Higher Risk For Alcohol Use Disorders Research Articles

Alcohol Use Disorder in Patients with Chronic Migraine: A Retrospective, Observational Study.

The relationship between migraine and alcohol consumption is unclear. We assessed the association between chronic migraine and alcohol use disorder(AUD), relative to chronic disease controls, and in conjunction with common comorbidities. We conducted a retrospective, observational study. The primary outcome was the odds ratio for AUD in patients with chronic migraine or with chronic migraine and additional comorbidities relative to controls. A total of 3701 patients with chronic migraine, 4450 patients with low back pain, and 1780 patients with type 2 diabetes mellitus met inclusion criteria. Patients with chronic migraine had a lower risk of AUD relative to both controls of low back pain (OR 0.37; 95% CI: 0.29-0.47, p < 0.001) and type 2 diabetes mellitus (OR 0.39; 95% CI: 0.29-0.52, p < 0.001). Depression was associated with the largest OR for AUD in chronic migraine (OR 8.62; 95% CI: 4.99-14.88, p < 0.001), followed by post-traumatic stress disorder (OR 6.63; 95% CI: 4.13-10.64, p < 0.001) and anxiety (OR 3.58; 95% CI: 2.23-5.75, p < 0.001). Patients with chronic migraine had a lower odds ratio of AUD relative to controls. But in patients with chronic migraine, those with comorbid depression, anxiety, or PTSD are at higher risk of AUD. When patients establish care, comorbid factors should be assessed and for those at higher risk, AUD should be screened for at every visit.

Psychoactive Substance Use Among Middle-Aged and Older Adults With Visual Impairment

Older adults with visual impairment may be at risk for developing substance use disorder (SUD) as psychoactive substance use is often used to cope with the stressors of vision loss. This study estimates the national prevalence and risk of psychoactive substance use among older adults with visual impairment. We analyzed data of respondents age ≥50 from the 2015-2019 National Survey on Drug Use and Health, an annual cross-sectional survey of a nationally representative sample of non-institutionalized individuals in the U.S. (N=43,886). We estimated and compared prevalence of past-year use of cannabis, cocaine, misuse of prescription opioids, sedatives, stimulants/tranquilizers, alcohol use disorder (AUD), any SUD, and nicotine dependence between adults with visual impairment to those without. Comparisons were conducted using chi-square and we used multivariable generalized linear models using Poisson and log link to estimate adjusted prevalence ratios (aPRs) for adults with visual impairment relative to those without, controlling for demographics and diagnosis of ≥2 chronic diseases. An estimated 6.1% experienced visual impairment. Those with visual impairment had higher prevalence of AUD, nicotine dependence, misuse of prescription opioids, tranquilizers, and stimulants, and SUDs. In adjusted analyses, vision-impaired adults had higher risk of AUD (aPR=1.71, 95% CI: 1.40-2.09), nicotine dependence (aPR =1.53, 95% CI:1.35-1.73), opioid misuse (aPR =1.54, 95% CI:1.26-1.90), and SUD (aPR=1.67, 95% CI:1.40-2.01). Psychoactive substance use adds unique health risks for older adults with vision loss, who may suffer significant psychological stress and loss of independence. Screening for substance use among all older adults with visual impairment should be considered.

Risk of alcohol use disorders in patients with insomnia: A population-based retrospective cohort study

The aim of this study was to explore the risk of alcohol use disorders (AUDs) in patients with insomnia. This was a population-based retrospective cohort study based on data from 2000 to 2013. Data from the Taiwan National Health Insurance Research Database were employed for this study. A total of 8076 patients with insomnia were identified as the study group. The control group comprised 16,152 age- and sex-matched patients. We conducted a Cox proportional hazard regression analysis to estimate the effects of insomnia on the risk of AUDs. The overall incidence of AUDs was 753.71 per 100,000 person-years for patients with insomnia, which was significantly higher than the incidence for those in the control group (377.73 per 100,000 person-years). Overall, patients with insomnia had a higher risk of AUDs than did those in the control group (adjusted hazard ratio [HR]=1.75, 95% confidence interval [CI]=1.42-2.10). We also observed a significantly higher risk of AUDs in patients with both insomnia and depression (adjusted HR=5.85; 95% CI=3.13-8.88) than in those without these conditions. The risk of AUDs in patients with insomnia was found to be significantly higher than that in individuals in the control group; the risk was particularly pronounced among those with insomnia and depression. These conditions thus exhibited a joint effect on AUDs risk.

Tetracycline derivatives reduce binge alcohol consumption in High Drinking in the Dark mice

Alcohol use disorders (AUDs) are prevalent, and are characterized by binge-like drinking, defined by patterns of focused drinking where dosages ingested in 2–4 ​h reach intoxicating blood alcohol levels (BALs). Current medications are few and compliance with the relatively rare prescribed usage is low. Hence, novel and more effective medications are needed. We developed a mouse model of genetic risk for binge drinking (HDID: High Drinking in the Dark mice) by selectively breeding for high BALs after binge drinking. A transcriptional analysis of HDID brain tissue with RNA-Seq implicated neuroinflammatory mechanisms, and, more specifically extracellular matrix genes, including those encoding matrix metalloproteinases (MMPs). Prior experiments from other groups have shown that the tetracycline derivatives doxycycline, minocycline, and tigecycline, reduce binge drinking in inbred C57BL/6J mice. We tested these three compounds in female and male HDID mice and found that all three reduced DID and BAL. They had drug-specific effects on intake of water or saccharin in the DID assay. Thus, our results show that the effectiveness of synthetic tetracycline derivatives as potential therapeutic agents for AUDs is not limited to the single C57BL/6J genotype previously targeted, but extends to a mouse model of a population at high risk for AUDs.

Family structure and alcohol use disorder: a register-based cohort study among offspring with and without parental alcohol use disorder.

To assess whether parental alcohol use disorder (AUD) is associated with higher risks of living in a non-intact family and assess whether non-intact family structure is associated with higher risks of AUD in the offspring. Prospective cohort study. Danish nation-wide registries. A total of 9948 parental AUD offspring and 98 136 reference offspring from the Danish population. Family structure assessed at birth and at each birthday until age 15 as intact or non-intact (with mother only, father only or neither parent); years lived in an intact family defined as total number of years lived with both parents from birth until the 15th birthday; AUD defined as registration in medical, treatment and cause of death registries. Data were analyzed by Cox regression. At birth, 30.9% [95% confidence interval (CI) = 29.1-32.6] of parental AUD offspring and 10.7% (95% CI = 10.3-11.0) of reference offspring lived in a non-intact family. At age 15, the numbers were 84.6% (95% CI = 83.9-85.3) and 38.4% (95% CI = 38.1-38.7). Parental AUD was associated with a higher risk of offspring AUD [hazard ratio (HR) = 1.88, 95% CI = 1.74-2.02]. Offspring were at lower risk of AUD if they lived 15 years in an intact family compared with offspring who never lived in an intact family (HR = 0.67, 95% CI = 0.52-0.87 for those with parental AUD, and HR = 0.53, 95% CI = 0.48-0.59 for those whose parents did not have AUD). Findings were inconclusive as to whether or not an association was present between family structure and AUD among offspring with parental AUD and reference offspring. The prevalence of non-intact family structure appears to be higher in offspring of parents with alcohol use disorder (AUD) than among offspring from the general population. Parental AUD appears to be associated with increased risk of offspring AUD, and non-intact family structure appears to be associated with increased risk of offspring AUD regardless of parental AUD.

Not in education, employment, or training (NEET) and risk of alcohol use disorder: a nationwide register-linkage study with 485 839 Swedish youths

ObjectiveTo investigate to what extent being outside education, employment or training after completed secondary education in Sweden might affect the risk of subsequent alcohol use disorders (AUDs), with sociodemographic indicators,...

Alcohol use disorder and health-related quality of life in Korean night-shift workers: A cross-sectional study using the KNHANES 2007-2015 data.

This study aimed to evaluate the prevalence of night-shift work, and the association of night-shift work with alcohol use disorders(AUDs), as well as with health-related quality of life(HRQL), in Korean adult workers. A total of 26,895 adult workers aged 20–59 years were included in the analysis. AUDs were assessed using the Alcohol Use Disorders Identification Test(AUDIT), and HRQL was measured by the EuroQol-5D questionnaire with five main dimensions. We found an interaction effect between gender and working status on AUDs (p = 0.0065), suggesting that women are more fragile than men in terms of the effects of night work but not regarding HRQL (p = 0.1729). Female night workers had higher risk of AUDs than female day workers (odds ratio(OR): 2.23, 95% confidence interval (CI): 1.48–3.38) but this effect was not noted in male night workers (OR: 0.97, 95% CI: 0.69–1.37). Lower HRQL was found in depression dimension for night workers compared to day workers (OR: 1.37, 95% CI: 1.00–1.89), whereas day-night regular shift workers were protected from depression. Risk of AUDs and lower HRQL were identified in female night workers but not in male night workers. This association suggests that women are more fragile than men in terms of the effects of night work.

Impact of Adolescent Intermittent Ethanol on Noradrenergic Development

In clinical populations, adolescent alcohol drinking has been shown to increase stress sensitivity and the likelihood of developing alcohol use disorders (AUDs) in adulthood. These findings suggest pathways mediating stress‐relating behaviors are impacted by developmental exposure to alcohol, contributing to a greater risk for alcoholism and potentially stress‐induced relapse following treatment. Animal models indicate tyrosine hydroxylase (TH) neurons in the A2 region of the nucleus of the tractus solitarius (NTS) contribute to stress‐induced relapse through enhanced norepinephrine signaling, subsequently increasing neuronal activity in the bed nucleus of the stria terminalus (BNST). Previous research suggests NTS TH expression undergoes developmental changes during adolescence that may make this neuronal population susceptible to modulation by alcohol during this age. We hypothesized adolescent intermittent ethanol (AIE) exposure in mice, a standard preclinical model of adolescent binge drinking, will impact NTS TH neuron development, ultimately altering the NTS‐BNST circuitry resulting in a higher risk of AUDs in adulthood. NTS TH mRNA expression in male and female C57Bl6/J mice exposed to AIE (postnatal day [PND] 28–42) or used as air controls was quantified via qRT‐PCR at different time points (PND29, PND36, PND43, PND49, PND70). Immunohistochemistry methods were implemented to determine the impact of AIE on NTS TH neuronal activity following an ethanol challenge in adulthood (PND70). Results showed a significant increase in TH mRNA in males one day after beginning AIE (PND29) relative to air controls, while females exhibited the greatest TH expression after their first week of exposure to ethanol (PND36). In both sexes, heightened TH mRNA expression occurred earlier than expected during normal development. Surprisingly, compared to adult ethanol naïve mice, AIE decreased the ability of ethanol at doses of 2g/kg and 4g/kg to alter NTS TH neuron cFos expression at PND70 compared to control. Together, these findings suggest an enhancement of NTS TH activity early in development and reduction of ethanol sensitivity in adulthood. Studies are in progress to further delineate the mechanisms by which AIE reduces adult ethanol sensitivity and how this may alter stress‐related behaviors.Support or Funding InformationAA22937AA017823This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Changes in prevalence and correlates of alcohol-use disorders in Finland in an 11-year follow-up

Aims: This study aimed to examine changes in prevalence and correlates of alcohol-use disorders (AUD) between 2000 and 2011. We also explored the impact of using multiple imputation on prevalence estimates, to address survey nonresponse.Methods: The study used a Finnish nationally representative survey of adults aged 30 years and older in 2000 and in 2011. The Munich Composite International Diagnostic Interview (M-CIDI) was used to diagnose AUD in 6005 persons in 2000 (response rate 75%) and 4381 in 2011 (response rate 55%). Multiple imputation using sociodemographic, health, and registry-linked data on mental health hospitalizations was compared with weights to account for nonresponse.Results: Prevalence of 12-month AUD in Finland decreased from 4.6% (95% CI 4.0–5.1) in 2000 to 2.0% in 2011 (95% CI 1.6–2.4). Lifetime AUD prevalence decreased from 10.8% (95% CI 9.9–11.6) to 7.5% (CI 95% 6.8–8.3) from 2000 to 2011. The reduction was observed for people aged 30–64 years. At both time points, AUD prevalence was higher among individuals aged 30–64, men and those unmarried, widowed or divorced. The observed prevalence changes can be partly attributed to reporting and selection bias. The latter was addressed by multiple imputation.Conclusions: Alcohol use disorders appear to have decreased in Finland from 2000 to 2011, especially for the 30–64 years age group. Males, younger adults and those unmarried, widowed or divorced had a higher risk of AUD.

Amygdala-orbitofrontal functional connectivity mediates the relationship between sensation seeking and alcohol use among binge-drinking adults

BackgroundDecreased amygdala-orbitofrontal cortex (OFC) neural functional connectivity (FC) positively predicts alcohol use among adolescents. Low amygdala-OFC FC is also associated with poor emotion regulation, a trait robustly linked to alcohol use. Thus, decreased amygdala-OFC connectivity may represent a risk factor for the development of alcohol use disorder (AUD) via impaired emotion regulation or reward processing. In this study, we examined amygdala-OFC FC among young adult binge drinkers at high risk for AUD. We also tested if amygdala-OFC FC mediates the relationship between externalizing personality traits and alcohol use. MethodsHealthy male and female (n = 39) binge drinkers completed a resting state fMRI scan and the Eysenck Impulsive Personality questionnaire. We utilized seed-based connectivity of the left and right amygdala to prefrontal regions as well as mediation analysis. ResultsIndividuals with higher weekly alcohol use displayed decreased right amygdala-OFC FC. Furthermore, high trait venturesomeness, but not impulsivness, was associated with decreased right amygdala-OFC FC. Finally, right amygdala-OFC FC mediated the relationship between trait venturesomeness and weekly drinking; individuals with high trait venturesomeness displayed decreased right amygdala-OFC FC, which in turn predicted greater weekly drinking. ConclusionsOur findings corroborate and extend the adolescent literature by showing that decreased amygdala-OFC FC is associated with higher alcohol consumption among adults at elevated risk for AUD. This study also demonstrates for the first time that this neural profile reflects a tendency to sensation seeking. In sum, our findings suggest that amygdala-OFC FC may be an objective neural target for alcohol use prevention and intervention.

Dissociative Tendencies and Alcohol Use Disorder

To review the literature on the association between a lack of coherent sense of self (i.e., dissociation) and alcohol use disorder (AUD). Child maltreatment leads to abnormal development of brain regions associated with possible mediators and moderators of the relationship between early life stress and AUD. People with a propensity to dissociate or to seek dissociative experiences (e.g., chemical dissociation) could have a higher risk of AUD and more generally of actions undertaken with limited conscious awareness (i.e., habits and routines). The study of the relationship between early caregiving interactions, dissociation states, suboptimal mind-body interactions, and AUD is important for devising more efficient prevention and treatments.

Sexual-orientation differences in alcohol use trajectories and disorders in emerging adulthood: results from a longitudinal cohort study in the United States.

We estimated sexual-orientation differences in alcohol use trajectories during emerging adulthood, and tested whether alcohol use trajectories mediated sexual-orientation differences in alcohol use disorders (AUDs). Longitudinal self-reported survey data from the Growing Up Today Study. United States. A total of 12 493 participants aged 18-25 during the 2003, 2005, 2007 or 2010 surveys. Stratified by gender, longitudinal latent class analyses estimated alcohol use trajectories (using past-year frequency, quantity and binge drinking from 2003 to 2010). Multinomial logistic regression tested differences in trajectory class memberships by sexual orientation [comparing completely heterosexual (CH) participants with sexual-minority subgroups: mainly heterosexual (MH), bisexual (BI) and gay/lesbian (GL) participants]. Modified Poisson regression and mediation analyses tested whether trajectories explained sexual-orientation differences in AUDs (past-year DSM-IV abuse/dependence in 2010). Six alcohol use trajectory classes emerged for women and five for men: these included heavy (23.5/36.9% of women/men), moderate (31.8/26.4% of women/men), escalation to moderately heavy (9.7/12.0% of women/men), light (17.0% for women only), legal (drinking onset at age 21; 11.1/15.7% of women/men) and non-drinkers (7.0/9.1% of women/men). Compared with CH women, MH and BI women had higher odds of being heavy, moderate, escalation to moderately heavy and light drinkers versus non-drinkers (odds ratios=2.02-3.42; P-values<0.01-0.04). Compared with CH men, MH men had higher odds of being heavy, moderate and legal drinkers versus non-drinkers (odds ratios=2.24-3.34; P-values<0.01-0.01). MH men and women, BI women and GLs had higher risk of AUDs in 2010 than their same-gender CH counterparts (risk ratios=1.34-2.17; P-values<0.01). Alcohol use trajectories mediated sexual-orientation differences in AUDs for MH and GL women (proportion of effect mediated=30.8-31.1%; P-values<0.01-0.02), but not for men. In the United States, throughout emerging adulthood, several sexual-minority subgroups appear to have higher odds of belonging to heavier alcohol use trajectories than completely heterosexuals. These differences partially explained the higher risk of alcohol use disorders among mainly heterosexual and gay/lesbian women but not among sexual-minority men.

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

BackgroundMost patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample.MethodsThe CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011–2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs.ResultsA total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22–75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14–24] and a median readiness to change drinking score of 5 (IQR 2.75–6.25) on a 1–10 Likert scale.ConclusionThe CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking.Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).

M62 - GABRA2 Association With Addiction-Related Endophenotypes Is Environmentally Influenced

Background The GABRA2 gene contains more than 250 SNPs that in Caucasians form two major common “Yin-Yang” haplotypes - having either all or none of the non-ancestral (NA) alleles. Since 2004, association of the non-ancestral, slightly less common haplotype with alcohol use disorder (AUD) and with increased beta waves in EEG has been reported and replicated many times. Methods In a longitudinal sample of >400 low SES families at high risk for AUD, we investigated the influence of these GABRA2 haplotypes on addiction related endophenotypes, and started to investigate potential functional implications. We found that the NA haplotype is associated with impulsivity and with increased activation of the insula in response to reward expectation, both of which partially mediate the association of the NA alleles with alcoholism. Impulsivity was also associated with reward expectation, independent of genetics. Results Moreover, the effect of parental monitoring on externalizing behavior trajectories across childhood and adolescence, i.e., consistently low, developmentally limited, and rising trajectories, was moderated by the NA alleles of GABRA2. Subjects with the NA alleles were more strongly influenced – both positively and negatively--by the extent of parental monitoring, while subjects with the ancestral alleles were not significantly influenced by the monitoring. In addition to parents, peers are also known to influence addiction-related behaviors such as rule breaking during adolescence. Association with delinquent peers increased rule breaking, particularly in those with NA alleles of GABRA2, while association with peers who displayed positive behaviors (such as religious activity and scholastic competence) decreased externalizing behaviors. Subjects with the ancestral alleles of GABRA2 were less affected by peers. Discussion Our results illustrate a more complex influence of genotypes on risk for common traits such as those associated with addiction. Our data suggest that the previously identified “risk” alleles impacts the strength of both adaptive and maladaptive environmental influences on risky behaviors such as rule breaking, and hence might be thought of as plasticity factors. None of the alleles of the GABRA2 haplotypes change an amino acid, and they have no major influence on level of expression (eQTL) in several large brain expression samples. Allelic imbalance is more sensitive to slight expression differences. Preliminary allelic imbalance RNASeq analyses of brain mRNA suggest that the NA alleles may increase expression. Our result is in contrast to a recent report of decreased expression of the risk alleles in iPSCs. Epigenetic modifications may be one pathway of how environmental influences on behavior are being molecularly mediated, and just as our results demonstrate plasticity at the behavioral level, plasticity may exist on the molecular level, in that expression of GABRA2 haplotypes may be influenced molecularly by different environments.

The gut in the brain: the effects of bariatric surgery on alcohol consumption.

Obesity represents a major medical and public health problem worldwide. Efforts have been made to develop novel treatments, and among them bariatric surgery is used as an effective treatment to achieve significant, long-term weight loss and alleviate medical problems related to obesity. Alcohol use disorder (AUD) is also a leading cause of morbidity and mortality worldwide. Recent clinical studies have revealed a concern for bariatric surgery patients developing an increased risk for alcohol consumption, and for AUD. A better understanding of the relationship between bariatric surgery and potential later development of AUD is important, given the critical need of identifying patients at high risk for AUD. This paper reviews current clinical and basic science research and discusses potential underlying mechanisms. Special emphasis in this review is given to recent work suggesting that, alterations in alcohol metabolism/pharmacokinetics resulting from bariatric surgery are unlikely to be the primary or at least the only explanation for increased alcohol use and development of AUD, as changes in brain reward processing are also likely to play an important role. Additional studies are needed to clarify the potential role and mechanisms of how bariatric surgery may increase alcohol use and lead to AUD development.

Integrating Chronic Care for AUDs Into Primary Care Settings

Integrating Chronic Care for AUDs Into Primary Care Settings

The Relationships of the Level of Response to Alcohol and Additional Characteristics to Alcohol Use Disorders Across Adulthood: A Discrete‐Time Survival Analysis

A low level of response (LR) to alcohol has been shown to relate to a higher risk for alcohol use disorders (AUDs). However, no previous research has examined the association between LR and the development of AUDs in the context of additional robust risk factors for AUDs. This study evaluated whether LR and other related characteristics predicted the occurrence of AUDs across adulthood using discrete-time survival analysis (DTSA). A total of 297 probands from the San Diego Prospective Study reported on the LR to alcohol, a family history (FH) of AUDs, the typical drinking quantity, the age of drinking onset, the body mass index and the age at the baseline (T1) assessment. Alcohol use disorders (AUDs) were evaluated at the 10-year (T10), T15, T20, and T25 follow-ups. A low LR to alcohol predicted AUD occurrence over the course of adulthood even after controlling for the effects of other robust risk factors. Interaction effects revealed that the impact of FH on AUDs was only observed for subjects with high T1 drinking levels, and probands with high T1 drinking were at high risk for AUDs regardless of their age of onset. The findings illustrate that LR is a unique risk factor for AUDs across adulthood, and not simply a reflection of a broader range of risk factors. The continued investigation of how LR is related to AUD onset later in life will help inform treatment providers about this high-risk population, and future longitudinal evaluations will utilize DTSA to assess rates of AUD remission as well as the onset of drinking outcomes in adolescent samples.

Factor structure of the Alcohol Use Disorders Identification Test (AUDIT) in a mental health clinic sample.

To examine the factor structure of the Alcohol Use Disorders Identification Test (AUDIT) and to identify the implications of this structure for its clinical use. The AUDIT was administered to mental health clinic outpatients (N = 197; 86% men) at high risk for alcohol-use disorders. Confirmatory and exploratory factor analyses were used to determine the underlying factor structure of the AUDIT for this high-risk population. Confirmatory analyses indicated that the a priori three- and one-factor solutions did not fit the observed data. The exploratory analyses supported a two-factor solution that included level of alcohol consumption and drinking problems, with both factors explaining substantial variance in AUDIT scores. These findings contrast the original three-factor design of the AUDIT and the conventional use of the AUDIT as a one-factor screening device with a single cutoff score. Other screening methods that incorporate this two-factor model may be important for mental health patient populations. Replication of these findings among other mental health samples is needed.