Unhealthy Drinking Research Articles

How digital interventions on screening and BI might be applied to psychiatric ED settings

Background Unhealthy drinking and other drug use are common comorbid problems among individuals receiving treatment in psychiatric Emergency Departments (ED). Several studies have shown that systematic screening and motivational brief interventions (SBIRT) are promising approaches for reducing alcohol and drug use that can be implemented in psychiatric ED settings. Recent digital screening and brief intervention trials have shown reductions in alcohol and other drug use among general (non-psychiatric) ED patients. These electronic approaches have yet to be tested for those receiving care in psychiatric ED settings. This presentation will provide an overview and framework for considering how SBIRT might be delivered electronically among psychiatric ED patients and how digital devices might be used to extend the impact of SBIRT beyond the psychiatric ED.

Vida PURA: A Cultural Adaptation of Screening and Brief Intervention to Reduce Unhealthy Drinking Among Latino Day Laborers

ABSTRACTBackground: Brief intervention is known to reduce drinking in primary care; however, because health care access is limited for Latino immigrants, traditional brief interventions are unlikely to reach this population. Methods: Using Barrera and Castro's framework, our study aims to culturally adapt a screening and brief intervention program to reduce unhealthy alcohol use among Latino day laborers, a particularly vulnerable group of Latino immigrant men. We conducted 18 interviews with Latino day laborers and 13 interviews with mental health and substance use providers that serve Latino immigrant men. Interviews were conducted until saturation of themes was reached. Themes from interviews were used to identify sources of mismatch between traditional screening and brief intervention in our target population. Results: Unhealthy alcohol use was common, culturally accepted, and helped relieve immigration-related stressors. Men had limited knowledge about how to change their behavior. Men preferred to receive information from trusted providers in Spanish. Men faced significant barriers to accessing health and social services but were open to receiving brief interventions in community settings. Findings were used to design Vida PURA, a preliminary adaptation design of brief intervention for Latino day laborers. Key adaptations include brief intervention at a day labor worker center provided by promotores trained to incorporate the social and cultural context of drinking for Latino immigrant men. Conclusions: Culturally adapted brief intervention may help reduce unhealthy drinking in this underserved population.

Behavior-based prevention of chronic diseases

Tobacco smoking, unhealthy alcohol drinking, overweight, and lack of physical activity add to more than 50% of myocardial infarction and are the most prevalent avoidable factors related to cancer. Cardiovascular disease and cancer may be curbed by preventive action in addition to medical care. The aim of this contribution is to present the elements that constitute prevention: participation rates, intervention programs, and outcomes. Criteria for outcomes include intention to change behaviors, the behavior change, total lifetime and time of life free of chronic disease and disability. Evidence reveals that national preventive action should include legal action, environmental change, and direct health behavior change. The measures include reducing the appeal of and increasing the protection against risky products. Such provisions will reduce cardiovascular disease and cancer incidence. Direct behavior change includes counseling individuals in the general population. Evidence is provided by cohort, modeling, and controlled trial data. All three approaches revealed success of prevention. Collaboration of prevention and medical care will add to synergies. A deficit of action exists. Effective preventive action should be implemented into practice, cooperation between prevention and medical care be supported.

Systemic therapy of psoriasis in diabetic patients

Psoriasis is a chronic inflammatory skin disease affecting 2-3% of worldwide population. Moderate to severe psoriasis is frequently associated with metabolic disorders including diabetes, obesity, dyslipidaemia, metabolic syndrome and non-alcoholic fatty liver disease. In particular, the prevalence of diabetes in patients with psoriasis ranges from 5 to 54%. Most of the studies found that the prevalence of diabetes is higher in patients with moderate to severe psoriasis compared to mild disease. The association between psoriasis and diabetes could be explained considering several factors including a common genetic background, the high prevalence of metabolic risk factors for diabetes in patients with psoriasis as well as unhealthy life-styles such heavy drinking, over-eating and sedentary, which are common in patients with psoriasis. From a clinical prospective, the understanding of the patients in the context of metabolic comorbidities including diabetes is very important to ensure that treatment is tailored to meet the individual patient needs. Indeed, some pharmacological treatments may negatively affect metabolic comorbidities, and have important interactions with drugs that are commonly used to treat them. Non-pharmacological intervention such as diet and physical exercise could both improve the response to treatments for psoriasis and reduce the risk of diabetes and cardiovascular events.

The impact of a stage tailored intervention on alcohol use trajectories among those who do not intend to change

BackgroundPersons not intending to change are an important target population for public health efforts. The aim of this study was to investigate whether subgroups characterized by different trajectories of alcohol use frequency and quantity among persons with unhealthy drinking but no intention to change benefitted differently from a stage tailored intervention. MethodsThis study was part of a randomized controlled trial among job-seekers. The participants of the intervention group (n=413) received feedback letters tailored to their motivational stage. The control group (n=414) received minimal assessment only. Among all participants, 629 (76.1%) did not intend to change alcohol use and constitute the study sample (60.7% men; mean age=29.7 years, SD=10.8). 3-, 6-, and 15-month follow-ups were conducted. Growth mixture modeling was applied to identify classes representing the heterogeneity in the development of alcohol use frequency and quantity and the influence of the intervention on different trajectories. ResultsFour classes were identified: a class of persons who achieved abstinence (2%), a class with low-frequent drinking with declining quantity (35%), a class with high-frequent drinking with low but slightly increasing quantity (30%), and a class with constant heavy episodic drinking (33%). Although non-significant, there was a tendency of different intervention effects for different classes. ConclusionsA sample of persons not intending to change unhealthy alcohol use was composed of subgroups characterized by different trajectories of alcohol use quantity and frequency. Trends towards beneficial intervention effects on motivation and drinking outcomes were not significant, possibly due to low power.

Drinking behaviors and patterns among floating population aged 18-59 years old in China, 2012

To understand the drinking behaviors and patterns among floating population in China. Floating population were selected through multistage clustering sampling method, stratified by 6 major industries in 170 counties and districts from 31 provinces/autonomous regions, and Xinjiang Construction Corps, in mainland China. Design-based methods were adopted to analyze the drinking behavior in subpopulations. A total of 48 697 floating population aged 18-59 years were included in the study. The overall prevalence rate of drinking was 51.7% with 71.9% in men and 24.7% in women, in the last 12 months. Among those who ever drank, the weekly drinking prevalence and daily alcohol intake were 53.9% and 18.7 g in males while 16.7% and 4.1 g in females, respectively, among those floating population. Weekly drinking prevalence rates, for both genders, increased along with the increase of age (P < 0.01), but declining with having higher education level (P < 0.01). Among male drinkers, daily alcohol intake increased with age(P < 0.01) but declining with those having higher education (P < 0.01). Prevalence rates on excessive drinking, hazardous drinking and harmful drinking among male drinkers were 23.6% , 6.6% and 6.9%, respectively, but among female drinkers the figures were 6.3% , 2.3% and 1.5% , respectively. More male and older drinkers had excessive drinking, hazardous drinking or harmful drinking than the younger drinkers (P < 0.01), while less male drinkers in those having lower education (P < 0.01). 71.2% male and 33.1% female drinkers experienced at least once binge drinking in the last 12 months. Distribution of binge drinking frequencies were statistically different among male drinkers by age groups, education levels, or occupation they engaged in (P < 0.01). Among all the 6 occupations, floating population from the construction industry had the highest prevalence rates on items as weekly drinking, daily alcohol intake and prevalence of unhealthy drinking behaviors, except for hazardous drinking behaviors. Drinking behavior was prevalent among floating population in China. Significant difference was seen between genders. Unhealthy drinking behaviors varied greatly among male drinkers at different age groups or education levels as well as among those working in the different industries.

Reprint of: The myth of conformity: Adolescents and abstention from unhealthy drinking behaviors

Adolescent peer groups with pro-drinking group norms are a well-established source of influence for alcohol initiation and use. However, classic experimental studies of social influence, namely ’minority influence’, clearly indicate social situations in which an individual can resist conforming to the group norm. Using the National Longitudinal Study of Adolescent Health (“Add Health”), a nationally representative sample of adolescents, we find evidence that being a non-drinking adolescent does not unilaterally put youth at risk for drinking onset when faced with a friendship network where the majority of friends drink. Our results also show that a non-drinking adolescent with a majority of drinking friends is significantly less likely to initiate alcohol abuse if he or she has a minority of non-drinking friend(s). Furthermore, a drinking adolescent with a majority of friends who drink has a decreased probability of continuing to drink and has overall lower levels of consumption if he or she has a minority of friends who do not drink. Our findings recognize that adolescent in-group friendships are a mix of behavioral profiles and can perhaps help adolescents continue or begin to abstain alcohol use even when in a friendship group supportive of alcohol use.

Call for extra funding to employ more alcohol health workers

LIAISON NURSES need more financial support to tackle unhealthy drinking, according to researchers at Leeds Metropolitan University and the University of York.

Alcohol use assessment in young adult cancer survivors.

To determine whether oncology practitioners assess for alcohol consumption rates and usage patterns among young adult cancer survivors, and to determine drinking patterns and frequency of alcoholic beverage consumption among young adult cancer survivors. Retrospective chart review. Two outpatient cancer clinics. 77 young adult survivors of childhood cancer aged 18-30 years. Charts were selected from June to December 2009 and data were extracted using a structured questionnaire. Oncology practitioner assessment of alcohol use and alcohol consumption of young adult cancer survivors. Alcohol screening was conducted for 48 participants. No significant differences were noted in most variables between those not screened for alcohol use and those screened for alcohol use. Of the 48 screened for alcohol use, 30 reported "no use." For the 18 who reported alcohol use, the terms used to describe the frequency varied and were vague. The key finding of the study was that screening and documentation of alcohol consumption was poorly and inconsistently performed in the authors' sample of young adult cancer survivors. Similar to healthy young adults aged 18-30 years, young adult cancer survivors are at a developmental age where it is likely they will engage in unhealthy drinking; therefore, they should be screened for alcohol use and binge drinking. Practitioners can incorporate simple, short questions into health assessment visits that allow them to screen for unhealthy alcohol use.

Alcohol and Associated Characteristics Among Older Persons Living With Human Immunodeficiency Virus on Antiretroviral Therapy

ABSTRACTBackground: Alcohol use, and particularly unhealthy alcohol use, is associated with poor human immunodeficiency virus (HIV)-related outcomes among persons living with HIV (PLWH). Despite a rapidly growing proportion of PLWH ≥50 years, alcohol use and its associated characteristics are underdescribed in this population. The authors describe alcohol use, severity, and associated characteristics using data from a sample of PLWH ≥50 years who participated in a trial of a telephone-based intervention to improve adherence to antiretroviral therapy (ART). Methods: Participants were recruited from acquired immunodeficiency syndrome (AIDS) service organizations in 9 states and included PLWH ≥50 years who were prescribed ART, reported suboptimal adherence at screening (missing >1.5 days of medication or taking medications 2 hours early or late on >3 days in the 30 days prior to screening), and consented to participate. The AUDIT-C (Alcohol Use Disorders Identification Test—Consumption) alcohol screen, sociodemographic characteristics, substance use, and mental health comorbidity were assessed at baseline. AUDIT-C scores were categorized into nondrinking, low-level drinking, and mild-moderate unhealthy, and severe unhealthy drinking (0, 1–3, 4–6, and 7–12, respectively). Analyses described and compared characteristics across drinking status (any/none) and across AUDIT-C categories among drinkers. Results: Among 447 participants, 57% reported drinking in the past year (35%, 15%, and 7% reported low-level drinking, mild-moderate unhealthy drinking, and severe unhealthy drinking, respectively). Any drinking was most common among men and those who were lesbian, gay, bisexual, or transgender (LGBT), married/partnered, had received past-year alcohol treatment, and never used injection drugs (P values all <.05). Differences in race, employment status, past-year alcohol treatment, and positive depression screening (P values all <.05) were observed across AUDIT-C categories, with African American race, less than full-time employment, past-year alcohol treatment, and positive depression screening being most common among those with the most severe unhealthy drinking. Conclusions: In this sample of older PLWH with suboptimal ART adherence, a majority reported past-year alcohol use and 22% screened positive for unhealthy alcohol use. Any and unhealthy alcohol use were associated with demographics, depression, and substance use history. Further research is needed regarding alcohol use among older PLWH.

The myth of conformity: Adolescents and abstention from unhealthy drinking behaviors

Adolescent peer groups with pro-drinking group norms are a well-established source of influence for alcohol initiation and use. However, classic experimental studies of social influence, namely ‘minority influence’, clearly indicate social situations in which an individual can resist conforming to the group norm. Using the National Longitudinal Study of Adolescent Health (“Add Health”), a nationally representative sample of adolescents, we find evidence that being a non-drinking adolescent does not unilaterally put youth at risk for drinking onset when faced with a friendship network where the majority of friends drink. Our results also show that a non-drinking adolescent with a majority of drinking friends is significantly less likely to initiate alcohol abuse if he or she has a minority of non-drinking friend(s). Furthermore, a drinking adolescent with a majority of friends who drink has a decreased probability of continuing to drink and has overall lower levels of consumption if he or she has a minority of friends who do not drink. Our findings recognize that adolescent in-group friendships are a mix of behavioral profiles and can perhaps help adolescents continue or begin to abstain alcohol use even when in a friendship group supportive of alcohol use.

An Online Alcohol and Oral Health Curriculum for Dental Students

Regular heavy alcohol use can cause or worsen several oral health disorders and is associated with complications during and after dental procedures. Dental student education should provide detailed knowledge of these issues together with skills needed to detect and counsel patients with unhealthy drinking patterns. This project was designed to develop and evaluate a five-module, online program to teach dental students about alcohol and oral health, systemic and oral biological effects of heavy drinking, required changes to treatment protocols for heavy drinkers, reliable methods of alcohol screening, and ways to provide heavy drinkers with brief interventions. Results indicated that the online program resulted in significant changes in knowledge, attitudes, and behavior. This online format could easily be incorporated into an already crowded dental school curriculum, with students learning the material at their own pace and in their own available time.

Exploring older adults’ views about alcohol consumption: implications for brief interventions with older heavy drinkers

Increasing alcohol consumption among older individuals in the UK is a public health concern. Although brief interventions (BIs) can effectively reduce heavy drinking in older age groups generally, social and contextual factors may influence implementation and effectiveness. Identities offer a useful theoretical concept to explain why the potential for public health messages to reduce rates of heavy drinking in this sector has not been realised, and can inform preventive approaches. A qualitative study explored older people’s reasoning about drinking in later life and how this interacted with health concerns, to inform future, targeted prevention in this group. A diverse sample of older adults in North East England (ages 51-90) participated in interviews (n=24, 12m, 12f) and three focus groups (participants n=27). Data were analysed using grounded theory and discursive psychology methods. Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking could be presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. These identities were flexible in older people’s talk since they could be applied to either moderate or heavy drinking. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker. Findings indicate that older UK adults do not recognise unhealthy drinking as distinct from dependent drinking, and are highly sensitive to stigma when discussing alcohol consumption. Preventive strategies should encourage older people’s identification of heavy drinking as neither healthy nor synonymous with dependence. BIs for heavy drinkers in later life should be tailored to address lay reasoning that is resistant to recognition of health risks.

Why Do Older Unhealthy Drinkers Decide to Make Changes or Not in Their Alcohol Consumption? Data from the Healthy Living as You Age Study

To understand characteristics of older at-risk drinkers and reasons why they decide to change or maintain their alcohol consumption. Secondary analysis of data from a randomized controlled trial to reduce drinking in at-risk drinkers. Three primary care sites in southern California. Six hundred thirty-one adults aged 55 and older who were at-risk drinkers at baseline, 521 of whom who completed a 12-month assessment. Sociodemographic and alcohol-related characteristics of 12-month assessment completers and noncompleters and among those completing the 12-month assessment by telephone or mail were compared using descriptive statistics. Reasons why respondents maintained or changed average alcohol consumption were asked of those who completed a 12-month assessment by telephone. Factors that might motivate at-risk drinkers to reduce drinking were asked about, and frequencies were calculated for these responses. Participants were primarily male, white, highly educated, and in good health. Those who responded to the 12-month assessment by mail were more likely to be working, to be in the intervention arm, and to drink more. Most who reduced alcohol consumption and heavy drinking did so because they thought it would benefit them. Those who did not thought that drinking was not a problem for them. Both groups cited their environment and circumstances as influencing their drinking. Remaining at-risk drinkers reported that medical evidence that alcohol was harming them would motivate them to reduce drinking. Older adults report that they reduce their drinking when they recognize that their drinking habits may be causing them harm; one's environment can hinder or help one to reduce drinking.

Unhealthy drinking in the Belgian elderly population: prevalence and associated characteristics

Knowledge about alcohol consumption patterns and alcohol problems among the Belgian elderly population is scarce. The aims of this study were to explore alcohol consumption patterns and alcohol problems among the Belgian elderly population aged ≥ 65 years living at home, and to determine their association with socio-demographic characteristics, health status and socio-economic status. In this cross-sectional study based on a representative sample of 4825 non-institutionalized Belgian elderly people (≥ 65 years) in the Belgian Health Interview Surveys 2001 and 2004, alcohol consumption patterns and alcohol problems were estimated according to age, gender, survey year, living situation, frequency of social contacts, smoking status, and socio-economic status. In all, 50.4% of the sample were non- or occasional drinkers, 29.1% were moderate drinkers, 10.4% at-risk drinkers, 4.6% heavy drinkers and 5.5% problematic drinkers. In total, 20.5% of the Belgian elderly population drank in excess of the National Institute on Alcohol Abuse and Alcoholism guidelines, and 4.7% had an alcohol problem according to the CAGE. In addition, 81.3% of the elderly people who consume alcohol used prescribed medications in the past 2 weeks. After adjustment for risk factors we found that, compared with moderate drinking, unhealthy drinking was significantly associated with age, gender, frequency of social contacts, health status and socio-economic status. Belgian health policy should be aware of the high level of at-risk drinkers in the elderly population and the underdetection and misdiagnosis of alcohol problems in this age group. An increased attention in public health initiatives among the Belgian elderly population is needed.

Comparing Alcohol Screening Measures Among HIV‐Infected and ‐Uninfected Men

Brief measures of unhealthy alcohol use have not been well validated among people with HIV. We compared the Alcohol Use Disorders Identification Test (AUDIT) to reference standards for unhealthy alcohol use based on 30-day Timeline Follow Back (TLFB) and Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM), among 837 male HIV-infected and -uninfected patients in the Veterans Aging Cohort Study. Three reference standards were (i) Risky drinking-based on TLFB >14 drinks over 7 consecutive days or >4 drinks on 1 day; (ii) Alcohol dependence-based on a CIDI-SAM diagnosis; and (iii) Unhealthy alcohol use-risky drinking or a CIDI-SAM diagnosis of abuse or dependence. Various cutoffs for the AUDIT, AUDIT-C, and heavy episodic drinking were compared with the reference standards. Mean age of patients was 52 years, 53% (444) were HIV-infected, and 53% (444) were African American. Among HIV-infected and -uninfected patients, the prevalence of risky drinking (14 vs. 12%, respectively), alcohol dependence (8 vs. 7%), and unhealthy alcohol use (22 vs. 20%) was similar. For risky drinking and alcohol dependence, multiple cutoffs of AUDIT, AUDIT-C, and heavy episodic drinking provided good sensitivity (≥80%) and specificity (≥90%). For unhealthy alcohol use, few cutoffs provided sensitivity ≥80%; however, many cutoffs provided good specificity. For all 3 alcohol screening measures, sensitivity improved when heavy episodic drinking was included with the cutoff. Sensitivity of measures for risky drinking and unhealthy alcohol use was lower in HIV-infected than in uninfected patients. For identifying risky drinking, alcohol dependence, and unhealthy alcohol use, AUDIT-C performs as well as AUDIT and similarly in HIV-infected and -uninfected patients. Cutoffs should be based on the importance of specific operating characteristics for the intended research or clinical use. Incorporating heavy episodic drinking increased sensitivity for detecting alcohol dependence and unhealthy alcohol use.

Unhealthy Alcohol Use, HIV Infection and Risk of Liver Fibrosis in Drug Users with Hepatitis C

AimTo analyze alcohol use, clinical data and laboratory parameters that may affect FIB-4, an index for measuring liver fibrosis, in HCV-monoinfected and HCV/HIV-coinfected drug users.Patients and MethodsPatients admitted for substance abuse treatment between 1994 and 2006 were studied. Socio-demographic data, alcohol and drug use characteristics and clinical variables were obtained through hospital records. Blood samples for biochemistry, liver function tests, CD4 cell count, and serology of HIV and HCV infection were collected at admission. Multivariate linear regression was used to analyze the predictors of FIB-4 increase.ResultsA total of 472 (83% M, 17% F) patients were eligible. The median age at admission was 31 years (Interquartile range (IQR) 27–35 years), and the median duration of drug use was 10 years (IQR 5.5–15 years). Unhealthy drinking (>50 grams/day) was reported in 32% of the patients. The FIB-4 scores were significantly greater in the HCV/HIV-coinfected patients (1.14, IQR 0.76–1.87) than in the HCV-monoinfected patients (0.75, IQR 0.56–1.11) (p<0.001). In the multivariate analysis, unhealthy drinking (p = 0.034), lower total cholesterol (p = 0.042), serum albumin (p<0.001), higher GGT (p<0.001) and a longer duration of addiction (p = 0.005) were independently associated with higher FIB-4 scores in the HCV-monoinfected drug users. The effect of unhealthy drinking on FIB-4 scores disappeared in the HCV/HIV-coinfected patients, whereas lower serum albumin (p<0.001), a lower CD4 cell count (p = 0.006), higher total bilirubin (p<0.001) and a longer drug addiction duration (p<0.001) were significantly associated with higher FIB-4 values.ConclusionsUnhealthy alcohol use in the HCV-monoinfected patients and HIV-related immunodeficiency in the HCV/HIV-coinfected patients are important risk factors associated with liver fibrosis in the respective populations

Project ART-ED: alcohol reduction and HIV testing in the emergency department

Unhealthy alcohol use and HIV risk often co-occur. To intervene on this association, we are conducting a pilot study to determine the feasibility and impact of providing brief alcohol- and sexual-risk reduction counseling with rapid HIV testing in a large urban emergency department (ED). We are recruiting ED patients aged 18-40 years who 1) meet National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking, 2) have >1 sexual-risk behavior, 3) have negative or unknown HIV status, and 4) are willing to undergo HIV testing. We are conducting a brief, manual-guided intervention combining an alcohol- and sexual-risk reduction counseling session with rapid HIV testing followed by a booster telephone call at two weeks. At baseline and eight weeks, we assess alcohol consumption with the Timeline Follow-Back for alcohol consumption and a modified HIV Risk Behavior Scale to characterize sexual risk behaviors. Statistical analyses include Wilcoxon Signed Rank test, McNemar test, and two-way ANOVA. Of the 82 participants enrolled to date, 60% are male, the mean age is 25 years, 63% are white, 83% are unmarried, 59% are college-educated, 41% are without primary care, and 79% have an AUDIT score of >8. All tested HIV negative. Among the 62 with follow-up data so far, alcohol consumption decreased with fewer average weekly drinks (25.5 versus 10.4, p < 0.0001) and binge drinking episodes (2.03 versus 0.99, p < 0.0001). This decrease was greater in men than women (p < 0.0002). Post-intervention, participants endorsed increased condom use (median change = 3 points on a 5-point scale, W = 275, p < 0.0001) and decreased episodes of sex while intoxicated (RR = 0.14, p < 0.0001). Mean intervention duration was 44 minutes. Preliminary analyses demonstrate that a brief intervention combining alcohol- and sexual-risk reduction counseling with rapid HIV testing in the ED is feasible and effective for reducing alcohol use and HIV risk behaviors among young unhealthy drinkers.

Third-generation internet-based brief interventions for problem drinkers: how far can technology take us, and what types of drinkers can be reached?

For over a decade, a number of randomized controlled trials (RCTs) have found that internet-based brief intervention (IBBI) can reduce consumption in people with alcohol use disorders. As technology becomes increasingly sophisticated, IBBI has the potential to offer highly tailored feedback to different populations. First launched in 2005, CheckYourDrinking.net (CYD), version 3.0, is a free anonymous IBBI that has undergone several randomized controlled trials and technical upgrades. Apart from the free online version, the technology has been modified for several specific populations such as college students, youth aged 13-17, public health institutions, and for use as a screening tool in private clinics. To illustrate how algorithms can be modified, we are examining data from 21,640 Canadian men (59%) and women (41%) who anonymously accessed CheckYourDrinking.net version 2.0 from April 8, 2008, to July 28, 2010. Through describing CYD’s development methodology and research-based maturation process, we illustrate how IBBI can be tailored for special populations. Technical limitations and other barriers are discussed. The purpose of this presentation is to share knowledge of the resources required for the ongoing technical enhancement and maintenance of IBBIs. With the use of sophisticated algorithms, IBBIs hold the exciting potential of providing highly tailored feedback to not only people with problem drinking but for those with specific unhealthy drinking patterns (i.e., heavy episodic drinking) and for special populations across languages and cultures. In order to fully understand the potential of IBBI technology, further research is required.

Drinking habits and disability retirement

To examine associations between drinking habits and disability retirement, and to determine whether the associations differ between all-cause disability retirement and the main causes of disability retirement, i.e. musculoskeletal diseases and mental disorders. A prospective cohort study with a mean follow-up time of 8 years. Middle-aged employees of the City of Helsinki, Finland. A total of 6275 municipal employees (78% women) who were 40-60 years old at baseline. Data on drinking habits, i.e. quantity and frequency of drinking, binge drinking and problem drinking, were derived from the baseline questionnaire. The data on disability retirement and its diagnoses came from the Finnish Centre for Pensions. The analyses were made using Cox regression analysis. Heavy average and frequent drinking were not associated with all-cause disability retirement, but increased the risk of disability retirement due to mental disorders even after adjusting for all covariates [hazard ratios (HR) and 95% confidence intervals (CI) 2.54 (1.26-5.12) and 2.10 (1.23-3.61), respectively]. Binge and problem drinking were both associated with all-cause disability retirement in the base models adjusted for age, gender and marital status. Problem drinking more than doubled the risk of disability retirement due to mental disorders even after all adjustments (HR 2.17, CI 1.53-3.08). Non-drinkers had an increased risk for disability retirement due to all mental and musculoskeletal diagnoses. Adverse drinking habits may contribute to disability retirement among the middle-aged working population. Tackling unhealthy drinking habits may lessen the likelihood of early retirement due to poor mental health.