Harmful Drinking Research Articles

The alcohol biomarker phosphatidylethanol (PEth) – test performance and experiences from routine analysis and external quality assessment

Phosphatidylethanol (PEth) are membrane molecules formed from phosphatidylcholine and ethanol through transphosphatidylation catalyzed by phospholipase D. Measurement of the main PEth form 16:0/18:1 is used as a specific and sensitive alcohol biomarker, since its formation requires ethanol, it accumulates in the blood upon repeated ethanol exposure, and it is only slowly eliminated during abstinence. PEth formation correlates with alcohol intake at the population level, albeit with considerable inter-individual variation as for the half-life during withdrawal. Over the past decade, the use of PEth has increased significantly and the applications have broadened. In Sweden, routine decision limits and the interpretation of test results for PEth were harmonized in 2013, using < 0.05 µmol/L (∼35 µg/L) as the recommended lower reporting limit and values > 0.30 µmol/L (∼210 µg/L) to indicate regular high alcohol intake. Routine test results show a large variation with about half being < 0.05 µmol/L and some even exceeding 10 µmol/L. In 2013, an external quality assessment (EQA) scheme for PEth 16:0/18:1 measurement in whole blood was also started (Equalis, Uppsala, Sweden), presently involving 56 laboratories from 13 countries. The agreement of PEth results between the laboratories has gradually improved to a CV < 15%. The current clinical and scientific information suggests that PEth values below the lower reporting limit (typically ∼0.03–0.05 µmol/L, or ∼20–35 µg/L) indicates sobriety or only low or occasional alcohol consumption, while regular high alcohol intake at levels corresponding to harmful drinking is required in most cases to reach PEth values > 0.30 µmol/L.

A Randomized Controlled Pilot Trial of Primary Care Treatment Integrating Motivation and Exposure Treatment (PC-TIME) in Veterans With PTSD and Harmful Alcohol Use

Individuals with posttraumatic stress disorder (PTSD) often engage in harmful alcohol use. These co-occurring conditions are associated with negative health consequences and disability. PTSD and harmful drinking are typically experienced as closely related—thus treatments that target both simultaneously are preferred by patients. Many individuals with PTSD and harmful alcohol use receive primary care services but encounter treatment barriers in engaging in specialty mental health and substance use services. A pilot randomized controlled trial of a brief integrated treatment for PTSD and harmful drinking versus primary care treatment as usual (PC-TAU) took place in three U.S. Department of Veterans Affairs (VA) primary care clinics. The intervention (primary care treatment integrating motivation and exposure [PC-TIME]) combines motivational interviewing to reduce alcohol use and brief prolonged exposure for PTSD delivered over five brief sessions. Participants (N = 63) were veterans with PTSD and harmful drinking. Multilevel growth curve modeling examined changes in drinking (average number of drinks per drinking day and percentage of heavy drinking days) and self-reported PTSD severity at baseline, 8, 14, and 20 weeks. Participants reported high satisfaction with PC-TIME and 70% (n = 23) completed treatment. As hypothesized, a significantly steeper decrease in self-reported PTSD severity and heavy drinking was evident for participants randomized to PC-TIME compared with PC-TAU. Contrary to expectations, no significant posttreatment differences in PTSD diagnoses were observed. PC-TIME participants were less likely to exceed National Institute for Alcoholism and Alcohol Abuse (NIAAA) guidelines for harmful alcohol use posttreatment compared with PC-TAU participants. PC-TIME is a promising brief, primary care-based treatment for individuals with co-occurring PTSD and harmful alcohol use. A full-scale randomized clinical trial is needed to fully test its effectiveness.

Family history, childhood maltreatment, and adolescent binge drinking exert synergistic effects on delay discounting and future alcohol use

ABSTRACT Background: The transition to college is associated with a sharp increase in alcohol binge drinking. Family history (FH) of alcohol use disorder (AUD), childhood maltreatment (CM), and adolescent binge drinking are each associated with heightened impulsivity and greater alcohol misuse. Objectives: We hypothesized that FH, CM, and adolescent binge drinking synergistically increase impulsivity and lead to binge drinking increases over the first year of college. Methods: Overall, 329 first-semester college students (18–19 years old, 70% female) with varying degrees of FH (Family History Assessment Module), CM (Childhood Trauma Questionnaire), and adolescent binge drinking (Carolina Alcohol Use and Patterns Questionnaire) completed an online study that included a computerized delay discounting task and surveys. Binge drinking was surveyed retrospectively to measure adolescent binge drinking, in addition to baseline and one-year follow-up measures. Linear regression analyses tested the interacting effects of FH, CM, and adolescent binge drinking on delay discounting as well as changes in binge drinking severity between baseline and one-year follow-up. A moderated mediation tested whether delay discounting mediated future binge drinking. Results: Greater levels of FH, CM, and adolescent binge drinking interacted to reduce the selection of delayed rewards (β=-0.12, SE = 0.06), indicating increased impulsivity. There was a similar interaction effect on increased binge drinking over the one-year follow-up period (β = 0.37, SE = 0.13). Although FH, CM, and adolescent binge drinking influenced individual paths, the moderated mediation analysis was not significant. Conclusions: Heritable and environmental risk factors for AUD predicted impulsivity and prospectively predicted college binge drinking. Interventions targeting delay discounting processes may represent an effective strategy to reduce harmful drinking specifically for certain high-risk college students.

Psilocybin history, action and reaction: A narrative clinical review.

Hallucinogenic mushrooms have been used in religious and cultural ceremonies for centuries. Of late, psilocybin, the psychoactive compound in hallucinogenic mushrooms, has received increased public interest as a novel drug for treating mood and substance use disorders (SUDs). In addition, in recent years, some states in the United States have legalized psilocybin for medical and recreational use. Given this, clinicians need to understand the potential benefits and risks related to using psilocybin for therapeutic purposes so that they can accurately advise patients. This expert narrative review summarizes the scientific basis and clinical evidence on the safety and efficacy of psilocybin-assisted therapy for treating psychiatric disorders and SUDs. The results of this review are structured as a more extensive discussion about psilocybin's history, putative mechanisms of action, and recent legislative changes to its legal status. There is modest evidence of psilocybin-assisted therapy for treating depression and anxiety disorders. In addition, early data suggest that psilocybin-assisted therapy may effectively reduce harmful drinking in patients with alcohol use disorders. The evidence further suggests psilocybin, when administered under supervision (psilocybin-assisted therapy), the side effects experienced are mild and transient. The occurrence of severe adverse events following psilocybin administration is uncommon. Still, a recent clinical trial found that individuals in the psilocybin arm had increased suicidal ideations and non-suicidal self-injurious behaviors. Given this, further investigation into the safety and efficacy of psilocybin-assisted therapy is warranted to determine which patient subgroups are most likely to benefit and which are most likely to experience adverse outcomes related to its use.

Relationship between attachment style, socio-demographic factors and alcohol abuse

Introduction and purpose Alcohol addiction is a major problem that affects both the affected individual and their immediate surroundings. The State Agency for Solving Alcohol Problems (PARPA) estimates that approximately 900,000 people in Poland are addicted to alcohol, and harmful drinking affects an even larger number of residents. Attachment style is a pattern of establishing relationships which derives from childhood. The aim of study is to assess the propensity alcohol abuse depending on attachment style and socio-demographic factors. Materials and methods Research material has been carried out by diagnostic survey method. The analysis has been conducted on the basis of data collected with a questionnaire designed by the author consisting of demographics and major part- updated Attachment Style IDR Labs Test (IDRLRAS) and Michigan Alcoholism Screening Test (MAST). The study involved 327 participants, 6 questionnaires have been rejected due to incorrectly filled form. All of the participants gave their informed consent for the research. The inclusion criterion was the age of above 18. The research has been conducted between 07.06.23 and 28.06.23. Results and conclusions In the group of studied individuals, there are relationships between attachment style, socio-demographic factors, and predisposition to alcohol addiction. It is important to conduct a larger number of studies on a more diverse research group in order to obtain the data needed to confirm the results discussed in the later part of the paper.

Utility of the Brief Young Adult Alcohol Consequences Questionnaire to Identify College Students At-Risk for Alcohol Related Problems: Relative Operating Characteristics across Seven Countries

Background: It is important to identify students who would benefit from early interventions to reduce harmful drinking patterns and associated consequences. the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ) could be particularly useful as a screening tool in university settings. Objectives. The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Objectives: The present study examined the utility of the B-YAACQ to distinguish among students at-risk for problematic alcohol use as measured by the AUDIT. Methods: A sample of 6382 students (mean age=20.28, SD=3.75, 72.2% females) from seven countries (i.e., U.S., Canada, South-Africa, Spain, Argentina, Uruguay, England) completed the B-YAACQ, the AUDIT and different measures of alcohol use. Results: ROC analyses suggested that a cutoff score of 5 maximized the YAACQ’s discrimination utility to differentiate between students at low versus moderate/high risk in the total sample and across countries (except in Canada, where the cutoff was 4). In addition, a cutoff of 7 differentiated between students at low/moderate versus high risk in the total sample, while cutoffs of 10, 9, 8 and 7 differentiate between students at low/moderate versus high risk in Uruguay, U.S and Spain (10), Argentina (9), England (8), and Canada and South-Africa (7), respectively. Students classified at the three risk levels (i.e., low, moderate and high) differed in age (i.e., a younger age was associated with higher risk) and drinking patters (i.e., higher drinking frequency, quantity, binge drinking and AUDIT and B-YAACQ scores in the higher risk groups). Conclusions: This study suggest that the B-YAACQ is a useful tool to identify college students at-risk for experiencing problematic patterns of alcohol use.

Mortality from chronic liver disease: Recent trends and impact of the COVID-19 pandemic.

Prepandemic time trends in mortality from chronic liver disease (CLD) differed according to specific cause of death (decreasing for liver cirrhosis, stable or increasing for liver cancer), etiology (increasing for nonalcoholic fatty liver disease, generally decreasing for other etiologies), and world region (decreasing in areas with the highest burden of hepatitis B virus, increasing in Eastern Europe and other countries). The coronavirus disease 2019 (COVID-19) pandemic affected mortality of patients with CLD both directly, with a higher risk for severe illness and death depending on age, stage and etiology of the disease, and indirectly, through social isolation and loss of support, harmful drinking, and difficulties in access to care. Nevertheless, only sparse data are available on variations in CLD as a cause of death during the pandemic. In the USA, in 2020-2021 a growth in mortality was registered for all liver diseases, more marked for alcoholic liver disease, especially among young people aged 25-44 years and in selected ethnic groups. COVID-19 related deaths accounted only for a minor part of the excess. Further data from mortality registers of other countries are warranted, preferably adopting the so-called multiple cause-of-death approach, and extended to deaths attributed to viral hepatitis and liver cancer.

Disentangling the cascade of seizure precipitants: A prospective observational study

BackgroundThe management of epilepsy includes appropriate antiseizure medication (ASM) treatment and careful avoidance of seizure precipitating factors. Seizure precipitants may be multiple occurring with low intensity adding to each other, thus leaving essential elements unrecognized. The aim of this study was to reveal the patients’ subjective perceptions of the most important factors and to compare them with standardized measurements. MethodsThe study included 152 acute hospital admissions for seizures. The patients were asked to score the impact of various seizure precipitants as perceived by themselves on a visual analogue scale (VAS). The following items related to seizure occurrence were quantified: sleep deprivation by sleep diaries, ASM adherence by therapeutic drug monitoring, the Alcohol Use Identification Test, and the Hospital Anxiety and Depression Scale. Statistical analyses, including multiple regression, were performed to discover relationships between various parameters. ResultsThe interaction of the various factors was high. The association between lack of sleep and hazardous drinking and anxiety was highly significant. Perceived stress correlated well with anxiety and depression. Relatively low VAS scores for missed medication in patients with identified non-adherence suggest that insufficient patient awareness is common. Low VAS-scores for alcohol in patients with harmful drinking also suggest low acknowledgment of alcohol-related seizures. High alcohol scores were associated with sleep deprivation, anxiety and depression. ConclusionThe circumstances leading to an epileptic seizure are complex. Stress, sleep loss, alcohol intake, and missed medication are among the most commonly reported seizure precipitants. They are often combined, and various facets of the same underlying cause may be at play. Their sequence and relative impact are often difficult to establish. Improved understanding of the cascade of events preceding a seizure can improve comprehensive personalized management of uncontrolled epilepsy.

Residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling by adults with lower incomes: Is increased access to primary care enough?

We investigate whether living in a state that expanded Medicaid eligibility is associated with receiving alcohol screening and brief counseling among nonelderly, low-income adults and a subgroup with chronic health conditions caused or exacerbated by alcohol use. Data are from the 2017 and 2019 Behavioral Risk Factor Surveillance System (N = 15,743 low-income adults; n = 7062 with a chronic condition). We used propensity score-weighted, covariate-adjusted, modified Poisson regression to estimate associations between residence in a Medicaid-expansion state and receipt of alcohol screening and brief counseling. Models estimated associations in the overall sample and chronic conditions subsample, as well as differential associations across sex, race, and ethnicity using interaction terms. Living in a state that expanded Medicaid eligibility was associated with being asked whether one drank (prevalence ratio (PR) = 1.15, 95% confidence interval (CI) = 1.08, 1.22), but not with further alcohol screening, guidance about harmful drinking, or advice to reduce drinking. Among individuals with alcohol-related chronic conditions, expansion state residence was associated with being asked about drinking (PR = 1.13, 95% CI = 1.05, 1.20) and, among past 30-day drinkers with chronic conditions, being asked how much one drank (PR = 1.28, 95% CI = 1.04, 1.59) and about binge drinking (PR = 1.43, 95% CI = 1.03, 1.99). Interaction terms suggest that some associations differ by race and ethnicity. Living in a state that expanded Medicaid is associated with a higher prevalence of receiving some alcohol screening at a check-up in the past 2 years among low-income residents, particularly among individuals with alcohol-related chronic conditions, but not with the receipt of high-quality screening and brief counseling. Policies may have to address provider barriers to delivery of these services in addition to access to care.

Baseline preferences for oral pre-exposure prophylaxis (PrEP) or dapivirine intravaginal ring for HIV prevention among adolescent girls and young women in South Africa, Uganda and Zimbabwe (MTN-034/IPM-045 study).

Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the HIV epidemic and face an array of challenges using proven behavioral and biomedical prevention methods. To address the urgent need for expanding prevention options, we evaluated the baseline preferences of HIV prevention methods among participants enrolled in the MTN-034/REACH crossover trial along with their stated product preference prior to product initiation. AGYW aged 16-21 years were enrolled at 4 study sites: Cape Town and Johannesburg, South Africa; Kampala, Uganda; and Harare, Zimbabwe and randomly assigned to the sequence of using oral PrEP and the dapivirine ring for 6 months each, followed by a choice period in which they could choose either product (or neither) for an additional six months. Eligible AGYW were HIV-negative, not pregnant and using effective contraception for at least two months prior to enrollment. Descriptive statistics were used to summarize demographic and behavioral data while multinomial analysis was used to determine predictors of stated product preference (ring or oral PrEP). Of the 247 AGYW enrolled in REACH, 34% were aged 16-17 and 89% had a primary partner.The median age of sexual debut was 16 years and 40% had ever been pregnant. At screening, 35% of participants were diagnosed with a sexually transmitted infection (STI), 39% had an AUDIT-C score associated with harmful drinking and 11% reported intimate partner violence in the past 6 months. Overall, 28% of participants, had CESD-10 scores suggestive of depressive symptoms (≥12) in the past week. At baseline, similar proportions stated a preference for the ring and oral PrEP (38.1% and 40.5% respectively), with 19% of participants stating they preferred both products equally. Only study site was significantly associated with product preference (P<0.05) with AGYW from Johannesburg having higher odds of preferring the ring and those from Kampala having higher odds of preferring both options equally. We successfully enrolled African AGYW with a clear unmet need for HIV prevention. The balanced preference between the two products suggests that multiple biomedical prevention options may be appealing to this age group and could address their prevention needs.

Analyzing the Relationship between Participation in Sports and Harmful Alcohol Drinking in Early Adolescence: Two-Year Prospective Analysis.

Alcohol drinking is an important health-related problem and one of the major risk factors for a wide array of non-communicable diseases, while there is a lack of studies investigating environment-specific associations between sports participation and alcohol drinking in adolescence. This study prospectively investigated the relationship between sports factors (i.e., participation in sports and competitive achievement), with the prevalence of harmful alcohol drinking (HD), and HD initiation in 14-to-16 years old adolescents from Bosnia and Herzegovina (n = 641, 337 females, 43% living in rural community). Participants were tested over 4-time points divided by approximately 6 months, from the beginning of high school to the end of the second grade. Variables included gender, factors related to sport participation, a community of residence (urban or rural), and outcome: alcohol consumption was assessed by the AUDIT questionnaire. Results evidenced that the prevalence of HD increased over the study period from 6 to 19%, with no significant differences between urban and rural youth. Logistic regression for HD as criterion evidenced adolescents who participated in sports and then quit as being at particular risk for drinking alcohol at the study baseline. Sports factors were not correlated with HD initiation in the period between 14 and 16 years of age. It seems that the problem of alcohol drinking should be preventively targeted in all youth, irrespective of living environment. Although sports participation was not evidenced as being a factor of influence on HD initiation, results highlight the necessity of developing targeted preventive campaigns against alcohol drinking for adolescents who quit sports.

Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis.

Due to its widespread use in the sex work industry, female sex workers (FSWs) in low- and middle-income countries (LMICs) are at high risk of harmful alcohol use and associated adverse health outcomes. Factors associated with harmful alcohol use include violence, mental health problems, drug use, sexual risk behaviors and HIV/STIs. To our knowledge, there has been no quantitative synthesis of FSW alcohol use data to date. This systematic review and meta-analysis aims to provide an estimate of the prevalence of harmful alcohol use among FSWs in LMICs and to examine associations with common health and social concerns. The review protocol was registered with PROSPERO, number CRD42021237438. We searched three electronic databases for peer-reviewed, quantitative studies from inception to 24th February 2021. Studies were selected for inclusion that reported any measure of prevalence or incidence of alcohol use among FSWs aged 18 or older from countries defined as LMIC in accordance with the World Bank income groups 2019. The following study designs were included: cross-sectional survey, case-control study, cohort study, case series analysis, or experimental study with baseline measures for alcohol use. Study quality was assessed with the Center for Evidence-Based Management (CEBMa) Critical Appraisal Tool. Pooled prevalence estimates were calculated for (i) any hazardous/harmful/dependent alcohol use, (ii) harmful/dependent alcohol use only, both overall and by region and (iii) daily alcohol use. Meta-analyses examined associations between harmful alcohol use and violence, condom use, HIV/STIs, mental health problems and other drug use. In total, 435 papers were identified. After screening, 99 papers reporting on 87 unique studies with 51,904 participants from 32 LMICs met the inclusion criteria. Study designs included cross-sectional (n = 89), cohort (n = 6) and experimental (n = 4). Overall, 5 scored as high quality, 79 studies scored as moderate and 15 scored as weak quality. Twenty-nine papers reporting on 22 unique studies used validated alcohol use tools including AUDIT, CAGE and WHO CIDI. The pooled prevalence of any hazardous/harmful/dependent alcohol use was 41% (95% CI: 31-51%), and of daily alcohol use was 26% (95% CI: 17-36%). There was variation in harmful alcohol use by global region (Sub-Saharan Africa: 38%; South Asia/Central Asia/ East Asia and Pacific: 47% and Latin America and the Caribbean:44%). Harmful alcohol use was significantly associated with inconsistent condom use (pooled unadjusted RR: 1.65; 95% CI: 1.01-2.67), STIs (pooled unadjusted OR: 1.29; 95% CI 1.15-1.46); and other drug use (pooled unadjusted OR of 2.44; 95% CI 1.24-4.80), but not with HIV, violence or mental health problems. We found a high prevalence of problem alcohol use and daily alcohol use among FSWs in LMICs. Harmful drinking was associated with important HIV risk factors such as inconsistent condom use, STIs and other drug use. Major limitations included heterogeneity in tools and cut-off scores to measure alcohol use and other common risk factors, and a paucity of longitudinal studies. There is an urgent need for tailored interventions for FSWs in LMICs that address alcohol use as well as the associated sex work risk environment.

Disentangling the messiness of natural experiments to evaluate public policy.

Disentangling the messiness of natural experiments to evaluate public policy.

Increase in educational inequalities in alcohol-related mortality in Spain during a period of economic growth.

Alcohol-related mortality risk is almost always greater in lower than higher socio-economic positions (SEPs). There is little information on the evolution of this SEP gradient and its relationship with the economic cycle. Some results suggest that during economic expansions, there is a hypersensitivity of low-SEP people to harmful drinking. The main objective of this study was to measure the evolution of educational inequality in alcohol-related and non-alcohol related mortality by sex and age group in Spain during 2012-19. This is a repeated cross-sectional study. This study includes all residents in Spain aged 25 years and over from 2012 to 2019. (1) We calculated age-standardized mortality rates (ASMRs) from strongly/moderately alcohol-related causes (directly alcohol-attributable, unspecified liver cirrhosis, liver and upper aerodigestive tract cancers and moderately alcohol-related), weakly alcohol-related causes and other causes by educational level. (2) We used age-adjusted relative index of inequality (RII) and slope index of inequality (SII) to measure relative and absolute educational inequality in mortality, respectively. (3) Age-adjusted annual percentage change (APC) was also used to measure linear trends in mortality by educational level. RII, SII and APC were obtained from negative binomial regression. Between 2012-15 and 2016-19, economic growth accelerated, the RII in mortality from strongly/moderately alcohol-related causes increased from 2.0 to 2.2 among men and from 1.1 to 1.3 among women, and the SII in deaths/100 000 person-years from 181.4 to 190.9 among men and from 18.9 to 46.5 among women. It also increased relative and absolute inequality in mortality from weakly alcohol-related and other causes of death in both men and women. These increases in inequality were due primarily to a flattening or even reversal of the downward mortality trend among low- and medium-educated people. During the economic expansion of 2012-19 in Spain, changes in mortality risk from strongly/moderately alcohol-related causes were especially unfavourable among low- and medium-educated people.

Sport, Physical Activity and (Harmful) Alcohol Drinking in University Students During the First Year After COVID-19 Pandemic: Gender-Stratified Cross-Sectional Study

Abstract Introduction. COVID-19 pandemic increased consumption of alcohol (including harmful drinking – HD), and decreased physical activity levels (PAL) globally, but there is an evident lack of studies examining the problem in the post-pandemic period. This study aimed to evaluate gender-specific associations between sport participation and PAL (independent variables), and HD (dependent variable) among college/university students during the first post-pandemic year of the COVID-19 pandemic. Material and Methods. The participants were college/university students, aged 18 to 21 years (n = 788; 409 females) from Croatia and Bosnia and Herzegovina. They were tested on socio-demographic factors, HD (using the AUDIT scale), sport participation and PAL (using the IPAQ questionnaire). Analysis of variance, Chi square test, and t-test for independent samples were used to evaluate differences, while logistic regression with dichotomized criterion (HD vs. non-harmful drinking – NHD) was calculated to establish associations between independent and dependent variables. Results. T-test indicated significant differences between HD and NHD in PAL (t-test = 2.16, p = 0.02), but only in males. Also, logistic regression indicated a significant correlation between PAL and HD in males (OR: 1.41, 95%CI: 1.11-1.76), while no association was evidenced: (i) between sport participation and HD (in both males and females), and (ii) between PAL and HD (in females). Conclusions. Results indicated that an overall increase in PAL could be helpful in decreasing HD among college/university students; however, to evaluate it more specifically, prospective analyses are needed.

Evaluating the effects of minimum unit pricing in Scotland on the prevalence of harmful drinking: a controlled interrupted time series analysis

ObjectivesIn May 2018, the Scottish Government introduced a minimum unit price (MUP) for alcohol of £0.50 (1 UK unit = 8 g ethanol) to reduce alcohol consumption, particularly among people drinking at harmful levels. This study aimed to evaluate MUP's impact on the prevalence of harmful drinking among adults in Scotland. Study designThis was a controlled interrupted monthly time series analysis of repeat cross-sectional data collected via 1-week drinking diaries from adult drinkers in Scotland (N = 38,674) and Northern England (N = 71,687) between January 2009 and February 2020. MethodsThe primary outcome was the proportion of drinkers consuming at harmful levels (>50 [men] or >35 [women] units in diary week). The secondary outcomes included the proportion of drinkers consuming at hazardous (≥14–50 [men] or ≥14–35 [women] units) and moderate (<14 units) levels and measures of beverage preferences and drinking patterns. Analyses also examined the prevalence of harmful drinking in key subgroups. ResultsThere was no significant change in the proportion of drinkers consuming at harmful levels (β = +0.6 percentage points; 95% confidence interval [CI] = −1.1, +2.3) or moderate levels (β = +1.4 percentage points; 95% confidence interval = −1.1, +3.8) after the introduction of MUP. The proportion consuming at hazardous levels fell significantly by 3.5 percentage points (95% CI = −5.4, −1.7). There were no significant changes in other secondary outcomes or in the subgroup analyses after correction for multiple testing. ConclusionsIntroducing MUP in Scotland was not associated with reductions in the proportion of drinkers consuming at harmful levels but did reduce the prevalence of hazardous drinking. This adds to previous evidence that MUP reduced overall alcohol consumption in Scotland and consumption among those drinking above moderate levels.

Minimum unit pricing and the messiness of evidence-based policy.

On the face of it, minimum unit pricing is a textbook case of evidence-based policymaking. Yet as John Holmes shows, policy evidence can be messy and ambiguous. To make sense of it, we should not be afraid to draw on wider evidence of pricing policies in other contexts. As somebody with a keen interest in evidence-based policy, and somebody who has been involved in United Kingdom alcohol policy analysis and debate for the past 7 years, following minimum unit pricing (MUP) in Scotland has been a fascinating experience. The Scottish Government's approach to evaluation has been, as John Holmes remarks, ‘notable for its ambition and comprehensiveness’ [1]. It is in many ways a model for other policymakers to follow. The Government embarked on an experimental new policy approach and committed to reviewing it after 6 years. In advance, it engaged a range of independent researchers, led by the arms-length body Public Health Scotland (PHS), to assess whether the policy is working. If the policy is successful, the Government will retain MUP. If it fails, the regulation will be dropped. It all seems a most admirable approach. The trouble, as John Holmes’ analysis shows, is that demonstrating a policy is ‘working’ is trickier than it seems. There may be some interventions that have such a huge and obvious impact that their success is incontrovertible. However, they are the exception. Most policies—and MUP seems to be among them—have more modest, ambiguous effects that may take some time to emerge. Modest and ambiguous does not mean trivial. A key piece of the evidence jigsaw puzzle that has emerged since Holmes’ article was completed is PHS’ estimate that MUP reduced deaths wholly attributable to alcohol by 13% [2]. That implies that hundreds of lives have been saved—PHS put the total at 156 a year. Yet sceptics of the policy will attribute such figures—alongside the 3% to 3.5% reduction in alcohol consumption in Scotland relative to England identified by Holmes—to random noise. They are likely to put more weight on the ambiguous evidence regarding the responsiveness of the heaviest and most harmful drinkers. In my view, the evidence we have so far is still just about consistent with the possibility that MUP had no real effect on harmful drinking, although you need to squint a bit, or apply some bad faith, to think it is the most likely explanation of the facts. This is the valley in which MUP finds itself. On the balance of probabilities, a success, but not yet an undeniable one. In assessing all this for myself, I have been struck by how far I have ended up relying on my ‘prior’ (as Bayesians would put it) that pricing policies are effective. In other words, I am more inclined to say that the balance of probabilities counts in favour of MUP being effective because the evidence we have on it is consistent with the theory and evidence that making alcohol more expensive reduces harm. The model of evidence-based policy I sketched earlier implied that we should only need to look at what is happening on the ground in Scotland to know whether MUP is achieving its aims. Yet, I personally have found it much more helpful to put it in the context of the range of studies, combined in multiple meta-analyses, confirmed by independent replication studies, that reinforce the conclusion that people drink less if prices go up, and if they drink less that has positive health and social consequences [3-6]. If we start with that context in mind, I do not think there is much in the accumulated evidence on MUP in Scotland that should shake us from our expectation that the policy should produce positive outcomes. Indeed, the evidence that we have is clearly consistent with those positive outcomes being achieved. I can see the argument that this amounts to a sort of prejudice, when evidence-based policy should mean judging individual policies on their merits. I am not so sure though. When the information we get from individual evaluations is as contestable as it is, I think we do ourselves a disservice if we fail to draw on the other things we know to reach balanced conclusions. To reach a proper understanding of MUP's effectiveness in Scotland, we may do well to widen our lenses. None. No data involved in this paper.

Why do adults drink alcohol? Development and validation of a Drinking Motives Questionnaire for adults.

The Drinking Motives Questionnaire-Revised (DMQ-R; Cooper, 1994) is frequently used to assess adult drinking motives despite being designed for younger drinkers. This study aimed to develop and validate a Drinking Motives Questionnaire for Adults (DMQ-A). A convenience sample of 1,617 adults (25-65-year-olds; Mage = 51.4, SD = 10.8; 67% female) and 145 young-adults (18-24-year-olds; Mage = 20.8, SD = 2.0; 72% female) who reported drinking at least monthly were asked how often they consumed alcohol due to 53 drinking motives. Using item endorsement and exploratory factor analysis on half of the split sample of adults, 20 items were selected for the DMQ-A. The DMQ-A was found to have social, coping, confidence, taste, and enhancement dimensions. The DMQ-R conformity dimension was replaced by one of drinking for confidence and a novel drinking for taste dimension was identified. The second half of the split sample was used to demonstrate the DMQ-A's adequate model fit (CFI = 0.93), good internal consistency (α = .81-.90) and 6-month test-retest reliability (r = .65-.74), correlation with corresponding DMQ-R dimensions (r = .90-.96), and better model fit for adults than young-adults (ΔCFI = .03). The DMQ-A also demonstrated higher endorsement for each of its dimensions and better model fit than the DMQ-R among adults (ΔCFI = .05). Like the DMQ-R, DMQ-A coping and enhancement dimensions correlated with alcohol consumption and harmful drinking (r = .19-.42). The DMQ-A is a promising tool for future research or clinical application involving adult alcohol use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Outcomes following liver transplant for alcohol-associated liver disease: comparing alcohol-associated hepatitis and cirrhosis.

Liver transplant (LT) is a highly effective therapy for refractory severe alcohol-associated hepatitis (SAH), but optimal selection criteria remain unknown. We aim to evaluate the outcomes of patients who received LT for alcohol-associated liver disease at our center following the introduction of updated selection criteria, including the removal of the minimum sobriety requirement. Data were collected on all patients who underwent LT for alcohol-associated liver disease from January 1, 2018, to September 30, 2020. Patients were divided into SAH and cirrhosis cohorts based on disease phenotype. One hundred twenty-three patients underwent LT for alcohol-associated liver disease, including 89 (72.4%) for cirrhosis and 34 (27.6%) for SAH. There was no difference in 1- (97.1 ± 2.9% vs. 97.7 ± 1.6%, p = 0.97) and 3-year (97.1 ± 2.9% vs. 92.4 ± 3.4%, p = 0.97) survival between SAH and cirrhosis cohorts. Return to alcohol use was more frequent in the SAH cohort at 1 year (29.4 ± 7.8% vs. 11.4 ± 3.4%, p = 0.005) and 3 years (45.1 ± 8.7% vs. 21.0 ± 6.2%, p = 0.005) including higher frequencies of both slips and problematic drinking. Unsuccessful alcohol use counseling (HR 3.42, 95% CI 1.12-10.5) and prior alcohol support meetings (HR 3.01, 95% CI 1.03-8.83) predicted a return to harmful alcohol use patterns in early LT recipients. Both duration of sobriety (c-statistic 0.32 (95% CI 0.34-0.43) and SALT score (c-statistic 0.47, 95% CI 0.34-0.60) were independently poor predictors of return to harmful drinking. Survival following LT was excellent in both SAH and cirrhosis cohorts. Higher rates of return to alcohol use highlight the importance of further individualized refinement of selection criteria and improved support following LT.

Measuring alcohol consumption while watching sport events: a feasibility and validity study comparing ecological momentary assessments and transdermal alcohol monitors

ABSTRACT Background This feasibility and validity study aimed to evaluate and compare ecological momentary assessment (EMA) surveys and transdermal SCRAM-CAM monitors to measure drinking while watching Australian Rules Football (AFL). Methods During 29 events, 13 participants wore a SCRAM-CAM monitor while completing EMA surveys. Correspondence in the alcohol levels detected and correlation between the self-reported drinks and transdermal alcohol concentration (TAC) were measured. An exit survey assessed participant experiences. Results Alcohol consumption was self-reported on 24 (83.3%) of 29 events, with an average of 5.0 standard drinks consumed over 2.3 hours. Correspondence in the levels of alcohol detected was good at 0.62. TAC curves showed large-sized correlations to the number of self-reported drinks (r = 0.55–0.67). Some participants noted discomfort from the SCRAM-CAM, whilst others reported annoyance completing EMA surveys during a match. Conclusions EMA surveys are a cost effective method for collecting information on drinking as well as contexts and other factors such as harms. A clear benefit of the SCRAM-CAM is the ability to provide detailed information on intoxication trajectories. We suggest that a combination of the two methods will inform the most meaningful approaches for prevention and intervention strategies to reduce harmful drinking among sport spectators.