Heavy Episodic Alcohol Research Articles

Alcohol and Cardiovascular Disease: How Much is Too Much?

Previous research suggests that low-moderate alcohol consumption may have cardioprotective effects, while heavy or binge-pattern drinking is harmful. New evidence and research methodology may inform safe thresholds of alcohol use. This review examines recent evidence regarding alcohol's effect on cardiovascular disease, with a special consideration of pattern, drink type, and total quantity. New epidemiologic research confirms the potential harmful cardiovascular effects of heavy episodic alcohol use and does not support the previous observation that low-moderate alcohol use protects against stroke. Alcohol consumption also appears to have a continuous positive relationship with the risk of atrial fibrillation. In addition, Mendelian randomization analyses suggest that alcohol may have a direct causal role in adverse cardiovascular effects. Recent studies have confirmed that heavy alcohol use (>14 drinks per week in women and >21 drinks per week in men) and heavy episodic drinking are associated with an increased risk of mortality. New research raises concerns that even low-moderate alcohol use may not offer cardio- or cerebrovascular protection. Drinking ≥3 drinks per day on a regular basis or ≥5 drinks in any one episode should be discouraged.

Binge Drinking: Current Diagnostic and Therapeutic Issues.

The concept of binge drinking (BD) refers to patterns of heavy episodic alcohol consumption, with BD primarily occurring among adolescents and young adults. Several official definitions of BD have been proposed, in particular by the World Health Organization, the National Institute on Alcoholism and Alcohol Abuse, and the Substance Abuse and Mental Health Services Administration. Nevertheless, none of these definitions address the psychosocial and medical consequences of the type of alcohol use seen in BD. In practice, BD can thus correspond to either hazardous or harmful use of alcohol (HUA), while the episodic nature of heavy drinking in BD means that it does not meet the criteria for 'alcohol dependence'. This diagnostic differentiation is important because it determines which type of intervention is recommended. Psychosocial, rather than pharmacological, interventions are recommended as first-line treatment for adults with HUA, while pharmacological treatment is recommended for alcohol dependence; however, HUA appears to be associated with much poorer outcomes in adolescents, which could thus warrant early use of pharmacotherapy in this patient group. For HUA, and especially in adolescents, there is currently a severe lack of data regarding the efficacy and safety of the different drugs that have been approved for adults with alcohol dependence. Various guidelines propose the use of drugs for some types of BD but that use remains off-label and empirical, which raises important safety and ethical concerns. Future research on BD should systematically assess the criteria for HUA to better differentiate its subtypes with actual consequences and better address the heterogeneity of BD in terms of both clinical profiles and outcomes. Regarding pharmacotherapy, some national guidelines have recommended nalmefene for 'mild' dependence or second-line treatment for HUA, but such recommendations are not supported by evidence. Only naltrexone has been investigated in HUA but not in adolescents. More clinical trials should be conducted among adolescents with BD and HUA criteria to determine the most appropriate use of drugs in this particularly vulnerable population of subjects.

Heavy episodic alcohol drinking among students from a rural South African university: Correlates with personal-social variables

The aim of the study was to explore the personal and social factors contributing to heavy episodic alcohol drinking (HEAD) in a sample of students from a rural South African university. A sample of 837 undergraduate students (females = 56.6%; age range of 17 to 43 years) participated in the study. Data on their use of alcohol were gathered using the AUDIT questionnaire. The students also self-reported on their personal-social variables. The descriptive analysis indicated 14% of the students engage in heavy episodic alcohol drinking, with more males being heavy drinkers (28% of the sample) when compared to their female peers (10% of the sample). Being female, attending church at least once a week and being in a non-abusive relationship were associated with lower likelihoods of HEAD. The percentage of women with HEAD increased three-fold from 6% in their first year to 18.4% in the fourth year of study, while that for men increased from 17.2% in the first year to 40% in the second year, then declined to 26.4% in third year before an increase to 34.7% in the fourth year of study. HEAD occurrences were similar across sociodemographic variables. The reasons for females engaging in HEAD more over the period of their university attendance need to be investigated to inform student counselling services.

Mostly Smokers: Identifying Subtypes of Emerging Adult Substance Users

ABSTRACTBackground: The concurrent use of marijuana and other substances among emerging adults (ages 18–25) is a major public health problem. This study examined if there are distinct subtypes of emerging adult marijuana users and if these are associated with demographic and substance use variables. Methods: The design was a cross-sectional interview with a community sample of 1,503 emerging adults in the northeastern U.S. who reported last month marijuana use. We used latent class analysis (LCA) to identify distinct subtypes of emerging adults who used additional substances and examined predictors of the latent classes. Results: We identified three distinct classes of emerging adults who use substances: “mostly smokers” (those who primarily use marijuana and nicotine), “moderate users” (those who primarily use marijuana and/or heavy episodic alcohol), and “polysubstance users.” Polysubstance users had higher probabilities of use of all assessed substances (e.g. cocaine, opiates, sleep medications, stimulants, synthetic marijuana, and inhalants) than the other two groups. Not being currently enrolled in school and male gender were associated with mostly smokers and polysubstance users group status. Conclusions: We identified a distinct group of emerging adult marijuana users who primarily smoke marijuana and cigarettes, suggesting that there could be a shared vulnerability for risk of co-occurrence.

Perceived racial discrimination, heavy episodic drinking, and alcohol abstinence among African American and White college students

ABSTRACTPrevious research has demonstrated that White college students are more likely to drink alcohol at a greater frequency and quantity compared to their African American counterparts. Examining race-related factors that structure alcohol use among college students remains an important area of research. In this study, we specifically examine perceived discrimination and its association with both heavy episodic drinking (HED) and alcohol abstinence among college students. Items that measured perceived racial discrimination in alcohol use contexts and demographic characteristics were used as independent and control variables. African American students were more likely to abstain from alcohol and less likely to engage in HED compared to their White counterparts. Results also suggest that students who believe their drinking will solicit race-based police bias have lower odds of engaging in HED and greater odds of alcohol abstention. We conclude that unsolicited policing, experienced by African Americans generally, and White Americans on campuses, explains effect sizes.

Elevated Soluble CD14 and Lower D-Dimer Are Associated With Cigarette Smoking and Heavy Episodic Alcohol Use in Persons Living With HIV.

Persons living with HIV are at increased risk for cardiovascular disease in part because of persistent inflammation and coagulation activation. We examined whether smoking and heavy episodic alcohol use (defined as 5 or more drinks on one occasion) were associated with greater monocyte activation (soluble CD14) and coagulation (D-dimer) in participants in the Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy (the "SUN" Study), a prospective observational cohort. Using regression analysis (n = 689), current smoking compared with nonsmoking was associated with significantly elevated soluble CD14 (B = 135.57, 95% confidence interval: 84.95 to 186.19, P < 0.001), whereas heavy alcohol use compared with nonheavy use was associated with significantly lower D-dimer levels (B = -0.059, 95% confidence interval: -0.102 to -0.016, P = 0.007). Smoking cessation should be encouraged by HIV care providers to improve mortality outcomes from all causes of death, particularly cardiovascular disease.

Trajectories of alcohol use and consequences in college women with and without depressed mood

College students with depressed mood face heightened risk for experiencing drinking-related negative consequences. However, few studies have examined prospective patterns of alcohol consequences among depressed students. In the present investigation, we assessed how first-year college women's trajectories of heavy episodic drinking (HED) and alcohol consequences differed as a function of depressed mood at college entry. Participants were 233 heavy drinking incoming first-year college females (61% White) at a mid-sized West Coast University. Participants completed an online baseline survey, attended a single brief group intervention session, and completed 1- and 6-month post-intervention follow-up surveys. Depressed mood, alcohol consumption, and alcohol consequences were assessed at each time point. We employed latent growth curve analyses. Females with depressed mood, versus without depressed mood, experienced greater levels of alcohol consequences overall, particularly during transitions to college. However, contrary to hypotheses, participants with depressed mood (vs. without) exhibited significantly steeper declining trends in consequences, controlling for treatment condition, age, race, and ethnicity, and despite stable drinking levels, depressed mood, and use of protective behaviors over time. Potential explanations and suggestions for future research are discussed.

Effects of Brief Alcohol Interventions on Drinking and Driving among Youth: A Systematic Review and Meta-analysis.

Alcohol-impaired driving persists as a major cause of traffic fatalities and injuries among young drivers. This meta-analysis examined whether brief alcohol interventions were effective in reducing driving after drinking among adolescents and young adults. Our systematic search identified 12 experimental/quasi-experimental evaluations (16 intervention groups) that measured driving while intoxicated and related consequences and provided data for effect size calculation (N = 5,664; M age =17 years; 57% male). The studies were published between 1991 and 2011. Three-level random-effects meta-analyses using a structural equation modeling approach were used to summarize the effects of the interventions. Compared with controls, participants in brief alcohol interventions reported reduced drinking and driving and related consequences (ḡ = 0.15, 95% CI [0.08, 0.21]). Supplemental analyses indicated that reductions in driving while intoxicated were positively associated with the reduced post-intervention heavy use of alcohol. These findings were not attenuated by study design or implementation factors. Brief alcohol interventions under 5 hours of contact may constitute a promising preventive approach targeting drinking and driving among adolescents and young adults. Reducing heavy episodic alcohol consumption appeared to be a major factor in reducing drunk-driving instances. Interpretation of the findings must be made with caution, however, given the possibility of publication bias and the small observed effect size. Future research should focus on the exact mechanisms of behavior change leading to beneficial outcomes of brief alcohol interventions and the potential effectiveness of combined brief interventions and other preventive approaches.

Examining the efficacy of a brief group protective behavioral strategies skills training alcohol intervention with college women.

College students' use of protective behavioral strategies (PBS; e.g., determining not to exceed a set number of drinks, avoiding drinking games) is related to lower levels of alcohol consumption and problems. The present study evaluated the efficacy of a novel brief, single-session group PBS skills training intervention aimed at increasing college students' use of PBS and reducing risky drinking and consequences. Participants (N = 226) were heavy-drinking incoming first-year college women randomized to either a PBS skills training intervention or study skills control condition. Participants attended a 45-min group session and completed online surveys pre- and postintervention (1 month and 6 months). We conducted a series of 2 × 2 × 3 repeated-measures ANCOVAs with condition and baseline mental health (anxiety/depression) as the between-subjects factors and time as the within-subjects factor. Intervention participants, relative to controls, reported significantly greater increases in PBS use and reductions in both heavy episodic drinking and alcohol consequences. The intervention was particularly effective in increasing PBS use at 1 month among participants with high anxiety. Further, tests of moderated mediation showed a significant conditional indirect effect of condition on 1-month consequences through PBS use among participants with high levels of anxiety. Findings provide preliminary support for a brief PBS-specific group intervention to reduce alcohol risk among college women, particularly anxious women. Future research is needed to strengthen the long-term effectiveness of the present approach and further explore the moderating effects of mental health.

Childhood ADHD Potentiates the Association Between Problematic Drinking and Intimate Partner Violence

Objective: Excessive alcohol consumption increases risk of perpetrating intimate partner violence (IPV). ADHD is associated with problematic drinking and IPV, but it is unclear whether problem drinkers with ADHD are more likely than those without ADHD to perpetrate IPV. Method: We compared the strength of association between problem drinking trajectories and IPV perpetration among 19- to 24-year-old men with (n = 241) and without (n = 180) childhood ADHD. Results: Men with ADHD who reported higher heavy episodic drinking or alcohol use problems at age 19, and slower decreases in alcohol use problems from age 19 to 24, were more likely to perpetrate IPV than problem drinkers without ADHD, among whom the same associations were non-significant. Associations between problem drinking and IPV were not attenuated in adults with ADHD upon controlling for antisocial personality disorder. Conclusion: Study findings highlight the heightened risk of problem drinkers with ADHD perpetrating IPV.

Heavy alcohol use, marijuana use, and concomitant use by adolescents are associated with unique and shared cognitive decrements.

To assess recovery of cognitive effects, we investigated neuropsychological performance after 1 month of monitored abstinence in teens with histories of heavy episodic drinking, protracted marijuana use, or concomitant use of alcohol and marijuana. Adolescents (ages 16-18 years) with histories of heavy episodic drinking (HED; n=24), marijuana use (MJ; n=20), both heavy alcohol and marijuana use (HED+MJ; n=29), and socio-demographically similar control teens (CON; n=55) completed a neuropsychological battery following 4 weeks of monitored abstinence. Groups were similar on 5th grade standardized test scores, suggesting comparable academic functioning before onset of substance use. Relative to CON, HED showed poorer cognitive flexibility (p=.006), verbal recall (p=.024), semantic clustering (p=.011), and reading skills (p=.018). MJ performed worse than CON on inhibition task accuracy (p=.015), cued verbal memory (p=.031), and psychomotor speed (p=.027). Similar to HED youth, HED+MJ showed differences relative to CON on cognitive flexibility (p=.024) and verbal recall (p=.049). As with MJ teens, HED+MJ showed poorer task accuracy (p=.020). Unique to the HED+MJ group was poorer working memory (p=.012) relative to CON. For all substance using participants, worse performance across domains correlated with more lifetime use of alcohol and of marijuana, more withdrawal symptoms from alcohol, and earlier age of onset of marijuana use (ps<.05). Heavy alcohol use, marijuana use, and concomitant use of both substances during adolescence appear to be associated with decrements in cognitive functioning, and each substance (or combination of substances) may be linked to poorer performance in specific cognitive domains.

Exploring heavy drinking patterns among black and white young adults.

ABSTRACT. This investigation examined patterns of heavy drinking among Black and White young adults from a person-centered perspective and linked family and individual factors in adolescence to young adult drinking patterns. The analysis focuses on 331 10th-grade students (168 Whites, 163 Blacks; 51% males) who were followed into young adulthood (ages 20 and 22). Cluster analyses using heavy episodic drinking, drunkenness, and alcohol problems in young adulthood resulted in groups of drinkers with different patterns. Groups were examined across and within race. Associations between young adult drinking groups and adolescent family and individual factors were tested. Groups followed well-established race differences, with Whites clustering into frequent drinking groups more than Blacks, and Blacks clustering into non-heavy drinking groups more than Whites. Further, Black heavy drinkers reported fewer alcohol problems than White counterparts. Parental monitoring, consistent discipline, ethnic identity, and delinquency were associated with adult heavy episodic drinking groups for both races. Monitoring and delinquency, along with parental norms, were associated with drunkenness groups for both races. However, race differences were observed for drunkenness clusters such that attachment was predictive for White clusters, and parental guidelines and discipline were predictive for Black clusters. Large race differences in heavy drinking at young adulthood were confirmed. Family dynamics in 10th grade were identified as important for the development of different drinking patterns in the early 20s, when many individuals have left home, which suggests a key target for substance use prevention programs. (J. Stud. Alcohol Drugs, 75, 839-849, 2014).

Adolescent drinking onset and its adult consequences among men: a population based study from India

BackgroundFew population-based studies from low-income and middle-income countries have addressed adolescent drinking onset and its association with adult alcohol-related adverse outcomes. The aims of this study were to: (1) estimate...

Childhood and adolescent predictors of heavy episodic drinking and alcohol use disorder at ages 21 and 33: a domain-specific cumulative risk model.

Guided by a domain-specific cumulative risk model and an emerging notion of general and alcohol-specific influences, this study examined whether general and alcohol-specific influences from family, peer, and school contexts in childhood and adolescence differentially predict heavy episodic drinking and alcohol use disorder at two developmental periods: the transition to adulthood (age 21) and later in adulthood (age 33). Data are from a longitudinal panel study (n = 808) examining the etiology of substance use problems and associated behavior problems from age 10 to age 33 in a Northwest United States urban community sample. The sample is ethnically diverse and evenly distributed by gender (51% male). At age 21, alcohol problems were most consistently predicted by adolescent family alcohol and peer alcohol environments and by peer general environment, but not by general family functioning. Conversely, by age 33, alcohol problems were more consistently predicted by general poor family functioning in adolescence and not by family alcohol or any of the peer environment measures. Adolescent family and peer alcohol environment influenced alcohol problems at the transition to adulthood. However, alcohol problems later in adulthood were more strongly associated with general poor family functioning in adolescence. These results suggest that alcohol prevention efforts should involve both components designed to reduce alcohol-specific risk and components to improve general family and peer environments during childhood and adolescence.

Linking masculinity to negative drinking consequences: the mediating roles of heavy episodic drinking and alcohol expectancies.

This study extends previous research on masculinity and negative drinking consequences among young men by considering mediating effects of heavy episodic drinking (HED) and alcohol expectancies. We hypothesized that masculinity would have a direct relationship with negative consequences from drinking as well as indirect relationships mediated by HED and alcohol expectancies of courage, risk, and aggression. A random sample of 1,436 college and university men ages 19-25 years completed an online survey, including conformity to masculine norms, alcohol-related expectancies, HED, and negative drinking consequences. Regression analyses and structural equation modeling were used. Six of seven dimensions of masculinity and the alcohol expectancy scales were significantly associated with both HED and negative consequences. In multivariate regression models predicting HED and negative consequences, the playboy and violence dimensions of masculinity and the risk/aggression alcohol expectancy remained significant. HED and the risk-taking dimension of masculinity were also significant in the model predicting negative consequences. The structural equation model indicated that masculinity was directly associated with HED and negative consequences but also influenced negative consequences indirectly through HED and alcohol expectancies. The findings suggest that, among young adult male college and university students, masculinity is an important factor related to both HED and drinking consequences, with the latter effect partly mediated by HED and alcohol expectancies. Addressing male norms about masculinity may help to reduce HED and negative consequences from drinking.

Effects of heavy episodic drinking on physical performance in club level rugby union players.

This study investigated the effects of acute alcohol consumption, in a natural setting, on exercise performance in the 2 days after the drinking episode. Additionally, alcohol related behaviours of this group of rugby players were identified. Prospective cohort study. Nineteen male club rugby players volunteered for this study. Measures of counter movement jump, maximal lower body strength, repeated sprint ability and hydration were made 2 days before and in the 2 days following heavy episodic alcohol consumption. Participants completed a questionnaire at each time point so that alcohol consumption and sleep hours from the previous 24 h period could be quantified. Additionally, participants completed the Alcohol Use Disorders Test (AUDIT) prior to completing baseline measures of performance. Reported alcohol consumption ranged from 6 to >20 standard drinks (mean category scale score=11-19 standard drinks). A significant decrease in sleep hours (p=0.01) was reported after the drinking episode with participants reporting 1-3 h for the night. A significant reduction (-1.8±1.5 cm) in counter movement jump (p<0.01) the morning after the drinking episode was observed; no other measures were altered at any time point compared to baseline (p>0.05). AUDIT scores for this group (18.2±4.3) indicate regular alcohol consumption at a hazardous level. Heavy episodic alcohol use, and associated reduced sleep hours, results in a reduction in lower body power output but not other measures of anaerobic performance the morning after a drinking session. Full recovery from this behaviour is achieved by 2 days post drinking episode.

A violent mix? The association between concurrent alcohol and cocaine use and violence amongst young people in England and Wales

Aim: This study explored the association between concurrent alcohol and cocaine use and its predictive probability of self-reported violent behaviour. Methods: A series of logistic regression models were run on a sample of 3098 young people (aged 16–25) from a national self-report study. Findings: Current cocaine use was identified as predictive of violent offending (Exp B = 2.363, p ≤ 0.01). Cocaine use was also more likely in those reporting heavy episodic drinking. Whilst findings suggested an additive risk for both heavy episodic drinking and cocaine consumption, there was no evidence of a multiplicative risk associated with concurrent use on the probability of assault outcomes. Results also suggest that heavy episodic alcohol drinking was mediated by experience of violent victimization and having been involved in anti-social behaviour. Conclusions: Findings suggest that whilst interventions aimed at reducing drinking or cocaine consumption are likely to have some effect in reducing offending behaviour, attention should also be given to other individual level factors such as prior violent victimization and wider involvement in anti-social behaviour as these may be confounded as part of a wider substance misusing lifestyle or associated with violence as part as a wider repertoire of anti-social behaviour.

Associations between heavy episodic drinking and alcohol related injuries: a case control study

BackgroundAlcohol is a significant risk factor for injuries. This study addresses 1) whether the risk of alcohol related injury increases with frequency of heavy episodic drinking (HED) in a linear fashion, and 2) whether a small group of high risk drinkers accounts for the majority of alcohol related injuries.MethodsWe applied a case – control design. Cases were BAC positive injured patients (n = 534) and controls were respondents to a general population survey in Norway (n = 1947). Age and gender adjusted association between self-reported past year HED frequency and alcohol related injury risk was estimated in logistic regression models for all alcohol related injuries and for violence injuries and accident injuries separately.ResultsAn increase in HED was associated with an increase in risk of alcohol related injury, resembling a linear risk function. The small fraction of high risk drinkers (6.6%) accounted for 41.6% of all alcohol related injuries, thus lending support to the validity of the prevention paradox.ConclusionThere is a strong relationship between frequency of heavy episodic drinking and risk of alcohol related injuries, yet the majority of alcohol related injuries are found among drinkers who are not in the high risk group.

Reassessing the Effects of Early Adolescent Alcohol Use on Later Antisocial Behavior: A Longitudinal Study of Students in Victoria, Australia and Washington State, United States.

The effect of early adolescent alcohol use on antisocial behavior was examined at one- and two-year follow-up in Washington, United States and Victoria, Australia. Each state used the same methods to survey statewide representative samples of students (N = 1,858, 52% female) in 2002 (Grade 7 [G7]), 2003 (Grade 8 [G8]), and 2004 (Grade 9 [G9]). Rates of lifetime, current, frequent, and heavy episodic alcohol use were higher in Victoria than Washington State, whereas rates of five antisocial behaviors were generally comparable across states. After controlling for established risk factors, few associations between alcohol use and antisocial behavior remained, except that G7 current use predicted G8 police arrests and stealing and G9 carrying a weapon and stealing; G7 heavy episodic use predicted G8 and G9 police arrests; and G7 lifetime use predicted G9 carrying a weapon. Hence, risk factors other than alcohol were stronger predictors of antisocial behaviors.

Psychosocial correlates of hazardous alcohol use among undergraduates in southwestern Nigeria

ObjectiveThe aim of this study was to examine the relationship between alcohol use and psychological well-being among undergraduates of a Nigerian tertiary institution. The objectives included determining the prevalence and pattern of problematic alcohol use and ascertaining the association between alcohol use and some sociodemographic variables. MethodThe Alcohol Use Disorders Identification Test (AUDIT) was used to evaluate for alcohol-related problems in 443 students of a university in southwestern Nigeria. A questionnaire was also used to obtain data on sociodemographic variables while psychological well-being was assessed with the General Health Questionnaire-28. ResultsThe prevalence of alcohol use was 40.6% while alcohol-related problems were found in 14.9% of the students using the AUDIT questionnaire with a cutoff score of 5. Heavy episodic alcohol use was reported by 31.1% while alcohol-related injury had occurred in 8.9% of the students. Male gender (χ2=4.54; P<.05), older age (χ2=3.92; P<.05) and higher paternal education (χ2=4.40; P<.05) were associated with problem drinking. In addition, psychological distress was significantly associated with heavy episodic drinking (χ2=9.58; P<.05) and history of alcohol-related injury (χ2=3.96; P<.05). ConclusionThe significant relationship between hazardous drinking and mental ill health among undergraduates in the institution suggests the need for integrating mental health services in screening, brief intervention and referral to treatment services in Nigerian university settings.