Alcohol Misuse Problems Research Articles

Implementation of universal behavioral health screening in a university health setting.

Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62% female) accessing a university health center. Each semester, 9-13% of students screened positive for depression, 2.5-3% for suicidal ideation, and 33-38% for alcohol misuse, while 10% wanted help with smoking cessation and 12-13% with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.

A retrospective cohort study describing six months of admissions under Section 136 of the Mental Health Act; the problem of alcohol misuse.

Section 136 of the Mental Health Act 1983 empowers police to remove a person they believe to be suffering from a mental disorder from a place to which the public have access, if they deem them a risk to themselves or others. In the UK, the number of Section 136 orders is increasing. This retrospective cohort study identified the demographic profiles, circumstances of detention and assessment outcomes of all individuals detained under Section 136 between February 2012 and July 2012 at a London Mental Health Trust. The study explored the relationship between alcohol and/or drug use, the process and outcomes. This study retrospectively obtained data from electronic notes for a six-month period. Demographic details were recorded. Other variables included previous admissions, reasons for assessment, evidence of intoxication, time taken for assessment and discharge outcomes. The effects of alcohol and/or drug intoxication on the process were recorded. A total of 245 individuals were assessed during the time period. Threatening to self-harm (n = 100, 44.8%) was the most common reason for assessment. Of the 245 patients assessed, 108 (44.1%) were found to be intoxicated with drugs and/or alcohol. Intoxication resulted in longer assessment times and a decreased likelihood of admission to hospital (p < .000).

A brief behavioral telehealth intervention for veterans with alcohol misuse problems in VA primary care

A brief behavioral telehealth intervention for veterans with alcohol misuse problems in VA primary care

I worry when […] insights into dual diagnosis from those who treat mothers misusing alcohol

Purpose – Alcohol misuse and mental health problems in parents are both known to contribute to impaired outcomes in children, although little is known about the specific parenting behaviours that might be affected. Mental health problems in parents who misuse alcohol may impact parenting in specific ways, and these may be different for mothers and for fathers. The purpose of this paper is to make a preliminary investigation of alcohol misuse and mental health problems in mothers, and explore ways in which these might affect their parenting. Design/methodology/approach – Semi-structured interviews were carried out with professionals involved in services for mothers who misuse alcohol, including those working in addiction psychiatry, in primary care, and in the provision of parenting services. These interviews were then examined using thematic analysis. Findings – Themes emerged including specific mental health problems (depression, anxiety and personality disorders), and related issues, such as self-medication. Particularly relevant for mothers were post-natal depression, the effect on maternal alcohol misuse and mental health when children are removed, the role of domestic violence, and the importance for identification of home visits by services. Different types of alcohol misuse were linked to different mental states and different parenting behaviours in parents. Findings in the general parenting and substance misuse literature were confirmed, and a new addition was that expressed emotion may play a role in families where mothers misuse alcohol. Originality/value – The findings increased the understanding of the relationships between maternal alcohol misuse, mental health issues and parenting, raising several new points for consideration.

Considerations in providing shared‐care psychological treatment for clients who have alcohol or other drug misuse problems

BackgroundMany people who have alcohol or other drug (AOD) misuse problems also have comorbid psychosocial and behavioural problems such as depression, anxiety, unstable treatment motivation, sleep disorders, chronic pain, post‐traumatic stress disorder, and suboptimal medication adherence. Agencies which provide treatment for such people commonly have limited resources for effectively addressing these problems.MethodsA telephone survey of psychologists and clinical psychologists in 12 New South Wales (NSW) postcode areas was conducted to investigate attitudes towards providing treatment for AOD clients.ResultsThe participation rate was 67%, and 61% of participants indicated they were “definitely” (52%) or “probably” (9%) interested in providing services for AOD clients. Thirty‐nine per-cent of interested participants indicated that they would always be willing to bulk‐bill Medicare to cover services for AOD clients, and only 7% of interested psychologists indicated that they would never be willing. Almost two thirds of interested participants indicated a delay of no more than one week to see new clients.ConclusionsIt would be worthwhile and feasible for private‐practice psychologists and clinical psychologists to develop shared‐care arrangements with AOD treatment providers and other related health services. We believe they should endeavour to do so, and we offer suggestions to assist in addressing that goal.

Meeting the needs of young people in hospital

Adolescent and young adult (AYA) health has been on the agenda for some time,1 with no shortage of reports and guidelines highlighting the importance of developing clinical services for young...

The Proposed Banning of Alcohol Advertising in a Developing Economy

The growing problem of alcohol misuse and its social consequences have been attributed to the advertising of alcohol, by some parties. Alcohol companies and the advertising industry have refuted this claim. It is against this background that this paper seeks to assess consumer attitudes towards alcohol advertising in South Africa. A survey was conducted amongst a sample of 400 respondents. Respondent demographics and attitudes towards the advertising of alcohol were ascertained. The results indicate no significant relationship between the selected demographic variables (viz. gender, age, income, education level and race) and attitude towards the advertising of alcohol. Some perspectives on the implications for policy and practice are presented.

Interventions for alcohol and drug problems in outpatient settings: A systematic review

Research evidence indicates a high prevalence of substance abuse among patients presenting in general hospital settings. Such misuse of alcohol and illicit drugs has a major impact on population health and on costs to health services and to society at large. This review aimed to identify the interventions for alcohol or illicit drug misuse problems that have been evaluated for hospital outpatient populations. Thirteen electronic databases including MEDLINE, EMBASE and PsycInfo were searched for published and unpublished studies in any language up to August 2011. Reference lists of included studies and reviews were also hand-searched. We included randomised and controlled clinical trials of any intervention for adult participants identified as having alcohol and/or drug problems presenting to hospital outpatient settings other than addiction or psychiatric units. Participants could be attending hospital for any reason other than treatment for substance abuse. A narrative synthesis was conducted. There is some evidence to suggest that interventions based on motivational techniques might be effective in treatment of alcohol misuse in oral-maxillofacial clinics but not in general outpatient departments. The evidence is insufficient to allow any conclusions to be derived on the effectiveness of interventions in the treatment of drug misuse and combined alcohol-drug misuse in outpatient settings. Further research is needed to investigate interventions for alcohol and drug misuse in outpatient settings. Additionally, problems remain in terms of study quality. Procedures to ensure the rigour of a study were often poorly reported.

Binge drinking and sleep problems among young adults

ObjectiveAs most of the literature exploring the relationships between alcohol use and sleep problems is descriptive and with small sample sizes, the present study seeks to provide new information on the topic by employing a large, nationally representative dataset with several waves of data and a broad set of measures for binge drinking and sleep problems. MethodsWe use data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative survey of adolescents and young adults. The analysis sample consists of all Wave 4 observations without missing values for the sleep problems variables (N=14,089, 53% females). We estimate gender-specific multivariate probit models with a rich set of socioeconomic, demographic, physical, and mental health variables to control for confounding factors. ResultsOur results confirm that alcohol use, and specifically binge drinking, is positively and significantly associated with various types of sleep problems. The detrimental effects on sleep increase in magnitude with frequency of binge drinking, suggesting a dose–response relationship. Moreover, binge drinking is associated with sleep problems independent of psychiatric conditions. ConclusionsThe statistically strong association between sleep problems and binge drinking found in this study is a first step in understanding these relationships. Future research is needed to determine the causal links between alcohol misuse and sleep problems to inform appropriate clinical and policy responses.

Mindfulness Based Interventions for Addictions: What is Next?

In this article the author explores the risks associated with the prescription of pregabalin (Lyrica) to those patients who have had a prior history of alcohol and/or other substance misuse problems. It is suggested that the abuse potential of pregabalin may have been underestimated and that a number of recent studies tend to indicate there is in fact a considerable risk of abuse of pregabalin when this drug is prescribed to patients who have a history of substance misuse.

Personalised normative feedback for preventing alcohol misuse in university students: Solomon three-group randomised controlled trial.

BackgroundYoung people tend to over-estimate peer group drinking levels. Personalised normative feedback (PNF) aims to correct this misperception by providing information about personal drinking levels and patterns compared with norms in similar aged peer groups. PNF is intended to raise motivation for behaviour change and has been highlighted for alcohol misuse prevention by the British Government Behavioural Insight Team. The objective of the trial was to assess the effectiveness of PNF with college students for the prevention of alcohol misuse.MethodologySolomon three-group randomised controlled trial. 1751 students, from 22 British Universities, allocated to a PNF group, a normal control group, or a delayed measurement control group to allow assessment of any measurement effects. PNF was provided by email. Participants completed online questionnaires at baseline, 6- and 12-months (only 12-months for the delayed measurement controls). Drinking behaviour measures were (i) alcohol disorders; (ii) frequency; (iii) typical quantity, (iv) weekly consumption; (v) alcohol-related problems; (vi) perceived drinking norms; and (vii) positive alcohol expectancies. Analyses focused on high-risk drinkers, as well as all students, because of research evidence for the prevention paradox in student drinkers.Principal FindingsFollow-up rates were low, with only 50% and 40% responding at 6- and 12-months, respectively, though comparable to similar European studies. We found no evidence for any systematic attrition bias. Overall, statistical analyses with the high risk sub-sample, and for all students, showed no significant effects of the intervention, at either time-point, in a completed case analysis and a multiple imputation analysis.ConclusionsWe found no evidence for the effectiveness of PNF for the prevention of alcohol misuse and alcohol-related problems in a UK student population.RegistrationControlled-Trials.com ISRCTN30784467

Alcohol education revisited: Exploring how much time we devote to alcohol education in the nursing curriculum

IntroductionThis study examines student nurses knowledge, attitudes and educational preparation to work with patients who misuse alcohol. The study begins to quantify how much time is devoted to alcohol education at one Scottish University. MethodThe study modified the Short Alcohol Attitudes Problem Perception Questionnaire (SAAPPQ) and incorporated three case vignettes to examine the student nurses knowledge, attitudes and experience of working with patients who have an alcohol problem. The questionnaire was hand delivered to a convenience sample of third year nursing students. ResultsThe results show that the student nurses exhibit positive attitudes and beliefs about working with patients who have an alcohol misuse problem. A series of significant associations was found between the adult nursing cohort and their ability to include a comprehensive alcohol history in their nursing assessments (χ2 = 19.82, df = 4, p < 0.0005); recognise signs of acute alcohol withdrawal (χ2 = 52.26, df = 16, p < 0.000); and the psychological signs associated with alcohol misuse (χ2 = 41.81, df = 16, p < 0.000). A baseline figure of 2.5 h of alcohol education is noted at this university. ConclusionsAlcohol education strongly features in three out of the five nursing programmes surveyed. Nurse education needs to focus on strategies that extend to teaching nurses how to respond, provide brief interventions and identify when to refer the patient for specialist intervention. These approaches should be universal to all areas of nursing practice.

Alcohol misuse in adolescents

Alcohol misuse in young people is of growing concern, even though alcohol consumption among adolescents has declined over recent years. Many 15 year olds have already consumed alcohol and adolsecents tend to consume large quantities of alcohol in one sitting. This article describes the problem of alcohol misuse in young people and the nurse's role in the prevention and treatment of alcohol misuse in this population. A stepped care, holistic approach is recommended, taking into consideration peer and family influence on alcohol misuse and the young person's motivation to change their behaviour.

The health and psychosocial burden of alcohol abuse

A ccording to the World Health Organization (WHO) (2013) the harmful use of alcohol results in 2.5 million worldwide deaths each year, with 320 000 young people aged 15–29 years dying from alcohol-related causes each year. This amounts to 9% of all deaths in that age group (WHO, 2013). Alcohol is the world’s third largest risk factor for disease burden; it is the leading risk factor in the Western Pacific and the Americas and the second largest in Europe (WHO, 2013). There is a mass of evidence demonstrating that alcohol misuse and alcohol-related problems compromise individual and psycho-social health and wellbeing (WHO, 2010; 2013; Department of Health (DH), 2013). This burden of alcohol misuse also affects the UK. According to the DH (2013), the consequences of alcohol misuse costs the country £21 billion pounds each year and the healthcare cost related to alcohol abuse is £1.6 billion pounds per year (DH, 2005; 2008; 2011; 2013). The increased number of patients being admitted with alcohol-related complications is costing the NHS 3% of its budget each year. For a significant and growing number of people in the UK, alcohol consumption is a major cause of ill health, with more than 10 million people in England (31% of men and 20% of women) regularly drinking above the recommended alcohol limits (National Audit Office, 2008; DH, 2013). The incidence of alcohol-related illness has risen over the past 20 years, with the National Institute for Health and Care Excellence (NICE) (2010) suggesting that 26% of adults not only drink above the recommended limits, but also drink in a manner that is actively harmful (impacts adversely on human physiology and health). The Office for National Statistics (ONS) (2011) states that the number of alcoholrelated deaths in the UK has risen since the early 1990s, from the lowest figure of 4023 (6.7 per 100 000 population) in 1992 to the highest of 9031 (13.6 per 100 000) in 2008 (ONS, 2011). Government recommendations state that men should drink no more than 3–4 units of alcohol a day, and that women should drink no more than 2–3 units a day. However, research suggests that many men and women exceed these recommended limits (DH, 2011).

Gender Differences in the Relationship between Alcohol Use and Depressive Symptoms in St. Petersburg, Russia

BACKGROUND: Gender differences in the relationship between alcohol use and depressive symptoms are inconsistent, and few studies have addressed this issue in Russia. Because this finding may have important implications for interventions to reduce alcohol misuse or alcohol related problems in Russia, we conducted a study to investigate whether the association between alcohol use and depressive symptoms differs by gender at high risk for HIV. METHODS: We used the Alcohol Use Disorders Identification Test (AUDIT) and the 10-item Center for Epidemiological Studies Depression Scale to measure alcohol use and depressive symptoms among 307 patients who attended a clinic for sexually transmitted infections in St. Petersburg, Russia. Logistic regression models were applied for the analysis. RESULTS: The comparison of data between men and women revealed a significant quadratic term of alcohol use and significant interactions between alcohol use and gender on depressive symptoms. Men with an AUDIT score in the first and fourth quartiles were more likely to report depressive symptoms in comparison to men in the second quartile. Their odds ratios (ORs) and 95% confidence intervals (CIs) were 7.54 (2.00-28.51) and 5.06 (1.31-19.63), respectively. Among women, a linear trend was observed such that those who misused alcohol were three times more likely to have depressive symptoms than those who did not misuse alcohol (OR = 3.03, 95% CI, 1.05-8.80). CONCLUSION: The association between alcohol use and depressive symptoms differed by gender. Additional research is needed to investigate this relationship in Russia. Strategies to reduce alcohol-related problems in Russia may need to consider these differences.

Detection and management of alcohol misuse by general practitioners.

Alcohol misuse and related problems are common in Sri Lanka. The appropriateness of the primary care setting in dealing with alcohol misuse is well recognised, and general practitioners (GPs) constitute an important first contact setting. One hundred and fifty randomly selected GPs practising in the Colombo and Gampaha districts were given a questionnaire to assess how they detect and manage alcohol misuse, and their attitudes towards persons who misuse alcohol. Seventy per cent of GPs responded [74 male; mean age 42 years (SD 6.7)]. Our results suggest that although a majority (81%) of GPs were frequently confronted with problems related to alcohol misuse, their efforts to detect the problem and knowledge regarding risk limits of alcohol consumption were poor. Only 25.7% had even heard of CAGE and MAST questionnaires. The majority of GPs felt inadequately trained to deal with alcohol misuse, but only a few made any self-directed efforts to improve their knowledge and skills regarding its management or referred their patients for specialised care. Participation in preventive programmes was minimal, and many GPs expressed negative attitudes towards persons misusing alcohol. The ability of general practitioners to detect and alcohol misuse appears to be inadequate.

The morning after: alcohol misuse and employment problems

Using a rich, recent and nationally representative longitudinal survey specifically designed to examine alcohol use and associated problems, we investigate the effects of alcohol misuse on a series of understudied and perhaps less common employment problems. Such problems include being fired or laid off from a job, sustained unemployment and conflicts with a supervisor and/or co-worker. After controlling for time-invariant omitted variables via fixed effects estimation, we find evidence that three measures of alcohol misuse are significantly related to employment problems. The results offer new information on the potential adverse labour market effects of alcohol misuse and shed light on potential mechanisms through which alcohol misuse may impact intensive labour supply and/or wages.

Strategies for characterizing complex phenotypes and environments: General and specific family environmental predictors of young adult tobacco dependence, alcohol use disorder, and co-occurring problems

BackgroundDefining phenotypes in studies of tobacco and alcohol misuse is difficult because of the complexity of these behaviors and their strong association with each other and with other problem behaviors. The present paper suggests a strategy for addressing this issue by conceptualizing and partitioning variance in phenotypes into either general or substance/behavior-specific. The paper also applies the general or substance/behavior-specific conceptualization to environmental predictors of tobacco and alcohol misuse and other problem behaviors. MethodsData were drawn from the Seattle Social Development Project, a contemporary, ethnically diverse and gender-balanced longitudinal panel including 808 participants. Latent variable modeling was used to partition variance in young adult (age 24) nicotine dependence, alcohol abuse and dependence, illicit drug abuse and dependence, involvement in crime, and engagement in HIV sexual risk behavior into general problem behavior and behavior-specific variance. Similarly, measures of general, drinking-specific, and smoking-specific adolescent family environment were constructed. ResultsConsistent with expectations, more positive general family environment during adolescence was associated with lower levels of shared variance in problem behaviors at age 24, but not with unique variance in tobacco or alcohol use disorder. Higher levels of family smoking and drinking environments during adolescence, however, were positively associated with unique variance in tobacco and alcohol use disorder, respectively, but did not predict shared variance in problem behaviors. ConclusionsResults support the utility of the proposed approach. Ways in which this approach might contribute to future molecular genetic studies are discussed.

Evaluation of Two Web-Based Alcohol Interventions in the U.S. Military

The U.S. military has traditionally had high rates of alcohol misuse and alcohol-related problems, necessitating effective treatment programs that minimize participant burden. Web-based interventions have shown promise as efficient treatment options for college students and adults but have not been widely evaluated in the military. This study evaluated the efficacy of two web-based alcohol interventions originally created for civilians and then adapted for U.S. military personnel. Two web-based alcohol interventions, Alcohol Savvy and Drinker's Check-Up, were adapted for use among military populations. The interventions were evaluated using a convenience sample of 3,070 active-duty military personnel at eight installations. Following a baseline survey, participants were assigned to one of three treatment conditions: (a) Alcohol Savvy, (b) Drinker's Check-Up, or (c) control (no program participation). Follow-up surveys were completed by 1,072 participants 1 month following baseline and by 532 participants 6 months following baseline. At 1-month follow-up, participants who completed the Drinker's Check-Up intervention had significant reductions in multiple measures of alcohol use relative to controls. Positive outcomes were found for average number of drinks consumed per occasion, frequent heavy episodic drinker status, and estimated peak blood alcohol concentration. These reductions in alcohol use at the 1-month follow-up were maintained at the 6-month follow-up. There were no statistically significant changes in alcohol use for participants who completed Alcohol Savvy. This study expands the literature on the effectiveness of web-based treatment for alcohol misuse. Findings indicate that web-based programs (Drinker's Check-Up in particular) can significantly decrease several indicators of alcohol use in U.S. military personnel.

Screening and Brief Intervention for Substance Misuse Among Older Adults: The Florida BRITE Project

We developed and examined the effectiveness of the Florida Brief Intervention and Treatment for Elders (BRITE) project, a 3-year, state-funded pilot program of screening and brief intervention for older adult substance misusers. Agencies in 4 counties conducted screenings among 3497 older adults for alcohol, medications, and illicit substance misuse problems and for depression and suicide risk. Screening occurred in elders' homes, senior centers, or other selected sites. Individuals who screened positive for substance misuse were offered brief intervention with evidence-based practices and rescreened at discharge from the intervention program and at follow-up interviews. Prescription medication misuse was the most prevalent substance use problem, followed by alcohol, over-the-counter medications, and illicit substances. Depression was prevalent among those with alcohol and prescription medication problems. Those who received the brief intervention had improvement in alcohol, medication misuse, and depression measures. The BRITE program effectively shaped state policy by responding to legislative mandates to address the needs of an increasing, but underserved, elder population. The pilot paved the way for obtaining a federally funded grant to expand BRITE to 27 sites in 17 counties in Florida.