Current Alcohol Problems Research Articles

The Comprehensive Early Drinking History Form: A Novel Measure of Early Alcohol Exposure.

Adolescent and young adult alcohol use is a major public health concern; alcohol is the most widely used substance by teenagers. It is imperative to better understand alcohol use during adolescence and early adulthood given the important changes that occur. Although numerous measures aim to capture alcohol use during this time, no existing measure gathers comprehensive information on alcohol use across these developmental stages. We developed the Comprehensive Early Drinking History Form (CEDHF), which retrospectively gathers drinking information for each year since onset of first regular use, including quantity/frequency of both regular use and periods of heaviest drinking. The CEDHF also collects information on aggregate drinking experiences between age of onset and age of first regular use. Using a sample of young adults (ages 21 to 27) from an ongoing longitudinal study, we examined whether the CEDHF predicted both concurrent (N=303) and future (N=75) alcohol-related problems over and above other commonly used alcohol use measures (e.g., age of onset, age of first intoxication, Timeline Follow-Back) and current alcohol problems. Controlling for gender, age, and current problems, the CEDHF predicted both concurrent and future alcohol-related problems over and above these other widely used measures of alcohol exposure. The CEDHF may be a valuable tool when longitudinal studies are not feasible as it provides more comprehensive information than other widely used measures of early alcohol exposure. Further, this measure can provide detailed information regarding who is at highest risk for future consequences.

Effect of Obesity on Bone Healing After Foot and Ankle Long Bone Fractures

As obesity has become more common, fractures in the obese population have become more frequent. Concern exists regarding alterations in bone health and healing in obese patients. A matched case-control study was performed at 1 institution to evaluate whether an association exists between nonunion and a high body mass index in metatarsal and ankle fractures. A total of 48 patients with nonunion were identified, and control patients matched 2 to 1 (n = 96) were selected. The control patients were matched for age, sex, and fracture type. No association was identified between nonunion and the continuous body mass index (p = .23) or morbid obesity, with a body mass index of ≥40 kg/m2 (p = .51). However, the results from both univariate and multivariate analysis suggested that patients with a current alcohol problem or a history of an alcohol problem might have a greater risk of nonunion. The odds ratio of a patient with a history of alcohol use experiencing nonunion was 2.7 (95% confidence interval 1.2 to 6.2). Further studies are warranted to confirm these findings.

Review of outcome research on marital and family therapy in treatment for alcoholism.

This review of controlled studies of marital and family therapy (MFT) in alcoholism treatment updates the earlier review by O'Farrell and Fals-Stewart (2003). We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, both Al-Anon facilitation and referral and spouse coping skills training (based on new findings) help family members cope better, and CRAFT promotes treatment entry and was successfully transported to a community clinic in a new study. Once the alcoholic enters treatment, MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. New BCT studies showed efficacy with women alcoholics and with gay and lesbian alcoholics, and BCT was successfully transported to a community clinic, a brief BCT version was tested, and BCT was adapted for family members other than spouses. Future studies should evaluate the following: MFT with couples where both members have a current alcohol problem and with minority patients, mechanisms of change, transportability of evidence-based MFT approaches to clinical practice settings, and replication of MFT outcomes of reduced partner violence and improved child functioning.

Predictors of effortful control among children of alcoholic and nonalcoholic fathers.

The purpose of this study was (1) to examine the association between fathers' alcoholism and children's effortful control and (2) to examine the role of parental warmth and toddler temperament as mediators or moderators of this relationship. Families were recruited through New York State birth records when their infant was age 12 months. The final sample consisted of 226 families (116 boys) constituting two major groups: a nonalcoholic group consisting of parents with no or few current alcohol problems (n = 102) and a father alcoholic group (n = 124). Families were assessed when their child was ages 12, 18, 24 and 36 months. Results indicate that boys of alcoholic fathers exhibit lower overall levels of effortful control than boys of nonalcoholic fathers. For boys, fathers' warmth over the second year of life mediated the association between fathers' alcoholism and effortful control. Maternal warmth was a unique predictor of effortful control for boys. For girls, fathers' alcoholism was associated with lower paternal warmth, which was in turn a significant predictor of effortful control. Child activity level and negative affect were associated with effortful control for boys but did not account for significant variance when entered in regression models with fathers' alcoholism and parenting variables. Sons of alcoholic fathers are at an increased risk of problems in self-regulation when they are ages 2 to 3 years. Paternal warmth mediates the association between fathers' alcoholism and self-regulation for both boys and girls, although the nature of mediation may vary by child gender.

Outcome of alcoholism in old age.

This retrospective study describes the follow-up of a birth cohort of alcohol dependent patients as they enter old age. The aim is to define the global outcome of survivors by combining a measure of current drinking behaviour with ratings for depression and dementia. A series of 100 referrals to a regional unit for alcohol misuse in Bristol, England, were followed up at a mean of 13 years after first referral for treatment. Survivors were traced when they were aged between 67 and 77 years. At follow-up interview, subjects were screened for current alcohol problems, depression and dementia. The mortality rate in the cohort was raised significantly. Almost one third of survivors had depressive symptoms at follow-up and rates of global dementia were higher than expected in an aged-matched sample of the general population. However, the majority of survivors were classified as having an intermediate global outcome with less than 10% having a poor outcome. The high rates of mortality and psychiatric morbidity observed in this cohort illustrate the importance of detecting alcohol problems in the elderly. Further prospective studies are necessary to validate these findings in a community sample of older people.

Paternal alcoholism, parental psychopathology, and aggravation with infants.

The purpose of this study was to examine the role of paternal alcohol problems, antisocial behavior, and depression in predicting parental attitudes toward their 12-month-old infants. Families were recruited from birth records and the final sample consisted of 216 families, 101 in the control group and 115 families with alcoholic fathers (92 with light drinking partners and 23 with heavy drinking partners). Results indicated that fathers' alcoholism was associated with higher paternal aggravation with the infant. Further, fathers' depression mediated the relationship between fathers' current alcohol problems and aggravation. Fathers' alcoholism was indirectly associated with maternal aggravation and warmth through the relationship with maternal antisocial behavior and depression. Results suggest that at least during early infancy, parental psychopathology associated with fathers' alcohol problems may play a more important role in predicting parental attitudes toward their infants than alcoholism per se. Results are further discussed in terms of their implications for parenting and later development among infants of alcoholics.

Alcohol problems among residents in old age homes in the city of Mannheim, Germany.

This study aims to determine the prevalence of alcohol problems among residents in old age homes, its demographic and clinical features, and its association with the risk of falling. All residents (n = 1922) living in 20 randomly selected residential and nursing homes in the city of Mannheim, Germany, were included. Based on routine documentation, details of their sociodemographic features, medical diagnoses made upon admission, and current medication were compiled. The home staff filled out for each resident a standardised assessment sheet on activities of daily living-impairment (Barthel Index), behaviour problems, alcohol consumption, and frequency of falls. According to the diagnoses of the primary care physicians, 7.4% of the residents had mental and behavioural disorders due to alcohol (ICD-10: F10). Rates were particularly high among men, and younger and single or divorced residents. A high percentage of those with a diagnosis of alcohol abuse/dependence (41.1%) were transferred from mental hospitals. Home staff reported current alcohol abuse/dependence among 3.4% of all residents. The risk of falling was significantly elevated (Odds ratio: 2.65; p<0.01) among those with current alcohol problems. The results corroborate the findings from other studies wherein residents of old age homes constitute a group at risk of alcohol abuse and dependence. Alcohol problems were more the cause for, rather than the consequence of, home admission.

Screening with the Alcohol use Disorders Identification Test (AUDIT) in an inner-city population.

1) To determine the operating characteristics of the Alcohol Use Disorders Identification Test (AUDIT) in an inner-city population and 2) to compare AUDIT performance with physician recognition of alcohol-related problems. New patients were administered a health habits questionnaire, which included the AUDIT and the alcohol portion of the Structured Clinical Interview for DSM-III-R (used as the "gold standard" for alcohol abuse or dependence). The findings were compared with physician recognition based on chart review. Inner-city general medicine clinic staffed by resident physicians with faculty supervision. Consecutive new patients over a ten-week period. Of 166 consecutive new patients, 23 were not contacted, 17 refused to participate, two were excluded for gross cognitive deficits, and 124 completed the study. Of the 124 patients, 41 (33%) met criteria for past or present alcohol abuse or dependence. The AUDIT correctly identified 26/27 (sensitivity of 96%) of patients with current problems and 0/14 of patients with past problems only. Physician rates of recognition of current and past alcohol-related problems based on chart review were 12/27 (sensitivity of 44%) and 1/14 (7%), respectively. The specificities of both the AUDIT and physician recognition were high, 96% and 99%, respectively. 1) Alcohol-related problems were common in this setting, 2) The AUDIT had a high sensitivity and a high specificity for detection of current alcohol problems in this setting, but it failed to detect patients with only past histories of alcohol problems. 3) The AUDIT performed significantly better than did the physicians in detecting alcohol problems. 4) The addition of an assessment of past alcohol use to supplement information from the AUDIT would appear to represent a promising screening strategy worthy of further investigation.

A Survey of Alcohol and other Drug Use Behaviors and Risk Factors in Health Profession Students

This survey assessed the alcohol and other drug (AOD) use habits and risk factors of health profession students at a midwestern university health science center. The authors administered a 75-item survey to 1,707 students in selected classrooms: 984 students responded for a return rate of 57.6%. In 1990, they found, alcohol use among the health profession students in the past year was comparable to that of undergraduate college students nationally (86%), although significantly fewer health profession students drank heavily (27% had five or more drinks in the past 2 weeks, compared with 41% of college students). The percentage of health profession students who reported using tobacco or illicit drugs was lower than the percentage of undergraduate students who used these substances. At the time of the study, 16% of the respondents may have had a potential current alcohol problem and 3.5% a potential drug problem. Pharmacy students most often reported negative consequences from their AOD use. Peer pressure influenced the drinking decisions of 55% of the respondents; students in dentistry and pharmacy experienced the least support from peers for their decisions to abstain from drinking. Family histories of alcohol problems were reported by 38% of the respondents, and family histories of drug use by 14.8%. Male health profession students, when compared with the female professional students, drank more and experienced more consequences of their drinking or drug use and were also more influenced by peers.

Factors associated with heroin users' AIDS risk‐taking behaviours

A survey was undertaken in Sydney in 1989 to identify factors associated with behaviour involving risk for human immunodeficiency virus infection. Self-report data on needle-sharing and sexual practices were collected from 91 heroin users entering a residential, drug-free detoxification unit. Data were analysed using polytomous and ordinal logistic regressions. Heroin-dependent subjects who also had a current alcohol problem were significantly more likely than others to report high risk needle-sharing behaviour. Subjects with more than one sexual partner in the last three months were significantly more likely to use condoms while those with a current benzodiazepine problem were significantly less likely to use condoms. Qualitative data suggest that high risk needle-sharing behaviour most often occurred around the time of relapse to injecting drug use and among homeless drug users occupying derelict buildings in inner-city suburbs.

Addiction Severity Index scores of four racial/ethnic and gender groups of methadone maintenance patients.

This report compares the findings for four racial/ethnic and gender groups of methadone maintenance (MM) patients--African-American men (n = 153), African-American women (n = 107), Hispanic men (n = 138), and Hispanic women (n = 70)--administered the Addiction Severity Index (ASI). African-American men had a history of more arrests and incarcerations than Hispanic men. African-Americans had a longer history of drug and alcohol abuse problems than Hispanics and more current alcohol problems. Women reported more medical, psychiatric, family-social, and employment problems than men. Men reported more legal and alcohol-related problems than women. With several exceptions, the study findings were consistent with those based on other instruments. Given the relatively large sample sizes, the data may provide a characteristic ASI profile of the racial/ethnic and gender groups studied. The implications of differential group problem levels for substance abuse treatment efforts are discussed.

THE ALCOHOL USE DISORDERS IDENTIFICATION TEST (AUDIT) AND THE SMAST-13: PREDICTIVE VALIDITY IN A RURAL PRIMARY CARE SAMPLE

This study was conducted to compare the validity of a new screening instrument developed by the World Health Organization, the Alcohol Use Disorders Identification Test (AUDIT), to the short version of the MAST in 287 primary care patients. Subjects were classified as meeting a lifetime or current DSM-III diagnosis of alcohol misuse and/or dependence based on the DIS-R interview schedule. Using the original WHO guidelines (score of 11 or more), 37 (13%) scored positive on the AUDIT and 103 (36%) had a weighted score of 5 or more on the SMAST-13. The internal reliability of the AUDIT was 0.86, compared to the SMAST-13 at 0.85. Cut-off scores in this sample for current alcohol problems, utilizing Receiver Operating Curves, were 7-8 for the AUDIT and 5 for the SMAST. This study confirms the utility of the AUDIT for current alcohol problems and the SMAST-13 for lifetime or past problems in a rural clinical sample.

MMPI substance abuse scales on drug addicts with and without concurrent alcoholism.

The range and utility of the MMPI-derived MacAndrew Alcoholism Scale (MAC) and the Heroin Addiction Scale (He) was assessed with a large sample of drug addicts with and without concurrent alcoholism. Results indicated that addicts with a co-existing alcohol problem obtained higher MAC scores than addicts without a current alcohol problem. Opiate abusers scored higher on the MAC than non-opiate abusers. No such effects were observed with the He scale. The MAC is a particularly robust scale that taps generic substance abuse and may even be sensitive enough to detect alcoholism in drug addicts.