Drinking patterns and problems among primary care patients: a comparison with the general population.

While problem drinking is believed to be over-represented in primary care practice, additional research in this area is needed. A probability sample of 394 patients attending all county-operated primary care clinics in Contra Costa County, California, were breathalyzed and interviewed regarding drinking patterns and alcohol problems. These data are compared with those obtained from a representative general population sample of over 3000 respondents living in the same county. While the clinic population reported higher rates of abstinence compared with the general population (38 versus 17%), among drinkers the clinic sample reported higher rates of heavy drinking. In the clinic sample 14% reported a physical health problem related to drinking and 22% reported three or more symptoms of alcohol dependence during the last year, compared with 3 and 10%, respectively, in the general population. The clinic sample was demographically different from those in the general population which could account, in part, for differences in heavy drinking and alcohol-related problems between the two populations. The prevalence of heavy and problem drinking in this primary care practice suggests the potential of primary care settings for early identification and treatment of alcohol-misusing patients.     

What Do Binge Drinkers Drink?: Implications for Alcohol Control Policy

BACKGROUND: Although binge drinking (drinking five or more drinks on an occasion) is an important public health problem, little is known about which beverage types are consumed by binge drinkers. This knowledge could guide prevention efforts because beer, wine, and liquor are taxed, marketed, and distributed differently. METHODS: Data from 14,150 adult binge drinkers who responded to the Behavioral Risk Factor Surveillance System binge-drinking module in 2003 and 2004 were analyzed. Information pertained to the amount of alcohol consumed during a binge drinker's most recent binge episode, including beverage-specific consumption. RESULTS: Overall, 74.4% of binge drinkers consumed beer exclusively or predominantly, and those who consumed at least some beer accounted for 80.5% of all binge alcohol consumption. By beverage type, beer accounted for 67.1%, liquor for 21.9%, and wine accounted for 10.9% of binge drinks consumed. Beer also accounted for most of the alcohol consumed by those at highest risk of causing or incurring alcohol-related harm, including people aged 18-20 years (67.0% of drinks were beer); those with three or more binge episodes per month (70.7%); those drinking eight or more drinks per binge episode (69.9%); those binging in public places (64.4%); and those who drove during or within 2 hours of binge drinking (67.1%). CONCLUSIONS: Beer accounted for two thirds of all alcohol consumed by binge drinkers and accounted for most alcohol consumed by those at greatest risk of causing or incurring alcohol-related harm. Lower excise taxes and relatively permissive sales and marketing practices for beer as compared with other beverage types may account for some of these findings. These findings suggest that equalizing alcohol control policies at more stringent levels would be an effective way to prevent excessive drinking.     

Women''s drinking and drinking problems: patterns from a 1981 national survey

A 1981 national survey of women's drinking interviewed 917 women in the general population, stratified on the basis of screening interviews to include 500 moderate-to-heavy drinkers. The survey found no evidence of any major recent increase in women's drinking, and no evidence of unusually heavy drinking among working wives. Adverse drinking consequences and episodes of extreme drinking were most common among women aged 21-34; women who were unmarried, divorced or separated, or cohabiting; and women with frequent drinkers as spouses or companions. Alcohol-related behavior problems and symptoms of alcohol dependence were closely related to levels of alcohol consumption. Among women averaging one ounce or more of ethanol per day, 45 per cent had driven while intoxicated in the past year, and 36 per cent reported memory lapses while drinking. Women at this consumption level were also more likely to report experiences with depression (61 per cent). Women with extremely high consumption levels were more likely to have histories of obstetrical and gynecological problems. Some women with alcohol-related problems reported periods of temporary abstention, a pattern not studied heretofore.     

Contrasting binge and continuous alcoholic drinkers using demographic and drinking history variables

While it is quite common for researchers and clinicians to categorize alcoholics as binge or continuous drinkers, relatively little is known about the characteristics of these two potentially distinct clinical populations. In the present study, binge and continuous alcoholics were evaluated on a number of demographic and drinking history variables. Binge drinkers were found to be significantly more likely than continuous drinkers to have been treated for liver problems and more likely to have reported parental alcoholism. They also tended to describe a greater number of alcohol-related arrests and hospitalizations. Six of the variables taken together yielded a discriminative function that was only moderately successful in classifying these drinkers. The potential clinical importance of objectively identifying binge versus continuous drinkers is discussed.     

Alcohol: a review of the impact of worksite interventions on health and behavioral outcomes

PURPOSE: To review, evaluate, and summarize research published in scientific journals linking alcohol-related interventions in the worksite to either individual or organizational outcomes. METHODS: A review of the literature published in peer-review journals between 1970 and 1995 identified 24 articles that reported the results of studies on the impact of worksite programs on alcohol control on health and behavioral outcomes. IMPORTANT FINDINGS: There is strong suggestive evidence and some conclusive evidence that worksite interventions including core components of employee assistance programs are effective in rehabilitating employees with alcohol problems. There is suggestive and conclusive evidence that worksite training oriented toward alcohol problems affects the attitudes of supervisors and employees for reasonable periods after the completion of training. CONCLUSIONS: Investment in worksite interventions directed at reducing alcohol-related problems appears to be a sound strategy, although considerably more research is needed. This research should include broad representation of appropriate worksite populations. Similar measurements should be used across studies. To the extent possible, randomized control group designs should be employed. Without significant external sponsorship, it is not likely that such an improved body of research data will emerge.     

Alcohol-Related Risk Behaviors and Sports Participation Among Adolescents: An Analysis of 2005 Youth Risk Behavior Survey Data

Using 2005 Youth Risk Behavior Survey data, we examined alcohol-related behaviors among adolescent sports participants. Male sports participants were more likely to report heavy drinking and driving after drinking in the past month. Females were less likely to report ever drinking, early drinking, and drinking in the past month.     

Drinking pattern and alcohol-related medical disorders.

Although heavy alcohol intake is known to be one of the most common causative factors of liver disease, pancreatitis, upper gastrointestinal and neurological disorders, the influence of the drinking pattern is largely unknown. The study investigated the relationship of alcohol-related medical disorders in alcoholics and their drinking pattern. Two hundred and forty-one chronic alcoholics were referred consecutively for detoxification and their drinking pattern was sufficient for them to be included in this study. History of alcohol abuse as well as drinking behaviour in the last 6 months were assessed by a semi-structured interview. Findings included intensive clinical examination with abdominal ultrasound in most subjects. Heavy drinking with frequent inebriation was most often found in our sample (44.4%), whereas continuous heavy alcohol consumption without intoxication (33.6%), and an episodic drinking style (22.0%) were less frequent. The heavy drinkers suffered more often from pancreatitis, oesophageal varices, polyneuropathy or erectile dysfunction than episodic drinkers. They also showed more upper gastrointestinal disorders, although the estimated life-time alcohol intake was comparable to continuous drinkers. No difference relating to withdrawal delirium or seizures could be found between the groups of alcoholics. Frequent heavy drinkers showed a trend to more alcohol-related medical disorders than alcoholics with a different drinking pattern, although they were younger and their estimated life-time alcohol intake was comparable to that of continuous drinkers. Thus, the drinking pattern, particularly frequent inebriation, has an influence on the occurrence of alcohol-related disorders.     

Alcohol consumption patterns and related problems: Results of a county survey

This study describes alcohol use in the general population of San Diego County. A random digit dial telephone survey was utilized to query 1656 adults about their drinking behavior. A quantity and frequency measure of alcohol consumption was used to classify drinking patterns. Alcohol problems were classified by acute problems and chronic problems. Males 18–25 years old reported the highest percentages of heavier drinking. Among females, this age group was also the most likely group to report heavier drinking. Overall, males and heavier drinkers were the most likely groups to report problems. However, lighter and moderate drinkers accounted for equal or greater percentages of each problem. Drinkers in the 18–25 year old age group were the group most likely to report the majority of all problems in both problem categories. Additionally, this group accounted for the majority of the reported acute problems.John D. Clapp, M.S.W., is Coordinator, Head Start Substance Abuse Prevention and Capacity Building Project, and Lance Segars, Ph.D., is Lecturer, both at San Diego State University, School of Social Work, San Diego, California, USA.     

At-risk drinking among patients making routine primary care visits

BACKGROUND: Addressing non-alcoholic, at-risk patterns of alcohol consumption that are associated with increased morbidity and mortality is an important health care priority. OBJECTIVE: The objective was to describe the prevalence and characteristics of at-risk drinkers in a population-based sample of adults with routine primary care visits. Methods: Three thousand four hundred thirty-nine patients with advance appointments in 23 primary care practices completed a health survey prior to their visit. At-risk drinking was defined as consuming an average of two or more drinks per day (chronic drinking), or two or more occasions of consuming five or more drinks in the past month (binge drinking), or, in the past month, one or more occasion of driving after consuming three or more drinks (drinking and driving). RESULTS: Prevalence was: 11% at-risk drinking; 63% light to moderate drinking; 26% abstinence. Abstainers differed from alcohol users on demographics (older, fewer Caucasian, lower income, more unemployed), other health behaviors (less exercise, lower rates of smoking, and marijuana and cocaine use), and family history of alcohol problems (lower). Abstainers also reported poorer physical and psychological health. Compared to light to moderate drinkers, at-risk drinkers were more likely to be male, unmarried, and to use other substances (tobacco, marijuana, and cocaine). Among at-risk drinkers, those with two or more risk factors were more likely male, consumed more alcohol per week, had higher AUDIT scores and were more motivated to change their drinking. Among those with only one risk factor, binge drinkers reported high rates of tobacco and marijuana use, relatively poor perceived health, and the highest proportion of negative consequences from drinking. CONCLUSIONS: At least 1 in 10 patients making routine primary care visits have drinking practices that place them at risk for negative consequences from drinking. Three drinking patterns that can be used to define at-risk drinking are relatively distinct.     

Average volume of alcohol consumption, patterns of drinking, and all-cause mortality: results from the US National Alcohol Survey

The objective of this study was to investigate the effects of an average volume of alcohol consumption and drinking patterns on all-cause mortality. The sample (n = 5,072) was drawn from the 1984 National Alcohol Survey, representative of the US population living in households. Follow-up time was until the end of 1995, with 532 people deceased during this period. The authors found a significant influence of drinking alcohol on mortality with a J-shaped association for males and an insignificant relation of the same shape for females. When the largest categories of equivalent average volume of consumption were divided into people with and without heavy drinking occasions, serving as an indicator of drinking pattern, this differentiation proved important in predicting mortality. Light to moderate drinkers had higher mortality risks when they reported heavy drinking occasions (defined by either eight drinks per occasion or getting drunk at least monthly). Similarly, when the category of exdrinkers was divided into people who did or did not report heavy drinking occasions in the past, people with heavy drinking occasions had a higher mortality risk. Finally, indicating alcohol problems in the past was related to higher mortality risk. Results emphasized the importance of routinely including measures of drinking patterns into future epidemiologic studies on alcohol-related mortality.     

Drinking patterns and traffic casualties in Switzerland: matching survey data and police records to design preventive action

OBJECTIVE: To examine the association between drinking patterns and alcohol-related traffic casualties. STUDY DESIGN: Data linkage of cross-sectional survey data on alcohol consumption with official traffic casualty records. METHODS: Alcohol consumption measures for usual heavy drinking and risky single occasion drinking were derived for different time segments of the day from a 7-day drinking diary study of 747 current drinkers. Measures were correlated with official records of alcohol-related traffic casualties. RESULTS: There was a high correlation between alcohol-related traffic casualties and the number of risky single occasion drinkers that consumed alcohol outside their homes (r=0.92). On average, about 50% of these drinking occasions were attributed to usual moderate drinkers. The proportion of usual heavy drinkers was lowest in the time segments with the most alcohol-related casualties. CONCLUSION: Preventive countermeasures should be targeted at the general population, enforced particularly during specific periods of the week.     

TEENAGE HEAVY DRINKERS: ALCOHOL-RELATED KNOWLEDGE, BELIEFS, EXPERIENCES, MOTIVATION AND THE SOCIAL CONTEXT OF DRINKING

During 1988 and 1989 a survey was conducted of the drinkinghabits and alcohol-related beliefs of a national sample of teenagersin England. Data were obtained from 6,244 respondents virtuallyall aged 14–16. Heavy drinkers were significantly morelikely to report drinking in a mixed sex group than were otherteenagers. They were also more likely than others to have drunkillegally in licensed premises, and were distinctive from otherteenagers in relation to their self-reported reasons for drinkingand their alcohol-related beliefs.     

Alcohol abuse among U.S. Navy recruits who were maltreated in childhood

AIMS: To examine relationships between childhood maltreatment and alcohol-related problems among U.S. Navy recruits. METHODS: An anonymous sample of 5697 Navy recruits completed a survey regarding their alcohol consumption, alcohol problems (binge drinking, drinking until drunk, alcohol dependence, alcohol-related arrests), and experiences of childhood physical and sexual abuse. RESULTS: Most of the recruits used alcohol, and a substantial proportion reported histories of childhood maltreatment. Recruits who had been victimized as children were more likely to use alcohol. Furthermore, among drinkers, those who had been abused were more likely to exhibit alcohol problems than were non-abused drinkers. CONCLUSION: Substantial numbers of personnel with alcohol-related problems may be using alcohol to self-medicate due to a history of childhood abuse. Attention to the association between alcohol abuse and childhood maltreatment might help improve the efficacy of military alcohol reduction programs.     

Epidemiology of self‐reported past heavy drinking in Hispanic adults

Objectives. Self‐reports of past heavy drinking correlate with the current drinking practices and with risk of mortality in non‐Hispanic males. The prevalence of past heavy drinking has not been reported in Hispanic populations.

Methods. Using data from the Hispanic Health and Nutrition Examination Survey (HHANES) we (1) report on the prevalence, duration and severity of past heavy drinking in three Hispanic groups, (2) compare the current alcohol consumption patterns among past heavy drinkers and those who do not report a history of past heavy drinking and (3) compare the risk factor profiles and health indicators in these two groups.

Results. The prevalence of past heavy drinking among Mexican American and Puerto Rican males ranged from 28–35% while the rates for Cuban American males ranged from 7–16%. The rates for Hispanic women were much lower (1–8%). The average years of past heavy drinking ranged from 2.3–14.9 years, while the alcohol consumption during the past heavy drinking period ranged from 24.4–44.0 drinks per week. Past heavy drinkers tended to consume more alcohol at present than did never heavy drinkers with the greatest differences found for Mexican American females. Comparisons of the risk factors and health indicators by drinking status revealed a higher prevalence of smoking among past heavy drinkers (50–60%) versus never heavy drinkers (34–43%). Past heavy drinking Mexican American females also reported significantly more chronic conditions and depressive symptoms than did never heavy drinkers.

Conclusions. Prevalence rates of past heavy drinking among Mexican American and Puerto Rican males are approximately three times higher than rates reported for non‐Hispanic male populations.     

Black-white differences in alcohol use by women: Baltimore survey findings

Although black women suffer disproportionately from alcohol-related illnesses and causes of death, little is known about the extent to which poorer outcomes are a function of differences in drinking, the use of health services, or some combination of these factors. This study, using interview data obtained in the Baltimore Epidemiologic Catchment Area household survey, compares racial differences in alcohol use and abuse among a sample of 2,100 women. After controlling for differences in sociodemographic characteristics, black women were found to be at no greater risk than whites for heavy drinking or for suffering from alcohol abuse or dependence. Racial differences, however, were observed in heavy drinking by years of education. A similar percentage of black women and white women who had not completed high school were heavy drinkers, but black women with 12 or more years of education were less likely to be heavy drinkers than whites with comparable education. These findings raise questions about the extent to which differences in drinking contribute to the poorer alcohol-related health outcomes of black women in Baltimore. Additionally, the finding that education was inversely related to heavy drinking among black women may be helpful in shaping early alcohol abuse intervention and treatment services that target black women.     

Alcohol consumption and increased mortality in Russian men and women: a cohort study based on the mortality of relatives

OBJECTIVE: To examine the relations between frequency of alcohol consumption and of binge drinking and adult mortality in Russian men and women. METHODS: Using modified indirect demographic techniques, a convenience cohort was constructed based on survey respondents' information about their close relatives. A random sample general population of the Russian Federation of 7172 respondents (response rate 61%) provided information on 10 475 male and 3129 female relatives, including age, vital status, and frequency of alcohol consumption and binge drinking. These relatives formed the cohort analysed in this report. The outcome measure was all-cause mortality after the age of 30 years. FINDINGS: There was a strong linear relation between frequency of drinking and of binge drinking and all-cause mortality in men; after controlling for smoking and calendar period of birth, the relative risk of death in daily drinkers compared to occasional drinkers was 1.52 (95% confidence interval (CI) 1.33-1.75). Male binge drinkers had higher mortality than drinkers who did not binge, which persisted after adjustment for drinking frequency (adjusted relative risk 1.09, 95% CI 1.00-1.19). In women, the increased mortality was confined to a small group of those who binged at least once a month (adjusted relative risk 2.68, 95% CI 1.54-4.66). CONCLUSION: The results suggest a positive association between alcohol and mortality in the Russian Federation. There was no evidence for the protective effect of drinking seen in western populations. Alcohol appears to have contributed to the high long-term mortality rates in Russian men, but it is unlikely to be a major cause of female mortality.     

Racial and ethnic differences in all-cause mortality risk according to alcohol consumption patterns in the national alcohol surveys

Previous studies have found J-shaped relations between volume of alcohol consumed and mortality risk in white Americans but not in African Americans, suggesting the need for studies in which race/ethnicity-defined subgroups are analyzed in separate comparable models. In the present study, the authors utilized mortality follow-up data (through 2006) on respondents from the 1984 and 1995 National Alcohol Surveys, including similar numbers of black, white, and Hispanic respondents by oversampling the minority groups. Cox proportional hazards models controlling for demographic, socioeconomic, mental health, and drug- and tobacco-use measures were used to estimate mortality risk from all causes. Findings indicated a protective effect of moderate alcohol drinking (2-30 drinks/month for women and 2-60 drinks/month for men) with no monthly ≥5-drink days) relative to lifetime abstention for whites only. Elevated mortality risk relative to moderate drinking was found in former drinkers with lifetime alcohol problems. Moderate drinkers who consumed ≥5 drinks in 1 day at least monthly were also found to have increased risk, suggesting the importance of identifying heavy-occasion drinking for mortality analyses. These differential results regarding lifetime abstainers may suggest bias from differential unmeasured confounding or unmeasured aspects of alcohol consumption pattern or may be due to genetic differences in the health impact of alcohol metabolism.     

Alcohol use beliefs and behaviors among high school students

Purpose: To identify specific alcohol use beliefs and behaviors among local high school students; to determine whether relationships exist between alcohol use and various sociodemographic and lifestyle behaviors; and to assist in the development and implementation of alcohol abuse prevention programs.Methods: This cross-sectional study involved the completion of a questionnaire by 1236 Grade 9–13 students (86% response rate) from 62 randomly selected classrooms in three Canadian urban schools. Data analyzed here are part of a larger lifestyle survey.Results: A total of 24% of students reported never having tasted alcohol, 22% have tasted alcohol but do not currently drink, 39% are current moderate drinkers, 11% are current heavy drinkers (five or more drinks on one occasion at least once a month), and 5% did not answer. Reasons stated most often for not drinking were “bad for health” and “upbringing,” while reasons stated most often for drinking were “enjoy it” and “to get in a party mood.” Student drinking patterns were significantly related to gender, ethnicity, grade, and the reported drinking habits of parents and friends. Older male adolescents who describe their ethnicity as Canadian are at higher risk for heavy drinking than students who are younger or female, or identify their ethnicity as European or Asian. Current heavy drinkers are at higher risk than other students for engaging in other high-risk behaviors such as drinking and driving, being a passenger in a car when the driver is intoxicated, and daily smoking.Conclusions: Heavy alcohol use in adolescents remains an important community health concern. Older self-described Canadian and Canadian-born male adolescents are at higher risk for heavy drinking. Current and heavy drinking rises significantly between Grades 9 and 12. Students who drink heavily are more likely to drink and drive, to smoke daily, and to have friends and parents who drink alcohol.     

Impact of an alcohol misuse intervention for health care workers--1: Frequency of binge drinking and desire to reduce alcohol use

AIMS: This report presents results of a 3-year study to evaluate the effects of an enhanced substance misuse prevention/early intervention programme on binge drinking and desire to reduce alcohol use among health care professionals employed in a managed care organization. METHODS: The intervention was implemented at one site, but not at satellite locations, which were used for comparison. The intervention included relatively low-cost elements, such as substance misuse awareness training for managers and the use of health risk appraisals (HRAs) and educational videos on how to reduce stress, depression and binge drinking. We evaluated intervention effects by comparing HRA scores of employees at the intervention site to all other employees who completed the HRA, while adjusting for demographic factors, reported stress levels, employment site and the effects of time. Outcomes analysed included number of days binge drinking (drinking 5 or more drinks per occasion in the past 30 days) and desire to reduce alcohol use. RESULTS: Binge drinking rates were not affected by the intervention. Among those who binge-drank, however, employees who completed the HRA at the intervention site in the post-intervention period were 2.59 times more likely to report a desire to cut down on alcohol use, compared with the pre-intervention time period and with both time periods in the comparison site (P < 0.05). CONCLUSIONS: We conclude that while the intervention did not significantly affect reported alcohol use, it did increase motivation to reduce alcohol use among binge drinkers.