DSM-IV alcohol dependence and marital dissolution: evidence from the National Epidemiologic Survey on Alcohol and Related Conditions

Prevalence and Correlates of Substance Use Among Youth Living with HIV in Fishing Communities in Uganda

Alcohol and drug use (ADU) poses a significant barrier to optimal HIV treatment outcomes for adolescents and youths living with HIV (AYLHIV). We aimed to investigate the prevalence and correlates of ADU among ALHIV in Ugandan fishing communities, areas characterized by high HIV and poverty rates. AYLHIV aged 18-24, who knew they were HIV-positive, were selected from six HIV clinics. Substance use was determined through self-report in the last 12 months and urine tests for illicit substances. Utilizing a socioecological framework, the study structured variables into a hierarchical logistic regression analysis to understand the multi-layered factors influencing ADU. Self-reported past 12 months substance use was 42%, and 18.5% of participants had a positive urine test for one or more substances, with alcohol, benzodiazepines, and marijuana being the most commonly used. With the addition of individual-level socio-demographics, indicators of mental health functioning, interpersonal relationships, and community factors, the logistic regression analysis revealed greater exposure to adverse childhood experiences increased the odds of substance use (Odds Ratio [OR] = 1.24; 95% Confidence Interval [CI]: 1.03-1.55). Additionally, exposure to alcohol advertisements at community events significantly raised the odds of substance use (OR = 3.55; 95% CI: 1.43-8.83). The results underscore the high prevalence among AYLHIV and emphasize the need for comprehensive interventions targeting individual (e.g., life skills education and mental health supports), interpersonal (e.g., peer support and family-based interventions), community (e.g., community engagement programs, restricted alcohol advertisements and illicit drug access), and policies (e.g., integrated care models and a national drug use strategy), to address ADU.

Profiles of quality of life among patients using emergency departments for mental health reasons

BACKGROUND

This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use.

METHODS

Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them.

RESULTS

Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions.

CONCLUSION

The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.

Changes in Marital Status Following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A US Multicenter Prospective Cohort Study

Among a US cohort followed 5 years after Roux-en-Y gastric bypass or sleeve gastrectomy, cumulative incidence of marriage and separation/divorce were 18% among unmarried (N=614) and 13% among married (N=827) participants, respectively. Preoperative predictors of marriage included younger age, college degree, lower BMI and cohabitating or being separated (versus single).

Implementing Behavioral Couples Therapy for Substance Use Disorders in Real-World Clinical Practice

Behavioral couple therapy (BCT) is an evidence-based, manualized treatment that has been primarily developed to treat alcohol use disorder. The treatment model leverages the intimate partner relationship to support recovery. Although the efficacy of BCT is well-supported in randomized controlled trials, little attention has been given to the translation of BCT to everyday practice settings. This article presents recommendations for implementing BCT in such settings. We describe a stepwise approach for getting a couple into BCT and determining whether it is an appropriate treatment for the couple. In addition, we provide recommendations for broadening inclusion criteria for everyday practice settings, including the use of BCT with couples who have drug use disorders with couples where both members exhibit substance use disorders and with couples who choose controlled drinking or drug use versus abstinence. Whereas BCT has mostly been researched in speciality substance use disorder settings, we provide recommendations for its use in general couple therapy settings. Based upon the extant research, we suggest implementing BCT as a standalone treatment or as an add-on to individual counseling for substance use disorders. We provide guidance for delivering BCT through telehealth and encourage future research to investigate this delivery modality. Future research should prioritize investigating the effectiveness of various BCT dissemination strategies and seek to determine what dosage and components of BCT will result in the best outcomes.

Couple and family therapy for substance use disorders: Evidence-based update 2010-2019

This article updates the evidence-based on couple and family therapy interventions for substance use disorders (SUD) since publication of the previous JMFT reviews in 2012. It first summarizes previous reviews along with findings from more recent reviews and meta-analytic studies. It then presents study design and methods criteria used to select 13 studies of couple and family therapy for level of support evaluation. Cumulative level of support designations are then determined for identified treatment approaches. Findings indicate that systemic family therapy is well-established as a standalone treatment, and behavioral family therapy and behavioral couple therapy are probably efficacious as standalone treatments and well-established as part of a multicomponent treatment. The article then suggests practice guidelines with regard to treatment modality considerations and implementation challenges. It concludes with future directions for delivering couple and family interventions in routine systems of care for SUD.

Heavy alcohol consumption before and after negative life events in late mid-life: longitudinal latent trajectory analyses

Background

People who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change within this group. This study aims to identify trajectories of heavy alcohol consumption before and after experiencing either divorce, or severe illness or death in the family. Furthermore, the aim is to examine characteristics of individuals belonging to each trajectory.

Methods

Longitudinal study of public sector employees from the Finnish Retirement and Aging Study with up to 5 years of annual follow-ups (n=6783; eligible sample n=1393). Divorce and severe illness or death in the family represented negative life events. Heavy alcohol consumption was categorised as >14 units/week.

Results

Based on latent trajectory analysis, three trajectories of heavy drinking were identified both for divorce and for severe illness or death in the family: ‘No heavy drinking’ (82% illness/death, 75% divorce), ‘Constant heavy drinking’ (10% illness/death, 13% divorce) and ‘Decreasing heavy drinking’ (7% illness/death, 12% divorce). Constant heavy drinkers surrounding illness or death in the family were more likely to be men, report depression and anxiety and to smoke than those with no heavy drinking. Constant heavy drinkers surrounding divorce were also more likely to be men and to report depression compared with those with no heavy drinking.

Conclusions

Most older workers who experience divorce or severe illness or death in the family have stable drinking patterns regarding heavy alcohol consumption, that is, most do not initiate or stop heavy drinking.

Legal, Social, and Occupational Problems in Persons with Alcohol Use Disorder: An Exploratory Study

BACKGROUND

Very few studies have examined the extent and nature of legal, social, and occupational problems among persons who have SUDs. This study was aimed at studying the prevalence and patterns of the aforementioned problems among individuals with alcohol use disorders (AUDs) and their relationship with the quantity of alcohol consumed and other variables.

METHODS

We conducted a cross-sectional study of adult patients with a diagnosis of AUDs admitted to the deaddiction unit of a tertiary care facility in India, using a semistructured questionnaire prepared for this study.

RESULTS

The mean age (SD) of the 91 subjects (95.6% males) was 40.3 years (8.5). Majority of them (92.3%) had started alcohol consumption before the age of 25 years. Common problems reported were work absenteeism (83.5%), a major altercation with spouse (69.3%), assaulting someone while intoxicated (53.8%), and driving under the influence of alcohol (59.3%). Significant association was found between being unemployed and having a police complaint lodged against them (chi-square = 5.7, P = 0.01). Quantity of alcohol consumed per day was significantly more among those who had a history of work absenteeism (Z = 2.27, P = 0.01), major altercation with spouse (Z = 2.25, P = 0.02) and assaulted someone under intoxication (Z = 2.33, P = 0.02).

CONCLUSION

The quantity of alcohol consumed is significantly more in those who had several legal, social, and occupational problems when compared to those who did not have, highlighting the need for routine assessment of the aforementioned problems among patients of AUDs. Treatment of AUDs should be multidisciplinary, with targeted interventions tailored to the aforementioned problems. Doing so will go a long way in reducing the harm to patients and the community at large.

The Three-Item Thinking about Your Partner's Drinking Scale (TPD-3): Item Response Theory, Reliability, and Validity

Interdependence is a defining feature of close relationships, and alcohol use is one domain where one person's motivations and behaviors can affect a partner's well-being. Concern about partner drinking is a gauge that determines whether a partner's alcohol use has the potential to be problematic to the relationship, and brief and efficient measurement of this construct can be used to serve clinicians, scientists, and practitioners. Across four studies (N = 1,807), we use item response theory analysis to present a 3-item brief screening tool assessing concern about partner drinking: Thinking about your Partner's Drinking-3 (TPD-3). The TPD-3 revealed strong test-retest reliability and expected patterns of convergent, concurrent, and incremental validity with perceived partner drinking and alcohol-related consequences, behavioral responses to partner drinking, and relationship well-being. We present the TPD-3 as a useful screening tool and for measurement of concern about partner drinking when efficient assessment is desired.

Income trajectories prior to alcohol-attributable death in Finland and Sweden

BACKGROUND AND AIMS

Mortality from alcohol-attributable causes is patterned by income. We study the income trajectories 17-19 years prior to death in order to determine: (1) whether income levels and trajectories differ between those who die of alcohol-attributable causes, survivors with similar socio-demographic characteristics, all survivors and those dying of other causes; (2) whether the income trajectories of these groups differ by education; and (3) whether there are differences in income trajectories between Finland and Sweden-two countries with differing levels of alcohol-attributable mortality but similar welfare-provision systems.

DESIGN

Retrospective cohort study using individual-level longitudinal register data including information on income, cause of death and socio-economic status.

SETTING

Finland and Sweden.

PARTICIPANTS

The subjects comprised an 11% sample of the Finnish population in 2006-07 and the total population of Sweden aged 45-64 years in 2007-08.

MEASUREMENTS

Median household income trajectories by educational group were calculated by cause of death and population alive during the respective years. Additionally, propensity score matching was used to match the surviving population to those dying from alcohol-attributable causes with regard to socio-demographic characteristics.

FINDINGS

The median income 17-19 years prior to death from alcohol-attributable causes was 92% (Finland) and 91% (Sweden) of survivor income: 1 year prior to death, the respective figures were 47% and 57%. The trajectories differed substantially. Those dying of alcohol-attributable causes had lower and decreasing incomes for substantially longer periods than survivors and people dying from other causes. These differences were more modest among the highly educated individuals. The baseline socio-demographic characteristics of those dying of alcohol causes did not explain the different trajectories.

CONCLUSIONS

In Finland and Sweden, income appears to decline substantially before alcohol-attributable death. Highly educated individuals may be able to buffer the negative effects of extensive alcohol use on their income level. Income trajectories are similar in Finland and Sweden, despite marked differences in the level of alcohol-attributable mortality.

Academic Achievement and Drug Abuse Risk Assessed Using Instrumental Variable Analysis and Co-relative Designs

Importance

Low academic achievement (AA) in childhood and adolescence is associated with increased substance use. Empirical evidence, using longitudinal epidemiologic data, may provide support for interventions to improve AA as a means to reduce risk of drug abuse (DA).

Objective

To clarify the nature of the association between adolescent AA and risk of DA by using instrumental variable and co-relative analysis designs.

Design, Setting, and Participants

This study, assessing nationwide data from individuals born in Sweden between 1971 and 1982, used instrumental variable and co-relative analyses of the association between AA and DA. The instrument was month of birth. Co-relative analyses were conducted in pairs of cousins (263 222 pairs), full siblings (154 295), and monozygotic twins (1623) discordant for AA, with raw results fitted to a genetic model. The AA-DA association was modeled using Cox regression. Data analysis was conducted from October 2017 to January 2018.

Exposures

Academic achievement assessed at 16 years of age (for instrumental variable analyses), and estimated discordance in AA in pairs of monozygotic twins (for co-relative analyses).

Main Outcomes and Measures

Drug abuse registration in national medical, criminal, or pharmacy registries.

Results

This instrumental variable analysis included 934 462 participants (478 341 males and 456 121 females) with a mean (SD) age of 34.7 (4.3) years at a mean follow-up of 19 years. Earlier month of birth was associated with a linear effect on AA, with the regression coefficient per month equaling -0.0225 SDs (95% CI, -0.0231 to -0.0219). Controlling for AA, month of birth had no association with risk of DA (hazard ratio [HR], 1.000; 95% CI, 0.997-1.004). Lower AA had a significant association with risk of subsequent DA registration (HR per SD, 2.33; 95% CI, 2.30-2.35). Instrumental variable analysis produced a substantial but modestly attenuated association (HR, 2.04; 95% CI, 1.75-2.33). Controlling for modest associations between month of birth and parental educational status and DA risk reduced the association to a HR of 1.92 (95% CI, 1.67-2.22). The genetic model applied to the results of co-relative analyses fitted the observed data well and estimated the AA-DA association in monozygotic twins discordant for AA to equal a HR of 1.79 (95% CI, 1.64-1.92).

Conclusions and Relevance

Two different methodological approaches with divergent assumptions both produced results consistent with the hypothesis that the significant association observed between AA at 16 years of age and risk of DA into middle adulthood may be causal. These results provide empirical support for efforts to improve AA as a means to reduce risk of DA.

Associations Between Divorce and Onset of Drug Abuse in a Swedish National Sample

Rates of drug abuse are higher among divorced individuals than among those who are married, but it is not clear whether divorce itself is a risk factor for drug abuse or whether the observed association is confounded by other factors. We examined the association between divorce and onset of drug abuse in a population-based Swedish cohort born during 1965-1975 (n = 651,092) using Cox proportional hazards methods, with marital status as a time-varying covariate. Potential confounders (e.g., demographics, adolescent deviance, and family history of drug abuse) were included as covariates. Parallel analyses were conducted for widowhood and drug-abuse onset. In models with adjustments, divorce was associated with a substantial increase in risk of drug-abuse onset in both sexes (hazard ratios > 5). Co-relative analyses (among biological relatives) were consistent with a partially causal role of divorce on drug-abuse onset. Widowhood also increased risk of drug-abuse onset, although to a lesser extent. Divorce is a potent risk factor for onset of drug abuse, even after adjusting for deviant behavior in adolescence and family history of drug abuse. The somewhat less-pronounced association with widowhood, particularly among men, suggests that the magnitude of association between divorce and drug abuse may not be generalizable to the end of a relationship.

Interactive Effects of Maternal Alcohol Problems and Parental Separation on Timing of Daughter's First Drink

BACKGROUND

Few studies examine risk to offspring who experience both parental alcohol problems and parental separation and still fewer consider gender of the affected parent. We examined interactive effects of maternal versus paternal alcohol problems and parental separation on timing of first alcoholic drink in daughters.

METHODS

Data were drawn from a sample of 3,539 European (or other) ancestry (EA) and 611 African ancestry (AA) female twins born between 1975 and 1985, median age 15 at first assessment. Cox proportional hazards regression models were estimated predicting age at first full drink from parental history of alcohol problems (mother only, father only, or both parents), parental separation during childhood, and the interaction of parental alcohol problems and parental separation. Cox models were estimated without and with adjustment for correlated risk factors, separately for EA and AA twins.

RESULTS

For both EA and AA twins, a significant interaction between parental separation and mother-only alcohol problems was observed, suggesting reduced risk of drinking associated with mother-only alcohol problems in separated versus intact families.

CONCLUSIONS

Findings highlight parental separation as an important moderator of risk to children of mothers who have a history of problem drinking, with interactive effects observed consistently across racial group. To identify underlying processes, additional research is needed with more detailed characterization of separated families where mother only has a history of alcohol problems.

Stressful and Traumatic Experiences among Women with Alcohol Use Disorders in India

AIM

The aim of the present study was to examine lifetime stressful and traumatic experiences among women with alcohol use disorders (AUDs).

METHODS

The sample comprised of two groups: a clinical group of 35 women with a diagnosis of AUD and a comparison group of 60 women drawn from the community. After screening out, the participants were administered Life Stressor Checklist-Revised.

RESULTS

On an average, clinical group was exposed to 7.57 (standard deviation [SD] = 4.14) stressful events and comparison group was exposed to 4.03 (SD = 2.80) stressful events across the lifespan (t = 4.976; P < 0.001). Clinical group reported a high number of childhood abuse and interpersonal traumas across lifespan than comparison group. The relationship between adverse life experiences and alcohol abuse among women was bidirectional.

CONCLUSION

Understanding the nature and experiences of trauma in this group has implications for planning gender-sensitive treatment programs for women seeking help for AUDs in India.

Psychosocial relationship status and quality as predictors of exercise intervention adherence and substance use outcomes: Results from the STRIDE (CTN-0037) study

Social/intimate relationship status and quality are associated with health-promoting behaviors, while living alone or being isolated are adversely associated with physical and mental health outcomes. Limited work has investigated how particular components of one's social environment - usual living arrangements, satisfaction with those arrangements, and global social and family discord - are related to substance use reduction and intervention adherence. We investigated these questions in 270 individuals receiving study intervention for stimulant abuse/dependence through the multi-site Stimulant Reduction Intervention using Dosed Exercise (CTN-0037) trial. Using mixed effects modeling, results indicated that individuals with baseline social discord used stimulants on more days throughout the intervention period than those without social discord (d=0.39). An interaction between gender, usual living arrangements, and satisfaction with those arrangements indicated that women who lived alone and were dissatisfied with that arrangement reported greater days of stimulant use compared to several other groups (d≥1.46). Finally, individuals who reported usually living with a non-partner over the past three years attended a greater percentage of intervention sessions compared to those usually living with a partner (d=0.34). These results identify sample subgroups with adverse stimulant use and intervention adherence outcomes and suggest areas for future inquiry/intervention.

Divorce and the Onset of Alcohol Use Disorder: A Swedish Population-Based Longitudinal Cohort and Co-Relative Study

OBJECTIVE

The purpose of this study was to clarify the magnitude and nature of the relationship between divorce and risk for alcohol use disorder (AUD).

METHOD

In a population-based Swedish sample of married individuals (N=942,366), the authors examined the association between divorce or widowhood and risk for first registration for AUD. AUD was assessed using medical, criminal, and pharmacy registries.

RESULTS

Divorce was strongly associated with risk for first AUD onset in both men (hazard ratio=5.98, 95% CI=5.65-6.33) and women (hazard ratio=7.29, 95% CI=6.72-7.91). The hazard ratio was estimated for AUD onset given divorce among discordant monozygotic twins to equal 3.45 and 3.62 in men and women, respectively. Divorce was also associated with an AUD recurrence in those with AUD registrations before marriage. Furthermore, widowhood increased risk for AUD in men (hazard ratio=3.85, 95% CI=2.81-5.28) and women (hazard ratio=4.10, 95% CI=2.98-5.64). Among divorced individuals, remarriage was associated with a large decline in AUD in both sexes (men: hazard ratio=0.56, 95% CI=0.52-0.64; women: hazard ratio=0.61, 95% CI=0.55-0.69). Divorce produced a greater increase in first AUD onset in those with a family history of AUD or with prior externalizing behaviors.

CONCLUSIONS

Spousal loss through divorce or bereavement is associated with a large enduring increased AUD risk. This association likely reflects both causal and noncausal processes. That the AUD status of the spouse alters this association highlights the importance of spouse characteristics for the behavioral health consequences of spousal loss. The pronounced elevation in AUD risk following divorce or widowhood, and the protective effect of remarriage against subsequent AUD, speaks to the profound impact of marriage on problematic alcohol use.

Alcohol use disorder and divorce: evidence for a genetic correlation in a population-based Swedish sample

AIMS

We tested the association between alcohol use disorder (AUD) and divorce; estimated the genetic and environmental influences on divorce; estimated how much genetic and environmental influences accounted for covariance between AUD and divorce; and estimated latent genetic and environmental correlations between AUD and divorce. We tested sex differences in these effects.

DESIGN

We identified twin and sibling pairs with AUD and divorce information in Swedish national registers. We described the association between AUD and divorce using tetrachorics and used twin and sibling models to estimate genetic and environmental influences on divorce, on the covariance between AUD and divorce and the latent genetic and environmental correlations between AUD and divorce.

SETTING

Sweden.

PARTICIPANTS

A total of 670 836 individuals (53% male) born 1940-1965.

MEASUREMENTS

Life-time measures of AUD and divorce.

FINDINGS

AUD and divorce were related strongly (males: r_tet  = +0.44, 95% CI = 0.43, 0.45; females r_tet  = +0.37, 95% CI = 0.36, 0.38). Genetic factors accounted for a modest proportion of the variance in divorce (males: 21.3%, 95% CI = 7.6, 28.5; females: 31.0%, 95% CI = 18.8, 37.1). Genetic factors accounted for most of the covariance between AUD and divorce (males: 52.0%, 95% CI = 48.8, 67.9; females: 53.74%, 95% CI = 17.6, 54.5), followed by non-shared environmental factors (males: 45.0%, 95% CI = 37.5, 54.9; females: 41.6%, 95% CI = 40.3, 60.2). Shared environmental factors accounted for a negligible proportion of the covariance (males: 3.0%, 95% CI = -3.0, 13.5; females: 4.75%, 95% CI = 0.0, 6.6). The AUD-divorce genetic correlations were high (males: rA = +0.76, 95% CI = 0.53, 0.90; females +0.52, 95% CI = 0.24, 0.67). The non-shared environmental correlations were modest (males: rE = +0.32, 95% CI = 0.31, 0.40; females: +0.27, 95% CI = 0.27, 0.36).

CONCLUSIONS

Divorce and alcohol use disorder are correlated strongly in the Swedish population, and the heritability of divorce is consistent with previous studies. Covariation between AUD and divorce results from overlapping genetic and non-shared environmental factors. Latent genetic and non-shared environmental correlations for alcohol use disorder and divorce are high and moderate.

Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study

BACKGROUND

Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited.

OBJECTIVE

To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes.

SETTING

10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to 7 years through January 2015.

RESULTS

Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age: 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95% confidence interval (CI): 18.5-23.3), 7.5% (95% CI: 6.1-9.1), and 3.5% (95% CI: 2.6-4.8), respectively, post-RYGB, and 11.3% (95% CI: 8.5-14.9), 4.9% (95% CI: 3.1-7.6), and .9% (95% CI: .4-2.5) post-LAGB. Undergoing RYGB versus LAGB was associated with higher risk of incident AUD symptoms (adjusted hazard ratio or AHR = 2.08 [95% CI: 1.51-2.85]), illicit drug use (AHR = 1.76 [95% CI: 1.07-2.90]) and SUD treatment (AHR = 3.56 [95% CI: 1.26-10.07]).

CONCLUSIONS

Undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.

Self-defining memories in recently detoxified alcohol-dependent patients

Patients with alcohol dependence have been shown to be impaired in recalling specific autobiographical events, yet little is known on how changes in the memory of these events may impact their self-representation. In this study, we examined Self-Defining Memories (SDMs), a specific type of autobiographical memory that plays a key role in the construction of personal identity, in 25 patients with alcohol dependence, abstinent from alcohol from 10 days to 6 months, compared to 28 control subjects. We observed that SDMs in patients were significantly less specific and included more reference to alcohol than those of controls. Patients also reported more SDMs with negative emotional valence and higher emotional intensity. These results suggest that recently abstinent alcohol-dependent patients may be prone to define themselves by negative events referring to alcohol consumption, which may contribute to an unfavorable perception of their self and subsequently of their ability to remain abstinent. These findings should be taken into account to optimize psychological approaches in the treatment of alcohol-dependence.

Parental alcohol-related disorders and school performance in 16-year-olds-a Swedish national cohort study

AIMS

To study the links between parental alcohol-related disorders and offspring school performance and, specifically, whether associations vary by gender of parent or child and whether associations are mediated by other adverse psychosocial circumstances commonly appearing together with parental alcohol problems, such as parental mental health problems or criminal behaviour.

DESIGN

Register study in a national cohort.

SETTING

Sweden.

PARTICIPANTS

A total of 740 618 individuals born in Sweden in 1990-96.

MEASUREMENTS

Parental hospital admissions for alcohol-related disorders and school performance in their offspring, in the final year of compulsory school at age 15-16 years was analysed in relation to socio-demographic confounders and psychosocial covariates, using linear and logistic regressions.

FINDINGS

Both mothers' and fathers' alcohol-related hospital admissions were associated with lower Z-scores of grades and national mathematics tests scores. After adjustment for parental education and socio-demographic confounders, beta-coefficients of Z-scores of grades were -0.42 [95% confidence interval (CI) = -0.45, -0.39] and -0.42 (95% CI =  -0.43, -0.40), and beta-coefficients of mathematics tests scores were -0.36 (95% CI = -0.39, -0.33) and -0.31 (95% CI = -0.33, -0.29), for mothers' and fathers' alcohol-related disorders, respectively. Adjusted odds ratios (ORs) for not being eligible for secondary school were 1.99 (95% CI = 1.84-2.15) and 2.04 (95% CI = 1.95-2.15) for mothers' and fathers' alcohol-related disorders, respectively. Adjusting the analyses for psychosocial factors in the family almost eradicated the statistical effects of parental alcohol-related disorders on offspring school performance to beta-coefficients of 0.03 to -0.10 and ORs of 0.89-1.15. The effect of a mother's alcohol-related hospital admission on school performance was stronger in girls than in boys, whereas no gender differences were seen for a father's alcohol-related hospital admission.

CONCLUSIONS

In Sweden, alcohol-related disorders in both mothers and fathers are associated with lower school performance in their children at age 15-16 years, with most of the statistical effects being attributed to psychosocial circumstances of the family, such as parental psychiatric disorders, drug use and criminality and receipt of social or child welfare interventions.

The effects of maternal alcohol use disorders on childhood relationships and mental health

PURPOSE

Despite millions of children living in the turmoil of their parents' active alcoholism or the aftermath of past abuse, research to date has not (1) provided a comprehensive examination of the effects of maternal alcohol use disorders (AUDs) on children's social ties outside of their relationships with parents, or (2) considered whether the number and quality of childhood social ties alter the effects of maternal AUDs on children's mental health.

METHOD

Using data from the National Longitudinal Surveys of Youth 1979 Children and Young Adults, analysis examined the influence of maternal AUDs on the number and quality of children's ties with siblings, extended family and family friends, peers, and neighborhood members. The analysis also considered how children's social ties influenced the association between maternal AUDs and children's internalizing and externalizing problems.

RESULTS

Children of alcoholic mothers had similarly sized networks but more distant relationships with siblings and friends, negative interactions with classmates, and isolating neighborhoods. Controlling for these aspects of children's social ties substantially reduced mental health disparities between children of alcoholic mothers and other children.

CONCLUSIONS

Findings support the view that maternal alcohol use disorders have the potential to damage children's mental health while also setting into motion long-term relationship problems. Future research should examine the networks of children who experience parental AUDs to further clarify the social processes that link parental AUDs to children's mental health.

Life course outcomes for women with different alcohol consumption trajectories: A population-based longitudinal study

INTRODUCTION AND AIMS

Relatively little is known about the consequences for women of sustained higher levels of alcohol consumption. We examine three outcomes (marital relationship, reproductive health and well-being) for women with different alcohol consumption trajectories over 21 years.

DESIGN AND METHODS

Data were from a prospective cohort study in Brisbane, Queensland (n = 3337). Group-based trajectory modeling measured women's alcohol consumption trajectories spanning 21 years. Outcomes were measured using a self-report questionnaire at the 27-year follow-up.

RESULTS

Four trajectories of women's alcohol consumption were identified: abstaining, low-stable drinkers, moderate-escalating drinkers and heavy-escalating drinkers. Abstaining predicts positive outcomes measured at the 27-year follow-up such as being married, never having a divorce, never having multiple partners, and fewer pregnancy terminations. Moderate and heavy-escalating trajectories predict being unmarried, having multiple partners, having fewer children, having a termination of a previous pregnancy, and reporting lower levels of well-being at the 27-year follow-up.

DISCUSSION AND CONCLUSIONS

The escalating-trajectory group is of particular interest as membership of this group is associated with a wide range of adverse life course outcomes by the 27-year follow-up. The consequences of moderate and heavy-escalating alcohol trajectories in a community sample of women whose pattern of alcohol consumption do not reach clinical criteria of problem drinking have not previously been described. Women with these sustained patterns of alcohol consumption are an appropriate target group for intervention programs. programs. [TranNT, Clavarino A,WilliamsGM,Najman JM. Life course outcomes for women with different alcohol consumption trajectories: A population-based longitudinal study. Drug Alcohol Rev 2016;35:763-771].

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.

Primary Care Management of Alcohol Misuse

More than one in four American adults consume alcohol in quantities exceeding recommended limits. One in 12 have an alcohol use disorder marked by harmful consequences. Both types of alcohol misuse contribute to acute injury and chronic disease, making alcohol the third largest cause of preventable death in the United States. Alcohol misuse alters the management of common conditions from insomnia to anemia. Primary care providers should screen adult patients to identify the full spectrum of alcohol misuse. A range of effective treatments are available - from brief counselling interventions and mutual help groups to medications and behavioral therapies.

Social network as predictor for onset of alcohol use disorder: A prospective cohort study

OBJECTIVE

Social network has been linked to alcohol use disorder in several studies. However, since the majority of such findings are cross-sectional, causal interpretation is difficult. The aim of the present study was to test if social network characteristics predict alcohol use disorder in a prospective design.

METHODS

Information on social network and covariates was obtained from 9589 men and women aged 21-99 years in the Copenhagen City Heart Study, followed for registration of alcohol use disorder in the Danish National Patient Registry and the WINALCO database.

RESULTS

Men who lived alone, were separated or divorced or widowers had a higher risk of developing alcohol use disorder: HR among men living alone vs. men not living alone was 2.28 (95% CI: 1.59-3.27), and HR among separated/divorced men vs. married men was 2.55 (95% CI: 1.33-4.89). No such associations were found among women. Frequency of contact with friends was associated with risk of developing alcohol use disorder among both sexes. For example, the HRs were 1.72 (CI 95%: 0.99-3.01) and 2.59 (95% CI: 1.42-4.71) among women who had contact with friends a couple of times per week and daily, respectively, compared with more rarely. Frequency of contact with family was not associated with risk of developing alcohol use disorder among either sex.

CONCLUSION

Living alone and not being married or cohabiting with a partner were predictors of developing alcohol use disorder among men. Further, frequent contact with friends was associated with higher risk of alcohol use disorder among both sexes.

Parental Separation and Offspring Alcohol Involvement: Findings from Offspring of Alcoholic and Drug Dependent Twin Fathers

BACKGROUND

We examined associations between parental separation during childhood and offspring alcohol involvement, adjusting for genetic and environmental risks specific to parental alcohol (AD) and cannabis/other illicit drug dependence (DD).

METHODS

The sample consisted of 1,828 offspring of male twins from the Vietnam Era Twin (VET) Registry, who completed a telephone diagnostic interview. Cox proportional hazards regression analyses were conducted predicting onset of first use, transition from first use to first AD symptom, and transition from first use to AD diagnosis from paternal and avuncular AD and DD history, parental separation, and offspring and family background characteristics. Paternal/avuncular DD/AD was based on the DSM-III-R; offspring and maternal AD were based on DSM-IV criteria.

RESULTS

Paternal DD/AD predicted increased offspring risk for all transitions, with genetic effects suggested on rate of transitioning to AD diagnosis. Parental separation was predictive of increased risk for early alcohol use, but a reduced rate of transition to both AD symptom onset and onset of AD. No interactions between separation and familial risk (indexed by paternal or avuncular DD/AD) were found.

CONCLUSIONS

Findings highlight the contribution of both parental separation and paternal substance dependence in predicting timing of offspring alcohol initiation and problems across adolescence into early adulthood.

Using multiple methods to examine gender differences in alcohol involvement and marital interactions in alcoholic probands

BACKGROUND

This study examined gender differences in alcohol involvement and marital interactions among probands with a past 1-year alcohol use disorder (AUD).

METHODS

Adults with alcohol dependence (37 males and 17 females) and their spouses were recruited from a local substance abuse treatment center and from the local community. Couples completed a series of self-report measures and a 15-min videotaped marital interaction task that was coded for negative and positive behaviors and sequential interactions. Couples also separately called in to an interactive voice response (IVR) system every night for 14 consecutive nights and reported on their spouse's negative and positive marital behaviors.

RESULTS

Compared to male probands, female probands reported a) more negative marital interactions in the previous month; b) higher levels of negative reciprocity and a lower positive-to-negative ratio in the marital interaction task; and c) more daily and nightly marital conflict over the 14-day diary period. Negative marital behaviors in the evening by female spouses were associated with higher odds of intoxication among male probands on the following day. In contrast, a) negative marital behaviors by male spouses were cross-sectionally associated with higher odds of intoxication among female probands within the same day; and b) positive marital behaviors by male spouses during the day were associated with lower odds of intoxication among female probands that night.

CONCLUSIONS

Marital conflict, assessed via multiple methods over multiple time scales, appears to be more frequent among female compared to male alcoholics. Marital conflict predicts daily intoxication among male and female probands.