Higher AUDIT Scores Research Articles

Changes in alcohol consumption during the COVID-19 among first-year university students in Spain, considering the risk of problematic use – UniHcos project

The aim of this study was to evaluate the possible impact of the COVID-19 pandemic on prevalence rates and self-reported changes in patterns of alcohol use among first-year university students in Spain, considering the risk of problematic alcohol use. A serial cross-sectional study based on the uniHcos project was carried out. Data from 10 518 first-year university students (73.3% female, mean age 19 (SD = 1.6)) collected between 2012 and 2022 were analysed. The evolution of the pooled prevalence rates during the time series was analysed and the risk of problematic alcohol consumption was assessed using the AUDIT. Also, self-reported changes in alcohol use patterns during the pandemic were assessed. According to the results, during the COVID-19 pandemic, the prevalence of alcohol use in the past 30-days was reduced (76.3% in 2019 vs. 63.7% in COVID-19) increasing again in the New Normal period. Thus, a similar pattern in the practice of binge drinking was observed. Regarding the AUDIT score, 21.7% (95%CI 20.9, 22.6) of the students had harmful alcohol consumption, with a higher proportion among males. In the multivariable logistic models, a higher AUDIT score was significantly associated (p-value < 0.001) with being male and living with roommates. According to self-reported changes in consumption patterns during the COVID-19 pandemic, a higher proportion of participants with harmful use reported an increase in alcohol consumption compared to those at low-risk (43% vs 19%). Finally, despite the overall reduction in drinking prevalence during COVID-19, changes were not equal for all students and depended on their previous level of problematic drinking, highlighting that this should be considered in the development of strategies against alcohol use in this population.

Exploring Experiences of Drink and Needle Spiking Incidents Among Global Drug Survey Respondents from 22 Countries

This study explored experiences of spiking following the re-opening of nightlife settings post COVID-19 lockdown. Global Drug Survey 2022, respondents were asked about experience, context, and consequences of drink/needle spiking. In a sample of 7697 respondents 2% reported experiencing spiking the last 12 months, and 20% over a year ago. Most occurred in clubs/bars (54.8%), but a quarter occurred in a private home. 84.9% of respondents suspected a drug was added to their drink; 4.2% thought they had been injected with a drug. Almost a fifth experienced sexual assault during the incident. Only 7.2% who experienced drink spiking reported it to police. Higher AUDIT scores, being a woman, recent illicit substance use and recent clubbing experience were also associated with recent spiking. Low rates of reporting means it is difficult to understand prevalence and causes. However, media reports of an epidemic of spiking appear to have been disproportionately emphasised.

Self-Esteem Mediates the Effects of Loneliness on Problematic Alcohol Use.

Loneliness has been associated with problematic alcohol use, but it is not known whether self-perceptions mediate this relationship. In this study, the general population in China (N = 1123) and Germany (N = 1018) was surveyed to assess whether self-esteem and self-efficacy mediate the effect of loneliness on problematic alcohol use in two culturally distinct environments. Multiple regression analysis demonstrated that higher AUDIT scores were negatively associated with self-esteem (b = -0.08, p < .001). Self-esteem mediated the effect of loneliness on AUDIT score (indirect effect: 0.06, CI: 0.03 - 0.10, p < .001), while self-efficacy did not (indirect effect: 0.02, CI: -0.003 - 0.05, p = .10). These findings suggest that self-esteem explains the relationship between loneliness and problematic alcohol use. As self-esteem may be more modifiable than external social factors, these results have positive practical implications for alcohol use disorder treatment strategies.

In people who drink more, facets of theory of mind may be impaired by alcohol stimuli

BackgroundTheory of mind (ToM) – the ability to understand others’ beliefs, mental states, and knowledge – is an important part of successful social interaction. There is a growing (albeit mixed) evidence base suggesting that individuals with substance use disorder or who are intoxicated (relative to sober controls) perform worse on a number of ToM tasks. The aim of this study was to explore the hitherto little explored notion that ToM-related capabilities such as the ability to see the world from another person’s perspective (termed Visual Perspective Taking; VPT), may be impacted by alcohol-related stimuli. MethodIn this pre-registered study, 108 participants (M age = 25.75, SD age = 5.67) completed a revised version of the director task where they followed the instructions of an avatar to move both alcohol beverages and soft drinks that were mutually visible (target objects) while avoiding those only visible to the participant (distractor items). ResultsContrary to predictions, accuracy was lower when the target drink was alcohol and the distractor was a soft drink, although higher AUDIT scores were associated with significantly lower accuracy when alcohol drinks were the distractor items. ConclusionsThere may be some contexts when being able to see alcohol beverages makes it harder to take another person’s perspective. It also appears that poorer VPT and perhaps ToM capacity may be evident in individuals who consume more alcohol. Future research is warranted to examine how alcohol beverages, alcohol consumption behaviours, and intoxication interact to impact VPT capacity.

Social networking site use and alcohol use behaviors among adolescents: A latent profile analysis

BackgroundAdolescent exposure to alcohol-related social networking site (SNS) content is associated with their own alcohol use. However, there is a need to better understand the relationship between varying levels of adolescent SNS use and alcohol-related risks. In this study, we sought to identify distinct patterns of SNS use across multiple platforms (Facebook, Instagram, and Snapchat) and to assess associations between those patterns and alcohol use outcomes. MethodsData were collected as part of a baseline assessment for a larger longitudinal experimental study. Participants (N = 306, age 15–20) completed measures of demographics, SNS use, and alcohol use. ResultsUsing latent profile analysis (LPA), three SNS use profiles were empirically derived: low SNS users (27.5%), high frequency, low duration users (47.4%), and high frequency, high duration users (25.2%). Significant differences in daily drinking (F [2, 301] = 3.39, p = 0.035) and AUDIT scores (F [2, 289] = 6.15, p = 0.002) were observed for the three profiles, with members of the high frequency, high duration profile reporting significantly more weekly drinks and higher AUDIT scores when compared to the other two profiles. ConclusionThese findings imply that a combination of high frequency and high duration SNS use may place individuals at risk for potentially problematic drinking. Given many clinicians have limited opportunities to delve into their patients’ SNS use patterns, results suggest that a simple understanding of frequency and duration of use may provide enough information to indicate who may be at risk.

Risk-taking in traffic is associated with unhealthy lifestyle: Contribution of aggressiveness and the serotonin transporter genotype

ObjectivesRisk taking behaviour, including in traffic, is related to impulsivity and aggressiveness, and so is unhealthy lifestyle. The serotonin transporter gene promoter polymorphism (5-HTTLPR) has been associated with impulsivity, aggression, alcohol use, speed limit exceeding and traffic accidents. The aim of this study was to examine whether subjects with less healthy eating and exercise habits take more risks in traffic, and whether impulsivity, aggressiveness and the serotonin transporter genotype could mediate or moderate any such associations. MethodA sub-sample of the Estonian Psychobiological Study of Traffic Behaviour (EPSTB (n ​= ​817) with mean age (SD) ​= ​31.4 (10.0) years filled out lifestyle questionnaires. Impulsivity was measured by Adaptive and Maladaptive Impulsivity Scale and aggressiveness by Buss – Perry Aggression Questionnaire. Traffic violation data in the previous 5 years period were obtained from police database. ResultsSpeed limit exceeders had higher physical and verbal aggression, higher AUDIT scores, they reported more vigorous physical activity and drinking energy drinks more often. Path analysis showed that higher AUDIT scores were associated with speeding via higher physical aggression. 5-HTTLPR was not directly associated with speeding or driving while impaired by alcohol (DWI), but 5-HTTLPR s’-allele carriers had lower AUDIT scores if they were not junk food eaters and the other way around, while l’/l’ homozygosity was associated with DWI via higher AUDIT scores. ConclusionSignificant associations exist between risky traffic behaviour and aspects of lifestyle such as consumption of alcohol or junk food or energy drinks, as well as engagement in vigorous physical activity, while traits such as aggressiveness and the variation in the serotonergic system appear as mediating and moderating factors. Interventions preventing accidents should focus on wider array of behaviours and use personalized approach. Genetic variation should be investigated regarding associations with risk taking and health behaviour, and response to interventions.

Exploring the Association between Alcohol Drinking and Physical Activity in Adolescence; Two-Year Prospective Study in Younger Adolescents from Bosnia and Herzegovina.

Insufficient physical activity and alcohol consumption (AC) are important health-threatening behaviors in adolescence, but there are controversial findings regarding the association that may exist between AC and physical activity levels (PALs) at this age. This study aimed to prospectively examine the relationship that may exist between AC and PAL in younger adolescence, considering the potential confounding effect of sports participation. The participants (n = 669, 337 females) were adolescents from Bosnia and Herzegovina who were tested on two occasions, at baseline (14 years of age) and again at follow-up (16 years of age). The variables included AC (as indicated by the AUDIT questionnaire), sports participation, age, gender (predictors), and PAL (obtained by the PAQ-A questionnaire) criterion. The results indicated that PAL at baseline was higher in those adolescents (boys) with a higher AUDIT score, but this association was partially confounded by sports participation. Multinomial regression indicated a higher risk of a decline in PAL over the study course in adolescents with a higher AUDIT score at baseline (OR = 1.32, 95%CI: 1.11–1.54 for being in the high-risk group for a decline in PAL). The most probable explanation is likely found in the high drop-out from sports in the studied period and earlier initiation of AC in adolescents involved in sports. Public health and sports authorities should urgently act preventively and develop educational programs against alcohol drinking in youth athletes.

Longitudinal associations with alcohol consumption during the first COVID-19 lockdown: Associations with mood, drinking motives, context of drinking, and mental health

BackgroundCoronavirus (COVID-19) resulted in lockdown measures in the UK, which has impacted alcohol use. Alcohol is often used as a coping mechanism and there are public health concerns regarding excessive consumption due to the pandemic. We aimed to longitudinally assess drinking behaviors, and associated factors, during the first UK government-mandated lockdown. MethodsAn online survey was distributed through social media (8th April 2020, onwards). Fortnightly follow up surveys were emailed to participants. The primary outcome measure was ‘weekly unit consumption’ and data was collected on a range of potentially related factors: demographics, factors relating to COVID-19 (e.g., health, work status), drinking motives, context of drinking, drinking intentions, mood, depression and anxiety. FindingsA total of 539 self-selected participants completed the baseline survey, with 186 completing at least 3 follow up surveys for multilevel modelling analysis. Personal coping motives, anxiety, drinking at home alone, and drinking at home with others were positively associated with alcohol consumption during lockdown. The following baseline measures also predicted increased consumption: male gender, lower education, and higher AUDIT scores (based on behavior prior to lockdown). Findings were consistent when utilizing an inverse probability weight to account for predictors of attrition (female, younger age, higher baseline AUDIT scores). ConclusionsThose already drinking at hazardous levels were more likely to increase their consumption, as were those who were drinking to cope. As we recover from the pandemic, there is a need for widespread alcohol support, and certain groups may need targeted support.

Psychoactive drug and medication use among patients referred to a tertiary sleep laboratory population

Psychoactive drugs including alcohol, caffeine, and prescription medications are commonly consumed to alter sleep/wake states, however the prevalence and impact of these drugs among populations seeking assessment from sleep physicians are unknown. We investigated the prevalence of commonly used drugs (alcohol and caffeine), and medications in a population (N=120; 50 females and 70 males) attending a tertiary sleep clinic for diagnostic polysomnography (PSG) assessment. In addition to objective sleep assessment, participants completed questionnaires assessing sleep quality (Pittsburgh Sleep Quality Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), alcohol use (Alcohol Use Disorders Identification Test, AUDIT), caffeine and medication use, as well as their experience of adverse events (motor vehicle accidents and near-miss crashes). Caffeine was consumed by 90% of the population and was associated with a reduction in excessive sleepiness symptomology; while high AUDIT scores were associated with increased near-miss crashes. Polypharmacy was common, with a greater number of medications associated with poorer sleep quality, and changes in sleep architecture. This study maps commonly used drugs in those attending a tertiary sleep clinic, and demonstrates associations between drug use and sleep outcomes assessed objectively and subjectively.

College Students’ Perceptions of Peer Alcohol Use: A Social Network Analytic Approach

Background: Traditional measures attempting to capture students’ perceptions of peer drinking fail to capture the unique social influence of their most proximal peers. Purpose: This study presents egocentric social network data assessing the relationship between students’ personal drinking behaviors and those of their closest social ties. Methods: 697 college students participated in the study by reporting on demographic information, alcohol use (AUDIT scores), and egocentric networks. Hierarchical linear regression assessed whether egocentric network variables uniquely predicted personal alcohol use, controlling for age, gender, race/ethnicity, and Greek-life affiliation. Results: Students with higher AUDIT scores were more likely to nominate persons close to them that engaged in more frequent, higher quantity drinking, and were also likely to mirror drinking behaviors to that of their close ties. Conclusion: Future studies should utilize SNA to capture the nuance associated with individuals’ perceptions of close others’ alcohol use and their own drinking behaviors. Interventions aimed at reducing collegiate drinking should consider the interpersonal nature of drinking behaviors among college student networks.

Implementation of AUDIT in the treatment planning process for alcohol use disorder in Greenland

Introduction The aim was to describe the treatment-seeking population with alcohol use disorder by means of data from the AUDIT questionnaire at referral and to evaluate and discuss if this information can be of use in treatment and service planning. Methods Data from 2016 to 2018 were extracted from the National Database on Substance Abuse Treatment. The sample included 1281 individual treatment seekers from all over Greenland. Results Mean age was 38.2 years (SD 12.1 years). Only 60.1% had a total AUDIT score suggesting dependency, and 15.5% had a harmful use. While most only drank 2–4 times a month, about 95% binge drank. Half reported loss of control at least weekly, and one of three had been unable to do what was expected of them, or needed a drink first thing in the morning weekly or more often. In two-third others had been concerned about the drinking. Users of cannabis had a higher AUDIT score, while gambling was unassociated to alcohol use. Substantial gender and regional differences were seen. Discussion The AUDIT screening was found useful in individual and national treatment planning. Data suggested that particular focus should be given to women in treatment, and the service offered to the East Greenlandic population.

Trends in and factors associated with the adoption of digital aids for smoking cessation and alcohol reduction: A population survey in England

BackgroundDigital smoking cessation and alcohol reduction aids are widely available in England. To estimate their public health impact, researchers need to consider their adoption in the target population. We assessed adoption rates, and characteristics of adopters, of digital smoking cessation and alcohol reduction aids in England. Methods3655 smokers and 2998 high-risk drinkers (defined as a score of >4 on the Alcohol Use Disorders Identification Test-Consumption; AUDIT-C) who had made a past-year quit/reduction attempt were surveyed as part of the Smoking and Alcohol Toolkit Studies between January 2015-October 2018. Respondents provided information on socio-demographic characteristics and whether they had used a digital aid in a recent quit/reduction attempt. Results2.7 % (95 % CI 2.2%–3.0%) of smokers and 3.6 % (95 % CI 2.9%–4.0%) of drinkers who had made a past-year quit/reduction attempt (26.9 % and 15.3 %, respectively) had used a digital aid. Survey year was not significantly associated with use in smokers or drinkers. None of the baseline characteristics were significantly associated with the use of a digital aid in smokers. Drinkers with high motivation to reduce alcohol consumption (ORadj = 2.49, 95 % CI 1.63–3.77, p < .001) and higher AUDIT scores (ORadj = 1.07, 95 % CI 1.03–1.11, p < .001) had greater odds of adoption. ConclusionsDigital smoking cessation and alcohol reduction aids are rarely used by smokers or high-risk drinkers attempting to quit/cut down in England, indicating that most of the target population is not being reached. Despite overall digital access improving, adoption rates remained similarly low between 2015–2018.

Intention to reduce drinking alcohol and preferred sources of support: An international cross-sectional study

IntroductionDrinking alcohol is legal in most countries of the world. Given the social acceptance of this behavior despite potential negative impact on health, help-seeking behavior could differ when compared to other drugs. This paper aimed to assess intentions to reduce drinking and the preferred sources of support among a large international sample of people who drink alcohol. Materials and methodsThe Global Drug Survey (GDS) is the world's largest annual survey of drug use. This paper included data from 82,190 respondents from 12 countries on four continents who reported the use of alcohol in the last 12 months, collected during November 2016–January 2017 (GDS2017). ResultsOverall, 34.8% said they would like to drink less in the following 12 months and 7.6% said they would like help to drink less. Online tools were the preferred source of support to reduce drinking by respondents from Australia, New Zealand, and the UK, those with low AUDIT scores and without a mental health condition. Specialist counselling was most preferred by those from Germany, Switzerland, and Denmark and those with high AUDIT scores, not educated to degree level and with a mental health condition. ConclusionInterest in online interventions for harmful drinking is significant and highest among people who drink at low risk. Online tools should offer brief screening and feedback, ensuring that people with high risk drinking patterns are referred to more specialist services.

Feasibility, acceptability, and validity of crowdsourcing for collecting longitudinal alcohol use data.

Challenges to conducting longitudinal research include financial, time, and geographic constraints. An emerging sampling method positioned to address these concerns is crowdsourcing. This study evaluated the feasibility, acceptability, and validity of collecting intensive longitudinal alcohol use data with the crowdsourcing platform, Amazon.com's Mechanical Turk (mTurk). Participants (N = 278) recruited from mTurk provided weekly recordings of daily alcohol and soda use over an 18-week period. Construct and external validity was evaluated using generalized linear mixed models describing associations of between-subject (e.g., alcohol use severity) and within-subject (e.g., day of week) variables with prospectively collected alcohol and soda use. High response rates were observed across the 18-week period demonstrating feasibility (64.1%-86.8%). The design was acceptable with 94% of participants indicating they were satisfied with the procedures. Multilevel models supported construct and external validity by replicating expected associations, such as more frequent and heavier drinking by individuals with higher AUDIT scores and on weekends. These effects were specific to alcohol use and did not extend to soda consumption. These data support the feasibility, acceptability, and validity of using mTurk for intensive longitudinal data collection. Future studies may leverage this platform to generate large, geographically diverse samples for prospective behavioral analytic research.

Association of serotonin and GABA pathway gene polymorphisms with alcohol dependence: A preliminary study.

Alcohol dependence (AD), characterized by profound disruptions in specific circuits of the brain is influenced by both environmental, which play a significant role in developing addiction and genetic factors, which make some individuals more susceptible to disruptions. Various polymorphisms in the neurotransmitter genes are reported to increase the risk of developing dependence. The present study aimed to identify association of serotonin and GABA polymorphisms with AD in Indian subjects. The study group comprised of 141 AD cases recruited as per DSM IV TR criteria from the outpatient Department of Psychiatry and 110 volunteers from the general population. Clinical and family history was noted and 5 ml blood drawn for genetic studies. Polymorphisms 5-HTTLPR and STin2 of serotonin and rs2279020 and rs3219151 of the GABA pathway were analyzed and results correlated with age at first use quantity consumed, duration of use, dependence and age at onset of dependence. The marker frequencies were similar between cases and controls except for rs3219151. 5-HTTLPR was significantly associated with high AUDIT scores and alcohol intake (p < 0.0001), GABAA rs2279020 and rs3219151 with age at first use (p < 0.0001); rs2279020 with higher AUDIT score (p = 0.002) and rs3219151 with quantity (p = 0.0001). High frequency of GABRA6 rs3219151 TT genotype in AD and its association with lower age at first use, higher intake/day, and higher duration of dependence appears to confer risk. This preliminary study, though on a smaller sample size, suggests an association of 5-HTTLPR and GABAA receptor polymorphisms with AD in our population.

Usefulness of hair analysis and psychological tests for identification of alcohol and drugs of abuse consumption in driving license regranting

The implementation of the points-based driving license helps to change the drivers’ behavior and is related to a reduction of traffic accidents and fatalities. In Spain, when a driver loses all points, the driving license is revoked, so the driver must enroll on a Driver Awareness and Re-education (DARE) course. However, at the moment offenders are not submitted to any test to confirm absence of alcohol or drugs of abuse consumption, even when 9% of Spanish drivers lose their driving license for driving under the influence (DUI). The objective of this pilot study was the comparison of the usefulness of psychological tests and hair analysis to identify those individuals with a chronic consumption of alcohol and drugs of abuse among drivers performing DARE courses. Volunteers were submitted to the AUDIT and DAST-10 tests. Also a hair sample was collected and analyzed for ethylglucuronide (EtG) (LOQ 5pg/mg) and 35 licit and illicit drugs (LOQ 5–50pg/mg) by LC–MS/MS. Sixty-one participants with a mean age of 37.2±11.6years, and mainly men (90.2%), were recruited and performed AUDIT and DAST-10 tests. All hair samples were analyzed for EtG and 17 samples for licit and illicit drugs. Mean AUDIT score was 9.6 (SD=7.5), showing a value ≥8 (indicator of hazardous and harmful alcohol use) in 52.4% of cases. Mean DAST-10 score was 2.9 (SD=3.3), but a score ≥6 was detected in 21.3% of cases (indicating drug abuse or dependence). Twenty-two samples were positive for EtG, 8 for drugs of abuse (8 cocaine, 2 opioids, 1 amphetamines, 1 cannabis), and 3 for medicines. EtG concentration (20.7–1254.1pg/mg) was higher than the Society of Hair Testing (SoHT) cut-off for chronic alcohol consumption (≥30pg/mg) in 21 cases. All positive cases for methadone and cannabis, and half of positive cases for opioids and cocaine presented higher concentrations than SoHT cut-offs for chronic consumption. Higher AUDIT score and higher EtG concentration in hair were statistically associated with declaration of alcohol consumption ≥4 times/month and with previous fine for DUI of alcohol. In addition, AUDIT scores and EtG concentration in hair had a moderate but significant Spearman correlation (r=0.331, p<0.05). The combination of psychological tests and hair analysis seems to be a promising tool to identify individuals with chronic and problematic consumption of alcohol and drugs of abuse. Moreover, their application during driving license regranting procedures could increase the effectiveness of DARE courses, reduce recidivism and improve road safety.

High Beck Depression Inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style

Beck Depression Inventory (BDI) is widely used in assessing adolescents’ psychological wellbeing, but occasionally the result diverges from diagnostics. Our aim was to identify factors associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population.The study comprised 206 inpatients (13–17 years old) and 203 age and gender matched non-referred adolescents. Study subjects filled self-reports on depression symptoms (BDI-21), alcohol use (AUDIT), defense styles (DSQ-40) and self-image (OSIQ-R), and on background information and adverse life events. Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available.We compared subjects who scored in BDI-21 either 0–15 points or 16–63 points firstly among subjects without current unipolar depression (n = 284), secondly among those with unipolar depression (n = 105). High BDI-21 scores in subjects without depression diagnosis (n = 48) were associated with female sex, adverse life events, parents’ psychiatric problems, higher comorbidity, higher AUDIT scores, worse self-image and more immature defense styles. Low BDI-21 scores among subjects with depression diagnosis (n = 23) were associated with male sex, more positive self-image and less immature defense style.In conclusion, high BDI-21 scores in the absence of depression may reflect a broad range of challenges in an adolescent's psychological development.

The association of alcohol use and quality of life in depressed and non-depressed individuals: a cross-sectional general population study

To compare the associations of alcohol-related variables with Quality of Life (QoL) in depressed and non-depressed individuals of the general population. This cross-sectional study utilized data from the FINRISK 2007 general population survey. A subsample (n = 4020) was invited to participate in an interview concerning alcohol use. Of them, 2215 (1028 men, 1187 women; response rate 55.1%) were included in the analyses. Bivariate associations between mean weekly alcohol consumption, frequency of binge drinking, Alcohol Use Disorders Identification Test (AUDIT)-score and QoL were analysed according to categorization into depressed and non-depressed using the Beck Depression Inventory, Short Form. Linear regression models were calculated in order to determine the associations of the alcohol variables and QoL after adjusting for socio-demographic variables as well as somatic and mental illness. Depressed individuals had lower mean QoL and higher AUDIT-scores than non-depressed respondents. Bivariate correlations showed that mean weekly alcohol consumption, frequency of binge drinking and AUDIT-scores were statistically significantly associated with impaired QoL in depressed individuals. Abstinence was not associated with QoL. After adjustment for covariates, frequency of binge drinking and AUDIT-score were statistically significantly associated with QoL in depressed individuals and AUDIT-score in the non-depressed group. When analysing all respondents regardless of depression, both AUDIT-score and binge drinking were associated with QoL. Of the alcohol-related variables, binge drinking and alcohol problems indicated by AUDIT-score contributed to impaired QoL in depressed individuals and both should be assessed as part of the clinical management of depression.

The Role of Alcohol on Antiretroviral Therapy Adherence Among Persons Living With HIV in Urban India.

The purpose of this study was to estimate the prevalence of alcohol use among men living with HIV on antiretroviral therapy (ART) and examine the association of alcohol use and psychosocial variables on ART adherence. The study was a cross-sectional survey supplemented by medical records and qualitative narratives as a part of the initial formative stage of a multilevel, multicentric intervention and evaluation project. A screening instrument was administered to men living with HIV (n = 3,088) at four ART Centers using the Alcohol Use Disorders Identification Test-consumption questions (AUDIT-C) to determine alcohol use for study eligibility. Alcohol screening data were triangulated with medical records of men living with HIV (n = 15,747) from 13 ART Centers to estimate alcohol consumption among men on ART in greater Mumbai. A survey instrument to identify associations between ART adherence and alcohol, psychosocial, and contextual factors was administered to eligible men living with HIV (n = 361), and in-depth interviews (n = 55) were conducted to elucidate the ways in which these factors are manifest in men's lives. Nearly one fifth of men living with HIV on ART in the Mumbai area have consumed alcohol in the last 30 days. Non-adherence was associated with a higher AUDIT score, consumption of more types of alcohol, and poorer self-ratings on quality of life, depression, and external stigma. The qualitative data demonstrate that non-adherence results from avoiding the mixing of alcohol with medication, forgetfulness when drinking, and skipping medication for fear of disclosure of HIV status when drinking with friends. As the demand for ART expands, Indian government programs will need to more effectively address alcohol to reduce risk and maintain effective adherence.

Interventions for Subjects with Depressive Symptoms with or without Unhealthy Alcohol Use: Are There Different Patterns of Change?

Background: It has been suggested that alcohol problems negatively affect therapeutic interventions for depression. This study examines the patterns of change in depressive symptoms following an intervention for depression, in participants with or without comorbid unhealthy alcohol use.Methods: Depressive symptoms (BDI–II), perceived control of depressive symptoms (UNCONTROL) and unhealthy alcohol use (AUDIT) were assessed in 116 patients before and after attending a cognitive behavioral psychoeducational intervention for depression. At pretest the mean score of AUDIT was 8.1, indicating a, on average, risk of harmful level of alcohol abuse. At pretest the majority of the total sample had a moderate degree of depressive symptoms, with a mean BDI–II score of 25.1 and 36.2% had a risky use of alcohol as measured with AUDIT score at 8 points or above. To assess the relationship between depressive symptoms, perceived uncontrollability of depression and alcohol use across time, a cross-lagged panel model was estimated.Results: A clinical significant reduction of depressive symptoms, and a parallel and statistically significant increase in the perceived control of depressive symptoms, was identified after attending a cognitive behavioral psychoeducational intervention for depression. At posttest, the mean BDI–II score was 17.8, demonstrating a statistically significant decrease of 7.3 points in depressive symptoms from before starting the course to 6 months later. The effect size (d-value) of 0.83 can be interpreted as a large decrease in depressive symptoms. In this sample alcohol use and depressive symptoms seemed to be unrelated. The cross-lagged correlation panel analysis indicated that a high degree of perceived control of depressive symptoms leads to a reduction in depressive symptoms, and not vice versa.Conclusion: We found that this intervention for depression were effective in reducing depressive symptoms. The patterns of change seemed to be independent of risky use of alcohol, although leaving the study was systematically associated with higher AUDIT-scores. As participants with or without unhealthy alcohol use show the same patterns of change regarding reduction of depressive symptoms and perceived control of depression, both groups could be offered the same cognitive behavioral psychoeducational interventions for depression.