Alcohol Misuse Problems Research Articles

Esketamine combined with a mindfulness-based intervention for individuals with alcohol problems.

Alcohol use disorder (AUD) is a major public health issue, posing harmful consequences for individuals and society. Recent advances in addiction research have highlighted the therapeutic potential of ketamine-assisted therapy for AUD. However, the exact mechanisms underlying its effectiveness remain unknown. This double-blind, pilot study aimed to investigate esketamine combined with mindfulness-based intervention (MBI) to examine whether esketamine enhances engagement in MBI for individuals with alcohol misuse problems and whether enhanced engagement has any impact on alcohol-related outcomes. In all, 28 individuals with alcohol problems were randomly assigned to receive sublingual esketamine hydrochloride (AWKN002: 115.1 mg) or vitamin C (placebo) in an oral thin film and took part in 2 weeks of daily MBI. Participants were assessed on various self-report measures, including mindfulness, engagement in MBI (physical and psychological), alcohol cravings and consumption. Esketamine enhanced psychological engagement with a daily MBI, compared to placebo, and led to transient decreases in alcohol cravings. Esketamine also resulted in significantly greater mystical experiences and dissociative states compared to placebo. The findings suggest that esketamine may improve treatment outcomes when combined with mindfulness-based therapies through its ability to increase engagement with meditative practice.

HEAVY DRINKING, MENTAL HEALTH PROBLEMS AND RECOVERY IN OLDER ADULTS: EXPLORING SUPPORT NEEDS

Abstract Many older adults who consume alcohol at harmful levels experience mental health problems. Common life events such as retirement, bereavement, and declining health, can contribute to anxiety and depression, with alcohol consumption being used as a coping mechanism. Tailored support is crucial to address the unique needs of older adults facing both alcohol misuse and mental health problems. These patients often fall into gaps between services (family practice/alcohol/mental health), which are unable to meet their complex support needs. This qualitative study aimed to understand the lived experiences of older adults with co-occurring heavy drinking and mental health problems, support received and unmet needs. We conducted semi-structured interviews with 14 older adults living in the North of England (completed Summer 2023). Thematic analysis and constant comparison were employed in data analysis. Findings highlighted the importance of age-tailored initiatives such as access to mental health support while actively drinking, supervised detoxification, increased peer support and services that are age inclusive and friendly. Risk factors such as grief, loneliness, financial problems and undiagnosed trauma in older adults contributed to development of these conditions. Older adults need services to work together, integrated around patient needs and addressing heavy drinking and mental health concerns at the same time. Future research should focus on improving mental health literacy and, developing holistic and preventive interventions to address risk factors for co-occurring alcohol and mental health problems in older adults.

Reaching out to patients with alcohol and drug misuse problems.

Jeff Fernandez, Lead Alcohol and Drug Nurse, Alcohol and Drug Liaison Team, Royal Free Foundation Trust, London (jfernandez@nhs.net). The team was the Gold Award winner in the Gastrointestinal Nurse of the Year category in the BJN Awards 2023.

Sex differences in the relation between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and National Guard soldiers.

Military sexual trauma (MST) is linked to a range of deleterious health outcomes. Extant literature has focused disproportionately on mental health sequelae of MST. Research is needed to better understand the extent to which MST contributes to alcohol misuse and related problems - key issues facing service members. Additionally, sex differences in the nature and prevalence of MST may impact sequelae. The present research examined (a) the prevalence of an MST history among female and male service members, (b) relations between MST history and risk for alcohol misuse and related problems, and (c) potential sex differences in these experiences and outcomes. Data from current and previous service members (334 males and 70 females) were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of U.S. Army Reserve and National Guard (USAR/NG) soldiers and their partners. Analyses examined the prevalence and types of MST experienced, relations between MST history and three alcohol-related variables (total consumption, heavy drinking frequency, and alcohol-related problems), and differences by sex. Approximately one-third (33.7%) of service members reported an MST history. Females (61.4%) reported an MST history at more than twice the rate of males (27.8%). Interactions between MST and sex were significant for all alcohol-related variables. Among males, an MST history was related to 70% higher alcohol consumption, 86% higher heavy drinking frequency, and 45% higher alcohol problem scores. An MST history was unrelated to alcohol-related variables among females. Findings suggest a higher prevalence of MST among USAR/NG service members than is often reported in the literature, particularly among males. An MST history was associated with higher and more hazardous/harmful current alcohol consumption among male service members, highlighting the need for greater screening, prevention, and intervention among a population already at high risk for problematic alcohol use. Results underscore that MST is an important and prevalent experience requiring greater study alongside more traditional notions of service-connected trauma.

Circumstances Contributing to Suicide Among U.S. Adolescents Aged 10–19 Years With and Without a Known Mental Health Condition: National Violent Death Reporting System, 2013–2018

PurposeSuicide is the second leading cause of death for adolescents in the United States; however, suicide is preventable and a better understanding of circumstances that contribute to death can inform prevention efforts. While the association between adolescent suicide and mental health is well established, multiple circumstances contribute to suicide risk. This study examines characteristics of adolescents who died by suicide and differences in circumstances between those with and without known mental health conditions at the time of death. MethodsLogistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals of circumstances contributing to suicide between decedents with and without known mental health conditions using data from the 2013 to 2018 National Violent Death Reporting System (analyzed in 2021). ResultsDecedents with a known mental health condition were 1.2–1.8 times more likely to experience problematic alcohol misuse, substance misuse, family and other nonintimate relationship problems, and school problems; however, there were no significant differences between those with and without a known mental health condition for the preceding circumstances of arguments or conflicts, criminal or legal problems, or any crisis occurring within the two weeks prior to death. DiscussionA comprehensive suicide prevention approach can address not only mental health conditions as a risk factor but also life stressors and other crises experienced among adolescents without known mental health conditions.

Cohesiveness in previously deployed Army National Guard units: Implications for postdeployment behavioral health.

A major health policy concern of deployed U.S. military personnel has been the observed high occurrence of postdeployment behavioral health problems. Unit cohesiveness is considered one of several protective factors against the negative effects of combat exposure. Studies, however, have not examined cohesiveness' group-level effects on the relationship of combat stressors to behavioral health problems. These relationships were examined both at the soldier level and unit level using hierarchical linear modeling. Recently, returned deployed Army National Guard soldiers (N = 4,567 in 50 companies) responded to questions about combat exposure, postdeployment unit cohesiveness, and behavioral health problems. Combat events were associated with more suicidal thoughts, alcohol misuse, and behavioral health problems. By comparison, unit cohesiveness was associated with fewer behavioral health problems both at the individual level (all three outcome variables) and unit level (alcohol misuse and behavioral health problems). At the soldier level, the buffering effect of unit cohesiveness was evident only for alcohol misuse. At the unit level the protective factor of unit cohesiveness on unit members' behavioral health was evident for alcohol misuse and behavioral health problems. In addition, the relationship of combat events to suicidal thoughts was less evident among units having higher rather than lower levels of unit cohesiveness (cross-leveling effect). Findings suggest that integrative unit relationships better enable soldiers to adjust to combat exposure. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Family’ members experiences of their older relative’s alcohol and substance misuse

ABSTRACT Background Alcohol consumption in Norway and much of the western world has increased during the past decades, in particular among older adults (> 65 years). Although living with a family member’s alcohol misuse has been shown to have a significant deleterious health impact, research on this topic is both lacking and urgently needed to develop targeted health services. Aim To generate knowledge of how family members are affected by their older relatives’ alcohol and other substance misuse problems. Method In 2020, 17 individual interviews were carried out with the wives and adult children of older adults with alcohol and other substance misuse problems. Data were analysed using content analysis. Findings Analyses revealed two main themes; the impact of living with psychological stress over time, and the impact over time on family relationships and functioning. Both included four subthemes, representing different dimensions of participants’ experiences of the impact of their older relative’s alcohol and substance misuse. Conclusion The challenges family members experienced through ongoing exposure to their relatives’ alcohol and/or other substance misuse increased over time. These experiences had significant negative consequences for their health and life situation.

Intimate partner violence and abuse experience and perpetration in UK military personnel compared to a general population cohort: A cross-sectional study.

SummaryBackgroundResearch exploring prevalence of, and factors associated with, increased risk of experiencing or perpetrating Intimate Partner Violence and Abuse (IPVA) in military communities is limited. This study aimed to describe IPVA prevalence in a military sample, explore the role of military-specific risk factors, and draw comparisons with a general population cohort.MethodsWe utilised data from a sample of military personnel participating in a cohort study of the health and wellbeing of UK military personnel who reported having an intimate relationship in the previous 12 months (n = 5557). To allow for comparison with civilian populations, participants from a general population cohort study in England (n = 6075) were matched on age and sex to the military cohort (n = 8093).FindingsThe 12-month prevalences of IPVA experience and perpetration in the military sample were 12.80% (95% CI 11.72–13.96%) and 9.40% (8.45–10.45%), respectively. Factors associated with both increased IPVA experience and perpetration included childhood adversity, relationship dissatisfaction, military trauma, and recent mental health and alcohol misuse problems. Compared to the civilian cohort, adjusted odds (95% CI) of IPVA experience and perpetration were higher in the military: 2.94 (2.15–4.01) and 3.41 (1.79–6.50), respectively.InterpretationThis study found higher prevalences of IPVA experience and perpetration in the military compared to the general population cohort and highlighted both non-military and military factors associated with increased risk of both. Relationship dissatisfaction, military trauma and mental health difficulties mark key areas for IPVA prevention and management efforts to target.FundingFunded by the UK Ministry of Defence and National Institute of Health Research.

Relationship conflict and partner violence by UK military personnel following return from deployment in Iraq and Afghanistan

PurposeRisk of violence by UK military personnel, both towards non-family and family, has been found to be higher post-deployment. However, no UK research to date has attempted to examine relationship conflict and intimate partner violence (IPV) in this period. This study estimated the prevalence of and risk factors for post-deployment relationship conflict and partner violence in UK military personnel.MethodsWe utilised data on military personnel who had deployed to Iraq and/or Afghanistan (n = 5437), drawn from a large cohort study into the health and well-being of UK military personnel.Results34.7% reported relationship conflict (arguing with partner) and 3.4% reported perpetrating physical IPV post-deployment. Males were more likely than females to report relationship conflict. There were similar rates of self-reported physical IPV perpetration among males and females. Among our male sample, factors associated with both relationship conflict and physical IPV perpetration post-deployment included being in the Army compared with the Royal Air Force, higher levels of childhood adversity, higher levels of military trauma exposure and recent mental health and alcohol misuse problems. Being over 40 at time of deployment (vs being under 25) and having deployed in a combat role were also associated with relationship conflict, but not physical IPV perpetration.ConclusionsDeployment-related variables and mental health and alcohol misuse problems were found to be key factors associated with post-deployment relationship conflict and IPV. Services providing health or welfare support to military personnel must collaborate with mental health services and consider history of deployment, and particularly deployment-related trauma, in their assessments to improve identification and management of intimate partner violence and abuse in military communities.

Adult offspring's experiences of living with a parent with an alcohol misuse problem

AbstractStudies on the effects of parental alcoholism on adult children of alcoholics (ACOAs) have been mostly quantitative. To acquire a richer and better understanding of this realm in Malta, while outlining concrete recommendations to further contain this problem, a qualitative study was thus employed. Six participants were selected after meeting all inclusion criteria. Data were analysed following interpretative phenomenological analysis (IPA) guidelines. Semi‐structured interviews were audio‐recorded and transcribed verbatim. Three superordinate themes, namely a) psychosocial impact, b) coping strategies, and c) a sense of identity, were elevated. A number of findings resulting from this study may point at the resilient nature and skills exhibited by ACOAs, who move on to lead successful lives, despite their past hard life. Recommendations for future applications are discussed. Overall, recognition of children of parents who misuse alcohol should be prioritised in service planning to ensure that their needs are not overlooked.

Audit of epilepsy healthcare provision in a large UK category B prison

PurposeWe reviewed all prisoners diagnosed with epilepsy within a large UK category B prison: collecting demographic information and the prevalence and nature of their seizure disorder; and reviewed standards of their epilepsy healthcare provision. Previous work has highlighted poorer seizure control and limited access to specialist services in this patient group. MethodsFifty-five male prisoners with a previously established diagnosis of epilepsy were identified by the prison healthcare manager during the six-month audit period. Anonymised audit data was collected during clinical interviews undertaken by members of a regional specialist epilepsy service and recorded on a standardised proforma. Data collection occurred during six prison visits within the audit period. ResultsPoint prevalence of epilepsy was 2%. Data suggest that demographics are complex and challenging in this patient group. We found increased rates of alcohol (40%) and drug (82%) misuse and mental health problems (85.5%). Just over one third of cases were prescribed medications with potential for misuse (diversion). Further optimization of anti-seizure medication (ASM) regimens was required in 67.3% of the study sample, with only 12.7% of cases being free of seizures for the last 12 months. Access to specialist epilepsy services was limited; only 38.2% had a specialist review in the last 12 months. Most cases (76.4%) did not recall receiving guidance on precautions that should be taken regarding duties or cell arrangements in relation to having a diagnosis of epilepsy. ConclusionsTighter collaboration between prison healthcare and local NHS specialist services is recommended to optimise epilepsy healthcare in UK prison settings.

Efficacy of a minimally guided internet treatment for alcohol misuse and emotional problems in young adults: Results of a randomized controlled trial

ObjectiveMany young adults struggle with comorbid alcohol misuse and emotional problems (i.e., depression and anxiety). However, there is currently a paucity of evidence-based, integrated, accessible treatment options for individuals with these comorbidities. The main goal of this study was to examine efficacy of a novel online, minimally guided, integrated program for comorbid alcohol misuse and emotional problems in young adults. Method: The study was an open-label two-arm RCT. Participants (N = 222, Mage = 24.6, 67.6% female) were randomized to one of two conditions: the Take Care of Me program (an 8-week, online integrated treatment condition consisting of 12 modules), or an online psychoeducational control condition. Intervention modules incorporated content based on principles of cognitive behavioral therapy and motivational interviewing. Participants completed assessment data at baseline, at the end of treatment (i.e., 8 weeks), and at follow-up (i.e., 24 weeks). Data were analyzed using generalized linear mixed models. Results: We observed that participants in the treatment condition showed larger reductions in depression, hazardous drinking, as well as increases in psychological quality of life and confidence at the end of treatment. We did not find group differences on total alcohol use at follow-up, but participants in the treatment group reduced their hazardous drinking and improved their quality of life at 24-week follow-up. Conclusions: Our study provides promising initial evidence for the first iteration of the comorbid alcohol misuse and emotional problems online program.

Armed conflict, HIV, and syndemic risk markers of mental distress, alcohol misuse, and intimate partner violence among couples in Uganda.

Northeastern Uganda has suffered from protracted armed conflict and HIV/AIDS and has some of the highest rates of intimate partner violence (IPV) globally. Little is known about how exposure to conflict and HIV influence individuals' syndemic risk markers or those of their partners. We conducted a population-based study using multistage sampling across three districts in Northeastern Uganda. We randomly surveyed 605 women aged 13-49 years and estimated syndemic problems for currently partnered women (N = 561) who reported for their male partners. Syndemic problems were lower in the low-conflict district than the high-conflict district, p = .009. Conflict exposure was associated with couples' syndemic scores, respondent: β = 0.182, p < .001; partner: β = .181, p < .001. Problem scores were significantly higher among women whose partner was either HIV positive, p = .031, or had an unknown HIV status, p = .016, compared with those whose partner was HIV negative. The total effects of women's, β = .15, p = .034, and men's, β = .137, p = .038, armed conflict exposure on male-to-female IPV were significant. For male partners, there were significant total effects of having an unknown, β = .669, p < .001, or positive, β = 1.143, p < .001, HIV status on experiencing female-to-male IPV. These results suggest that syndemic problems and corresponding treatments should consider couple influences. Addressing mediating problems of mental distress and alcohol misuse may reduce the risk of male-to-female IPV. Providing couple-based HIV psychosocial interventions could reduce men's exposure to IPV.

Public stigma on substance users in China

ABSTRACT Background: Public stigma is a form of devaluation by other people’s negative reactions to a specific behavior or mental health condition. When dealing with the physical consequences of addiction, substance users experience distress due to negative prejudice against them and their families. Method: In Shanghai, China, a community survey was conducted with four experimental vignettes to examine the general public’s experience with mental health issues and their perceptions toward substance users. Respondents were randomly assigned to answer one of these vignettes regarding public stigma toward a male or female vignette subject (VS) with substance addiction. Results: Data from 123 respondents showed no statistical significance in public stigma perception toward a male or female subject either with alcohol or cocaine misuse problems. However, older individuals perceived mental illness more negatively when it is connected to substance addiction. These respondents see public stigma as a matter of “family shame,” “hostility,” “discrimination,” and “labeling” that represent the risks that hinder help-seeking. Conclusion: This study suggests designing culturally sensitive treatment models that could help substance users recognize face-saving factors in their help-seeking process. Community education as a prevention measure should emphasize the importance of treating substance users as an individual, not as a problem.

Statistically derived patterns of behavioral economic risk among heavy-drinking college students: A latent profile analysis.

High levels of 3 behavioral economic indices (delay discounting, alcohol demand, and proportionate substance-related reinforcement) are consistently associated with greater alcohol misuse and alcohol-related problems. However, it is unclear whether and how these variables jointly increase the risk for alcohol-related outcomes among college students who engage in heavy episodic drinking (HED; 4/5+ drinks for women/men, respectively). The current study used a person-centered approach to identify similar patterns of behavioral economic domains among heavy-drinking college students and investigate the relationship between these empirically derived classes and alcohol-related outcomes. A sample of 393 college students (60.8% female, 78.9% White/Caucasian) reporting at least 2 heavy drinking episodes in the previous month completed measures of alcohol use and problems, demographics, delay discounting, and alcohol reward value (alcohol demand and proportionate substance-related reinforcement). Latent profile analyses revealed that a 3-class solution provided the best fit to the data: a low reward value, high discounting (LRHD) class (n = 53), a moderate reward value, low discounting (MRLD) class (n = 214), and a high reward value, high discounting (HRHD) class (n = 126). Members of the HRHD class reported significantly greater alcohol consumption, past-month HED episodes, alcohol-related problems, and symptoms of alcohol use disorder than those in the MRLD and LRHD classes. The results suggest that there are 3 constellations of behavioral economic processes and that, consistent with the reinforcer pathology model, students who overvalue alcohol-related reward and discount the future more steeply are at the greatest risk for alcohol misuse and alcohol-related problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Patient experiences of alcohol specialist nurse interventions in a general hospital, and onwards care pathways.

To provide insight into patient experiences of a general hospital-based alcohol specialist nurse intervention during alcohol detoxification, experiences of alcohol specialist nurse hospital-based follow-up appointments (Pathway A) as well as the experiences of patients who did not have access to this additional help post detoxification (Pathway B). A longitudinal qualitative study. A thematic analysis of semi-structured interviews (2016-2017) with 24 patient participants (N=12 in each pathway; purposive selection) 1-4weeks post-detoxification and at 3 and 6months, to identify patient experiences of these interventions. Participants gave accounts of how 'empathic' and 'straight talking' interactions with alcohol specialist nurses during detoxification helped them to 'open up' and orient towards change. After detoxification follow-up, outpatient appointments in the hospital setting were seen as supporting change in early recovery and engagement with a wider range of services. Those with no access to nurse follow-up described experiencing a 'void' in available help. Participants in both groups described barriers to engagement with community alcohol services, peer groups and access to help for mild-moderate mental health problems. Patient accounts indicate alcohol specialist nurse interventions during and after unplanned detoxification in a hospital setting can help orient patients towards change and support early recovery. Providing alcohol specialist nurse interventions in general hospitals offers one route to initiating recovery in alcohol-dependent patients. This has potential to improve the lives of those affected and to reduce related demands on hospital services, but further research is needed.

Necrotizing Sialometaplasia of the Hard Palate Mimicking Oral Cancer: a Case Report

Necrotizing sialometaplasia (NS) is a rare, benign condition, which typically affects minor salivary glands. Although there have been case reports that highlight the need for urgent referral and importance of excluding malignancy, MRI from presentation to resolution has not been described. This case occurred in the hard palate of a 40-year-old, with a background of alcohol misuse and mental health problems. There was bony destruction in keeping with malignancy on initial MRI and CT scans, yet with histological diagnosis of NS and conservative management, subsequent scans at 1 and 4 months showed soft tissue and bony resolution. Histology is crucial for diagnosis when suspecting an oral malignancy, and MRI can provide a useful adjunct in diagnosis and monitoring of NS.

Shortfalls of funding for general practice in deprived areas.

In April 2019 the Haxby Group, through a contract tender process, acquired two surgeries in a deprived area of Hull, Yorkshire. These are specifically located in Calvert and Newington with approximately 10 000 patients. This, in addition to six sites in York and three other sites in Hull, with centralised administrative services, make up the Haxby Group. The transformative process that has followed has highlighted many positive outcomes from the use of at-scale general practice and diversifying the workforce but has become increasingly hindered by funding deficits. In particular the use of the Carr-Hill formula and Quality and Outcomes Framework (QOF)-driven payments negatively impact a practice’s ability to provide appropriate care in deprived populations. The population served by this new contract is predominantly young (Figure 1). The area, like most of Hull, is especially high on the Index of Multiple Deprivation, scoring 43.7, compared with 28.1 at another Haxby practice in Hull and 10.4 in York. As is often seen in deprived areas, there is a high incidence of drug and alcohol misuse plus mental health problems. Alongside this, 9.0% of the patients are recorded with obesity and 55.9% as smokers. However, given the average age of the population, most chronic diseases have a prevalence below the clinical commissioning group (CCG) and national averages (Table 1). Figure 1. Patient age distribution in years of males (blue) and females (red) at Calvert and Newington in 2019. View this table: Table 1. Comparison of prevalence data for major comorbidities in Calvert and Newington, nationally,8 …

A service evaluation of a Hospital In-reach Service for people who are homeless in South England

Abstract Background Homelessness has increased dramatically in the last decade, with an estimated 165% increase in rough sleeping alone in England since 2010. People experiencing homelessness can often have what is referred to as the tri-morbidity; mental health, substance and or alcohol misuse and physical health problems. Hospital admission presents a potential point of intervention to address the health problems people have been experiencing, to link them in with services and as a bridge to housing. This service evaluation explored the role of a Hospital In-reach Service team for safer hospital discharge. Methods A qualitative in-depth interview study was conducted with six participants related to a Hospital In-reach Service team in South England. The interviews were transcribed, and analysed following Burnard's fourteen stage method. The ethical approval was obtained from Brighton and Sussex Medical School Research Governance and Ethics Committee (ER/BSMS4284/2). Results Three key themes were identified; the role of the Hospital In-reach Service team, barriers to, and facilitators for advocating patients' needs. The results indicate that the service team works incredibly well, building strong and trusting relationships with patients, community and hospital teams, taking a holistic approach to patient care. However, the structural discrimination against this patient group is reiterated in this study. Despite progress, there are still problems with non-specialist staff understanding this patient group's needs. Conclusions There is a need for clarification within Adult Social Care regarding the distribution of responsibility between hospital and community social work teams. There also appears to be a need for expansion of training for non-specialist service staff, including ward staff, discharge teams and social workers. In-reach housing services and expansion of the service team would be invaluable Key messages Hospital In-reach Service team in South England works incredibly well taking a holistic approach to patient care. Clarification in role of hospital and community social work teams is required for better management of this issue.

Pathways Linking Childhood Physical Abuse to Alcohol Misuse in Adolescent Boys and Girls: A Prospective Cohort Study From Rio de Janeiro, Brazil

The purpose of this study was to identify if childhood physical abuse is a risk factor for adolescent alcohol misuse and the specific pathways linking childhood physical abuse and alcohol misuse in boys and girls. The study enrolled 785 students from the baseline and first wave of a prospective cohort study developed at six high schools in Rio de Janeiro, Brazil. The Childhood Trauma Questionnaire (CTQ), Conflict Tactics Scale-Form R (CTS-1), and Alcohol Use Disorders Identification Test (AUDIT) were used to identify childhood and adolescence physical abuse and alcohol misuse, respectively. Multigroup path analysis was performed to explore the postulated pathways between the exposures and outcomes. Childhood physical abuse was a significant risk factor for alcohol misuse in adolescence for both sexes. Among girls, childhood physical abuse increased the risk of adolescent revictimization and school delay, which were mediators between childhood physical abuse and alcohol misuse. Among boys, childhood physical abuse has a direct effect on increasing the risk of alcohol misuse. School delay was also a mediator from more social determinants to alcohol misuse in both sexes, whereas not living with the mother in adolescence mediated such effects only among boys. Childhood physical abuse increases the risk of alcohol misuse in adolescence through different pathways in boys and girls. Strategies aimed at reducing alcohol misuse and other mental health problems in adolescence should incorporate such specificities.