A European study on alcohol and drug use among young drivers: the TEND by Night study design and methodology

Young individuals are the age group with the highest risk of car accidents. One of main explanations relies on the use of psychoactive substances (alcohol, illegal and medicinal drugs), which are known to be major risk factors of road accidents, and whose consumption is almost universally more common among younger drivers. Although the correlation between psychoactive substances use and decrease in driving performance has been established in controlled experimental or laboratory settings, few studies were conducted in naturalistic circumstances. The TEND by Night project has been designed to evaluate the relationship between driving performance and psychoactive substances assumption in young drivers enrolled at typical places of consumption.

The TEND by Night project, endorsed by the European Commission, is a multidisciplinary, multi-centric, cross-sectional study conducted in six European countries (Italy, Belgium/Netherlands, Bulgaria, Spain, Poland and Latvia). The study population consists of 5000 young drivers aged 16-34 years, attending recreational sites during weekend nights. The intervention is based on the portal survey technique and includes several steps at the entrance and exit of selected sites, including the administration of semi-structured questionnaires, breath alcohol test, several drug assumption test, and measurement of the reaction time using a driving simulator. The main outcome is the difference in reaction time between the entrance and exit of the recreation site, and its correlation with psychoactive substances use. As a secondary outcome it will be explored the relationship between reaction time difference and the amount of consumption of each substance. All analyses will be multivariate.

The project methodology should provide some relevant advantages over traditional survey systems. The main strengths of the study include the large and multicentric sample, the objective measurement of substance assumption (which is typically self-reported), the application of a portal survey technique and the simultaneous evaluation of several psychoactive substances.

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Early Adoption of Injectable Naltrexone for Alcohol-Use Disorders: Findings in the Private-Treatment Sector

The U.S. substance-abuse treatment system has been slow to adopt medications for the treatment of alcohol-use disorders (AUDs).

The objectives of this study are to (a) determine how the inherent characteristics of injectable naltrexone (i.e., relative advantage, complexity, trialability, observability, compatibility) shape organizational-level decisions to adopt the medication and (b) identify key predictors of adoption and barriers that impede adoption.

This study uses data from a nationally representative sample of 345 privately funded U.S. substance-abuse treatment programs to examine adoption (current use) of injectable naltrexone.

Sixteen percent of private treatment programs are early adopters of injectable naltrexone. Multivariate logistic regression models reveal that organizational size and percentage of patients paying with private insurance are significant predictors of adoption. The most salient predictor of adoption is innovation compatibility, measured by program use of other AUD pharmacotherapies. Barriers to adoption include cost, lack of access to prescribing physicians, and lack of knowledge about the medication. Injectable naltrexone, however, is addressing the patient compliance barrier, demonstrated by 70% of patients receiving at least 2 months of medication.

The adoption of AUD pharmacotherapies remains low, with only half of the sampled programs prescribing any AUD pharmacotherapies. Patterns of early adoption of injectable naltrexone are, however, promising. Results highlight innovation compatibility and relative advantage as explanations of organizational decisions to adopt injectable naltrexone.

Future research will move beyond issues of adoption and provide a more detailed examination of the implementation process.

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Parental R-Rated Movie Restriction and Early-Onset Alcohol Use

The aim of this study was to determine if parental restriction regarding Restricted-rated movies (R movies) predicts lower rates of early-onset alcohol use.

Students from 15 northern New England middle schools were surveyed in 1999, and never-drinkers were resurveyed 13-26 months later to determine alcohol use. Drinking was determined by the question, "Have you ever had beer, wine, or other drink with alcohol that your parents didn't know about?" R-movie restriction was assessed by the question, "How often do your parents allow you to watch movies that are rated R?"

The sample included 2,406 baseline never-drinkers who were surveyed at follow-up, of whom 14.8% had initiated alcohol use. At baseline, 20% reported never being allowed to watch R movies, and 21% reported being allowed all the time. Adolescents allowed to watch R-rated movies had higher rates of alcohol initiation (2.9% initiation among never allowed, 12.5% once in a while, 18.8% sometimes, and 24.4% all the time). Controlling for sociodemographics, personality characteristics, and authoritative parenting style, the adjusted odds ratios for initiating alcohol use were 3.0 (95% CI [1.7, 5.1]) for those once in a while allowed, 3.3 [1.9, 5.6] for those sometimes allowed, and 3.5 [2.0, 6.0] for those always allowed to watch R-rated movies. Alcohol initiation was more likely if R-rated movie restriction relaxed over time; tightening of restriction had a protective effect (p < .001). A structural model was developed that modeled two latent parenting constructs: (a) authoritative parenting and (b) media parenting. Both constructs had direct inverse paths to trying alcohol and indirect paths through lower exposure to R-rated movies. After accounting for differences in authoritative parenting style, adolescents reporting lesser restrictions for R movies have higher odds of future alcohol use. The structural model suggests that media parenting operates independently from authoritative parenting and should be incorporated explicitly into parenting prevention programs.

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Assessment of Self-Regulatory Code Violations in Brazilian Television Beer Advertisements

Research suggests that alcoholic beverage advertisements may have an adverse effect on teenagers and young adults, owing to their vulnerability to suggestive message content.

This study was designed to evaluate perceived violations of the content guidelines of the Brazilian alcohol marketing self-regulation code, based on ratings of the five most popular beer advertisements broadcast on television in the summer of 2005-2006 and during the 2006 FIFA (Federation Internationale de Football Association) World Cup games.

Five beer advertisements were selected from a previous study showing that they were perceived to be highly appealing to a sample of Brazilian teenagers. These advertisements were evaluated by a sample of Brazilian high school students using a rating procedure designed to measure the content of alcohol advertisements covered in industry self-regulation codes.

All five advertisements were found to violate multiple guidelines of the Brazilian code of marketing self-regulation. The advertisement with the greatest number of violations was Antarctica's "Male Repellent," which was perceived to violate 11 of the 16 guidelines in the code. Two advertisements had nine violations, and one had eight. The guidelines most likely to be violated by these advertisements were Guideline 1, which is aimed at protecting children and teenagers, and Guideline 2, which prohibits content encouraging excessive and irresponsible alcoholic beverage consumption.

The five beer advertisements rated as most appealing to Brazilian teenagers were perceived by a sample of the same population to have violated numerous principles of the Brazilian self-regulation code governing the marketing of alcoholic beverages.

Because of these numerous perceived code violations, it now seems important for regulatory authorities to submit industry marketing content to more systematic evaluation by young people and public health experts and for researchers to focus more on the ways in which alcohol advertising influences early onset of drinking and excessive alcohol consumption.

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Negative Affect, Relapse, and Alcoholics Anonymous (AA): Does AA Work by Reducing Anger?

Anger and other indices of negative affect have been implicated in a stress-induced pathway to relapse. The Alcoholics Anonymous (AA) literature states that reduction of anger is critical to recovery, yet this proposed mechanism has rarely been investigated.

Using lagged, controlled hierarchical linear modeling analyses, this study investigated whether AA attendance mobilized changes in anger and whether such changes explained AA-related benefit.

Alcohol-dependent adults (N = 1, 706) receiving treatment as part of a clinical trial were assessed at intake and at 3, 6, 9, 12, and 15 months.

Findings revealed substantially elevated levels of anger compared with the general population (98th percentile) that decreased over 15-month follow-up but remained high (89th percentile). AA attendance was associated with better drinking outcomes, and higher levels of anger were associated with heavier drinking. However, AA attendance was unrelated to changes in anger.

Although support was not found for anger as a mediator, there was strong convergence between AA's explicit emphasis on anger and the present findings: Anger appears to be a serious, enduring problem related to relapse and heavy alcohol consumption.

Methodological factors may have contributed to the lack of association between AA and anger, but results suggest that AA attendance alone may be insufficient to alleviate the suffering and alcohol-related risks specifically associated with anger.

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An Item-Response Theory Analysis of DSM-IV Alcohol-Use Disorder Criteria and "Binge" Drinking in Undergraduates

This is the first study to examine the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for alcohol-use disorders and heavy episodic (or "binge") drinking in a college sample using item-response theory (IRT) analysis. IRT facilitates assessment of the severity of the criteria, their ability to distinguish between those at greatest and lowest risk, and the value of adding a "binge" drinking criterion.

In a sample of undergraduate drinkers (n = 353), we conducted factor analyses to determine whether the criteria best fit a one- or two-factor structure. We then conducted IRT analyses to obtain item-characteristic curves indicating the probability of endorsing a criterion at increasing levels of alcohol-use-disorder risk. These analyses were first conducted including current (i.e., past-year) DSM-IV alcohol-use-disorder criteria only and then rerun adding weekly "binge" drinking.

A single-factor model of the DSM-IV criteria did not differ significantly from a two-factor model. After including "binge" drinking, two factors fit the data slightly better than one factor but with a dominant single factor. Withdrawal was the most severe criterion, whereas tolerance and "larger/longer" were the least severe. Time spent drinking and a combined social/legal difficulties criterion had the best ability to discriminate those at greatest and lowest risk for an alcohol-use disorder. "Binge" drinking showed both low discrimination and low severity.

To our knowledge, this is the first study to examine DSM-IV criteria in an undergraduate sample using IRT. In this sample, abuse and dependence were intermixed on a continuum of severity, and "binge" drinking was in the least severe region.

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The Five-Year Diagnostic Utility of "Diagnostic Orphans" for Alcohol Use Disorders in a National Sample of Young Adults

This study was conducted to assess the association of "diagnostic orphans" at baseline and subsequent development of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorders (AUDs) 5 years later.

A sample of 8,534 respondents was drawn from the National Longitudinal Survey of Youth for the years 1989 and 1994. Diagnostic orphans were defined as respondents who met one or two alcohol dependence symptom criteria but did not meet the criteria for a diagnosis of alcohol abuse or dependence. Using multinomial logistic regression analysis, 1994 assessments of DSM-IV AUD were regressed on 1989 baseline assessments of diagnostic orphan status and DSM-IV AUD. In addition to demographic characteristics, other background variables included heavy episodic drinking at baseline and early problem behaviors (antisocial behaviors, illicit substance use, and age at onset of alcohol use).

Findings from this 5-year prospective study indicate that diagnostic orphan status at baseline was predictive of DSM-IV AUD at follow-up. These associations remained significant when other early behavioral problems were included in the models.

The present findings have important diagnostic implications for the proposed DSM-V, particularly for a dimensional diagnosis incorporating less severe forms of alcohol dependence.

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Reasons for Quitting Among Emerging Adults and Adolescents in Substance-Use-Disorder Treatment

Understanding developmental differences in reasons for quitting substance use may assist clinicians in tailoring treatments to different clinical populations.

This study investigates whether alcohol-disordered and problem-drinking emerging adults (i.e., ages 18-25 years) have different reasons for quitting than younger adolescents (i.e., ages 13-17 years)

Using a large clinical sample of emerging adults and adolescents, we compared endorsement rates for 26 separate reasons for quitting between emerging adults and adolescents who were matched on clinical severity. Then age group was regressed on total, interpersonal, and personal reasons for quitting, and mediation tests were conducted with variables proposed to be developmentally salient to emerging adults.

Among both age groups, self-control reasons were the most highly endorsed. Emerging adults had significantly fewer interpersonal reasons for quitting (Cohen's d = 0.20), and this association was partially mediated by days of being in trouble with one's family. There were no differences in personal reasons or total number of reasons for quitting.

Our findings are consistent with developmental theory suggesting that emerging adults experience less social control, which here leads to less interpersonal motivation to refrain from alcohol and drug use.

As emerging adults in clinical samples may indicate few interpersonal reasons for quitting, one challenge to tailoring treatments for them will be identifying innovative ways of leveraging social supports and altering existing social networks.

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smithdc@illinois.edu

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Factors Associated With Retention in Alcohol and Other Drug Treatment Among Disadvantaged Communities in Cape Town, South Africa

Retention in alcohol and other drug (AOD) treatment is strongly associated with positive outcomes. To design interventions to improve outcomes, it is therefore important to uncover the factors contributing to treatment retention. To date, South African AOD research has not examined the factors associated with retention among disadvantaged communities.

This study aimed to address this gap by exploring client-level factors associated with retention in AOD treatment.

Secondary data analysis was conducted on cross-sectional survey data collected from 434 persons residing in disadvantaged communities in the Cape Town metropolitan area who had accessed AOD treatment in 2006.

Multiple regression analyses revealed that race, therapeutic alliance, abstinence-specific social support, and anxiety were significant partial predictors of treatment retention. Black African participants spent significantly fewer days in treatment than "Coloured" individuals.

Findings point to the need to improve treatment retention among Black African clients specifically. For clients from poor South African communities, treatment retention rates can be improved by increasing abstinence-specific social support, improving perceptions of AOD treatment, and strengthening the counselor-client therapeutic alliance.

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Cost-Effectiveness of a Motivational Intervention for Alcohol-Involved Youth in a Hospital Emergency Department

Brief interventions in the emergency department targeting risk-taking youth show promise to reduce alcohol-related injury.

This study models the cost-effectiveness of a motivational interviewing-based intervention relative to brief advice to stop alcohol-related risk behaviors (standard care). Average cost-effectiveness ratios were compared between conditions. In addition, a cost-utility analysis examined the incremental cost of motivational interviewing per quality-adjusted life year gained.

Microcosting methods were used to estimate marginal costs of motivational interviewing and standard care as well as two methods of patient screening: standard emergency-department staff questioning and proactive outreach by counseling staff. Average cost-effectiveness ratios were computed for drinking and driving, injuries, vehicular citations, and negative social consequences. Using estimates of the marginal effect of motivational interviewing in reducing drinking and driving, estimates of traffic fatality risk from drinking-and-driving youth, and national life tables, the societal costs per quality-adjusted life year saved by motivational interviewing relative to standard care were also estimated. Alcohol-attributable traffic fatality risks were estimated using national databases.

Intervention costs per participant were $81 for standard care, $170 for motivational interviewing with standard screening, and $173 for motivational interviewing with proactive screening. The cost-effectiveness ratios for motivational interviewing were more favorable than standard care across all study outcomes and better for men than women. The societal cost per quality-adjusted life year of motivational interviewing was $8,795. Sensitivity analyses indicated that results were robust in terms of variability in parameter estimates.

This brief intervention represents a good societal investment compared with other commonly adopted medical interventions.

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Reducing Drinking Among Junior Enlisted Air Force Members in Five Communities: Early Findings of the EUDL Program's Influence on Self-Reported Drinkin

In the fall of 2006, the Office of Juvenile Justice and Delinquency Prevention awarded discretionary grants to five communities in four states as part of the Enforcing Underage Drinking Laws initiative. These 3-year grants were designed to support implementation of a set of interventions using an environmental strategies approach to reduce drinking and associated alcohol-related misconducts among active-duty Air Force members ages 18-25, with a specific focus on the underage population.

The current article presents findings from Year 1 of the evaluation.

Data on alcohol use were obtained from a large-scale, anonymous survey that fielded in the spring of 2006 (i.e., pretest) and the spring of 2008 (i.e., posttest) from a stratified random sample of Air Force members at five demonstration and five comparison communities.

The percentage of junior enlisted personnel at risk for an alcohol problem dropped 6.6% in the Air Force overall during the last 2 years but dropped as much as 13.6% and 9.8% in two Arizona demonstration communities that implemented the intervention.

The first-year results suggest that the Enforcing Underage Drinking Laws intervention may have been one factor that helped to reduce the percentage of junior enlisted Air Force members at risk for an alcohol problem in the demonstration communities.

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Adolescent Alcohol Intoxication in the Dutch Hospital Departments of Pediatrics

This study was conducted to investigate the number and characteristics of adolescent alcohol intoxication cases in hospital Departments of Pediatrics. The study also analyzes drinking patterns and intoxication characteristics.

Data were collected using the Dutch Pediatric Surveillance System, in which about 92% of general pediatricians and 83% of academic pediatricians participate. In 2007, questionnaires were collected every month within 56 hospitals. A total of 297 adolescent alcohol intoxications were reported, of which 231 cases were analyzed.

Hospital-admitted adolescents in this study are 12-18 years old, with an average age of 15.3 years. Intoxicated adolescents appear to be a representative sample of the Dutch population on all background variables (gender, educational level, family structure).

This study shows the serious nature of adolescent intoxication and may indicate that more strict governmental alcohol control policies are required.

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Suppression Effects of Partner Type on the Alcohol–Risky Sex Relationship in Young Irish Adults

The present study examined the link between alcohol consumption and condom use, testing whether partner type suppresses the effects of alcohol consumption on condom use.

This study also sought to determine whether the effects of alcohol on condom use during casual sex remain after adjusting for condom-use intentions and planning or preparatory behaviors, such as having a condom available.

A retrospective, cross-sectional study design was used. A subset of participants aged 19-30 years from the national Irish Study of Sexual Health and Relationships were recontacted (n = 388). Telephone interviews regarding participants' most recent sexual event in their normal social environment (i.e., not on holidays) were conducted (n = 362). Partnership type was defined as "just met," "casual," or "steady." Men comprised 51% of the sample. The mean age was 23.9 years.

Both alcohol consumption and condom use were more common in casual sexual events than steady sexual events. In addition, partnership type was found to suppress the effects of alcohol consumption on condom use, such that the relationship between alcohol consumption and condom use became significant and negative only after controlling for partner type. Furthermore, the negative effects of alcohol consumption on condom use during casual sex remained after adjusting for condom-use intentions and planning.

These findings illustrate the complexity of the relationship between alcohol consumption and condom use, highlighting the importance of contextual factors such as partner type.

Furthermore, the effects of alcohol on condom use during casual sex cannot be explained by the fact that such events tend to be more spontaneous and less planned.

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gcousins@rcsi.ie


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Traffic Crash Victimizations of Children and Teenagers by Drinking Drivers Age 21 and Older

Motor-vehicle crash victimizations by age of the drinking driver and the age of the victim, particularly the toll inflicted by drinkers 21 and older on children and teenagers, have not been quantified in detail. This article presents and analyzes the available data.

Cases of fatal crashes involving drivers who tested positive for alcohol use were extracted from the Fatality Analysis Reporting System's online encyclopedia for 1998-2007. These data, along with data for other drivers, passengers, and vehicle nonoccupants involved in the same crashes, were arranged in cross tabulations showing relationships of ages of drinking drivers to ages, injury severity, and person type of corresponding victims. National Highway Traffic Safety Administration estimates of alcohol-related crash involvements were used to estimate all alcohol-related traffic victimizations by driver and victim age.

Drinking drivers age 21 and older caused an estimated 2.7 million crashes from 1998 through 2007 that victimized persons younger than age 20, killing 3,630 children below the age of 16 and 4,290 teens ages 16-19 and injuring 470,000 children and 390,000 teens. Drinking drivers age 21 and older victimize 1.3 times more teenage drivers than vice versa and account for large majorities of passenger and nonoccupant alcohol-related crash victimizations of both children and teens.

If tabulated as a separate mortality cause, drinking and driving among those age 21 and older would represent the sixth leading cause of death for teenagers and the ninth leading cause for children. The hazards of underage and overage drinking to young people are integrated issues requiring unified countermeasures.

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Acute Alcohol Administration and Placebo Effectiveness in Older Moderate Drinkers: Influences on Cognitive Performance

Placebo effectiveness and subsequent influence on cognitive performance were investigated in older moderate drinkers (ages 50-69; N = 30; 15 men) following acute alcohol administration.

Double-blind, placebo-controlled alcohol administration techniques were designed to produce peak breath alcohol concentration levels consistent with an episode of social drinking (40 mg/100 ml). Cognitive performance, measured via a covert attentional processing task, was assessed. Participants were also asked to rate their perceived levels of intoxication and impairment.

The placebo beverage was effective in older moderate drinkers, with 63% of participants who received placebo reporting that they received alcohol.

Placebo beverage effectiveness influenced cognitive performance. Participants who received placebo, but reported they received alcohol, demonstrated slower reaction times on the covert attentional processing task, similar to those receiving alcohol. Placebo effects did not influence accuracy on the covert attentional processing task or self-reported measures of intoxication and impairment.

As expected, participants who received alcohol had less accuracy on the covert attentional processing task and more self-reported impairment and intoxication than those who received placebo, regardless of placebo effectiveness.

These results suggest that belief of having received a moderate dose of alcohol has an effect on reaction time similar to that of its pharmacological effect in older moderate drinkers. Although placebo effects are not novel, these findings suggest that cognitive processes are differentially affected. The study of moderate doses and more complex real-world tasks is an important next step.

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Rerquest Reprint E-Mail: rjgilber@ufl.edu


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Trauma, Posttraumatic Stress Symptoms, and Alcohol-Use Initiation in Children

This study examined initiation of alcohol use among adolescents, in relation to their earlier traumatic experiences and symptoms of posttraumatic stress disorder (PTSD).

Data were from a longitudinal study of children of Puerto Rican background living in New York City's South Bronx and in San Juan, Puerto Rico. The subsample (n = 1,119; 51.7% male) of those who were 10-13 years old and alcohol naive at baseline was used in the analyses.

Alcohol-use initiation within 2 years after baseline was significantly more common among children reporting both trauma exposure and 5 or more of a maximum of 17 PTSD symptoms at baseline (adjusted odds ratio = 1.84, p < .05) than among those without trauma exposure, even when potentially shared correlates were controlled for. Children with trauma exposure but with fewer than five PTSD symptoms, however, did not differ significantly from those without trauma exposure, with regard to later alcohol use. PTSD symptoms in children 10-13 years old may be associated with early onset of alcohol use. It is important to identify and treat PTSD-related symptoms in pre-adolescent children.

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Examining the Etiology of Associations Between Perceived Parenting and Adolescents' Alcohol Use: Common Genetic and/or Environmental Liabilities?

Although twin studies yield consistent evidence of heritability in the frequency of adolescent alcohol use, parallel findings on parenting are more equivocal, supporting the role of genes in affective parenting but not as supportive in relation to parental control. The extent to which these patterns generalize to more nuanced forms of parenting is less clear.

Furthermore, despite evidence linking parents' socialization practices with adolescents' alcohol-use behaviors, this study is the first attempt to determine the sources of this covariation.

The present study used epidemiological data from 4,729 adolescent twins (2,329 females) to examine the nature of associations between their perceptions of parenting at age 12 and frequencies of alcohol use at age 14. Univariate analyses assessed the relative contributions of genetic and environmental influences on variability within six domains of parenting. Among those displaying consistent evidence of heritability, bivariate models were used to explore sources of covariation with drinking frequency.

Univariate models suggested both genetic and environmental sources of variability across parenting phenotypes, including sex-specific sources of genetic liability within one dimension of parenting.

However, despite evidence for heritability, bivariate analyses indicated that the covariation between alcohol use and perceptions of parental knowledge and warmth were entirely mediated through shared environmental pathways.

This study elucidates genetic and environmental sources of variability within individual parenting behaviors and characterizes the etiological nature of the association between parental socialization and adolescent alcohol use.

The identification of specific and modifiable socialization practices will be crucial for the future development of parent-based prevention/intervention strategies.

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Alcohol use in Denmark: A descriptive study on drinking contexts

Using data from the National Health and Morbidity Survey from 2005, we examined the contexts of alcohol use in Denmark in relation to gender and age.

Among the 21,832 subjects invited to participate, 14,566 completed the survey. For the entire study population and restricted to heavy users (>21 standard drinks per week for males; >14 for females), we computed the prevalence of each age and gender group who indicated to drink alcohol in different drinking contexts. To compare the contexts for heavy use between age groups, we estimated prevalence ratios for each group compared to the 16–20-year-old age group, with adjustments for gender.

Results showed that more than 68% of the study population drank alcohol in social contexts, such as at home with/visiting family and friends, or in party contexts.

We found similar patterns among males and females; however, there was a predominance of males for drinking alcohol during work and leisure-times. The majority of heavy users also drank alcohol in social and party contexts.

Among heavy users, drinking at home alone was eight times more prevalent among those aged 45–64 compared with those aged 16–20 years.

We concluded that drinking contexts varied in relation to gender and age. Our findings provided useful insight into contexts for alcohol use in Denmark and will enable us to understand better some of the many aspects associated with alcohol use.

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Familial drinking in Italy: Harmful or protective factors?

This study examined relations between cultural norms and drinking practices in Italian young people using qualitative interviewing techniques. We collected self-report drinking history information from young people including whether or not they were allowed alcohol with meals in a family setting when growing up.

We conducted ethnographic interviews of 80 adolescent (ages 16–18) and 80 young adult (ages 25–30) regular and heavy drinkers in two regions (Abruzzo and Umbria). All 20 Italian regions produce wine. Abruzzo has a high ratio of heavy drinkers while Umbria has a high ratio of regular drinkers. We used the AUDIT to determine eligibility. We queried age at first drink, first 5+, first drunk, context of drinking, drinking with family during meals, availability of alcohol at home, parent's relationship to, attitudes about and discussion about alcohol.

Half of regular and heavy drinkers were allowed alcohol in a family setting while growing up. Those allowed alcohol with meals when growing up consumed less on their first drink occasion and were more likely to never drink 5+ or get drunk than those not allowed. They also had reduced or delayed 5+ or drunk occasions.

In Italy the tradition of incorporating alcohol with meals in a family setting may protect against harmful drinking. Other qualitative research should explore family, other adult and peer relationships to clarify alcohol use and risk-related behaviors. Research in countries with similar and different early age introduction would increase knowledge about the protective aspect of drinking in a family setting.

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Request Reprint E-Mail: strunin@bu.edu

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Dynamic Deconstructive Psychotherapy Versus Optimized Community Care for Borderline Personality Disorder Co-Occurring With Alcohol Use Disorders: A 30

Patients having co-occurring borderline personality disorder and alcohol use disorders represent a common, but particularly severe and refractory subgroup.

An individual, time-limited treatment, dynamic deconstructive psychotherapy (DDP), has been shown to be effective for this subgroup, but long-term outcomes are not known.

Participants were recruited from a sample of 30 patients enrolled in a 12-month randomized controlled trial of DDP versus optimized community care (OCC). Outcomes were assessed after an additional 18 months of naturalistic follow-up.

DDP participants received an equivalent amount of individual treatment and less group therapy than those receiving OCC, but demonstrated large, sustained treatment effects over a broad range of outcomes and achieved significantly greater improvement in core BPD symptoms, depression, parasuicide, and recreational drug use over the 30-month study.

These results suggest that DDP is a cost-effective treatment that can lead to broad and sustained improvement for the dually diagnosed subgroup.

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Request Reprint E-Mail: gregoryr@upstate.edu

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