Harmful Drinking Patterns Research Articles

Overview of the Genetics of Alcohol Use Disorder.

Alcohol Use Disorder (AUD) is a chronic psychiatric illness characterized by harmful drinking patterns leading to negative emotional, physical, and social ramifications. While the underlying pathophysiology of AUD is poorly understood, there is substantial evidence for a genetic component; however, identification of universal genetic risk variants for AUD has been difficult. Recent efforts in the search for AUD susceptibility genes will be reviewed in this article. In this review, we provide an overview of genetic studies on AUD, including twin studies, linkage studies, candidate gene studies, and genome-wide association studies (GWAS). Several potential genetic susceptibility factors for AUD have been identified, but the genes of alcohol metabolism, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), have been found to be protective against the development of AUD. GWAS have also identified a heterogeneous list of SNPs associated with AUD and alcohol-related phenotypes, emphasizing the complexity and heterogeneity of the disorder. In addition, many of these findings have small effect sizes when compared to alcohol metabolism genes, and biological relevance is often unknown. Although studies spanning multiple approaches have suggested a genetic basis for AUD, identification of the genetic risk variants has been challenging. Some promising results are emerging from GWAS studies; however, larger sample sizes are needed to improve GWAS results and resolution. As the field of genetics is rapidly developing, whole genome sequencing could soon become the new standard of interrogation of the genes and neurobiological pathways which contribute to the complex phenotype of AUD. This review examines the genetic underpinnings of Alcohol Use Disorder (AUD), with an emphasis on GWAS approaches for identifying genetic risk variants. The most promising results associated with AUD and alcohol-related phenotypes have included SNPs of the alcohol metabolism genes ADH and ALDH.

Screening questionnaires to identify problem drinking in the primary care setting: a systematic review

Guidance on screening instruments is lacking. Early recognition of harmful drinking patterns is of socio-economic importance for health policies. Aim of this systematic review was to investigate the validity and reliability of alcohol screening questionnaires to identify problem drinking as a secondary prevention measure. About eight million people live in Austria and approximately 360,000 are diagnosed with chronic alcoholism. In 2011, the direct medical cost for alcohol-related diseases was 374 million Euros. The hazardous effects of excessive drinking and the problems caused by alcohol are frequently documented. A systematic search of the literature was conducted in online databases between September and December 2014. Inclusion criteria included the use of alcohol-screening instrument compared to a gold standard, primary care setting, and adults over 18 years. Eight diagnostic accuracy studies and three systematic reviews were included in this review. The reviewed scientific literature demonstrates the validation of five alcohol-screening instruments plus their abbreviated versions that are currently available in German-speaking countries. Those instruments are suitable for primary care depending on the validated setting. Primary healthcare workers do not routinely screen for harmful drinking in their usual practice in German-speaking countries. Brief interventions are initiated based on results of screening tests; hence, the opportunity for brief interventions is missed. However, guidance and training on validated alcohol-screening instruments and information on the content of brief interventions is currently missing in German-speaking countries.

Everyone else is doing it: examining the role of peer influence on the relationship between social anxiety and alcohol use behaviours

Social anxiety has been linked with harmful alcohol use, alcohol-related negative consequences, and less use of protective behavioural strategies among college students. The inability to resist peer influence has also been shown to be predictive of college student drinking behaviour. The current study examined the moderating role of resistance to peer influence in the relationship between social anxiety, alcohol-related negative consequences and protective behavioural strategies. Participants were 562 undergraduates who completed measures of social anxiety, resistance to peer influence, harmful drinking patterns, alcohol-related negative consequences and protective behavioural strategy use. As predicted, students with higher levels of social anxiety who also expressed being more susceptible to peer influence reported more harmful drinking and alcohol-related negative consequences, and fewer protective behavioural strategies. Thus, students with more social anxiety who may have been drinking in order to be accepted by their peers were more likely than others to engage in more problematic and less safe drinking behaviours. Interventions that focus on harm reduction with college students who drink and experience social anxiety would benefit from addressing their need to be accepted by peers and how that relates to their use of protective behavioural strategies.

Cultural specificity in alcohol use disorders

In their Seminar on alcohol use disorders, Jason Connor and colleagues 1 Connor JP Haber PS Hall W Alcohol use disorders. Lancet. 2015; (published online Sept 4.)http://dx.doi.org/10.1016/S0140-6736(15)00122-1 Google Scholar summarise the risk of alcohol consumption to health for the drinker and for whole populations. The authors offer useful advice, insofar as the evidence base allows, on how clinicians should respond to and try to change a patient's hazardous and harmful drinking pattern. The evidence base is from a narrow range of the world's cultures. However, for some interventions—eg, mutual support groups—the principles and practice often vary with culture. 2 Room R Mutual help movements for alcohol problems in an international perspective. Addiction. 1998; 6: 131-145 Google Scholar Alcohol use disordersAlcohol use disorders are common in developed countries, where alcohol is cheap, readily available, and heavily promoted. Common, mild disorders often remit in young adulthood, but more severe disorders can become chronic and need long-term medical and psychological management. Doctors are uniquely placed to opportunistically assess and manage alcohol use disorders, but in practice diagnosis and treatment are often delayed. Brief behavioural intervention is effective in primary care for hazardous drinkers and individuals with mild disorders. Full-Text PDF

Anticonvulsants for the treatment of alcohol withdrawal syndrome and alcohol use disorders.

Alcoholic patients suffer from harmful allostatic neuroplastic changes in the brain causing an acute withdrawal syndrome upon cessation of drinking followed by a protracted abstinence syndrome and an increased risk of relapse to heavy drinking. Benzodiazepines have long been the treatment of choice for detoxifying patients and managing alcohol withdrawal syndrome (AWS). Non-benzodiazepine anticonvulsants (NBACs) are increasingly being used both for alcohol withdrawal management and for ongoing outpatient treatment of alcohol dependence, with the goal of either abstinence or harm reduction. This expert narrative review summarizes the scientific basis and clinical evidence supporting the use of NBACs in treating AWS and for reducing harmful drinking patterns. There is less evidence in support of NBAC therapy for AWS, with few placebo-controlled trials. Carbamazepine and gabapentin appear to be the most promising adjunctive treatments for AWS, and they may be useful as monotherapy in select cases, especially in outpatient settings and for the treatment of mild-to-moderate low-risk patients with the AWS. The body of evidence supporting the use of the NBACs for reducing harmful drinking in the outpatient setting is stronger. Topiramate appears to have a robust effect on reducing harmful drinking in alcoholics. Gabapentin is a potentially efficacious treatment for reducing the risk of relapse to harmful drinking patterns in outpatient management of alcoholism. Gabapentin's ease of use, rapid titration, good tolerability, and efficacy in both the withdrawal and chronic phases of treatment make it particularly appealing. In summary, several NBACs appear to be beneficial in treating AWS and alcohol use disorders.

Use of Alcohol Surrogates by Alcohol Dependent Patients

Introduction The problem of the consumption of alcohol surrogates in the former Soviet republics has attracted the attention of researchers after the epidemic of poisonings by surrogate alcohols, which swept across Russia and Belarus in 2006. Isolated studies suggest that the main consumers of noncommercial alcohol are heavy drinkers and alcohol dependent individuals. Objectives This study was design to explore the prevalence, drinking pattern, types, reasons and correlates of the consumption of alcohol surrogates among alcohol dependent patients. Methods The study was conducted in the Belarusian city Grodno in 2013 with 326 alcohol dependent patients (223 men and 103 women) admitted to narcological clinic using structured interviews. Results The results suggest that 52.9% of men and 30.3% of women regularly consume samogon (moonshine), while 11.8% of men and 10.8% of women use surrogates, the most popular among which are medications with a high percentage of ethanol and industrial spirits. The belief that, according to quality criteria, samogon exceeds licensed vodka is the main motive for its consumption. Conclusions This is the first in-depth study of the alcohol surrogates drinking pattern, types, reasons and correlates among alcohol dependent patients in Belarus. The results from present study confirm that the use of alcohol surrogates is common among alcohol dependent patients even though its use may have been underreported. These findings emphasize the urgency of implementing comprehensive alcohol policy, which need to address overall consumption, harmful drinking pattern and taking into account the consumption of alcohol from illicit sources.

Associations among depressive symptoms, drinking motives, and risk for alcohol-related problems in veterinary students.

Hazardous alcohol consumption among medical students appears to occur at a level comparable to the general population; however, among medical students, it has been found that the motivation to use alcohol partially stems from unique stressors related to their professional training. Although veterinary students may also experience psychological distress in association with their training, little work has focused on the way that these students use alcohol to cope with their distress. The current study sought to examine the severity of depressive symptoms and alcohol consumption among veterinary students as well as students' specific motives for drinking alcohol. The majority of our sample reported experiencing at least one depressive symptom, and a significant proportion engaged in high-risk drinking, with men reporting more harmful alcohol use patterns. Drinking motives related to managing internal bodily and emotional states accounted for variance in drinking patterns. Further, drinking to ameliorate negative emotions partially accounted for the relationship between psychological distress and high-risk drinking. The results of this study suggest that depressive symptoms among veterinary students may be related to harmful drinking patterns, due to alcohol being used as a coping mechanism to regulate emotions. The findings from this study can be used to develop targeted interventions to promote psychological well-being among veterinary students.

Ethnic Drinking Cultures, Gender, and Socioeconomic Status in Asian American and Latino Drinking

Heterogeneity in drinking across national groups is well documented, but what explains such heterogeneity is less clear. To improve understanding of the underlying cultural conditions that may lead to diverse drinking outcomes, we investigate whether 3 dimensions of ethnic drinking culture (EDC)-alcohol consumption level, drinking prevalence, and detrimental drinking pattern (DDP) in the country of origin (COO)-are significantly associated with alcohol consumption in Asian Americans and Latina/os, and whether the associations vary by gender and socioeconomic status (SES) as assessed by educational level. A nationally representative sample of 1,012 Asian American and 4,831 Latino adults extracted from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions data was used. A series of multiple logistic and linear regression models were fitted separately for Asian Americans and for Latinos. Analyses were also stratified by gender and educational level. Overall, the associations between EDC variables and drinking outcomes were more pronounced for all Asian Americans than for all Latina/os, for males than for females among Asian Americans, and for Latinas than for Latinos. In analyses simultaneously stratifying on gender and education level, however, there was a clear pattern of COO DDP associated with heavier drinking and alcohol consumption volume only for Latinos without a college degree. Ethnic drinking cultures may influence drinking in Asian American and Latino subgroups, albeit to a varying degree. Low-SES Latinos may be at disproportionate risk of harmful drinking patterns pervasive in their COO. Future research might investigate the complex interplay between socioeconomic disadvantage and cultural conditions to inform targeted interventions for subgroups at high risk of alcohol-related harms.

Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities.

Medication adherence is an important determinant of successful medical treatment. Marginalized populations, such as homeless and vulnerably housed individuals, may face substantial barriers to medication adherence. This study aimed to determine the prevalence of, reasons for, and factors associated with medication nonadherence among homeless and vulnerably housed individuals. Additionally, we examined the association between medication nonadherence and subsequent emergency department utilization during a 1-year follow-up period. Data were collected as part of the Health and Housing in Transition study, a prospective cohort study tracking the health and housing status of 595 homeless and 596 vulnerably housed individuals in 3 Canadian cities. Logistic regression was used to identify factors associated with medication nonadherence, as well as the association between medication nonadherence at baseline and subsequent emergency department utilization. Among 716 participants who had been prescribed a medication, 189 (26%) reported nonadherence. Being ≥40 years old was associated with decreased likelihood of nonadherence (adjusted odds ratio [AOR] = 0.59; 95% confidence interval [CI] = 0.41-0.84), as was having a primary care provider (AOR = 0.49; 95% CI = 0.34-0.71). Having a positive screen on the AUDIT (Alcohol Use Disorders Identification Test; an indication of harmful or hazardous drinking) was associated with increased likelihood of nonadherence (AOR = 1.86; 95% CI = 1.31-2.63). Common reasons for nonadherence included side effects, cost, and lack of access to a physician. Self-reported nonadherence at baseline was significantly associated with frequent emergency department use (≥3 visits) over the follow-up period at the bivariate level (OR = 1.55; 95% CI = 1.02-2.35) but was not significant in a multivariate model (AOR = 1.49; 95% CI = 0.96-2.32). Homeless and vulnerably housed individuals face significant barriers to medication adherence. Health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.

Assessment of liver disease in Tower Hamlets, London, UK: foundation for integrated solutions

BackgroundAlthough most liver disease is preventable and rates are falling across Europe, morbidity and mortality are increasing in England. The London Borough of Tower Hamlets has one of the highest liver disease mortality rates in England (29·1/100 000 compared with 18·9/100 000 national average). We undertook a collaborative needs assessment with our local clinical commissioning group to better understand this local problem and identify priorities for intervention. MethodsData collation and descriptive analysis of information from primary care, secondary care, public health, and national sources were conducted over 6 months during 2013–14. The disease burden, common causes, and trends were identified, with particular focus on at-risk population groups. Service provision was reviewed and measured against need. Two-stage stakeholder engagement was undertaken: initial consultation with key partners and subsequent borough-wide consultation. FindingsAlcohol-related disease, non-alcoholic fatty liver disease, and viral hepatitis all contributed to local burden of disease. Tower Hamlets had the highest rates of cirrhosis admissions and liver cancer mortality in England. There were increasingly high rates of alcohol-related admissions (2290/100 000 vs 1912/100 000 for London and 1895/100 000 for England). 51% of the Tower Hamlets population (133 989/262 723, based on 2012 census estimates) were non-alcohol drinkers, but 43% of alcohol drinkers exhibited harmful drinking patterns. We noted high levels of obesity (30% in adults) and diabetes (6·1% prevalence, rapidly rising), proxy measures for non-alcoholic fatty liver disease. We found high rates of hepatitis B infection (incidence per 100 000, 2·38 vs 1·04 nationally) and hepatitis C infection (fourth highest rate nationally [1089/100 000], despite high rates of underdiagnosis). Important factors included ethnicity, deprivation, population movement, and hazardous alcohol use in subgroups. Although specialist services exist for all major disease subtypes, we found evidence of mismatch between service targeting and high-risk groups, and underdeveloped service integration. InterpretationComplex factors contribute to the picture of liver disease in Tower Hamlets. For example, high rates of hazardous alcohol use within some population groups are masked by high abstinence rates among others (such as the large Bangladeshi population). Insights from this work have facilitated the development of a joined-up tailored approach to address various contributing components. We are working with partners to develop clear care pathways, improve service provision, increase hepatitis screening, and consider universal hepatitis B immunisation in areas of high prevalence. FundingNone.

Protective Behavioral Strategies and Alcohol Use Outcomes Among College Women Drinkers: Does Disordered Eating and Race Moderate This Association?

The current study examined the degree to which associations that protective behavioral strategy use had with alcohol consumption and alcohol-related negative consequences were moderated by disordered eating and race. Participants were 382 female undergraduates (ages 18-25) who had consumed alcohol at least once within the previous month. Participants completed online self-report measures concerning their use of protective behavioral strategies, disordered eating, weekly alcohol consumption, harmful drinking patterns, and alcohol-related negative consequences. White non-Hispanic women who used the fewest protective behavioral strategies reported the highest levels of alcohol consumption and harmful drinking patterns. Protective behavioral strategy use was associated with lower levels of alcohol-related negative consequences except for African American women with low levels of disordered eating behaviors. For interventions targeting drinking among college women, disordered eating behaviors may increase risky behaviors and qualify relationships between protective behavioral strategies and alcohol-related negative consequences. Thus, assessment of disordered eating behavior as part of drinking interventions may be helpful.

Social anxiety symptoms and drinking behaviors among college students: the mediating effects of drinking motives.

The impact of social anxiety on negative alcohol-related behaviors among college students has been studied extensively. Drinking motives are considered the most proximal indicator of college student drinking behavior. The current study examined the mediating role of drinking motives in the relationship that social anxiety symptoms have with problematic (alcohol consumption, harmful drinking, and negative consequences) and safe (protective behavioral strategies) drinking behaviors. Participants were 532 undergraduates who completed measures of social anxiety, drinking motives, alcohol use, harmful drinking patterns, negative consequences of alcohol use, and protective behavioral strategy use. Our results show that students with higher levels of social anxiety symptoms who were drinking for enhancement motives reported more harmful drinking and negative consequences, and used fewer protective behavioral strategies. Thus, students who were drinking to increase their positive mood were participating in more problematic drinking patterns compared with students reporting fewer social anxiety symptoms. Further, conformity motives partially mediated the relationship between social anxiety symptoms and negative consequences. Thus, students with more symptoms of social anxiety who were drinking in order to be accepted by their peers were more likely than others to experience negative consequences. Clinical and research implications are discussed.

EPA-0246 - Aggregate level effect of binge drinking on suicide mortality rate in russia

Introduction Suicide is one of the main causes of premature mortality in Russia. There is strong evidence of a crucial role of harmful drinking pattern (binge drinking) in explanation a high suicide rate in this country. Objectives This paper was design to estimate the aggregate level effect of binge drinking on suicide mortality rate in Russia. Method Trends in age-adjusted, sex-specific suicide mortality and fatal alcohol poisoning rate (as a proxy for binge drinking) from 1980 to 2005 were analyzed employing a distributed lags analysis in order to asses bivariate relationship between the two time series. Results The results of the time series analysis indicate the presence of a statistically significant association between the two time series at zero lag for male (R = 0.44; P Conclusions This study indicates that substantial proportion of suicide deaths in Russia is due to acute effect of binge drinking. The findings from the present study also suggest that a restrictive alcohol policy can be considered as an effective measure of suicide prevention in countries where higher rate of alcohol consumption and binge drinking pattern.

C4-4: Prevalence of Hazardous and Harmful Drinking Patterns Among Older US Adults: Data from the 2005-2008 NHANES

Background/Aims While heavy drinking and alcohol abuse pose clear health risks, even moderate alcohol consumption may be risky or frankly harmful in older adults with certain co-morbidities, medication use, symptoms, and functional limitations. However, national estimates of the prevalence of risky alcohol use by older adults are presently unavailable. Methods In 2005-2008 National Health and Nutrition Examination Survey respondents 65 years and older, reported alcohol consumption was considered alone and in the context of the individual's co-morbidities, medication use, and physical and psychological functional status to classify their consumption as Harmful (already experiencing alcohol-related health problems), Hazardous (at risk of alcohol-related health problems), or Healthwise, using the classification algorithm of the Alcohol-Related Problems Survey (ARPS), a screening tool for older adults. Weighted national prevalence estimates and adjusted prevalence odds ratios in subgroups defined by sex, age, and race/ ethnicity were calculated using survey statistical procedures. Results Among older adult drinkers, 85.5% (14,341,531 of 16,771,716; 95% Confidence Interval [CI]: 83.2%, 87.9%) consumed alcohol within recommended limits, but 37.4% (6,280,569 of 16,771,716; 95% CI: 34.9%, 40.0%) had Harmful consumption and more than half (53.3%; 8,946,997 of 16,771,716; 95% CI: 50.1%, 56.6%) had either Hazardous/Harmful consumption. Men had significantly greater odds of having Hazardous/ Harmful consumption than women (Odds Ratio [OR] = 2.14 [95% CI: 1.77, 2.6]). Blacks had significantly greater odds of having Hazardous/Harmful consumption than whites (OR = 1.49; 95% CI: 1.02, 2.17) despite having lower sex-specific rates of heavy drinking. The health status indicators most prevalent among Harmful drinkers were anti-hypertensive medication use, hypertension, quantity and frequency of alcohol consumption, and symptoms of depression/anxiety. Conclusions Most Americans 65 years and older drink less than the current recommended maxima for their age, yet in the context of their co-morbidities, medication use, functional status, and recent symptoms, the alcohol consumption of a substantial proportion compromises or places their health at risk. Issues of medication safety and effectiveness, chronic disease management, and prevention and wellness are critical issues for this population. Language: en

P4.068 Hazardous Alcohol Consumption and Sexual Partner Concurrency Among Adults in Rural South Africa

ObjectivesSexual partner concurrency and hazardous alcohol consumption patterns both lead to accelerated transmission of HIV/STIs. While there has been considerable research undertaken documenting the correlation of alcohol and HIV risk...

Fragile Self-Esteem and Alcohol-Related Negative Consequences Among College Student Drinkers

The pattern of alcohol consumption among college students and its negative consequences have been extensively studied. The purpose of the present study was to gain a better understanding of the connection between self-esteem and alcohol use among college students. Participants were 623 undergraduates who completed measures of self-esteem level (i.e., an overall evaluation of one's own value and worth), contingent self-esteem (i.e., what an individual believes he or she must accomplish in order to have value and worth as a person), alcohol use, harmful drinking patterns, and negative consequences of alcohol use. Our results show that individuals who possess high levels of self-esteem that are contingent (their positive self-views are strongly influenced by whether they have met the goals or standards they have set for themselves) report more alcohol-related negative consequences than individuals with noncontingent high self-esteem. Implications of these findings for understanding the connection between sel...

Patterns of alcohol consumption among male adults at a slum in Kolkata, India.

Globally, alcohol-abuse is a major cause of mortality and morbidity. Consumption of alcohol has increased in India in the recent decades. It is imperative to know the patterns of alcohol consumption among different types of consumers to launch a well-planned nationwide programme for the prevention and control of this devastating social pathology. This community-based, cross-sectional study was undertaken to identify the patterns of alcohol intake among different types of alcohol consumers and to assess the clinical signs of chronic harmful alcohol-use. A predesigned, pretested, semi-structured alcohol-use disorders identification test (AUDIT) questionnaire was used for interviewing males, aged >18 years, selected by random sampling from an updated household list of a randomly-selected sector of the service area of the Urban Health Centre in Chetla, Kolkata, West Bengal, India. Written informed consents were obtained from all the respondents. Relevant clinical examination for chronic harmful alcohol-use was done according to the AUDIT clinical screening procedures. The results revealed that 65.8% (150/228) were current consumers of alcohol; 14% were alcohol-dependents; 8% were hazardous or harmful consumers, and 78% were non-hazardous non-harmful consumers. The mean age of the respondents at the initiation of drinking alcohol was 20.8+5.9 years. Eighty-six percent of dependents (n=21) took both Indian-made foreign liquor and locally-made alcoholic beverages. The proportions of alcohol consumers who drank alone among alcohol-dependents, hazardous or harmful consumers, and non-hazardous non-harmful consumers were 71.4%, 50%, and 7.7% respectively, and the difference was significant (p<0.01). Forty-one percent of the consumers drank at public places and workplaces, which may be socially harmful. About 38% of the dependents purchased alcohol from unlicensed liquor shops. Only 16% expressed concerns for their drinking habit mainly to the past illness. The proportion of the concerned respondents was higher in the hazardous and harmful drinking patterns than in the non-hazardous non-harmful drinking pattern, and the difference was significant (p<0.05). About 62% of the dependents had clinical signs of chronic alcohol consumption. The presence of a considerable proportion of alcohol-dependents, the low mean age at initiation of drinking alcohol, and the habit of drinking in public places and workplaces are the main areas that need special emphasis by intervention programmes.

Does Self-Esteem Moderate the Associations between Protective Behavioral Strategies and Negative Outcomes Associated with Alcohol Consumption?

Previous research has shown that protective behavioral strategies tend to be associated with lower levels of alcohol consumption and fewer negative alcohol-related consequences. The purpose of the present study was to examine whether self-esteem would moderate the association between protective behavioral strategies and alcohol-related outcomes. Participants were undergraduates (94 men and 363 women) between the ages of 18-25 who reported that they had consumed alcohol within the past 30 days. Results showed that greater use of protective behavioral strategies was associated with lower rates of alcohol consumption, less harmful drinking patterns, and fewer negative consequences for everyone except men with low self-esteem. The implications of these findings for understanding the link between protective behavioral strategies and alcohol-related outcomes are discussed.

Alcohol, violence and substance related presentations to A&amp;E in 16-18 year olds: the need for targeted adolescent services

Hazardous and harmful drinking patterns are increasing in adolescents. Heavy adolescent drinkers are more likely to continue as hazardous drinkers. Furthermore, alcohol and substance misuse in young adults is linked to violence and mental health problems later in life, meaning these problems should be managed as early as possible. This audit9s aim was to ascertain the influence of alcohol, substance abuse and violence, on presentations to A&amp;E, of 16-18 year-olds over one year. <h3>Method</h3> Symphony computer tracking system was used. Presentations of patients aged 16 to 18 years from 1 March 2010 to 1 March 2011 were studied. Their presenting complaints were recorded; non-specific presenting complaints were explored individually for misuse of alcohol, substance abuse and/or violence. <h3>Results</h3> There were 2192 presentations. ‘Apparently drunk’ and ‘assault’ featured in the top 20 presenting complaints; 9.1% of all presentations involved violence and 4% involved alcohol (figure 1). These presenting complaints are only the tip of the iceberg (figure 2). Many triaged cases did not specify whether alcohol, violence or substance abuse were involved. Cases may be missed by not being flagged up at the triage stage. <h3>Impact</h3> Subsequently, a multidisciplinary group including nurses and doctors from paediatric and adult A&amp;E have established guidelines for referral and produced an adolescent related proforma to ask about sexual health, mental health, alcohol and substance misuse. As the hospital became a Major Trauma Centre in January 2011, the number of cause for concern forms increased by a factor of 8, many being patients in the 16-18 year age bracket. This meant a steep learning curve for adult A&amp;E doctors and nurses. Children, adolescents, vulnerable young people are discussed at the weekly interdepartmental meeting (includes CAMHS team, substance misuse and alcohol worker, and liaison social workers). Alcohol and substance misuse information and advice leaflets, geared to adolescents, are available in the Emergency Department. Having set these standards, this work will be repeated in one year to see if there has been an improvement in the quality of care delivered to this vulnerable group.

Gender Differences in Response to Deployment Among Military Healthcare Providers in Afghanistan and Iraq

Despite their growing numbers in the United States military, little has been published on healthcare providers (HCP) or female service members from conflicts in Afghanistan and Iraq. The purpose of this secondary analysis of data from the 2005 Department of Defense (DoD) Survey of Health Related Behaviors Among Active Duty Military Personnel was to determine gender differences in reaction to the impact of operational stress in deployed military healthcare providers. The unweighted study sample selected for this data analysis included results from female and male active duty military personnel over the age of 18 years (n=16,146) deployed at least once to Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) within the past 3 years (n=1,425), for a final sample consisting of either officer (healthcare officer) or enlisted (healthcare specialist) personnel (n=455) (weighted n=23,440). Indices of psychologic distress and social relations were explored and compared. Enlisted female HCPs were more likely to be African American (42.3%) and single (63.0%) and represented the greater percentage with significant psychologic difficulties, as shown by serious psychologic distress endorsement (11.3%) and positive screen results for depression (32.2%). More harmful drinking patterns (Alcohol Use Disorders Identifications Test [AUDIT] score 8-15) were found in more female HCPs (enlisted 61.8%, officers 76.4%) compared with males (enlisted 41.1%, officers 67.1%). Female HCPs serving in the current military conflicts are reporting significant psychologic distress that may adversely impact their performance within the military, in theaters of operations, and in their lives at home. Implications for clinical care of female service members and veterans of current wars are addressed.