Severity Of Alcohol-related Problems Research Articles

Indirect effects of personality on high-intensity drinking: The role of drinking motives.

Researchers have long been interested in identifying risk factors for binge drinking behavior (4+/5+ drinks/occasion for females/males), but many studies have demonstrated that a substantial proportion of young adults are drinking at levels far beyond (often 2 to 3 times) the standard binge threshold. The consumption of such large quantities of alcohol, typically referred to as high-intensity drinking (HID), can cause severe alcohol-related problems, such as blackouts, unintended sexual experiences, and death. This study is the first to investigate whether personality is indirectly associated with the likelihood of HID via drinking motives in a large (N=999) sample of underage young adult drinkers. We hypothesized that trait neuroticism would be indirectly associated with the likelihood of HID via coping motives and that extraversion would be indirectly associated with the likelihood of HID via social and enhancement motives. To investigate these hypotheses, we used two archival data sets that recruited current underage (18- to 20-year-old) adult drinkers residing in the United States from online panel services. Participants completed self-report survey items assessing constructs of interest. To investigate the role of drinking motives in the association between personality and HID, both the direct and indirect effects were calculated via three path analyses. Findings revealed that neuroticism was partially indirectly associated with the likelihood of HID via coping motives (b= 0.02, SE=0.004, p< 0.01). In addition, extraversion was indirectly associated with the likelihood of HID via social (b= 0.031, SE=0.002, p< 0.01) and enhancement motives (b=0.01, SE=0.002, p=0.01). These findings are an initial step in examining the interplay among personality traits, drinking motives, and HID in underage drinkers and point to the need for longitudinal studies assessing these associations.

The effectiveness of a mobile intervention to reduce young adults' alcohol consumption to not exceed low-risk drinking guidelines.

Young adults' drinking habits often exceed low-risk drinking guidelines. As young adults show increased access, use, and interest in personalized content related to physical and mental well-being, mobile applications might be a suitable tool to reach this target group. This study investigates the effectiveness of "Boozebuster", a self-guided mobile application incorporating various therapeutic principles to reduce young adults' alcohol consumption to not exceeding low-risk drinking guideline levels, compared to an educational website condition. Young adults aged 18-30 wanting to reduce their alcohol consumption entered a two-arm, parallel-group RCT. There were no minimum drinking severity inclusion criteria. Primary outcomes included alcohol consumption quantity and frequency. Secondary outcomes included binge drinking frequency and alcohol-related problem severity. Baseline, 6-week postbaseline, and 3-month post-baseline assessments were analyzed using linear mixed model analyses. Sex, treatment adherence, experienced engagement and motivation to change alcohol use behavior were investigated as moderators. Sub-group analyses contained problem drinkers and binge drinkers. 503 participants were randomized to the intervention or control condition. Results showed no intervention effects on primary or secondary outcomes compared to the control group. Both groups showed within-group reductions on all outcomes. Sub-group analyses in problem drinkers or binge drinkers showed similar results. Motivation to change drinking behavior and experienced engagement with the application significantly moderated the intervention effect regarding the quantity or frequency of alcohol consumption, respectively. Exploratory analyses showed that participants who indicated they wanted to change their drinking patterns during the initial PNF/MI module showed a significantly greater reduction in drinking quantity compared to those who indicated not wanting to change their drinking patterns. The intervention group did not show a greater reduction in alcohol-related outcomes compared to the control group, but both groups showed a similar decrease. Potential explanations include similar effectiveness of both condition due to using a minimal active control in participants predominantly in the action stage of motivation to change. Future research should further explore the effectiveness of using mobile application to reduce young adults' drinking behavior to not exceed low-risk drinking guideline levels and identify factors that motivate participants to engage with such an intervention.

A new paradigm in management of frequent attenders to emergency departments with severe alcohol use disorder-A pilot study for assertive community treatment in Singapore.

A majority of frequent users of emergency medical services in Singapore present with alcohol-related problems. These patients are known to engage poorly with traditional addiction services and frequently attend Emergency Departments (EDs) instead, resulting in high healthcare burden. Assertive Community Treatment (ACT) is an alternative intervention to traditional addiction management. ACT involves community visits with focus on holistic care and harm-reduction. We conducted a prospective before-and-after cohort study at the major tertiary center for addiction disorders in Singapore. The main objective was to evaluate effectiveness of ACT in reducing alcohol-related attendances at EDs nationwide. Socio-demographics, alcohol-related ED attendances, and the Christo Inventory for Substance-misuse Services (CISS) scores were collected for the patients recruited from April 2018 to March 2019. Descriptive analyses and the Wilcoxon Signed-Rank Test were performed. All 14 patients were male with a mean age of 55 years. There was a significant 45.3% reduction in average alcohol-related ED attendances from 6.8 (range 3-22, median 5.5) in the pre-intervention 6-month period, to 3.7 (range 0-28, median 1.5) in the post-intervention 6-month period (Z = -2.244, p = 0.025). CISS scores showed significant improvement from a pre-intervention median of 13.5 (range 9-16) to a post-intervention median of 6.5 (range 1-10, p = 0.001), corresponding to reduction in alcohol-related problem severity. This pilot study suggests that ACT can be effective in reducing alcohol-related ED attendances and alcohol-related problem severity in patients with AUD who frequently attend ED. A multicenter, prospective study using ACT for such patients across four hospitals in Singapore is currently underway.

Ethnic discrimination and alcohol-related problem severity among Hispanic/Latin drinkers: The role of social anxiety in the minority stress model

IntroductionHispanic/Latin individuals in the U.S. experience many health disparities, including worse alcohol-related outcomes. Thus, identifying psycho-sociocultural factors that may play a role in alcohol-related problems among these individuals is vital to informing prevention and treatment efforts. Minority stress-based models of alcohol misuse posit that some Hispanic/Latin individuals may drink (and continue to drink despite drinking-related problems) to alleviate negative affect associated with experiencing ethnic discrimination. Yet, little research has directly tested this hypothesis. Given the social nature of both ethnic discrimination and drinking, it follows that experiencing more ethnic discrimination could be related to greater social anxiety and some individuals may misuse alcohol to cope with this type of negative affect. MethodsParticipants were 373 Hispanic/Latin current drinking undergraduates. ResultsEthnic discrimination was significantly, positively correlated with alcohol-related problems, social anxiety, and coping motivated drinking, even after controlling for drinking frequency and quantity, traumatic life events, and several relevant demographic variables. Discrimination was indirectly related to alcohol-related problems via the sequential relations of social anxiety and coping motives. Alternative model testing indicated that social anxiety was not related to alcohol problems via discrimination, strengthening confidence in directionality of proposed relations. ConclusionsDiscrimination is associated with greater anxiety about negative evaluation among Hispanic/Latin individuals. The current study extended understanding of the impact of this type of anxiety by determining that social anxiety appears to play an important role in the relation between discrimination and alcohol-related problems among Hispanic/Latin young adults.

A Deep Learning Algorithm to Predict Hazardous Drinkers and the Severity of Alcohol-Related Problems Using K-NHANES.

Purpose: The number of patients with alcohol-related problems is steadily increasing. A large-scale survey of alcohol-related problems has been conducted. However, studies that predict hazardous drinkers and identify which factors contribute to the prediction are limited. Thus, the purpose of this study was to predict hazardous drinkers and the severity of alcohol-related problems of patients using a deep learning algorithm based on a large-scale survey data.Materials and Methods: Datasets of National Health and Nutrition Examination Survey of South Korea (K-NHANES), a nationally representative survey for the entire South Korean population, were used to train deep learning and conventional machine learning algorithms. Datasets from 69,187 and 45,672 participants were used to predict hazardous drinkers and the severity of alcohol-related problems, respectively. Based on the degree of contribution of each variable to deep learning, it was possible to determine which variable contributed significantly to the prediction of hazardous drinkers.Results: Deep learning showed the higher performance than conventional machine learning algorithms. It predicted hazardous drinkers with an AUC (Area under the receiver operating characteristic curve) of 0.870 (Logistic regression: 0.858, Linear SVM: 0.849, Random forest classifier: 0.810, K-nearest neighbors: 0.740). Among 325 variables for predicting hazardous drinkers, energy intake was a factor showing the greatest contribution to the prediction, followed by carbohydrate intake. Participants were classified into Zone I, Zone II, Zone III, and Zone IV based on the degree of alcohol-related problems, showing AUCs of 0.881, 0.774, 0.853, and 0.879, respectively.Conclusion: Hazardous drinking groups could be effectively predicted and individuals could be classified according to the degree of alcohol-related problems using a deep learning algorithm. This algorithm could be used to screen people who need treatment for alcohol-related problems among the general population or hospital visitors.

The efficacy of iCBT added to treatment as usual for alcohol-dependent patients in primary care: study protocol for a randomized controlled trial

BackgroundAlcohol dependence is a common disorder with a continuum regarding severity. Most alcohol-dependent persons have a moderate level of dependence and live under socially orderly conditions. Treatment-seeking in this group is low, mainly due to stigma and because treatment options are seen as unappealing.Alcohol is a relevant topic to discuss in many primary care (PC) consultations and PC is less stigmatizing to visit compared to addiction care units for people with alcohol problems. However, general practitioners (GPs) hesitate to engage in treating alcohol problems due to time constraints and lack of knowledge. Screening and brief interventions are effective for high consumers but there are few studies on dependence.MethodsThis is a two-group, parallel, randomized controlled trial (RCT). The aim is to study whether an Internet-based Cognitive Behavioral Treatment (iCBT) when added to treatment as usual (TAU) is more effective than TAU only for alcohol dependence in PC. Two hundred and sixty adults with alcohol dependence will be included. Participants are randomized to iCBT and TAU or TAU only. The primary study outcome is alcohol consumption in grams per week and heavy-drinking days. Secondary outcomes include alcohol-related problem severity, number of diagnostic criteria for alcohol dependence, depression and anxiety symptoms, health-related quality of life and biochemical markers for high consumption and liver pathology. Data will be analyzed using mixed-effect models.DiscussionInternet-based interventions are attractive to, and have been shown to reach, people with alcohol problems. Yet there are no studies investigating the efficacy of Internet treatment of alcohol dependence in PC. In this study we hypothesize that iCBT when added to TAU will improve treatment outcome for alcohol dependence in PC, compared to TAU only. If effective, iCBT can be distributed to the public to a low cost for a stakeholder and has the opportunity to reduce both short-term and long-term public health costs.Trial registrationISRCTN69957414. Retrospectively registered on 7 June 2018.

The profile of people living in extreme poverty in the region of Crete

Abstract Background The financial crisis of the last decade has increased the number of people living in extreme poverty in Greece. Until today, there is no research evidence on the bio-psycho-social needs of the population. The current study, among other, aimed at investigating the living and working conditions, the health and mental health status of these people and produced recommendations for health care policy and planning. Methods A cross-sectional study was carried out in Crete Region with adult beneficiaries of material support benefits (according to income-related criteria). The study was part of the program FAED, which was co-funded by the EU and offered material support (e.g. food, material for personal hygiene, etc. to more than 17.000 beneficiaries in Crete region within 2016-2017. A structured questionnaire extracted information on various aspects including, working, housing and living conditions, health and mental health status. Results 798 individuals (46.5% male; 43.3 years) consented to participate and completed the questionnaire. Mean time of unemployment was 4.2 years. 26.8% was accommodated by relatives, 23.5% rented a house and 18% lacked heating. Nearly half of the participants reported a chronic disease (47.0%), 24.1% reported disability certified by health authorities. 4.9% had severe alcohol-related problems, 50.6% had mild to severe depression symptoms and 40.3% mild to severe symptoms of anxiety disorder. 12.0% totally lacked a support network for daily practical and emotional issues. Conclusions Personal psychosocial needs seem to have been neglected because of complex family needs. Socioeconomic deprivation seems to have exacerbated chronic disease management due to neglect of health care needs. A huge burden of mental diseases is evident necessitating community mental health care. Key messages Mapping of bio-psychosocial needs is important for social policy and health care planning. Integrated care is necessary to meet the complex needs of people living in extreme poverty.

Predictors of aging out of heavy episodic drinking in emerging adults: a systematic review protocol

BackgroundHeavy episodic drinking (HED) refers to alcohol consumption that exceeds the recommended threshold for a given episode and increases risk for diverse negative alcohol-related consequences. A pattern of weekly HED is most prevalent in emerging adults (i.e., age 18–25). However, rates of HED consistently decline in the mid to late twenties, referred to as ‘aging out’ or ‘maturing out’ of HED. Although many individual studies have followed changes in drinking behaviour over the transition to adulthood, there has yet to be a systematic review to identify consistent factors contributing to risk (i.e. failure to age out) and protection (i.e. successful aging out). The objective of this review will be to summarize and critically appraise the literature on factors contributing to aging out of HED among emerging adults.MethodsA systematic search of observational cohort studies following drinking behaviours in age cohorts overlapping with the emerging adulthood period will be conducted in MEDLINE, EMBASE, PsychInfo, and CINAHL. Two independent reviewers will evaluate identified studies for inclusion eligibility, extract study data, and assess the quality of included studies. Primary outcomes will be quantity/frequency of alcohol use (e.g. drinks/week) and severity of alcohol-related problems. Predictors of maturing out of HED will be reported narratively, and where appropriate, random effects meta-analyses will be conducted to provide pooled effect sizes. An evidence map will be created to characterize the overall pattern of findings.DiscussionThis systematic review will provide a timely and warranted summary of published work contributing to understanding aging out of heavy episodic drinking. Our findings will provide critical commentary on the developmental course of HED during the transition from adolescence to adulthood and will be the first review to consider both protective and risk factors for maturing out of frequent binge drinking. By highlighting factors identifying those at-risk for prolonged heavy episodic drinking, our conclusions will have important treatment implications for primary, secondary, and tertiary intervention strategies.Systematic review registrationPROSPERO CRD42017078436.

Gender-Specific Association between Alcohol Consumption and Stress Perception, Depressed Mood, and Suicidal Ideation: The 2010-2015 KNHANES.

ObjectiveAlcohol drinking can cause various psychiatric and medical diseases. Although women generally consume less alcohol than men, they may be at a greater risk for alcohol-related psychological distress. The aim of the current study is to evaluate whether the association between alcohol consumption and psychological distress, including stress, depressed mood, and suicidal ideation and the risks of psychological distress differ based on gender. MethodsThe cross-sectional study included 31,657 participants (17,915 women and 13,742 men) from the 2010–2013 and 2015 Korea National Health and Nutrition Examination Survey. Alcohol drinking and Alcohol Use Disorders Identification Test (AUDIT) levels were assessed for evaluating the amount of alcohol intake and alcohol-related problems. Self-perception of stress, depressed mood, and suicidal ideation were assessed for evaluating psychological distress. Odds ratio and 95% confidence intervals for psychological distress were calculated using multiple logistic regression models. ResultsThe risks of psychological distress were not significantly associated with drinking level in both sexes. However, the risks of psychological distress were associated with an increase in AUDIT levels, and there were gender differences in the psychological consequences of alcohol-related problems. The association was more drastic in women, and women showed a significant association even though the severity of drinking problem was low with the exception of stress perception. ConclusionThe risks of psychological distress were associated with the severity of alcohol-related problems and women were more likely to be susceptible. Therefore, it is recommended that women even at low-risk for problematic drinking should be screened for psychological distress.

Bidirectional relationships between future time perspective and alcohol use: an exploratory study in a clinical setting

Gaining a better grasp on factors related to changes in alcohol use is of particular interest for clinicians. Past research has highlighted a negative link between future time perspective (i.e. a disposition guiding how individuals consider and act regarding their future) and alcohol misuse. However, much remains at stake in the understanding of this association. The objective of this research was to explore bidirectional relationships between future time perspective and severity of alcohol-related problems, in a clinical setting. The sample includes 79 patients followed up in an outpatient alcohol treatment centre. Two measurement times were planned: at entry into care and 6 months later. Multiple linear regression analyses were carried out, controlling for sociodemographic variables. We found that baseline future time perspective predicted level of alcohol-related problems after 6 months in treatment, even when effects of baseline alcohol-related problems and sociodemographic variables were controlled. This study shows that the way patients see and position themselves regarding their future can affect level of alcohol-related problems. It may be useful for clinicians to identify patients with low future time perspective to offer tailored interventions and consider this dimension as a resource for change.

An Empirical Study of the Cut-Off Point for the Iranian Version of Alcohol Use Disorders Identification Test (AUDIT)

Background: AUDIT is constructed to be able to identify hazardous drinking and less severe alcohol-related problems. The original AUDIT was shown to have a cut-off score of 8 and above for identifying hazardous or harmful alcohol consumption. The aim of this study was to establish the optimal cut-off point of the Persian version of Alcohol Use Disorders Identification Test (AUDIT) in psychiatric out-patients. Methods: Participants were a sample of consecutive patients at Imam Hossein Hospital (Tehran/Iran). They consisted of 99 patients, 49 of them diagnosed with alcohol dependency and 50 patients randomly selected from a sample of patients using alcohol but with other primary diagnoses. All statistics including means and standard deviations as well as medians and interquartile range were calculated in SPSS 24 software environment. Results: A Receiver Operating Curve analysis showed that by using a 20-point cut-off, the AUDIT had an optimal combination of sensitivity (.92) and specificity (.74). The rate of discrimination was .88. Conclusions: Given the high sensitivity and acceptable specificity of the AUDIT, the test can be used as an effective instrument for identification of alcohol use disorders in the Persian psychiatric out-patient population. Furthermore, the receiver operating curve found in this study resembles the one found in previous studies despite the differences in alcohol cultures between Iran and countries with higher alcohol consumption.

Testing the stress-strain-coping-support (SSCS) model among family members of an alcohol misusing relative: The mediating effect of burden and tolerant-inactive coping

BackgroundExcessive alcohol use may harm not only the individual drinker, but also the lives of their family members. The stress-strain-coping-support (SSCS) model emphasizes that the stress experienced by family members could lead to the development of various physical and psychological symptoms. ObjectivesThe aim of the current study is to examine the possible moderating and mediating role of coping on the relationship between stress and strain among family members seeking help due to a relative's alcohol misuse. MethodsData from 168 help-seeking affected family members were analyzed (mean age: 44.61 years; 87.5% were female). The cross-sectional study used a set of standard questionnaires measuring the perceived severity of the relative's alcohol-related problem, the family member's feelings of hopelessness, their coping styles, and the strain and burden of caring for the relative who is misusing alcohol. Path analyses were used to test the direct and indirect effects of the mediational model. ResultsCurrent findings provided support for the moderating effect of engaged coping. Moreover, tolerant-inactive coping style and burden on hopelessness have an addictive effect. The mediational model showed an adequate fit. The pathways between (1) the perceived alcohol-related problem – burden – hopelessness, (2) the perceived alcohol-related problem – tolerant coping – hopelessness, and (3) the perceived alcohol problem-related – burden –tolerant coping – hopelessness each showed significant indirect effects. ConclusionsThe findings support the suggestion of the SSCS-model on the mediating role of coping between stress and strain. Affected family members who perceive more severe alcohol-related problems could show increased rates of burden and tolerant-inactive coping style, which could separately or sequentially result in increased symptoms of hopelessness.

Does managing the consumption of people with severe alcohol dependence reduce harm? A comparison of participants in six Canadian managed alcohol programs with locally recruited controls

Managed alcohol programs (MAP) are intended for people with severe alcohol-related problems and unstable housing. We investigated whether MAP participation was associated with changes in drinking patterns and related harms. One hundred and seventy-five MAP participants from five Canadian cities (Hamilton, Ottawa, Toronto, Thunder Bay and Vancouver) and 189 same-city controls were assessed for alcohol consumption, health, safety and harm outcomes. Length of stay in a MAP was investigated as a predictor of drinking patterns, non-beverage alcohol consumption and related harms. Statistical controls were included for housing stability, age, gender, ethnic background and city of residence. Negative binomial regression and logistic regression models were used. Recently admitted MAP participants (≤2 months) and controls were both high consumers of alcohol, predominantly male, of similar ethnic background, similarly represented across the five cities and equally alcohol dependent (mean Severity of Alcohol Dependence Questionnaire = 29.7 and 31.4). After controlling for ethnicity, age, sex, city and housing stability, long-term MAP residents (>2 months) drank significantly more days (+5.5) but 7.1 standard drinks fewer per drinking day than did controls over the last 30 days. Long-term MAP residents reported significantly fewer alcohol-related harms in the domains of health, safety, social, legal and withdrawal. Participation in a MAP was associated with more frequent drinking at lower quantities per day. Participation was associated with reduced alcohol-related harms over the past 30 days. Future analyses will examine outcomes longitudinally through follow-up interviews, police and health care records.

P.6.b.001 - Relationship of early onset alcoholism with impulsivity and severity of alcohol related problems in a sample of inpatients with alcohol use disorder

P.6.b.001 - Relationship of early onset alcoholism with impulsivity and severity of alcohol related problems in a sample of inpatients with alcohol use disorder

Relationship of attention-deficit/hyperactivity disorder symptom severity with severity of alcohol-related problems in a sample of inpatients with alcohol use disorder.

PurposeAttention-deficit/hyperactivity disorder (ADHD) has been shown to be related to a higher risk of developing psychiatric problems such as depressive disorders, substance use disorder, and impulsivity. Adults who have comorbid ADHD and alcohol use disorder (AUD) are at greater risk of negative outcomes. Thus, it is important to evaluate the relationship of ADHD symptoms and the severity of alcohol-related problems among patients with AUD. The aim of the present study was to evaluate the effect of ADHD symptoms on severity of alcohol-related problems, while controlling the effects of depression and impulsivity in a sample of inpatients with AUD.Patients and methodsParticipants (n=190) were evaluated with the Beck Depression Inventory, the Short Form Barratt Impulsiveness Scale, the Michigan Alcohol Screening Test, and the Adult ADHD Self-Report Scale.ResultsSeverity of the scale scores was positively correlated with each other. Although severity of depression and impulsivity (particularly non-planning impulsivity) predicted the severity of alcohol-related problems in a linear regression model, when severity of ADHD symptoms was included in the analysis, the inattentive subscale score, in particular, predicted the severity of alcohol-related problems together with non-planning impulsivity, whereas depression was no longer a predictor.ConclusionThese findings suggest that, together with non-planning impulsivity, symptoms of ADHD (particularly inattentive factor) are an important factor that predict alcohol-related problems, while controlling the severity of depressive symptoms among inpatients with AUD.

Distress tolerance in social versus solitary college student drinkers

Low distress tolerance has been an inconsistent predictor of alcohol-related consequences in college students, but its relationships to depression and coping motives for alcohol have received stronger support. Research on college students who drink heavily in isolation suggests that this population is more likely to have a greater number and severity of alcohol-related problems, depression, and coping motives. Solitary heavy drinkers were therefore hypothesized to have lower distress tolerance than other drinkers. This study examined differences in self-reported and behavioral distress tolerance across two groups of university students: those who endorsed heavy solitary drinking (20.1%) versus those who endorsed other types of drinking. Students completed a self-report measure (Distress Intolerance Self-Report, or DISR) and behavioral measure of distress tolerance (Paced Auditory Serial Addition Test, or PASAT). Students who reported drinking heavily in isolation differed from other students on the DISR, F(1, 132)=4.645, p=.033, η2=.034, but not on the PASAT, F(1, 132)=0.056, p=.813. These students also endorsed more coping motives for alcohol. Distress tolerance did not predict drinking consequences directly, yet a mediation model linking distress tolerance to consequences through coping motives supports previous findings of distress tolerance as a distal, indirect predictor of drinking problems. The unique characteristics of solitary binge drinkers and the significance of distress tolerance as an indirect predictor of alcohol-related consequences are discussed.

Substance Use Among Medical Students in Greece

Introduction Limited research exists worldwide on medical students’ substance use patterns including alcohol and marijuana use. Aim The aim of the study was to examine the prevalence of substance use, including marijuana, alcohol and other illicit substances (i.e. cocaine, hallucinogens and ecstasy) in a sample of medical students in Greece. Methods 655 students from the School of Medicine of Thessaloniki completed an anonymous, web-based survey including the CAGE questionnaire for alcohol abuse. Students were asked to report the frequency (lifetime, past year, past month) and the motive of the use. Results 72% percent of the students reported having never used any illegal substance and 21% reported marijuana use at least once in their lifetime. 20.9 % were nicotine smokers. No gender difference regarding marijuana use was observed. Marijuana users underestimated the risk of marijuana use on their health compared to non users. Although the relative mean Cage scores are low indicating a lack of severe alcohol related problems in our sample, there is a significantly higher mean CAGE score in students who use marijuana. The use of other illicit substances was rare (3% used inhalers, 2.3 % cocaine, 2.3% ecstasy, 2% ketamine, 1.8% amphetamines and 1.7% mephedrone). However, the use of marijuana was significantly correlated with use of cocaine, LSD, ecstasy, ketamine, amphetamine and mephedrone. Conclusions The findings represent initial data on the prevalence of substance use among Greek medical students. Nationwide studies are needed further investigating the prevalence, the motivation and the impact of this risky behaviour among this population.

Prevalence of major depressive disorder among spouses of men who use alcohol in a rural community in Central Sri Lanka.

Aims: To estimate the prevalence of major depressive disorder (MDD) among spouses of men who use alcohol in two rural areas in Sri Lanka, and to examine whether the severity of alcohol-related problems (ARPs) in men and presence of alcohol-related domestic violence are associated with MDD among these women.Method: In a cross-sectional study, ARPs among men were assessed using Alcohol Use Disorders Identification Test (AUDIT) questionnaire filled in by men, and domestic violence and husbands' drinking pattern data obtained from the women. MDD among the women was ascertained using the Structured Clinical Interview for DSM–IV Disorders for major depression. Using logistic regression we examined whether age, past history of depression, different indices of ARPs and domestic violence were associated with current MDD among the women.Results: Point prevalence of MDD in the sample was 33.3% (95% CI: 25.93, 40.73%). Once adjusted for other factors, morning drinking of the spouse (odds ratio = 4.11, 95% CI: 1.25, 13.47; P = 0.019) and increasing age (odds ratio = 1.05, 95% CI: 1.01, 1.09; P = 0.003) significantly increased the odds of MDD. Being subjected to domestic violence/arguments also had a trend to be associated with MDD among women, but was not significant (odds ratio = 2.29, 95% CI: 0.95, 5.48; P = 0.062).Conclusion: The prevalence of MDD among spouses of men who use alcohol is markedly higher than that has been observed among Sri Lankan women in previous studies. The prevalence of MDD in women seems to increase when their husbands are morning drinkers, and with increasing age.

SY05-1 * A COUNTERMEASURE AGAINST ALCOHOL-RELATED PROBLEMS IN THE TSUNAMI-STRICKEN AREAS CAUSED BY THE GREAT EAST JAPAN EARTHQUAKE

Since the Great East Japan Earthquake, the Tohokukai Mental Hospital has provided support to resolve alcohol-related problems in the disaster-stricken areas of Miyagi Prefecture, as we assumed that alcohol consumption and alcohol-related problems might increase in the disaster areas as a reaction to disaster-related stress. Because no other hospital with specialized treatment programs for alcoholism exists, other than the Tohokukai Mental Hospital, and because the number of mutual aid groups is limited in Miyagi coastal areas, it is difficult to assess the severity of alcohol-related problems and to resolve alcohol-related issues within the Miyagi coastal areas. In this presentation, I would like to report the following: (1) changes in alcohol-use disorders at our hospital before and after the Great East Japan Earthquake, and (2) support that we have provided for alcohol-related problems in distressed areas, particularly the effect of a ‘group approach.’

Predictors of Dropout in an Outpatient Treatment for Problem Drinkers Including Cognitive-Behavioral Therapy and the Opioid Antagonist Naltrexone

This study investigated predictors of dropout in an outpatient treatment program for problem drinking that included individual cognitive-behavioral therapy combined with naltrexone. Specifically, we investigated whether sociodemographic factors, severity of alcohol dependence, history of problem drinking, or intensity of alcohol craving assessed at the beginning of the treatment predicted dropout from an outpatient program among a sample of 372 patients (65% male). We also investigated whether the effectiveness of the treatment (the change in alcohol consumption and symptoms of alcohol craving) or adherence to naltrexone was related to dropout. Predictors of dropout were investigated using an analysis of covariance with the number of attended treatment sessions as an independent variable. Our results demonstrated that the treatment entry factors predictive of dropout were younger age, lower severity of alcohol dependence, better ability to resist and control alcohol use, and lower obsession with alcohol. In addition, those who dropped out were more likely to begin the program by abstaining from alcohol and had lower adherence to naltrexone use than those who completed the program. The length of stay for treatment was not related to change in alcohol consumption. Patients with less severe alcohol-related problems may lack motivation for treatment, specifically cognitive-behavioral therapy and naltrexone. These patients may benefit more from less intensive treatments.