What if Americans drank less? The potential effect on the prevalence of alcohol abuse and dependence

Psychosocial Determinants of Premature Health Deterioration in a Changing Society: The Case of Hungary

The drastic increase of morbidity and mortality rates in the transforming Central-Eastern European countries, characterizing the last decades, offers a unique opportunity to analyse the relationship of those social, psychological and biological processes that contribute to rapid health modifications. In 1988 and 1995, two national representative surveys of the Hungarian population aged 16 or older ( N = 20,902 and 12,640 respectively) were conducted. The results show that depressive symptom severity mediates between relative socio-economic deprivation and higher self-rated morbidity rates. The worsening of traditional risk factors such as alcohol consumption and smoking, are also the consequences of social and psychological problems. A vicious circle might be hypothesized between social deprivation and depressive symptomatology, which substantially contributes to higher morbidity and mortality rates.

Are Estimates of the Concentration of Alcohol Consumption Affected by Undercoverage? Evidence from Five Pooled U.S. Surveys

Conclusions concerning the properties of alcohol consumption distributions are often based on surveys that underestimate the amount consumed by sampled populations. Relationships between underreporting of alcohol consumption and the concentration of heavy drinking could present problems for several important research findings. Using data from five US telephone surveys, we compared state-level survey estimates of alcohol consumption and concentration with published estimates based on sales and taxes. Demographic factors predicting undercoverage were assessed in a multilevel analysis. Concentration was not significantly related to coverage, but it was related to rates of any drinking. State-level undercoverage was predicted by the proportion of males, younger age, political conservatism, Hispanic ethnicity, and the proportion of ethanol sold as spirits. Additional research is needed to determine the consequences ofthe relationships between these factors and undercoverage, but national estimates ofconsumption distribution properties are unlikely to be affected greatly by low coverage rates.

The impact of alcohol use severity on anxiety treatment outcomes in a large effectiveness trial in primary care

OBJECTIVE

The presence of anxiety disorders is associated with poorer alcohol use disorder treatment outcomes, but little is known about the impact of alcohol use problems on anxiety disorder treatment outcomes despite their high comorbidity. The current study examined the impact of alcohol use symptom severity on anxiety disorder treatment outcomes in a multi-site primary care effectiveness study of anxiety disorder treatment.

METHOD

Data came from the Coordinated Anxiety Learning and Management (CALM) effectiveness trial. Participants (N=1004) were randomized to an evidence-based anxiety intervention (including cognitive behavioral therapy and medications) or usual care in primary care. Participants completed measures of alcohol use, anxiety, and depression at baseline, 6-, 12-, and 18-month follow-up periods. Patients with alcohol dependence were excluded.

RESULTS

There were no significant moderating (Treatment Group × Alcohol Use Severity) interactions. The majority of analyses revealed no predictive effects of alcohol use severity on outcome; however, alcohol problems at baseline were associated with somewhat higher anxiety and depression symptoms at the 18-month follow-up.

CONCLUSIONS

These data indicate that patients with alcohol problems in primary care can be effectively treated for anxiety disorders. Baseline alcohol problems were associated with some poorer long-term outcomes, but this was evident across CALM and usual care. These findings provide preliminary evidence that there may be no need to postpone treatment of anxiety disorders until alcohol problems are addressed, at least among those who have mild to moderate alcohol problems. Replication with more severe alcohol use disorders is needed.

Estimating older hazardous and binge drinking prevalence using AUDIT-C and AUDIT-3 thresholds specific to older adults

BACKGROUND

This study aimed to provide hazardous and binge drinking prevalence, odds and risk attributable to specific demographic correlates in community dwelling older adults using both the standard and new older-specific AUDIT-C thresholds.

METHODS

Hazardous drinking was assessed using the AUDIT-C in a cross-sectional postal survey of 6662 New Zealanders aged 55-70 years old (m=60.94, SD=4.70) randomly selected from the New Zealand Electoral Roll. Prevalence data is presented for whole sample and stratified by key demographic correlates using standard and older-specific threshold scores on the AUDIT-C. Hazardous drinking prevalence using the standard AUDIT-C threshold was 56.01%, as compared to 42.28% and 50.20% under two older-specific thresholds.

RESULTS

Being younger, male, and wealthy were consistent drinking predictors across thresholds but the older-specific thresholds substantially altered the prevalence and risk for females, Asians, and poorer people. Past-month binge prevalence of 18.18% was considerably lower than the past-year prevalence of 33.51%, but change from past-month to past-year binge threshold had no significant effect on the demographic composition of binge drinkers. The standard AUDIT-C threshold over-estimates hazardous drinking prevalence in older adults by up to 33%, but even the most conservative rates in this study are cause for concern regarding the level of drinking by older people in New Zealand.

CONCLUSION

Older hazardous drinkers are predominantly younger, wealthier, white, partnered males, whichever threshold is used, but binge drinkers are more likely to be rural, Māori, and lack tertiary education. Further efforts are needed to determine factors underpinning hazardous drinking, especially in older Māori.

Alcohol Consumption and Problems: The Relevance of Drinking Patterns

BACKGROUND

Data on risks and benefits associated with drinking patterns provide the scientific basis for moderate, low-risk drinking guidelines. Illustrated are methods to investigate and adjust for heterogeneity in relations between three-dimensional drinking patterns and 41 alcohol problems assessed among current regular drinkers in the 1988 National Health Interview Survey.

METHODS

Three dimensions of mean drinking patterns, (i.e., usual quantities, heavy drinking rates (days of 5+ drinks/drinking days x 100), and drinking frequencies) were estimated in overlapping subsets of the population reporting each of the 41 problems, and mean usual quantities and heavy drinking rates were plotted against frequencies. Respondents were categorized into drinking problem groups associated with comparable mean drinking patterns; and main and interactive effects of age and sex on drinking patterns were examined by conducting three regression analyses within each group, with quantity, frequency, and heavy drinking rates as dependent variables, respectively.

RESULTS

Analyses revealed substantial heterogeneity in relations between drinking patterns and alcohol problems. Respondents having only minor problems drank on average two days a week, usually had 2.6 drinks, and drank heavily 12-13 days a year. Whereas, those having minor and severe problems drank an average of 3.5 days a week, usually had 4.7 drinks, and drank heavily 58 days a year. Within each problem group, usual quantity and frequency were higher among males than females, but the greatest gender differences were seen in heavy-drinking rates. Age-related differences in drinking patterns were striking. Usual quantity and heavy-drinking rates associated with problems decreased with age, whereas drinking frequency increased.

CONCLUSIONS

Findings demonstrated the importance of assessing and adjusting for heterogeneity in relations between drinking patterns and alcohol problems when aggregating and interpreting such data, (e.g., when assessing alcohol dependence criteria or evaluating guidelines for moderate drinking), and illustrated new methods for doing so.

The prevalence and impact of alcohol problems in major depression: a systematic review

Major depression and alcohol problems are common in primary care, yet little is known about the prevalence of alcohol problems in patients with depression or alcohol's effect on depression outcomes. We strove to answer the following questions: How common are alcohol problems in patients with depression? Does alcohol affect the course of depression, response to antidepressant therapy, risk of suicide/death, social functioning and health care utilization? In which alcohol categories and treatment settings have patients with depression and alcohol problems been evaluated? English language studies from MEDLINE, PsychINFO, and Cochrane Controlled Trial Registry were reviewed. Studies were selected using predefined criteria if they reported on the prevalence or effects of alcohol problems in depression. Thirty-five studies met criteria and revealed a median prevalence of current or lifetime alcohol problems in depression of 16% (range 5-67%) and 30% (range 10-60%), respectively. This compares with 7% for current and 16-24% for lifetime alcohol problems in the general population. There is evidence that antidepressants improve depression outcomes in persons with alcohol dependence. Alcohol problems are associated with worse outcomes with respect to depression course, suicide/death risk, social functioning, and health care utilization. The majority of the studies, 34 of 35 (97%), evaluated alcohol abuse and dependence, and 25 of 35 (71%) were conducted in psychiatric inpatients. We conclude that alcohol problems are more common in depression than in the general population, are associated with adverse clinical and health care utilization outcomes, and that antidepressants can be effective in the presence of alcohol dependence. In addition, the literature focuses almost exclusively on patients with alcohol abuse or dependence in psychiatric inpatient settings, and excludes patients with less severe alcohol problems and primary care outpatient settings.

Stability in the drinking habits of older problem-drinkers recruited from nontreatment settings

Few prospective studies have examined older problem-drinkers not currently in treatment to determine the stability in alcohol problems over time. Seventy-eight currently drinking, older adults meeting a diagnosis of alcohol abuse or dependence were recruited via advertising to complete a health interview; 48 were reinterviewed approximately 3 years later. Participants were categorized based on alcohol consumption (risk) and alcohol-related diagnostic symptoms (problem) at baseline and follow-up. At follow-up, few older adults (11.4%) were resolved using both risk and problem criteria. Alcohol risk/problem groups were not significantly stable between baseline and follow-up. Health problems was the most common reason for changing drinking habits. Average and maximum consumption at baseline and follow-up were significant markers of follow-up risk group and follow-up alcohol-related consequences, respectively, with maximum consumption being more robust. The course of alcohol problems among older adults fluctuates over time, and heavy drinking appears to be the best indicator of problem continuation.

Lifestyle factors and stroke risk: exercise, alcohol, diet, obesity, smoking, drug use, and stress

Various lifestyle factors have been associated with increasing the risk of stroke. These include lack of exercise, alcohol, diet, obesity, smoking, drug use, and stress. Guidelines endorsed by the Centers for Disease Control and Prevention and the National Institutes of Health recommend that Americans should exercise for at least 30 minutes of moderately intense physical activity on most, and preferably all, days of the week. Recent epidemiologic studies have shown a U-shaped curve for alcohol consumption and coronary heart disease mortality, with low-to-moderate alcohol consumption associated with lower overall mortality. High daily dietary intake of fat is associated with obesity and may act as an independent risk factor or may affect other stroke risk factors such as hypertension, diabetes, hyperlipidemia, and cardiac disease. Homocysteine is another important dietary component associated with stroke risk, while other dietary stroke risk factors are thought to be mediated through the daily intake of several vitamins and antioxidants. Smoking, especially current smoking, is a crucial and extremely modifiable independent determinant of stroke. Despite the obstacles to the modification of lifestyle factors, health professionals should be encouraged to continue to identify such factors and help improve our ability to prevent stroke.

Parents' health, health care utilization, and health behaviors following the violent deaths of their 12- to 28-year-old children: a prospective longitudinal analysis

Health status, health care utilization, and health behaviors of parents bereaved by the violent deaths of their adolescent and young adult children were examined 4, 12, and 24 months later. Participants were 261 bereaved parents (171 mothers, 90 fathers). About 20% of the parents reported "poor" physical health during the early bereavement period compared with 16% of Americans the same age. Over time, mothers' health improved whereas fathers' health deteriorated. Fathers in poor health compared with fathers in good health are 15 times more likely to report emotional distress and 4.6 times more likely to report trauma symptoms. Mothers in poor health compared with mothers in good health are 11 times more likely to report emotional distress and 3 times more likely to report trauma symptoms. Mothers' reports of physician visits and medication use were higher than fathers', however, mothers' rates for both decreased significantly over time whereas fathers' rates remained constant. Over 70% of the mothers and nearly 60% of the fathers practiced 2 or more health protective behaviors over time--a finding significantly associated with fewer stress-related illnesses, days absent from work, and non-productivity at work. Implications for the findings are discussed.

Patients with alcohol problems in primary care: understanding their resistance and motivating change

How can physicians motivate patients with alcohol problems when they resist advice to change? A framework for understanding patient resistance is described to help physicians use this motivational approach more effectively with patients.

PTSD among bereaved parents following the violent deaths of their 12- to 28-year-old children: a longitudinal prospective analysis

This study examined the prevalence of posttraumatic stress disorder (PTSD) among parents bereaved by the violent deaths of their 12- to 28-year-old children. A community-based sample of 171 bereaved mothers and 90 fathers was recruited by a review of Medical Examiner records and followed for 2 years. Four important findings emerged: Both parents' gender and children's causes of death significantly affected the prevalence of PTSD symptoms. Twice as many mothers and fathers whose children were murdered met PTSD caseness (full diagnostic) criteria compared with accident and suicide bereavement. Symptoms in the reexperiencing domain were the most commonly reported. PTSD symptoms persisted over time, with 21% of the mothers and 14% of the fathers who provided longitudinal data still meeting caseness criteria 2 years after the deaths. Parents who met caseness criteria for PTSD, compared with those who did not, were significantly different on multiple study variables. Both theoretical and clinical implications for the findings are discussed.

The use of alcohol by lesbians: a review and research agenda

This article reviews the literature on alcohol use by lesbians. Comparisons of data on lesbians and women from the general population show that lesbians tend to drink more than other women; that rates of drinking do not decline with age as is true for general population women; and that even when levels of drinking are equivalent between lesbians and general population women, lesbians report greater difficulties related to alcohol consumption. Differences in sampling techniques and differences in definitions of drinking among the papers made comparisons of results difficult. These issues are discussed and recommendations are made concerning standardization of data collection.

Review of Canadian low-risk drinking guidelines and their effectiveness

This study compared 18 low-risk drinking guidelines that were gathered from Canadian government agencies, non-government agencies, medical bodies, and public and private agencies involved in the treatment of addictions. The results show that two sets of guidelines are predominantly used in Ontario. The formulation of these guidelines was entirely independent and their intended audiences are also different. However, a direct comparison of the two guidelines shows that differences are more apparent than real. This study also examines the literature evaluating low-risk drinking guidelines Very little literature exists on evaluating low-risk drinking guidelines as vehicles for primary prevention and it is not known to what extent such guidelines influence knowledge and drinking behaviour. Future low-risk drinking recommendations should be evaluated for knowledge about standard drink units, awareness of the guidelines, use of materials and aids included in the dissemination program, and changes in behaviour from campaign exposure.

Review of Canadian low-risk drinking guidelines and their effectiveness

This study compared 18 low-risk drinking guidelines that were gathered from Canadian government agencies, non-government agencies, medical bodies, and public and private agencies involved in the treatment of addictions. The results show that two sets of guidelines are predominantly used in Ontario. The formulation of these guidelines was entirely independent and their intended audiences are also different. However, a direct comparison of the two guidelines shows that differences are more apparent than real. This study also examines the literature evaluating low-risk drinking guidelines Very little literature exists on evaluating low-risk drinking guidelines as vehicles for primary prevention and it is not known to what extent such guidelines influence knowledge and drinking behaviour. Future low-risk drinking recommendations should be evaluated for knowledge about standard drink units, awareness of the guidelines, use of materials and aids included in the dissemination program, and changes in behaviour from campaign exposure.

Moderate drinking in women: a concept analysis

This analysis clarifies the concept of moderate drinking in women. The literature reflects a variety of definitions of moderate drinking and refers largely to drinking in men. Several strategies for concept analysis suggested by Walker and Avant (1995) resulted in the formulation of a theoretical definition of moderate drinking in women applicable to practice and research. The defining attributes of women's moderate drinking in contemporary U.S. culture include (1) minimization of risks of alcohol-related problems, (2) a desire for any potential health benefits, (3) deliberate adoption of personal drinking guidelines based on some knowledge of the effects of alcohol, (4) control of when and how much alcohol is consumed, (5) sensitization to special drinking considerations faced by women, and (6) having at least one interpersonal relationship with another moderate drinker.

The relationship between alcohol symptoms and consumption among older drinkers

The present study assessed the relationship between current alcohol symptoms and consumption levels in a heterogeneous sample of older adults. The sample consisted of 443 participants over age 55 who reported drinking within the past year, including social drinkers, alcoholics in treatment, and alcoholics not in treatment. Symptoms for the past year were assessed using the Diagnostic interview Schedule (DIS-III-R) alcohol section, and subjects were subsequently assigned to two groups (symptom-free and symptomatic), depending on whether they experienced any DSM-III-R alcohol symptoms in the last year. For both men and women, average daily consumption and the frequency of heavy drinking contributed to whether participants had experienced any alcohol symptoms. The results indicate that the consumption levels of men and women differed only for symptomatic drinkers. The findings support recommendations that consumption limits for older adults should be lower than those recommended in the literature for younger adults. Furthermore, the results suggest that, in addition to limiting average daily consumption to no more than one drink per day, eliminating episodes of heavy drinking (consuming five or more drinks) could further reduce the risk of alcohol-related symptoms for older adults.

High alcohol-related premature mortality in France: concordant estimates from a prospective cohort study and national mortality statistics

This study examines the magnitude of alcohol-related premature death in the French population, which still has the highest average alcohol intake in the world and a relatively low coronary heart disease mortality rate. Two data sources were used: the national mortality data in 1990 and a prospective mortality experience in a cohort of 2,687 middle-aged working men examined in 1980-1985 and followed-up during an average of 9.3 years. In the general population study, alcohol-related premature mortality (35-64 years) was calculated using alcohol-attributable fractions (AAFs) derived from studies of alcohol involvement in deaths from various causes. In the cohort, it was estimated from AAFs and attributable risk using both alcohol exposure prevalence and relative risks of death according to alcohol intake categories. In 1990, estimates of 19.1% and 13.0% of all premature deaths in French men and women were attributed to alcohol. Digestive diseases followed by malignant neoplasms in men and by unintentional injuries in women were major contributors to the total number of alcohol-related premature deaths. In the cohort study, 90 deaths occurred during the follow-up period. The estimation of alcohol-related premature mortality using AAFs was 24.4%. The relative risk of total mortality (adjusted for age, smoking habits, and body mass index) for men who consumed > 60 ml/day of alcohol, compared with those who consumed 0-25 ml/day was 1.9 (95% confidence interval: 1.1-3.5). The consumption of 26-60 ml/day was not associated with reduced risk of mortality, and the adjusted relative risk for this group was 1.3 (95% confidence interval: 0.7-2.5). The estimated attributable risk of premature mortality caused by consumption of > 25 ml/day of alcohol was 29.9%. This study reports the persisting high alcohol-related premature mortality in the French general population, as well as in middle-aged working men. The results suggest that efforts should be paid to reduce further the consumption of alcohol in France.