Experience Of Alcohol-related Problems Research Articles

Randomized controlled trial of a smartphone app designed to reduce unhealthy alcohol consumption

Background and aimsUnhealthy alcohol use is common and causes tremendous harm. Most people with unhealthy alcohol use will never seek formal alcohol treatment. As an alternative, smartphone apps have been developed as one means to provide help to people concerned about their alcohol use. The aim of this study was to test the efficacy of a smartphone app targeting unhealthy alcohol consumption in a general population sample. MethodsParticipants were recruited from across Canada using online advertisements. Eligible participants who consented to the trial were asked to download a research-specific version of the app and were provided with a code that unlocked it (a different code for each participant to prevent sharing). Those who entered the code were randomized to one of two different versions of the app: 1) the Full app containing all intervention modules; or 2) the Educational only app, containing only the educational content of the app. Participants were followed-up at 6 months. The primary outcome variable was number of standard drinks in a typical week. Secondary outcome variables were frequency of heavy drinking days and experience of alcohol-related problems. ResultsA total of 761 participants were randomized to a condition. The follow-up rate was 81 %. A generalized linear mixed model revealed that participants receiving the full app reduced their typical weekly alcohol consumption to a greater extent than participants receiving the educational only app (incidence rate ratio 0.89; 95 % confidence interval 0.80 to 0.98). No significant differences were observed in the secondary outcome variables (p > .05). Discussion and conclusionThe results of this trial provide some supportive evidence that smartphone apps can reduce unhealthy alcohol consumption. As this is the second randomized controlled trial demonstrating an impact of this same app (the first one targeted unhealthy alcohol use in university students), increased confidence is placed on the potential effectiveness of the smartphone app employed in the current trial.ClinicalTrials.org number: NCT04745325

History of sexual assault, past-year alcohol use, and alcohol-related problems in American Indian adolescents

American Indian (AI) adolescents have been found to experience higher rates of sexual violence, alcohol misuse, and alcohol-related consequences compared to other racial and ethnic groups. Adolescent alcohol use and sexual assault experiences have been linked to increased negative consequences across physical and mental health, school, work, and legal domains. The purpose of the present study was to examine the associations among endorsing a history of experiencing sexual assault, past-year alcohol use, and experiences of alcohol-related problems, and to examine how these associations differed across sex, using a large, nationally-representative sample of reservation-dwelling AI adolescents. The present study utilized secondary data analysis of a sample of 3498 AI 7th to 12th grade students from a larger national epidemiological study. Participants completed The American Drug and Alcohol Survey™ to assess their alcohol use, sexual assault history, and alcohol-related consequences. Multilevel regression analyses revealed a significant effect of an alcohol use by sex by sexual assault history interaction on experiencing alcohol-related problems (b = −0.88, 95%CI [−1.55, −0.22], p = .009). Furthermore, results revealed that males who endorsed a history of experiencing sexual assault demonstrated the strongest relationship between past-year alcohol use and alcohol-related consequences (b = 2.60, p < .001). Results indicate the importance of early intervention for alcohol use, alcohol-related problems, and sexual assault, perhaps particularly among adolescent males. Future research should examine the directionality between alcohol-use and sexual assault among AI adolescents.

Positive excessive drinker prototypes predict greater drinking and alcohol problems.

According to the prototype willingness model, risky behaviours such as heavy drinking may be influenced by images of others who engage in this behaviour. In this study, we examined whether college students' prototypes of an individual who frequently drinks "over the limit" were associated with their own alcohol consumption and experience of alcohol-related problems during their first 2years in college. We assessed students' (N=340) prototypes of excessive drinkers and their own alcohol consumption and problems at four time points, across their first 2years in college. Along with examining the trajectory of prototypes, consumption, and problems, we tested whether prototypes significantly predicted consumption and problems across the 2years. Additional analyses examined whether the predictive value of prototypes was unique from related variables including perceived descriptive norms, perceived injunctive norms, and peer pressure to drink alcohol. Primary analyses indicated that more positive prototypes of an excessive drinker were significantly associated with greater alcohol consumption in both year 1 and year 2. More positive prototypes were also significantly associated with experiencing more alcohol-related problems in year 2. These findings held when controlling for perceived descriptive and injunctive norms, and peer pressure. Findings further support the importance of drinker prototypes to one's own drinking behaviour. By examining prototypes over time and their relationship to alcohol-related problems, this study makes a novel contribution to the existing research. Statement of contribution What is already known on this subject? Perceived norms (beliefs about how much others drink and what they approve of) are associated with own drinking. Individuals construct "risk prototypes," or images of people who engage in risky behaviours like drinking alcohol. Positive risk prototypes of drinkers have been associated with own willingness to drink and subsequent drinking. What does this study add? This study shows the trajectory of drinker prototypes across the first 2years of college. Findings highlight consistent patterns of positive associations between drinker prototypes and own drinking. More positive drinker prototypes are associated with a greater number of problems with alcohol.

Personality and learning predictors of adolescent alcohol consumption trajectories.

In a sample of 1,897 youth studied across the last year of elementary school to the second year of high school, we identified five trajectories of drinking frequency. Three of those (nondrinkers, middle onset, and late onset drinkers) were not drinking in elementary school; two others (moderate drinkers and early high drinkers) were. Among originally nondrinking groups, multiple impulsigenic traits and the acquired preparedness risk model predicted membership in groups that subsequently began drinking. Membership in trajectory groups characterized by drinking during this age period was associated with (a) the experience of alcohol-related problems and (b) further increases in both impulsigenic traits and alcohol expectancies. Youth vary considerably in the development of drinking behavior across the transitions from elementary to high school. Harms associated with early drinking involve both problems from drinking and increases in high-risk personality traits. (PsycINFO Database Record

Preventing and Responding to Sexual Misconduct: Preliminary Efficacy of a Peer-Led Bystander Training Program for Preventing Sexual Misconduct and Reducing Heavy Drinking Among Collegiate Athletes.

Sexual misconduct occurs with disproportionate frequency on college campuses, and alcohol is involved in most sexual assaults. Importantly, collegiate athletes are at risk for both heavy drinking and sexual misconduct. Thus, the current study evaluated the efficacy of a novel, 2.5-hr, peer-facilitated, interactive, group-based bystander intervention program for student athletes that integrated information on sexual misconduct and risky drinking (Preventing and Responding to Sexual Misconduct [PRSM]). In all, 205 athletes completed 25-min surveys immediately before and after the training, and 76 (of 94 invited) completed a 3-month follow-up. Participating in the workshop was associated with significant increases in acknowledgment that sexual misconduct is a problem on campus, knowledge of where to get help if sexual misconduct occurs, knowledge about the college's procedures for addressing sexual misconduct, confidence that the college's procedures for addressing sexual misconduct are fair, bystander confidence, and engagement in a range of bystander activities. A significant decrease in rape myths also was observed. Participating in the workshop also produced changes in alcohol-related beliefs and behaviors. After participating in PRSM, athletes reported increased expectations that drinking alcohol can produce negative effects including aggression and acute intoxication. Participating in the workshop also was associated with significant reductions in drinking frequency, the total number of drinks consumed per month, the maximum drinks consumed in 24 hours, the frequency of binge-drinking episodes, and the experience of alcohol-related problems. In sum, the PRSM program evidenced preliminary efficacy as a program designed to increase prosocial bystander behavior and decrease high-risk drinking among collegiate athletes; changes in beliefs and behaviors consistent with reducing risk for sexual misconduct and problem drinking were observed after workshop participation. Future research should evaluate whether the PRSM program is effective for use with other high-risk populations like fraternity members or more diverse institutions of higher education including large universities.

Racial discrimination, binge drinking, and negative drinking consequences among black college students: serial mediation by depressive symptoms and coping motives

ABSTRACTObjectives: Experiences of racial discrimination have been associated with diverse negative health outcomes among racial minorities. However, extant findings of the association between racial discrimination and alcohol behaviors among Black college students are mixed. The current study examined mediating roles of depressive symptoms and coping drinking motives in the association of perceived racial discrimination with binge drinking and negative drinking consequences.Design: Data were obtained from a cross-sectional study of Black college students attending a predominantly White institution in the northeastern US (N = 251, 66% female, mean age = 20 years).Results: Results from path analysis showed that, when potential mediators were not considered, perceived racial discrimination was positively associated with negative drinking consequences but not frequency of binge drinking. Serial multiple mediation analysis showed that depressive symptoms and in turn coping drinking motives partially mediated the associations of perceived racial discrimination with both binge drinking frequency and negative drinking consequences (after controlling for sex, age, and negative life events).Conclusions: Perceived racial discrimination is directly associated with experiences of alcohol-related problems, but not binge drinking behaviors among Black college students. Affective responses to perceived racial discrimination experiences and drinking to cope may serve as risk mechanisms for alcohol-related problems in this population. Implications for prevention and intervention efforts are discussed.

Evaluations and Perceptions of Others' Evaluations of Negative Alcohol-Related Consequences Predict Negative Alcohol-Related Consequences Among College Drinkers.

A key assumption when assessing alcohol-related problems is that these problems are considered negative. A growing literature suggests that college drinkers do not perceive all measured consequences to be negative. Research has established the impact of others' beliefs on personal beliefs and behaviors. The purpose of this study was to assess the effect of perceptions of others' evaluations (POE) of consequences on one's own evaluations and subsequent experiences of consequences. A sample of 885 heavy drinking college students participated in a longitudinal study. Participants reported the number of alcoholic drinks consumed per week, experiences of alcohol-related problems, evaluations of those consequences, and perceptions of how typical university students evaluate those consequences. A moderated mediation of POE on negative alcohol-related consequences via evaluations of consequences at differing levels of alcohol consumption was conducted, with gender, baseline consequences, and intervention effects being controlled for. Results indicated that POE had no direct effect on subsequent consequences. However, an indirect effect was found through evaluations of consequences, such that there was a positive association between both POE and evaluations of consequences, and evaluations of consequences and subsequent consequences. Average weekly drinking moderated the association between POE and evaluations of consequences, such that the association between POE and evaluations of consequences was stronger for those who drank more heavily. Results are consistent with social cognition processes, such as pluralistic ignorance, and suggest that POE and evaluations of consequences should be considered in the construction of interventions targeting heavy-drinking college students.

Pregaming and Emotion Regulation’s Relationship to Alcohol Problems in College Students: A Cross-Sectional Study

ABSTRACTBackground: Pregaming is a high-risk drinking behavior associated with increased alcohol consumption and alcohol-related problems. Quantity of alcohol consumed does not fully explain the level of problems associated with pregaming; yet, limited research has examined factors that may interact with pregaming behavior to contribute to the experience of alcohol-related problems. Objectives: The current study examined whether use of two emotion regulation strategies influence pregaming’s contribution to alcohol-related problems. Methods: Undergraduates (N = 1857) aged 18–25 years attending 19 different colleges completed an online survey in 2008–2009. Linear mixed models were used to test whether emotion regulation strategies moderate the association between pregaming status (pregamers vs. non/infrequent pregamers) and alcohol-related problems, when controlling for alcohol consumption, demographic covariates, and site as a random effect. Results: Greater use of cognitive reappraisal was associated with decreased alcohol problems. Expressive suppression interacted with pregaming status. There was no relationship between pregaming status and alcohol problems for students who rarely used expression suppression; however, the relationship between pregaming status and alcohol problems was statistically significant for students who occasionally to frequently used expression suppression. Conclusions/Importance: Findings suggest that the relationship between pregaming and alcohol-related problems is complex. Accordingly, future studies should utilize event-level methodology to understand how emotion regulation strategies influence alcohol-related problems. Further, clinicians should tailor alcohol treatments to help students increase their use of cognitive reappraisal and decrease their use of suppression.

Heavy alcohol consumption among marginalised African refugee young people in Melbourne, Australia: motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking

ABSTRACTObjective. Little is known about substance use among resettled refugee populations. This study aimed to describe motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking among marginalised African refugee young people in Melbourne, Australia.Design. Face-to-face interviews were conducted with 16 self-identified African refugees recruited from street-based settings in 2012–2013. Interview transcripts were analysed inductively to identify key themes.Results. Participants gathered in public spaces to consume alcohol on a daily or near-daily basis. Three key motivations for heavy alcohol consumption were identified: drinking to cope with trauma, drinking to cope with boredom and frustration and drinking as a social experience. Participants reported experiencing a range of health and social consequences of their alcohol consumption, including breakdown of family relationships, homelessness, interpersonal violence, contact with the justice system and poor health. Strategies for managing drinking included attending counselling or residential detoxification programmes, self-imposed physical isolation and intentionally committing crime in order to be incarcerated.Conclusion. These findings highlight the urgent need for targeted harm reduction education for African young people who consume alcohol. Given the importance of social relationships within this community, use of peer-based strategies are likely to be particularly effective. Development and implementation of programmes that address the underlying health and psychosocial causes and consequences of heavy alcohol use are also needed.

Attention to pleasant stimuli in early adolescence predicts alcohol-related problems in mid-adolescence

Attenuated responses to natural rewards have been found to predict subsequent substance use among dependent populations, suggesting that this may be a premorbid risk factor for later problematic substance use. However, research on adolescent risk-taking suggests that exaggerated, rather than blunted, reward responsiveness predicts later substance abuse. Acoustic startle-induced event-related potentials (ERP) were recorded in a sample of 11–13 year-olds while they viewed affective pictures, and participants were reassessed four years later regarding alcohol use and experience of alcohol-related problems. Increased attenuation of the amplitude of the P300 component of the ERP during viewing of pleasant pictures, relative to amplitude during neutral pictures (an indicator of increased attention to pleasant pictures), predicted increased likelihood of alcohol-related problems at follow-up. These findings further support research indicating that increased reward responsiveness predicts risky behaviours in adolescence, with anhedonia primarily a consequence of substance dependence.

Alcohol screening and brief interventions for offenders in the probation setting (SIPS Trial): a pragmatic multicentre cluster randomized controlled trial.

To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in the probation setting. Offender managers were randomized to three interventions, each of which built on the previous one: feedback on screening outcome and a client information leaflet control group, 5 min of structured brief advice and 20 min of brief lifestyle counselling. A pragmatic multicentre factorial cluster randomized controlled trial. The primary outcome was self-reported hazardous or harmful drinking status measured by Alcohol Use Disorders Identification Test (AUDIT) at 6 months (negative status was a score of <8). Secondary outcomes were AUDIT status at 12 months, experience of alcohol-related problems, health utility, service utilization, readiness to change and reduction in conviction rates. Follow-up rates were 68% at 6 months and 60% at 12 months. At both time points, there was no significant advantage of more intensive interventions compared with the control group in terms of AUDIT status. Those in the brief advice and brief lifestyle counselling intervention groups were statistically significantly less likely to reoffend (36 and 38%, respectively) than those in the client information leaflet group (50%) in the year following intervention. Brief advice or brief lifestyle counselling provided no additional benefit in reducing hazardous or harmful drinking compared with feedback on screening outcome and a client information leaflet. The impact of more intensive brief intervention on reoffending warrants further research.

Academic and personal problems among Australian university students who drink at hazardous levels: web‐based survey

Australian university students consume large amounts of alcohol. There is little published information about personal and academic problems associated with this behaviour. We sought to estimate the prevalence, and identify variables associated with, alcohol-related problems among undergraduate hazardous drinkers. The control group members (942 undergraduates, 53.3% male, mean age 19.4 years) of an internet-based intervention trial, who scored ≥8 on the Alcohol Use Disorders Identification Test, completed two validated questionnaires about their experience of alcohol-related problems in the preceding 4 weeks. Regression models were used to identify associations between individual characteristics and alcohol-related problems. One-quarter of participants had missed a class (25.6%) and/or had been unable to concentrate in class (25.7%), and 45% reported that their drinking had impacted negatively on their learning or grades. The most frequent non-academic problems were hangovers (74.8%), blackouts (44.8%), emotional outbursts (30.5%), vomiting (28.1%), arguments (20.2%) and drink-driving (23.2%). Male gender, lower age, being a smoker, being in the Faculty of Health (versus Humanities) and living in shared housing (versus with parents/guardians) were each associated with alcohol-related problems, whereas year of study had no association. There is a high prevalence of preventable alcohol-related problems among undergraduates drinking at hazardous levels and a need for restriction of the availability and promotion of alcohol as well as intervention for individuals at high risk. SO WHAT?: Universities have a duty of care to large populations of young people drinking at hazardous levels and should make greater efforts to address hazardous alcohol consumption.

Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial

Objective To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a...

Age of First Use and Delay to First Intoxication in Relation to Trajectories of Heavy Drinking and Alcohol-Related Problems During Emerging Adulthood

Using alcohol at an early age is a well-documented risk factor for heavy drinking and the experience of a range of negative social and health consequences. However, it remains unclear if early consumption of any alcohol or early drinking to intoxication confers the greatest risk. Age of onset (AO) and delay to first intoxication (delay) were examined as independent predictors of heavy drinking and the experience of alcohol-related problems (problems) in a sample of incoming college freshmen (n=1,160) who completed biannual assessments from the summer following senior year of high school through senior year of college. The sample included more women (66%) than men and a majority were Caucasian (59%). We employed latent growth curve modeling to examine self-reported AO and delay to self-defined first intoxication as predictors of the frequency of heavy drinking and problems during year 4 of college, as well as changes in these alcohol-related outcomes from high school through college. An earlier AO and/or a shorter delay was associated with increased frequency of heavy drinking and problems during senior year of college. Although individuals with a later AO and/or a longer delay were at lower risk overall, they showed larger increases in heavy drinking and problems over time. The findings highlight the importance of distinguishing between AO and delay to first intoxication. Delay accounted for unique variance in drinking outcomes relative to AO, and the effects of AO were stronger when delay was included as a predictor variable. Results are discussed with regard to potential mechanisms through which an early age of intoxication may confer unique risk relative to AO. The implications for cross-cultural differences in risk for problems attributable to early drinking are also discussed.

Social Inequalities and Gender Differences in the Experience of Alcohol-Related Problems

To examine the influence of country-level characteristics and individual socio-economic status (SES) on individual alcohol-related consequences. Data from 42,655 men and women collected by cross-sectional surveys in 25 countries of the Gender, Alcohol and Culture: An International Study study were used. The individual SES was measured by the highest attained educational level. Alcohol-related consequences were defined as the self-report of at least one internal or one external consequence in the last year. The relationship between individuals' education and alcohol-related consequences was examined by meta-analysis. In a second step, the individual level data and country data were combined in multilevel models. As country-level indicators, we used the purchasing power parity of the gross national income (GNI), the Gini coefficient and the Gender Gap Index. Lower educated men and women were more likely to report consequences than higher educated men and women even after controlling for drinking patterns. For men, this relation was significant for both internal and external problems. For women, it was only significant for external problems. The GNI was significantly associated with reporting external consequences for men such that in lower income countries men were more likely to report social problems. The fact that problems accrue more quickly for lower educated persons even if they drink in the same manner can be linked to the social or environmental dimension surrounding problems. That is, those of fewer resources are less protected from the experience of a problem or the impact of a stressful life event.

Is Spirits Really the Most Harmful Alcoholic Beverage? Evidence from a Recent Alcohol Survey in Sweden

The aim of this study was to determine if spirits consumption is more harmful than consuming milder beverage types in Sweden, using monthly survey data for the period 2005–2009. Logistic regression modeling was performed to estimate the association between different beverages and harmful drinking, controlling for gender, age, and socioeconomic factors. There was no support for the idea that spirits consumption is characterized by more harmful drinking patterns and consuming strong beer, in particular, was a better predictor of heavy drinking and harm. It also appeared that people who include spirits, strong beer, and cider/alcopops in their consumption pattern more often had harmful drinking patterns and experiences of alcohol-related problems. The present findings suggest that strong beer is the most problematic alcoholic beverage in Sweden, but also that patterns combining several beverage types are also good measures of harmful drinking, particularly patterns including strong beer, cider/alcopops, and spirits.

The association of ability and trait emotional intelligence with alcohol problems

Ability and trait emotional intelligence may be complimentary dimensions of adaptive emotional functioning. Some previous research links both low ability and low trait emotional intelligence with more alcohol problems. A dimensional model of adaptive emotional functioning proposes that higher levels of ability emotional intelligence may predispose individuals to display emotionally intelligent characteristics more often, resulting in higher trait emotional intelligence, and more adaptive functioning. This model suggests that trait emotional intelligence might mediate between ability emotional intelligence and alcohol outcomes. This study investigated (1) whether ability and trait emotional intelligence are related to heavy episodic drinking (binge drinking) and to alcohol-related problems and (2) whether trait emotional intelligence mediates between ability emotional intelligence and alcohol outcomes. One hundred Australian participants completed measures of ability and trait emotional intelligence, heavy episodic drinking, and experience of alcohol-related problems. Both lower ability and lower trait emotional intelligence were associated with more heavy episodic drinking and more alcohol-related problems. Trait emotional intelligence mediated significantly between ability emotional intelligence and both alcohol problems and heavy episodic drinking. These findings provide information regarding the relationship between ability and trait aspects of emotional intelligence and suggest that emotional intelligence holds promise in facilitating the understanding of problem drinking.

Travellers' Alcohol Imports to Sweden at the Beginning of the 21st Century

Background Privately imported alcohol has increased during the last decade in Sweden. Estimates suggest an increase from 1.1 liter (pure alcohol) per inhabitant in 1996 to 2.7 liters in 2004, and a decrease to 1.8 liters by 2007. Privately imported alcohol represented approximately 20% of total consumption in Sweden during the period 2001–2007 and thus represents a large amount of all alcohol consumed. However, the drinking habits of importers have been rarely studied. Aim The main aim of this paper is to examine drinking patterns and experiences of alcohol-related problems among Swedes who bring alcohol in from abroad and to investigate whether these differ according to the levels of importing. In addition those who bring alcohol in from abroad are compared with those who do not. Data &amp; Methods Data on private import of alcohol, alcohol consumption, adverse consequences of alcohol and socio-demographics were obtained from a monthly telephone survey for the period January 2002 until December 2007 and were aggregated into annual data. For each month a randomised population of 1,500 individuals where asked whether they had returned to Sweden from abroad. If they responded affirmatively they where then asked questions on how many times abroad, during the last 30 days, and if they had brought any alcohol to Sweden the last and or the second-to-the-last time. Irrespective of the respondent had been abroad or not questions on alcohol consumption, drinking patterns, adverse consequences and socio-demographics were asked. On average the telephone interviews lasted for approximately ten minutes. Logistic regressions was used to estimate the association between drinking habits (and problems) and different amounts of alcohol imports. Results The findings of this study indicate that those who import alcohol drink more and engage in binge drinking more frequently than those who do not. However, adverse consequences of alcohol consumption were not reported to the same degree as among the non-importers.

INTRODUCTION TO SPECIAL ISSUE ‘GENDER, CULTURE AND ALCOHOL PROBLEMS: A MULTI-NATIONAL STUDY’

This paper provides an introduction to a series of articles reporting results from the EU concerted action "Gender, Culture and Alcohol Problems: A Multi-national Study" which examined differences in drinking among women and men in 13 European and two non-European countries. The gender gap in alcohol drinking is one of the few universal gender differences in human social behavior. However, the size of these differences varies greatly from one society to another. The papers in this issue examine, across countries, (1) men's and women's drinking patterns, (2) the prevalence of men's and women's experience of alcohol-related problems, (3) gender differences in social inequalities in alcohol use and abuse, (4) gender differences in the influence of combinations of social roles on heavy alcohol use, and (5) how societal-level factors predict women's and men's alcohol use and problems on a regional and global level. Country surveys were independently conducted and then centralized at one institution for further data standardization and processing. Several results indicated that the greater the societal gender equality in a country, the smaller the gender differences in drinking behavior. In most analyses the smallest gender differences in drinking behaviour were found in Nordic countries, followed by western and central European countries, with the largest gender differences in countries with developing economies.

Childhood and adult sexual abuse: relationships with alcohol and other psychoactive drug use

AbstractQuestions concerning sexual abuse before and after the age of 16 years were included in a general population survey of a representative sample of 1052 UK women and 975 UK men. A total of 12.5% of women reported experiencing some form of sexual abuse before the age of 16 years. The corresponding figures for men in this category were 11.7%. After the age of 16, the figure for women remained at this level. However, the proportion of men reporting these traumatic experiences dropped to 3.2%. Sexual abuse both pre and post age 16 was associated with being single or cohabiting, with higher levels of cigarette‐smoking, alcohol consumption, experience of alcohol‐related problems and use of illicit drugs. The relationship between drinking and other forms of psychoactive drug use and sexual abuse is complex. Some possible explanations for this connection and its therapeutic and practical implications are discussed. Copyright © 2004 John Wiley &amp; Sons, Ltd.