Diagnosis Of Alcohol Abuse Research Articles

Follow-up encounters within 30 days of a substance abuse-related inpatient discharge.

O treatment for substance use disorders promotes recovery and reduces readmission (1,2).Wemeasured the annual percentage of individuals aged 13–64 who were covered under employer health plans and who received outpatient treatment for a substance use disorder within 30 days of a related inpatient stay. All data (2001–2012) were from the Truven Health MarketScan Commercial Claims and Encounters Database, which includes claims of employed individuals and dependents from all U.S. Census divisions. Data were weighted to be nationally representative of individuals with employer-sponsored insurance, 48% of the U.S. population in 2012 (3). The denominator was number of claims that met these criteria: discharge from an inpatient acute or residential facility, age 13–64, primary ICD-9-CM discharge diagnosis of drug or alcohol abuse or dependence, discharge date between January 1 and December 1 (to allow for 30 days of December follow-up), discharge status was not death or transfer to another facility, and continued plan enrollment for 30 days after discharge. The numerator was number of denominator stays for which there was an outpatient visit related to a substance use disorder within 30 days, defined by a primary ICD-9-CM diagnosis or code pertaining to mental health or substance abuse. We captured both types of diagnoses because substance use disorders are often recorded as mental disorders. Since 2003 the rate at which individuals have received outpatient treatment for a substance use disorder within 30 days of a related inpatient stay has alternated between plateaus and periods of increase (Figure 1). The rate has grown at least a little every year since 2005, reaching 66.1% in 2012. A single measure in the Healthcare Effectiveness Data and Information Set (HEDIS) tracks the rate of outpatient follow-up within seven or 30 days of an inpatient psychiatric discharge. There is no exact analog for substance use disorders. Themost similarHEDIS measure, “engagement” in substance use disorder treatment, requires two outpatient visits related to a substance use disorder within 30 days of “initiation,” which does not require a hospital stay. The dissimilarity of the two follow-up measures makes it difficult to compare outcomes for persons with substance use disorders and those with othermental disorders. A 30-day followup measure for substance use disorders would promote care delivery, research, policy making, and advocacy. The figure presented here represents a first step toward that goal.

Monkey alcohol tissue research resource: banking tissues for alcohol research.

An estimated 18 million adults in the United States meet the clinical criteria for diagnosis of alcohol abuse or alcoholism, a disorder ranked as the third leading cause of preventable death. In addition to brain pathology, heavy alcohol consumption is comorbid with damage to major organs including heart, lungs, liver, pancreas, and kidneys. Much of what is known about risk for and consequences of heavy consumption derive from rodent or retrospective human studies. The neurobiological effects of chronic intake in rodent studies may not easily translate to humans due to key differences in brain structure and organization between species, including a lack of higher-order cognitive functions, and differences in underlying prefrontal cortical neural structures that characterize the primate brain. Further, rodents do not voluntarily consume large quantities of ethanol (EtOH) and they metabolize it more rapidly than primates. The basis of the Monkey Alcohol Tissue Research Resource (MATRR) is that nonhuman primates, specifically monkeys, show a range of drinking excessive amounts of alcohol (>3.0 g/kg or a 12 drink equivalent per day) over long periods of time (12 to 30 months) with concomitant pathological changes in endocrine, hepatic, and central nervous system (CNS) processes. The patterns and range of alcohol intake that monkeys voluntarily consume parallel what is observed in humans with alcohol use disorders and the longitudinal experimental design spans stages of drinking from the EtOH-naïve state to early exposure through chronic abuse. Age- and sex-matched control animals self-administer an isocaloric solution under identical operant procedures. The MATRR is a unique postmortem tissue bank that provides CNS and peripheral tissues, and associated bioinformatics from monkeys that self-administer EtOH using a standardized experimental paradigm to the broader alcohol research community. This resource provides a translational platform from which we can better understand the disease processes associated with alcoholism.

College students who endorse a sub-threshold number of DSM-5 alcohol use disorder criteria: Alcohol, tobacco, and illicit drug use in DSM-5 diagnostic orphans

Diagnostic orphans (DOs) represent a group of individuals with no formal diagnosis, despite endorsing some criteria of an alcohol use disorder (AUD). Prior research has indicated that rates of DSM-IV DOs in college are high and closely resemble those with an alcohol abuse diagnosis across pertinent alcohol use risk factors. However, significant changes to the DSM-IV AUD criteria have been made for the current DSM-5 manual, which may impact how DOs are classified. This study examined the unique alcohol and illicit drug use characteristics of a group of 2,620 DSM-5 DOs in college and tested whether DOs differed from those with and without a DSM-5 AUD across pertinent alcohol and drug use risk factors. Participants were 2,620 DSM-5 DO undergraduate college students, between the ages of 18 and 30, recruited from three public universities in the Southeastern, United States. Diagnostic orphans represented 19.6% (n = 506) of the sample; with the most frequently endorsed criteria being tolerance and consuming alcohol in hazardous situations. DOs reported significantly greater alcohol consumption, alcohol and drug related problems, and illicit drug use compared to those with no DSM-5 AUD diagnosis. Alternatively, DOs reported significantly lower alcohol use and illicit drug use compared to those with a DSM-5 AUD. The present findings indicate that DSM-5 DOs in college represent a distinct group of drinkers relative to those with and without a DSM-5 AUD. Current screening initiatives should target this group to prevent future escalation of problem drinking.

Predicting an Alcohol Use Disorder in Urban American Indian Youths

This study examines predictors of alcohol use disorders (AUDs) among an urban American Indian cohort who were followed from approximately age 11 to age 20. Approximately 27% of the sample had a lifetime diagnosis of alcohol abuse or dependence. The results indicated that externalizing, but not internalizing, behaviors, family conflict, and school liking served as significant predictors of an AUD. Neither having an alcoholic mother nor an alcoholic father was found to be significantly predictive of an alcohol use disorder at ages 19 and 20. Finally, early alcohol initiation was a substantial predictor of an AUD and acted as a partial mediator.

A study correlating the quantity and duration of alcohol consumption with liver function tests

Objectives:Alcoholism is an important health problem all over the world. Biochemical tests are important tools in diagnosing alcohol abuse and identifying the stages of alcoholic liver disease. This study is an attempt to describe the biochemical changes that can be observed in individuals with history of significant alcohol intake as well as to correlate the quantity and duration of alcohol consumption with derangements in the liver function tests. Methods:Fifty males with history of alcohol consumption in significant quantity were included in the study and were interviewed for the quantity and duration of alcohol consumption. Liver function tests which included estimation of serum albumin, globulin, AST, ALT, prothrombin time and bilirubin were done. Derangements in liver function tests were observed and correlated with the quantity and duration of alcohol consumption. Results:Of the 50 individuals, 40% had hypoalbuminemia, 28% had hyperglobulinemia; the percentage of patients with elevated AST,ALT, ALP, bilirubin and prolonged prothrombin time were 42%, 8%, 12%,40% and 28% respectively. 76% had ratio of AST to ALT more than 1 with 40% having more than 2. Karl- Pearson correlation correlation for quantity of alcohol consumption with albumin, blumin, SGPT, bilirubin and prothrombin time was -0.497, 0.519, 0.440, 0.354 and 0.380 with p value 0.00, 0.00, 0.001, 0.012 and 0.007 respectively. The ‘r’ value for duration of alcohol with albumin and bilirubin was - 0.485 and 0.486 with a p value of 0.00 and 0.00 respectively. Conclusion: There was a statistically significant positive correlation between quantity of alcohol consumption and serum levels of globulin, SGPT, bilirubin and prothrombin time. Where as for serum albumin levels there was a negative correlation. There was a statistically significant correlation between duration of alcohol consumption with albumin, which is negative and bilirubin, positively.

Alcohol abuse or dependence and other psychiatric disorders. Madrid study on the prevalence of dual pathology

The objective of this study was to analyse the alcohol addict subgroup from the Madrid study on the prevalence of dual pathology in community mental health and substance misuse services. The sample consisted of 837 outpatients from Madrid, Spain. We compared 528 subjects with a lifetime diagnosis of alcohol abuse or dependence and 182 with other substance use disorders (SUDs) not involving alcohol. The Mini International Neuropsychiatric Interview (MINI) was used to evaluate Axis I disorders and the Personality Disorder Questionnaire to evaluate personality disorders. It was considered that 76.1% of the alcohol addicts had a current dual diagnosis, the most prevalent being mood and anxiety disorders. Fifty-two per cent had a personality disorder and most of them (81.6%) had other SUDs. There was a greater prevalence of dual pathology in the alcohol addict subgroup than in the subgroup without problems of alcohol abuse or dependence. Alcohol addicts were associated with diagnoses of several types of person...

Five-Year Healthcare Utilization and Costs Among Lower-Risk Drinkers Following Alcohol Treatment

Lower-risk drinking is increasingly being examined as a treatment outcome for some patients following addiction treatment. However, few studies have examined the relationship between drinking status (lower-risk drinking in particular) and healthcare utilization and cost, which has important policy implications. Participants were adults with alcohol dependence and/or abuse diagnoses who received outpatient alcohol and other drug treatment in a private, nonprofit integrated healthcare delivery system and had a follow-up interview 6months after treatment entry (N=995). Associations between past 30-day drinking status at 6months (abstinence, lower-risk drinking defined as nonabstinence and no days of 5+ drinking, and heavy drinking defined as 1 or more days of 5+ drinking) and repeated measures of at least 1 emergency department (ED), inpatient or primary care visit, and their costs over 5years were examined using mixed-effects models. We modeled an interaction between time and drinking status to examine trends in utilization and costs over time by drinking group. Heavy drinkers and lower-risk drinkers were not significantly different from the abstainers in their cost or utilization at time 0 (i.e., 6months postintake). Heavy drinkers had increasing odds of inpatient (p<0.01) and ED (p<0.05) utilization over 5years compared with abstainers. Lower-risk drinkers and abstainers did not significantly differ in their service use in any category over time. No differences were found in changes in primary care use among the 3 groups over time. The cost analyses paralleled the utilization results. Heavy drinkers had increasing ED (p<0.05) and inpatient (p<0.001) costs compared with the abstainers; primary care costs did not significantly differ. Lower-risk drinkers did not have significantly different medical costs compared with those who were abstinent over 5years. However, post hoc analyses found lower-risk drinkers and heavy drinkers to not significantly differ in their ED use or costs over time. Performance measures for treatment settings that consider treatment outcomes may need to take into account both abstinence and reduction to nonheavy drinking. Future research should examine whether results are replicated in harm reduction treatment, or whether such outcomes are found only in abstinence-based treatment.

ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood — A naturalistic long-term follow-up study

The purpose of the study was to estimate the risk of substance use disorder (SUD) and alcohol abuse in adulthood among children and adolescents with attention-deficit hyperactivity disorder (ADHD) compared to the background population. Furthermore, to examine whether the age at initiation and duration of stimulant treatment in childhood predicts SUD and alcohol abuse in adulthood. 208 youths with ADHD (183 boys; 25 girls) were followed prospectively. Diagnoses of SUD and alcohol abuse were obtained from The Danish Psychiatric Central Register. The relative risk (RR) of SUD and alcohol abuse for cases with ADHD, compared to the background population was 7.7 (4.3–13.9) and 5.2 (2.9–9.4), respectively. Female gender, conduct disorder in childhood and older age at initiation of stimulant treatment increased the risk of later SUD and alcohol abuse. Our results warrant increased focus on the possibly increased risk of substance abuse in females with ADHD compared to males with ADHD.

Gender differences in the prevalence of DSM-IV alcohol use disorders in adolescents

Despite the availability of data about drinking frequency and patterns, the surveys on alcohol use among adolescents carried out in Europe tend not to provide information about diagnostic criteria for alcohol use disorders (AUD) or estimation of their prevalence. This study assesses the prevalence of AUD among a sample of Spanish adolescents, to identify the most prevalent symptoms, and explore gender differences in AUD in this population. The final sample consisted of 504 participants aged 15 to 18, obtained by means of random sampling from all the schools in the region of Asturias (Spain). The presence of alcohol abuse (AA) and alcohol dependence (AD) disorders was evaluated according to DSM-IV-TR criteria. The results showed that 12.5% of the sample met the criteria for the diagnosis of AUD (6.7% for alcohol abuse, AA, and 5.8% for alcohol dependence, AD). The most prevalent symptoms were having social problems for AA diagnosis (9% of students who reported alcohol use in the past year) and tolerance for AD diagnosis (45.8% of students who reported alcohol use in the past year). Males showed a significantly higher score than females in AUD, AA and two AA diagnosis criteria (hazardous use and legal problems). The prevalence of AUD among Spanish adolescents is very high, males being more likely than females to endorse criteria for AUD and AA, though not for AD. These findings reveal a serious health issue and highlight the need to develop preventive efforts and provide coordinated alcohol-abuse interventions.

Alcohol abuse in developed and developing countries in the World Mental Health Surveys: Socially defined consequences or psychiatric disorder?

Previous single country research has raised concerns that: (1) the DSM-IV diagnosis of alcohol abuse (AA) is met primarily through the hazardous use criterion related to drinking and driving and (2) that the hazardous use and social consequences AA criteria primarily reflect varying socioeconomic and cultural factors rather than psychiatric disorder. Using representative cross-national data from the 21 countries in the World Mental Health surveys, adults meeting DSM-IV lifetime criteria for AA but not dependence from 10 developed (n=46,071) and 11 developing (n=49,761) countries were assessed as meeting AA with the hazardous use or the social consequences criteria. Between 29.3% (developed) and 16.2% (developing) of respondents with AA met only the hazardous use criterion. AA cases with and without hazardous use were similar in age-of-onset, course, predictors, and psychopathological consequences in both developed and developing countries. Despite some associations of the AA criteria with socioeconomic factors, the hazardous use and social consequences criteria were significantly associated with psychiatric predictors and sequelae. The findings indicate that these criteria reflect psychiatric disorder and are appropriate for inclusion as DSM-5 Alcohol Use Disorder criteria. These findings support a psychiatric rather than a sociocultural view of the hazardous use and social consequences symptoms and provide evidence that they are appropriate diagnostic criteria cross-nationally with utility in a wide range of socioeconomic environments. This suggests consideration for their adoption by ICD-11. Further research is needed on the implications of these results for prevention and treatment.

Prospective associations between childhood low-level lead exposure and adult mental health problems: The Port Pirie cohort study

Low-level environmental lead exposure during childhood is associated with poorer emotional/behavioural functioning in later childhood and adolescence. Scarce research has examined whether these apparent effects persist into adulthood. This study is the first to examine prospective associations between lead exposure across early childhood and several common adult mental health problems.Childhood data (including blood lead concentrations) and adult data (from mental health questionnaires and psychiatric interviews) were available for 210 participants (44% males, mean age=26.3 years) from the Port Pirie cohort study (1979–1982 birth cohort).Participants had a mean childhood (to 7 years) average blood lead concentration of 17.2μg/dL. Among females, childhood blood lead showed small significant positive associations with lifetime diagnoses of drug and alcohol abuse and social phobia, and with anxiety, somatic and antisocial personality problems. For example: for a 10μg/dL blood lead increase, females were 2.84 times (95% CI 1.10, 7.30) more likely to have an alcohol abuse diagnosis. However, adjustment for childhood covariates – particularly stimulation within the home environment – rendered these associations non-significant. No significant or sizeable unadjusted or adjusted associations were seen for males.The associations between early lead exposure and emotional/behavioural functioning in children might persist into adulthood, at least for females. However, it is unclear whether such results arise from residual confounding, or other mechanisms. Interventions that focus on improving the childhood home environment may have a long-term positive impact on adult mental health outcomes. However, more prospective research using large and representative samples is needed to substantiate these results.

The AVI-R2: An inventory for a differentiated diagnosis of alcohol problems

Often in clinical practice, a diagnosis of alcohol dependence or abuse does not provide enough information to establish an adequate treatment plan. Hence, multidimensional instruments have been constructed better to describe the extent and character of a patient's alcohol problem. The purpose of the current article is to present the AVI-R2, a self-report test that provides a standardized and differentiated description of an ongoing drinking problem. The instrument includes 81 items categorized into 16 primary scales that were further summarized into four secondary scales: alcohol dependence, psychological benefits, relational complications and multiple dependence. The article provides reference values and psychometric properties of the Swedish version of the test. Data were based on 270 alcoholic patients recruited from the Centre for Dependency Disorders in Stockholm. Except for one primary scale (social complications due to drinking), the psychometric properties of the test were satisfactory. Recommendations on when and how the test can be used were also provided.

Frequent Emergency Department Visits are More Prevalent in Psychiatric, Alcohol Abuse, and Dual Diagnosis Conditions than in Chronic Viral Illnesses Such as Hepatitis and Human Immunodeficiency Virus

BackgroundRepeat users of Emergency Departments (ED), so-called “frequent visitors,” place a substantial burden on limited ED resources. The illness features of frequent visitors have not been well defined, though chronic medical and psychiatric illness and substance abuse are implicated. Study ObjectivesThis study assessed whether chronic conditions such as hepatitis C (HCV) and human immunodeficiency virus (HIV) are more prevalent in frequent ED users compared to a viral condition with relatively less disability, hepatitis B (HBV). As a comparison, psychiatric complaints and alcohol abuse were also compared in frequent and non-frequent visitors. MethodsAll visits to a university ED in a particular calendar year were retrospectively reviewed. Frequent visitors were defined as those who made four or more visits. Presenting complaints and past medical history were examined for HCV, HIV, HBV, psychiatric complaints, and alcohol abuse. ResultsFrequent visitors accounted for 28% of all ED visits. HCV, HIV, and alcohol abuse were more prevalent in frequent visitors than non-frequent visitors. People with HBV comprised a small proportion of both groups. Frequent visitors with psychiatric complaints were more prevalent than those with HBV or alcohol abuse. Psychiatric history comorbid with alcohol abuse and HCV with alcohol abuse were more prevalent in frequent vs. non-frequent visitors. ConclusionAlthough chronic hepatitis and psychiatric complaints are both implicated in frequent ED visits, patients with psychiatric complaints present to the ED more often. Patients with a “dual diagnosis” of psychiatric condition and alcohol abuse are likely to be frequent visitors. This population should be targeted for creative intervention strategies, both within and outside of the emergency system, that comprehensively screen for symptomatology and integrate mental health treatment with substance abuse interventions.

P4.026 Indian Boarding School Experience and HIV Sexual Risk Behaviors Among Urban Two-Spirit American Indian/Alaska Natives

Background As part of a systemic effort of assimilation between the late 19 th and mid-20 th centuries, thousands of American Indian/Alaska Native (AIAN) children were placed in residential Indian boarding schools. To understand the impact of forced attendance in Indian boarding schools on HIV risk, we explored sexual risk behaviours, STI diagnosis, and substance misuse among AIAN two-spirit (gay, lesbian, bisexual, and transgender) adults who had attended Indian boarding school as children compared to those with no history of boarding school. Methods The current investigation was part of a comprehensive multi-site, cross-sectional national health survey of 447 AIAN two-spirit people from seven metropolitan areas in the U.S. To minimise selection bias, multiple sampling strategies were used including targeted, partial network, and respondent-driven sampling (RDS) techniques. Results Eighty-two (22.9%) respondents had a history of Indian boarding school attendance. Compared to others, respondents who attended boarding school were more likely to have a diagnosis of alcohol abuse or dependence (58.5% vs. 44.9%, p p p p p p p Conclusion Findings from this study provide some of the first data on boarding school experience and HIV risk among an urban two-spirit AIAN community sample and underscore the need for increased HIV/STI prevention efforts in AIAN communities. In addition, advanced statistical models are needed that identify mediational pathways to health outcomes and risk behaviours.

Alcohol consumption and alcohol problems after bariatric surgery in the swedish obese subjects study

Increased sensitivity to alcohol after gastric bypass has been described. The aim of this study was to investigate whether bariatric surgery is associated with alcohol problems. The prospective, controlled Swedish Obese Subjects (SOS) study enrolled 2,010 obese patients who underwent bariatric surgery (68% vertical banded gastroplasty (VBG), 19% banding, and 13% gastric bypass) and 2,037 matched controls. Patients were recruited between 1987 and 2001. Data on alcohol abuse diagnoses, self-reported alcohol consumption, and alcohol problems were obtained from the National Patient Register and questionnaires. Follow-up time was 8-22 years. During follow-up, 93.1% of the surgery patients and 96.0% of the controls reported alcohol consumption classified as low risk by the World Health Organization (WHO). However, compared to controls, the gastric bypass group had increased risk of alcohol abuse diagnoses (adjusted hazard ratio [adjHR] = 4.97), alcohol consumption at least at the WHO medium risk level (adjHR = 2.69), and alcohol problems (adjHR = 5.91). VBG increased the risk of these conditions with adjHRs of 2.23, 1.52, and 2.30, respectively, while banding was not different from controls. Alcohol consumption, alcohol problems, and alcohol abuse are increased after gastric bypass and VBG.

µ-Opioid Receptor Gene (OPRM1) Polymorphism A118G: Lack of Association in Finnish Populations with Alcohol Dependence or Alcohol Consumption

Aims: The molecular epidemiological studies on the association of the opioid receptor µ-1 (OPRM1) polymorphism A118G (Asn40Asp, rs1799971) and alcohol use disorders have given conflicting results. The aim of this study was to test the possible association of A118G polymorphism and alcohol use disorders and alcohol consumption in three large cohort-based study samples. Methods: The association between the OPRM1 A118G (Asn40Asp, rs1799971) polymorphism and alcohol use disorders and alcohol consumption was analyzed using three different population-based samples: (a) a Finnish cohort study, Health 2000, with 503 participants having a DSM-IV diagnosis for alcohol dependence and/or alcohol abuse and 506 age- and sex-matched controls; (b) a Finnish cohort study, FINRISK (n = 2360) and (c) the Helsinki Birth Cohort Study (n = 1384). The latter two populations lacked diagnosis-based phenotypes, but included detailed information on alcohol consumption. Results: We found no statistically significant differences in genotypic or allelic distribution between controls and subjects with alcohol dependence or abuse diagnoses. Likewise no significant effects were observed between the A118G genotype and alcohol consumption. Conclusion: These results suggest that A118G (Asn40Asp) polymorphism may not have a major effect on the development of alcohol use disorders at least in the Finnish population.

Does Unemployment Lead to Greater Alcohol Consumption?

Using panel data from Waves 1 and 2 of the NESARC, we estimate gender-specific effects of changes in employment status on overall alcohol consumption, binge drinking episodes, and a diagnosis of alcohol abuse and/or dependence. We employ various fixed-effects models to address potential bias from unobserved and time-invariant individual heterogeneity. All results show a positive and significant effect of unemployment on drinking behaviors and the findings are robust to numerous sensitivity tests. Perhaps macroeconomic policy decisions intended to stimulate the economy during economic downturns should also consider the avoided personal costs and externalities associated with alcohol misuse.

Generalizability of Clinical Trial Results for Bipolar Disorder to Community Samples

Research on the generalizability of clinical trial results for bipolar disorder is limited. The present post hoc study sought to quantify the generalizability of clinical trial results in individuals with DSM-IV bipolar disorder to a large representative community sample. Data were derived from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large, nationally representative sample of 43,093 adults from the United States population. We applied a standard set of eligibility criteria representative of clinical trials to all adults with DSM-IV bipolar depression (n = 785) or mania (n = 724) in the past 12 months and then to a subsample of participants seeking treatment for bipolar depression (n = 276). Our aim was to determine the proportion of participants with bipolar depression or acute mania who would have been excluded from a clinical trial by typical eligibility criteria. We found that more than 5 of 10 participants with bipolar depression (58.17%) or mania (55.75%) would have been excluded by at least 1 eligibility criterion. In the subgroup of participants with bipolar depression who sought treatment, the exclusion rate by at least 1 criterion was higher (63.87%). Having a significant risk of suicide was the criterion excluding the highest percentage of participants in the bipolar depression samples, while having a current DSM-IV diagnosis of alcohol abuse or dependence was the one leading to the greatest exclusion rate in clinical trials for participants with acute mania. Exclusion rates were higher for participants with bipolar I depression compared with those with bipolar II depression. Traditional clinical trials tend to exclude a majority of individuals with bipolar disorder. Clinical trials should carefully consider the impact of eligibility criteria on the generalizability of their results and explain the rationale for their use. Future trials should weigh the trade-offs between internal validity and the representativeness of the study.

Diagnostic efficiency of the AUDIT-C in U.S. veterans with military service since September 11, 2001

BackgroundAlcohol screening with the 3-item alcohol use disorders identification test (AUDIT-C) has been implemented throughout the U.S. Veterans Health Administration. Validation of the AUDIT-C, however, has been conducted with samples of primarily older veterans. This study examined the diagnostic efficiency of the AUDIT-C in a younger cohort of veterans who served during Operation Enduring Freedom and/or Operation Iraqi Freedom (OEF/OIF). MethodsVeteran participants (N=1775) completed the alcohol use disorders identification test (AUDIT) and underwent the structured clinical interview for DSM-IV-TR for Axis I disorders (SCID) in research settings within four VA medical Centers. Areas under receiver operating characteristic curves (AUCs) measured the effiency of the full AUDIT and AUDIT-C in identifying SCID-based diagnoses of past year alcohol abuse or dependence. ResultsBoth measures performed well in detecting alcohol use disorders. In the full sample, the AUDIT had a better AUC (.908; .881–.935) than the AUDIT-C (.859; .826–.893; p<.0001). It is notable that this same result was found among men but not women, perhaps due to reduced power. Diagnostic efficiency statistics for the AUDIT and AUDIT-C were consistent with results from older veteran samples. The diagnostic efficiency of both measures did not vary with race or age. ConclusionsBoth the AUDIT and AUDIT-C appear to be valid instruments for identifying alcohol abuse or dependence among the most recent cohort of U.S. veterans with service during OEF/OIF within research settings.

Predictors of Initial and Sustained Remission from Alcohol Use Disorders: Findings from the 30‐Year Follow‐Up of the San Diego Prospective Study

Individuals who report problematic drinking early in life often recover from alcohol-related disorders, with or without formal treatment. While risk factors associated with developing alcohol use disorders (AUDs), such as a family history of alcoholism and the genetically influenced low level of response (LR) to alcohol, have been identified, less is known about characteristics that relate to remission from AUDs. The male subjects (98% Caucasian) for this study were 129 probands from the San Diego Prospective Study who were first evaluated at age 20 as drinking but not alcohol-dependent young men, most of whom were college graduates by follow-up. The individuals evaluated here met criteria for an AUD at their first follow-up at ages 28 to 33 and were followed every 5 years for the next 2 decades. Discrete-time survival analysis was used to examine rates of initial and sustained AUD remission and to evaluate the relationships of premorbid characteristics and other risk factors to these outcomes. Sixty percent of the sample met criteria for an initial AUD remission of 5 or more years, including 45% with sustained remission (i.e., no subsequent AUD diagnosis). Higher education, lower drinking frequency, and having a diagnosis of alcohol abuse (rather than dependence) were associated with higher rates of initial AUD remission. A lower LR to alcohol at age 20, as well as lower drinking frequency, having received formal alcohol treatment, and older age at the first follow-up all predicted a greater likelihood of sustained AUD remission. This study identified key factors associated with initial and sustained AUD remission in subjects diagnosed with AUD in young adulthood. Characteristics associated with better outcomes early in the life span, such as lower drinking frequency and early treatment, appear to have a lasting impact on remission from AUD across adulthood.