Drinking Standards Research Articles

Negative but Not Positive Alcohol-Related Consequences Tend to Occur Above the Heavy Episodic Drinking Threshold: A Daily Study of Young Adult Heavy Drinkers.

This study used event-level data to identify the threshold (i.e. number of standard alcoholic drinks) at which specific negative and positive alcohol-related consequences are likely to occur. Ninety-six college students aged 18-20 reporting weekly heavy episodic drinking (HED) or at least one negative alcohol-related consequence in the past 2weeks completed ecological momentary assessment over 28days. Participants reported number of standard drinks consumed and negative (e.g. nausea) and positive (e.g. new friend) alcohol-related consequences on 492 drinking nights. The area under the receiver operating characteristic (AUROC) curve measured the ability of an increasing number of drinks consumed to discriminate between nights with versus without a given consequence. The Youden Index method was used to identify the optimal threshold of drinks for each consequence. Thresholds were examined for each consequence by participants' biological sex and heavy drinking status. Across subgroups, most consequences occurred on nights where participants reported higher consumption levels relative to nights where consequences did not occur. Thresholds for negative consequences ranged between four and nine drinks and thresholds for positive consequences were between three and six drinks. Many negative consequences are likely to occur following the traditional HED threshold of 4+/5+ drinks (females/males), with more severe consequences occurring at slightly higher thresholds. Positive consequences are likely to occur at lower thresholds. There may be an optimal number of drinks that maximize positive while minimizing negative consequences for heavy drinking college students.

PROBLEMATIC ALCOHOL CONSUMPTION, KNOWLEDGE OF ALCOHOLIC DRINKS AND HEALTH RISKS AMONG FUTURE HEALTH PROFESSIONALS IN IFAKARA, MOROGORO REGION, TANZANIA

Aims
 This study was conducted to determine the prevalence of alcohol use disorder, drinking attitude, knowledge of standard drinks and health risks associated with alcohol consumption among health science students in Ifakara town, Morogoro region in Tanzania.
 Design
 This study was a cross-sectional survey conducted between June and October 2020 among 372 medicine and allied health students. Participants were selected from the study institutions using random sampling. Results were presented by descriptive statistics, chi- square (χ2) test for associations and logistics regression was used to estimate odds ratios (OR) and 95% confidence (CI) for alcohol use disorder among participants.
 Results
 The prevalence of alcohol consumption is 39.2% with males accounting a higher prevalence among drinkers (63.7%). Ages 21-25 accounted for the highest drinking prevalence (65.8% of drinkers). There were associations between drinking and gender (p=0.002), institution of study (p=0.000) and course of study (p=0.000). Ever drinkers were about 41% of respondents. The median age of first consumption is 20.0 (IQR: 17-22). The prevalence rates of AUD (AUDIT score greater than 8) is 16.4%. Women were significantly less likely than men to report AUD (OR=0.22, 95% CI (0.11-0.47), p<0.05). Over 60% of participants did not know the number of standard drinks in commonly sold alcoholic beverages in Tanzania.
 Conclusion
 The prevalence of alcohol consumption and hazardous drinking is high among health sciences students. There is also a poor knowledge of standard drinks and recommended drinking limits.

Factors influencing alcohol consumption among university students in Southern Thailand.

Underage drinkers are the primary cause of death and illness worldwide. Initiation of drinking at younger ages and levels of drinking during young adulthood may also shape future public health by influencing alcohol consumption. From this situation, it is necessary to study various factors to provide sufficient information to reduce adolescent alcohol consumption. This study aimed to examine the prevalence and factors that influenced alcohol consumption of first-year students in a university network in Southern Thailand. A total participant 685 of 1,100 first-year students from 12 universities in southern Thailand were randomized and recruited using eligible criteria. The instrument was an online questionnaire based on the preceding model that consisted of 9 parts with 93 items. For descriptive analysis, percentages were used to describe the characteristics and alcohol consumption behaviours of participants. In addition, logistic regressions were used to determine the factors influencing. The results showed 62.3% of participants responded to the online questionnaire. During the past six months, 36% reported consuming alcohol. Males reported drinking more (45.3%) than females. The most popular drink was beer (57.7%). There were 8.16 standard drinks, (82.3%) consumed at night, (70.2%) drank at their place, and consumed with friends (83.6%). The results of multiple logistic regression showed significant factors influencing drinking alcohol. The lower attitude was 2.56 times more likely to consume alcohol than a high level (AOR: 2.56, 95%CI: 1.53-4.28). Reversely, the higher marketing perception was more likely to consume alcohol than a low level (AOR: 5.35, 95%CI: 1.94-14.58). In addition, students with mother drinker, lover drinker, and close friend drinker were more likely to consume alcohol (AOR: 2.35, 95%CI: 1.07-5.16), (AOR: 3.60, 95%CI: 1.99-6.50), and (AOR: 5.29, 95%CI: 3.31-8.45) respectively. In conclusion, attitude, marketing factors, and social factors were associated with alcohol consumptionamong Thai university students that were revealed as positive predictors regarding binge drinking. The study shows howhealthcare providers may reduce binge drinking by designing effective prevention programs.

The effectiveness of ginger extract addition in calorified drinks during perioperative period to nausea severity, vomitus, post-operative anxiety, and metabolic disorder: A randomized control trial.

This study was aimed to evaluate the effect of ginger extract addition to pre-operative high calorie drink to reduce nausea, vomiting, anxiety level, and lactate level as a parameter for metabolic derangement in patients undergoing surgery. A prospective single-blinded randomized controlled trial design, with a study subject elective surgical procedures patient at the Department of Surgery, Dr Hasan Sadikin Hospital, Bandung. Patient were divided into two groups, group A with standard high calorie drink, and group B standard high calorie drink with ginger extract addition. Anxiety was measured by HARS score and the occurrence of nausea and vomiting were assessed after the operation. The difference of lactate levels was compared before and after operation in two groups. The data distribution was calculated by kolmogorov-smirnov for continues variables. Normal distribution was calculated by t-test, non-normal distribution was calculated by Mann-U Whitney. Nominal data calculated by chi-square test and ordinal data calculated by Mann-U Whitney. 40 subjects were randomly divided into two groups. The occurrence of nausea and vomiting were lower in group B patients (p<0.0285). HARS score anxiety level was lowered in group B patients (p<0.0293). Lactate level was lowered in group B patients, although is not statistically significant (p 0.54). Addition of ginger extract in pre-operative high calorie drink reduce postoperative nausea, vomiting, and anxiety level.

Relationship between Alcohol Consumption and Testosterone Deficiency according to Facial Flushes among Middle-Aged and Older Korean Men.

This study examined the relationship between alcohol consumption and total testosterone deficiency based on facial flushing among Korean men. A total of 314 men were included in this study and divided into non-drinkers (n=78) and drinkers (n=236). Drinkers were also divided into flushers (n=96) and non-flushers (n=140). Flushers and non-flushers were separated into two groups based on the amount of alcohol consumed: moderate drinkers (≤8 standard drinks per week) and heavy drinkers (>8 standard drinks per week). Total testosterone <3.5 ng/mL was defined as testosterone deficiency. The risk of testosterone deficiency was significantly higher in heavy drinkers who flushed than in nondrinkers (odds ratio, 4.37; 95% confidence interval, 1.20-15.88; P=0.025). However, no significant difference was observed in the risk of testosterone deficiency in non-flushers, regardless of the amount of alcohol consumed. This study suggests that the risk of testosterone deficiency increases in heavy drinkers (>8 drinks per week) who flush compared to that in non-drinkers.

The Protection Conferred by HSD17B13 rs72613567 on Hepatic Fibrosis Is Likely Mediated by Lowering Ballooning and Portal Inflammation

The Protection Conferred by HSD17B13 rs72613567 on Hepatic Fibrosis Is Likely Mediated by Lowering Ballooning and Portal Inflammation

Capturing Russian drinking patterns with the Alcohol Use Disorders Identification Test: An exploratory interview study in primary healthcare and narcology centers in Moscow.

Despite a considerable reduction in alcohol consumption, Russia has one of the highest levels of alcohol-attributable burden of disease worldwide due to heavy episodic drinking patterns. Further improvement of alcohol control measures, including early provision of screening and brief interventions (SBI), is needed. The legislative framework for delivering SBI in Russia was introduced in 2013. As part of the creation and validation of a Russian version of the Alcohol Use Disorders Identification Test (AUDIT), the present contribution explored challenges in using the AUDIT in Russia to inform a subsequent validation study of the tool. Qualitative in-depth expert interviews with patients and healthcare professionals from four primary healthcare and narcology facilities in Moscow. A total of 25 patients were interviewed, 9 from a preventive medicine hospital, 8 from a polyclinic, and 9 from narcology clinics. Also, 12 healthcare professionals were interviewed, 5 of whom were primary healthcare doctors and 7 were narcologists. Patients and healthcare professionals expressed difficulties in dealing with the concept of a "standard drink" in the AUDIT, which is not used in Russia. Various patients struggled with understanding the meaning of "one drinking occasion" on the test, mainly because Russian drinking patterns center around festivities and special occasions with prolonged alcohol intake. Narcology patients had specific difficulties because many of them experienced zapoi-a dynamic drinking pattern with heavy use and a withdrawal from social life, followed by prolonged periods of abstinence. Surrogate alcohol use was described as a common marker of alcohol dependence in Russia, not accounted for in the AUDIT. The provided analyses on the perception of the Russian AUDIT in different patient and professional groups suggest that a series of amendments in the test should be considered to capture the specific drinking pattern and its potential harms.

Abstract 10284: Alcohol Consumption and Cardiovascular Outcomes in Patients With Atrial Fibrillation; a RE-LY AF Registry Analysis

Introduction: The role of alcohol intake in patients with atrial fibrillation (AF) has been long debated. We aim to assess the association between different alcohol intake levels and cardiovascular outcomes in patients with AF. Methods: We performed a cross-sectional analysis of the RE-LY AF registry, which included 15,400 AF patients who visited emergency departments across 46 countries and were followed for one year after the baseline visit. Alcohol intake level was retrospectively ascertained and categorized into abstainers, light (&lt;7 standard drinks [SD]/week), moderate (7-13 SD/week), and heavy drinkers (≥14 SD/week) based on self-reported intake levels. The outcomes of interest were stroke/systemic embolism, heart failure (HF) hospitalization, all-cause mortality, and major bleeding events. Logistic mixed-effects regression models adjusted for baseline covariates were used to calculate the adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results: A total of 14,058 AF patients (mean age: 65.9 years; 48% women) with available data on alcohol intake level were included. The odds of stroke/systemic embolism were not significantly increased in light (aOR 0.87, 95% CI: 0.60-1.26), moderate (aOR 0.92, 95% CI: 0.54-1.58), nor heavy drinkers (aOR 0.76, 95% CI: 0.39-1.49) compared to abstainers. Light and moderate drinking, compared to alcohol abstinence, were associated with reduced odds of HF hospitalization (light: aOR 0.75, 95% CI: 0.59-0.95; moderate: aOR 0.57, 95% CI: 0.38-0.85) and all-cause mortality (light: aOR 0.42, 95% CI: 0.30-0.58; moderate: aOR 0.42, 95% CI: 0.26-0.68; heavy: aOR 0.58, 95% CI: 0.35-0.97). Alcohol consumption was not associated with an excess risk of major bleeding events. Conclusion: As compared to non-drinkers, light and moderate alcohol drinking in patients with AF are associated with a lower risk of mortality and HF hospitalization, with no difference in thromboembolic and bleeding risk.

Prevalence and Predictors of Increased and Hazardous Alcohol Consumption in a Cohort of Older South Australian Men during COVID-19 Restrictions

Background: Increasing levels of risky alcohol consumption in older men observed in many countries, combined with trends for increased alcohol-related misuse by men during COVID, indicate a need to examine alcohol use by older men during the pandemic. Aim: To examine the prevalence and predictors of increased and hazardous alcohol consumption in older South Australian men during COVID-19 restrictions. Method: Data collected in the latest (eighth) wave of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) cohort study were interrogated. Participants were 746 community-dwelling older men (mean age 69 years) who completed a self-report survey on mental health, coping, COVID-related worries, and alcohol consumption during pandemic restrictions. Alcohol-related items asked about changes to overall consumption (analysed as increased vs. decreased/same) and number of standard drinks per occasion (analysed as &lt;5 drinks [not hazardous consumption] vs. 5+ drinks [hazardous]). Two hierarchical binary logistic regressions were conducted to explore predictors of increased and hazardous alcohol intake. Results: Eight percent of men reported increased alcohol intake and nine percent reported hazardous alcohol consumption during COVID-19 restrictions. Being in a younger age group (‘younger old’; OR=0.46, 95%CI=1.03, 2.28), having mild to severe depressive symptoms (OR=1.39, 95%CI=1.10, 5.05), and greater concern about becoming sick with COVID-19 (OR=1.52, 95%CI=1.03, 2.28) were predictive of increased alcohol consumption during restrictions. Younger age group (OR=0.46, 95%CI=0.34, 0.62) and greater concern about becoming sick with COVID-19 (OR=1.67, 95%CI=1.13, 2.51) were also predictive of hazardous alcohol consumption during this time. Discussion: Men participating in longitudinal health study follow-ups may be less inclined to engage in unhelpful coping behaviours such as problematic alcohol use. Clinicians should regularly screen older men for risky alcohol consumption; a particular focus on screening ‘younger old’ men, those with more significant concerns around COVID-19, and those with depression symptoms may be warranted.

Alcohol and health

The GBD 2020 Alcohol Collaborators study1GBD 2020 Alcohol CollaboratorsPopulation-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020.Lancet. 2022; 400: 185-235Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar suggests alcohol use is harmful in younger adults but protective in older adults.1GBD 2020 Alcohol CollaboratorsPopulation-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020.Lancet. 2022; 400: 185-235Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar The number of drinks per day equivalent to non-drinking is shown to rise from approximately one and a half standard drinks for individuals aged 50 years to approximately four standard drinks for individuals 80 years and older.1GBD 2020 Alcohol CollaboratorsPopulation-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020.Lancet. 2022; 400: 185-235Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar Associations of alcohol use with disease and death are from cohort studies and case-control studies.1GBD 2020 Alcohol CollaboratorsPopulation-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020.Lancet. 2022; 400: 185-235Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar Confounding undoubtedly introduces biases into estimates of moderate drinking because moderate drinkers probably have many protective moderate habits.2Naimi TS Brown DW Brewer RD et al.Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults.Am J Prev Med. 2005; 28: 369-373Summary Full Text Full Text PDF PubMed Scopus (260) Google Scholar More insidiously, alcohol use is typically a lifelong habit in adulthood, which could start before recruitment into a study. Specifically, for those who survive to recruitment, exposure time is too short. For those who do not survive to recruitment, exposure time and alcohol-related deaths are missing. Missing non-survivors can attenuate or reverse estimates.3WikipediaSurvivorship bias.https://en.wikipedia.org/wiki/Survivorship_biasDate: 2022Date accessed: July 16, 2022Google Scholar The older the age at recruitment the more the study is biased by only representing survivors of alcohol use. In a hypothetical cohort of people recruited at age 20 years, the effect of alcohol to age 60 years (at 40 years follow-up) could be harmful, but the effect in survivors from the same cohort recruited at 50 years of age could appear protective because of missing data for people who had already died from alcohol-related causes (appendix). Considering that a trial4Beckett NS Peters R Fletcher AE et al.Treatment of hypertension in patients 80 years of age or older.N Engl J Med. 2008; 358: 1887-1898Crossref PubMed Scopus (2467) Google Scholar on the treatment of hypertension in older people (80 years and older) showed that treatment had benefits despite contradictory observations, observational studies on the effects of alcohol use on death or disease that recruit older participants are open to unrecoverable bias and cannot provide a reliable guide to alcohol policy. We declare no competing interests. Download .pdf (.13 MB) Help with pdf files Supplementary appendix

Excessive Drinking Among Men Who Have Sex With Men Recruited From Web-Based Resources: Cross-sectional Questionnaire Study.

US and Northern European studies have found a higher prevalence of alcohol-related problems among men who have sex with men (MSM) than among the general population of men (GPM). However, most of them relied on traditional sampling methods, not profiting from MSM dating apps and websites for recruitment. Besides, analogous comparisons in Southern Europe are lacking. This study aimed to compare several indicators of excessive drinking between MSM and GPM in Spain. Overall, 5862 MSM were recruited through dating apps or websites for the Méthysos Project, and 10,349 GPM were recruited using probability sampling via the Household Survey on Alcohol and Drugs in Spain from 2018 to 2020. The outcomes were the prevalence of hazardous or harmful drinking (Alcohol Use Disorders Identification Test [AUDIT] ≥8), hazardous drinking (AUDIT-Consumption ≥4), harmful drinking (AUDIT-Problem ≥4), regular hazardous drinking (&gt;14 standard drinks per week), and monthly binge drinking. The prevalence of excessive drinking indicators was calculated for MSM and GPM and compared using the adjusted prevalence ratio (aPR). Two different aPRs and their 95% CIs were estimated using Poisson regression models with robust variance. The first was adjusted for sociodemographic characteristics, and the second was adjusted for the aforementioned covariates plus other drug use. The prevalence of hazardous or harmful drinking was 15.6% (913/5862) among MSM versus 7.7% (902/10,349) among GPM. After adjusting for sociodemographic covariates, the risk was higher in MSM than in GPM for harmful or hazardous drinking (aPR 1.8, 95% CI 1.6-2.0), harmful drinking (aPR 2.3, 95% CI 2.0-2.7), and binge drinking (aPR 1.7, 95% CI 1.5-1.9); the same in both populations for hazardous drinking (aPR 0.9, 95% CI 0.9-1.0); and higher in GPM than in MSM for regular hazardous drinking (aPR 0.7, 95% CI 0.6-0.9). The relative excess risk of harmful drinking and binge drinking among MSM tended to increase with increasing education level and size of the place of residence, and the opposite was true for the deficit risk in regular hazardous drinking. Additional adjustment for other drug use greatly buffered the relative excess risk in harmful drinking and binge drinking in MSM, while it deepened its deficit risk in regular hazardous drinking. The use of web-based resources allowed recruiting a large sample of MSM. The risk of hazardous or harmful drinking was 80% greater in MSM than in GPM, which was mainly because of the higher risk of harmful drinking and binge drinking among MSM. Nearly 1 in 6 MSM would benefit from early brief alcohol intervention procedures. The subgroup with harmful or binge drinking combined with other drug use is an important contributor to excess MSM risk in hazardous or harmful drinking and must be a priority target for harm reduction interventions.

Eye-tracking to examine differences in alcohol product appeal by sex among young people

ABSTRACT Background: Advertising of traditional alcopops contains elements that appeal to youth, especially females. Supersized alcopops are marketed differently than traditional alcopops and contain up to 5.5 standard alcoholic drinks. Young females are more likely to underestimate the alcohol content of supersized alcopops, putting them at higher risk of overconsumption. Similar to supersized alcopops, beer is packaged in large cans and in the same areas of store shelves. Objective: This study examined among young people whether supersized alcopops versus beer products disproportionately appealed to females. Methods: Eleven adolescents (13–17 years old) and 72 college students (21–26 years old) were recruited during 2019–2020. Participants viewed 19 photos of convenience store display cases containing both supersized alcopop and beer products. While viewing each image, participants were instructed to click on the beverage that looked the “coolest” (i.e. most appealing). Eye-tracking hardware and software measured the amount of time participants visually fixated on each product. Participants completed a survey to record demographic characteristics. Results: Compared to males (n=25), females (n=58) fixated on supersized alcopops for 6.8 seconds longer (95%CI 0.3,13.3). Females also had 3.7 times the odds of selecting a supersized alcopop as the product they found most appealing compared to males (95%CI 1.68,8.01), adjusting for amount of time visually fixating on supersized alcopops, which was also a significant predictor. Conclusions: Young females’ strong preference for supersized alcopops is concerning given they disproportionately underestimate their potency, relative to males, and are more likely to obtain dangerously high BAC levels from consuming one or two supersized alcopops.

A Hospital-based Managed Alcohol Program in a Canadian Setting.

A managed alcohol program (MAP) is a harm reduction strategy that provides regularly, witnessed alcohol to individuals with a severe alcohol use disorder. Although community MAPs have positive outcomes, applicability to hospital settings is unknown. This study describes a hospital-based MAP, characterizes its participants, and evaluates outcomes. A retrospective chart review of MAP participants was conducted at an academic hospital in Vancouver, Canada, between July 2016 and October 2017. Data included demographics, alcohol/substance use, alcohol withdrawal risk, and MAP indication. Outcomes after MAP initiation included the change in mean daily alcohol consumption and liver enzymes. Seventeen patients participated in 26 hospital admissions: 76% male, mean age of 54 years, daily consumption prehospitalization of a mean 14 alcohol standard drinks, 59% reported previous nonbeverage alcohol consumption, and 41% participated in a community MAP. Most participants were high risk for severe, complicated alcohol withdrawal and presented in moderate withdrawal. Continuation of community MAP was the most common indication for hospital-based MAP initiation (38%), followed by a history of leaving hospital against medical advice (35%) and hospital illicit alcohol use (15%). Hospital-based MAP resulted in a mean of 5 fewer alcohol standard drinks daily compared with preadmission ( P = 0.002; 95% confidence interval, 2-8) and improvement in liver enzymes, with few adverse events. Participation in a hospital-based MAP may be an effective safe approach to reduce harms for some individuals with severe alcohol use disorder. Further study is needed to understand who benefits most from hospital-MAP and potential benefits/harms following hospital discharge.

The relationship between age at first drink and later risk behaviours during a period of youth drinking decline.

Alcohol consumption among teenagers in many high-income countries has steadily declined since the early 2000s. There has also been a steady increase in the average age at first drink, a reliable marker of later alcohol problems. This study measured whether young people who initiated drinking early were at increased risk of alcohol problems in young adulthood in recent cohorts where early initiation was comparatively rare. Analysis of six waves of a repeated cross-sectional household survey (2001-16). Australia. A total of 9576 young adults (aged 20-25 years) who had initiated drinking before the age of 20 years. Respondents were classified into three groups based on their self-reported age at first drink (< 16, 16-17, 18-19 years). Outcome variables were self-reported experiences of memory loss while drinking, risky and delinquent behaviour while drinking and monthly or more frequent drinking occasions of 11 or more 10-g standard drinks. Later initiators reported lower levels of all outcomes [e.g. odds ratios (ORs) for memory loss were 0.56, 95% confidence interval (CI) = 0.50, 0.63] for those who first drank at 16 or 17 years compared with those who first drank at age 15 or younger). Significant interactions between age at first drink and survey year showed that early initiation was more strongly associated with harms (e.g. for memory loss, OR = 0.97, 95% CI = 0.94, 0.99 for 18-19 versus 15 or younger) in young adulthood for recent cohorts where early drinking was less common. The decline in youth drinking may have contributed to a concentration of risk of alcohol problems among those young people who consume alcohol in early adolescence. Early initiation of drinking may be an increasingly important marker of broader risk taking as alcohol becomes less normative for teenagers.

Hope for the best, prepare for the worst: examining the preloading motivations associated with alcohol use and past harms during a night-out

We investigated the relationship between preloading motivations, alcohol consumption, intoxication, and alcohol related harms (ARHs), sampled in a night-time entertainment district (NED). The sample comprised 2,159 (1,109 males; 1,050 females) patrons entering Brisbane NEDs (Queensland, Australia) on Thursday, Friday, and Saturday nights between 9:00 pm and 1:00 am. We measured the patrons primary preloading motivations, their estimations of standard drinks consumed at preloading, their level of alcohol intoxication by breathalyser and their past experience of ARHs in the NED. ‘Socialising’ (29.98%) and ‘saving money’ (25.17%) were the most prominent preloading motivations followed by ‘multiple’ motivations (12.52%), and then by emotional motivations (2.46–4.02%). Minor significant differences were observed between preloading motivations in alcohol intoxication, but not for alcohol consumption. ‘Get as drunk as possible’ and ‘feel comfortable/relaxed’ preloading motivations were associated with higher occurrences of past ARHs. Individuals who preload often exceed recommended drinking guidelines to prevent ARHs before the night-out begins. Our findings suggest that it is the emotionally motivated alcohol consumers who are more likely to have experienced past harms in the NED. Implications for theoretical developments of preloading and the prevention of harmful preloading are discussed.

Causal associations of alcohol consumption with cardiovascular diseases and all-cause mortality among Chinese males

The causal effects of moderate alcohol consumption on cardiovascular diseases (CVDs) are continuously debated, especially on coronary artery disease (CAD). We aimed to explore the causal associations of alcohol consumption with CVDs and all-cause mortality among Chinese males. A prospective cohort study was conducted in 40,386 Chinese males, with 17,676 being genotyped for the rs671 variant in the aldehyde dehydrogenase 2 (ALDH2) gene. A Cox proportional hazards model was conducted to estimate the effects of self-reported alcohol consumption. Mendelian randomization (MR) analysis was performed to explore the causality using rs671 as an instrumental variable. During the follow-up of 303,353 person-years, 2406 incident CVDs and 3195 all-cause mortalities were identified. J-shaped associations of self-reported alcohol consumption with incident CVD and all-cause mortality were observed, showing decreased risks for light (≤25g/d) and moderate drinkers (25-≤60g/d). However, MR analyses revealed a linear association of genetically predicted alcohol consumption with the incident CVD (P-trend=0.02), including both CAD (P-trend=0.03) and stroke (P-trend=0.02). The HRs (95% CIs) for incident CVD across increasing tertiles of genetically predicted alcohol consumption were 1 (reference), 1.18 (1.01, 1.38), and 1.22 (1.03, 1.46). After excluding heavy drinkers, the risk of incident CVD and all-cause mortality was increased by 27% and 20% per standard drink increment of genetically predicted alcohol consumption, respectively. Our analyses extend the evidence of the harmful effect of alcohol consumption to total CVD (including CAD) and all-cause mortality, highlighting the potential health benefits of lowering alcohol consumption, even among light-to-moderate male drinkers.

Drink for drink: measurement of preloading motivations for field and survey research with correlates of alcohol related harms

Field researchers often use categorical systems to record primary preloading motivations, while survey researchers use continuous systems to examine preloading motivation ratings. We tested the psychometric properties of the two systems for measuring preloading motivations. Six hundred and eight-one undergraduate students and social media recruited participants (178 males; 503 females) completed an online survey pertaining to their last preloading experience. We measured preloading motivations by the categorical and continuous systems, general drinking motivations, estimations of preloaded standard drinks and harm. Measurements of preloading motivations by categorical (primary motivation) and continuous systems (motivation ratings) were concordant. The continuous system of preloading motivations held mix concurrence with general drinking motivations, implying conceptual differences between the two constructs. ‘Enhancement-based’ preloading motivations had strong relationships with estimations of preloaded standard drinks, while general drinking motivations for ‘coping’ were strong correlates of harm. Preloading motivations can be measured through either categorical or continuous systems. Implications for future psychometric measurement development is discussed.

Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder

Although classic psychedelic medications have shown promise in the treatment of alcohol use disorder (AUD), the efficacy of psilocybin remains unknown. To evaluate whether 2 administrations of high-dose psilocybin improve the percentage of heavy drinking days in patients with AUD undergoing psychotherapy relative to outcomes observed with active placebo medication and psychotherapy. In this double-blind randomized clinical trial, participants were offered 12 weeks of manualized psychotherapy and were randomly assigned to receive psilocybin vs diphenhydramine during 2 day-long medication sessions at weeks 4 and 8. Outcomes were assessed over the 32-week double-blind period following the first dose of study medication. The study was conducted at 2 academic centers in the US. Participants were recruited from the community between March 12, 2014, and March 19, 2020. Adults aged 25 to 65 years with a DSM-IV diagnosis of alcohol dependence and at least 4 heavy drinking days during the 30 days prior to screening were included. Exclusion criteria included major psychiatric and drug use disorders, hallucinogen use, medical conditions that contraindicated the study medications, use of exclusionary medications, and current treatment for AUD. Study medications were psilocybin, 25 mg/70 kg, vs diphenhydramine, 50 mg (first session), and psilocybin, 25-40 mg/70 kg, vs diphenhydramine, 50-100 mg (second session). Psychotherapy included motivational enhancement therapy and cognitive behavioral therapy. The primary outcome was percentage of heavy drinking days, assessed using a timeline followback interview, contrasted between groups over the 32-week period following the first administration of study medication using multivariate repeated-measures analysis of variance. A total of 95 participants (mean [SD] age, 46 [12] years; 42 [44.2%] female) were randomized (49 to psilocybin and 46 to diphenhydramine). One participant (1.1%) was American Indian/Alaska Native, 3 (3.2%) were Asian, 4 (4.2%) were Black, 14 (14.7%) were Hispanic, and 75 (78.9%) were non-Hispanic White. Of the 95 randomized participants, 93 received at least 1 dose of study medication and were included in the primary outcome analysis. Percentage of heavy drinking days during the 32-week double-blind period was 9.7% for the psilocybin group and 23.6% for the diphenhydramine group, a mean difference of 13.9%; (95% CI, 3.0-24.7; F1,86 = 6.43; P = .01). Mean daily alcohol consumption (number of standard drinks per day) was also lower in the psilocybin group. There were no serious adverse events among participants who received psilocybin. Psilocybin administered in combination with psychotherapy produced robust decreases in percentage of heavy drinking days over and above those produced by active placebo and psychotherapy. These results provide support for further study of psilocybin-assisted treatment for AUD. ClinicalTrials.gov Identifier: NCT02061293.

Genetic overlap between mood instability and alcohol-related phenotypes suggests shared biological underpinnings.

Alcohol use disorder (AUD) is a pervasive and devastating mental illness with high comorbidity rates with other mental disorders. Understanding the genetic architecture of this comorbidity could be improved by focusing on intermediate traits that show positive genetic correlation with the disorders. Thus, we aimed to characterize the shared vs. unique polygenicity of AUD, alcohol consumption (AC) and mood instability (MOOD)-beyond genetic correlation, and boost discovery for jointly-associated loci. Summary statistics for MOOD (a binary measure of the tendency to report frequent mood swings), AC (number of standard drinks over a typical consumption week) and AUD GWASs (Ns > 200,000) were analyzed to characterize the cross-phenotype associations between MOOD and AC, MOOD and AUD and AC and AUD. To do so, we used a newly established pipeline that combines (i) the bivariate causal mixture model (MiXeR) to quantify polygenic overlap and (ii) the conjunctional false discovery rate (conjFDR) to discover specific jointly associated genomic loci, which were mapped to genes and biological functions. MOOD was highly polygenic (10.4k single nucleotide polymorphisms, SNPs, SD = 2k) compared to AC (4.9k SNPs, SD = 0.6k) and AUD (4.3k SNPs, SD = 2k). The polygenic overlap of MOOD and AC was twice that of MOOD and AUD (98% vs. 49%), with opposite genetic correlation (-0.2 vs. 0.23), as confirmed in independent samples. MOOD&AUD associated SNPs were significantly enriched for brain genes, conversely to MOOD&AC. Among 38 jointly associated loci, fifteen were novel for MOOD, AC and AUD. MOOD, AC and AUD were also strongly associated at the phenotypic level. Overall, using multilevel polygenic quantification, joint loci discovery and functional annotation methods, we evidenced that the polygenic overlap between MOOD and AC/AUD implicated partlyshared biological underpinnings, yet, clearly distinct functional patterns between MOOD&AC and MOOD&AUD, suggesting new mechanisms for the comorbidity of AUD with mood disorders.

Optimizing internet-delivered cognitive behaviour therapy for alcohol misuse—a randomized factorial trial examining effects of a pre-treatment assessment interview and guidance

BackgroundInternet-delivered cognitive behavioral therapy (ICBT) for alcohol misuse has potential to radically improve access to evidence-based care, and there is a need to investigate ways to optimize its delivery in clinical settings. Guidance from a clinician has previously been shown to improve drinking outcomes in ICBT, and some studies suggest that pre-treatment assessments may contribute in initiating early change. The objective of this study was to investigate the added and combined effects of a pre-treatment assessment interview and guidance on the outcomes of ICBT for alcohol misuse delivered in an online therapy clinic.MethodsA 2X2 factorial randomized controlled trial was conducted where participants received access to an 8-week ICBT program, and either a pre-treatment assessment interview (Factor 1), guidance (Factor 2), a combination of these, or neither of these. Participants were 270 individuals (66.8% female, mean age = 46.5) scoring 8 or more on the Alcohol Use Disorders Identification Test and consuming 14 standard drinks or more in the preceding week. Primary outcomes were number of drinks consumed and number of heavy drinking days during the preceding week, 3 months post-treatment.ResultsLarge within-group effects were found in terms of alcohol reductions (dw ≥ 0.82, p < 0.001), but neither of the factors significantly improved drinking outcomes. Guidance was associated with greater adherence (i.e. completed modules).ConclusionsNeither a pre-treatment assessment interview nor guidance from a clinician appears to improve drinking outcomes resulting from internet-delivered cognitive behaviour therapy for alcohol misuse when delivered in a routine online therapy clinic.Trial registration: NCT03984786. Registered 13 June 2019, https://clinicaltrials.gov/ct2/show/NCT03984786