quality of life.

METHODS

Data from the Singapore Mental Health Study 2016 (N = 6126) on binge drinking were included in the analysis. Multiple logistic regressions were used to assess the adjusted odds ratio (OR_adj) between binge drinking and relevant socio-demographic variables, and mental health conditions.

RESULTS

In the sample, 13.7% of respondents reported past-year binge drinking, 17.6% of males and 9.8% of females were binge drinkers. Most of them were infrequent binge drinkers (7.3% binge drink less than monthly). Moderate associations between binge drinking and mood and anxiety disorders (OR_adj = 1.8-4.4), were noted, while associations with alcohol use disorders were much stronger (OR_adj = 5.3-9.7). Associations between binge drinking and anxiety disorders were observed exclusively in females (OR_adj = 2.3-3.3). Binge drinkers reported a lower quality of life compared to their non-binging counterparts; binge-drinking males seemed to be more affected.

CONCLUSIONS

The prevalence of binge drinking is low in Singapore compared to global estimates; most binge drinkers in Singapore were infrequent binge drinkers. However, binge drinking was found to be associated with a myriad of mental health conditions, and a decline in quality of life was noted among binge drinkers.

The role of depression in unnatural death: A case-based retrospective study

BACKGROUND

Depression affects the life of millions around the globe and perhaps also the manner of death. This study examined the role of depression in specific causes of unnatural death and whether alcohol and substance use affect this relationship, in one locality in Scotland.

METHODS

The research used a retrospective case-based study approach to analyse 168 cases, quantifying data reported in mortuary files to allow for quantitative statistical analysis of associations and differences amongst the variables.

RESULTS

A diagnosis of depression was associated with a higher likelihood of unnatural death due to suicide, drugs or homicide. A diagnosis of substance abuse was associated with a diagnosis of depression and with an increased likelihood of death due to suicide or drugs. A diagnosis of alcohol abuse was associated with a reduced likelihood of a diagnosis of depression but was associated with an increased likelihood of suicide.

LIMITATIONS

This study relied on a small sample from one locality in Scotland which limited the ability to generalise the results and the retrospective case-based design also limited the potential for checking data accuracy or to consider temporal relationships, which limited the ability to interpret causality.

CONCLUSIONS

This study found that there was a relationship between depression and unnatural death, which was mediated by alcohol and substance use. The importance of this study lies within the recognition of these relationships which identified the complexities of these relationships but suggested that some unnatural deaths within this population could be prevented.

Psychological correlates and binge drinking behaviours among Canadian youth: a cross-sectional analysis of the mental health pilot data from the COMPASS study

OBJECTIVE

The objective of this study was to examine associations between depression, anxiety and binge drinking among a large sample of Canadian youth, while testing the moderating effect of flourishing. This research uses data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, Sedentary Behaviour (COMPASS) study (2012-2021) with a large sample size collecting data on youth health behaviours within Canadian secondary schools.

DESIGN

Cross-sectional SETTING: 14 secondary schools across Ontario and British Columbia, Canada.

PARTICIPANTS

A sample of grade 9-12 students (n=6570) who participated in the Mental Health pilot of the COMPASS study PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported questionnaires assessed student binge drinking behaviours (5≥drinks), symptoms of depression (Center for Epidemiologic Studies Depression Scale (Revised)-10 scores≥10) and anxiety (Generalised Anxiety Disorder 7-item Scale scores≥10), and flourishing (Diener's Flourishing Scale: 8-40).

RESULTS

In our sample of 6570 students, 37.0% of students reported binge drinking in the last year, and 41.4% and 31.7% of students report clinically-relevant symptoms of depression and anxiety, respectively. Anxiety (adjusted OR (AOR): 0.57, (99% CI 0.15 to 2.22)) and depression (AOR: 1.98, (99% CI 0.76 to 5.13)) symptoms were not found to be associated with binge drinking and we did not detect any moderating role of flourishing. Rather, factors that were associated with increased odds of binge drinking included sports team participation (AOR: 1.67, (99% CI 1.37 to 2.03)) and use of other substances (tobacco (AOR: 3.00, (99% CI 2.12 to 4.25)) and cannabis (AOR: 7.76, (99% CI 6.36 to 9.46))). Similar associations were found for frequency of binge drinking.

CONCLUSIONS

Consistent with existing literature, binge drinking behaviours were problematic, as well as clinically-relevant symptoms of depression and anxiety. However, mental health problems and well-being may not be responsible for explaining patterns of binge drinking in youth. Targeted intervention efforts towards student athletes and concurrent substance users are necessary for addressing binge drinking in youth populations.

Behavioral and Cerebral Impairments Associated with Binge Drinking in Youth: A Critical Review

Binge drinking is a widespread alcohol consumption pattern in youth that is linked to important behavioral and cerebral impairments, in both the short and the long term. From a critical review of the current literature on this topic, we conclude that binge drinkers display executive impairments, cerebral modifications, and problems with emotion-related processes. Five key empirical and theoretical topics are discussed to pave the way for future research in the field: (1) the specificity of the brain modifications observed in binge drinkers that may index a compensatory mechanism or result from multiple withdrawals; (2) the nature of the relationship between binge drinking and impairments, suggesting reciprocal influences between excessive alcohol consumption and executive deficits; (3) the possible recovery of brain and cognitive functioning after the cessation of binge drinking; (4) the validity of the continuum hypothesis, suggesting links between binge drinking and severe alcohol use disorders; and (5) the existing strategies to reduce binge drinking habits or rehabilitate the associated cognitive deficits. Future perspectives are described in relation to the questions raised to identify the crucial variables to be addressed in research and clinical practice.

Problematic alcohol use and depression in secondary school students in Miri, Malaysia

BACKGROUND

Alcohol consumption in the under-aged is one of the main concerns regarding Malaysian adolescents. There is no previous study on problematic alcohol use (PAU) in adolescents in Sarawak. The aim of this study was to determine the prevalence of PAU, its associated variables and its relationship with depression.

METHODS

This was a cross-sectional study. A total of 327 secondary school students completed the Alcohol Use Disorder Identification Test and Children's Depression Inventory, and a sociodemographic questionnaire. Binary and multivariable logistic regression were used to examine the relationship between the different variables.

RESULTS

A total of 42.2% of adolescents had PAU. Urban adolescents had a higher prevalence compared with rural adolescents (OR, 1.612; 95% CI: 1.036-2.508 P = 0.034). Female adolescents (56.8%) and Bumiputera Sarawak adolescents (76.8%) comprised a large proportion of the respondents with PAU. Cultural norm (78.3%) and curiosity (68.1%) were the two main reasons for PAU. Only family history of alcohol use (OR, 2.273; 95% CI: 1.013-5.107; P = 0.047), ever consumed alcohol (OR, 57.585; 95% CI: 21.885-151.525; P < 0.001) and ever consumed beer (OR, 2.564; 95% CI: 1.032-6.372; P = 0.043) were significantly associated with PAU. The prevalence of depression was 21.4%. A significant relationship between PAU and depression was seen (OR, 2.557; 95% CI: 1.479-4.420; P = 0.001).

CONCLUSION

There is a high prevalence of PAU in adolescents in Miri, Malaysia. More effort is needed to implement policies for this vulnerable group, with collaboration between agencies to ensure their mental and physical wellbeing and prevent a negative impact later. Clinicians should be more vigilant in detecting depression in adolescents with PAU to enable early intervention.

Binge drinking in young people: protocol for a systematic review of neuropsychological, neurophysiological and neuroimaging studies

INTRODUCTION

Binge drinking is the most common pattern of alcohol use among young people in Western countries. Adolescence and young adulthood is a vulnerable developmental period and binge drinking during this time has a higher potential for neurotoxicity and interference with ongoing neural and cognitive development. The purpose of this systematic review will be to assess and integrate evidence of the impact of binge drinking on cognition, brain structure and function in youth aged 10-24 years. Cross-sectional studies will synthesise the aberrations associated with binge drinking, while longitudinal studies will distinguish the cognitive and neural antecedents from the cognitive and neural effects that are a consequence of binge drinking.

METHODS AND ANALYSIS

A total of five peer-reviewed databases (PubMed, EMBASE, Medline, PsychINFO, ProQuest) will be systematically searched and the search period will include all studies published prior to 1 April 2018. The search terms will be a combination of MeSH keywords that are based on previous relevant reviews. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and study quality will be assessed using The Grades of Recommendation, Assessment, Development and Evaluation approach. All studies will be screened against eligibility criteria designed to synthesise studies that examined a young binge drinking sample and used neuropsychological, neurophysiological or neuroimaging assessment techniques. Studies will be excluded if participants were significantly involved in other substances or if they had been clinically diagnosed with an alcohol use disorder, or any psychiatric, neurological or pharmacological condition. If available data permits, a meta-analysis will be conducted.

ETHICS AND DISSEMINATION

Formal ethics approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication, conference presentations and social media.

TRIAL REGISTRATION NUMBER

International Prospective Register for Systematic Reviews (PROSPERO) number: CRD42018086856.

Emergency Department Alcohol Intervention: Effects on Dating Violence and Depression

OBJECTIVES

With this study, we examined secondary outcomes of an emergency department (ED)-based brief intervention (BI) on dating violence perpetration and victimization and depression symptoms over 3, 6, and 12 months.

METHODS

ED patients (14-20 years) were screened for risk drinking. Patients who received positive screen results were randomly assigned to a computer BI (n = 277), therapist BI (n = 278), or control condition (n = 281). After the 3-month assessment, participants were randomly assigned to receive the post-ED BI or control condition. BIs were used to address alcohol consumption and consequences (eg, dating violence and depression symptoms) by using motivational interviewing.

RESULTS

A total of 836 patients were enrolled in the randomized controlled trial of 4389 patients screened and 1054 who reported risky drinking. Regression models were used to examine longitudinal effects of the alcohol BI on dating violence perpetration, dating violence victimization, and depression symptoms. The therapist BI resulted in a significant reduction of dating violence perpetration up to 12 months (incidence rate ratio [IRR] = 0.53; 95% confidence interval [CI]: 0.37-0.77) and depression symptoms up to 3 months (IRR = 0.85; 95% CI: 0.72-1.00) after the intervention. Computer BI resulted in a reduction of dating violence perpetration (IRR = 0.52; 95% CI: 0.35-0.76) and depression symptoms (IRR = 0.78; 95% CI: 0.66-0.94) 6 months postintervention. Post-ED BIs were associated with lower perpetration at 12 months and lower victimization at 6 and 12 months, irrespective of BI intervention randomization at baseline; however, they did not affect depression symptoms.

CONCLUSIONS

A single-session ED BI revealed previously to show promise in reducing underage drinking also demonstrates promise in preventing dating violence perpetration and depression symptoms. These technology-enhanced BIs could be particularly helpful given the potential for more efficient resource usage and ease of future implementation.

Binge Drinking and the Young Brain: A Mini Review of the Neurobiological Underpinnings of Alcohol-Induced Blackout

Binge drinking has significant effects on memory, particularly with regards to the transfer of information to long-term storage. Partial or complete blocking of memory formation is known as blackout. Youth represents a critical period in brain development that is particularly vulnerable to alcohol misuse. Animal models show that the adolescent brain is more vulnerable to the acute and chronic effects of alcohol compared with the adult brain. This mini-review addresses the neurobiological underpinnings of binge drinking and associated memory loss (blackout) in the adolescent and young adult period. Although the extent to which there are pre-existing versus alcohol-induced neurobiological changes remains unclear, it is likely that repetitive binge drinking in youth has detrimental effects on cognitive and social functioning. Given its role in learning and memory, the hippocampus is a critical region with neuroimaging research showing notable changes in this structure associated with alcohol misuse in young people. There is a great need for earlier identification of biological markers associated with alcohol-related brain damage. As a means to assess in vivo neurochemistry, magnetic resonance spectroscopy (MRS) has emerged as a particularly promising technique since changes in neurometabolites often precede gross structural changes. Thus, the current paper addresses how MRS biomarkers of neurotransmission (glutamate, GABA) and oxidative stress (indexed by depleted glutathione) in the hippocampal region of young binge drinkers may underlie propensity for blackouts and other memory impairments. MRS biomarkers may have particular utility in determining the acute versus longer-term effects of binge drinking in young people.

Impact of Depressive Symptoms and Alcohol Use on Disordered Eating and Suicidality: A Moderated Mediation Study

While previous studies have tested the mediating or moderating effects of select factors on disordered eating pathologies, no empirical studies have examined a moderated mediation model. Thus, filling a gap in the literature base, the current study examined a moderated mediation model to test the associations among disordered eating, depressive symptoms, alcohol use, and suicidality. The current study sample included 1,598 students (mean age 21.3 years; 80.9% female) across major universities in the United States. Results showed that disordered eating was significantly associated with suicidality, and the association was mediated by depressive symptoms. Further, the indirect effect of disordered eating via depressive symptoms varied in magnitude as a function of alcohol use. Findings suggest that clinical mental health counselors and other providers working with emerging adults should be vigilant in recognizing behaviors and thoughts associated with disordered eating and related signs and symptoms, including depressive symptoms and alcohol use.

Effects of depression and past-year binge drinking on cognitive control processes during a flanker task in college-aged adults

BACKGROUND

Recent but largely separate literatures have examined neurocognitive alterations related to both depression and binge drinking, suggesting similar patterns of impairments in attention control and decisional processes. However, depression and problematic alcohol use tend to co-occur, and few studies have examined whether cognitive processing effects of depression and binge drinking are independent or interacting.

OBJECTIVE

The current study examined joint effects of depressive symptoms and past-year binge drinking on cognitive processing (measured via EEG assessment).

METHODS

University students aged 18 and over (N = 46; 63.4% female) were recruited based on self-reported depressive symptoms and also provided reports of alcohol use (51% reported significant depression; 46% reported at-least one past-year binge-drinking episode). Participants completed a computerized flanker task, assessing cognitive control processes. Forty-one participants providing useable data were included in analyses.

RESULTS

Past-year binge drinking was associated with slower and more accurate behavioral responding. The interaction of binge-drinking and depressive symptoms was related to the magnitude of early attentional components (N1 and N2), with individuals reporting high depressive symptoms and a history of binge-drinking exhibiting attenuated early attentional engagement (e.g., less negative N1) coupled with enhanced attention control processing (e.g., more negative N2). Depressive symptoms also predicted a lack of discriminated P3 amplitudes on congruent versus incongruent trials.

CONCLUSION

The data suggest that depression and binge drinking in the past-year jointly interact to predict early attentional processing, with the pattern of responding consistent with a compensatory response process. Results highlight the importance of future work on binge-drinking accounting for co-occurring depression.

Mood disorder, anxiety, and suicide risk among subjects with alcohol abuse and/or dependence: a population-based study

Objective:

To evaluate the prevalence of alcohol abuse and/or dependence in a population-based sample of young adults and assess the prevalence of comorbid mood disorders, anxiety, and suicide risk in this population.

Methods:

This cross-sectional, population-based study enrolled 1,953 young adults aged 18-35 years. The CAGE questionnaire was used to screen for alcohol abuse and/or dependence, with CAGE scores ≥ 2 considered positive. Psychiatric disorders were investigated through the structured Mini International Neuropsychiatric Interview (MINI).

Results:

Alcohol abuse and/or dependence was identified in 187 (9.60%) individuals (5.10% among women and 15.20% among men). Alcohol abuse and/or dependence were more prevalent among men than women, as well as among those who used tobacco, illicit drugs or presented with anxiety disorder, mood disorder, and suicide risk.

Conclusion:

These findings suggest that alcohol abuse and/or dependence are consistently associated with a higher prevalence of psychiatric comorbidities, could be considered important predictors of other psychiatric disorders, and deserve greater public heath attention, pointing to the need for alcohol abuse prevention programs.

Differential impairments across attentional networks in binge drinking

RATIONALE

The cognitive deficits observed in young binge drinkers have been largely documented during the last decade. Yet, these earlier studies have mainly focused on high-level cognitive abilities (particularly memory and executive functions), and uncertainty thus still abounds regarding the integrity of less complex cognitive processes in binge drinking. This is particularly true for attentional abilities, which play a crucial role in behavior regulation and are impaired in other alcohol-related disorders.

OBJECTIVES AND METHODS

To specify the attentional deficits associated with binge drinking, two groups of university students (40 binge drinkers and 40 matched controls) performed the Attention Network Task, a theoretically grounded test assessing three independent attentional networks: alerting, orienting, and executive control.

RESULTS

Binge drinkers displayed preserved orienting performance but impaired alerting and executive control. Binge drinking is thus not related to a general attentional impairment but rather to specific impairments of the alerting and executive control networks.

CONCLUSIONS

These results underline that, beyond the already explored high-level deficits, binge drinking is also related to impairments for attentional abilities. In view of the role played by attentional impairments in alcohol dependence, the present data also suggest that rehabilitation programs should be developed to improve attentional abilities at the early stages of alcohol-related disorders.

Associations between alcohol-use and depression symptoms in adolescence: Examining gender differences and pathways over time

Several studies examining alcohol use and depression in youth have focused on documenting prevalence of overlap, or temporal ordering in longitudinal samples. Fewer studies have examined pathways connecting alcohol use and depression over time. This study examined gender differences between depression and alcohol use across adolescence while examining peer and family pathways as possible mediators of effects. Data was collected longitudinally from 593 families from three urban public middle schools in the United States. Participants were recruited in 6th grade and followed through 9th grade. We examined gender differences using a nested model comparison approach. Results indicated the association between depression and alcohol use differs by gender. For males, depression and alcohol use were independent across adolescence, and no significant indirect pathways were observed. For females, bidirectional effects were found between alcohol use and depression, as well as an indirect effect from depression to alcohol use via peer deviance.

Functional and structural brain connectivity of young binge drinkers: a follow-up study

Adolescence is a period of ongoing brain maturation characterized by hierarchical changes in the functional and structural networks. For this reason, the young brain is particularly vulnerable to the toxic effects of alcohol. Nowadays, binge drinking is a pattern of alcohol consumption increasingly prevalent among adolescents. The aim of the present study is to evaluate the evolution of the functional and anatomical connectivity of the Default Mode Network (DMN) in young binge drinkers along two years. Magnetoencephalography signal during eyes closed resting state as well as Diffusion Tensor Imaging (DTI) were acquired twice within a 2-year interval from 39 undergraduate students (22 controls, 17 binge drinkers) with neither personal nor family history of alcoholism. The group comparison showed that, after maintaining a binge drinking pattern along at least two years, binge drinkers displayed an increased brain connectivity of the DMN in comparison with the control group. On the other hand, the structural connectivity did not show significant differences neither between groups nor over the time. These findings point out that a continued pattern of binge drinking leads to functional alterations in the normal brain maturation process, even before anatomical changes can be detected.

Factors associated with heavy drinking among off-reserve First Nations and Métis youth and adults: Evidence from the 2012 Canadian Aboriginal Peoples Survey

Objective . Aboriginal people in Canada are at higher risk to heavy alcohol consumption than are other Canadians. The objective of this study was to examine a set of culturally specific correlates of heavy drinking among First Nations and Métis youth and adults. Methods . Demographic, geographic, socioeconomic and health-related variables were also considered. Data were used from Statistics Canada's 2012 Aboriginal Peoples Survey to predict heavy drinking among 14,410 First Nations and Métis 15years of age and older. Separate sets of binary sequential logistic regression models were estimated for youth and adults. Results . Among youth, those who had hunted, fished or trapped within the last year were more likely to be heavy drinkers. In addition, current smokers and those who most frequently participated in sports were at higher odds of heavy alcohol consumption. Among adults, respondents who had hunted, fished or trapped within the last year were more likely to drink heavily. On the other hand, those who had made traditional arts or crafts within the last year were less likely to drink heavily. Conclusions . Men, younger adults, smokers, those who were unmarried, those who had higher household incomes, and those who had higher ratings of self-perceived health were more likely to be heavy drinkers. Efforts aimed at reducing the prevalence of heavy drinking among this population may benefit from considering culturally specific factors, in addition to demographic variables and co-occurring health-risk behaviors.

Binge drinking and subsequent depressive symptoms in young women in Australia

BACKGROUND

The long-term impact of binge drinking on subsequent depressive symptoms is unclear. The aims were to identify longitudinal patterns of binge drinking and whether binge drinking preceded depressive symptoms in the short-term (1-6 years) and long-term (10-15 years).

METHODS

Longitudinal data from 1996, 2000 and 2009 mailed surveys of 8,197 women in the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Latent class analysis was used to identify binge drinking patterns and logistic regression to estimate associations with subsequent depressive symptoms.

RESULTS

Five binge drinking trajectories were identified with predicted proportions of women who were very infrequent (24%), fluctuating infrequent (17%), frequent (17%), very frequent (26%) or extremely frequent binge drinkers (16%) between 16 and 21 years. At 22-27 years, depressive symptoms were significantly higher for extremely frequent binge drinkers (31% versus 21% in the short-term; 22% versus 16%-18% in the long-term) than for less frequent bingers. Unadjusted odds of depressive symptoms were 1.70 (95%CI:1.38;2.08) times for extremely frequent binge drinkers than very infrequent bingers and were 1.30 (95%CI:1.04;1.63) after adjusting for demographics, relationships and experience of violence. At 31-36 years, the odds of depressive symptoms were 1.34 (95%CI:1.09-1.64) times for extremely frequent than very infrequent binge drinkers, but were not significant after adjusting for relationships and violence.

CONCLUSIONS

Extremely frequent binge drinking (more than weekly) in late adolescence appears to elevate the risk of subsequent depressive symptoms in young women in their early twenties and thirties, emphasising the need for preventive strategies to curb binge drinking.

Reciprocal Effects of Internalizing and Oppositional Defiance Symptoms on Heavy Drinking and Alcohol-Related Harms in Young Adulthood

There is a need for longitudinal research to understand how psychopathology relates to the onset and maintenance of substance use from adolescence into young adulthood. Hence, we investigate the longitudinal, reciprocal influences of internalizing (anxiety and depression) and externalizing (oppositional defiance) symptoms on heavy episodic drinking (HED; ≥5 drinks per occasion) and alcohol-related harms in a community-based sample of youth aged 12–27 years. Participants were chosen from the Victoria Healthy Youth Survey, followed six times, biennially between 2003 and 2013 (N = 662). Analyses used cross-lagged panel models to examine reciprocal relations over time. Differences across age and sex were also tested. Defiance symptoms predicted increases in HED, which reciprocally predicted increases in defiance symptoms for females. Internalizing symptoms were related to HED within time for females. Alcohol-related harms had reciprocal positive associations with internalizing and defiance symptoms for both males and females. Associations were largely invariant across age groups, suggesting that the presence and strength of associations persisted across development. While psychopathology preceded the onset of HED and harms, the overall findings suggest that these risk processes are mutually reinforcing across development and that youth may become entrenched in an interdependent cycle that significantly increases their risk of comorbid disorders in adulthood.

Multivariate analysis of binge drinking in young adult population: Data analysis of the 2007 Survey of Lifestyle, Attitude and Nutrition in Ireland

AIMS

Alcohol use is the third highest risk factor for disease and disability. This study explored the association between binge drinking and mental health, general health, and diet and nutrition of young adults.

METHODS

A sub-sample of 2590 adults aged 18-29 years was selected from 10 364 participants in the survey to investigate the effect of binge drinking exposure on depression, anxiety, quality of life and nutrition. The Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) was used to assess hazardous drinking. A short version of the World Health Organization Composite International Diagnostic Interview was used to assess mental health. The quality of life was measured through the World Health Organization Quality of Life Survey. Multivariate regression analysis was performed. Potential confounders were age, gender, social class and AUDIT-C score. A two-tailed P-value was presented with a significance cut-off point at 0.05.

RESULTS

Univariate regression analysis showed significant associations between binge drinking and depression (odds ratio [OR] = 1.8; P < 0.03), eating fried food (OR = 0.4; P < 0.001) and poor quality of life (OR = 1.5; P = 0.01). In a multivariate model adjusted for age, gender, social class and the AUDIT-C results, the association between binge drinking and depression disappeared despite the high risk indicated by the OR in the univariate analysis. A significant relation was found between binge drinking and eating fried food (OR = 0.43 and P < 0.001) and quality of life (OR = 1.09; P = 0.01) in the fully adjusted models.

CONCLUSIONS

The link between alcohol drinking and mental health remains poorly understood. More research into the relation between different aspects of alcohol consumption, mental health and quality of life is required.

Exploring the motives and mental health correlates of intentional food restriction prior to alcohol use in university students

This study explored the prevalence of and motivations behind ‘drunkorexia’ – restricting food intake prior to drinking alcohol. For both male and female university students ( N = 3409), intentionally changing eating behaviour prior to drinking alcohol was common practice (46%). Analyses performed on a targeted sample of women ( n = 226) revealed that food restriction prior to alcohol use was associated with greater symptomology than eating more food. Those who restrict eating prior to drinking to avoid weight gain scored higher on measures of disordered eating, whereas those who restrict to get intoxicated faster scored higher on measures of alcohol abuse.

Binge drinking and the risk of suicidal thoughts, plans, and attempts

BACKGROUND

Major depression is one of the strongest known risk factors for suicide. However, of the estimated 8.5 million adults with serious thoughts of suicide in the past year, only half had a major depressive episode (MDE). Identifying risk factors for suicide in the absence of depression may provide additional targets for prevention and intervention. This study uses nationally representative data to evaluate the association of binge drinking with suicidal thoughts, plans, and attempts in adults with and without MDE.

METHODS

Combined 2008-2012 National Survey on Drug Use and Health data were analyzed. Sex-stratified prevalence estimates of past year suicide indicators were generated by past month binge drinking and past year MDE status. Logistic regression was used to evaluate the association of binge drinking with suicide indicators by sex with and without MDE.

RESULTS

Unadjusted prevalence estimates for suicide indicators in males and females were higher among binge drinkers than among nonbinge drinkers, regardless of MDE status. Regression analyses indicated that binge drinking was associated with suicidal thoughts (adjusted odds ratio [aOR]=1.51, 95% confidence interval [CI]=1.28-1.79), plans (aOR=1.75, CI=1.23-2.48), and attempts (aOR=2.57, CI=1.74-3.79) in females without MDE and with suicidal thoughts in males without MDE (aOR=1.25, CI=1.04-1.49). Among males and females with MDE, binge drinking was not associated with any of the suicide indicators (p>.05).

CONCLUSIONS

Binge drinking in females without MDE may be an indicator for identifying at risk individuals for targeting suicide prevention activities.

A Systematic Review of School-Based Alcohol and other Drug Prevention Programs

BACKGROUND

Alcohol use in adolescents constitutes a major public health concern. Europe is the heaviest drinking region of the world. Several school-based alcohol prevention programs have been developed but it is not clear whether they are really effective. The present study was aimed at identifying the typology with the best evidence of effectiveness in European studies.

METHODS

A systematic search of meta-analyses and/or randomized controlled trials (RCTs) on interventions school-based prevention programs aimed at preventing alcohol consumption or changing the attitudes to consume alcohol.

RESULTS

A meta-analysis published in 2011 and 12 RCTs more recently published were identified. The meta-analysis evaluated 53 RCTs but only 11.3% of them were conducted in Europe. Globally, 23 RCTs (43.4%) showed some evidence of effectiveness, and 30 RCTs (56.6%) did not find significant difference between the groups. According to the conclusions of the meta-analysis, the Unplugged program should be considered as a practice option in Europe. Among the other 12 RCTs, 42% were conducted in Europe. Globally, 7 studies (58.3%) achieved positive results, and 5 studies (41.7%) did not find significant differences or produced a mixed pattern of results. Three of the 5 European trials (60%) used the Unplugged program with positive results.

CONCLUSION

Even if further studies should be conducted to confirm these results, Unplugged appears to be the prevention project with the best evidence of effectiveness in European studies.

School difficulties and co-occurring health risk factors: substance use, aggression, depression, and suicidal behaviors

PROBLEM

Effective prevention requires understanding vulnerable populations, early signs of health risks, and the impact of social contexts. We tested a model of co-occurring mental health risks among at-risk youth experiencing school difficulties.

METHODS

We analyzed data from a random sample of 336 at-risk youth, grades 9-12, who completed a comprehensive risk/protective factors assessment.

FINDINGS

Simultaneously controlling for correlations among health risks, we observed systematic associations among risk factors, with generally consistent patterns for males and females.

CONCLUSIONS

The findings underscore the importance of developing interventions that incorporate contextual influences and of identifying common adaptable strategies for attenuating co-occurring health risks for at-risk youth.

Evolution of the binge drinking pattern in college students: neurophysiological correlates

It is well known that alcohol impairs response inhibition and that adolescence is a critical period of neuromaturation where cognitive processes such as inhibitory control are still developing. In recent years, growing evidence has shown the negative consequences of alcohol binge drinking on the adolescent and young human brain. However, the effects of cessation of binge drinking on brain function remain unexplored. The objective of the present study was to examine brain activity during response execution and inhibition in young binge drinkers in relation to the progression of their drinking habits over time. Event-related potentials (ERPs) elicited by a Go/NoGo task were recorded twice within a 2-year interval in 57 undergraduate students (25 controls, 22 binge drinkers, and 10 ex-binge drinkers) with no personal or family history of alcoholism or psychopathological disorders. The results showed that the amplitude of NoGo-P3 over the frontal region correlated with an earlier age of onset of regular drinking as well as with greater quantity and speed of alcohol consumption. Regression analysis showed that NoGo-P3 amplitude was significantly predicted by the speed of alcohol intake and the age of onset of regular drinking. The group comparisons showed that, after maintaining a binge drinking pattern for at least 2 years, binge drinkers displayed significantly larger NoGo-P3 amplitudes than controls, whereas ex-binge drinkers were in an intermediate position between the two other groups (with no significant differences with respect to controls or binge drinkers). These findings suggest that binge drinking in young people may impair the neural functioning related to inhibitory processes, and that the cessation of binge drinking may act as a brake on the neurophysiological impairments related to response inhibition.

Beyond inhibition: a dual-process perspective to renew the exploration of binge drinking

Binge drinking is a widespread alcohol-consumption pattern in youth and is linked to cognitive consequences, mostly for executive functions. However, other crucial factors remain less explored in binge drinking and notably the emotional-automatic processes. Dual-process model postulates that addictive disorders are not only due to impaired reflective system (involved in deliberate behaviors), but rather to an imbalance between under-activated reflective system and over-activated affective-automatic one (involved in impulsive behaviors). This proposal has been confirmed in alcohol-dependence, but has not been tested in binge drinking. The observation of comparable impairments in binge drinking and alcohol-dependence led to the “continuum hypothesis,” suggesting similar deficits across different alcohol-related disorders. In this perspective, applying the dual-process model to binge drinking might renew the understanding of this continuum hypothesis. A three-axes research agenda will be proposed, exploring: (1) the affective-automatic system in binge drinking; (2) the systems’ interactions and imbalance in binge drinking; (3) the evolution of this imbalance in the transition between binge drinking and alcohol-dependence.

Binge drinking, reflection impulsivity, and unplanned sexual behavior: impaired decision-making in young social drinkers

BACKGROUND

The repeated pattern of heavy intoxication followed by withdrawal from alcohol (i.e., "binge drinking") has been found to have substantial adverse effects on prefrontal neural systems associated with decision-making and impulse control. Repeated binge drinking has been linked to risky and unplanned sexual behavior; however few studies have examined the role of impulsivity and related cognitive processes in understanding this association. The aim of this study was to examine the relationship between binge drinking, "reflection impulsivity" (deficits in gathering and evaluating information during decision-making), alcohol-related expectancies, and unplanned sexual behavior in a sample of young social drinkers.

METHODS

Ninety-two university students completed the alcohol use questionnaire (AUQ) to measure alcohol intake and binge drinking. Two groups (low-binge and high-binge) were generated from the AUQ data. The Information Sampling Task (IST) was used to measure reflection impulsivity; the Alcohol Expectancy Questionnaire (AEQ) for alcohol outcome expectancies; and an unplanned sexual behavior questionnaire, which asked about the number of unplanned sexual events.

RESULTS

When compared to the low-binge drinking group, the high-binge drinkers had significantly more unplanned sexual encounters and were impaired on the IST, reflection-impulsivity task. They scored higher on the alcohol expectancy factors of sociability, risk and aggression, negative self-perception, and in particular liquid courage. In a regression analysis, number of unplanned sexual encounters, binge drinking score, and liquid courage were all significantly related.

CONCLUSIONS

These results support the role of binge drinking in reduced impulse control and decision-making deficits. The findings indicate that high-binge drinkers demonstrate impairments on an impulse control task similar to that observed in dependent samples and this may be a factor in understanding the negative behavioral consequences associated with excessive alcohol use.

Experiences of pediatric emergency physicians in providing alcohol-related care to adolescents in the emergency department

OBJECTIVE

The emergency department (ED) is a key clinical care setting for identifying and managing patients with alcohol-related presentations. We explored the experiences of emergency physicians in providing alcohol-related care to adolescents.

METHODS

Purposeful sampling was used to identify pediatric emergency physicians with at least 1 year of experience (n = 12) from pediatric EDs across Canada. Data were collected via telephone using a semistructured interview guide. Hermeneutic phenomenology was used to identify common and unique experiences among respondents, using Moustakas' immersion/crystallization procedures.

RESULTS

Physicians expressed frustration with patient behaviors accompanying intoxication and described providing care as a struggle; developing an effective therapeutic alliance was challenging. Physicians believed intoxicated adolescent patients required more clinical time and resources than they could offer. Although physicians described the ED as unsuitable for ensuring continuity of care and addressing the broader social issues that accompany alcohol use, they did view the ED as a place to medically stabilize the patient and initiate a discussion on alcohol use and its harmful effects.

CONCLUSIONS

Pediatric ED physicians struggled during the caring experience and were skeptical that broader, more chronic social issues that are often associated with adolescent alcohol misuse can be effectively managed in a clinical setting where they feel primarily responsible for providing medical stabilization. Physicians did believe the ED was an appropriate place to ensure medical stability of a patient and then initiate a conversation regarding alcohol use and its harmful effects.

Neuropsychological functioning is compromised in binge drinking young adults with depression

For many young people, binge drinking is the most common form of alcohol misuse, particularly in those with a depressive disorder. Nonetheless, relatively little is known about the effects that the combination of depression and binge drinking has on neuropsychological outcomes. This study aimed to determine whether binge drinkers with depression show more pronounced neuropsychological dysfunction compared to their peers with depression alone or binge drinking alone. Neuropsychological testing was conducted on help-seeking young people (18-30 years) recently diagnosed with a depressive disorder and classified as either 'binge drinkers' (n=43) or 'non-bingers' (n=48). Two healthy control groups (i.e. binge drinkers, n=24 and non-bingers, n=21) were additionally recruited and also underwent the same testing. Qualitatively, binge-drinking patients with depression performed consistently below controls, depression alone, or binge drinking alone. In keeping with our hypotheses, visual learning and memory was significantly reduced in depressed binge drinkers, whereas mental flexibility was reduced at a trend level. There were no significant differences in neuropsychological performance in depressed alone or binge drinking alone individuals compared to controls. The findings suggest that when treating young people with a depressive disorder, strategies targeting binge drinking may contribute to preventing potential neurobiological changes underlying poorer long-term clinical outcomes.

Cold-inducible RNA-binding protein is an important mediator of alcohol-induced brain inflammation

Binge drinking has been associated with cerebral dysfunction. Ethanol induced microglial activation initiates an inflammatory process that causes upregulation of proinflammatory cytokines which in turn creates neuronal inflammation and damage. However, the molecular mechanism is not fully understood. We postulate that cold-inducible RNA-binding protein (CIRP), a novel proinflammatory molecule, can contribute to alcohol-induced neuroinflammation. To test this theory male wild-type (WT) mice were exposed to alcohol at concentrations consistent to binge drinking and blood and brain tissues were collected. At 5 h after alcohol, a significant increase of 53% in the brain of CIRP mRNA was observed and its expression remained elevated at 10 h and 15 h. Brain CIRP protein levels were increased by 184% at 10 h and remained high at 15 h. We then exposed male WT and CIRP knockout (CIRP^−/−) mice to alcohol, and blood and brain tissues were collected at 15 h post-alcohol infusion. Serum levels of tissue injury markers (AST, ALT and LDH) were significantly elevated in alcohol-exposed WT mice while they were less increased in the CIRP^−/− mice. Brain TNF-α mRNA and protein expressions along with IL-1β protein levels were significantly increased in WT mice, which was not seen in the CIRP^−/− mice. In cultured BV2 cells (mouse microglia), ethanol at 100 mM showed an increase of CIRP mRNA by 274% and 408% at 24 h and 48 h respectively. Corresponding increases in TNF-α and IL-1β were also observed. CIRP protein levels were markedly increased in the medium, suggesting that CIRP was secreted by the BV2 cells. From this we conclude that alcohol exposure activates microglia to produce and secrete CIRP and possibly induce pro-inflammatory response and thereby causing neuroinflammation. CIRP could be a novel mediator of alcohol-induced brain inflammation.

Adolescence and Alcohol: a review of the literature

Up to two thirds of adolescents consume alcohol and about a quarter engage in abusive behavior at some point. Many users begin alcohol use at young ages, and binge drinking is a dominant pattern for a proportion of youth. Because neurogenesis is inhibited by ethanol, consequences of adolescent alcohol abuse include changes in brain development and impairment of neurocognitive performance. A variety of mental and psychosocial problems are also often witnessed in alcohol abusing youth. Apart from the influence exerted by genetic and psychosocial factors, the chance of developing problematic alcohol consumption is increased by consumption in a binge drinking manner and by first contact with alcohol at a young age. Discrimination of alcohol consumption within the frames of normal adolescent behavior from problematic use is still a challenging issue. Different prevention programs provide treatment either directly to the adolescent, in the context of the school, or within the frame of the adolescent's family. Although some of these efforts have been shown to be effective in reducing alcohol misuse in youth, hardly any intervention reveals satisfactory outcomes in a long-term prospect. Successful prevention strategies would need to comprise treatment of current neuropsychological impairment as well as of comorbid mental health problems and concurrent other substance misuse.

Clinical classification in mental health at the cross-roads: which direction next?

BACKGROUND

After 30 years of consensus-derived diagnostic categories in mental health, it is time to head in new directions. Those categories placed great emphasis on enhanced reliability and the capacity to identify them via standardized checklists. Although this enhanced epidemiology and health services planning, it failed to link broad diagnostic groupings to underlying pathophysiology or specific treatment response.

DISCUSSION

It is time to adopt new goals that prioritize the validation of clinical entities and foster alternative strategies to support those goals. The value of new dimensions (notably clinical staging), that are both clinically relevant and directly related to emerging developmental and neurobiological research, is proposed. A strong emphasis on 'reverse translation' (that is, working back from the clinic to the laboratory) underpins these novel approaches. However, it relies on using diagnostic groupings that already have strong evidence of links to specific risk factors or patterns of treatment response.

SUMMARY

The strategies described abandon the historical divides between clinical neurology, psychiatry and psychology and adopt the promotion of pathways to illness models.

Depressive symptoms are a vulnerability factor for heavy episodic drinking: a short-term, four-wave longitudinal study of undergraduate women

Heavy episodic drinking is increasingly common among undergraduate women. Cross-sectional research suggests that depressive symptoms and heavy episodic drinking are related. Nonetheless, surprisingly little is known about whether depressive symptoms are an antecedent of heavy episodic drinking, a consequence of heavy episodic drinking, or both. Such knowledge is essential to the accurate conceptualization of heavy episodic drinking, depressive symptoms, and their interrelations. In the present short-term longitudinal study, depressive symptoms and heavy episodic drinking were proposed to reciprocally influence each other over time, with depressive symptoms predicting changes in heavy episodic drinking over 1 week and vice versa. This reciprocal relations model was tested in 200 undergraduate women using a 4-wave, 4-week longitudinal design. Structural equation modeling was used to conduct cross-lagged analyses testing reciprocal relations between depressive symptoms and heavy episodic drinking. Consistent with hypotheses, both depressive symptoms and heavy episodic drinking were temporally stable, and depressive symptoms predicted changes in heavy episodic drinking over 1 week. Contrary to hypotheses, heavy episodic drinking did not predict changes in depressive symptoms over 1 week. Results are consistent with a vulnerability model suggesting depressive symptoms leave undergraduate women vulnerable to heavy episodic drinking. For undergraduate women who are struggling with feelings of sadness, worthlessness, and hopelessness, heavy episodic drinking may provide a temporary yet maladaptive means of avoiding or alleviating depressive symptoms.