Impact Of Alcohol Use Disorders Research Articles

Assessing the Adoption, Acceptability and Fidelity of the Alcohol Use Disorders Test for Alcohol Use Disorders screening in HIV Clinics in Malawi.

Alcohol use disorders (AUD) are a common cause of poor treatment outcomes among people with HIV (PWH). In Malawi, routine screening for AUD among PWH is unavailable. We piloted the utility of the Alcohol Use Disorders Identification Test (AUDIT) in screening for AUD among PWH and assessed its adoption, acceptability and fidelity in HIV clinics in Malawi. We implemented the AUDIT tool at Mchinji, Kapiri and Kochirira hospitals in Mchinji District between April and May 2021. AUD were defined and classified based on WHO classification as low-risk, harmful/hazardous alcohol use or alcohol dependence. We calculated the prevalence of AUD, the proportion of providers who conducted AUD screening (adoption) and the proportion of providers who conducted AUD screening as intended (fidelity) and compared between clinics. Lastly, we assessed acceptability through a survey among providers. Out of 2036 PWH, 875 (43%) were screened for AUD and 51% were female, mean age was 41 years (SD±12) and 338 (39%) had AUD. Adoption was highest at Mchinji (58%) compared to Kapiri (31%) and Kochiria (29%) (P<0.001). Overall Fidelity was 96%, and it was highest at Kapiri (99%) compared to Mchinji (95%) and Kochirira (98%) (P=0.01). AUD screening with AUDIT was highly acceptable as most providers agreed or completely agreed that the AUDIT was important (100%), easy to use (96%), satisfactory (96%), agreed to continue use (61%) and recommended it for other facilities in the district (100%). AUD were common among PWH. While the adoption of AUDIT for AUD screening was moderate, acceptability and fidelity were high. The impact of AUD on HIV treatment outcomes needs to be assessed to determine the role of routine AUD screening in HIV clinics in Malawi.

Analysis of the Causes, Effects, and Treatment of Alcohol Use Disorder

The number of people with alcohol problems is increasing year by year. There is a trend people of younger ages are even more affected by this issue. Alcohol use disorder is an important issue that contemporary society has started paying attention to, thereby making it one of the key topics of today's research. Researchers have made progress in determining the causes and effects of alcohol use disorder, but there are still gaps in research in certain areas, as well as a lack of unified explanations regarding the issues with cognition that alcohol problems cause. In that sense, studies have been conducted on how alcohol use disorder affects working memory, along with other aspects of cognition. Yet, these studies conclude that additional research is necessary in order to discover how the working memory abilities of people with alcohol use disorder can be increased. In studies of alcohol use disorder causes the physical and emotional aspects, experts note that decision-making processes, positive emotions, and negative experiences are common factors that lead to the disorder. To explore therapy and suggestions to treat alcohol use disorder, this paper examined the literature of negative impact of alcohol use disorders on working memory. The results of the analysis concluded that alcohol use disorder severely affects cognition, especially working memory. Further findings determine that combining behavioral therapy and medications is the best strategy patients can have when they are reluctant to stop using alcohol. The consequences of alcohol use disorder are also provided, including both the physical aspects and the cognitive impacts that affect people’s daily lives.

Examining Interhemispheric PFC Connectivity during AUD Abstinence with Multilevel Modeling

ABSTRACT Objective The prefrontal cortex (PFC) is a communicative network involved in information processing and behavioral regulation and is crucial to understanding the impact of alcohol use disorders (AUD). Functional interhemispheric connectivity across PFC regions may be important aspect of networking while seeking abstinence from AUD. This study examines functional PFC activation of persons seeking continued abstinence from AUD to explore potential interhemispheric connectivity in response to alcohol cues and how such connectivity is associated with abstinence duration. Method This study analyzed cerebral blood flow from PFC regional associations or couplings of 46 persons seeking continued abstinence from AUD were presented with alcohol and other affective cues. Intraclass correlations calculated using multilevel modeling (MLM) served as a measure of functional interhemispheric connectivity. Results Connectivity was found in response to alcohol and other affective cues. Results also suggest that interhemispheric connectivity in response to alcohol cues is negatively associated with abstinence duration. Conclusions Findings of this study suggest that functional interhemispheric connectivity may be important during the processing of alcohol-related cues for persons seeking continued abstinence from AUD. Abstaining from consumption in the early stages of abstinence may be a particularly high demand task requiring both PFC hemispheres, with this need decreasing as abstinence length increases.

The impact of alcohol use disorders and alcohol consumption on treatment-seeking individuals with social anxiety disorder.

Comorbid social anxiety and alcohol use disorders (SAD-AUD) in the community and the complex interactions that occur between these disorders have emerged as a significant clinical, public health, and research issue. The authors examined (a) the rates of comorbid SAD-AUD, (b) the impact of comorbid SAD-AUD on outcomes targeting social anxiety disorder, and (c) the effect of pretreatment alcohol consumption and alcohol use before, during, and after social situations on a composite measure of social anxiety in 172 adults presenting with social anxiety disorder. There was low incidence of AUD in this sample of individuals with SAD. Results indicated that alcohol consumption did not lead to worse social anxiety symptoms; however, alcohol use before and during social situations was associated with more severe social anxiety symptoms. These findings suggest that the function of alcohol use may be more important than the overall level of alcohol use and has implications for treatment.

Alcohol Use Disorders Are Associated With a Unique Impact on Airway Epithelial Cell Gene Expression.

Alcohol use disorders (AUDs) and cigarette smoking both increase risk for the development of community-acquired pneumonia (CAP), likely through adverse effects on proximal airway mucociliary clearance and pathogen recognition. Smoking-related alterations on airway gene expression are well described, but little is known about the impact of AUDs. We measured gene expression in human airway epithelial cells (AECs), hypothesizing that AUDs would be associated with novel differences in gene expression that could alter risk for CAP. Bronchoscopy with airway brushings was performed in participants with AUDs and controls to obtain AECs. An AUD Identification Test was used to define AUD. RNA was extracted from AECs, and mRNA expression data were collected on an Agilent micro-array. Differential expression analyses were performed on the filtered and normalized data with correction for multiple testing. Enrichment analyses were performed using clusterProfiler. Expression data from 19 control and 18 AUD participants were evaluated. After adjustment for smoking, AUDs were associated with significant differential expression of 520 AEC genes, including genes for ribosomal proteins and genes involved in protein folding. Enrichment analyses indicated significant differential expression of 24 pathways in AUDs, including those implicated in protein targeting to membrane and viral gene expression. Smoking-associated AEC gene expression differences mirrored previous reports, but differed from those associated with AUDs. AUDs have a distinct impact on AEC gene expression that may influence proximal airway function independent of smoking. Alcohol-associated alterations may influence risk for CAP through modifying key mechanisms important in protecting proximal airway integrity.

Psychometric validation of the Japanese version of Alcohol Quality of Life Scale (AQoLS-Japan) in the treatment of patients with alcohol use disorder

PurposeThe Alcohol Quality of Life Scale (AQoLS) is accepted as a useful measure in assessing impact of alcohol use disorders (AUD) on health-related quality of life (HR-QoL) in Western cultures. We aimed to assess the psychometric properties of the Japanese version of the AQoLS (AQoLS-Japan).MethodsThis was a 3-month, observational cohort study in patients undergoing routine treatment for AUD in Japan. HR-QoL was assessed using the AQoLS-Japan (34 items, 7 dimensions). Scale psychometrics were analyzed using correlative techniques.ResultsData from 132 patients were analyzed. Inter-item and item-scale correlations for the AQoLS-Japan scale were moderate to strong. Confirmatory factor analysis results supported the AQoLS-Japan structure but there was evidence of interdependency among some items and factors. Cronbach’s alpha coefficients for internal consistency ranged from 0.73 to 0.97, and intraclass correlation coefficients for scores between test (baseline) and retest (2 weeks) ranged from 0.65 to 0.82. Convergent and divergent validity and known-groups validity were supported. Evaluation of within-group change demonstrated that the AQoLS-Japan total and domains consistently demonstrated statistically significant improvement (p < 0.001 in all cases) in HR-QoL over time. Estimates for minimal clinically important difference on the AQoLS-Japan total score ranged from 13.2 to 18.2 for group-level change and from 2.4 to 15.7 for a group-level difference.ConclusionsThe AQoLS-Japan is a reliable and valid measure of HR-QoL that is able to demonstrate benefits associated with the routine treatment of AUD in Japan.

The impact of alcohol use disorders on pulmonary immune cell inflammatory responses to Streptococcus pneumoniae.

Community-acquired pneumonia due to Streptococcus pneumoniae occurs commonly in alcohol use disorders (AUDs). Pneumonia in the AUD patient is associated with poorer outcomes, and specific therapies to mitigate disease severity in these patients do not exist. Numerous investigations have attributed increased severity of pneumonia in AUDs to aberrant function of the alveolar macrophage (AM), a lung immune cell critical in host defense initiation. No studies have examined the response of human AMs to S.pneumoniae in AUDs. We hypothesized that the inflammatory mediators released by AMs after S.pneumoniae stimulation would differ quantitatively in individuals with AUDs compared to non-AUD participants. We further postulated that AM inflammatory mediators would be diminished after exposure to the antioxidant, N-acetylcysteine (NAC). For comparison, responses of peripheral blood mononuclear cells (PBMCs) to pneumococcal protein were also examined. Otherwise healthy participants with AUDs and smoking-matched controls underwent bronchoalveolar lavage and peripheral blood sampling to obtain AMs and PBMCs, respectively. Freshly collected cells were cultured with increasing doses of heat-killed S.pneumoniae protein, with and without exposure to N-acetylcysteine. Cell culture supernatants were collected, and inflammatory mediators were measured, including interferon (IFN)-γ, interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α. IFN-γ and IL-6 were significantly higher in unstimulated AM cell culture supernatants from subjects with AUDs. After stimulation with pneumococcal protein, a dose-response and time-dependent increase in pro-inflammatory cytokine production by both AMs and PBMCs was also observed; differences were not observed between AUD and non-AUD subjects. Addition of NAC to pneumococcal-stimulated AMs and PBMCs was generally associated with diminished cytokine production, with the exception of IL-1β that was elevated in AM culture supernatants from subjects with AUDs. Our observations suggest that AUDs contribute to basal alterations in AM pro-inflammatory cytokine elaboration, but did not support consistent differences in pneumococcal-stimulated AM or PBMC inflammatory mediator secretion that were referable to AUDs.

Multiple sclerosis and alcohol use disorders: in-hospital mortality, extended hospital stays, and overexpenditures

IntroductionThe objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. MethodsWe conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. ResultsThe 10249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1116.9euros per patient). ConclusionsAccording to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures.

The Impact of Alcohol Use on Drop-out and Psychological Treatment Outcomes in Improving Access to Psychological Therapies Services: an Audit.

The impact of alcohol use disorders (AUD) on psychological treatments for depression or anxiety in primary care psychological treatment services is unknown. To establish levels of alcohol misuse in an Improving Access to Psychological Therapies (IAPT) service, examine the impact of higher risk drinking on IAPT treatment outcomes and drop-out, and to inform good practice in working with alcohol misuse in IAPT services. 3643 patients completed a brief questionnaire on alcohol use pre-treatment in addition to measures of depression, anxiety and functioning. Symptom and functioning measures were re-administered at all treatment sessions. Severity of alcohol misuse was not associated with treatment outcomes, although those scoring eight or more on the AUDIT-C were more likely to drop out from treatment. IAPT services may be well placed to offer psychological therapies to patients with common mental disorders and comorbid AUD. Patients with AUD can have equivalent treatment outcomes to those without AUD, but some higher risk drinkers may find accessing IAPT treatment more difficult as they are more likely to drop out. Alcohol misuse on its own should not be used as an exclusion criterion from IAPT services. Recommendations are given as to how clinicians can: adjust their assessments to consider the appropriateness of IAPT treatment for patients that misuse alcohol, consider the potential impact of alcohol misuse on treatment, and improve engagement in treatment for higher risk drinkers.

Esclerosis múltiple y trastornos asociados al consumo de alcohol: mortalidad atribuible, prolongación de estancias y exceso de costes hospitalarios

IntroductionThe objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. MethodsWe conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. ResultsThe 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). ConclusionsAccording to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures.

Health and social consequences of an alcohol-related admission to critical care: a qualitative study

ObjectiveTo examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital...

Do alcohol use disorders impact on long term outcomes from intensive care?

IntroductionThere is limited evidence regarding the impact of alcohol use disorders on long term outcomes from intensive care. The aims of this study were to analyse the nature and complications of alcohol related admissions to intensive care and determine whether alcohol use disorders impact on survival at six months post ICU discharge.MethodThis was an 18 month prospective observational cohort study in a 20 bedded mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk, harmful/hazardous, or alcohol dependency.Results34.4% of patients were admitted with an alcohol use disorder. Those with an alcohol related admission (either harmful/hazardous or alcohol dependent) had an increased odds of developing septic shock during their admission, compared with the low risk group (OR 1.67; 95% CI 1.13-2.47, p = 0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p = 0.01) and hospital mortality (OR 2.43; 95% CI 1.28-4.621, p = 0.004). After adjustment for deprivation category and age, alcohol dependence was associated with an almost two fold increased odds of mortality at six months post ICU discharge (HR 1.86; CI 1.30-2.70, p = 0.001).ConclusionAlcohol use disorders are a significant risk factor for the development of septic shock in intensive care. Further, alcohol dependency is independently associated with poorer long term outcomes from intensive care.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0909-6) contains supplementary material, which is available to authorized users.

Alcohol Use Disorders and Community-Acquired Pneumococcal Pneumonia: Associated Mortality, Prolonged Hospital Stay and Increased Hospital Spending

IntroductionThe aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. MethodsRetrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008–2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. ResultsAmong 16,202 non-elective admissions for CAPP in patients aged 18–74years, 2685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI 95%: 44.3–54.3%), prolonged length of stay (2.3days; CI 95%: 2.0–2.7days) and increased costs (1869.2€; CI 95%: 1498.6–2239.8€). ConclusionsAccording to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending.

Prevalence and impact of comorbid alcohol use disorder in bipolar disorder: A prospective follow-up study.

Alcohol use disorder may very well increase the likelihood of affective episodes in bipolar disorder, but prospective data on survival are inconsistent. The authors examined the prevalence of alcohol use disorders and their impact on the risk of relapse. A total of 284 consecutively admitted International Classification of Diseases-10 bipolar I (n = 161) and II (n = 123) patients were followed up naturalistically over a period of 4 years. The prevalence of alcohol use disorders was higher in bipolar II disorder than in bipolar I disorder (26.8% vs 14.9%; χ(2) = 5.46, p = 0.019), with a global prevalence of alcohol use disorders of 20.1% in the whole sample. A total of 8.7% of bipolar I patients suffered from alcohol abuse and 6.2% from alcohol dependency, whereas 13% bipolar II patients had alcohol abuse and 13.8% alcohol dependency. Male bipolar subjects had a higher prevalence of alcohol use disorders than female patients (38.3% vs 12.8%; χ(2) = 21.84, p-value < 0.001). The presence of alcohol use disorders was associated with an increased risk of depressive relapse in bipolar I patients (Cox regression analysis hazard ratio = 2.7, p = 0.005). The increased risk was not modulated by medication. Our data underline the negative long-term impact of alcohol use disorders on bipolar disorder with more depressive bipolar I episodes and the importance of its detection and treatment.

Trastornos por consumo de alcohol y neumonía neumocócica adquirida en la comunidad: mortalidad atribuible, prolongación de estancias y sobrecostes hospitalarios

IntroductionThe aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. MethodsRetrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. ResultsAmong 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). ConclusionsAccording to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending.

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Learning Objectives: Alcohol related admissions to critical care are increasing. However, there is uncertainty about the optimum rehabilitation approach for this group of patients and the impact which alcohol use disorders have on recovery. This study aimed to explore the impact of alcohol use disorders on recovery from intensive care. Methods: Patients who had been ventilated for greater than 72 hours in one University teaching hospital were recruited. Data was collected using in depth semi structured interviews with patients three to seven months post ICU discharge. On admission to the ICU patients were allocated to one of three alcohol groups: low risk; harmful/hazardous or alcohol dependency. Patients from each of the three study groups were purposively sampled and data analysis was undertaken using Interpretative Phenomenological Analysis. Analysis explored both the similarities and differences between the three study groups. Results: 21 patients were interviewed over 12 months. six patients from the low risk group; six patients from the harmful/hazardous group and nine patients with from the alcohol dependency group. These interviews focused on the patient’s experience of intensive care and recovery from critical illness, including the impact of alcohol use disorders. Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience; impact and support for activities of daily living; social support and cohesion and the impact of alcohol use disorders on recovery. Conclusions: There is a significant interplay between alcohol misuse and recovery from critical illness, with haphazard approaches to rehabilitation. A more targeted rehabilitation pathway for all patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, needs to be generated.

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Learning Objectives: Alcohol related admissions to critical care are increasing. However, the impact of alcohol on the ICU journey has not been extensively studied. Further, there is limited evidence regarding the impact on long terms outcomes for patients admitted to critical care with a background of alcohol misuse. This study aimed to explore the impact of alcohol use disorders on the ICU stay and on longer term outcomes. Methods: 18 month prospective observational cohort study in a 20 bedded mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk; harmful/hazardous or alcohol dependency. Results: 580 ICU patients were screened for the presence of alcohol use disorders during the study period. 34.4% of patients were admitted with a background of alcohol misuse. Those with an alcohol related admission (either the harmful/hazardous or alcohol dependent) had an almost two fold increased odds of developing septic shock during their ICU admission, compared with the low risk group (OR 1.67; 95% CI 1.13-2.47, p=0.01). When adjusted for the presence of liver cirrhosis, the odds of developing septic shock increased even further in those with an alcohol related admission (OR 1.81; 95% CI 1.19-2.76, p=0.005). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p=0.01) and hospital mortality (OR 2.43; 95% CI 1.28-4.621, p=0.004). After adjustment for the presence of septic shock during the ICU admission, age and APACHE II, alcohol dependence was independently associated with mortality at six months post ICU discharge (HR 1.50; 95% CI 1.02-2.22, p= 0.0387). Conclusions: Alcohol related admissions account for a significant proportion of admissions to critical care. Alcohol use disorders are a significant risk factor for the development of septic shock in ICU. Further, alcohol dependency is independently associated with ICU, hospital and 6 month outcomes.

Addiction Research Centres and the Nurturing of Creativity

The aim of this paper is to present a concise account of the history, mission, structure and some recent achievements of the US National Institute on Alcohol Abuse and Alcoholism (NIAAA). Created by the US Congress 40 years ago, the NIAAA has evolved from an entity charged mainly with building a national system of alcoholism treatment services to one with responsibility for developing, nurturing and supporting the biomedical and behavioral science foundation necessary to reduce the significant domestic and global public health impact of alcohol use disorders. The NIAAA is unique in that it functions both as a funding agency, supporting research at universities and other external, or 'extramural' research institutions, and is also a research institution itself, where alcohol research is carried out in-house, or 'intramurally'. Of a $450.2 million 2009 Congressional Appropriation, approximately 90% was devoted toward the former and approximately 10% towards the latter objective. The current NIAAA Strategic Plan builds on a new organizing principle for long-range research planning, based on a life-span perspective that recognizes that human biology and behavior continue to change throughout life and changes occurring throughout the life-span affect individuals' drinking patterns as well as the decisions they may make to change their drinking habits or to seek help for alcohol use problems. Within this framework, major efforts are currently being devoted to educating practitioners on clinically useful, science-based assessment and treatment methods that exist today, and development of personalized new treatments for tomorrow.

Temporal sequence of incident cigarette, coffee, and alcohol use among AA participants

Background: Cigarettes and coffee are widely used psychoactive substances among alcoholics. Due to the devastating public health impact of alcohol use disorders, it is important to determine if using cigarettes or coffee may influence alcoholism. Previous studies indicate that cigarette smoking is associated with progression of alcohol dependence, but the effects of coffee drinking have yet to be investigated. Objectives: To retrospectively determine the temporal sequence of incident cigarette, coffee, and alcohol use and attributed subjective effects in AA participants. Methods: Volunteers at all Nashville open-AA meetings (n = 289 [126 women], completion rate = 94.1%) were administered a Lifetime Drinking History modified to also include lifetime cigarette and coffee consumption, as well as coffee consumption and effects questions, the Fagerstrom Test for Nicotine Dependence, and the Smoking Effects Questionnaire. Results: Average ages (years) at first regular use of alcohol, cigarettes, and coffee were 15.4 (IQR: 13.0–18.0), 16.7 (IQR: 13.0–18.5), and 18.5 (IQR: 14.0–23.5), respectively. In a subset who used all three substances (n = 236;102 women) alcohol consumption preceded cigarette smoking (p < .001) and coffee drinking (p < .001), and cigarette smoking preceded coffee drinking (p < .001); these relationships did not differ by gender. Conclusions: Recovering alcoholics started regular alcohol consumption prior to cigarette smoking and coffee drinking. Scientific Significance: In AA participants, coffee does not precede initiation of regular smoking or alcohol drinking as might be anticipated for a gateway drug.

Social Functioning of Patients With Personality Disorder in Secondary Care

Social Functioning of Patients With Personality Disorder in Secondary Care