Comparison of Three Methods to Assess Binge Consumption: One-Week Retrospective Drinking Diary, AUDIT, and Quantity/Frequency

A new statistical model for binge drinking pattern classification in college-student populations

Background

Binge drinking (BD) among students is a frequent alcohol consumption pattern that produces adverse consequences. A widely discussed difficulty in the scientific community is defining and characterizing BD patterns. This study aimed to find homogenous drinking groups and then provide a new tool, based on a model that includes several key factors of BD, to assess the severity of BD regardless of the individual's gender.

Methods

Using the learning sample (N1 = 1,271), a K-means clustering algorithm and a partial proportional odds model (PPOM) were used to isolate drinking and behavioral key factors, create homogenous groups of drinkers, and estimate the probability of belonging to these groups. Robustness of our findings were evaluated with Two validations samples (N2 = 2,310, N3 = 120) of French university students (aged 18-25 years) were anonymously investigated via demographic and alcohol consumption questionnaires (AUDIT, AUQ, Alcohol Purchase Task for behavioral economic indices).

Results

The K-means revealed four homogeneous groups, based on drinking profiles: low-risk, hazardous, binge, and high-intensity BD. The PPOM generated the probability of each participant, self-identified as either male or female, to belong to one of these groups. Our results were confirmed in two validation samples, and we observed differences between the 4 drinking groups in terms of consumption consequences and behavioral economic demand indices.

Conclusion

Our model reveals a progressive severity in the drinking pattern and its consequences and may better characterize binge drinking among university student samples. This model provides a new tool for assessing the severity of binge drinking and illustrates that frequency of drinking behavior and particularly drunkenness are central features of a binge drinking model.

O consumo de bebida alcoólica e o binge drink entre os graduandos de Medicina de uma Universidade de Minas Gerais

RESUMO Objetivos O estudo objetivou verificar o padrão de consumo de bebidas alcoólicas e a presença do beber pesado episódico (BPE) entre os estudantes de Medicina de uma universidade do centro-oeste de Minas Gerais. Métodos Trata-se de um estudo transversal, exploratório e descritivo, realizado com 202 graduandos do curso de Medicina de uma universidade do centro-oeste de Minas Gerais. A coleta de dados foi realizada no primeiro semestre de 2015, com a utilização de um questionário sociodemográfico e do questionário Audit. O tratamento estatístico dos dados foi realizado com a utilização da análise bivariada, por meio do teste qui-quadrado ou do teste de Fisher e de modelos multivariados de regressão logística. Resultados Observou-se que o álcool é utilizado por 76,6% dos estudantes pesquisados, e 53,7% praticavam o BPE. O consumo de bebidas alcoólicas teve associação significativa com a idade e o fato de não morar com a família e estar acima do terceiro ano de graduação. O BPE, por sua vez, esteve associado com o sexo masculino e com o fato de não morar com a família. Conclusões Este trabalho mostrou que o consumo de álcool entre os estudantes de Medicina é maior do que o da população geral e que a prática do BPE possui alta prevalência nesse grupo. Idade, não morar com a família e período mais avançado do curso foram associados a maior consumo de álcool. Ser do sexo masculino e não morar com a família se associaram a maior risco de BPE.

Motivation to reduce alcohol consumption and subsequent attempts at reduction and changes in consumption in increasing and higher-risk drinkers in England: a prospective population survey

AIMS

To assess how far motivation to reduce alcohol consumption in increasing and higher-risk drinkers in England predicts self-reported attempts to reduce alcohol consumption and changes in alcohol intake during the following 6 months.

METHODS

This study used self-reported data from 2928 higher-risk drinkers in the Alcohol Toolkit Study (ATS): a series of monthly cross-sectional household surveys of adults aged 16+ years of age in England. Alcohol consumption was measured in an initial survey and in a 6-month telephone follow-up interview using the Alcohol Use Disorders Identification Test (AUDIT)-C questionnaire. Motivation was measured in the initial survey using the Motivation to Reduce Alcohol Consumption (MRAC) scale. Attempts to reduce alcohol consumption during the past 6 months were recorded at follow-up. Data were analysed using repeated-measures difference-in-differences and logistic regression models.

RESULTS

Participants with higher initial motivation to reduce alcohol consumption were more likely to report that they had made an attempt to reduce consumption at follow-up [adjusted odds ratio (ORadj ) = 2.39, 95% confidence interval (CI) = 1.75-3.29]. There was an overall reduction in alcohol consumption between initial survey and follow-up (ORadj  = 0.72, 95% CI = 0.65-0.79), but there was insufficient evidence of an additional effect of motivation to reduce consumption on subsequent changes in alcohol consumption, with the difference-in-differences effect instead suggesting an average increase (ORadj  = 1.37, 95% CI = 1.00-1.88).

CONCLUSIONS

Increasing and higher-risk drinkers in England who report greater motivation to reduce their consumption are more likely to report making an attempt to reduce during the next 6 months, but this may not be associated with a reduction in alcohol consumption.

Perfil do consumo de álcool e prática do beber pesado episódico entre universitários brasileiros da área da saúde

RESUMO Objetivo Identificar entre os universitários da área da saúde de uma universidade brasileira a prevalência, o perfil do consumo de álcool e a prática do beber pesado episódico (BPE). Métodos Estudo transversal, quantitativo, com amostra randomizada dos universitários dos 12 cursos da saúde. Foram aplicados questionários individualizados, em formulário eletrônico, utilizando a escala AUDIT, após consentimento informado. Foi realizada análise estatística descritiva e inferencial. Resultados Entre os 619 estudantes selecionados, a prevalência de consumo de álcool foi de 85%, com perfil do consumo de baixo risco (77,1%). Consumo nocivo e provável dependência foram detectados em 2,7%. A prática do BPE foi de 51,6%, quase o dobro em comparação com outros estudos. As características que mais se associaram ao consumo de álcool foram: ser solteiro, do sexo masculino e frequentar festas semanalmente. Conclusão O consumo de álcool é elevado entre os estudantes avaliados, embora a maioria esteja no perfil de baixo risco. Contudo, fica evidente a necessidade de ações educativas para a promoção da saúde do estudante, visando à redução e ao consumo consciente de bebidas alcoólicas.

Temporal patterns of alcohol consumption and attempts to reduce alcohol intake in England

BACKGROUND

The Alcohol Toolkit Study (ATS) is a monthly survey of approximately 1700 adults per month aged 16 years of age or more in England. We aimed to explore patterns of alcohol consumption and motivation to reduce alcohol use in England throughout the year.

METHODS

Data from 38,372 participants who answered questions about alcohol consumption (March 2014 to January 2016) were analysed using weighted regression using the R survey package. Questions assessed alcohol consumption (AUDIT-C) and attempts to reduce consumption.

RESULTS

Sixty-seven percent of participants reported using alcohol, with a small negative trend of about 2 % reduction over 12 months in the studied period (P < 0.01). These include ~25 % higher risk drinkers and ~10 % regular binge drinkers. About 20 % of higher risk drinkers indicated they were attempting to reduce their alcohol consumption. Attempts were lowest in December (-20 %; 95 % CI 0-35 %), but increases significantly in January (+41 %; 95 % CI 16-73 %) compared with other months (P < 0.001), indicating a small net gain; at least in attempts to reduce. However, there was no evidence that the increased motivation in January was accompanied by a reported decrease in consumption or binge drinking events. This could be an artefact of the use of AUDIT questions, but could also reflect a disconnect between attempting to reduce alcohol consumption and subsequent change; maybe as a result of lack of continuing support.

CONCLUSIONS

January is associated with moderate increased attempts to reduce alcohol consumption. However, we find little evidence of a change in alcohol consumption. In part, this may be due to temporal insensitivity of the AUDIT questions.

Does a retrospective seven-day alcohol diary reflect usual alcohol intake for a predominantly disadvantaged Australian Aboriginal population?

BACKGROUND

Alcohol disproportionately affects socially disadvantaged groups including Aboriginal and Torres Strait Islander Australians. METHODs to assess alcohol intake for disadvantaged communities need to be able to capture variable or episodic drinking. The ability of a seven-day diary to capture typical consumption for a predominantly Aboriginal sample has not been assessed.

OBJECTIVE

One aim of this paper was to examine agreement between a seven-day retrospective diary and 'usual' drinking assessed by a modified version of the Alcohol Use Disorders Identification Test question 3 (AUDIT-3m; two questions). Other aims were to describe drinking patterns as reported in the seven-day diary.

METHOD

In 2012, consecutive adults attending an Aboriginal Community Controlled Health Service completed a cross-sectional health risk survey on a touch screen laptop (n = 188). Alcohol consumption questions included the retrospective diary and AUDIT-3m. Agreement was assessed using weighted kappa analysis.

RESULTS

There was good agreement between the two measures of consumption; however, the AUDIT-3m questions identified more current drinkers. Respondents who were drinkers (54%) tended to consume large amounts per drinking occasion: almost half (46%) of diary completers reported nine or more standard drinks on at least one occasion in the last week.

CONCLUSIONS

The seven-day diary did not adequately capture variability in alcohol consumption common among this sample. Although the AUDIT-3m appeared acceptable, alternative approaches to assess usual or risky alcohol consumption, such as asking about specific drinking occasions, or allowing participants to respond in non-standard drink sizes, also need to be considered for indigenous and other disadvantaged communities.

Under the radar: a cross-sectional study of the challenge of identifying at-risk alcohol consumption in the general practice setting

Background

Primary care providers are an important source of information regarding appropriate alcohol consumption. As early presentation to a provider for alcohol-related concerns is unlikely, it is important that providers are able to identify at-risk patients in order to provide appropriate advice. This study aimed to report the sensitivity, specificity, positive predictive value and negative predictive value of General Practitioner (GP) assessment of alcohol consumption compared to patient self-report, and explore characteristics associated with GP non-detection of at-risk status.

Method

GP practices were selected from metropolitan and regional locations in Australia. Eligible patients were adults presenting for general practice care who were able to understand English and provide informed consent. Patients completed a modified AUDIT-C by touchscreen computer as part of an omnibus health survey while waiting for their appointment. GPs completed a checklist for each patient, including whether the patient met current Australian guidelines for at-risk alcohol consumption. Patient self-report and GP assessments were compared for each patient.

Results

GPs completed the checklist for 1720 patients, yielding 1565 comparisons regarding alcohol consumption. The sensitivity of GPs’ detection of at-risk alcohol consumption was 26.5%, with specificity of 96.1%. Higher patient education was associated with GP non-detection of at-risk status.

Conclusions

GP awareness of which patients might benefit from advice regarding at-risk alcohol consumption appears low. Given the complexities associated with establishing whether alcohol consumption is ‘at-risk’, computer-based approaches to routine screening of patients are worthy of exploration as a method for prompting the provision of advice in primary care.

Expectativas e beber problemático entre universitários

O beber problemático é recorrente entre universitários e está associado a inúmeras conseqüências negativas. Portanto, é importante compreender os fatores de risco para este fenômeno. Examinou-se a relação entre expectativas sobre os efeitos do álcool e o padrão de beber de risco em universitários. Os participantes foram 165 universitários, com média de 22 anos (dp=2,5) que responderam aos inventários AUDIT e IECPA. Constatou-se que 44% dos participantes eram consumidores de risco e que 48% possuíam expectativas positivas altas. Entre elas, facilitação das intersações sociais, diminuição e/ou fuga de emoções negativas, ativação e prazer sexual, efeitos positivos na atividade e humor e na avaliação de si mesmo. Houve correlação entre beber problemático e expectativas positivas. Investigar a relação entre padrão de uso e expectativas sobre os efeitos do álcool favorece o planejamento de intervenções terapêuticas e estratégias preventivas mais precisas que visem a reduzir os riscos do beber problemático entre universitários.

Assessment of binge drinking of alcohol in highly educated employees

This study evaluated the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE, a standardized screening instrument for detecting alcohol dependence in identifying binge drinking among highly educated employees. Brochures were mailed to an entire workforce inviting employees to learn about their coping strategies, stress levels, and risk for alcohol-related problems, with 228 employees providing complete data. Binge drinking in the previous 3 months was reported by 29% of the employees, with greater binge drinking reported by White employees, of mixed/other ethnic background, or younger. The AUDIT achieved a sensitivity of 35% in identifying respondents who reported binge drinking and a specificity of 98% in accurately identifying respondents who did not report binge drinking. Sensitivity using the cut-off of scoring one or more positive hits on the CAGE was 67%, and specificity was 84%. Therefore, neither the AUDIT nor the CAGE achieved adequate sensitivity, as well as specificity, as screening tools for assessing binge drinking. A more accurate method for assessing binge drinking appears to be by directly asking for the largest number of drinks consumed in a single drinking session.

Community-based alcohol counselling: a randomized clinical trial

AIMS

To examine the effectiveness of a brief intervention (BI) and cognitive behaviour therapy (CBT) for alcohol abuse.

DESIGN

A randomized trial with clients randomized within counsellors.

SETTING

Community-based drug and alcohol counselling in Australia.

PARTICIPANTS

Of all new clients attending counselling. 869 (82%) completed a computerized assessment at their first consultation. Four hundred and twenty-one (48%) were defined as eligible, of whom 295 (70%) consented and were allocated randomly to an intervention. Of these, 13 3 (45%) were followed-up at 6 months post-test.

INTERVENTIONS

BI comprised the elements identified by the acronym FRAMES:feedback, responsibility, advice, menu, empathy, self-efficacy. Face-to-face counselling time was not to exceed 90 minutes. CBT comprised six consecutive weekly sessions: introduction: cravings and urges; managing crises; saying 'no' and solving problems: emergencies and lapses: and maintenance. Total face-to-face counselling time was 270 minutes (six 45-minute sessions).

MEASUREMENTS

Treatment outcomes are measured in terms of counsellor compliance, client satisfaction, weekly and binge consumption, alcohol-related problems, the AUDIT questionnaire and cost-effectiveness.

FINDINGS

When analysed on an intention-to-treat basis and for those followed-up. treatment outcomes between BI and CBT were not statistically significantly different at pre- or post-test, whether considered as continuous or categorical variables. BI was statistically significantly more cost-effective than CBT and there was no difference between them in clients' reported levels of satisfaction.

CONCLUSION

For low-dependence alcohol abuse in community settings, BI may be the treatment of choice.

Community-based drug and alcohol counselling: who attends and why?

In order to develop and tailor treatment approaches in drug and alcohol counselling accurately, it is necessary to identify characteristics of the relevant client group. This study describes the demographic and substance use characteristics of 1212 community-based drug and alcohol counselling clients from a regional Area Health Service in NSW, Australia. Findings identify these clients as predominantly young, unmarried, unemployed males with low incomes. Alcohol use is characterized by binge consumption (83%) and alcohol-related problems (94%). A substantial proportion use tobacco (74%), cannabis (61%), opiates (15%) and amphetamines (22%). Of those using illicit drugs other than marijuana, the incidence of sharing syringes (10%) is of concern. These data differ from those reported by both general practice patients in the same geographical area, as a treatment-seeking population in an alternative community-based setting, and a general community sample. It is argued that there is a need for interventions delivered in community-based drug and alcohol settings that are aimed specifically at polydrug use, attempt to minimize drug-related harm and are relevant to those of lower socio-economic status.

Screening of binge drinking among patients on an emergency surgical ward

In a sample of 149 emergency surgical patients, binge drinking was assessed through interviews. Sensitivity, specificity, and positive and negative predictive values were calculated for three questionnaires-the Malmö modification of brief MAST (Mm-MAST), CAGE, and the Trauma Scale-and two biological markers-carbohydrate-deficient transferrin (CDT) and gamma-glutamyltransferase (GGT). Binge drinking was reported by 42% of male patients, aged 16-29 years; 66% of female patients, aged 16-29 years; 27% of male patients, aged 30-73 years; and 16% of female patients, aged 30-73 years. All alcohol biomarkers had low sensitivity to binge drinking among women. Mm-MAST alone and CAGE and CDT combined were sensitive to identifying binge drinking among men aged 30-73 years. The three questionnaires combined had a sensitivity of 0.82 to binge drinking among men aged 16-29 years.