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Ingesson-Hammarberg S, Molander O, Hammarberg A. Clinical cutoffs of the Alcohol Use Disorder Identification Test for identification of DSM-5 alcohol use disorder: A psychometric evaluation in treatment-seeking patients. Drug Alcohol Depend 2024; 256:111115. [PMID: 38364648 DOI: 10.1016/j.drugalcdep.2024.111115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
The AUDIT is considered a gold-standard self-rating instrument used in various settings for the identification of alcohol use disorders. Although the AUDIT is widely used, there is not yet a consensus concerning the clinical cutoff for the identification of an alcohol use disorder according to the DSM-5. The current study aimed to investigate the optimal gender-based cutoffs on both AUDIT and AUDIT-C for different levels of AUD severity according to DSM-5. METHODS A sample (n=271) was collected from two clinical trials including adult individuals with no AUD, and AUD recruited at a specialized addiction clinic, in Stockholm, Sweden. Receiver operating characteristic curves were estimated for AUDIT and AUDIT-C scores on AUD severity levels using dichotomized variables for each diagnostic level. Optimal cutoff scores were decided based on the measures of sensitivity, specificity and Youden's Index. RESULTS The optimal cutoff score for both men and women was 7 on the AUDIT as the diagnostic threshold, i.e., mild AUD. For both moderate and severe AUD, the optimal cutoff score was 18/16 in men/women. On AUDIT-C, the optimal cutoff score was suggested to be 6/4 in men/women, and was suggested as one common cutoff score for all levels of AUD. DISCUSSION In a treatment-seeking sample, gender-based cutoffs on AUDIT were not motivated, instead seven was suggested as the common diagnostic threshold for a mild AUD. On AUDIT-C, a general cutoff for all levels of AUDs was suggested, and gender specific cutoffs were justified to achieve optimal sensitivity to detect an AUD.
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Affiliation(s)
- S Ingesson-Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden.
| | - O Molander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - A Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
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Ingram PF, Finn PR. The nomological network of drinker identity: A scoping review. Addict Behav 2023; 141:107654. [PMID: 36791641 PMCID: PMC10031804 DOI: 10.1016/j.addbeh.2023.107654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/18/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Despite the growing interest in the construct of drinker identity and empirical evidence for its role in drinking behavior, there is a paucity of papers that evaluate and integrate the results of studies on drinker identity, leaving a gap in our knowledge of the importance of the drinker identity construct. The current paper addresses this gap by reviewing and integrating the results of the studies of drinker identity. METHODS The scoping review identified, retrieved, and evaluated the existing literature regarding drinker identity. English language studies from EBSCOHost, PubMed, ScienceDirect, and Scopus databases were reviewed. Studies were included in the review if they were data-based studies or theoretical publications with drinker identity as the primary topic published in peer-reviewed journals. Studies were reviewed and coded based on their reported methodology and findings and codes were used to integrate and present findings. RESULTS This review advances this line of research in four ways. First, the operationalization of drinker identity is evaluated by examining the theoretical frameworks defining the construct. Second, the conceptualization and measurement of drinker identity is assessed, with suggestions for future measurement research. Third, an integrated framework of predictors, outcomes, moderators, and mediators is presented. Finally, the research gaps, future recommendations, and clinical implications are discussed. CONCLUSIONS There is a need for continued research, specifically research which aims to standardize and improve measurement of drinker identity, considers longitudinal and developmental processes, and broadens the research samples and settings.
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Affiliation(s)
- Polly F Ingram
- Department of Psychological and Brain Sciences, 1101 E 10th St, Indiana University, Bloomington, IN 47405, United States.
| | - Peter R Finn
- Department of Psychological and Brain Sciences, 1101 E 10th St, Indiana University, Bloomington, IN 47405, United States
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3
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Lee CM, Cadigan JM, Kilmer JR, Cronce JM, Suffoletto B, Walter T, Fleming C, Lewis MA. Brief Alcohol Screening and Intervention for Community College Students (BASICCS): Feasibility and preliminary efficacy of web-conferencing BASICCS and supporting automated text messages. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:840-851. [PMID: 34110840 PMCID: PMC8942086 DOI: 10.1037/adb0000745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective: The Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff et al., 1999) is an evidence-based approach to reduce high-risk drinking and associated harms; however, implementation may present challenges for community colleges (CCs) that have limited budgets and mostly non-residential students. We examined feasibility, acceptability, and efficacy of BASICS for CC students (BASICCS) delivered remotely via web-conferencing with supporting automated text messages. Method: Participants included 142 CC students who reported exceeding National Institute on Alcohol Abuse and Alcoholism (NIAAA's) weekly low-risk drinking recommendations and/or heavy episodic drinking (HED). Participants were randomized to BASICCS or assessment-only control (AOC) and completed 1- and 3-month follow-up assessments. Results: Most students liked the personalized information in the program and found the web-conferencing platform useful, however intervention completion rate was 56%. Significant differences were found between BASICCS and AOC. At 1-month, individuals in BASICCS had 33% fewer alcohol consequences than those in AOC. At 3-month follow-up, individuals in BASICCS had lower estimated peak blood alcohol concentration, 29% fewer drinks per week, 62% fewer episodes of HED, and 24% fewer consequences than those in AOC. Conclusions: BASICCS showed evidence of being acceptable and the technology proved feasible, although the intervention completion rate in the non-treatment-seeking volunteer sample was modest. Preliminary evidence does suggest BASICCS shows promise in reducing alcohol use and consequences. Technology-based platforms could be a viable prevention solution for CC students. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Christine M. Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Jason R. Kilmer
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Jessica M. Cronce
- Department of Counseling Psychology and Human Services, University of Oregon
| | | | - Theresa Walter
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Charles Fleming
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Melissa A. Lewis
- Department of Health Behavior and Health Systems, University of North Texas Health Sciences Center, Fort Worth TX
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Davier MV. Commentary: Matching IRT Models to PRO Constructs- Modeling Alternatives, and Some Thoughts on What Makes a Model Different. PSYCHOMETRIKA 2021; 86:825-832. [PMID: 34342818 DOI: 10.1007/s11336-021-09790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/14/2021] [Indexed: 06/13/2023]
Abstract
This commentary is an attempt to present some additional alternatives to the suggestions made by Reise et al. (2021). IRT models as they are used for patient-reported outcome (PRO) scales may not be fully satisfactory when used with commonly made assumptions. The suggested change to an alternative parameterization is critically reflected with the intent to initiate discussion around more comprehensive alternatives that allow for more complex latent structures having the potential to be more appropriate for PRO scales as they are applied to diverse populations.
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Montes KS, Pearson MR. I am what I am: A meta-analysis of the association between substance user identities and substance use-related outcomes. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:231-246. [PMID: 33829814 DOI: 10.1037/adb0000721] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Research indicates that a substance user identity (i.e., drinking, smoking, and marijuana identity) is positively correlated with substance use-related outcomes (e.g., frequency, quantity, consequences, and disorder symptoms). The current study aimed to meta-analytically derive single, weighted effect size estimates of the identity-outcome association as well as to examine moderators (e.g., substance use type, explicit/implicit assessment, demographic characteristics, and research design) of this association. METHOD Random effects meta-analysis was conducted on 70 unique samples that assessed substance user identity and at least one substance use-related outcome (frequency, quantity, consequences, and/or disorder symptoms), and provided the necessary information for effect size calculations. RESULTS Substance user identity was found to be a statistically significant moderate-to-large correlate of all substance use-related outcomes examined in the current study (r w = .365, p < .001, rw² = .133). The strongest associations were observed between identity and disorder symptoms (alcohol) and frequency of substance use (tobacco or marijuana). In terms of moderators of the identity-outcome association, the link between explicit drinking identity and alcohol use-related outcomes appeared to be stronger in magnitude than the relationship between implicit drinking identity and alcohol use-related outcomes; however, this difference appears to be largely due to the finding that implicit measures have lower reliability. The strongest identity-outcome association was observed among younger individuals. CONCLUSIONS Substance user identity is clearly an important correlate of substance use-related outcomes and this association is stronger among younger individuals. Additional theoretical, empirical, and intervention research is needed to utilize knowledge gleaned from the current study on the identity-outcome association. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Montanaro EA, Magnan R. A latent profile analysis using the theory of planned behavior to predict alcohol use. Psychol Health 2021; 37:799-810. [PMID: 33775196 DOI: 10.1080/08870446.2021.1903462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The current study sought to identify subgroups of adult drinkers who differ in their level of association between alcohol-related Theory of Planned Behavior (TPB) constructs (attitudes, perceived norms, self-efficacy, and intentions), and explore if distinct subgroup profiles relate to alcohol use two weeks later. DESIGN Participants (N = 121) were recruited to participate in a two-week study about daily experiences with exercise and alcohol (Mage = 30.93; SDage = 9.88; 59.2% female; 71.1% Caucasian). MAIN OUTCOME MEASURES Alcohol attitudes, subjective norms, alcohol refusal self-efficacy, and intentions were used to create class membership. Behavioral outcomes included (1) drinking frequency, (2) drinking quantity, and (3) drinking to get drunk. RESULTS Two classes of drinkers were determined - Class 1 was categorized by moderate scores on all constructs, whereas Class 2 was categorized by moderate scores on attitudes and high scores on norms, alcohol refusal self-efficacy, and intentions. Class designation was associated with frequency, but not quantity of use. CONCLUSION The current study suggests that a minority of individuals who score moderately across all constructs should receive intervention efforts that focus on just those included in the TPB, while the vast majority may require additional constructs to be addressed.
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Affiliation(s)
- Erika A Montanaro
- Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Renee Magnan
- Department of Psychology, Washington State University, Vancouver, WA, USA
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Paulus DJ, Gallagher MW, Neighbors C, Zvolensky MJ. Computer-delivered personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity: A pilot randomized controlled trial. Behav Res Ther 2021; 141:103847. [PMID: 33813352 DOI: 10.1016/j.brat.2021.103847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/05/2020] [Accepted: 03/15/2021] [Indexed: 12/29/2022]
Abstract
Hazardous drinkers with emotional vulnerabilities (e.g., elevated anxiety sensitivity) remain an underserved group. This study aimed to evaluate the feasibility, acceptability, and initial efficacy of a single session remotely-delivered personalized feedback intervention (PFI) targeting alcohol (mis)use and anxiety sensitivity among college students. Hazardous drinkers with elevated anxiety sensitivity (N = 125; 76.8% female; Mage = 22.14; 66.4% racial/ethnic minorities) were randomized to receive the integrated PFI (n = 63) or attention control (n = 62). Follow-up assessments were conducted one-week, one-month and three-months post-intervention. Latent growth curve modeling was used to test pilot outcomes. It was feasible to recruit and retain hazardous drinking students with elevated anxiety sensitivity through follow-up with no group differences in retention. The integrated PFI was rated as more acceptable than the control with medium/large differences (p's < 0.004; d's = 0.54-0.80). The integrated PFI group had statistically significantly greater change in primary outcomes: motivation, hazardous alcohol use, and anxiety sensitivity (p's < 0.05; d's = 0.08-0.37) with larger within-group effect sizes (d's = 0.48-0.61) than in control (d's = 0.26-0.54). Despite a small sample size, this one-session intervention offers promise among a high-risk group of drinkers with emotional vulnerabilities. The computer-based format may allow for mass distribution of a low-cost intervention in the future; however, follow-up testing in larger samples is needed.
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Affiliation(s)
- Daniel J Paulus
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, 15213, USA.
| | - Matthew W Gallagher
- University of Houston, Department of Psychology, Houston, TX, 77204, USA; University of Houston, Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, 77204, USA
| | - Clayton Neighbors
- University of Houston, Department of Psychology, Houston, TX, 77204, USA
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, 77204, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, 77030, USA; Health Institute, University of Houston, Houston, TX, 77204, USA
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Zhao J, Linn B, Bradizza C, Lucke J, Ruszczyk M, Stasiewicz P. Heterogeneity in DSM-5 Symptom Criteria: Phenotypes of Alcohol Use Disorder in a Sample Seeking Alcohol Treatment. Alcohol Alcohol 2021; 56:660-668. [PMID: 33420777 DOI: 10.1093/alcalc/agaa138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS This study sought to identify phenotypic variations among individuals with alcohol use disorder (AUD) that may, in part, help improve the effectiveness of existing AUD interventions. METHODS Latent class analysis was conducted to examine the potential heterogeneity of AUD in a sample (N = 220; Mage = 51.19 years, standard deviation = 9.94; 37.7% female) of treatment-seeking participants diagnosed with AUD using DSM-5 criteria. RESULTS AND CONCLUSIONS Three distinct patterns of responses to the 11 DSM-5 AUD symptoms emerged: Class 1 (n = 114, 51.8%), Class 2 (n = 78, 35.5%) and Class 3 (n = 28, 12.7%). The identified profiles were further differentiated by demographics, alcohol-related constructs, individual difference characteristics and diagnostic and treatment variables. The findings have implications for refining AUD assessment as well as optimizing personalized treatment.
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Affiliation(s)
- Junru Zhao
- School of Social Work, University at Buffalo-The State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
| | - Braden Linn
- Clinical and Research Institute on Addictions, University at Buffalo-The State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
| | - Clara Bradizza
- School of Social Work, University at Buffalo-The State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
| | - Joseph Lucke
- Department of Psychiatry, University at Buffalo-The State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
| | - Melanie Ruszczyk
- School of Social Work, University at Buffalo-The State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
| | - Paul Stasiewicz
- School of Social Work, University at Buffalo-The State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
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Mejldal A, Andersen K, Bilberg R, Möller S, Nielsen AS. DSM-5 Latent Classes of Alcohol Users among Treatment Seeking Older Adults. Subst Use Misuse 2020; 55:1214-1222. [PMID: 32107951 DOI: 10.1080/10826084.2020.1731546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Understanding the variation of alcohol use disorder (AUD) among a clinical sample of patients aged 60 and older, by identifying latent classes of AUD and exploring risk factors and outcomes of treatment associated with the class. Method: We used the Danish subsample (n = 341) from the Elderly Study. Latent class analysis was used to identify classes based on the 11 symptoms of DSM-5 AUD. We analyzed the associations between class membership and sociodemographic variables, alcohol consumption, and drinking-related outcome of treatment. Results: Three latent classes were identified. Individuals in the low-symptomatic class (34.85%) displayed low endorsement of DSM-5 criteria "Withdrawal", "Time Spent", "Less activities" compared to the other classes, and had fewest drinks per drinking day. Individuals in the moderate-symptomatic class (32.69%) were most likely to be intoxicated in hazardous situations, and those in the high-symptomatic class (32.47%) displayed, with a few exceptions, the highest probabilities of all DSM-5 criteria. Female gender, living alone and prior AUD treatment was associated with increased risk of being in the high-symptomatic class. No difference between classes was found with respect to years with AUD and frequency of drinking days, and latent class membership had no effect on drinking outcome after treatment, when controlling for baseline. Conclusions: Three classes of DSM-5 AUD among older adults in treatment emerged, displaying a low-moderate-high distribution, advocating for a unidimensional construct of DSM-5 AUD. Although different with respect to baseline risk factors, no strong connection between DSM-5 latent class and alcohol consumption after AUD treatment was found.HighlightsAmong 341 older alcohol use disorder (AUD) outpatients, three latent classes of DSM-5 AUD emerged.The classes of DSM-5 AUD displayed a low-moderate-high endorsement of DSM-5 AUD characteristics.The three classes had similar alcohol-related treatment outcomes.
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Affiliation(s)
- Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark.,Department of Mental Health Odense, Region of Southern Denmark, Odense, Denmark
| | - Randi Bilberg
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
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Long EC, Ohlsson H, Sundquist J, Sundquist K, Kendler KS. Different Characteristics and Heritabilities of Alcohol Use Disorder Classes: A Population-Based Swedish Study. Alcohol Alcohol 2019; 54:647-655. [PMID: 31556919 DOI: 10.1093/alcalc/agz069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/23/2019] [Accepted: 07/14/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The aims of the present study are to identify alcohol use disorder (AUD) classes among a population-based Swedish sample, determine if these classes differ by variables known to be associated with AUD and determine whether some AUD classes have stronger genetic influences than others. METHODS A latent class analysis (LCA), based on types of registrations, was conducted on Swedish individuals with an AUD registration born between 1960 and 1990 (N = 184,770). These classes were then validated using demographics; patterns of comorbidity with drug abuse, psychiatric disorders and criminal behavior; and neighborhood-level factors, i.e. peer AUD and neighborhood deprivation. The degree of genetic and environmental influence was also investigated. RESULTS The best-fit LCA had four classes: (a) outpatient/prescription, characterized by a mix of outpatient medical and prescription registrations, (b) low-frequency inpatient, characterized entirely by inpatient medical registrations, with the majority of individuals having one AUD registration, (c) high-frequency mixed, characterized by a mix of all four registration types, with the majority having four or more registrations and (d) crime, characterized almost entirely by criminal registrations. The highest heritability for both males and females was found for Class 3 (61% and 65%, respectively) and the lowest for Class 1 (20% for both), with shared environmental influences accounting for 10% or less of the variance in all Classes. CONCLUSIONS Using comprehensive, nationwide registry data, we showed evidence for four distinct, meaningful classes of AUD with varying degrees of heritability.
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Affiliation(s)
- E C Long
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, 314 Biobehavioral Health Building, University Park, PA 16802, USA
| | - H Ohlsson
- Center for Primary Health Care Research, Clinical Research Center, Lund University, Box 50332, 202 13 Malmö, Sweden
| | - J Sundquist
- Center for Primary Health Care Research, Clinical Research Center, Lund University, Box 50332, 202 13 Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., New York, NY 10029, USA
| | - K Sundquist
- Center for Primary Health Care Research, Clinical Research Center, Lund University, Box 50332, 202 13 Malmö, Sweden.,Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl., New York, NY 10029, USA
| | - K S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, 800 E. Leigh St., Biotech One, Suite 100, Richmond, VA 23219, USA.,Department of Psychiatry, Virginia Commonwealth University, 1200 East Broad St., P.O. Box 980710, Richmond, VA 23298, USA.,Department of Human and Molecular Genetics, Virginia Commonwealth University, 1101 East Marshall St., Box 980033, Richmond, VA 23298, USA
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Linden-Carmichael AN, Dziak JJ, Lanza ST. Dynamic Features of Problematic Drinking: Alcohol Use Disorder Latent Classes Across Ages 18-64. Alcohol Alcohol 2019; 54:97-103. [PMID: 30351364 DOI: 10.1093/alcalc/agy074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/04/2018] [Indexed: 01/09/2023] Open
Abstract
Aims Alcohol use disorders (AUDs) are linked with numerous severe detrimental outcomes. Evidence suggests that there is a typology of individuals with an AUD based on the symptoms they report. Scant research has identified how these groups may vary in prevalence by age, which could highlight aspects of problematic drinking behavior that are particularly salient at different ages. Our study aimed to (a) identify latent classes of drinkers with AUD that differ based on symptoms of AUD and (b) examine prevalences of latent classes by age. Short summary Our findings advocate for personalized treatment approaches for AUD and highlight the need for carefully considering the role of age in prevention and intervention efforts. Methods We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Current drinkers aged 18-64 who met criteria for a past-year AUD were included (n = 5402). Results Latent class analysis (LCA) based on 11 AUD criteria revealed 5 classes: 'Alcohol-Induced Injury' (25%), 'Highly Problematic, Low Perceived Life Interference' (21%), 'Adverse Effects Only' (34%), 'Difficulty Cutting Back' (13%) and 'Highly Problematic' (7%). Using time-varying effect modeling (TVEM), each class was found to vary in prevalence across age. The Adverse Effects Only and Highly Problematic, Low Perceived Life Interference classes were particularly prevalent among younger adults, and the Difficulty Cutting Back and Alcohol-Induced Injury classes were more prevalent as age increased. Conclusions Findings suggest that experience of AUD is not only heterogeneous in nature but also that the prevalence of these subgroups vary across age.
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Affiliation(s)
- Ashley N Linden-Carmichael
- Department of Biobehavioral Health and the Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 314 Biobehavioral Health, University Park, PA, USA
| | - John J Dziak
- The Methodology Center, The Pennsylvania State University, 408 Health and Human Development Building, University Park, PA, USA
| | - Stephanie T Lanza
- Department of Biobehavioral Health and the Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 314 Biobehavioral Health, University Park, PA, USA
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Boness CL, Lane SP, Sher KJ. Not all alcohol use disorder criteria are equally severe: Toward severity grading of individual criteria in college drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:35-49. [PMID: 30676037 DOI: 10.1037/adb0000443] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol use disorder (AUD) diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) contains a severity gradient based on number of criteria endorsed, implicitly assuming criteria are interchangeable. However, criteria vary widely in endorsement rates, implying differences in the latent severity associated with a symptom (e.g., Lane, Steinley, & Sher, 2016) and demonstrating criteria are not interchangeable (Lane & Sher, 2015). We evaluated whether variation in the severity of criteria could be resolved by employing multiple indicators of each criterion varying in item-level severity. We assessed 909 undergraduate students aged 18 years or older with at least 12 drinking occasions in the past year. Participants self-administered questions on alcohol consumption and past year AUD symptoms via an online survey. For each of the 11 AUD criteria, we selected three indicators based on the difficulty values of the one-parameter logistic item response theory model ranging from low to high. We first tested a higher order AUD factor defined by 11 lower order criterion factors, χ2(551) = 2,959.35, p < .0001; root mean square error of approximation = 0.09. The 33 items were used to create severity scores: a criterion count (0-11), symptom count (0-33), and factor scores derived from a bifactor model. Though our new scores resulted in incremental validity over DSM-5 across a range of external validators, when the standardized regression estimates were compared, the new scores did not consistently outperform the DSM-5 suggesting this approach is viable for developing more sensitive diagnostic instruments but needs further refinement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Sean P Lane
- Department of Psychological Sciences, Purdue University
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri
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Blevins CE, Abrantes AM, Anderson BJ, Caviness CM, Herman DS, Stein MD. A longitudinal evaluation of the role of alcohol self-concept in alcohol use, motives, negative affect, and alcohol-related problems among emerging adults. Am J Addict 2018; 27:501-508. [DOI: 10.1111/ajad.12768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/13/2018] [Accepted: 07/08/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Claire E. Blevins
- Butler Hospital; Behavioral Medicine and Addictions Research; Providence Rhode Island
- Department of Psychiatry and Human Behavior; Alpert Medical School of Brown University; Providence Rhode Island
| | - Ana M. Abrantes
- Butler Hospital; Behavioral Medicine and Addictions Research; Providence Rhode Island
- Department of Psychiatry and Human Behavior; Alpert Medical School of Brown University; Providence Rhode Island
| | - Bradley J. Anderson
- Butler Hospital; Behavioral Medicine and Addictions Research; Providence Rhode Island
| | - Celeste M. Caviness
- Butler Hospital; Behavioral Medicine and Addictions Research; Providence Rhode Island
| | - Debra S. Herman
- Butler Hospital; Behavioral Medicine and Addictions Research; Providence Rhode Island
- Department of Psychiatry and Human Behavior; Alpert Medical School of Brown University; Providence Rhode Island
| | - Michael D. Stein
- Butler Hospital; Behavioral Medicine and Addictions Research; Providence Rhode Island
- Department of Health Law, Policy, and Management; Boston University; Boston Massachusetts
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Luquiens A, Said AB, Sadik H, Ferrer Sánchez Del Villar E, Le Manach A, Ambrosino B, Tzourio C, Benyamina A, Aubin HJ. Alcohol consumption, drinker identity, and quality of life among students: why there cannot be one prevention strategy for all. Qual Life Res 2018; 27:2629-2637. [PMID: 29934797 DOI: 10.1007/s11136-018-1923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The objective for this study was to combine drinking characteristics and two subjective measures, drinker identity and alcohol-related quality of life, i.e., negative impact of alcohol on quality of life, to determine relevant profiles for indicated prevention programs. In particular, we hypothesized that different profiles of students with high level of alcohol consumption exist when exploring subjectivity. METHODS We performed an online survey among 16,930 students. We collected sociodemographics and environmental data, including alcohol-related quality of life, drinker identity, and drinking characteristics. We performed a hierarchical clustering on principal components. We described all variables in each cluster and explored between clusters differences by Kruskal-Wallis tests. RESULTS We identified five clusters as regarding drinker identity, drinking characteristics, and alcohol-related quality of life. Among these five clusters, three clusters presented high drinking characteristics. A very vulnerable cluster showed high level of alcohol consumption, impact on quality of life and on academic results, and strong drinker identity. An egodystonic cluster showed high level of consumption, mild impact on quality of life and on academic results, but low drinker identity. A cluster seemed short-term super-adapted in heavy drinking environment, showing high level of alcohol consumption and drinker identity, but low impact on quality of life and on academic results (all between clusters p values < 0.001 with Kruskal-Wallis tests). CONCLUSION The subjective experience of students from these clusters was significantly different (p value < 0.001), and could explain some inadequacy of certain prevention strategies, considering binge drinker student as a homogeneous group. Prospective studies are needed to explore changes over time of these clusters.
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Affiliation(s)
- Amandine Luquiens
- Addiction department, Hôpital Paul Brousse, APHP, 12 avenue Paul Vaillant-Couturier, 94804, Villejuif cedex, France. .,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France. .,CMAP, Ecole Polytechnique, Palaiseau, France.
| | | | - Haïm Sadik
- Ecole Centrale-Supélec Paris, Paris, France
| | | | | | | | - Christophe Tzourio
- Team HEALTHY, Bordeaux Population Health Research Center, INSERM, Univ. Bordeaux, UMR 1219, CHU Bordeaux, 33000, Bordeaux, France
| | - Amine Benyamina
- Addiction department, Hôpital Paul Brousse, APHP, 12 avenue Paul Vaillant-Couturier, 94804, Villejuif cedex, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - Henri-Jean Aubin
- Addiction department, Hôpital Paul Brousse, APHP, 12 avenue Paul Vaillant-Couturier, 94804, Villejuif cedex, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
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Blevins CE, Abrantes AM, Anderson BJ, Caviness CM, Herman DS, Stein MD. Identity as a cannabis user is related to problematic patterns of consumption among emerging adults. Addict Behav 2018; 79:138-143. [PMID: 29289853 DOI: 10.1016/j.addbeh.2017.12.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Cannabis use has become a more normative, socially-acceptable behavior in the United States, despite research indicating that frequent use may become problematic for some individuals. Emerging adulthood, a time of identity development, is the most common time for cannabis use. Cannabis self-concept, or one's identification with cannabis as part of their personality or identity, is one factor that may influence use behavior. This study extends previous research that reported a link between self-concept, motivational factors, and normative beliefs by evaluating relationships between cannabis self-concept, motives for use, motivation to change, perceived descriptive norms, as well as cannabis-related outcomes (use, using alone, and cannabis-related problems). METHODS Emerging adults who used cannabis in the previous month (n=345, 53.9% male, mean age 21.0, 67.5% Non-Latino White) were recruited from a community sample for a health behaviors study. Participants were assessed for explicit cannabis self-concept, frequency of use, problems associated with use, motives for use, motivation to change, and normative beliefs about others' use. RESULTS Participants reported using cannabis on an average of 17.9 (SD=11.1) days of the previous month. Correlational analyses revealed that cannabis self-concept was positively associated with frequency of use, use-related problems, several motives for use, descriptive norms, and with using cannabis alone. Multivariate analyses revealed that rates of use, problems, and social and enhancement motives were independently and positively associated (p<0.05) with cannabis self-concept, while self-concept was negatively associated with desire to reduce cannabis use. CONCLUSIONS Cannabis self-concept may be a marker for more problematic patterns of use.
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Lee CK, Corte C, Stein KF. Drinker Identity: Key Risk Factor for Adolescent Alcohol Use. THE JOURNAL OF SCHOOL HEALTH 2018; 88:253-260. [PMID: 29399840 DOI: 10.1111/josh.12603] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/13/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adolescent alcohol use continues to be a critical public health problem with both short- and long-term negative health consequences. Defining oneself in terms of alcohol, a drinking-related identity, has been shown to predict high levels of alcohol use. Because adolescence is the developmental period during which identity development is most salient, preventing the development of the drinker identity and early identification of youth who have a developing drinker identity may be important for prevention and early intervention. METHODS We review the theory- and evidence-based literature about identity development and the effects of a drinker identity on alcohol use behaviors in adolescents, discuss potential determinants of the drinker identity, and discuss future implications for practice and research. RESULTS There is some evidence that the drinker identity forms in early adolescence and becomes more well-developed during adolescence. The drinker identity predicts alcohol use behaviors both concurrently and over time in adolescence and young adulthood. There is also some evidence that early exposure to alcohol may contribute to formation of the drinker identity. CONCLUSIONS Identity-based approaches may be promising strategies to identify adolescents who are at risk for alcohol use and to intervene with early prevention or treatment within the school setting.
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Affiliation(s)
- Chia-Kuei Lee
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan
| | - Colleen Corte
- College of Nursing, University of Illinois at Chicago, 845 South Damen Avenue, Chicago, IL 60612
| | - Karen F Stein
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642
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Harrell PT, Naqvi SMH, Plunk AD, Ji M, Martins SS. Patterns of youth tobacco and polytobacco usage: The shift to alternative tobacco products. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:694-702. [PMID: 27668320 PMCID: PMC5440212 DOI: 10.1080/00952990.2016.1225072] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/19/2016] [Accepted: 07/31/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite significant declines in youth cigarette smoking, overall tobacco usage remains over 20% as non-cigarette tobacco product usage is increasingly common and polytobacco use (using 1+ tobacco product) remains steady. OBJECTIVES The present study was designed to identify patterns of youth tobacco use and examine associations with sociodemographic characteristics and tobacco dependence. METHODS The current analysis uses Latent Class Analysis (LCA) to examine the 6,958 tobacco users (n = 2,738 female) in the National Youth Tobacco Survey (2012 and 2013). We used as indicators past month use of tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookah, snus, pipes, bidis, and kreteks) and regressed resulting classes on sociodemographic characteristics and tobacco dependence. RESULTS Nine classes emerged: cigarette smokers (33.4% of sample, also included small probabilities for use of cigars and e-cigarettes), cigar smokers (16.8%, nearly exclusive), smokeless tobacco users (12.3%, also included small probabilities for cigarettes, cigars, snus), hookah smokers (11.8%), tobacco smokers/chewers (10.7%, variety of primarily traditional tobacco products), tobacco/hookah smokers (7.2%), tobacco/snus/e-cig users (3.3%), e-cigarette users (2.9%,), and polytobacco users (1.7%, high probabilities for all products). Compared to cigarette smokers, tobacco/hookah smokers and hookah smokers were more likely to report Hispanic ethnicity. Polytobacco users were more likely to report dependence (AOR:2.77, 95% CI:[1.49-5.18]), whereas e-cigarette users were less likely (AOR:0.49, 95% CI:[0.24-0.97]). CONCLUSION Findings are consistent with other research demonstrating shifts in adolescent tobacco product usage towards non-cigarette tobacco products. Continuous monitoring of these patterns is needed to help predict if this shift will ultimately result in improved public health.
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Affiliation(s)
- Paul T Harrell
- a Department of Pediatrics, Eastern Virginia Medical School , Norfolk , VA , USA
| | | | - Andrew D Plunk
- a Department of Pediatrics, Eastern Virginia Medical School , Norfolk , VA , USA
| | - Ming Ji
- b Department of Statistics/Biostatistics, College of Nursing , University of South Florida , Tampa , FL , USA
| | - Silvia S Martins
- c Department of Epidemiology , Columbia University Mailman School of Public Health , New York , NY , USA
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18
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Implicit and explicit drinking identity predict latent classes that differ on the basis of college students' drinking behaviors. Drug Alcohol Depend 2017; 178:579-585. [PMID: 28755560 PMCID: PMC5584548 DOI: 10.1016/j.drugalcdep.2017.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to identify distinct classes of college students on the basis of recent and past drinking behaviors and evaluate how implicit and explicit measures of drinking identity predict membership in these classes. METHODS US undergraduate students (N=456) completed online implicit (Implicit Association Test) and explicit (self-report) measures of drinking identity and assessments of drinking behaviors, including past month drinking, at-risk drinking in the past year, and lifetime history of intoxication. Latent class analysis (LCA) was used to identify classes of college students based on their drinking behaviors. RESULTS LCA identified five classes: (1) Lifetime Nondrinker, (2) Recent Nondrinker/Past Risk, (3) Light Drinker, (4) Moderate Drinker, and (5) Heavy Drinker. Overall, stronger implicit and explicit drinking identities were uniquely associated with greater odds of belonging to classes with greater alcohol consumption and related consequences relative to those classes characterized by lower alcohol consumption and consequences. Notably, explicit drinking identity was positively associated with odds of membership to the Recent Nondrinker/Past Risk class relative to the Lifetime Nondrinker and Light Drinker classes, and implicit and explicit drinking identities were positively associated with odds of membership to the Heavy Drinker class relative to all other classes. CONCLUSIONS Findings suggest that drinking identity is sensitive to risky drinking experiences in the past, is especially strong among the highest-risk group of college student drinkers, and may be an important cognitive factor to consider as a target for intervention.
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Cole VT, Bauer DJ, Hussong AM, Giordano ML. An Empirical Assessment of the Sensitivity of Mixture Models to Changes in Measurement. STRUCTURAL EQUATION MODELING : A MULTIDISCIPLINARY JOURNAL 2017; 24:159-179. [PMID: 29075091 PMCID: PMC5653313 DOI: 10.1080/10705511.2016.1257354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The current study explored the extent to which variations in self-report measures across studies can produce differences in the results obtained from mixture models. Data (N = 854) come from a laboratory analogue study of methods for creating commensurate scores of alcohol- and substance-use-related constructs when items differ systematically across participants for any given measure. Items were manipulated according to four conditions, corresponding to increasing levels of alteration to item stems, response options, or both. In Study 1, results from latent class analyses (LCA) of alcohol consequences were compared across the four conditions, revealing differences in class enumeration and configuration. In Study 2, results from factor mixture models (FMM) of alcohol expectancies were compared across two of the conditions, revealing differences in patterns and magnitude of the factor loadings and thresholds. The results suggest that even subtle differences in measurement can have substantively meaningful effects on mixture model results.
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Affiliation(s)
- Veronica T Cole
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill
| | - Daniel J Bauer
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill
| | - Andrea M Hussong
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill
| | - Michael L Giordano
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill
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Lindgren KP, Neighbors C, Gasser ML, Ramirez JJ, Cvencek D. A review of implicit and explicit substance self-concept as a predictor of alcohol and tobacco use and misuse. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:237-246. [PMID: 27715328 DOI: 10.1080/00952990.2016.1229324] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This paper provides an overview of the self-concept as it relates to substance use. Self-concept has a long history in psychological theory and research; however, substance self-concept (e.g., viewing one's self as a drinker or smoker) is an understudied area of research with the potential to expand existing conceptualizations of substance use, addiction, and prevention and treatment efforts, and should receive greater research attention. OBJECTIVES First, we review and provide a theoretical framework of substance self-concept that draws from dual process models and distinguishes between implicit and explicit self-concept. Next, we summarize key findings related to substance use in the extant literature, focusing on alcohol and tobacco (smoking). RESULTS Across both substances, there is converging evidence that substance self-concept is associated with substance use outcomes, including quantity and frequency of use and problems associated with use, and that change in substance self-concept is associated with recovery from substance misuse. Recommendations for the substance self-concept research agenda include routine assessment of substance self-concept, expanded use of implicit measures, investigation of moderators of substance self-concept, and targeting substance self-concept directly in prevention and intervention efforts. CONCLUSION Ultimately, we suggest that substance self-concept is a promising, but understudied, construct. Greater research attention to substance self-concept could clarify its potential as an important risk factor for hazardous use and addiction as well as its utility as a prevention and treatment target.
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Affiliation(s)
- Kristen P Lindgren
- a Department of Psychiatry & Behavioral Sciences , Center for the Study of Health and Risk Behaviors, University of Washington , Seattle , WA , USA
| | - Clayton Neighbors
- b Department of Psychology , University of Houston , Houston , TX , USA
| | - Melissa L Gasser
- a Department of Psychiatry & Behavioral Sciences , Center for the Study of Health and Risk Behaviors, University of Washington , Seattle , WA , USA
| | - Jason J Ramirez
- a Department of Psychiatry & Behavioral Sciences , Center for the Study of Health and Risk Behaviors, University of Washington , Seattle , WA , USA
| | - Dario Cvencek
- c Institute for Learning & Brain Sciences, University of Washington , Seattle , WA , USA
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Duroy D, Iglesias P, Perquier F, Brahim N, Lejoyeux M. [Hazardous drinking in Parisian medical students]. Encephale 2016; 43:334-339. [PMID: 27374157 DOI: 10.1016/j.encep.2016.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/11/2016] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Binge drinking is widespread in medical students but is poorly studied in France. The aim was to evaluate the number of binge drinking episodes and to better characterize them among a sample of French medical students. METHODS We carried out a cross-sectional study at Paris VII's Faculty of Medicine. Through a brief self-questionnaire we focused on the prevalence rate of binge drinking in the past two weeks and examined the associations between hazardous drinking and the number of drinks consumed, demographic data (gender, age, familial status and student fraternity membership), clinical aspects (context, intended effects and adverse consequences), tobacco or illegal substances use, and eventual relationship with alcohol or tobacco use disorders. RESULTS Among 302 medical students, 74.8% of them experienced at least one binge-drinking episode in the last two weeks. There was no significant difference in demographic data. However, the association between binge drinking and to living alone was borderline significant (P=0.051). Students experienced on mean 2.4 (SD, 1.6) episodes in the last two weeks and their mean maximum number of drinks was equal to 10.3 (SD, 4.6). We observed a significant association between the number binge drinking episodes and the mean maximum consumption of alcohol drinks (P=0.004). The maximum quantity of alcohol drinks was significantly higher (P<0.001) in students who experienced two binge-drinking episodes (mean=11.23, SD=4.56), compared to those who experienced only one episode (mean=9.04, SD=3.96). Binge drinkers were more likely to consume alcohol at a party than at a friendly drink (P=0.029) and more frequently sought drunkenness (P<0.001) and to escape from daily concerns (P=0.004). They experienced more negative events like black-outs (P<0.001), aggressive behaviors (P=0.002), drunk driving (P=0.025), unsafe sexual relationships (P=0.010) and need of emergency responders (P=0.047). Binge drinkers were more likely to simultaneously consume tobacco (P<0.001) or illegal substances (P<0.001), and presented more alcohol use disorder (P<0.001) and tobacco-dependence (P=0.007). CONCLUSIONS This first French study in 302 medical students has highlighted the extent of binge drinking in this specific population. The threshold of two binge-drinking episodes in two weeks may be useful to identify a distinctive pattern of consumption and set up adequate prevention actions. Finally binge drinking seemed to be close to an addictive process. Our findings support the need to develop targeted prevention programs in French medical students, which could be designed around several interventions in campuses and student parties. Cohort studies could be necessary to provide an epidemiological follow-up of the French medical student population, particularly about the risk of alcohol use disorder.
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Affiliation(s)
- D Duroy
- Département de psychiatrie et d'addictologie, AP-HP, hôpital Bichat-Claude-Bernard, 75018 Paris, France; Université Paris Diderot-Paris-VII, 75013 Paris, France.
| | - P Iglesias
- Université Paris Diderot-Paris-VII, 75013 Paris, France
| | - F Perquier
- Département d'épidémiologie, communauté hospitalière de territoire (CHT) pour la psychiatrie parisienne, 75013 Paris, France
| | - N Brahim
- Département de psychiatrie et d'addictologie, AP-HP, hôpital Bichat-Claude-Bernard, 75018 Paris, France
| | - M Lejoyeux
- Département de psychiatrie et d'addictologie, AP-HP, hôpital Bichat-Claude-Bernard, 75018 Paris, France; Université Paris Diderot-Paris-VII, 75013 Paris, France; Département d'épidémiologie, communauté hospitalière de territoire (CHT) pour la psychiatrie parisienne, 75013 Paris, France
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Fujii H, Nishimoto N, Yamaguchi S, Kurai O, Miyano M, Ueda W, Oba H, Aoki T, Kawada N, Okawa K. The Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) is more useful than pre-existing laboratory tests for predicting hazardous drinking: a cross-sectional study. BMC Public Health 2016; 16:379. [PMID: 27165437 PMCID: PMC4862044 DOI: 10.1186/s12889-016-3053-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 04/29/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND It is important to screen for alcohol consumption and drinking customs in a standardized manner. The aim of this study was 1) to investigate whether the AUDIT score is useful for predicting hazardous drinking using optimal cutoff scores and 2) to use multivariate analysis to evaluate whether the AUDIT score was more useful than pre-existing laboratory tests for predicting hazardous drinking. METHODS A cross-sectional study using the Alcohol Use Disorders Identification Test (AUDIT) was conducted in 334 outpatients who consulted our internal medicine department. The patients completed self-reported questionnaires and underwent a diagnostic interview, physical examination, and laboratory testing. RESULTS Forty (23 %) male patients reported daily alcohol consumption ≥ 40 g, and 16 (10 %) female patients reported consumption ≥ 20 g. The optimal cutoff values of hazardous drinking were calculated using a 10-fold cross validation, resulting in an optimal AUDIT score cutoff of 8.2, with a sensitivity of 95.5 %, specificity of 87.0 %, false positive rate of 13.0 %, false negative rate of 4.5 %, and area under the receiver operating characteristic curve of 0.97. Multivariate analysis revealed that the most popular short version of the AUDIT consisting solely of its three consumption items (AUDIT-C) and patient sex were significantly associated with hazardous drinking. The aspartate transaminase (AST)/alanine transaminase (ALT) ratio and mean corpuscular volume (MCV) were weakly significant. CONCLUSIONS This study showed that the AUDIT score and particularly the AUDIT-C score were more useful than the AST/ALT ratio and MCV for predicting hazardous drinking.
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Affiliation(s)
- Hideki Fujii
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka, 532-0034, Japan.
| | - Naoki Nishimoto
- Department of Radiological Technology, Hokkaido University of Science, Maeda, Teine, Sapporo, Hokkaido, 006-8585, Japan
| | - Seiko Yamaguchi
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka, 532-0034, Japan
| | - Osamu Kurai
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka, 532-0034, Japan
| | - Masato Miyano
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka, 532-0034, Japan
| | - Wataru Ueda
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka, 532-0034, Japan
| | - Hiroko Oba
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka, 532-0034, Japan
| | - Tetsuya Aoki
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka, 532-0034, Japan
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine, Osaka City University, Abeno, Osaka, 545-8585, Japan
| | - Kiyotaka Okawa
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital, Nonaka-kita, Yodogawa, Osaka, 532-0034, Japan
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