Drinking Standards Research Articles

Alcohol use in the year following approach bias modification during inpatient withdrawal: secondary outcomes from a double-blind, multi-site randomized controlled trial.

Approach bias modification (ApBM) targeting alcohol approach bias has been previously shown to reduce likelihood of relapse during the first 2 weeks following inpatient withdrawal treatment (IWT). We tested whether ApBM's effects endure for a longer period by analysing alcohol use outcomes 3, 6 and 12 months post-discharge. A double-blind, sham-controlled randomized controlled trial. Four IWT units in Melbourne, Australia. Three hundred alcohol IWT patients (173 men, 126 women, 1 non-binary; mean age 43.5years) were recruited between 4 June 2017 and 14 July 2019. Follow-up data collection was completed on 22 September 2020. Four ApBM sessions were delivered during IWT. ApBM trained participants (n= 147) to avoid alcohol and approach non-alcohol beverage cues. Controls (n= 153) responded to the same stimuli, but without approach/avoidance training. Date of first lapse was recorded for non-abstinent participants to determine time to first lapse. Time-line follow-back interviews assessed past-month alcohol consumption at each follow-up, with participants reporting no alcohol consumption classified as abstinent. In analyses of past-month abstinence, non-abstinence was assumed in participants lost to follow-up. Number of past-month drinking days, standard drinks and heavy drinking days (five or more standard drinks for women or non-binary; six or more standard drinks for men) were calculated for non-abstinent participants at each follow-up. ApBM significantly delayed time to first lapse [ApBM median: 53 days, 95% confidence interval (CI) = 21-61; controls = 12 days, 95% CI =9-21, P= 0.045]. Past-month abstinence rates at 3-, 6- and 12-month follow-ups were 33/153 (21.6%), 30/153 (19.6%), and 24/153 (15.7%) in controls; and 51/147 (34.7%), 30/147 (20.4%) and 29/147 (19.7%) in the ApBM group, respectively. Past-month abstinence was significantly more likely in ApBM participants than controls at the 3-month follow-up [odds ratio (OR) =1.93, 95% CI =1.16-3.23, P= 0.012], but not at 6- or 12-month follow-ups (6-month OR =1.05, 95% CI =0.60-1.95, P= 0.862; 12-month OR =1.32, 95% CI =0.73-2.40, P= 0.360). No significant group differences were found for indices of alcohol consumption in non-abstinent participants. Approach bias modification for alcohol delivered during inpatient withdrawal treatment helps to prevent relapse, increasing rates of abstinence from alcohol for at least 3months post-discharge.

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

SummaryBackgroundThe health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year.MethodsFor this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol.FindingsThe burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male.InterpretationThere is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol.FundingBill & Melinda Gates Foundation.

Complex relationship between health and moderate alcohol use

In The Lancet, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 Alcohol Collaborators 1 GBD 2020 Alcohol CollaboratorsPopulation-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020. Lancet. 2022; 400: 185-235 Summary Full Text Full Text PDF Scopus (6) Google Scholar provide a further study to systematically determine thresholds for low-risk alcohol consumption while considering background rates of disease. Overall, the authors estimated the amount of alcohol that minimises health risks to be between 0 (95% uncertainty interval 0–0) and 1·87 (0·50–3·30) standard drinks per day. Levels of zero, or very close to zero, were observed among individuals aged 15–39 years (ranging from 0 to 0·603 standard drinks per day), but higher levels were reported for individuals aged 40 years and older (ranging from 0·114 to 1·87 standard drinks per day). These findings seemingly contradict a previous GBD estimate published in The Lancet, which emphasised that any alcohol use, regardless of amount, leads to health loss across populations. 2 GBD 2016 Alcohol CollaboratorsAlcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018; 392: 1015-1035 Summary Full Text Full Text PDF PubMed Scopus (1361) Google Scholar Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Full-Text PDF Open AccessDepartment of ErrorBurton R, Sheron N. Complex relationship between health and moderate alcohol use. Lancet 2022; 400: 141–43—In this Comment, the email has been corrected. This correction has been made to the online version as of July 18, 2022. Full-Text PDF

Modeling reciprocal relations between emotion dysregulation and alcohol use using dynamic structural equation modeling: Amicro-longitudinal study.

Research examining emotion dysregulation and alcohol use has increased exponentially over the past decade. However, these studies have been limited by their use of cross-sectional designs and narrow definitions of emotion dysregulation. To address these significant gaps in the extant literature, this study utilized state-of-the-art methodology (i.e., experience sampling) and statistics (i.e., dynamic structural equation modeling) to examine potential reciprocal associations between negative and positive emotion dysregulation and alcohol use at the momentary level. Participants were 145 community women (mean age=40.56, 40.3% white) experiencing intimate partner violence (IPV) and using substances. Surveys assessing negative and positive emotion dysregulation and alcohol use (i.e., number of standard drinks) were administered three times a day for 30 days using phone-based interactive voice recording. Significant contemporaneous effects indicated that negative and positive emotion dysregulation both co-occurred with alcohol use. However, levels of negative and positive emotion dysregulation did not predict later alcohol use, nor did alcohol use predict later levels of negative or positive emotion dysregulation. There was significant variability among participants in cross-lagged effects. Findings showed that negative and positive emotion dysregulation co-occurred with alcohol use and that there was significant interindividual variability in the cross-lagged associations between negative and positive emotion dysregulation and alcohol use. Research using idiographic approaches may identify women experiencing IPV for whom negative and positive emotion dysregulation drive alcohol use and alcohol use drives negative and positive emotion dysregulation.

Long-term drinking behavior change patterns and its association with hyperuricemia in chinese adults: evidence from China Health and Nutrition Survey

BackgroundWe aimed to explore the association between long-term drinking behavior change patterns with hyperuricemia (HUA) in Chinese community adults.MethodsThis study was designed as a community-based unbalanced cohort study involving 4127 adults aged between 18 ~ 75 years, derived from the China Health and Nutrition Survey (CHNS) in 1997 and 2009. Drinking behavior change patterns were categorized into: never drinking, change to drinking, quitting drinking, and continued drinking. The alcoholism, type, and frequency of drinking were further categorized. We applied logistic regression models to explore the associations between drinking behavior change patterns and HUA.ResultsThe average age of the participants was 54.6 (± 11.3) years and 47.8% were male. The overall prevalence of HUA was 15.5%. Drinking behavior change patterns of quitting (aOR 1.8; 95% CI 1.1 ~ 2.8) and continued drinking (aOR 2.0; 95% CI 1.3 ~ 3.0) were positively associated with high risks of HUA in the male participants. Early drinking behaviors such as liquor intake (aOR 1.8; 95% CI 1.4 ~ 2.5) and high consumption or frequency showed a positive correlation with HUA. Of note, heavy alcoholism (aOR 2.0; 95% CI 1.4 ~ 2.8) and daily drinking (aOR 2.5; 95% CI 1.7 ~ 3.6) had the highest risks of HUA. Furthermore, in the male participants, the association between early total alcohol intake and HUA was more pronounced at 18 standard drinks intake, with a stable increasing trend. In contrast, no statistical correlation was observed between the drinking behaviors and HUA in the female participants.ConclusionsDrinking behavior change patterns of quitting and continued drinking are strongly associated with increased risks of HUA in males. The risks emanated from early drinking behaviors such as liquor drinking, high drinking frequency, and alcohol consumption. Although quitting drinking was associated with lower HUA risks compared to continued drinking, it still presented an undeniable risk for HUA.

What Counts as a Drink? Understanding Standard Drink Equivalence and U.S. Dietary Guidelines for Alcohol

ObjectivesThe Dietary Guidelines for Americans recommends that adults who choose to consume alcohol do so in moderation, defined as up to 2 drinks/day for males and up to 1/day for females. The Dietary Guidelines defines a standard drink as containing 0.6 ounces of pure alcohol (ethanol). Today's beer, wine, and spirits products come in a range of containers with varying alcohol content, making it a challenge for consumers to know how many standard drinks they are consuming. Because food and nutrition communicators (e.g., dieticians, educators, media) are key sources of information for consumers, the objective was to learn about awareness and understanding of these topics among this group and to assess how a brief educational session improved knowledge and intentions.MethodsIn January 2022, participants completed an online survey (N = 29). They included registered dieticians, nutrition experts; food influencers/journalists; and health educators. A week later, they attended a 15-minute, in-person presentation on standard drinks and the Dietary Guidelines for alcohol. A week later, participants completed a follow-up survey (n = 27). Pre/post responses were compared.ResultsPrior to the presentation, 41% of participants considered the alcohol content of a beverage when they purchased or consumed it. After the presentation, that proportion more than doubled, with 93% saying they would think about alcohol content the next time they purchased or consumed it. At baseline, less than one-half (48%) knew that ethanol is the pure alcohol in all beverage alcohol, and slightly more than two-thirds (69%) knew the recommended daily limits of moderate alcohol consumption for males and females. At follow-up, 81% knew that ethanol is in all beverage alcohol, and 81% knew the recommendations for moderate consumption.ConclusionsKnowing the definitions of a standard drink and of moderation are essential aspects of responsible alcohol consumption, yet some food and nutrition experts lack this knowledge – as do many consumers. Given the important role they play in influencing consumer behavior, these findings underscore the importance of ‘educating the educators,’ when it comes to the U.S. Dietary Guidelines for alcohol.Funding SourcesThe authors received no financial support for the research or authorship of this presentation.

Associations of maternal periconceptional alcohol consumption with offspring prehypertension/hypertension at age 6 years: the Growing Up in Singapore Towards healthy Outcomes prospective mother-offspring cohort study.

To evaluate the relationship of the levels of maternal alcohol consumption during the 1 year before pregnancy recognition with childhood cardiorenal, metabolic, and neurocognitive health. In 1106 women and their children from the Growing Up in Singapore Towards healthy Outcomes mother-offspring cohort, quantity of maternal alcohol consumption in the 12 months prior to pregnancy recognition was categorized as high (≥75th percentile: 1.9 g/day), low (<1.9 g/day), and none, and frequency of alcohol consumption was categorized as high (≥2-3 times/week), low (<2-3 times/week), and none. Offspring MRI-based abdominal fat depot, kidney, and brain volumes, blood pressure, metabolic syndrome score, and cognitive intelligence scores were assessed. Child prehypertension/hypertension at age 6 years was defined using a simplified pediatric threshold of 110/70 mmHg. The average maternal alcohol consumption in the year prior to pregnancy recognition was 2.5 g/day, which is lower than the daily maximal limit of one standard drink (10 g) recommended for women by Singapore's Ministry of Health. After adjusting for participant characteristics, alcohol consumption at least 1.9 g/day was associated with over two-fold higher risk (risk ratio = 2.18, P = 0.013) of child prehypertension and 15% greater kidney growth between early infancy and age 6 years (P = 0.040) compared with abstinence. Alcohol consumption was not associated with metabolic and neurocognitive health at age 6-7 years. The associations with high frequency of alcohol consumption were concordant with those obtained for quantity of alcohol consumption. Maternal self-reported alcohol consumption at least 1.9 g/day prior to pregnancy recognition was associated with increased risk of child prehypertension and rapid kidney growth. Our findings highlight the potential detrimental effects of low periconceptional alcohol consumption, below national guidelines on offspring cardiorenal health.

Concurrent use of alcohol and cocaine: which is the best drug choice?

IntroductionPatients with comorbid cocaine and alcohol dependence have a worse prognosis with lack of adherence to follow-up and treatment, frequent psychosocial problems, and higher rates of relapse [1]. Concurrent use of both substances produces cocaethylene, which is associated with more toxicity than cocaine alone [2].ObjectivesTo determine the efficacy of disulfiram compared to nalmefene in the treatment of comorbid cocaine and alcohol use.MethodsA quasi-experimental open study was designed on 41 outpatients, with a follow-up of at least 1 year at the Mental Health Unit, aged between 18 and 65 years, diagnosed with cocaine and alcohol dependence (ICD-10). A minimum simultaneous weekly consumption of 2 grams of cocaine and 12 SD (Standard Drink) of alcohol during the month before, described by self-records was established. Treatment with oral disulfiram 250mg/day was assigned to 21 patients, and with oral nalmefene 18mg/day to 20 individuals. Observation period was for 6 months. Urinalysis and alcohol breath test were carried out twice a week. Abstinence was defined by obtaining negative results for at least 4 consecutive weeks. Statistical analysis were performed using SPSS v21.0 (significance p&lt;0.05).Results61.9% of patients treated with disulfiram achieved a minimum of 4 consecutive weeks of abstinence from cocaine and alcohol, compared to 40% in the nalmefene group (χ²=1.188; gl=1; p=0.276). There were no significant differences.ConclusionsDisulfiram or nalmefene monotherapy seems clinically ineffective or insufficient in reducing the combined use of cocaine and alcohol. Further research is needed to assess the effect of both drugs simultaneously.DisclosureNo significant relationships.

The risk of depressive symptoms in offspring exposed to prenatal alcohol and tobacco use: evidence from a population-based longitudinal study

IntroductionEvidence from epidemiological studies indicated that intrauterine exposure to alcohol and tobacco is linked with a number of adverse outcomes in offspring. However, few studies have linked prenatal alcohol and tobacco exposures to offspring depressive symptoms with mixed results.ObjectivesThe objective of this study was to examine the link between maternal prenatal alcohol and tobacco exposures and depressive symptoms in offspring.MethodsUsing data from the Raine Study, a prospective multigenerational observational study, we examined the associations between maternal prenatal alcohol and tobacco use and the risk of depressive symptoms in offspring at age 17 years (N=1168). Depressive symptoms in offspring were measured using the Beck Depression Inventory for Youth. Log-binomial regression was used to estimate relative risk (RR) for associations between exposures and outcome. To better investigate the role of potential confounders, risk factors were sequentially added as adjustment variables in separate models.ResultsAfter adjustment for potential confounders, depressive symptoms in offspring remained related to maternal alcohol use of six or more standard drinks per week during the first trimester of pregnancy [RR 1.59 (95% CI: 1.11-2.26)]. Further, the risk of depressive symptoms was 50% higher for offspring exposed to prenatal tobacco use when compared to non-exposed. The Associations did not appear to be mediated by the effects of prenatal alcohol and tobacco use on adverse pregnancy outcomes.ConclusionsEarly screening and prevention of these exposures could possibly reduce depressive symptoms in offspring. Moreover, future examinations such as Mendelian Randomization that allow a stronger causal inference is warranted.DisclosureNo significant relationships.

Alcohol everywhere, anytime, coming to a world near you.

Nigeria ranks first for per capita consumption and heavy episodic drinking prevalence in Africa. Yet, there are no alcohol policies, standard drink measurements, or low-risk drinking guidelines (LRDG) in the country.This study explored the awareness and understanding/interpretations of the alcohol industry-sponsored ‘responsible drinking message’ (RDM) among Nigerian youth. Data were elicited through 53 semi-structured interviews and 3 focus groups (N=26), and we also observed product labels and industry websites.Undergraduate participants were aware of ‘‘drink responsibly’’ (one of the RDMs), but some out-of-school participants with low-level education did not know it existed. This is likely because drink responsibly message is promoted in English language without any indigenous language alternatives. It is embedded in conventional advertisements that glamorize drinking without stand-alone public health messages encouraging low-risk drinking behaviours. Participants shared divergent but subjective interpretations of drink responsibly, but none associated it with abstinence. Some associated drink responsibly with the ability to hold one's drink, stating that it means: ‘drinks very well, but don't get drunk’, and ‘drink to your satisfaction, but don't misbehave’. Other interpretations included: ‘know your limit’ and ‘drink in moderation'. Drink responsibly was also understood to mean ‘drink in excess but respect yourself’. Alcohol companies in Nigeria redirect consumers to Drinkaware's and DrinkIQ's websites in the UK but use inconspicuous fonts to inscribe ‘drink responsibly’ on product labels.By design, alcohol companies frame RDMs to promote drinking and individual responsibility. Thus, it engenders subjective interpretations, including high-risk drinking behaviours. Policymakers should jettison self-regulation, implement alcohol policies, and introduce LRDG to encourage low-risk drinking. Stand-alone public health interventions that promote abstinence or low-risk drinking behaviours should be developed, while Drinkaware's and DrinkIQ's websites should be avoided. To be effective, all RDMs should include the indigenous language versions.

Effects on physiologic measures of appetite from intragastric balloon and endoscopic sleeve gastroplasty: results of a prospective study.

Background:Endoscopic bariatric therapies can help address widening management gaps in obesity. Their ability to facilitate weight loss is largely tied to influences on appetite through perturbations of gastric emptying and accommodation. As these tools gain traction in obesity therapy, their physiologic underpinnings require exploration, which may enhance efficacy, tolerance, and patient-tailored care.Methods:We prospectively assessed consecutive subjects with fluid-filled intragastric balloons (IGBs) (n = 18) placed between October 2016 and June 2017 or underwent endoscopic sleeve gastroplasty (ESG) (n = 23) from March 2018 to June 2018. Patients underwent physiologic appraisal at 3 months with 13C-spirulina-based gastric emptying breath test to determine time to half emptying (T50), as well as maximum tolerated volume (MTV) of a standard nutrient drink test. Changes in T50 and MTV at 3 months were compared with percent total body weight loss (%TBWL) at 3 and 6 months using best-fit linear regression.Results:The change in T50 at 3 months correlated with %TBWL at 3 months for IGB (P = 0.01) and ESG (P = 0.01) but with greater impact on %TBWL in IGB compared to ESG (R2 = 0.42 vs. 0.26). Change in T50 at 3 months was predictive of weight loss at 6 months for IGB (P = 0.01) but not ESG (P = 0.11). ESG was associated with greater decrease in MTV compared to IGB (340.25 ± 297.97 mL vs. 183.00 ± 217.13 mL, P = 0.08), indicting an enhanced effect on satiation through decreased gastric accommodation. Changes in MTV at 3 months did not correlate with %TBWL for either IGB (P = 0.26) or ESG (P = 0.49) but trended toward significance for predicting %TBWL at 6 months for ESG (P = 0.06) but not IGB (P = 0.19).Conclusion:IGB and ESG both induce weight loss but likely through distinct gastric motor function phenotypes, and gastric emptying may predict future weight loss in patients with IGB.

The Societal Cost of Excessive Drinking in North Carolina, 2017.

BACKGROUND Excessive drinking, including binge and heavy drinking, is a leading cause of morbidity and mortality in North Carolina. In 2010, excessive drinking cost North Carolina $7.03 billion, and this analysis aimed to update this figure for 2017.METHODS Following the methods of Sacks, et al. (2015), we obtained proxies for the 2010 and 2017 incidence and price for 26 alcohol-attributable cost components. We then multiplied each component's 2010 cost by the incidence trend (2017 incidence/2010 incidence) and price trend (2017 price/2010 price) to estimate the 2017 cost. Finally, we summed these cost components to calculate the total cost and allocated them by payer and county.RESULTS Excessive drinking cost $9.72 billion in North Carolina in 2017, which equals approximately $2.09 per standard drink. Government paid $4.43 billion (45.6%), drinkers paid $3.76 billion (38.7%), and persons other than the drinker paid $1.53 billion (15.7%).LIMITATIONS These methods relied on alcohol-attributable fractions, which were calculated using scientific literature and national data. If consumption patterns differ between the United States and North Carolina, these fractions may not generalize. Scaling processes may over- or underestimate individual cost components, so total state costs should be interpreted as estimates.CONCLUSIONS The societal costs from excessive drinking are high but spread across public sectors. This can make it difficult to attribute this burden to alcohol. While drinkers paid less than half of the costs of excessive drinking, a broad range of stakeholders bore the burden. Evidence-based strategies to reduce excessive drinking may decrease these costs.

Making sense of ''drink responsibly'' messages: Explorations of the understanding and interpretations of young Nigerians who use alcohol.

Nigeria ranks first for per capita consumption and heavy episodic drinking prevalence in Africa. Yet, there are no alcohol policies, standard drink measurements, or low-risk drinking guidelines (LRDG) in the country. This study explored the awareness and understanding/interpretations of the alcohol industry-sponsored 'responsible drinking message' (RDM) among Nigerian youth. Data were elicited through 53 semi-structured interviews and 3 focus groups (N=26), and we also observed product labels and industry websites. Undergraduate participants were aware of ''drink responsibly'' (one of the RDMs), but some out-of-school participants with low-level education did not know it existed. This is likely because drink responsibly message is promoted in English language without any indigenous language alternatives.It is embedded in conventional advertisements that glamorize drinking without stand-alone public health messages encouraging low-risk drinking behaviours. Participants shared divergent but subjective interpretations of drink responsibly, but none associated it with abstinence.Some associated drink responsibly with the ability tohold one's drink, stating that it means: 'drinks very well, but don't get drunk', and 'drink to your satisfaction, but don't misbehave'. Other interpretations included: 'know your limit' and 'drink in moderation'. Drink responsibly was also understood to mean 'drink in excess but respect yourself'. Alcohol companies in Nigeria redirect consumers to Drinkaware's and DrinkIQ's websites in the UK but use inconspicuous fonts to inscribe 'drink responsibly' on product labels. By design, alcohol companies frame RDMs to promote drinking and individual responsibility. Thus, it engenders subjective interpretations, including high-risk drinking behaviours. Policymakers should jettison self-regulation, implement alcohol policies, and introduce LRDG to encourage low-risk drinking. Stand-alone public health interventions that promote abstinence or low-risk drinking behaviours should be developed, while Drinkaware's and DrinkIQ's websites should be avoided. To be effective, all RDMs should include the indigenous language versions.

Nigeria: A Country in Need of a Standard Drink Measure and Low-Risk Drinking Guidelines

Nigeria: A Country in Need of a Standard Drink Measure and Low-Risk Drinking Guidelines

Australian first-year university college residents’ alcohol consumption and alcohol-related harms

Aim: The study sought to develop an understanding of Australian first-year university residential college students’ alcohol consumption, their experience of alcohol-related harms and their alcohol knowledge. Method: Students were surveyed during Orientation Week in 2015 (N = 84, men 36%) and again in 2017 (N = 97, men = 45%) using the Alcohol Use Disorders Identification Test (AUDIT) to measure alcohol consumption, and purpose-designed measures of alcohol-related harms and alcohol knowledge. Results: The mean AUDIT score across the two cohorts was 10.79, placing these first-year college residents at much riskier consumption levels than their Australian undergraduate and international peers. Three-quarters were consuming alcohol at hazardous/harmful levels. They reported frequent occurrence of alcohol-related harms and, given the higher levels of drinking, these were for the most part more pronounced than in other studies: vomiting (73%), memory loss (55%), regretting their actions when drinking (41%), not having enough money because of money spent on alcohol (31%), doing something dangerous just for fun (29%), being injured (27%), poor performance at work (22%), poor physical health (21%), loss of consciousness (20%), and having sexual encounters they later regretted (19%). Poor knowledge of standard drink measures, particularly in relation to blood alcohol concentration, was also indicated. Conclusions: The study highlights the worrying occurrence of hazardous/harmful drinking in Australian first-year university residential college students and high levels of alcohol-related harms experienced by these residents. It also highlights poor alcohol knowledge and the need for early intervention prior to and within university college residences to minimise harm.

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

BackgroundDuring a COVID-19 outbreak in the congregate shelter system in Halifax, Nova Scotia, Canada, a healthcare team provided an emergency “safe supply” of medications and alcohol to facilitate isolation in COVID-19 hotel shelters for residents who use drugs and/or alcohol. We aimed to evaluate (a) substances and dosages provided, and (b) outcomes of the program. MethodsWe reviewed medical records of all COVID-19 isolation hotel shelter residents during May 2021. The primary outcome was successful completion of 14 days isolation, as directed by public health orders. Adverse events included (a) overdose; (b) intoxication; and (c) diversion, selling, or sharing of medications or alcohol. ResultsSeventy-seven isolation hotel residents were assessed (mean age 42 ± 14 years; 24% women). Sixty-two (81%) residents were provided medications, alcohol, or cigarettes. Seventeen residents (22%) received opioid agonist treatment (methadone, buprenorphine, or slow-release oral morphine) and 27 (35%) received hydromorphone. Thirty-one (40%) residents received prescriptions stimulants. Six (8%) residents received benzodiazepines and forty-two (55%) received alcohol. Over 14 days, mean daily dosages increased of hydromorphone (45 ± 32 – 57 ± 42 mg), methylphenidate (51 ± 28 – 77 ± 37 mg), and alcohol (12.3 ± 7.6 – 13.0 ± 6.9 standard drinks). Six residents (8%) left isolation prematurely, but four returned. During 1059 person-days, there were zero overdoses. Documented concerns regarding intoxication occurred six times (0.005 events/person-day) and medication diversion/sharing three times (0.003 events/person-day). ConclusionsCOVID-19 isolation hotel residents participating in an emergency safe supply and managed alcohol program experienced high rates of successful completion of 14 days isolation and low rates of adverse events.

Common Laboratory Parameters Are Useful for Screening for Alcohol Use Disorder: Designing a Predictive Model Using Machine Learning.

The diagnosis of alcohol use disorder (AUD) remains a difficult challenge, and some patients may not be adequately diagnosed. This study aims to identify an optimum combination of laboratory markers to detect alcohol consumption, using data science. An analytical observational study was conducted with 337 subjects (253 men and 83 women, with a mean age of 44 years (10.61 Standard Deviation (SD)). The first group included 204 participants being treated in the Addictive Behaviors Unit (ABU) from Albacete (Spain). They met the diagnostic criteria for AUD specified in the Diagnostic and Statistical Manual of mental disorders fifth edition (DSM-5). The second group included 133 blood donors (people with no risk of AUD), recruited by cross-section. All participants were also divided in two groups according to the WHO classification for risk of alcohol consumption in Spain, that is, males drinking more than 28 standard drink units (SDUs) or women drinking more than 17 SDUs. Medical history and laboratory markers were selected from our hospital’s database. A correlation between alterations in laboratory markers and the amount of alcohol consumed was established. We then created three predicted models (with logistic regression, classification tree, and Bayesian network) to detect risk of alcohol consumption by using laboratory markers as predictive features. For the execution of the selection of variables and the creation and validation of predictive models, two tools were used: the scikit-learn library for Python, and the Weka application. The logistic regression model provided a maximum AUD prediction accuracy of 85.07%. Secondly, the classification tree provided a lower accuracy of 79.4%, but easier interpretation. Finally, the Naive Bayes network had an accuracy of 87.46%. The combination of several common biochemical markers and the use of data science can enhance detection of AUD, helping to prevent future medical complications derived from AUD.

Alcohol Use During COVID-19 in Adults with Severe Untreated AUD

ABSTRACT Evidence demonstrating increased alcohol use during COVID-19 comes from low- to moderate-alcohol use samples and has yet to use adults with severe but untreated AUD. Using a community sample of adults with severe AUD, this exploratory, cross-sectional study examined associations of COVID-19 alcohol use. Participants were recruited for a phase-II RCT. Only baseline measures, completed prior to randomization, were analyzed in the present study. Key variables were alcohol consumption, COVID-19-related worries and experiences, and qualitative responses of 1) alcohol use and 2) positive changes during COVID-19. At total of 176 pariticpants recruited since COVID-19 were on average 41.4 years old, 49.1% female, and 79% White. Participants drank alcohol nearly 23 of the past 30 days, consumed 7 standard drinks per drinking day, and nearly 90% reported increased alcohol use. More heavy episodic drinking was reported in the first six-months of COVID-19 and more COVID-related concerns in the most recent six-months. Participants reported drinking increased due to “more time on their hands,” but the pandemic also “strengthened relationships.” Results affirm an increase in alcohol use during COVID-19 in adults with severe, untreated AUD. Findings underscore the need to understand how alcohol use and pandemic-related circumstances may influence one another for adults with severe AUD.

Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease

Observational studies have consistently proposed cardiovascular benefits associated with light alcohol consumption, while recent genetic analyses (ie, mendelian randomization studies) have suggested a possible causal link between alcohol intake and increased risk of cardiovascular disease. However, traditional approaches to genetic epidemiology assume a linear association and thus have not fully evaluated dose-response estimates of risk across different levels of alcohol intake. To assess the association of habitual alcohol intake with cardiovascular disease risk and to evaluate the direction and relative magnitude of cardiovascular risk associated with different amounts of alcohol consumption. This cohort study used the UK Biobank (2006-2010, follow-up until 2016) to examine confounding in epidemiologic associations between alcohol intake and cardiovascular diseases. Using both traditional (ie, linear) and nonlinear mendelian randomization, potential associations between alcohol consumption and cardiovascular diseases (eg, hypertension and coronary artery disease) as well as corresponding association shapes were assessed. Data analysis was conducted from July 2019 to January 2022. Genetic predisposition to alcohol intake. The association between alcohol consumption and cardiovascular diseases, including hypertension, coronary artery disease, myocardial infarction, stroke, heart failure, and atrial fibrillation. This study included 371 463 participants (mean [SD] age, 57.0 [7.9] years; 172 400 [46%] men), who consumed a mean (SD) 9.2 (10.6) standard drinks per week. Overall, 121 708 participants (33%) had hypertension. Light to moderate alcohol consumption was associated with healthier lifestyle factors, adjustment for which attenuated the cardioprotective epidemiologic associations with modest intake. In linear mendelian randomization analyses, a 1-SD increase in genetically predicted alcohol consumption was associated with 1.3-fold (95% CI, 1.2-1.4) higher risk of hypertension (P < .001) and 1.4-fold (95% CI, 1.1-1.8) higher risk of coronary artery disease (P = .006). Nonlinear mendelian randomization analyses suggested nonlinear associations between alcohol consumption and both hypertension and coronary artery disease: light alcohol intake was associated with minimal increases in cardiovascular risk, whereas heavier consumption was associated with exponential increases in risk of both clinical and subclinical cardiovascular disease. In this cohort study, coincident, favorable lifestyle factors attenuated the observational benefits of modest alcohol intake. Genetic epidemiology suggested that alcohol consumption of all amounts was associated with increased cardiovascular risk, but marked risk differences exist across levels of intake, including those accepted by current national guidelines.

The Impact of Exercise and Virtual Reality Executive Function Training on Cognition Among Heavy Drinking Veterans With Traumatic Brain Injury: A Pilot Feasibility Study.

Executive function (EF) underlies self-control deficits in alcohol use disorder (AUD) and traumatic brain injury (TBI). Cognitive training is a promising adjunctive treatment targeting TBI- and AUD- related cognitive dysfunction. However, major limitations related to compliance and generalizability in the field of cognitive training exist. Physical activity is associated with enhanced cognitive performance across several executive functions and may enhance the benefits of cognitive training. Virtual reality provides multisensory embodied experiences which are likely to engage brain networks more efficiently than standard cognitive training systems, ultimately resulting in greater near- and far-transfer effects. This pilot study aimed to obtain feasibility data and a preliminary assessment of an enriched virtual reality (VR) EF training (EFT) intervention combined with exercise (NCT03786276). Using an 8-week randomized adaptive design study, 30 AUD treatment seeking U.S. Veterans completed nine sessions of exercise-only (n = 15) or gameplay control (n = 15) over 3 weeks, followed by a week-4 repeat assessment in Phase 1. Twenty-three participants completed and moved onto Phase II, where they completed up to nine sessions of VR-EFT plus exercise and completed a week-8 end-of-study assessment. Primary outcomes included feasibility to retain participants, usability, and satisfaction of using VR-EFT. Secondary and exploratory outcomes included within group assessment of change in cognitive function, alcohol use, alcohol craving, and post-concussive symptoms among the three treatment conditions.VR-EFT was feasible with moderate usability and high acceptability ratings.The most common VR-related adverse effect was motion sickness (n = 2/16, 12.5%). The VR-EFT condition was associated with significant improvement in inhibition-switching and visual scanning (both p < 0.05) during Phase II. Exercise-only was associated with significant improvements in cognitive inhibition, cognitive flexibility, reductions in alcohol craving, and number of standard alcohol drinks per week (all p ≤ 0.05). The gaming-control condition was associated with improvement in cognitive flexibility and visuospatial immediate recall (both p < 0.05) during Phase 1. Recruitment and retention of U.S. veterans with AUD and TBI into an exercise plus VR-EFT intervention is feasible, but technological barriers may impact usability. VR-EFT was associated with improvement in executive function domains that were targeted in as little as 3-week and nine sessions of VR-EFT exposure. Results are promising and indicate the need for a larger controlled investigation to assess the efficacy of VR-EFT to enhance treatment outcomes among AUD treatment-seeking U.S. veterans with co-occurring AUD and TBI.Clinical Trial Registrationwww.ClinicalTrials.gov, Identifier: NCT03786276.