Severe Alcohol Problems Research Articles

Potentially traumatic events and the association with hazardous alcohol use in 19,128 middle aged and elderly adults: the Tromsø Study 2015-2016.

The aim was to examine the association between a wide range of potentially traumatic events (PTEs) experienced in childhood, adulthood or both, and hazardous alcohol use, including the relationship between the total sum of PTEs and hazardous alcohol use in middle aged and elderly adults. Previous studies have predominantly focused on childhood PTEs or isolated PTEs and more severe alcohol problems, little focus has been given to middle aged and elderly adults with hazardous alcohol use and PTE experiences. We used logistic regression analysis to study the relation between a broad range of PTEs and hazardous alcohol defined by the alcohol use disorder identification test (AUDIT) in 19,128 women and men aged 40years and above participating in the seventh survey of the Norwegian population-based Tromsø Study in 2015-2016. Alcohol abstainers were excluded from the analyses. Experience of violence, sexual abuse, bullying, painful or frightening medical and dental treatments, and serious illness or accident by a loved one were associated with higher odds for hazardous alcohol use. Further, there were higher odds of hazardous alcohol use per additional experienced PTE (OR = 1.22, 95% CI 1.20-1.25, p ≤ 0.001). PTEs were prevalent among participants who had a hazardous alcohol use. Also, most of the PTEs occurring in childhood, adulthood or both were independently related to hazardous alcohol use. Moreover, the findings indicate an association in the relationship between the number of PTEs and hazardous alcohol use.

Recovery capital profiles among a heterogeneous sample of individuals in recovery from alcohol problems.

Recovery capital (RC) is a framework for conceptualizing the resources individuals use to support alcohol and other drug recovery across social, physical, human, and cultural domains. The goal of this study was to identify subgroups of individuals in recovery with distinct combinations of RC across domains and characteristics of individuals with unique RC patterns. Latent profile analyses investigated patterns in both within-domain amount and variability of RC across each of the four domains using the Multidimensional Inventory of Recovery Capital, a theoretically and psychometrically sound RC measure. The sample included U.S. participants closely reflecting 2020 Census demographics (n = 482, 49% female, 38% racial/ethnic minority, Mage = 42.57) identifying as having resolved a prior problem with alcohol (alone or with other drugs). Latent profile analyses distinguished four RC profiles: Low/Inconsistent (23%), Moderate/Consistent (43%), Moderate/Inconsistent (12%), and High/Consistent (22%). Females and individuals who were unemployed, nonabstinent, and had greater alcohol problem severity were more likely to belong to the Low/Inconsistent profile. Individuals in unassisted recovery were more likely to belong to the Moderate/Inconsistent profile. Older age and more time in recovery were associated with High/Consistent profile membership. Race/ethnicity was not associated with profile membership. These person-oriented analyses elucidate complex patterns of resources that individuals utilize during recovery and individual characteristics underpinning differences across RC patterns. The empirically derived subgroups in this heterogeneous sample highlight multiple combinations of resources that individuals leverage to achieve recovery and indicate characteristics of individuals who may need greater amounts and/or consistency of RC to continue sustaining recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors Associated With Motivation to Reduce Alcohol Use Among Patients With Chronic Liver Disease.

Alcohol use is prevalent among hepatology clinic patients with chronic liver disease (CLD). We explored factors associated with the importance and confidence dimensions of motivation to reduce drinking. Participants (N = 121) with unhealthy alcohol use (i.e., over NIH guidelines) receiving care in hepatology clinics from a safety-net hospital (SN, N = 54) and two Veterans Affairs Healthcare Systems (VA, N = 67) were enrolled in an alcohol intervention trial from March 2022 through October 2023. Baseline assessments included Generalised Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Alcohol Use Disorders Identification Test (AUDIT), COVID-19 stress; and measures of importance and confidence to decrease alcohol use (readiness rulers, scales of 1-10). Liver disease aetiology and severity were extracted from electronic health records. We performed multivariable linear regression models with forward selection to assess pre-specified variables' associations with importance and confidence. The sample was 84% male, 40% Latino, 31% White, 18% Black and 11% other races; median age was 61 years. Median (Q1-Q3) AUDIT score was 16 (12-24), importance was 9 (6-10) and confidence was 8 (5-9). On multivariable analysis, VA site (vs. SN) participants had a 0.97-point lower importance score (p = 0.02); higher symptoms of depression (PHQ-8 score ≥ 10 vs. < 10) and AUDIT scores (for each point increase) were associated with higher importance score (estimates 1.2 and 0.08, p < 0.05, respectively). Liver disease aetiology and severity were not significantly associated with outcomes. Depression, alcohol problem severity and treatment site may influence motivation to reduce alcohol use and could inform future hepatology-based interventions.

Willingness to wait outperforms delay discounting in predicting drinking severity.

Alcohol misuse ranks among the leading causes of preventable death worldwide. Therefore, discovering measures that can predict hazardous drinking is critical. The delay discounting paradigm-which assesses relative preference for immediate rewards over larger, later rewards-has frequently been used as a proxy for impulsive choice, but it does not capture how long someone is willing to wait for delayed rewards when the arrival time is uncertain. In contrast, a newer willingness-to-wait task measures how long someone is willing to wait for a delayed reward of uncertain timing before giving up. We hypothesized that performance in this willingness-to-wait task would be associated with drinking severity and that this task may even outperform delay discounting as a predictor of drinking severity. We pooled data from multiple studies of mostly college-aged adult participants. Drinking severity was assessed with the Alcohol Use Disorders Identification Test. Willingness to wait under temporal uncertainty, but not delay discounting, was associated with severity of alcohol problems among participants who drank (n = 212). Individuals engaging in hazardous drinking were less willing to wait for rewards when delays were unknown than were individuals with low-risk drinking habits. Thus, willingness to wait under temporal uncertainty may be an important predictor of problematic drinking.

Plant Medicine, Psychedelics and the Inner-Sciences of Mental Wellness: Implications for Healthy Longevity and Rejuvenation

Plant Medicine, Psychedelics and the Inner-Sciences of Mental Wellness: Implications for Healthy Longevity and Rejuvenation

Tapping into alcohol use during COVID: Drinking correlates among bartenders and servers.

The COVID pandemic placed a spotlight on alcohol use and the hardships of working within the food and beverage industry, with millions left jobless. Following previous studies that have found elevated rates of alcohol problems among bartenders and servers, here we studied the alcohol use of bartenders and servers who were employed during COVID. From February 12-June 16, 2021, in the midst of the U.S. COVID national emergency declaration, survey data from 1,010 employed bartender and servers were analyzed to quantify rates of excessive or hazardous drinking along with regression predictors of alcohol use as assessed by the 10-item Alcohol Use Disorders Identification Test (AUDIT). Findings indicate that more than 2 out of 5 (44%) people surveyed reported moderate or high rates of alcohol problem severity (i.e., AUDIT scores of 8 or higher)-a rate 4 to 6 times that of the heavy alcohol use rate reported pre- or mid-pandemic by adults within and outside the industry. Person-level factors (gender, substance use, mood) along with the drinking habits of one's core social group were significantly associated with alcohol use. Bartenders and servers reported surprisingly high rates of alcohol problem severity and experienced risk factors for hazardous drinking at multiple ecological levels. Being a highly vulnerable and understudied population, more studies on bartenders and servers are needed to assess and manage the true toll of alcohol consumption for industry employees.

Individual Differences in Substance Use Motives, Trauma, and Stress Among College-Based Polysubstance Users

Background : Co-use of alcohol and other drugs within a certain time frame (i.e., polysubstance use) has become increasingly prevalent, particularly among college-aged individuals, but understanding motives for co-use remains limited. Polysubstance use has been associated with a higher likelihood of negative health consequences as compared to single substance use. Objectives : The current study examined associations between motivations for using alcohol, tobacco, and cannabis among college students who use multiple substances versus students using only one substance or no substances. Additionally, we examined the effect of trauma and daily stress on polysubstance use in self-report data from individuals (N=134) participating in the MAPme Study. Results : First, the observed prevalence of polysubstance use was greater than expected by chance, with most individuals co-using alcohol and cannabis. “Alcohol and Other Drug Users” were more frequently motivated to drink for social (β=0.27, CI=[0.07, 0.44]), enhancement (β=0.26, CI=[0.01, 0.42]) and coping (β=0.21, CI=[0.06, 0.47]) reasons compared to individuals who consumed alcohol alone. Conclusions : Individual differences in motivations for use were partly explained by frequency of alcohol use and alcohol problem severity, but not by history of trauma or stress. Finally, while patterns of correlations among motivations for use across substances suggested a general tendency to be motivated to use substances for similar reasons, this was not supported by confirmatory factor models. Overall, shared motives may inform potential behavioral patterns for co-use of substances during college and might advise future treatment efforts.

Criminogenic Needs andLegal Problem Severity Among Legal System Involved Veterans.

Many veterans seeking behavioral health services have history of criminal-legal involvement. Research on criminogenic needs of legal system involved veterans is burgeoning. However, most research has relied on cross-sectional examinations and the vast majority of prior work has focused assessment on just one criminogenic need per study. The present study evaluated seven key criminogenic needs of legal system involved veterans (N = 341) enrolled in one of three U.S. Veterans Health Administration residential behavioral health treatment programs. Criminogenic needs and legal problem severity were assessed at baseline, and at 6 months and 12 months post-baseline. Directionality of associations between participants' criminogenic needs and legal problem severity was examined using latent change score models. Results revealed having more antisocial associates at a previous timepoint was associated with greater subsequent improvements in legal problem severity ($\beta $=-0.01, P < 0.02) and greater improvements in legal problem severity predicted greater subsequent improvements in alcohol problem severity ($\beta $=0.13, P < 0.01). In one of the most comprehensive single-study assessments of criminogenic needs among a sample of legal system involved veterans, results highlight links between antisocial associates and alcohol problem severity with legal problem severity.

Alcohol Craving and Severity are Associated with Dorsal Anterior Cingulate Choline Levels in Individuals with an Alcohol Use Disorder.

Magnetic resonance spectroscopy (MRS) has been used to probe inflammation in the brain. While altered MRS metabolite levels have previously been found in individuals with alcohol use disorder (AUD), the relationship between potential metabolite markers of inflammation and the clinical correlates of AUD remains understudied. Therefore, this exploratory study sought to elucidate the clinical significance of inflammation in AUD by examining relationships between metabolites, AUD severity, alcohol consumption, and craving in individuals with AUD. Data for this secondary analysis are derived from a two-week clinical trial of ibudilast to treat AUD. Forty-three non-treatment-seeking individuals with an AUD (26M/17F) completed an MRS scan and alcohol-related questionnaires. MRS was performed using a multi-voxel array placed above the corpus callosum, extending from the pregnenual anterior cingulate to premotor cortex. The dorsal anterior cingulate was selected as the volume of interest. Metabolite levels of choline-compounds (Cho), myo-inositol (mI), and creatine+phosphocreatine (Cr) were quantified. Separate hierarchical regression models were used to evaluate the independent effects of metabolite levels on alcohol craving, alcohol problem severity, and alcohol consumption. Dorsal anterior cingulate Cho predicted alcohol craving and alcohol problem severity over and above demographics, medication, and alcohol consumption measures. mI and Cr did not predict alcohol craving or alcohol problem severity. Metabolite markers were not predictive of alcohol consumption. This preliminary study indicates that dACC Cho is sensitive to clinical characteristics of AUD. This is a further step in advancing neurometabolites, particularly Cho, as potential biomarkers and treatment targets for AUD.

Change in Alcohol Use during the Prolonged COVID-19 Pandemic and Its Psychosocial Factors: A One-Year Longitudinal Study in Japan.

This study investigated changes in alcohol use and its related psychosocial factors during the COVID-19 pandemic in Japan. Two online surveys were completed by participants between 15 and 20 June 2021 (phase 1) and 13 and 30 May 2022 (phase 2). A total of 9614 individuals participated in both phases (46% women, mean age = 50.0 ± 13.1 years) and a repeated three-way analysis of variance and multinomial logistic regression analysis were conducted. These data analyses showed that the presence of hazardous alcohol use at phase 2 was predicted by being male and unmarried, having a higher annual household income and age, having a larger social network, and displaying fewer COVID-19 prevention behaviors at phase 1. Further, the presence of potential alcoholism at phase 2 was predicted by being male, being more anxious, having a larger social network, exercising more, showing a deterioration of economic status, having more difficulties owing to a lack of daily necessities, having less healthy eating habits, and showing fewer COVID-19 prevention behaviors at phase 1. These findings suggest that psychological problems and increased work (or academic) and economic difficulties were associated with severe alcohol problems during a later stage of the COVID-19 pandemic.

Predictive risk markers in alcoholism.

The medical disorders of alcoholism rank among the leading public health problems worldwide and the need for predictive and prognostic risk markers for assessing alcohol use disorders (AUD) has been widely acknowledged. Early-phase detection of problem drinking and associated tissue toxicity are important prerequisites for timely initiations of appropriate treatments and improving patient's committing to the objective of reducing drinking. Recent advances in clinical chemistry have provided novel approaches for a specific detection of heavy drinking through assays of unique ethanol metabolites, phosphatidylethanol (PEth) or ethyl glucuronide (EtG). Carbohydrate-deficient transferrin (CDT) measurements can be used to indicate severe alcohol problems. Hazardous drinking frequently manifests as heavy episodic drinking or in combinations with other unfavorable lifestyle factors, such as smoking, physical inactivity, poor diet or adiposity, which aggravate the metabolic consequences of alcohol intake in a supra-additive manner. Such interactions are also reflected in multiple disease outcomes and distinct abnormalities in biomarkers of liver function, inflammation and oxidative stress. Use of predictive biomarkers either alone or as part of specifically designed biological algorithms helps to predict both hepatic and extrahepatic morbidity in individuals with such risk factors. Novel approaches for assessing progression of fibrosis, a major determinant of prognosis in AUD, have also been made available. Predictive algorithms based on the combined use of biomarkers and clinical observations may prove to have a major impact on clinical decisions to detect AUD in early pre-symptomatic stages, stratify patients according to their substantially different disease risks and predict individual responses to treatment.

Effectiveness of a Stand-alone Telephone-Delivered Intervention for Reducing Problem Alcohol Use

Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established. To examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample. This double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020. The telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets. The primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument. This study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis). Based on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment. ANZCTR Identifier: ACTRN12618000828224.

The intergenerational transmission of gambling and other addictive behaviors: Implications of the mediating effects of cross-addiction frequency and problems

IntroductionThis study examined the degree to which perceptions of familial and household participation in gambling and other addictive behaviors in youth was associated with frequency and problem severity of gambling, alcohol and/or drug use in participants as adults. MethodThe study measured perceived frequency of gambling, alcohol use, drug use and other potentially addictive behaviors in family/household members and the frequency and problem severity of gambling, alcohol, and drugs in an epidemiological sample of adults 18 and older (N = 3,499; m = 48.26 %, f = 51.74 %). ResultsAbout 23.45 % of participants reported their father gambled when they were a child or adolescent, followed by mother (13.56 %), grandfather (9.73 %), or grandmother (7.83 %). A pathway model demonstrated cross-addiction inter- and intra-generational influences. Gambling by a father, mother or brother; substance use by a sister; and/or engagement in other behaviors by a brother, sister, grandmother or other household member was related to higher frequency of participant gambling (ps < 0.05), and, in turn, to higher levels of gambling, alcohol, and drug use problem severity (ps < 0.05). DiscussionFindings demonstrate the complex contributions of specific family and household members in the transmission of addictive behaviors. Frequency of gambling, alcohol use, and drug use mediated the relationship of perceived family behavior with and across addictions. In addition, perceptions regarding use of alcohol and/or other drugs, or engagement in other behaviors by family or household members was related not only to participants' alcohol and drug use but also to problem gambling frequency and severity.

Impact of early, weekly drinking on latent classes of alcohol involvement progression and recovery: Evidence from the NESARC Waves 1 and 2

IntroductionEarly drinkers have been found to have higher risk of developing alcohol use disorder; however, the association of early drinking with progression to problematic alcohol involvement that does not meet disorder criteria (i.e., subclinical problems) or to severe stages of alcohol involvement, sex-specific associations, and relationship of early drinking with alcohol recovery have rarely been investigated. MethodsUsing data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we applied latent transition analyses to investigate the impact of weekly drinking before age 18 on alcohol progression and recovery operationalized as three classes of alcohol involvement using abuse and dependence indicators. We analyzed data separately for male (n = 12,276) and female (n = 14,750) drinkers and applied propensity score methods to address confounding. ResultsWe observed significant associations between early, weekly drinking and alcohol involvement class membership at Wave 1 for both males and females. For males, early, weekly drinking was also associated with greater odds of transitioning from moderate to severe alcohol problems (aOR = 3.19, 95% CI = 1.72, 5.35). For females, early, weekly drinking predicted the transition from no to severe problems (aOR = 2.98, 95% CI = 1.11–8.00). Contrary to our hypothesis, early, weekly drinking was associated with greater likelihood of transition from severe to no problems for males (aOR = 3.23, 95% CI = 1.26, 8.26). DiscussionFrequent, early drinking seems to be an important indicator of drinking progression with differential associations by sex. This information is useful to identify those at greater risk of progressing to severe drinking problems to intervene appropriately.

The Interaction Between Genetic Variant ZNF804A rs1344706 and Alcohol Withdrawal on Impulsivity: Evidence for the Diathesis-Stress Model.

Objective: Alcohol use disorder (AUD) is the most common substance use disorder, which may relate to increased impulsivity. A more detailed understanding of the potential moderating factor on association between AUD and impulsivity is likely to have far-reaching effects. This study aims to examine whether the interaction between a genetic variant ZNF804A rs1344706 and alcohol use is related to impulsivity in Chinese Han adult males diagnosed with AUD.Methods: A total of 455 Chinese Han adult males diagnosed with AUD were included in this study. Impulsivity was assessed using Barratt Impulsiveness Scale. Alcohol dependence was measured by Michigan Alcoholism Screening Test. Genomic DNA was extracted from peripheral blood of participants and genotyped.Results: Hierarchical multiple regression yielded a significant interaction between ZNF804A rs1344706 and alcohol use (β = 0.20, p = 0.0237). Then, A region of significance (RoS) test was performed to interpret the interaction effect. Re-parameterized regression models revealed that the interaction between ZNF804A rs1344706 and alcohol problem severity fit to the weak diathesis-stress model (R2 = 0.15, p < 0.0010), indicating that the T allele carriers are more susceptible to alcohol problem severity, jointly contributing to impulsivity.Conclusions: This study, which analyzed a specific gene-environment interaction, demonstrated that carriers of the T allele of ZNF804A rs1344706 may be more susceptible to alcohol problem severity, correlated with higher levels of impulsivity during withdrawal.

Motivation to Reduce Drinking and Engagement in Alcohol Misuse Treatment in Alcohol-Related Liver Disease: A National Health Survey.

The study aim was to identify predictors of motivation to reduce alcohol consumption and whether motivation predicts engagement in alcohol misuse treatment in alcohol-related liver disease (ALD). Data from health surveys and health-care registries were combined. Of 674 patients with ALD, 65% consumed alcohol. Recent hospital admission and severe alcohol problems were associated with motivation to reduce alcohol consumption. Two-year probability for engagement in misuse treatment was 29% for patients with motivation to reduce alcohol consumption versus 6.5% for patients without motivation. ALD patients with recent hospital admission were more motivated to cut down alcohol consumption, and motivation predicted engagement in alcohol misuse treatment. This insight can help us target brief interventions.

Alcohol and drug use among clients receiving internet-delivered cognitive behavior therapy for anxiety and depression in a routine care clinic – Demographics, use patterns, and prediction of treatment completion and outcomes

BackgroundResearch shows that alcohol and drug use among mental health clients is common and has the potential to negatively impact treatment outcomes. Internet-delivered cognitive behavior therapy (ICBT) as a treatment for anxiety and depression is on the rise, but little is known about the prevalence of alcohol and drug use among clients and how this use affects treatment completion and outcomes. ObjectiveThe objective of the current study was to explore the prevalence of alcohol and drug use among clients in ICBT for depression and anxiety, and to investigate the impact of alcohol and drug use on treatment completion and symptom outcomes. Material and methodsData was collected from 1155 clients who participated in two randomized ICBT trials for depression and anxiety, conducted in a routine care clinic. Thirty-five individuals reporting severe substance use when applying to the trials were excluded. Demographic variables, and alcohol and drug use were measured at screening, and measures of depression and anxiety were administered at pre- and post-treatment. ResultsFour out of five clients reported having used alcohol in the past year, while one in five reported having used drugs in the past year. Around a third of clients had reported either problematic alcohol use, drug problems, or both. The analyses showed that drug problems, and combined alcohol and drug problems were negatively associated with treatment completion, but neither alcohol nor drug use had an impact on depression and anxiety outcomes. ConclusionsAlcohol and drug problems are likely to be present among a large proportion of patients using ICBT for anxiety and depression. This may not be a barrier to treatment benefit, at least when those with severe alcohol and drug problems have been excluded.

Preliminary study of alcohol problem severity and response to brief intervention

BackgroundFindings have been mixed as to whether brief intervention (BI) is appropriate and effective for individuals with more severe alcohol use problems. Motivation to change drinking has been supported as a mechanism of behavior change for BI. This exploratory study examined aspects of motivation as mechanisms of clinical response to BI and alcohol problem severity as a moderator of treatment effects.MethodsNon-treatment-seeking heavy drinkers (average age = 35 years; 57% male) were randomized to receive BI (n = 27) or attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and post-intervention: importance, confidence, and readiness. Moderated mediation analyses were implemented with treatment condition as the focal predictor, changes in motivation as mediator, 1-month follow-up drinks per day as the outcome, and an alcohol severity factor as second-stage moderator.ResultsAnalysis of importance displayed a significant effect of intervention condition on importance (p < 0.003) and yielded a significant index of moderated mediation (CI − 0.79, − 0.02), indicating that the conditional indirect effect of treatment condition on drinking through importance was stronger for those with higher alcohol severity. For all motivation indices, alcohol severity moderated the effect of post-intervention motivation levels on drinking (p’s < 0.05). The direct effect of treatment condition on drinking was not significant in any model.ConclusionsFindings highlight the relevance of considering one’s degree of alcohol problem severity in BI and alcohol screening efforts among non-treatment seeking heavy drinkers. These nuanced effects elucidate both potential mechanisms and moderators of BI response.Trial registration Clinicaltrials.gov: NCT04710095. Registered January 14, 2021—retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT04710095.

Ready2Change: Preliminary effectiveness of a telephone-delivered intervention program for alcohol, methamphetamine and cannabis use problems.

Telehealth has considerable potential to overcome many of the barriers to accessing care for substance use problems, thereby increasing the opportunity for earlier intervention. The Ready2Change program is a multiple-session outbound telephone-delivered cognitive and behavioural intervention for mild-to-moderate substance use disorders, embedded within a long-established 24/7 alcohol and drug helpline. We sought to analyse routinely collected program data in a preliminary study to examine the effectiveness of Ready2Change in reducing substance use problem severity and psychological distress. A retrospective analysis of program data from December 2013 to June 2018 was performed. Analysed cases were 249 clients living in Victoria, Australia with alcohol (n=191), methamphetamine (n=40) or cannabis (n=18) as their primary drug of concern. A within-subjects design was used to examine pre- and post-intervention substance use problem severity and psychological distress. For alcohol cases, there was a statistically significant decrease in alcohol problem severity [AUDIT, mean difference=-12.7, 95% confidence interval (CI) -14.0, -11.5]. Statistically significant reductions in drug problem severity (DUDIT) were observed for methamphetamine (mean difference=-17.3, 95% CI -20.9, -13.7) and cannabis (mean difference=-15.9, 95% CI -22.3, -9.6) cases. All groups showed reductions in problem severity for other substances used (P < 0.05) and psychological distress (P < 0.001). Results suggest Ready2Change benefits clients with alcohol, methamphetamine and cannabis use problems, with the potential to improve treatment access for health inequity groups including those living in remote areas. These findings warrant further investigation into the effectiveness of this program.

How Do Register-Based Studies Contribute to Our Understanding of Alcohol's Harms to Family Members? A Scoping Review of Relevant Literature

This review maps the research literature on register-based studies of alcohol's harms to family members and identifies areas for future research. Using a scoping review methodology, the PubMed/MEDLINE, EMBASE, and PsycINFO databases were searched in August 2019 with keywords to identify studies that included register-based outcome sources, a family relationship, and an exposure to heavy drinking. In total, 5,961 records were screened, 403 full-text articles were assessed for eligibility, and 91 studies were included in the final review. Register-based research on alcohol's harms to family members has largely drawn on hospital records to identify heavy drinkers and has primarily focused on children of heavy drinkers; 79 of the included studies solely investigated harms to children, whereas 2 focused on partners and 10 on multiple first-degree or unspecified relatives. Register-based studies show that children of heavy drinkers are at a higher risk for mental disorders, disease and injury hospitalizations, infant and child mortality, criminality, poor employment and educational outcomes, abuse/neglect, and placement in residential/foster care, among other negative outcomes. A substantial body of register-based research shows that children of parents with the most severe alcohol problems are at an increased risk for numerous adverse experiences. Register-based studies have investigated diverse, yet precisely defined outcomes, using large samples followed over long periods, and have examined the contribution of genetic, biological, and environmental factors. Our understanding of alcohol's harms to families could be enhanced by further register-based research on other household family members of heavy drinkers.