Estimated Blood Alcohol Concentration Research Articles

Impact of Sleepiness and Sleep Deficiency on Public Health—Utility of Biomarkers

Sleep disorders and sleep deficiency are important causes of adverse health effects and increased mortality in the United States and worldwide. Sleep deficiency can also result in myriad adverse behavioral consequences, including profound sleepiness, cognitive slowing, automatic behavior, attentional failures and performance degradation, errors, and accidents. It is important to recognize that sleepiness and sleep deficiency are not synonymous.

Alcohol, conscientiousness and event-level condom use

Alcohol impairs judgement and could be causally implicated in sexual risk taking. However, meta-analytic studies do not find an association between alcohol use and unprotected sexual intercourse at the event level, where both behaviours refer to the same point in time. Associations between personality traits and sexual risk taking have been replicated across several studies. Traits may be better conceptualized as independent risk factors, where alcohol use mediates the association between personality and condom use. The objective of our study was to determine the direct and indirect effects connecting big five personality traits with condom use, potentially mediated through alcohol use during the most recent sexual encounter. A sample of community-dwelling adults (N= 190) completed measures of big five personality traits and a detailed assessment of event-level sexual behaviour and alcohol use. In regression model adjusting for known confounding factors, including oral contraceptive use, partner type, and hazardous drinking patterns, one standard deviation increase in conscientiousness was associated with a 1.14-fold increase in the odds of using a condom with most recent sexual partner (p= .04). Repeating the analysis using zero-inflated regression for estimated blood alcohol concentration (eBAC) values revealed an association between conscientiousness and eBAC (p= .002). There was no association between alcohol and condom use in either analysis. The results illustrate that personality traits are strong independent risk factors for sexual risk taking and eBAC values during sexual events, and both should be incorporated into research designs. Future research should evaluate specific facets of conscientiousness, and whether eBAC mediates the association between personality and condom use in other samples. The possibility of tailoring interventions to personality traits is discussed.

Predictors and Outcomes of Variability in Subjective Alcohol Intoxication Among College Students: An Event-Level Analysis Across 4 Years

Individual differences in subjective alcohol intoxication, as measured by laboratory-based alcohol challenge, have been identified as a phenotypic risk factor for alcohol use disorders. Further, recent evidence indicates that subjective alcohol response is also associated with event-level physiological consequences among college students, including blackouts and hangovers. The current investigation tested predictors of and outcomes associated with subjective intoxication in the natural drinking environment. In a preliminary laboratory alcohol-challenge study (n = 53), we developed a brief measure of subjective alcohol intoxication for use in event-level research. Participating students in the principal study (n = 1,867; 63% women; 54% Caucasian) completed 30 days of Web-based self-monitoring in each of the 4 college years. In the principal study, generalized estimating equation analyses revealed that both lighter drinking and a family history of alcohol problems predicted greater subjective intoxication after accounting for estimated blood alcohol concentration (eBAC). Moreover, greater subjective intoxication during a given drinking episode was associated with negative alcohol-related consequences, illicit drug use, and unsafe sex, and at higher eBACs, was associated with aggression, sex, and property crime. Students who on average experienced greater subjective intoxication were also more likely to experience negative consequences and engage in illicit drug use, sex, unsafe sex, and aggression. These findings suggest that both within-person variability and between-person individual differences in subjective intoxication may be risk factors for adverse drinking outcomes at the event level. Intervention efforts aimed at reducing problems associated with collegiate drinking may benefit from consideration both of who experiences greater subjective intoxication and of the situations in which they are more likely to do so.

Alcohol trajectories over three years in a Swedish residence hall student population.

Although it is known that college students have a high alcohol consumption, less is known about the long-term drinking trajectories amongst college students and, in particular, students living in residence halls, known to be high-risk drinkers. Over four consecutive years, the drinking habits of 556 Swedish residence hall students were analyzed. The main instruments for measuring outcome were AUDIT (Alcohol Use Identification Disorders Test), SIP (Short Index of Problems) and eBAC (estimated Blood Alcohol Concentration). The drinking trajectories among Swedish residence hall students showed stable and decreasing drinking patterns, with age and gender being predictors of group membership.

Polymorphisms of the mu-opioid receptor and dopamine D4 receptor genes and subjective responses to alcohol in the natural environment.

Polymorphisms of the mu-opioid receptor (OPRM1) and dopamine D4 receptor (DRD4) genes are associated with subjective responses to alcohol and urge to drink under laboratory conditions. This study examined these associations in the natural environment using ecological momentary assessment. Participants were non-treatment-seeking heavy drinkers (n = 112, 52% female, 61% alcohol dependent) who enrolled in a study of naltrexone effects on craving and drinking in the natural environment. Data were culled from 5 consecutive days of drinking reports prior to medication randomization. Analyses revealed that, after drinking, carriers of the Asp40 allele of the OPRM1 gene reported higher overall levels of vigor and lower levels negative mood, as compared to homozygotes for the Asn40 variant. Carriers of the long allele (i.e., >or=7 tandem repeats) of the DRD4 endorsed greater urge to drink than homozygotes for the short allele. Effects of OPRM1 and DRD4 variable-number-of-tandem-repeats genotypes appear to be alcohol dose-dependent. Specifically, carriers of the DRD4-L allele reported slight decreases in urge to drink at higher levels of estimated blood alcohol concentration (eBAC), and Asp40 carriers reported decreases in vigor and increases in negative mood as eBAC rose, as compared to carriers of the major allele for each gene. Self-reported vigor and urge to drink were positively associated with alcohol consumption within the same drinking episode. This study extends findings on subjective intoxication, urge to drink, and their genetic bases from controlled laboratory to naturalistic settings.

Predictors of Error in Estimates of Blood Alcohol Concentration: A Replication

To identify predictors of error in estimated blood alcohol concentration (eBAC) in a sample of bar patrons. Six hundred sixty-six patrons (43.6% female) were randomly sampled from 32 bars. Patrons were asked to provide a breath sample into a handheld breath alcohol concentration test unit upon entrance and exit from the bar. Patrons also completed a brief survey at entrance and exit. For analyses, this sample was stratified by whether patrons consumed alcohol before attending the bar. Estimates of BAC were calculated using Matthews and Miller's formula (1979). A three-category dependent variable was created based on the estimation accuracy of eBAC relative to breath alcohol concentration: accurate (within .02), underestimate of BAC, and overestimate of BAC. Of those that drank before arriving at the bar, 29% of eBACs were accurate, 32.3% were underestimates, and 38.8% were overestimates. For those who drank only at the bar, 42.0% were accurate, 20.8% were underestimates, and 37.7% were overestimates. Among those who drank before attending the bar, the number of drinks consumed before attending the bar was significantly related to eBAC underestimate. Among those who drank only at the bar, predictors of overestimate included being female, drinking more, and drinking longer. The accuracy of eBAC is poor at best. In an earlier study of parties, eBACs were often underestimated; in the bar setting, eBACs were often overestimated. More research is needed to understand the role of setting on eBAC calculations.

Intervention for hazardous alcohol use and high level of stress in university freshmen: A comparison between an intervention and a control University

Background The first year of university studies is associated with increased levels of alcohol drinking and stress. This study examines the one-year outcome of both primary and secondary interventions of one alcohol programme and one stress intervention programme at an intervention university in comparison with a control university. Methods At the intervention university all freshmen were offered a primary prevention programme for hazardous alcohol use and stress management and, in addition, those who had high ratings for stress and/or hazardous alcohol use were offered a secondary intervention programme for alcohol consumption and/or stress management. Freshmen still attending the two universities one year later responded to follow-up questionnaires. Results The primary alcohol and stress interventions were associated with lower alcohol expectancies and mental symptoms, but no differences in AUDIT scores (- 0.2, CI 95% - 0.5 to 0.1), estimated blood alcohol concentrations or stress in comparison to freshmen at the control university. The secondary alcohol interventions were associated with decreased AUDIT (– 1.1, CI 95% - 2.0 to – 0.2) as well as alcohol expectancies, blood alcohol concentrations, stress and mental symptoms in comparison to high-risk freshmen at the control university. The secondary stress interventions were associated with decreased mental symptoms and alcohol expectancies, but not stress, AUDIT scores (- 0.6, CI 95% - 1.4 to 0.2) and blood alcohol concentrations in comparison to high-risk freshmen at the control university. Conclusion This study suggests that both primary and secondary alcohol and stress interventions have 1-year effects in university freshmen and could be implemented in university settings.

Subjective Responses to Alcohol Prime Event-Specific Alcohol Consumption and Predict Blackouts and Hangover

Individual differences in subjective response to alcohol and the occurrence of blackouts and hangover are associated with the development of alcohol-use disorders. As such, subjective responses to alcohol, blackouts, and hangover may share a biological vulnerability to excessive alcohol consumption. The purpose of the current study was to examine subjective responses to alcohol as predictors of estimated blood alcohol concentration (BAC), blackouts, and hangover for a single heavy drinking event. Data were collected on 150 (50% female) college students at a large, public university who reported consuming alcohol during their 21st birthday celebration. Using semi-structured interviews and self-report measures, subjective responses to alcohol (at midpoint of a 21 st birthday celebration) were examined as predictors of final estimated BAC, blackouts, and hangover. Stimulant effects reported for the midpoint of the drinking event predicted final estimated BAC. Both stimulant and sedative alcohol effects directly predicted blackouts during the drinking event and the occurrence of a hangover. Neither stimulant nor sedative effects were mediated by final estimated BAC. Retrospective reports of subjective responses to alcohol were associated with the level of intoxication, blackouts, and hangover during a heavy drinking event. Findings therefore suggest the utility of incorporating subjective responses to alcohol into event-specific interventions that are designed to reduce or prevent heavy episodic drinking.

Alcohol screening and brief intervention in a college student health center: a randomized controlled trial.

This study tested the effectiveness of brief primary care provider interventions delivered in a college student health center to a sample of college students who screened positive for high-risk drinking. Between November 2005 and August 2006, 8,753 students who presented as new patients to the health service at a large public university were screened for high-risk drinking, and 2,484 students (28%) screened positive on the 5/4 gender-specific high-risk drinking question (i.e., five or more drinks per occasion for men and four or more for women). Students who screened positive for high-risk drinking and consented to participate (N= 363; 52% female) were randomly assigned either to a control group (n = 182) or to an experimental group (n = 181). Participants in the experimental group received two brief intervention sessions that were founded in motivational interviewing techniques and delivered by four specially trained providers within the student health center. Data on alcohol use and related harms were obtained from a Web-based Healthy Lifestyle Questionnaire, 30-day Timeline Followback alcohol-use diaries, the Rutgers Alcohol Problem Index (RAPI), and eight items from the Drinker Inventory of Consequences-2L. Repeated measures analysis showed that, compared with the control group (C), the intervention group (I) had significant reductions in typical estimated blood alcohol concentration (BAC) (C = .071 vs I = .057 at 3 months; C = .073 vs I = .057 at 6 months), peak BAC (C = . 142 vs I = .112 at 3 months; C = .145 vs I = .108 at 6 months), peak number of drinks per sitting (C = 8.03 vs I = 6.87 at 3 months; C = 7.98 vs I = 6.52 at 6 months), average number of drinks per week (C = 9.47 vs I = 7.33 at 3 months; C = 8.90 vs I = 6.16 at 6 months), number of drunk episodes in a typical week (C = 1.24 vs I = 0.85 at 3 months; C = 1.10 vs I = 0.71 at 6 months), number of times taken foolish risks (C = 2.24 vs I = 1.12 at 3 months), and RAPI sum scores (C = 6.55 vs I = 4.96 at 6 months; C = 6.17 vs I = 4.58 at 9 months). Brief interventions delivered by primary care providers in a student health center to high-risk-drinking students may result in significantly decreased alcohol consumption, high-risk drinking, and alcohol-related harms.

Body mass index and alcohol consumption: Family history of alcoholism as a moderator.

Recent research suggests that excess food consumption may be conceptualized as an addictive behavior. Much of the evidence comes from neurobiological similarities between drug and food consumption. In addition, an inverse relation between alcohol consumption and body mass index (BMI) has been observed. Previous research has hypothesized that this inverse relation is attributable to competition between food and alcohol for similar neurotransmitter receptors. The current study explored this neurobiological hypothesis further by examining the influence of an indicator of biological risk associated with alcohol problems (family history of alcoholism) on the relationship between alcohol and food intake. Data from 37,259 participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were included in the study. BMI, family history of alcoholism, gender, and race/ethnicity were assessed as predictors of typical drinking frequency and estimated blood alcohol concentration (BAC). An inverse relationship between alcohol consumption and BMI was demonstrated. An attenuation of family history effects on drinking behavior was evident for obese compared to nonobese participants. The results suggest a neurobiological link between alcohol use and food consumption, consistent with theories characterizing excess food consumption as an addictive behavior.

Estimated Blood Alcohol Concentrations for Child and Adolescent Drinking and Their Implications for Screening Instruments

Blood alcohol concentrations (BACs) in children after consumption of different numbers of standard drinks of alcohol have not been estimated previously. The goal was to determine the number of drinks at each age that led to a BAC of > or =80 mg/dL, the National Institute on Alcohol Abuse and Alcoholism criterion for binge drinking. The updated Widmark equation to estimate BAC was modified to take account of the differing body composition (total body water) and accelerated rates of ethanol elimination of children. The modified formula was used with 1999-2002 National Health and Nutrition Examination Survey data to estimate BACs for >4700 children and adolescents from 9 through 17 years of age, for intake levels of 1 to 5 standard drinks. The estimated BACs for children after consumption of just 3 standard drinks within a 2-hour period were between 80 and 139 mg/dL for boys 9 to 13 years of age and for girls 9 to 17 years of age, indicating substantial potential alcohol impairment. With 5 drinks within 2 hours (the level used to define binge drinking among college students), children 9 to 13 years of age were estimated to have BACs 2 to 3 times the adult legal limit for intoxication of 80 mg/dL. Binge drinking should be defined as > or =3 drinks for 9- to 13-year-old children, as > or =4 drinks for boys and > or =3 drinks for girls 14 or 15 years of age, and as > or =5 drinks for boys and > or =3 drinks for girls 16 or 17 years of age.

A web application for moderation training: Initial results of a randomized clinical trial

Eighty-four heavy drinkers who responded to a newspaper recruitment advertisement were randomly assigned to receive either (a) training in a Moderate Drinking protocol via an Internet-based program ( www.moderatedrinking.com) and use of the online resources of Moderation Management (MM; www.moderation.org) or (b) use of the online resources of MM alone. Follow-ups are being conducted at 3, 6, and 12 months. Results of the recently completed 3-month follow-up (86% follow-up) indicated both groups significantly reduced their drinking based on these variables: standard drinks per week, percent days abstinent, and mean estimated blood alcohol concentration (BAC) per drinking day. Both groups also significantly reduced their alcohol-related problems. Relative to the control group, the experimental group had better outcomes on percent days abstinent and log drinks per drinking day. These short-term outcome data provide evidence for the effectiveness of both the Moderate Drinking Web application and of the resources available online at MM in helping heavy drinkers reduce their drinking and alcohol-related problems.

Alcohol study on blood concentration estimation: Reliability and applicability of Widmark formula on Chinese male population

Widmark formula suggests estimating blood alcohol concentration level (BAC) on a given amount of alcohol administrated with knowledge of subject’s body weight and sex. The idea has been referenced extensively in forensic science with application in drink driving prosecution. A sample of Chinese subjects was collected in the drinking experiment, and in this study we mainly focus on the verification of the validity of Widmark formula on Chinese male population. A promising result is obtained where the extrapolated BAC measurement is directly proportional to the amount of alcohol administrated, and inversely to the subject’s body weight. The results noted in the general linear model is further supported by the nonlinear regression analysis and a concordant argument reaches by deploying the concept to the BAC level attained at peak.

Biological Markers of Drug Use in the Club Setting

The prevalence of drug and alcohol use among patrons of clubs featuring electronic music dance events was determined by using biological assays at entrance and exit. Using a portal methodology that randomly selects groups of patrons on arrival at clubs, oral assays for determining level and type of drug use and level of alcohol use were obtained anonymously. Patrons provided self-reported data on their personal characteristics. A total of 362 patrons were interviewed at entrance and provided oral assay data, and 277 provided data at both entrance and exit. Overall, one quarter of all patrons surveyed at entrance were positive for some type of drug use. Based on our exit sample, one quarter of the sample was positive at exit. Individual drugs most prevalent at entrance or exit included cocaine, marijuana, and amphetamines/stimulants. Only the amphetamine/stimulant category increased significantly from entrance to exit. Drug-using patrons arrive at the club already using drugs; few patrons arrive with no drug use and leave with detectable levels of drug use. Clubs vary widely in drug-user prevalence at entrance and exit, suggesting that both events and club policies and practices may attract different types of patrons. Approximately one half of the total entrance sample arrived with detectable alcohol use, and nearly one fifth arrived with an estimated blood alcohol concentration of .08 or greater. Based on our exit sample data, one third of patrons were intoxicated, and slightly less than one fifth were using both drugs and alcohol at exit. Clubs attract a wide array of emerging adults, with both genders and all ethnicities well represented. Clubs also attract emerging adults who are not in college and who are working full time. At clubs featuring electronic music dance events, drug use and/or high levels of alcohol use were detected using biological assays from patrons at entrance and exit from the clubs. Thus, these clubs present a potentially important location for prevention strategies designed to reduce the risks associated with drug and alcohol use for young people. Combined substance use may prove particularly important for prevention efforts designed to increase safety at clubs. Personal characteristics do not identify drug users, suggesting that environmental strategies for club safety may offer more promise for promoting health and safety.

Internet-based personalized feedback to reduce 21st-birthday drinking: A randomized controlled trial of an event-specific prevention intervention.

This article presents an initial randomized controlled trial of an event-specific prevention intervention. Participants included 295 college students (41.69% male, 58.31% female) who intended to consume 2 or more drinks on their 21st birthday. Participants completed a screening/baseline assessment approximately 1 week before they turned 21 and were randomly assigned to receive Web-based personalized feedback or assessment only. Feedback included normative information, protective behaviors, and personalized blood alcohol concentration information. A follow-up assessment was completed approximately 1 week after a student's birthday. Results indicated a significant intervention effect in reducing estimated blood alcohol concentration (d = 0.33). The intervention effect was moderated by 21st-birthday drinking intentions, and the intervention was primarily effective among those who intended to reach higher levels of intoxication. Results provide some support for normative information as a mediator of intervention efficacy. Overall results provide support for Web-based personalized feedback as an intervention approach for specific events associated with extreme drinking.

Deconvolving blood‐alcohol concentration and alcohol beverage consumption from sensor measurements of transdermal alcohol

AbstractWe utilize mathematical, statistical and deconvolution techniques to estimate blood alcohol concentration and alcohol ingestion rate from vapor alcohol measurements coming from a new electro‐chemical transdermal alcohol bio‐sensor. A protocol suggesting how this can be done and a theoretical framework for the convergence of the method are also shown. (© 2008 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)

Enhanced Case Management to Prevent Fetal Alcohol Spectrum Disorders in Northern Plains Communities

Women proven to be extremely high risk for drinking during pregnancy were provided case management (CM) enhanced with strategies derived from motivational interviewing (MI) as a part of a comprehensive Fetal Alcohol Syndrome (FAS) epidemiology and prevention program in four American Indian communities in Northern Plains states. Data on the first women enrolled (n=131) revealed that they have extreme issues with alcohol abuse to overcome. Sixty-five percent of these women have experienced extensive alcohol use within their immediate family. At intake, 24% of CM clients reported binge drinking one or more days in the preceding week. Heavy drinking resulted in estimated blood alcohol concentrations (BAC) as high as .576 using the BACCUS methodology. Project staff has attempted to actively engage each of these women in CM. Clients have been in CM an average of 17.2 months (SD=16.6). The mean number of significant contacts (face-to-face or telephone MI sessions) was 19. Thirty-one percent of the women entered some type of formal alcohol or drug treatment while in CM. Data were collected at 6 month intervals from 6 to 72 months after enrollment. Consumption of alcohol, as measured by both quantity and frequency measures, was reduced at 6 months. Thirty-eight percent of enrolled women reported complete abstinence from alcohol use at 6 months, and the number of binges while drinking in CM declined significantly from 15 at baseline to 4.3 at 6 months. However, mean peak BACs for the heavy drinking sessions were still problematic for those who continued to drink. They ranged from .234 to .275 from baseline to 12 month follow-up, but the total number of binges was reduced substantially at 12 months as well. Furthermore, the most important outcomes are the status of the children born while in CM. One hundred and forty nine pregnancies have occurred among these women, and 76% of those pregnancies have resulted in normal deliveries, and only two children born in CM are suspected of having some form of severe FASD. At 6, 12, 18, and 24 month follow-up milestones, 70% of the women who were not currently pregnant were protected from having a child with FAS by not drinking, using birth control, or both. Other measures of CM success include enrolling in school, regaining custody of children, completing substance abuse treatment, probation from the criminal justice system, substantial periods of abstinence, enrolling in programs to improve life skills, and employment.

Gender Differences in the Relationship Between Alcohol and Violent Injury: An Analysis of Cross-National Emergency Department Data

The objectives of the present study were twofold: (1) to determine whether gender differences exist in the roles of drinking in the event (i.e., self-reported drinking before the injury and estimated blood alcohol concentration [BAC] captured after injury) and drinking pattern (i.e., heavy episodic drinking) in explaining violent versus nonviolent injuries and (2) to assess whether these gender differences vary by country. Emergency department data were analyzed from 30 hospitals in 15 countries, as part of the Emergency Room Collaborative Alcohol Analysis Project and the World Health Organization Collaborative Study of Alcohol and Injuries. Interaction effects between gender and alcohol were tested in the prediction of violent versus nonviolent injury for each country. The bivariate analyses revealed significantly larger effects of drinking-in-the-event variables for men than for women in three countries (i.e., 6 hours before the injury in Argentina and having a positive BAC in Belarus and Spain). In the multivariate analyses, restricted to countries with sufficient sample sizes (i.e., Mexico, South Africa, and the United States), no significant gender differences were found between the drinking-in-the-event variables and violent injury. In the bivariate and multivariate analyses, a significant interaction effect between gender and heavy episodic drinking was found in the United States, indicating that heavy episodic drinking predicted violent injury for women but not for men. Although the results are preliminary, treatment and prevention programs may need to target both genders equally or perhaps even focus more on heavydrinking women, particularly in the United States.

Use of Real‐Time Interactive Voice Response in a Study of Stress and Alcohol Consumption

The goal of this study was to investigate whether Interactive Voice Response is a technology with which to perform real-time assessments of alcohol consumption and stress. Fifteen subjects (men and women) were recruited from a previous 4-year intervention study (n = 2,032). The Interactive Voice Response technique was based on mobile telephones. During 1 week, stress and alcohol were measured automatically 3 times daily. In addition, the subjects called the system at the start of the drinking session, and an automated hourly contact was established for the drinking period. Of the data collection calls, 305 (97%) were answered. Real-time drinking was assessed 9 times of 9 (100%). The average length of the IVR assessment was only 28 seconds because of modified technology. Individuals with an estimated blood alcohol concentration above 0.1% under-reported drinking in their day-after reports by between 1 and 10 drinks. The same subjects had more pronounced stress reduction than those with lower BAC levels. Interactive Voice Response methodology offers a promising new technology for daily as well as real-time assessments.

Two‐Year Outcome of an Intervention Program for University Students Who Have Parents With Alcohol Problems: A Randomized Controlled Trial

Only a few intervention studies aiming to change high-risk drinking behavior have involved university students with heredity for alcohol problems. This study evaluated the effects after 2 years on drinking patterns and coping behavior of intervention programs for students with parents with alcohol problems. In total, 82 university students (57 women and 25 men, average age 25 years) with at least 1 parent with alcohol problems were included in the study. The students were randomly assigned to 1 of the 3 programs: (i) alcohol intervention program, (ii) coping intervention program, or (iii) combination program. All the 3 intervention programs were manual based and individually implemented during 2 2-hour sessions, 4 weeks apart. Before the participants were randomly assigned, all were subjected to an individual baseline assessment. This assessment contained both a face-to-face interview and 6 self-completion questionnaires: the Alcohol Use Disorders Identification Test, estimated Blood Alcohol Concentration, Short Index of Problems, the Symptom Checklist-90, Coping with Parents' Abuse Questionnaire, and The Interview Schedule for Social Interaction (ISSI). Follow-up interviews were conducted after 1 and 2 years, respectively. The results after 1 year have previously been reported. All participants finished the baseline assessment, accepted and completed the intervention. Ninety-five percent of the students completed the 24-month follow-up assessment. Only the group receiving the combination program continued to improve their drinking pattern significantly (p < 0.05) from the 12-month follow-up to the 24-month follow-up. The improvements in this group were significantly better than in the other 2 groups. The group receiving only alcohol intervention remained at the level of improvement achieved at the 12-month follow-up. The improvements in coping behavior achieved at the 12-month follow-up remained at the 24-month follow-up for all the 3 groups, i.e., regardless of intervention program. Positive effects of alcohol intervention between 1 and 2 years were found only in the combined intervention group, contrary to the 1-year results with effects of alcohol intervention with or without a combination with coping intervention.