Alcohol Problems Questionnaire Research Articles

An application of moderated nonlinear factor analysis to develop a commensurate measure of alcohol problems across four alcohol treatment studies

BackgroundSelf-report measures of alcohol problems are commonly included in studies evaluating treatment and recovery from alcohol use disorder (AUD), but no prior study has examined the replicability of the measurement of alcohol problems across studies with various measures and diverse samples. Further, it is unclear which items may be better indicators of alcohol problems for patient subgroups. In the present study, we integrated data from four large alcohol treatment studies to develop a commensurate measure of alcohol problems using moderated nonlinear factor analysis (MNLFA). MethodsData were from the COMBINE study, Project MATCH, the Relapse Replication and Extension Project (RREP), and the United Kingdom Alcohol Treatment Trial (UKATT), yielding a total sample size of 4414. MNLFA was carried out on the Drinker Inventory of Consequences (COMBINE, MATCH, RREP) and Alcohol Problems Questionnaire (UKATT). ResultsWe successfully created a 78-item commensurate measure of alcohol problems and examined differential item functioning (DIF) by study membership, time, and socio-demographic characteristics. Sixty-two items demonstrated intercept DIF, suggesting differences in rates of item endorsement for clients with the same underlying levels of alcohol problems across patient subgroups. Six items demonstrated loading DIF, suggesting differences in the extent to which the items were indicative of alcohol problems across patient subgroups. ConclusionsThe self-reported measurement of alcohol problems replicates across measures and diverse samples. Items with DIF have clinical implications for the treatment of AUD. Finally, MNLFA scores can be used to test substantive research questions across these studies.

World Health Organization risk drinking level reductions are associated with improved functioning and are sustained among patients with mild, moderate and severe alcohol dependence in clinical trials in the United States and United Kingdom

To examine whether World Health Organization (WHO) risk-level reductions in drinking were achievable, associated with improved functioning and maintained over time among patients at varying initial alcohol dependence severity levels. Design and setting Secondary data analysis of multi-site randomized clinical trials: the US Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study and the UK Alcohol Treatment Trial (UKATT). Individuals with alcohol dependence enrolled in COMBINE (n=1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n=742; 74.1% male). Interventions Naltrexone, acamprosate or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT. WHO risk-level reductions were assessed via the calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol-related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey) and liver enzyme tests. One- and two-level reductions in WHO risk levels in the last month of treatment were maintained at the 1-year follow-up [adjusted odds ratio (OR), 95% confidence interval (CI)= one-level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol-related consequences [e.g. B, 95% CI=one-level reduction COMBINE: -26.22 (-30.62, -21.82)], better mental health [e.g. B, 95% CI=one-level reduction UKATT: 9.53 (7.36, 11.73)] and improvements in γ-glutamyltransferase [e.g. B, 95% CI=one-level reduction UKATT: -89.77 (-122.50, -57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded. Conclusions Reductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning and maintained over time in both the United States and the United Kingdom.

Nursing Students Learn Online Interprofessional Education on Substance Use.

Interprofessional education strategies are becoming more prevalent as nursing schools integrate interprofessional practice activities into their curricula. This paper presents the results of a federally funded project to deliver online interprofessional education to nursing students on screening for alcohol and substance use in rural areas, in which their perceptions about interprofessional education were measured. A quasi-experimental within-subjects repeated measures design was utilized. Students in the bachelor or associate degree program were recruited from two rural nursing schools. A demographic questionnaire, Alcohol and Alcohol Problems Questionnaire, Drug and Drug Problems Questionnaire, and Interprofessional Education Perception Scale were utilized. General linear modeling was used to determine changes in these measurements over time. Data collection was performed at pretraining, posttraining, and following an online interprofessional dialogue. The study consisted of 89 nursing students. The participants were 87% female (n = 77/89) and 91% white (n = 81/89); their mean age was 24.9 years (standard deviation = 10.36). Analysis of evaluation questionnaires demonstrated increased levels of confidence in working with patients who consume alcohol or other drugs and on certain aspects of interprofessional education. Online interprofessional preservice education holds the potential to positively increase nursing students' confidence in working with patients and to increase their interprofessional practice.

Hausärztliche Bereitschaft zur Intervention bei zu hohem Alkoholkonsum: Eine Frage der Sicherheit im Umgang mit betroffenen Patienten?

Only a few general practitioners (GPs) are committed to screen their patients for alcohol consumption and, in case of excessive alcohol consumption conduct by a brief intervention according to WHO recommendations. Apart from inadequate compensation and work load, another barrier identified by the GPs was their uncertainty about how to deal with affected patients. Most German universities presently spend no more than 90minutes lecture time on addiction medicine teaching. Our research aims to investigate the question whether medical studies and advanced medical education increases the role security of medical students and physicians and their commitment to implementing alcohol screening and brief intervention. Moreover, we will explore whether lack of therapeutic commitment can be related to lack of role security. Questionnaires were administered to pre-clinical and clinical medical students as well as senior house officers. Role security and therapeutic commitment of students and senior house officers were assessed using the Alcohol and Alcohol Problems Questionnaire (SAAPPQ) subscales "Role Security" and "Therapeutic Commitment". Analysis was based on 367 questionnaires. As expected, senior house officers reported more Role Security than clinical medical students who showed a higher level of Role Security than pre-clinical medical students. No differences could be found for Therapeutic Commitment. An association between Role Security and Therapeutic Commitment was only revealed for clinical medical students. Medical studies and advanced medical education can increase students' and senior house officers' Role Security to treat patients with excessive alcohol consumption, but not Therapeutic Commitment. Moreover, no association between Role Security and Therapeutic Commitment could be found for senior house officers. Hence, it may be assumed that educational activities aiming to increase Role Security do not promote the development of motivational aspects such as Therapeutic Commitment to the management of patients with excessive alcohol intake.

Randomised controlled trial of a brief alcohol intervention in a general hospital setting

BackgroundThe evidence suggests that brief alcohol-focused interventions, directed at hazardous and harmful drinkers in non-specialist settings such as primary care are effective in reducing alcohol consumption. However, there is a need for further research in the hospital setting. This is a randomised controlled trial to investigate the effectiveness of a 10-minute brief intervention amongst 'at risk’ drinkers admitted to general hospital wards. Unlike some previous trials, this trial is randomised, used blinded assessors, includes an intention-to-treat analysis, included female subjects and excluded people with alcohol dependence.MethodsA total of 250 'at risk’ drinkers admitted to King’s College Hospital were identified using the Alcohol Use Disorders Identification Test (AUDIT). Some 154 subjects entered the study and were randomly allocated to the control and intervention groups. Subjects in the control group received no advice about their drinking whilst subjects in the intervention group received 10 minutes of simple advice on reducing alcohol consumption. Recruitment took place between 1995 and 1997. The primary outcome was the AUDIT questionnaire at 12 months. Secondary outcomes were a previous week’s Drinks Diary, questionnaires (General Health Questionnaire, Alcohol Problems Questionnaire and the Severity of Alcohol Dependence Questionnaire) and laboratory blood tests (gamma glutamyl transferase, mean cell volume and haemoglobin).ResultsAt 3-month and 12-month follow-up, all participants were included in the intention-to-treat analysis. At both time points there was no evidence of an intervention effect that could be attributed to the brief intervention. Both the intervention and control groups had an improved AUDIT score and reduced levels of alcohol consumption as measured by a subjective Drinks Diary at 3 months which was maintained at 12 months.ConclusionsThis study has added further evidence on brief interventions in the hospital setting. In contrast to the recent Cochrane review by McQueen et al., the results of this study do not support the effectiveness of a brief alcohol intervention in general hospital wards. However our study was underpowered and there were flaws in the statistical analyses, and these limitations temper the strength of our conclusions.

Confirming the factor structure of the alcohol and alcohol problems questionnaire (AAPPQ) in a sample of baccalaureate nursing students

The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) is a multi-dimensional measure of clinicians' attitudes toward working with patients with alcohol problems. In the past 35 years, five- and six-subscale versions and a short version of the AAPPQ have been published. While the reliability of the AAPPQ subscales has remained acceptable, the factor structure has not been verified using confirmatory techniques. In the current study, we split a sample of 299 baccalaureate nursing students to use exploratory (EFA) and confirmatory factor analyses (CFA). When compared to the original six-factor solution and an imposed six-factor structure in CFA, the EFA seven-factor solution with three original items (19, 20, and 25) removed had the best model fit.

UK Alcohol Treatment Trial: client–treatment matching effects

To test a priori hypotheses concerning client-treatment matching in the treatment of alcohol problems and to evaluate the more general hypothesis that client-treatment matching adds to the overall effectiveness of treatment. Pragmatic, multi-centre, randomized controlled trial (the UK Alcohol Treatment Trial: UKATT) with open follow-up at 3 months after entry and blind follow-up at 12 months. Five treatment centres, comprising seven treatment sites, including National Health Service (NHS), social services and joint NHS/non-statutory facilities. Motivational enhancement therapy and social behaviour and network therapy. Matching hypotheses were tested by examining interactions between client attributes and treatment types at both 3 and 12 months follow-up using the outcome variables of percentage days abstinent, drinks per drinking day and scores on the Alcohol Problems Questionnaire and Leeds Dependence Questionnaire. None of five matching hypotheses was confirmed at either follow-up point on any outcome variable. The findings strongly support the conclusion reached in Project MATCH in the United States that client-treatment matching, at least of the kind examined, is unlikely to result in substantial improvements to the effectiveness of treatment for alcohol problems. Possible reasons for this failure to support the general matching hypothesis are discussed, as are the implications of UKATT findings for the provision of treatment for alcohol problems in the United Kingdom.

Internet-Based Interactive Health Intervention for the Promotion of Sensible Drinking: Patterns of Use and Potential Impact on Members of the General Public

Background Heavy drinking is responsible for major health and social problems. Brief interventions have been shown to be effective, but there have been difficulties in reaching those who might benefit from them. Pilot studies have indicated that a Web-based intervention is likely to be acceptable to heavy drinkers and may produce some health benefits. However, there are few data on how many people might use such a program, the patterns of use, and potential benefits.Objectives The aim was to examine the demographic characteristics of users of a free, Web-based, 6-week intervention for heavy drinkers and to describe the methods by which users identified the site, the pattern of site use and attrition, the characteristics associated with completing the program, and the self-reported impact on alcohol-related outcomes.Methods Cohort study. Visitors to the Web site were offered screening with the Fast Alcohol Screening Test, and those scoring above the cutoff for risky drinking were invited to register with the program. Demographic information was collected routinely at registration, and questionnaires were completed at the end of weeks 1 and 6. The outcome measures assessed dependency (Short Alcohol Dependency Data Questionnaire), harms (modified Alcohol Problems Questionnaire), and mental health (Clinical Outcomes in Routine Evaluation–Outcome Measure).Results The records of 10000 users were analyzed. The mean age was 37.4 years, 51.1% were female, 37.5% were single, and 42.4% lived with children. The majority were White British, lived in the United Kingdom, and reported occupations from the higher socioeconomic strata. Over 70% connected to the Down Your Drink (Down Your Drink) site from another Internet-based resource, whereas only 5.8% heard about the site from a health or other professional. Much of the Web site use (40%) was outside normal working hours. Attrition from the program was high, with only 16.5% of registrants completing the whole 6 weeks. For those who completed the program, and the final outcome measures, measures of dependency, alcohol-related problems, and mental health symptoms were all reduced at week 6.Conclusions The Web-based intervention was highly used, and those who stayed with the program showed significant reductions in self-reported indicators of dependency, alcohol-related problems, and mental health symptoms; however, this association cannot be assumed to be causal. Programs of this type may have the potential to reach large numbers of heavy drinkers who might not otherwise seek help. There are significant methodological challenges and further research is needed to fully evaluate such interventions.

A profile of Chinese alcoholics in Singapore.

Eighty-five Chinese alcoholics, referred consecutively to the psychiatric unit of a general hospital, were assessed with the Alcohol Problems Questionnaire (APQ) and the Severity of Alcohol Dependence Questionnaire (SADQ). There were 72 men (mean age 44.3, SD 13.9) and 13 women (mean age 36.7, SD 11.6). The common alcohol-related problems reported concerned physical health, finance, work, friends, depression and marriage. The SADQ score for men was 19.6 (SD 7.8) and women 15.6 (SD 8.4). Highly significant Pearson product moment correlations were found between the SADQ score and APQ subscales in physical health, depression and finance; but there was no correlation with children or legal (police) problems. The strongly positive correlation between the SADQ and APQ scores were independent of the quantity of alcohol consumption. Female drinkers had more depressive symptoms than males, but there was no significant difference in alcohol-related problems pertaining to physical health, work, marriage, finance or friends for male or female drinkers.

A randomised trial of early warning signs relapse prevention training in the treatment of alcohol dependence

A pragmatic randomised trial examined the effects of Early Warning Signs Relapse Prevention Training (EWSRPT) on drinking in alcohol dependent persons with history of relapse. Participants were 124 abstinent alcohol dependent patients with a history of relapse (median five relapses) who entered the trial as they completed a 6-week day treatment programme. They were randomly allocated to receive either (1) Aftercare as Usual (AU) or (2) AU plus 15 individual sessions of EWSRPT using Gorski's protocol. Assessment carried out at entry to the trial, and 4, 8, and 12 months later, included self-report of drinking, blood tests (gamma glutamyl transferase, GGT; serum alanine aminotransferase, ALT) and measures of functioning (Alcohol Problems Questionnaire, APQ; SF36, Brief Symptom Inventory, BSI; Assessment of Warning-signs of Relapse, AWARE). Intention to treat analysis found no significant differences in continuous abstinence during the follow-up year (17% of 58 AU, 31% of 58 EWSRPT, p=0.08). The EWSRPT participants had a significantly lower probability of drinking heavily (74% of AU, 55% of EWSRPT, p=0.04), and significantly fewer days drinking ( p=0.05) and heavy drinking ( p=0.04). These clinically worthwhile effects for a relapse-prone group justify further research into EWSRPT.

Positive or negative history of childhood sexual abuse among problem drinkers: relationship to substance use disorders and psychiatric co-morbidity

Background Victims of childhood sexual abuse (CSA) show higher rates of several psychiatric and substance abuse disorders in adulthood. High rates of CSA have been reported in alcohol- or drug-dependent patients presenting to treatment. However, there is a paucity of European research with regard to in-patient alcohol-dependent populations. Aims The aim was to describe the prevalence of CSA in a UK sample of alcohol-dependent in-patients admitted over a 3-year period to a specialist alcohol unit; also to identify sociodemographic, alcohol and other substance use-related variables, and co-morbid psychiatric disorders associated with CSA. Method Clinical and socio-demographic data and information on childhood sexual abuse (CSA) were collected from 414 admissions, between September 1995 and September 1998, to the Specialist Alcohol Inpatient Unit. Results In the total sample of 414 subjects, 52 had experienced CSA. Of the 311 male subjects included in the study, 20 (6.4%) had experienced CSA. Of the 103 female subjects in the study sample, 32 (31.1%) disclosed having a history of CSA (CSA-females). Women victims of CSA were more likely to be non-white, to have a positive family history of alcoholism and to have fewer years of excessive drinking prior to admission. They were also significantly more likely to a have a lifetime diagnosis of depressive, anxiety and eating disorders, as well as being more likely to have a co-morbid post-traumatic stress disorder and a borderline personality disorder. Male victims had significantly higher Alcohol Problems Questionnaire (APQ) scores, were more likely to live alone, to be single, separate, divorced or widowed and to have a post-traumatic stress disorder and a borderline personality disorder. Conclusions Very few alcohol and drug abuse treatment units have developed programmes specifically designed to meet the needs of patients, and particularly women, who have experienced sexual abuse during childhood. However, as reflected by the relationship between CSA and dual diagnosis shown in this study, victims of CSA may represent an important subgroup of alcohol-dependent patients with specific needs. They may require the combination of various forms of pharmacological and psychological treatments to match their clinical characteristics. Declaration of interest None.

Drinking goal selection and treatment outcome in out‐patients with mild‐moderate alcohol dependence

AbstractSelection of drinking goal is examined at baseline, post‐treatment and at 6 months follow‐up for a sample of mild‐moderate alcohol‐dependent out‐patients. Drinking goal is identified as abstinent or controlled drinking, with the latter group being asked to further specify per session and per week drinking limits. Group comparisons for drinking goal post‐treatment show those who were not assigned motivational enhancement therapy, had more drinking days and lower scores on the Alcohol Problems Questionnaire and Internal Motivation were more likely to choose controlled drinking. The only variable to predict independently whether or not the controlled drinking goal was within the promoted drinking guidelines was age, with younger participants more likely to choose a goal above this limit. Goal selection was significantly related to drinking outcome, with those aiming to drink within guidelines having better outcome than those aiming for higher limits. There was no significant difference in drinking outcome category when those aiming for within limits were compared to those aiming for abstinence. Clinical implications of these findings are discussed.

Quality of life measures and outcome in alcohol-dependent men and women

A sample of 82 (41 men 41 women) DSM IV alcohol-dependent inpatients admitted for detoxification was studied at baseline and followed-up 12 weeks thereafter. The following questionnaires were administered 4–5 days after admission for detoxification: Socio-demographic information, Severity of Alcohol Dependence Questionnaire (SADQ), Alcohol Problems Questionnaire (APQ), Rotterdam Symptoms Checklist (RSCL), Life Situation Survey (LSS), Beck Depression Inventory (BDI), General Health Questionnaire (GHQ 12), and Nottingham Health Profile (NHP). All indices other than socio-demographic data, the SADQ, and APQ were administered at 12-week follow-up. After controlling for confounding factors at baseline, women were more likely to be in a higher social class, prescribed anti-depressants during the previous 12 months, drink fewer units of alcohol in a typical week, and have a higher level of psychiatric caseness scores (GHQ-12). A total of 80 subjects (97%) were successfully followed-up. Difference between gender did not significantly impact upon any of the 12-week outcome measures. There was no significant difference in the study relapse rates or time taken to relapse between men and women. The only significant total sample change was a reduction in the amount of alcohol consumed in a typical week. This was significantly related to changes in the following Quality of Life (QoL) measures, NHP emotional reaction sub-scores, LSS, and BDI scores.

Measurement of quality of life in alcohol-dependent subjects by a cancer symptoms checklist

There are few studies of Quality of Life measures (QoL) in alcohol-misusing patients. The present study addresses this deficiency. The sample consisted of 60 (39 men, 21 women) alcohol dependent subjects defined by DSM-IV criteria (American Psychiatric Association, 1994). At baseline (4–5 days after admission and detoxification) sociodemographic data were collected, and three questionnaires were administered: the Rotterdam Symptoms Checklist (RSCL), the Severity of Alcohol Dependence Questionnaire (SADQ), and Alcohol Problems Questionnaire (APQ). QoL scores for dependent alcoholics both for physical and psychological measures were significantly worse (higher) than those reported for a variety of cancer patients. Psychological symptom scores were higher than physical symptoms at baseline. Correlations of RSCL scores to both SADQ and APQ were greater for RSCL physical compared to psychological symptom scores. The subjects were followed up at 12 weeks when the RSCL was re-administered and relapse status ascertained. Fifty-eight (97%) subjects were successfully contacted at 12 weeks of whom 36 (62%) had relapsed. After a repeated measures ANOVA psychological and physical symptom subscores were statistically significantly improved as a result of not relapsing to heavy drinking. There was no significant change in scores in the relapse group when baseline and week 12 scores were compared. The RSCL measure is a useful QoL assessment tool in alcohol-dependent subjects.

Sexual abuse in people with alcohol problems. A study of the prevalence of sexual abuse and its relationship to drinking behaviour.

There is evidence that people with a history of sexual abuse may have an increased risk of developing alcohol and drug problems. A self-completion sexual abuse questionnaire was designed and administered to a sample of attenders at three London alcohol services. Drinking behaviour was assessed using the Severity of Alcohol Dependence Questionnaire and the Alcohol Problems Questionnaire, and additional data were derived from case notes. Fifty-four per cent of women and 24% of men identified themselves as victims of sexual abuse or assault For the majority this had started before the age of 16 and involved non-relatives. Subjects with a history of sexual abuse were younger, reached drinking milestones earlier, were more likely to have a family history of alcohol misuse and had more alcohol-related problems than non-abused subjects. Sexual abuse, age and alcohol dependence predicted level of problems in a regression analysis. The high rates of sexual abuse and its association with indications of increased morbidity suggest it is an important issue for the management of alcohol problems. More use could be made of self-completion questionnaires for the investigation of sexual abuse.

The Alcohol Problems Questionnaire: reliability and validity

The Alcohol Problems Questionnaire (APQ) was designed as a clinical instrument for measuring alcohol-related problems. It has been used to study the relationship between alcohol-related problems and dependence within the bi-axial model. The reliability of the APQ was, however, unknown. In the present study 101 subjects participated in a test-retest reliability study. Dependence and consumption scores were obtained along with socio-demographic information in order to study the construct validity of the APQ. The APQ was found to be highly reliable and the previous finding that dependence is a mediating factor in the relationship between consumption and problems was replicated. These findings add further weight to the view that alcohol-related problems represent a phenomenon which is conceptually, as well as statistically, distinct from dependence. Further, the APQ is reliable, simple to administer and is likely to be useful in the assessment and study of problem drinkers in the clinical and research settings.

The relationship between alcohol dependence and alcohol–related problems in a clinical population

The relationship between alcohol dependence and alcohol-related problems was studied in a group of 103 problem drinkers. Responses to a 46-item Alcohol Problems Questionnaire (APQ) were compared with the Severity of Alcohol Dependence Questionnaire (SADQ), alcohol consumption and demographic data. A strongly positive correlation was found between aggregate problems and dependence scores (r = 0.63; p = 0.001) which existed independently of the quantity of alcohol consumed. Analysis of questionnaire subscales revealed that certain problem domains were more closely related to particular aspects of dependence than others. A higher level of problems was found in subjects of younger age and lower socio-economic class. No significant sex differences were found. The implications of these findings are discussed.