Overview and Definition of Alcohol Related Disorders
Epidemiology
Aetiology
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Information Gathering at the In Person Assessment
Analysis of Effect on Functional Ability
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Wednesday, July 10, 2013
Medical Assessment Protocol - Alcohol Dependency
Overview and Definition of Alcohol Related Disorders
Epidemiology
Aetiology
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Information Gathering at the In Person Assessment
Analysis of Effect on Functional Ability
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Trends in socioeconomic inequalities in adolescent alcohol use in Germany between 1994 and 2006
To examine socioeconomic differences in adolescent alcohol use in Germany as well as their changes between 1994 and 2006.
Data were obtained from the “Health Behaviour in School-aged Children” study conducted in North Rhine-Westphalia, Germany in 1994, 1998, 2002 and 2006. The analysis is based on 5.074 15-year-old students. Prevalence and trends were analysed for each category of family affluence and educational track separately using log-binominal regression models.
An increase in weekly alcohol use between 1994 and 2002 was followed by a strong decrease from 2002 to 2006. Family affluence only had a weak effect on weekly drinking with a tendency for lower-affluent students reporting less alcohol use. Educational track showed almost no relationship with weekly alcohol use. Trend analyses within the subgroups revealed that the overall trend in alcohol use was similar in all socioeconomic and educational groups.
Socioeconomic patterns in drinking behaviour are not yet developed in 15-year-old adolescents. Adolescence could therefore be an important time frame for tackling inequalities in alcohol use later in life.
Request Reprint E-Mail: m.richter@medizin.uni-halle.de
Health in the Long-Term Unemployed
Although the unemployment rate in Germany is currently low, more than a million persons in the country have been out of work for more than a year. In this review article, we address these persons' state of health, the effect of unemployment on health, and the influence of macroeconomic factors and social policy.
This article is based on a selective review of pertinent literature in the PubMed database.
Large-scale meta-analyses and systematic reviews have shown that the long-term unemployed have an at least twofold risk of mental illness, particularly depression and anxiety disorders, compared to employed persons. Their mortality is 1.6-fold higher. Unemployment seems to be not only an effect of illness, but also a cause of it (i.e., there is evidence for both selection and causality). Learned helplessness is an important psychological explanatory model. Limited evidence indicates that the long-term unemployed have a moderately elevated prevalence of alcoholism; unemployment can be both an effect and a cause of alcoholism. Unemployment also seems to be associated with higher risks of heart attack and stroke. Cancer can lead to loss of employment. The link between unemployment and poorer health is strengthened by macroeconomic crises and weakened by governmental social interventions.
The long-term unemployed carry a markedly higher burden of disease, particularly mental illness, than employed persons and those who are unemployed only for a short time. The burden of disease increases with the duration of unemployment. The vicious circle of unemployment and disease can be broken only by the combined effects of generally available health care, special health-promoting measures among the unemployed, and social interventions.
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Prenatal Alcohol Exposure and Educational Achievement in Children Aged 8–9 Years
This study examines the relationships between the dose, pattern, and timing of prenatal alcohol exposure and achievement in reading, writing, spelling, and numeracy in children aged 8 to 9 years.
Data from a randomly selected, population-based birth cohort of infants born to non-Indigenous women in Western Australia between 1995 and 1997 (n = 4714) (Randomly Ascertained Sample of Children born in Australia’s Largest State Study cohort) were linked to the Western Australian Midwives’ Notification System and the Western Australian Literacy and Numeracy Assessment statewide education testing program. The records for 86% (n = 4056) of the cohort were successfully linked with education records when the children were aged 8 to 9 years. The associations between prenatal alcohol exposure and achievement of national benchmarks in school numeracy, reading, spelling, and writing tests and nonattendance for the tests was examined. Logistic regression was used to generate adjusted odds ratios (aOR) and 95% confidence intervals (CI), adjusting for potential confounding factors. The referent group included children of mothers who previously drank alcohol but who abstained during pregnancy.
The type of learning problems expressed depends on the dose, pattern, and timing of prenatal alcohol exposure.
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Request Reprint E-Mail: colleen.oleary@curtin.edu.au.
The impact of school alcohol policy on student drinking
Although it is common for secondary schools to implement alcohol policies to reduce alcohol misuse, there has been little evaluation of the efficacy of these policies.
The purpose of this study was to test the impact of the degree and type of alcohol policy enforcement in state representative samples of secondary students in Washington State, USA, and Victoria, Australia (n = 1848). Multivariate logistic regressions were used to examine the prospective association between student reports of school alcohol policy in Grade 8 and self-reported alcohol use in Grade 9, controlling for age, gender, state, family socio-economic status and Grade 8 alcohol use.
The likelihood of students drinking on school grounds was increased when students perceived lax policy enforcement. Student perceptions of harm minimization alcohol messages, abstinence alcohol messages and counselling for alcohol policy violators predicted reduced likelihood of binge drinking.
Students perceiving harm minimization messages and counselling for alcohol policy violators had a reduced likelihood of experiencing alcohol-related harms.
Perceptions of harsh penalties were unrelated to drinking behaviour.
These results suggest that perceived policy enforcement may lessen drinking at school 1 year later and that harm minimization messages and counselling approaches may also lessen harmful drinking behaviours as harm minimization advocates suggest.
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Request Reprint E-Mail: tracy.evanswhipp@mcri.edu.au
Binge Drinking Impairs Vascular Function in Young Adults
The aim of this study was to assess whether young binge drinkers (BD) have impaired macrovascular and microvascular function and cardiovascular disease risk factors compared with age-matched alcohol abstainers (A).
Binge drinking rates are highest on college campuses and among those age 18 to 25 years; however, macrovascular and microvascular endothelial function in young adults with histories of repeated binge drinking (≥5 standard drinks in 2 h in men, ≥4 standard drinks in 2 h in women) has not been investigated.
Cardiovascular profiles, brachial artery endothelial-dependent flow-mediated dilation (FMD), and flow-independent nitroglycerin (NTG)–mediated dilation and vasoreactivity of resistance arteries (isolated from gluteal fat biopsies) were evaluated in A and BD.
Men and women (18 to 25 years of age; A, n = 17; BD, n = 19) were enrolled. In the BD group, past-month mean number of binge episodes was 6 ± 1, and the mean duration of binge drinking behavior was 4 ± 0.6 years. FMD and NTG-mediated dilation were significantly lower in the BD group (FMD: 8.4 ± 0.7%, p = 0.022; NTG-mediated dilation: 19.6 ± 2%, p = 0.009) than in the A group (FMD: 11 ± 0.7%; NTG-mediated dilation: 28.6 ± 2%). Acetylcholine-induced and sodium nitroprusside–induced dilation in resistance arteries was not significantly different between the A and BD groups. However, endothelin-1–induced constriction was significantly enhanced in the BD group compared with the A group (p = 0.032). No differences between groups were found in blood pressure, lipoproteins, and C-reactive protein.
Alterations in the macrocirculation and microcirculation may represent early clinical manifestations of cardiovascular risk in otherwise healthy young BD. This study has important clinical implications for screening young adults for a repeated history of binge drinking.
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Request Reprint E-Mail: shanep@uic.edu
Adolescence to Young Adulthood: When Socioeconomic Disparities in Substance Use Emerge
We examined trends in cigarette, alcohol, and marijuana use by eventual educational attainment in 1,902 participants from Project EAT, a 10-year longitudinal study following participants from early adolescence through young adulthood.
Generally, for cigarettes and marijuana, disparities were evident by early adolescence with prevalence of use highest among those who had no secondary education.
With alcohol, use diverged during young adulthood when the college group reported the most weekly alcohol use while those without postsecondary education reported greatest daily use.
When disparities in substance use behaviors first emerge and later escalate can guide how to craft and target interventions.
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Request Reprint E-Mail: widome@umn.edu
Substance Use over the Military-Veteran Life Course: An Analysis of a Sample of OEF/OIF Veterans Returning to Low-Income Predominately Minority Communities
This paper presents an overview of substance use patterns of recent veterans returning to low-income predominately minority communities over four periods of the military-veteran career.
Respondent driven sampling (RDS) was used so that unbiased estimates could be obtained for the characteristics of the target population.
The majority of participants had used marijuana but no other illegal drugs. In the military, marijuana use was substantially lower and alcohol was the drug of choice; the majority were binge drinkers and nearly half were heavy drinkers.
While deployed, alcohol and marijuana use were both lower, though some participants (6%) initiated the misuse of prescription painkillers.
After separating from the military and returning to civilian life, heavy drinking was much lower, marijuana use increased, and some veterans misused prescription painkillers (7%).
Further research based on these data will examine these distinct periods of substance use, contexts of use, related substance and mental health problems, treatment use and avoidance, and civilian reintegration.
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Request Reprint E-Mail: Golub@ndri.org
Demographic, socioeconomic, disease history, dietary and lifestyle cancer risk factors associated with alcohol consumption
Data are lacking regarding the association of alcohol consumption with a broad range of other cancer risk factors.
Objectives: 1) to assess which sociodemographic, lifestyle and dietary factors were associated with alcohol consumption; 2) to identify profiles of alcohol consumers by beverage type; 3) to estimate the number of cancer risk factors accumulated on the individual level according to alcohol consumption. Alcohol and dietary intakes were assessed by six 24h records among 29,566 adults of the NutriNet-Santé cohort. Factors associated with alcohol consumption were assessed by polytomic multivariate logistic regression stratified by gender. Among alcohol consumers, percentages of alcohol brought by each beverage type were compared across sociodemographic and lifestyle characteristics using Kruskal-Wallis rank tests.
Several factors were associated with alcohol consumption ≥10g/d both genders: older age , smoking , higher socioprofessional category , higher income , and less healthy dietary intakes. Profiles of subjects varied across alcoholic beverage types. Men with history of cardiovascular disease or depression and women with history of cirrhosis consumed less alcohol. In women, personal history of cancer was associated with a lower proportion of moderate alcohol users only In both genders, higher alcohol drinkers clustered more cancer risk factors (median=5, apart from alcohol) than non-drinkers (median=4).
The multiplicity of deleterious lifestyle behaviours combined with alcohol drinking must be taken into account in cancer prevention efforts. Gender-specific medical advice for people with personal or family history of alcohol-related diseases, including cancer, should be strengthened.
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Request Reprint E-Mail: m.touvier@uren.smbh.univ-paris13.fr
Tuesday, July 9, 2013
Workplace alcohol and other drug programs - July 2013
Welcome to the 8th edition of PolicyTalk from the Australian Drug Foundation. PolicyTalk provides an overview of topical debates to help senior policy makers find the right solutions for the community on alcohol and other drug issues.
Alcohol and other drug problems in the workplace is the subject of this edition. It may not be well understood that the impact of alcohol misuse alone on productivity is colossal – an estimated cost of over $6 billion per annum. This accounts for the largest single contribution to the toll exacted on the whole community by excessive drinking. For the most part it remains a hidden cost as many businesses are blind to its impact or reluctant to face up to it. Yet tackling this problem is an imperative for employers and employees alike. > > > > Read More
Service engagement among Polish street drinkers in a London borough
A new feasibility study exploring alcohol service engagement among Polish street drinkers is now available in the Alcohol Library. Based on an Alcohol Research UK Small Grant, the study sets out to understand the lived experiences of Polish street drinkers and their perspectives on approaching and engaging with alcohol services.
The Alcohol Insight and Final Report are available here:
New Directions in the Study of Alcohol Group 2013
LOCATION Birmingham
EVENT THEME Alcohol Policy
EVENT SUMMARY
New Directions in the Study of Alcohol Group has provided a safe environment where alcohol practitioners, researchers, service managers and commissioners have explored and debated contemporary challenges in the field since the mid 1970. 2013 conference reviews the development of alcohol related work with families including some of the leading researchers internationally: Professor Jim Orford; Professor Alex Copello and Professor Richard Velleman. > > > > Read More
Webinar - Why Living in Safe, Sober and Peer Supportive Environments Matters in Recovery
Part 1: Thursday August 1, 2013 from 3:00 - 5:00 PM EST
Part 2: Thursday August 8, 2013 from 3:00 - 5:00 PM ES
- The spectrum of recovery-oriented housing and service available
- How to tell your recovery story and relate it to recovery residence issues
- How to broaden public understanding of the
importance of recovery-oriented housing and how to advocate and communicate
about it.
> > > > Read More
Multiple behavioural impulsivity tasks predict prospective alcohol involvement in adolescents
We investigated reciprocal prospective relationships between multiple behavioural impulsivity tasks (assessing delay discounting, risk-taking, and disinhibition) and alcohol involvement (consumption, drunkenness, and problems) among adolescents. We hypothesised that performance on the tasks would predict subsequent alcohol involvement, and that alcohol involvement would lead to increases in behavioural impulsivity over time.
Cross-lagged prospective design in which impulsivity and alcohol involvement were assessed five times over two years (once every six months, on average).
Classrooms in secondary schools in North West England.
Two hundred and eighty seven adolescents (51% Male) who were aged 12 or 13 at study enrolment.
Participants reported their alcohol involvement and completed computerized tasks of disinhibition, delay discounting, and risk-taking at each assessment. Cross-sectional and prospective relationships between the variables of interest were investigated using cross-lagged analyses.
All behavioural impulsivity tasks predicted a composite index of alcohol involvement six months later (all ps < .01), and these prospective relationships were reliable across the majority of time points. Importantly, we did not observe the converse relationship across time: alcohol involvement did not predict performance on behavioural impulsivity tasks at any subsequent time point.
Several measures of impulsivity predict escalation in alcohol involvement in young adolescents, but alcohol use does not appear to alter impulsivity.
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Request Reprint E-Mail: mfield@liv.ac.uk
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Request Reprint E-Mail: mfield@liv.ac.uk
For Debate - Reducing intoxication among bar patrons: some lessons from prevention of drinking and driving
Intoxication in and around licensed premises continues to be common, despite widespread training in the responsible service of alcohol and laws prohibiting service to intoxicated individuals.
However, research suggests that training and the existence of laws are unlikely to have an impact on intoxication without enforcement, and evidence from a number of countries indicates that laws prohibiting service to intoxicated individuals are rarely enforced. Enforcement is currently hampered by the lack of a standardized validated measure for defining intoxication clearly, a systematic approach to enforcement and the political will to address intoxication.
We argue that adoption of key principles from successful interventions to prevent driving while intoxicated could be used to develop a model of consistent and sustainable enforcement. These principles include: applying validated and widely accepted criteria for defining when a person is ‘intoxicated’; adopting a structure of enforceable consequences for violations; implementing procedures of unbiased enforcement; using publicity to ensure that there is a perceived high risk of being caught and punished; and developing the political will to support ongoing enforcement.
Research can play a critical role in this process by: developing and validating criteria for defining intoxication based on observable behaviour; documenting the harms arising from intoxication, including risk curves associated with different levels of intoxication; estimating the policing, medical and social costs from intoxicated bar patrons; and conducting studies of the cost-effectiveness of different interventions to reduce intoxication.
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Request Reprint E-Mail: kgraham@uwo.ca
Comparative performance of biomarkers of alcohol consumption in a population sample of working-aged men in Russia: the Izhevsk Family Study
To assess the performance of a range of biomarkers of alcohol consumption in a heavy-drinking population of working-aged Russian men.
Cross-sectional study of men originally sampled at random from a population register.
Izhevsk, a Russian city with a population of 650 000 people.
A total of 1023 men aged 27–59 years living in Izhevsk who took part in a health check examination in 2008–2009.
Self-reported alcohol consumption, hazardous drinking behaviours, socio-economic position, anthropometric measurements plus blood levels of alcohol biomarkers [carbohydrate-deficient transferrin (CDT, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and mean cell volume of erythrocytes (MCV)] and hepatitis B and C status.
In the year before interview there was a high prevalence of high-risk alcohol consumption indicated by consumption of non-beverage alcohols (5%), problem drinking behaviours (4.4%) and alcohol consumption exceeding an average 40 g per day (12.6%). All biomarkers were associated strongly with total beverage alcohol consumption even after adjustment for confounders. CDT performed best as an alcohol biomarker, with a sensitivity of 67% and specificity of 71% for detecting an average consumption of more than 40 g per day versus less. For all biomarkers sensitivity was considerably lower than specificity. Hazardous drinking patterns per se were not well detected by any of the biomarkers, all with sensitivity below 60%.
In a Russian population with high levels of alcohol consumption, carbohydrate-deficient transferrin (CDT) might be the most sensitive and specific biomarker for detecting ethanol consumption above 40 g/day. A biomarker reflecting hazardous drinking patterns has yet to be established.
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Drinking motives moderate the impact of pre-drinking on heavy drinking on a given evening and related adverse consequences—an event-level study
To test whether (i) drinking motives predict the frequency of pre-drinking (i.e. alcohol consumption before going out); (ii) drinking motives predict HDGE (heavy drinking on a given evening: 4+ for women, 5+ for men) and related adverse consequences (hangover, injuries, blackouts, etc.), even when pre-drinking is accounted for, and (iii) drinking motives moderate the impact of pre-drinking on HDGE and consequences.
Using the internet-based cellphone-optimized assessment technique (ICAT), participants completed a series of cellphone questionnaires every Thursday, Friday and Saturday evening over 5 weeks.
French-speaking Switzerland.
A total of 183 young adults [53% female, mean age (standard deviation) = 23.1 (3.1)] who completed 7828 questionnaires on 1441 evenings.
Drinking motives assessed at baseline, alcohol consumption assessed at 8 p.m., 9 p.m., 10 p.m., 11 p.m. and midnight and consequences assessed at 11 a.m. the next day.
Gender-separate multi-level models revealed that pre-drinking predicted HDGE (men: B = 2.17, P < 0.001; women: B = 2.12, P < 0.001) and alcohol-related consequences (men: B = 0.24, P < 0.01; women: B = 0.29, P < 0.001). Enhancement motives were found to predict HDGE (B = 0.48, P < 0.05) and related consequences (B = 0.09, P < 0.05) among men, while among women coping motives had the same effect (HDGE: B = 0.73, P < 0.001; consequences: B = 0.13, P < 0.01). With the exception of conformity motives among women (B = 0.54, P < 0.05), however, no drinking motive dimension predicted the frequency of pre-drinking, while coping and conformity motives moderated the impact of pre-drinking on HDGE (men, conformity: B = −1.57, P < 0.05) and its consequences (men, coping: B = −0.46, P < 0.01; women, coping: B = 0.76, P < 0.05).
Among young adults in Switzerland, heavy weekend drinking and the related consequences seem to result from the combination of pre-drinking, level of negative reinforcement drinking for women and positive reinforcement drinking for men.
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Request Reprint E-Mail: ekuntsche@suchtschweiz.ch
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Request Reprint E-Mail: ekuntsche@suchtschweiz.ch
Alcohol-related biases in selective attention and action tendency make distinct contributions to dysregulated drinking behaviour
To assess whether alcohol-related biases in selective-attention and action tendency uniquely or concurrently predict the ability to regulate alcohol consumption.
Two groups of undergraduate social drinkers (total n = 55) who differed in their ability to regulate their alcohol consumption completed a novel Selective-Attention/Action-Tendency Task (SA/ATT), which assessed separately alcohol-related biases in selective attention and action tendency.
University of Western Australia, Australia.
Dysregulated drinking was operationalized as a self-reported high level of alcohol consumption on the Alcohol Consumption Questionnaire, and a high desire to reduce consumption on the Brief Readiness to Change Algorithm. Selective attention and action tendency were assessed using the SA/ATT, working memory was assessed using the operation-span task and participant characteristics were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES).
Results indicated that (i) there was no significant association between alcohol-related biases in selective attention and action tendency, r = 0.16, P = 0.274, and (ii) biases towards alcohol, in both selective attention, β = 1.01, odds ratio = 2.74, P = 0.022, and action tendency, β = 1.24, odds ratio = 3.45, P = 0.015, predicted independent variance in dysregulated-drinker status.
Biases in selective attention and action tendency appear to be distinct mechanisms that contribute independently to difficulty regulating alcohol consumption. Treatment components that could be combined to target both mechanisms could enhance treatment outcomes for alcohol-use disorders.
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Request Reprint E-Mail: jason.sharbanee@grs.uwa.edu.au
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Request Reprint E-Mail: jason.sharbanee@grs.uwa.edu.au
Alcohol consumption and self-reported (SF12) physical and mental health among working-aged men in a typical Russian city: a cross-sectional study
To investigate the association between patterns of alcohol consumption and self-reported physical and mental health in a population with a high prevalence of hazardous drinking.
Cross-sectional study of an age-stratified random sample of a population register.
The city of Izhevsk, The Russian Federation, 2008–09.
A total of 1031 men aged 25–60 years (68% response rate).
Self-reported health was evaluated with the SF12 physical (PCS) and mental (MCS) component summaries. Measures of hazardous drinking (based on frequency of adverse effects of alcohol intake including hangover, excessive drunkenness and extended episodes of intoxication lasting 2 or more days) were used in addition to frequency of alcohol consumption and total volume of beverage ethanol per year. Information on smoking and socio-demographic factors were obtained.
Compared with abstainers, those drinking 10–19 litres of beverage ethanol per year had a PCS score 2.66 [95% confidence interval (CI) = 0.76; 4.56] higher. Hazardous beverage drinking was associated with a lower PCS score [mean diff: −2.95 (95% CI = −5.28; −0.62)] and even more strongly with a lower MCS score [mean diff: −4.29 (95% CI = −6.87; −1.70)] compared to non-hazardous drinkers, with frequent non-beverage alcohol drinking being associated with a particularly low MCS score [−7.23 (95% CI = −11.16; −3.29)]. Adjustment for smoking and socio-demographic factors attenuated these associations slightly, but the same patterns persisted. Adjustment for employment status attenuated the associations with PCS considerably.
Among working-aged male adults in Russia, hazardous patterns of alcohol drinking are associated with poorer self-reported physical health, and even more strongly with poorer self-reported mental health. Physical health appears to be lower in those reporting complete abstinence from alcohol compared with those drinking 10–19 litres per year.
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