Alcohol Consumption Problems Research Articles

Snow Control - An RCT protocol for a web-based self-help therapy to reduce cocaine consumption in problematic cocaine users

BackgroundCocaine use has increased in most European countries, including Switzerland, and many states worldwide. The international literature has described treatment models that target the general population. In addition to supplying informative measures at the level of primary and secondary prevention, the literature also offers web-based self-help tools for problematic substance users, which is in line with tertiary prevention. Such programs, however, have been primarily tested on individuals with problematic alcohol and cannabis consumption, but not on cocaine-dependent individuals.Methods/DesignThis paper presents the protocol of a randomised clinical trial to test the effectiveness of a web-based self-help therapy to reduce cocaine use in problematic cocaine users. The primary outcome is severity of cocaine dependence. Secondary outcome measures include cocaine craving, consumption of cocaine and other substances of abuse in the past month, and changes in depression characteristics. The therapy group will receive a 6-week self-help therapy to reduce cocaine consumption based on methods of Cognitive Behavioural Therapy, principles of Motivational Interviewing and self-control practices. The control group will be presented weekly psycho-educative information with a quiz. The predictive validity of participant characteristics on treatment retention and outcome will be explored.DiscussionTo the best of our knowledge, this will be the first randomised clinical trial to test the effectiveness of online self-help therapy to reduce or abstain from cocaine use. It will also investigate predictors of outcome and retention. This trial is registered at Current Controlled Trials and is traceable as NTR-ISRCTN93702927.

‘I don't know anyone that has two drinks a day’: Young people, alcohol and the government of pleasure

Problematic alcohol consumption is a major public health, health education and health promotion issue in Australia and internationally. In an effort to better understand young people's drinking patterns and motivations we investigated the cultural drivers of drinking in 14–24 year-old Australians. We interviewed 60 young people in the state of Victoria aged 20–24 about their drinking biographies. At the time of interviewing, the draft guidelines on low-risk drinking were released by the National Health and Medical Research Council, Australia, and we asked our participants what they knew about them and if they thought they would affect their drinking patterns. Their responses indicate that pleasure and sociability are central to young people's drinking cultures which is supported by a range of research. However, O’Malley and Valverde claim that pleasure is silenced and/or deployed strategically in neo-liberal governance discourses about drugs and alcohol such as these guidelines which raises questions about the limits of such discourses to affect changes in drinking patterns.

Impacto del trastorno por consumo de alcohol en la mortalidad: ¿hay diferencias según la edad y el sexo?

Objectives To estimate excess mortality in patients with an alcohol use disorder and to calculate the population-based impact attributable to this disorder, with emphasis on differences according to gender and age. Methods We carried out a longitudinal study of a dynamic retrospective cohort in which 7,109 patients (76.5% men) aged 18-64 years who started medical day treatment between 1997 and 2006 were recruited. Deaths were monitored until the end of 2006 using a national mortality register. Standardized mortality ratios (SMR) by age and gender and population attributable risks (PAR) by age group were estimated. Results There were 557 deaths (83% were men). The total excess mortality was 8 times higher than in the general population aged 18-64 years, especially in the group aged 25-34 years old (SMR: 11.2 [95% CI: 7.8-16.0] in men and 24 [IC95%: 11.5-50.4] in women). Significant differences by gender were found in all the variables analyzed. In Barcelona, alcohol use disorder was estimated to cause 73 deaths per year, representing 3.3% of the total annual deaths in this city in persons aged 18-64 years. This percentage was substantially higher in the groups aged 25-34 years (PAR: 19.4% [95% CI: 19.2-19.6]) and 18-24 years (PAR: 11.1% [95% CI: 10.7-11.4]). Conclusions Women and young men with an alcohol use disorder have a higher risk of early mortality. Early detection of problematic alcohol consumption and selective and well-indicated prevention programs should be improved.

New developments in brief interventions to treat problem drinking in nonspecialty health care settings.

The delivery of brief interventions (BIs) in health care settings to reduce problematic alcohol consumption is a key preventive strategy for public health. However, evidence of effectiveness beyond primary care is inconsistent. Patient populations and intervention components are heterogeneous. Also, evidence for successful implementation strategies is limited. In this article, recent literature is reviewed covering BI effectiveness for patient populations and subgroups, and design and implementation of BIs. Support is evident for short-term effectiveness in hospital settings, but long-term effects may be confounded by changes in control groups. Limited evidence suggests effectiveness with young patients not admitted as a consequence of alcohol, dependent patients, and binge drinkers. Influential BI components include high-quality change plans and provider characteristics. Health professionals endorse BI and feel confident in delivering it, but training and support initiatives continue to show no significant effects on uptake, prompting calls for systematic approaches to implementing BI in health care.

Labour market status, requirements and social support—single male clients with problematic alcohol consumption

The study presented in this article investigates relations between two phenomena that are widely considered to be social problems—unemployment and alcohol abuse. The investigated group is that of single male clients receiving social assistance in Sweden. Difficulty in supporting themselves is thus the main reason why these clients have contact with the social welfare office, but to some extent the clients in focus do also have a drinking problem (defined as notes on drinking problems in their case files). Case files on male, single clients in which alcohol-related notes were present are investigated (n=297). The results indicate that social workers are more active in making demands on clients to change their alcohol habits if the clients are able to support themselves through work than if they are not. This implies that resources for the treatment of alcohol and drug abuse may be allocated on the basis of which clients it is possible to remove from the social service system—i.e. who are able to support themselves through work—and not on the basis of which clients are the most needy.

Selbsteingeschätzte Alkoholtoleranz durch den Magdeburger Alkoholtoleranztest für Jugendliche (J-MATT)

Objectives: Based on the Magdeburger Alcohol Tolerance Test for adults (MATT), a respective questionnaire version for adolescents was developed (J-MATT). The goal was to help identify adolescents with respect to the extent of their alcohol tolerance in order to allow an earlie r detection of problematic alcohol consumption. Methods: The MATT (version with 50 items) was supplemented by 30 items addressing alcohol tolerance and consumption in adolescents. The J-MATT was completed by 160 subjects (aged 12 ‐ 26 years). Factor and item analyses were accomplished using these data. The results were compared with reference samples of the MATT [medical students (N = 164); adults without (N = 165) and with alcohol dependency (N = 41)]. Results: 23 items remained following factor and item analyses. Three factors of the J-MATT (alcohol tolerance/functional tolerance, physical performance, environment / function of alcohol consumption ) correlated with consumed amounts of alcohol. The age of first consumption of a lcohol was 12;10 ± 1;10 (years; months). The amount of alcohol needed to subjectively perceive an effect was 62 g. Adolescents had higher alcohol tolerance than medical students and adults without alcohol dependency. Only adults with alcohol dependency showed higher alcohol tolerance levels than adolescents. Conclusion: Reported alcohol consumption and tolerance levels of adolescents were alarmingly high and exceeded the established limits for very risky alcohol consumption. However, some of these effects may be explained by adolescents’ tendency to exaggerate.

Behavioral and Neurochemical Studies in Distinct Animal Models of Ethanols Motivational Effects

In the last decades, the goal of creating a unique and complete model of alcohol use and alcoholism has been replaced by a myriad of different animal models, each addressing a specific feature of problematic alcohol consumption. This mini-review highlights selected findings in the field of alcohol abuse and dependence, as found through the use of animal models. There are models (e.g., drinking in the dark, drinking after alcohol adulteration or alcohol deprivation) in which animals self-administer alcohol, that are useful to analyze determinants and consequences of binge drinking, progression from casual to problematic alcohol use and relapse or loss of control over alcohol drinking. In other models (e.g., conditioned place preference, conditioned taste aversion, ethanol-induced behavioral sensitization) alcohol dosing is precisely controlled by the experimenter. These models are useful to study motivational (i.e, appetitive, aversive and negative reinforcing) effects of alcohol and neuroadaptive changes that occur after repeated alcohol exposure. The study of age-related differences in reactivity to alcohol provides yet another avenue for analyzing alcohol's acute and chronic consequences. Ethanol interacts with several neurotransmitter (dopaminergic, glutamatergic, opioidergic and cannabinoid) and neuromodulators and these interactions are involved in the development and maintenance of alcohol self-administration. The findings described in the review, however, indicate a key role of the endogenous opioid system, notably in the mediation of alcohol's postitive rewarding effects. The Review also highlights the need to further assess the inter-relationship between different indices of ethanol's motivational effects as well as their association with alcohol intake and preference.

Women's patterns of everyday occupations and alcohol consumption

Earlier studies on women's health and drinking and the contemporary associated risk factors have highlighted the need for more complex approaches in understanding the pathways into women's problem drinking. Research, from both social science and from occupational therapy models, has underlined the importance of deconstructing the often dichotomized way of investigating women's daily lives (such as in paid and unpaid work or in work and leisure) when discussing factors from the daily life environment and their impact on health issues. The aim of this study was to explore the relationship between women's patterns of everyday occupation and alcohol consumption using the broader concept of occupation from occupational therapy models. This was a cross-sectional study from the latest wave (2000) of a population-based project, Women and Alcohol in Gothenburg (WAG). The study group consisted of 851 women, aged 20–55 years. Using an individually oriented method, two-step clustering, three distinct patterns of everyday occupations were identified. Significant associations with problematic alcohol consumption were found in the clusters, characterized by lower engagement in leisure activities and a larger amount of spare time. The need for new preventive approaches, including investigating the importance of having engaging leisure activities, is discussed.

Severity of alcohol-related problems and mortality: results from a 20-year prospective epidemiological community study

There is evidence that high alcohol use is associated with an increase in mortality. Little is known about long-term effects of problematic alcohol consumption in non-clinical (community) populations. The aim of our study was to obtain data on this and related issues in a representative rural community sample assessed longitudinally over a period of 20years. Assessments focused on a baseline survey from 1980 to 1984 and 20-year follow-up from 2001 to 2004. Based on expert interviews and standardized self-rating scales (e.g. MALT; Munich Alcoholism Test), the following three groups were defined (a) severe alcohol problems, (b) moderate alcohol problems, and (c) no alcohol problems. Mortality and hazard rates were analyzed with logistic and Cox regression adjusted for several health risk factors. From an original community sample of 1,465 individuals, 448 were deceased at 20-year follow-up. Participation rates were high. Baseline prevalence according to the MALT was 1.6% for severe alcohol problems and 4.0% for moderate alcohol problems. Over the 20-year time span, individuals with severe alcohol problems had a significantly elevated risk for dying earlier than the group with no alcohol problems (2.4 times higher). Mortality for those with moderate alcohol problems at baseline had a non-significantly elevated 20-year mortality risk (1.5 times higher) compared to those with no alcohol problems. Cox survival analyses corroborate these findings from multiple sequential logistic regression analyses. In discussing the mortality risk of persons with alcohol problems, the severity of the alcohol problems must be taken into account.

Zur erhöhten Prävalenz des problematischen Alkoholkonsums bei Studierenden

To compare the prevalence rates of problematic alcohol consumption in students and in the general population. A sample of students (n=1 115) and a population sample (n=631) were assessed with the Patient Health Questionnaire (PHQ). The PHQ probes for problematic alcohol consumption with five questions. An "alcohol syndrome" is suspected if at least one of these indicators is present. The alcohol syndrome was present more frequently among students than in the population sample (30,1% versus 8,1%). The odds ratio, adjusted for age, gender and education, was OR=3,7. However, when the five indicators were analysed separately, only two of them were significantly more frequent in students than in the comparison sample. Both indicate a neglect of duties as a consequence of alcohol consumption. Intervention strategies aimed at students' alcohol consumption should focus on binge drinking and the risks associated with this problematic form of alcohol consumption.

Are overweight and obese adolescents different from their peers?

To identify psychosocial and lifestyle indicators including alcohol consumption, that may distinguish overweight and obese adolescents from their peers, and align them with other adolescents with chronic conditions. The sample included 6 131 6th, 8th, and 10th grade public school Portuguese students, aged 11-16 years, who participated in the Health Behavior in School-Aged Children (HBSC)/WHO survey of adolescent health. Body mass index (BMI) was based on self reported weight and height. Separate analyses of psychosocial and behavioral variables were conducted by gender, age group, and BMI, using Chi square, and ANOVA. Obese and overweight teens when compared with non-overweight teens, were more likely to report a negative attitude towards their appearance; to believe that others made negative comments about them; had a lower level of life satisfaction; had more difficulty in making new friends, and were more likely to describe themselves as unhappy. Moreover, obese teens were significantly more likely than their non-obese peers to describe themselves as having health problems, to report drinking alcohol daily, as well as having been drunk more than 10 times. The present study provides further evidence regarding the association between overweight and obesity in adolescence, and body image dissatisfaction, poorer self-assessed health status, potential social isolation, decreased life satisfaction, and problematic alcohol consumption patterns. Overweight and obese adolescents should, where possible, be reached with appropriate interventions addressing the broad spectrum of their psychological needs, enhancing their skill development for behavioral change, and providing support for dealing with potentially harmful behaviors.

Reizexpositionsbehandlung der Alkoholabhängigkeit - Ein Behandlungsmodell zur Rückfallprophylaxe

Die Verbesserung der suchtmedizinischen Versorgungssituation und die weitere Entwicklung effektiver Behandlungsverfahren erscheinen angesichts aktueller Schätzungen der Anzahl von Menschen mit Alkoholproblemen als eine wichtige Aufgabe. So wird in neueren Untersuchungen die Zahl der alkoholabhängigen Erwachsenen in Deutschland (12-Monats-Prävalenz) auf mehr als 1,7 Millionen (2,4 %) geschätzt (2). Ein „schädlicher Gebrauch” liegt nach diesen Berechnungen bei etwa weiteren 1,7 Millionen Erwachsenen vor. Ein neuer therapeutischer Ansatz stellt die Reizexpositionsbehandlung für alkoholabhängige Patienten dar, welche die Ergebnisse aus der neurobiologischen Grundlagenforschung aufgreift. Die Ergebnisse einer Therapievergleichsstudie verdeutlichen das Potenzial, aber auch die Grenzen dieses Ansatzes.

Drinkers and bettors: Investigating the complementarity of alcohol consumption and problem gambling

Regulated gambling is a multi-billion dollar industry in the United States with greater than 100% increases in revenue over the past decade. Along with this rise in gambling popularity and gaming options comes an increased risk of addiction and the associated social costs. This paper focuses on the effect of alcohol use on gambling-related problems. Variables correlated with both alcohol use and gambling may be difficult to observe, and the inability to include these items in empirical models may bias coefficient estimates. After addressing the endogeneity of alcohol use when appropriate, we find strong evidence that problematic gambling and alcohol consumption are complementary activities.

Prevalence and the factors associated with binge drinking, alcohol abuse, and alcohol dependence: a population-based study of chinese adults in Hong Kong

To examine the patterns of drinking, the relationship between binge drinking, alcohol abuse, and dependence, and the sociodemographic factors associated with problem drinking among Hong Kong Chinese. An anonymous, random telephone survey was conducted on 9860 Hong Kong Chinese adults from April to June, 2006. The age-adjusted prevalence amongst men for binge drinking was 14.4% with 5.3% of males being alcohol abusers and 2.3% dependent on alcohol. The corresponding figures for women were all lower at 3.6%, 1.4%, and 0.7%, respectively. Younger age groups showed the highest prevalence of these drinking problems. Among male binge drinkers, 18.7% were also alcohol abusers and 12.3% were alcohol dependent. Among female binge drinkers, 16% reported alcohol abuse and 9.9% reported dependence. Male binge drinkers were less likely to be older, less likely to be students but more likely to be employed in the service industry. Female binge drinkers were less likely to be over 60 years of age or married but more likely to be smokers. In both genders, smoking was significantly associated with the likelihood of binge drinking (OR = 3.6-12.3), alcohol abuse (OR = 3.0-12.1), and dependence (OR = 5.2-20.6). Although binge drinking has been well tolerated in Chinese culture, it is strongly associated with alcohol abuse and dependence in both genders in Hong Kong. Our findings suggest that prevalence of problematic alcohol consumption warrants greater promotion of alcohol harms awareness. Higher rates of heavy drinking in younger-aged individuals may reflect changing lifestyle behaviors and herald higher future levels of alcohol-related health and social problems.

Consumo problemático de alcohol en Bucaramanga, Colombia: diseño y validación de una prueba

Excessive alcohol intake can pose a serious problem in public health. The development of instruments to classify the consumers correctly is the first stage in the epidemiologic investigation. The internal validity and the reliability was evaluated for a test of problematic alcohol consumption (CP-alcohol) in Bucaramanga, Colombia. 2005--2006. This work provides a measure that is internally consistent and improved reliability of diagnostic technology. Six hundred one subjects between 18 and 60 years participated in the test for CP-alcohol on two occasions. At the same time, a survey on biological variables (VB), socioeconomic (VSE) and dietary (D) was administered. The internal consistency of CP-alcohol was evaluated by calculating the coefficient alpha of Cronbach, and the reliability with coefficients of Spearman and Cohens Kappa. To evaluate the associations among problematic consumption, VB, VSE, D and the risk of alcoholism, the prevalence ratios were calculated using binomial regression. The frequency of problematic alcohol consumption was of 46.9 (CI 42.9-50.9). Men presented an increased frequency of problematic alcohol use 1.6 times that of women (p<0.001). The coefficient alpha of Cronbach was moderate for all the questions of the test (minimum 0.41, maximum 0.61). In the first application of CP-alcohol, Cronbachs alpha was 0.63, and, in the second, 0.49. Spearmans correlation coefficient was of 0.87 (CI 0.84-0.90) for the population-for men 0.86 (CI 0.82-0.90) and for women 0.86 (CI 0.82-0.90). The Kappas obtained were very good, 0.70 to 0.89. Sex, pleasure provided by alcoholic drinks , risk of alcoholism according to Cut Down on Drinking, Annoyed by Criticism, Guilty Feeling, and Eye Opener (CAGE) and the quantity of consumed alcohol were all correlated with problematic consumption. CP-alcohol is a useful test for investigating the epidemiology of health problems associated with alcohol use.

Trajectoires de soins de patients alcoolodépendants: une étude longitudinale en Suisse italophone

Alcohol abuse predisposes to numerous public health problems leading to important direct and indirect costs. One out of four hospital beds in Switzerland is occupied by a patient presenting a diagnosis of alcohol consumption. The objectives of this retrospective study are firstly to have an overview of the therapeutic orientation of the patients in the existing alcohology network of the canton of Tessin and to analyse the treatment trajectories of the adult hospitalised patients, in the general psychiatric hospital, presenting a problematic alcohol consumption and in particular to evaluate the impact of socio-demographic and clinical factors on the eventual readmissions. The analysis of this longitudinal retrospective study (1995-2000) is based on the data collected from the computerised register of the socio-psychiatric cantonal organisation (OSC) and that of the Centre Ingrado, a centre specialised in alcohology. Two principal results are highlighted. Firstly, two groups of patients can be distinguished by their psychosocial aspects. Secondly, the two groups are distinguished by their post-hospitalisation trajectories. In the first group of patients subjects older than 50 years are overrepresented, those living in companionship as well as those having less antecedents of a specific healthcare. This group was preferentially sent to private practitioners and presented comparatively less rehospitalisations. The second group appears as socially less well integrated, has many antecedents of health care and had longer hospitalisations in 1995.The patients of this second group were addressed to specialised psychiatric health care structures and or those specialised in alcohology. The rehospitalisations were more frequent for patients of the second group. In the appreciation of the results of the study, its limits have to be taken into consideration. On the one hand, it is a retrospective study with the major limiting factor being a limited choice of predictive variables, the indicators of the trajectory of the patient, and on the other hand, the social class. It was not possible during the course of the study to take the social class into account as a predictive variable. Finally, we also lack the data on the eventual deaths, occurring in our cohort, outside the psychiatric hospital, during the observation period of the study. In conclusion, despite the fact that the alcohology network of the canton of Tessin needs in part to be systematised, we can nevertheless note that the existing practices and services are fully convenient. Future conceptualisations ideally need to rest on this experience in privileging mainly a perspective of treatment trajectory and to a lesser extent the option of a sequential episode of treatment.

Self-reported health functioning in Swedish alcohol-dependent individuals: Age and gender perspectives

The aim of this study was to investigate health functioning and drinking patters in a Swedish alcohol-dependent treatment sample. Gender and two age groups were, respectively, compared in these characteristics. Data for demographic characteristics, substance use and health functioning were collected by a structured interview, using the Addiction Severity Index. A total sample of 125 individuals (30 women and 95 men) was interviewed shortly after arrival to the inpatient treatment. Differences between genders were found in drinking patterns, where men had earlier onset of first drink, earlier onset of problematic alcohol consumption and longer duration of problematic consumption. No differences between genders were found regarding somatic and psychiatric health. When comparing the two age groups (29–47 years and 49–69 years), the younger individuals had more lifetime and current psychiatric symptoms (including depression, anxiety, suicidal ideation etc.), whereas the older individuals had more chronic somatic disorders. The younger individuals had also an earlier onset of first drink of alcohol and had started a problematic consumption at earlier ages. They had also more lifetime experience of illicit drugs (including benzodiazepines and analgesics). The findings from the present study indicate that an age-perspective in treatment planning may be of more importance than a gender perspective, where younger individuals probably need more of psychiatric consultation and their older counterparts need more of consultations by medical professionals.

Exploring the utility of general strain theory in explaining problematic alcohol consumption by police officers

Research has shown a link between police officer stress and negative coping strategies, particularly problematic alcohol consumption. Unfortunately, most research on this topic has not been theoretically informed. Agnew's general strain theory (GST) offers a potential theoretical explanation for this relationship. Furthermore, few studies of GST had been conducted on samples other than school-aged adolescents or college students. The purpose of this study was two-fold. First, the authors examined whether GST could explain drinking prevalence and problematic alcohol consumption among police officers. Second, the generalizability of GST to a sample of police officers was examined. Using data collected from a large sample of Baltimore, Maryland police officers, support for GST was found. Consistent with theoretical expectations, multivariate logit and ordinal logit regression models showed that the relationship between work-related strain and drinking prevalence and problematic alcohol consumption was mediated through anxiety/depression. Ideas for future research are discussed.

Problem-free drinking over 16 years among individuals with alcohol use disorders

Background Limited data exist on the rates and long-term stability of non-problem drinking in individuals who sought help for an alcohol use disorder. Methods A sample of initially untreated individuals with alcohol use disorders ( n = 420) was surveyed at baseline and 1 year and was re-assessed at 8 and 16 years. Results In the 6 months prior to the 1-year assessment, 36% ( n = 152) of participants reported abstinence from alcohol, 48% ( n = 200) reported drinking with problems, and 16% ( n = 68) reported non-problem drinking. At each follow up, 16–21% of the sample reported non-problem drinking. Compared to individuals in the abstinent and problem-drinking groups, individuals who were drinking in a problem-free manner at 1 year had reported, at baseline, fewer days of intoxication, drinks per drinking day, alcohol dependence symptoms, and alcohol-related problems, less depression, and more adaptive coping mechanisms. Over time, 48% of participants who engaged in non-problem drinking at 1 year continued to report positive outcomes (either non-problem drinking or abstinence) throughout the long-term follow-up, whereas 77% of those abstaining at 1 year reported positive outcomes throughout the same time period. Additionally, 43% of individuals with problematic alcohol consumption at 1 year reported positive outcomes over the remaining follow-up interval, a rate that was not significantly different from the rate of positive outcomes of 48% observed in those with initial problem-free drinking. Conclusions Although some individuals report non-problem drinking a year after initially seeking help, this pattern of alcohol use is relatively infrequent and is less stable over time than is abstinence. An accurate understanding of the long-term course of alcohol use and problems could help shape expectations about the realistic probability of positive outcomes for individuals considering moderate drinking as a treatment goal.

Detection and management of alcohol use disorders in German primary care influenced by non-clinical factors

The primary objective was to assess the proportion of detected and correctly referred patients in German primary care. The secondary objective was to identify patient and practitioner characteristics that predict detection and correct referral. In this clustered cross-sectional survey in German primary care, 3003 patients were consecutively invited to participate, and were asked to fill in a standardized health questionnaire. They were then screened for problematic alcohol consumption using the Alcohol Use Disorders Identification Test. The physicians recorded their assessment of the presence of any alcohol use disorder and documented the treatment course of all identified patients for 3 months. Correctly identified problem drinkers were 38.6% in a per-protocol analysis and 33.6% using a worst-case scenario. Referral behaviour of physicians was in conformity with current practice guidelines in 64.6% of the documented cases and 27.0% in a worst-case scenario. Several patient (e.g. sex, age) and practitioner characteristics (e.g. age), which influence the diagnosis and referral of patients, could be identified. There is a clear need to increase the special diagnostic and therapeutic skills of general practitioners so that they may be able to indicate and perform secondary prevention. Further research should focus on the likely effects of the implementation of these diagnostic and management tools.