Regular Alcohol Use Research Articles

Parental alcohol use, alcohol-related problems, and alcohol-specific attitudes, alcohol-specific communication, and adolescent excessive alcohol use and alcohol-related problems: An indirect path model

Alcohol-specific parent–child communication has often been studied in relation to regular alcohol use of adolescents. However, it might be as important to focus on adolescent problematic alcohol use. In addition, the way parents communicate with their children about alcohol might depend on their own (problematic) drinking behaviors. Therefore, the current study examined the direct effects of parental alcohol use, alcohol-related problems, and parental alcohol-specific attitudes on adolescent excessive drinking and alcohol-related problems later in life. It also looked at indirect effects via alcohol-specific communication. The sample consisted of 428 Dutch families including fathers, mothers and adolescents from two age groups (13 and 15years old) at T1, who have been surveyed annually for 5years. We tested the model with structural equation modeling (SEM). The results showed that parental alcohol-related problems were positively associated with communication about alcohol, which in turn was related with less excessive adolescent drinking and alcohol-related problems. Lenient parental attitudes about alcohol and parental alcohol-related problems were directly related to more excessive drinking and alcohol-related problems in adolescents. In conclusion, alcohol-specific communication intervenes in the relationship between parental alcohol-related problems and adolescent excessive drinking and alcohol-related problems. This indicates that in family alcohol interventions targeted at youth alcohol use, parental alcohol-related problems should be taken into account.

Prevalence and patterns of problematic alcohol use among Australian parents

Limited research data exists on the prevalence, and characteristics associated with parental alcohol use, particularly in Australia. This study aims to examine the drinking patterns of Australian parents, and to determine whether the drinking pattern differs by family type. The characteristics associated with regular parental alcohol use were also assessed. Data from a representative sample of 23,356 Australians were analysed from the 2007 National Drug Strategy Household Survey. The study found that parents were less likely to drink at levels defined as risky. Additionally, single mothers were more likely to report monthly and weekly binge drinking, compared to other mothers. Four predictors of risky parental alcohol use were identified: male; a current tobacco smoker; reporting higher levels of psychological distress; and lower levels of education. Although this study found that parents were less likely to consume alcohol at risky levels, population estimates suggest a considerable number of Australian children live in households where risky parental alcohol use occurs. This study provides the first step to extending the knowledge base on the prevalence of parental alcohol use which will help to inform public health policy and early intervention programs.

Peer substance involvement modifies genetic influences on regular substance involvement in young women

Peer substance involvement (PSI) is a robust correlate of adolescent substance use. A small number of genetically informative studies suggest that shared genetic and environmental factors contribute to this association. We examine mechanisms by which PSI influences the etiology of regular substance involvement (RSI), particularly in women. Population-based cohort study of twin women from the US Midwest. 2176 twin women. To examine the relationship between self-reported PSI during adolescence and a composite RSI representing regular tobacco, alcohol and cannabis use during young adulthood, using genetically informative correlation, moderation and joint correlation-moderation models. There was evidence for a significant additive genetic X environment interaction. PSI was moderately heritable (h(2) = 0.25). Genetic, shared and non-shared influences on RSI overlapped with influences on PSI (genetic correlation of 0.43). Even after controlling for these shared genetic influences, RSI was more heritable in those reporting greater PSI. While young women may select peers based on certain dispositional traits (e.g. permissiveness towards substance use), the social milieu constructed by PSI does modify the architecture of increased RSI in those individuals with increasing levels of PSI being associated with stronger expression of heritable influences.

Predictors of Transitions Across Stages of Alcohol Use and Alcohol-Use Disorders in South Africa

High rates of alcohol use and alcohol-use disorders have been noted in South Africa. Although a number of risk factors for alcohol use and abuse/dependence have been identified, there is a lack of information regarding risk factors for progression through the different stages of alcohol use and alcohol-use disorders. Our aim was to examine sociodemographic predictors of transition across stages of alcohol use, abuse and dependence (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and remission in the South African population. A national probability sample of 4,315 adult South Africans was administered Version 3.0 of the World Health Organization Composite International Diagnostic Interview. We found high rates of transition from regular alcohol use to abuse but low rates from alcohol abuse to dependence. All stages of alcohol use and alcohol-use disorders were more common in younger than in older respondents at comparable time points. Younger age (below 50), male gender, lower education, and having been a student were all associated with ever using alcohol, but only male gender was associated with the transition to regular use and abuse. Furthermore, younger age and late age at onset of alcohol abuse were associated with remission from abuse. The importance of socio-demographic predictors appears to vary across stages of alcohol use and could be used to guide the precision of intervention strategies.

Self-mutilative behaviours in male alcohol-dependent inpatients and relationship with posttraumatic stress disorder

The aim of this study was to investigate the relationship between self-mutilation (SM) and posttraumatic stress disorder (PTSD) in male alcohol-dependent inpatients, and to examine whether there is something unique about self-mutilaters with the PTSD/alcohol-dependence co-morbidity, compared with self-mutilaters without PTSD in this population. Participants were 156 consecutively admitted male alcohol-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire (SMBQ), the Traumatic Experiences Checklist (TEC), the Clinician Administered PTSD Scale (CAPS), the Symptom Checklist-Revised (SCL-90-R) and the Michigan Alcoholism Screening Test (MAST). Among alcohol-dependent inpatients, 34.0% ( n = 53) were considered as group with SM. Rate of being unemployed, history of any trauma, history of suicide attempt and lifetime PTSD diagnosis were higher, whereas being married, current age, age at onset of regular alcohol use and duration of education were lower in the group with SM. Mean scores of SCL-90 subscales, TEC and MAST were higher in the SM group. Although SM might be related with PTSD among male alcohol-dependent inpatients, predictors of SM were age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and hostility. Age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and somatisation predicted SM in the subgroup of patients without PTSD, whereas hostility predicted SM alone in the subgroup of patients with PTSD. Results support the anti-suicide and the affect-regulation models of SM in the non-PTSD group, whereas they support the hostility model of SM in the subgroup with PTSD in alcohol-dependent inpatients. Thus, to reduce self-mutilative behaviour (SMB)among alcohol-dependent patients, clinicians must address different subjects in different subgroup patients; that is, focussing hostility in those with PTSD co-morbidity.

Spatial Mobility, Alcohol Use, Sexual Behavior and Sexual Health Among Males in India

This paper examines the linkages of permanent migration, temporary mobility and alcohol consumption with risky sexual behavior and sexually transmitted infections (STIs) including HIV infection among males in India using a nationally representative dataset. The study shows that non-migrant men and migrant men do not differ significantly in any indicator of risky sexual behavior and STIs. Temporary long duration mobile men reported significantly more often than the non-mobile men or short duration mobile men that they had sex with multiple sex partners during their lifetime as well as sex with a high risk partner and had paid sex in the 12 months preceding the survey. Males who drank alcohol almost every day notwithstanding with their migration or mobility status were most prone to lifelong as well as more recent sexual risk behavior. Controlling for sociodemographic characteristics long duration mobile men and men who used alcohol almost daily had higher sexual risk behaviors and STI infections. Further migration and mobility did not show any significant relationship with tested HIV prevalence among males in India, controlling for sociodemographic characteristics. Males who had lifetime multiple sex partners were at the highest risk of tested HIV infection controlling for sociodemographic characteristics, migration, mobility, alcohol use and STI infection. Interventions focusing on HIV prevention in India need to target both non-migrant and migrant men, particularly those who drink alcohol more frequently or daily. Targeted interventions are required for temporary mobile men, particularly for those mobile men who have to stay away from their homes continuously for a longer duration. Long duration mobile men are most prone to regular alcohol use and risky sexual behavior.

Bullying behaviour and substance abuse among underage psychiatric inpatient adolescents

Background and objective Only a few studies have examined the putative association between substance use and bullying others, and to our knowledge none of the previous studies have investigated substance abuse among victims or those who are both bullies and victims. The aim of our study was to investigate substance use among all of these three bullying subgroups and to examine the putative association between substance use and bullying behaviour. Methods The study sample consisted of 508 Finnish adolescents (age 12–17) admitted to psychiatric inpatient care between April 2001 and March 2006. We used the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) to obtain DSM-IV psychiatric diagnoses, information about bullying behaviour and substance abuse of the adolescents. The level of nicotine dependence (ND) was assessed by using the modified Fagerström Tolerance Questionnaire (mFTQ). Results Our study showed that both among boys and girls, regular daily smoking and alcohol use among boys were statistically significantly associated with bullying behaviour. Further, among girls, but not among boys, there was also an association between bullying behaviour and more severe substance use, such as ND, use of cannabis and hard drugs. Conclusion Since an association between bullying and severe substance use was found in this study, our novel finding needs replication in adolescent general population samples.

History of trauma and relationship with alexithymia, temperament and character dimensions in male alcohol dependent inpatients

History of trauma and relationship with alexithymia, temperament and character dimensions in male alcohol dependent inpatients Objective: To evaluate the relationship of trauma history with alexithymia and personality dimensions in male alcohol dependent inpatients. Method: Participants were 156 consecutively admitted male alcohol dependents. Patients were investigated with the Toronto Alexithymia Scale (TAS-20), the Temperament and Character Inventory (TCI) and the Traumatic Experiences Checklist (TEC). Results: Among alcohol dependent inpatients, 49.4% (n=77) were considered as the group having trauma history according to definition of DSM-IV, although this rate was 92% according to TEC. Rate of being single and alexithymic were higher, whereas age for regular alcohol use was lower in traumatic group. Current age, employment status, and duration of education did not differ between groups. Mean scores of difficulty in identifying feelings, alexithymia total score and personality dimensions of novelty seeking, harm avoidance and self-transcendence were higher in traumatic group whereas self-directedness (S) and cooperativeness (C) were lower in this group. Lower S score was determinant for trauma history (according to the DSM-IV) in Forward Logistic Regression model, whereas lower C was determinant for number of trauma types (according to the TEC) in Stepwise Linear Regression model. Conclusions: Alexithymia, temperament and character may all be related with trauma history in male alcohol dependent inpatients. Finding low S score which predicts the presence of trauma history and low C score which predicts the severity of trauma suggest that lifetime trauma experience is related with higher

Associations Between ADH Gene Variants and Alcohol Phenotypes in Dutch Adults

Recently, Macgregor et al. (2009) demonstrated significant associations of ADH polymorphisms with reactions to alcohol and alcohol consumption measures in an Australian sample. The aim of the present study was to replicate these findings in a Dutch sample. Survey data on alcohol phenotypes came from 1,754 unrelated individuals registered with the Netherlands Twin Register. SNPs in the ADH gene cluster located on chromosome 4q (n = 491) were subdivided in seven gene sets: ADH5, ADH4, ADH6, ADH1A, ADH1B, ADH1C and ADH7. Within these sets associations of SNPs with alcohol consumption measures, age at onset variables, reactions to alcohol and problem drinking liability were examined. Of the original 38 SNPs studied by Macgregor et al. (2009), six SNPs were not available in our dataset, because one of them had a minor allele frequency < .01 (rs1229984) and five could not be imputed. The remaining SNP associations with alcohol phenotypes as identified by Macgregor et al. (2009) were not replicated in the Dutch sample, after correcting for multiple genotype and phenotype testing. Significant associations were found however, for reactions to alcohol with a SNP in ADH5 (rs6827292, p = .001) and a SNP just upstream of ADH5 (rs6819724, p = .0007) that is in strong LD with rs6827292. Furthermore, an association between age at onset of regular alcohol use and a SNP just upstream of ADH7 (rs2654849, p = .003) was observed. No significant associations were found for alcohol consumption and problem drinking liability. Although these findings do not replicate the earlier findings at the SNP level, the results confirm the role of the ADH gene cluster in alcohol phenotypes.

Clinical Factors Associated with Relapse in Male Alcohol Dependents During Six-Month Follow-up

ABSTRACTObjective: Aim of this study was to evaluate the clinical factors associated with relapse to alcohol use during six-month after inpatient treatment in male alcohol dependents.Method: Participants were 156 consecutively admitted male alcohol dependents. Among these patients 107 were available to examine 6 months after inpatient treatment. Patients were administered the Symptom Checklist-Revised-90 (SCL-90-R), and Michigan Alcoholism Screening Test (MAST) at baseline and the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), AMATEM Motivation for Treatment Scale (AMTS), and the PENN Alcohol Craving Scale (PACS) six-month later at follow-up.Results: Among 107 alcohol dependent inpatients 53.3% (n=57) were considered as relapsed to alcohol use. Current age, age at regular alcohol use, duration of education, and marital and employment status did not differ between groups. Mean scores of MAST, awareness of problems of AMTS and GSI also did not differ significantly between groups, whereas...

P03-211 - Relationship of posttraumatic stress disorder and alexithymia with relapse during 12 months in male alcohol dependent inpatients

ObjectiveAim of this study was to evaluate the relationship of posttraumatic stress disorder (PTSD) and alexithymia with relapse to alcohol use during 12 month follow-up after inpatient treatment in male alcohol dependents. Age at regular alcohol use, severity of alcohol related problems and psychiatric symptoms were controlled while evaluating these relationships.MethodAmong 156 consecutively admitted male alcohol dependents 136 could be reached at the end of 12 months. Patients were investigated with the Clinician Administered PTSD Scale, the Symptom Check List and the Michigan Alcoholism Screening Test (MAST) and with the Toronto Alexithymia Scale (TAS-20) at baseline.ResultsAmong 136 alcohol dependent patients 66.2% (n=90) were considered to be relapsed according to telephone interview. Among these 102 were interviewed face to face. Rate of alexithymia and relapse and mean of “difficulty in identifying feelings-DIF” of TAS-20 were higher in PTSD group. Other than these there were no significant relationship between PTSD, alexithymia and relapse. PTSD diagnosis predicted relapse during 12 month follow-up (n=136). When only those who were evaluable to interview face to face included, only DIF predicted relapse (n=102).ConclusionsPTSD and alexithymia (particularly DIF factor) may be related with relapse during 12 month follow-up. This study suggest that rather than the early onset of alcohol use, the severity of alcohol related problems and the general psychiatric symptoms, PTSD and DIF, which may be related, are two factors to focus when relapse prevention programs are planning.

Spectrum of cardiovascular disorders in a national referral centre, Ghana

Objective : To determine the pattern of cardiovascular disorders in Ghana. Design : A four-year prospective study. Setting : National Cardiothoracic Centre (NCTC), Korle-Bu Teaching Hospital, Accra, Ghana. Subjects : Seven hundred and eight subjects with cardiovascular disorders referred to the NCTC, Accra, were evaluated clinically and with ancillary laboratory tests, chest x-ray, and electrocardiography. Subjects were also assessed with the aid of two-dimensional echocardiography with doppler and colour flow mapping. Results : Hypertensive heart disease(n=133), rheumatic heart disease(n=123), idiopathic cardiomyopathy(n=103), congenital heart disease(n=90) and coronary artery disease(n=80) were the major causes of cardiovascular morbidity. The mean age of the subjects was 41.6 ± 0.8 years. The male to female ratio was 1.3:1.0. The peak incidence of cardiovascular disease occurred in the fifth decade. Subjects with coronary artery disease were relatively older and had the highest incidence of hypertension(66.3%), diabetes(22.5%), smokers(11.8%), hyperlipidaemia(8.8%) and regular alcohol use(12.5%). The commonest rheumatic valvular lesion was mitral regurgitation. Dilated cardiomyopathy was the commonest form of cardiomyopathy(n=56). Hypertrophic cardiomyopathy and endomyocardial fibrosis were seen in 25 and 22 subjects respectively. Ventricular septal defect, atrial septal defect, tetralogy of Fallot and patent ductus arteriosus were the commonest congenital lesions. The major cardiovascular disorders in children were congenital (n=27) and rheumatic heart(n=11). Idiopathic cardiomyopathy(n=1) was rare in children. Conclusion : Major causes of cardiovascular morbidity in Ghanaians were hypertension, rheumatic heart disease and cardiomyopathy. Congenital and rheumatic heart diseases were the commonest cardiovascular disorders in Ghanaian children. Idiopathic cardiomyopathy was rare in children.

Health insurance and mortality in US adults.

A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death. Among all participants, 3.1% (95% confidence interval [CI]=2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time.

Could Modification of Lifestyle Factors Prevent Second Primary Breast Cancers?

Could Modification of Lifestyle Factors Prevent Second Primary Breast Cancers?

Ethnicity and Adolescent Pathways to Alcohol Use

This study examined the influence of ethnicity on factors affecting alcohol-use behaviors in a community sample of white, black, and Hispanic youth (N = 323). Conduct problems, positive alcohol expectancies, and socioeconomic status were expected to mediate the effect of negative affectivity and a paternal history of substance dependence on the age at onset of regular drinking and the frequency of drinking. Subjects ages 14-21 (57.9% female; 60.7% white) were interviewed along with their fathers at baseline (Time 1), and subjects only were interviewed again 5 years later (Time 2). A structural equation model was used to test a deviance proneness model for predicting drinking behaviors and to evaluate differences on model paths by ethnicity. Ethnic group membership moderated mediational pathways linked to the onset of regular alcohol use but not to drinking frequency. An increase in the number of childhood conduct problems predicted an earlier age at onset of regular drinking for blacks, whereas more positive alcohol expectancies were associated with an earlier initiation of regular drinking for whites and Hispanics. Findings from this study provide evidence that risk factors for alcohol use in adolescents and young adults vary according to ethnic group.

Prevalência e fatores associados ao tabagismo em estudantes de medicina de uma universidade em Passo Fundo (RS)

To determine the prevalence of and factors associated with smoking among medical students, as well as to evaluate the profile of this group. A total of 316 medical students (98.7% of the total) at the University of Passo Fundo, in the city of Passo Fundo, Brazil, completed a self-report questionnaire with questions on tobacco intake and on attitudes related to smoking. In accordance with the World Health Organization guidelines, the students were classified as daily smokers, occasional smokers, former smokers or nonsmokers, those in the two first categories being considered active smokers. We found that 16.5% of the students were active smokers (daily smokers, 5.4%; occasional smokers, 11.1%) and that 3.5% were former smokers. The mean age was 22.2 +/- 2.4 years. Factors significantly associated with the smoking habit (p < 0.05) were male gender, paternal smoking, regular alcohol consumption and use of antidepressants or anxiolytics. For the majority (69.2%) of the smokers, the age at smoking onset was 15-19 years of age, and the main motivations to start smoking were selfinitiative and influence of friends. The conceptualization of smoking as an illness was significantly higher among the nonsmokers. In 70.6% of the smokers, tobacco intake was 1-10 cigarettes a day. Among the smokers, 92.3% agreed that smoking is harmful to health, 67.3% had tried to quit smoking, 96.0% believed themselves able to do so, and 87.2% intended to quit smoking. The prevalence of smoking remains significant among medical students. Therefore, it is fundamental that we develop more effective strategies for smoking prevention and cessation in order to reduce the number of smokers among future doctors.

Interaction between dopamine D2 receptor genotype and parental rule-setting in adolescent alcohol use: evidence for a gene-parenting interaction

Association studies investigating the link between the dopamine D2 receptor gene (DRD2) and alcohol (mis)use have shown inconsistent results. This may be due to lack of attention for environmental factors. High levels of parental rule-setting are associated with lower levels of adolescent alcohol use and delay of initiation of drinking. We tested whether DRD2 TaqI A (rs1800497) genotype interacts with alcohol-specific parenting practices in predicting the uptake of regular adolescent alcohol use. Non-regular drinkers were selected from a Dutch, nationwide sample of 428 adolescents (mean age 13.4 years at baseline) and participated in a prospective, community-based study with three annual waves. Parental rule-setting was directly and inversely related to adolescent alcohol use over time. For DRD2 genotype no significant main effect was found. DRD2 genotype interacted with parental rule-setting on adolescent alcohol use over time: adolescents, with parents highly permissive toward alcohol consumption and carrying a genotype with the DRD2 A1 (rs1800497T) allele, used significantly more alcohol over time than adolescents without these characteristics. The DRD2 genotype may pose an increased risk for alcohol use and abuse, depending on the presence of environmental risk factors, such as alcohol-specific parenting.

Disinhibition and reward sensitivity in relation to alcohol consumption by university undergraduates

Deficits of prefrontal cortex functioning and associated executive cognitive impairments are well-known correlates of chronic alcoholism and may reflect cumulative effects of high alcohol exposure. However, such associations may also reflect traits predating alcohol exposure which predispose to heavy drinking. In the present investigation, 60 university undergraduates aged 18–25 years were administered the Alcohol Use Disorders Identification Test (AUDIT), Frontal Systems Behavior Scale (FrSBe), and Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). All participants reported they were at least occasional drinkers who rarely or never used illicit drugs and had no reported history of head injury or neurological problems. All were sober at time of testing. AUDIT total scores were positively correlated with both FrSBe Disinhibition scores and SPSRQ Reward Sensitivity scores. The latter were negatively correlated with age at onset of regular alcohol use. High risk drinkers (as defined by AUDIT) had higher FrSBe Disinhibition and SPSRQ Reward Sensitivity scores compared to low risk drinkers. Findings indicate that even in a highly selected subset of young adults–undergraduates attending a prestigious private university–associations may be present between indices of prefrontal cortex dysfunction and alcohol consumption, perhaps reflecting traits that predispose to heavy drinking.

Sociodemographic predictors of transitions across stages of alcohol use, disorders, and remission in the National Comorbidity Survey Replication

Background Although much is known about risk factors for the initiation of alcohol use, abuse, and dependence, few population-based studies have examined the predictors of transitions across these stages. Aim The aim of this study is to examine the sociodemographic predictors of transitions across 6 stages of alcohol use in the National Comorbidity Survey Replication, a nationally representative household survey of the US population. Methods A lifetime history of alcohol use, regular use (at least 12 drinks in a year), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition alcohol abuse and dependence with abuse was collected in 5692 National Comorbidity Survey Replication respondents using the World Health Organization Composite International Diagnostic Interview, Version 3.0. Results Lifetime prevalence estimates were 91.7% for lifetime alcohol use, 72.9% for regular use, 13.2% for abuse, and 5.4% for dependence with abuse. Male sex, young age, non-Hispanic white race/ethnicity, low education, student status, and never being married predicted the onset of alcohol use, the transition from use to regular use, and from regular use to abuse. An early age of onset of alcohol use also predicted the latter transition. The transition from abuse to dependence was associated with an early age of onset of regular alcohol use, being previously married, and student status. Remission was predicted by young age and a later age of onset of alcohol abuse. Conclusion The reduced number and magnitude of factors associated with transitions to dependence and remission suggest qualitatively different risk factors at these stages relative to other stages of progression. Further knowledge is needed concerning the mechanisms underlying these differences to guide selective and indicated prevention programs.

Alcohol use and cardiovascular health outcomes: a comparison across age and gender in the Winnipeg Health and Drinking Survey Cohort

research has reliably demonstrated cardioprotection from regular alcohol use. Heavy episodic drinking (HED), however, negates these beneficial effects and increases the risk of cardiovascular disease (CVD). The impact of age on the health effects of episodic drinking has not been evaluated. to examine the association between alcohol volume and pattern of consumption on the risk of cardiovascular morbidity and mortality across the lifespan. prospective, community-based cohort study of adults in Winnipeg, Manitoba, Canada. a total of 1,154 participants (580 men and 574 women) aged 18-64 surveyed at baseline (1990-91) on alcohol consumption levels and pattern of use. usual alcohol consumption was measured using a quantity-frequency approach. HED was estimated by asking participants how often they consumed eight or more drinks in one sitting in the past year. Questions were asked separately for wine, beer and spirits. Surveillance for cardiovascular events was conducted for 10 years (i.e. up to age 74 years). Diagnoses of CVD were obtained via health utilization records. Cox proportional hazard models were derived for both genders and for 'young adults' (baseline age 18-34), 'middle-aged adults' (baseline age 35-49) and 'older adults' (baseline 50-64). Models were adjusted for marital status, cigarette smoking status and educational level. Reduced risk of CVD was associated with usual consumption, whereas an increased risk was associated with HED. Among male usual drinkers, cardioprotection was afforded only to middle and older age groups. The benefits of regular consumption were seen only in the youngest age group among women. The heaviest usual consumption category was associated with a decreased risk of CVD in men. Heavy episodic drinking increased the risk of coronary heart disease in middle-aged men and was marginally significant in middle-aged women. Risk of hypertension was elevated in older men with heavy episodic drinking. The well-established relationship between regular alcohol consumption and decreased risk of CVD may not become evident until middle age or older in men. Women may benefit from usual consumption at a much younger age. In both sexes, however, these beneficial effects of alcohol use are negated when alcohol is consumed in a heavy episodic drinking pattern, particularly for middle-aged and older men.