The Relationship Between Excessive Alcohol Consumption and Alcohol Use Disorders According to DSM-IV and DSM-5

Dynamic longitudinal relations among solitary drinking, coping motives, & alcohol problems during emerging adulthood

INTRODUCTION

Solitary drinking (i.e., drinking alone) and coping drinking motives are risk factors for alcohol problems. Theoretical models suggest that solitary drinking and coping motives are highly related. However, the direction of effects between solitary drinking and coping motives is unclear. It also remains unclear if relations are present solely at the between-person level, or if there are also dynamic, within-person relations. Therefore, the current study tested dynamic, reciprocal relations among solitary drinking, coping motives, and alcohol problems using Random Intercept Cross Lagged Panel Modeling (RI-CLPM).

METHODS

Data came from a large alcohol administration study with longitudinal follow-ups over 2 years (N = 448). Participants completed a baseline session and then were followed up 6, 12, 18, and 24 months later. Participants reported their solitary drinking frequency, coping motives, drinking behavior, and alcohol problems at all assessments.

RESULTS

Person-level solitary drinking was related to person-level coping motives and alcohol problems, and person-level coping motives were related to person-level alcohol problems. There were also contemporaneous within-person effects, such that a within-person increase in solitary drinking was associated with a concurrent within-person increase in coping motives, and a within-person increase in coping motives was associated with a concurrent within-person increase in alcohol problems. There were no within-person prospective relations among any variables.

CONCLUSIONS

Findings suggest strong between-person associations among solitary drinking, coping motives, and alcohol problems. Within-person associations were concurrent but not prospective. Targeting solitary and coping-motivated drinkers, as well within-person increases in both, may be effective at reducing risk for alcohol problems.

Predictors of early and sustained cessation of heavy drinking over 5 years among adult primary care patients

AIMS

To identify factors asociated with early and sustained cessation of heavy drinking.

DESIGN

Retrospective cohort study over 5 years.

SETTING

Kaiser Permanente Northern California, United States.

PARTICIPANTS

Adults reporting heavy drinking during primary care-based alcohol screening between 1 June 2013 and 31 May 2014. The sample (n = 85 434) was 40.7% female and 33.8% non-white; mean age was 50.3 years (standard deviation = 18.1).

MEASUREMENTS

Following US guidelines, early and sustained cessation of heavy drinking was defined as reporting lower-risk drinking or abstinence at 1 year and to 5 years after achieving early cessation, respectively. Associations between patient characteristics and service use and cessation outcomes were examined using logistic regression with inverse probability weights addressing attrition.

FINDINGS

Nearly two-thirds of participants achieved early cessation of heavy drinking. Women [odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.35, 1.44], middle-age (35-64 years: ORs = 1.16-1.19), non-white race/ethnicity (ORs = 1.03-1.57), medical conditions (OR = 1.05, 95% CI = 1.04, 1.06), psychiatric (OR = 1.10, 95% CI = 1.06, 1.15) and drug use disorders (OR = 1.35, 95% CI = 1.17, 1.56) and addiction treatment (OR = 1.19, 95% CI = 1.09, 1.30) were associated with higher odds of early cessation, while older age (≥ 65 years: OR = 0.91, 95% CI = 0.86, 0.96), smoking (OR = 0.81, 95% CI = 0.77, 0.84), higher index drinking levels (exceeding both daily and weekly limits: OR = 0.30, 95% CI = 0.29, 0.32) and psychiatric treatment (OR = 0.91, 95% CI = 0.84, 0.99) were associated with lower odds. Among those who achieved early cessation (n = 19 200), 60.0% sustained cessation. Associations between patient factors and sustained cessation paralleled those observed in analyses of early cessation. Additionally, routine primary care (OR = 1.57, 95% CI = 1.44, 1.71) and addiction treatment post-1 year (OR = 1.41, 95% CI = 1.19, 1.66) were associated with higher odds of sustained cessation. Lower-risk drinking versus abstinence at 1 year was associated with lower odds of sustained cessation (OR = 0.62, 95% CI = 0.57, 0.66).

CONCLUSIONS

Nearly two-thirds of a large, diverse sample of patients who reported heavy drinking in a Californian health-care system achieved early and sustained cessation of heavy drinking. Vulnerable subgroups (i.e. non-white patients and those with psychiatric disorders), patients who received routine primary care and those who received addiction treatment were more likely to sustain cessation of heavy drinking than other participants.

The long-lasting impact of childhood trauma on adult chronic physical disorders

BACKGROUND

It is unclear if childhood trauma (CT) is an independent risk factor of adult chronic physical disorders or whether its impact is (also) due to underlying poorer mental health.

METHODS

Data were obtained from baseline measurements among 13,489 respondents of the Netherlands Mental Health Survey and Incidence Study-1 and -2, cohort studies of the Dutch general population aged 18-64 years. We used a childhood trauma questionnaire measuring emotional, psychological, physical or sexual trauma before the age of 16. Lifetime mood, anxiety and substance use disorders were assessed with the Composite International Diagnostic Interview version 1.1 and 3.0. A standard self-report checklist was used to assess a broad range of chronic physical disorders treated by a medical doctor in the previous 12 months.

RESULTS

Respondents with a history of CT (N = 4054) suffered significantly more often from digestive (OR: 1.89-2.95), musculoskeletal (OR: 1.21-1.75) and respiratory disorders (OR: 1.39-1.91) and migraine (OR: 1.42-1.66). We found indirect associations between CT and digestive, musculoskeletal and respiratory disorders through lifetime mood (54%, 52% and 48% respectively), anxiety (44%, 55% and 44% respectively) and substance use disorders (33%, 23% and 38% respectively). Mood (69%) and anxiety disorders (67%) also impacted the relationship with migraine.

CONCLUSIONS

CT predicts the development of adult physical disorders, even after controlling for sociodemographic and lifestyle factors. This association is substantially influenced by mental health disorders. Treatment programs for CT should include interventions aimed at enhancing both mental and physical health.

Age-related differences in the associations among at-risk drinking, alcohol use disorder, and psychological distress across the adult lifespan: a nationwide representative study in South Korea

PURPOSE

To investigate age-related differences in the relationships among at-risk alcohol consumption, alcohol use disorder (AUD), and psychological distress with a special focus on older adults.

METHODS

We used a nationwide cross-sectional study of a representative sample of community-dwelling adults from the Korean Epidemiologic Catchment Area study for psychiatric disorders conducted by door-to-door interviews. The Korean version of the Composite International Diagnostic Interview was applied. Subjects were categorized into four age groups: young-to-middle-aged (20-54 years), near-old (55-64 years), early-old (65-74 years), and late-old (≥ 75 years). The associations among at-risk drinking, alcohol use disorder, and psychological distress were examined according to age groups.

RESULTS

Among a total of 5102 individuals, half of them drank alcohol in the previous year, of whom 20.5% were at-risk drinkers (≥ 100 g/week). Older people were less often diagnosed with AUD than young-to-middle-aged adults with a similar degree of at-risk drinking. They were less likely to meet the DSM-5 AUD criteria in terms of social and vocational role disruption or creation of a physically hazardous situation. However, at-risk drinking showed a stronger association with subjective psychological distress in older adults, particularly in the near-old group (adjusted odds ratio 1.82, 95% confidence interval 1.09-3.03; p = 0.023).

CONCLUSIONS

These findings indicate the importance of screening for mental health problems in older adults, especially near-old adults, who drink more than 100 g of alcohol per week even when they do not satisfy the criteria for a diagnosis of AUD.

Prevalence of Alcohol Use Disorders and Their Association with Sociodemographic Determinants and Depression/Anxiety Disorders in a Representative Sample of the Greek General Population

BACKGROUND

Country-level epidemiological data about alcohol-related problems is useful for planning prevention and treatment services. Heavy Alcohol Consumption (HAC) and Alcohol Use Disorder (AUD) are two syndromes of alcohol-related problems that have been recognized worldwide. Study of the epidemiological determinants of HAC and AUD in different sociocultural contexts could inform hypotheses about the etiology or the consequences of alcohol-related problems.

OBJECTIVES

We assessed the prevalence and associations of HAC and AUD with sociodemographic variables adjusting for common mental disorders in a representative sample of the general population of Greece (N = 4894 participants). The period of data collection just preceded the emergence of the financial crisis in Greece.

RESULTS

The majority of the population did not report HAC, AUD or abstinence from alcohol. HAC was reported by 12.7% (95% CI: 11.8-13.6) of the population while 3.1% (95% CI: 2.7-3.6) met criteria for AUD. Younger age, divorce, lower educational level, living in an urban area, physical health problems, and smoking were associated with a higher prevalence of both conditions. Presence of severe financial difficulties and never married family status were associated with a higher prevalence of HAC but not AUD. HAC was associated with nonspecific psychiatric morbidity while AUD was associated with more specific psychiatric disorders. Conclusion/Importance. Both alcohol-related problems are frequent in the general population and have common and distinct determinants. The comparison between the findings of our study and those of similar studies during or after the period of financial austerity in Greece, would offer the opportunity to assess the possible effects of changes in the economical context in the determinants of alcohol-related problems.

Multiple trajectories of alcohol use and the development of alcohol use disorder: Do Swiss men mature-out of problematic alcohol use during emerging adulthood?

(A) OBJECTIVE

This study aimed to identify trajectories of alcohol use (AU) and their associations with the development of alcohol use disorder (AUD) among young men with different weekly drinking patterns.

(B) METHOD

A longitudinal latent class analysis integrating several aspects of AU, such as drinking quantity and frequency on weekends vs workweek days, involving 4719 young Swiss men at ages 20, 21, and 25, and collected by the Cohort Study on Substance Use Risk Factors, was used to identify different AU trajectories over time. The development of AUD scores in these trajectories was investigated using generalized linear mixed models.

(C) RESULTS

Six AU trajectory classes, similar to those described in the literature, were identified: 'abstainers-light drinkers', 'light workweek increasers', 'light decreasers', 'moderate weekend decreasers', 'moderate workweek increasers', and 'heavy drinkers'. Only 12% of participants were assigned to a trajectory class with decreasing AU associated with a decline in their AUD score. AUD scores increased in trajectory classes exhibiting increasing AU on workweek days, despite low and moderate general AU. Finally, more than 59% of participants were on an AU trajectory presenting no change in their mean AUD score over time.

(D) CONCLUSIONS

Maturing out of problematic AU in emerging adulthood is not the norm in Switzerland, and the AUD score developed in late adolescence remains until at least emerging adulthood. AU on workweek days is a more practical marker of potentially problematic AU. This calls for timely interventions in adolescence and concerning regular drinking on workweek days in emerging adulthood.

Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort

BACKGROUND

This study examined associations of sexual orientation and gender identity with prevalence of substance use disorders (SUDs) and co-occurring multiple SUDs in the past 12-months during young adulthood in a United States longitudinal cohort.

METHODS

Questionnaires self-administered in 2010 and 2015 assessed probable past 12-month nicotine dependence, alcohol abuse and dependence, and drug abuse and dependence among 12,428 participants of an ongoing cohort study when they were ages 20-35 years. Binary or multinomial logistic regressions using generalized estimating equations were used to estimate differences by sexual orientation and gender identity in the odds of SUDs and multiple SUDs, stratified by sex assigned at birth.

RESULTS

Compared with completely heterosexuals (CH), sexual minority (SM; i.e., mostly heterosexual, bisexual, lesbian/gay) participants were generally more likely to have a SUD, including multiple SUDs. Among participants assigned female at birth, adjusted odds ratios (AORs) for SUDs comparing SMs to CHs ranged from 1.61 to 6.97 (ps<.05); among participants assigned male at birth, AORs ranged from 1.30 to 3.08, and were statistically significant for 62% of the estimates. Apart from elevated alcohol dependence among gender minority participants assigned male at birth compared with cisgender males (AOR: 2.30; p < .05), gender identity was not associated with prevalence of SUDs.

CONCLUSIONS

Sexual and gender minority (SGM) young adults disproportionately evidence SUDs, as well as co-occurring multiple SUDs. Findings related to gender identity and bisexuals assigned male at birth should be interpreted with caution due to small sample sizes. SUD prevention and treatment efforts should focus on SGM young adults.

Binge drinking: Prevalence, correlates, and expectancies of alcohol use among individuals with first-episode psychosis

AIM

This study examines the prevalence and correlates of binge drinking and its association with expectancies of alcohol use, within a sample of patients with first-episode psychosis enrolled in the Early Psychosis Intervention Programme (EPIP) in Singapore's Institute of Mental Health.

METHODS

A total of 280 patients from the EPIP were recruited for an on-going longitudinal study examining cigarette smoking and alcohol habits. Only baseline data were used, pertaining to socio-demographics, alcohol use, clinical symptomology, quality of life, and expectancies of alcohol use.

RESULTS

Overall 23.9% (N = 67) reported ever binge drinking in their lifetime, and 11.4% (N = 32) had binged in the past 2 weeks. Controlling for all other socio-demographic and clinical factors, binge drinking was significantly associated with higher education levels, having children, current or past history of cigarette smoking, and lower negative symptom scores. Binge drinkers were also more likely to endorse statements relating to the themes of enhancement seeking (ie, using alcohol to alter or enhance experiences in a pleasurable way), coping with distress, and socializing-related expectancies of alcohol use.

CONCLUSION

Similar to past studies, the prevalence of binge drinking among our first-episode sample was relatively high. Our findings suggest certain lifestyle and social factors associated with risky drinking behaviour that future prevention efforts may address. Additionally, the three motivations of enhancement seeking, coping, and socializing also suggest psychological processes and coping styles that could be targeted for interventions.

Intensity of Daily Drinking and Its Relation to Alcohol Use Disorders

BACKGROUND

Daily drinking is an important public health concern and informative for evaluating diagnostic classification. In particular, daily binge drinkers might be considered as the prototype of some forms of alcoholism, as this drinking pattern may drive many alcohol use disorder (AUD) symptoms. However, daily drinking potentially captures a wide range of drinkers, including light-moderate daily drinkers who exhibit presumed control over their drinking behavior and might benefit from salutary effects on health. This study examined the heterogeneity of daily drinkers in detail.

METHODS

Data from the 2 waves of the National Epidemiologic Survey on Alcohol and Related Conditions were used. Participants who reported drinking "every day" during the last 12 months were classified as daily drinkers. A series of regression and logistic regression analyses were conducted to investigate the association between daily drinking and various outcomes.

RESULTS

Daily drinkers were found to vary considerably from each other with respect to diagnostic status, level of consumption, demographic composition, and a range of drinking and health correlates. Further, a substantial number of daily binge drinkers were not diagnosed with AUD under the DSM-IV or DSM-5, although in most groups, the DSM-5 criteria diagnosed a larger percentage of participants.

CONCLUSIONS

Daily drinkers represent a highly heterogeneous group, and the correlates of daily drinking depend on the usual quantity of daily drinks and the frequency of alcohol-related problems in a given sample. Moreover, AUD, defined both according to DSM-IV and DSM-5, did not capture more than 68% of daily binge drinkers. Given that daily binge drinking is an extremely high threshold for use, this finding may present a challenge for our current classification system.

The mental health of fire-fighters: An examination of the impact of repeated trauma exposure

OBJECTIVE

Emergency workers, such as fire-fighters, are routinely exposed to potentially traumatic events. While a number of studies have examined the occurrence of post-traumatic stress disorder, the role of multiple traumas on other mental health sequelae, such as depression and alcohol misuse, among emergency workers remains unclear. This study aimed to assess the prevalence of post-traumatic stress disorder, depression and alcohol misuse in a sample of current and retired fire-fighters and examine their relationship with cumulative trauma exposure.

METHOD

A cross-sectional survey was completed by current (n = 488) and retired (n = 265) fire-fighters from Fire and Rescue New South Wales, Australia. Demographic and occupational information was collected, including the number of fatal incidents fire-fighters reported attending across years of service. Validated, self-report measures were used to determine probable caseness for post-traumatic stress disorder, depression and heavy drinking.

RESULTS

Among current fire-fighters, rates of post-traumatic stress disorder and depression were 8% and 5%, respectively, while 4% reported consumption of more than 42 alcoholic drinks per week. Retired fire-fighters reported significantly greater levels of symptomatology, with the prevalence estimates of post-traumatic stress disorder at 18% (p = 0.001), depression at 18% (p < 0.001) and heavy drinking at 7%. There was a significant positive linear relationship between the number of fatal incidents attended and rates of post-traumatic stress disorder, depression and heavy drinking.

CONCLUSION

Fire-fighters suffer from high rates of mental disorders, with rates of post-traumatic stress disorder, depression and heavy drinking continuing to rise in a linear manner with each additional trauma exposure. The level of psychiatric morbidity among retired fire-fighters appears to be particularly high. Our findings have important implications for the ongoing debates surrounding the detection of mental disorders in high-risk occupations and for policy considerations around the welfare of current and retired emergency workers.

Transdermal alcohol concentration data collected during a contingency management program to reduce at-risk drinking

BACKGROUND

Recently, we demonstrated that transdermal alcohol monitors could be used in a contingency management procedure to reduce problematic drinking; the frequency of self-reported heavy/moderate drinking days decreased and days of no to low drinking increased. These effects persisted for three months after intervention. In the current report, we used the transdermal alcohol concentration (TAC) data collected prior to and during the contingency management procedure to provide a detailed characterization of objectively measured alcohol use.

METHODS

Drinkers (n=80) who frequently engaged in risky drinking behaviors were recruited and participated in three study phases: a 4-week Observation phase where participants drank as usual; a 12-week Contingency Management phase where participants received $50 each week when TAC did not exceed 0.03g/dl; and a 3-month Follow-up phase where self-reported alcohol consumption was monitored. Transdermal monitors were worn during the first two phases, where each week they recived $105 for visiting the clinic and wearing the monitor. Outcomes focused on using TAC data to objectively characterize drinking and were used to classify drinking levels as either no, low, moderate, or heavy drinking as a function of weeks and day of week.

RESULTS

Compared to the Observation phase, TAC data indicated that episodes of heavy drinking days during the Contingency Management phase were reduced and episodes of no drinking and low to moderate drinking increased.

CONCLUSIONS

These results lend further support for linking transdermal alcohol monitoring with contingency management interventions. Collectively, studies to date indicate that interventions like these may be useful for both abstinence and moderation-based programs.

From DSM-IV to DSM-5 alcohol use disorder: an overview of epidemiological data

INTRODUCTION

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has made several changes to criteria for alcohol use disorder (AUD). The objective of this systematic review is to assess if new DSM-5 diagnostic criteria will increase the prevalence rates of AUD in clinical and non-clinical samples as compared with DSM-IV criteria.

METHODS

We searched PubMed, Scopus, and PsycINFO (via ProQuest) electronic databases, with no language restrictions. We included studies with data available on both DSM-IV (and DSM-IV-TR) and DSM-5 AUD in samples of adults, estimating from each study an expected increase in prevalence rates with relevant 95% confidence intervals (CIs).

RESULTS

Twelve studies were included in this review. Seven studies showed an increase, two no substantial difference, and three a decrease in AUD prevalence according to DSM-5 diagnostic criteria, with differences in rates (95% CIs) varying between -12.4% (-27.4 to +5.6%) and +61.3% (+46.7 to +77.3%). Additional analyses provided confirmatory results.

CONCLUSIONS

DSM-5 diagnostic criteria seem to inflate prevalence rates of AUD as compared with DSM-IV. The increasing likelihood of a DSM-5 AUD diagnosis may be explained by the amount of DSM-IV 'diagnostic orphans' which are more prevalent than DSM-IV single-criterion alcohol abuse individuals. Further research should be aimed to study if similar trends are detectable also for other substance use disorders that experienced similar changes in DSM-5 diagnostic criteria.

Clustering of health risk behaviours and the relationship with mental disorders

BACKGROUND

Health risk behaviours tend to co-occur and are found to be related to mental health symptoms. This is the first study to identify health behaviour clusters in relation to mental disorders.

METHODS

Data were used from the second wave of the Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), a nationally representative sample of adults (n=5303). Latent class analysis was performed to identify clusters based on four health risk behaviours (smoking, heavy drinking, physical inactivity, and unhealthy diet). Concurrently, we examined the relationship between the identified clusters and a range of DSM-IV diagnoses, assessed with the Composite International Diagnostic Interview 3.0.

RESULTS

Four distinct health behaviour clusters were identified: most healthy (mainly non-smokers, moderate drinkers, active, healthy diet; class 1: 79.3%); smokers, moderate drinkers, inactive, unhealthy diet (class 2: 13.2%); smokers, heavy episodic drinkers, active, unhealthy diet (class 3: 3.8%); Smokers, frequent heavy drinkers, active, low fruit (class 4: 3.6%). Despite their different lifestyles, individuals in all three unhealthy clusters had double the risk of depression. Unhealthy behaviour clusters were strongly associated with drug dependence (classes 2 and 3), alcohol abuse and dependence (classes 3 and 4), and social phobia (class 4).

LIMITATIONS

Due to the cross-sectional design, no conclusions about the causality of the relationship between HRB clusters and mental disorders can be drawn from the current study.

CONCLUSIONS

Health behaviour clusters are strongly associated with mental disorders. This co-existence of behaviours and disorders emphasises the importance of an integrative approach in the prevention of mental illnesses.

Alcohol consumption and symptoms as predictors for relapse of DSM-5 alcohol use disorder

BACKGROUND

Alcohol consumption levels and alcohol use disorder (AUD) symptoms may serve as easily quantifiable markers for AUD relapse after remission and might help prevention workers identify at-risk individuals. We investigated the predictive value of alcohol consumption and AUD symptoms on relapse.

METHODS

Data are from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). We selected 506 people in ≥12-month DSM-5 AUD remission at baseline and assessed their status at 3-year follow-up. AUD symptoms and drinking patterns were assessed using the Composite International Diagnostic Interview 3.0. Time since remission was assessed retrospectively at baseline and ranged from 1 to 48 years. Predictors for relapse were examined using Cox regression analysis.

RESULTS

Cumulative AUD relapse rate was 5.6% at 5 years, 9.1% at 10 years and 12.0% at 20 years. Relapse was predicted by both medium (15-28/22-42 drinks weekly for women/men) and high (≥29/43) past alcohol intake, 6+ lifetime AUD symptoms, 'impaired control over use', and at-risk (≥8/15) current intake. The risk of relapse was especially high when medium or high past intake or 6+ lifetime symptoms coincided with current at-risk drinking.

CONCLUSIONS

Only a minority of people in DSM-5 AUD remission relapsed, but the risk of relapse increased substantially with the presence of at least one of the risk factors. Moreover, at-risk current drinking coupled with other risk factors substantially increased the likelihood of relapse. Therefore, current drinking may provide an adequate reference point for relapse prevention.

Predicting the transition from frequent cannabis use to cannabis dependence: a three-year prospective study

BACKGROUND

Frequent cannabis users are at high risk of dependence, still most (near) daily users are not dependent. It is unknown why some frequent users develop dependence, whereas others do not. This study aims to identify predictors of first-incidence DSM-IV cannabis dependence in frequent cannabis users.

METHODS

A prospective cohort of frequent cannabis users (aged 18-30, n=600) with baseline and two follow-up assessments (18 and 36 months) was used. Only participants without lifetime diagnosis of DSM-IV cannabis dependence at baseline (n=269) were selected. Incidence of DSM-IV cannabis dependence was established using the Composite International Diagnostic Interview version 3.0. Variables assessed as potential predictors of the development of cannabis dependence included sociodemographic factors, cannabis use variables (e.g., motives, consumption habits, cannabis exposure), vulnerability factors (e.g., childhood adversity, family history of mental disorders or substance use problems, personality, mental disorders), and stress factors (e.g., life events, social support).

RESULTS

Three-year cumulative incidence of cannabis dependence was 37.2% (95% CI=30.7-43.8%). Independent predictors of the first incidence of cannabis dependence included: living alone, coping motives for cannabis use, number and type of recent negative life events (major financial problems), and number and type of cannabis use disorder symptoms (impaired control over use). Cannabis exposure variables and stable vulnerability factors did not independently predict first incidence of cannabis dependence.

CONCLUSIONS

In a high risk population of young adult frequent cannabis users, current problems are more important predictors of first incidence cannabis dependence than the level and type of cannabis exposure and stable vulnerability factors.