We do what we think is the best--a content analysis of experiences of alcohol problem prevention in Sweden. A short report

This short report describes an ongoing project whose aim was to explore how respondents from local institutions in a Swedish municipality describe their efforts in preventing alcohol consumption and related problems. Data were collected in focus group interviews, conducted during 2003 with key informants, comprising middle-ranking civil servants from different administrative sectors such as school, social welfare, and the public health office, in four Swedish municipalities: one city district, one town, and two small municipalities. We identified low knowledge of evidence-based methods for prevention of alcohol consumption-related problems and a lack of consistent focus on strategies known to be effective. The main target group for preventive efforts was identified as young people and the most common setting mentioned was the schools. Further, the key informants appeared to regard a wide range of activities as being community* alcohol and drug use prevention. Generally these activities also lacked specification. Increased knowledge of alcohol and drug use prevention methods that are effective at the local level is needed within Swedish municipalities, as is greater understanding of how to implement those methods.     

“We Do What We Think Is the Best”—A Content Analysis of Experiences of Alcohol Problem Prevention in Sweden. A Short Report

This short report describes an ongoing project whose aim was to explore how respondents from local institutions in a Swedish municipality describe their efforts in preventing alcohol consumption and related problems. Data were collected in focus group interviews, conducted during 2003 with key informants, comprising middle-ranking civil servants from different administrative sectors such as school, social welfare, and the public health office, in four Swedish municipalities: one city district, one town, and two small municipalities. We identified low knowledge of evidence-based methods for prevention of alcohol consumption–related problems and a lack of consistent focus on strategies known to be effective. The main target group for preventive efforts was identified as young people and the most common setting mentioned was the schools. Further, the key informants appeared to regard a wide range of activities as being community alcohol and drug use prevention. Generally these activities also lacked specification. Increased knowledge of alcohol and drug use prevention methods that are effective at the local level is needed within Swedish municipalities, as is greater understanding of how to implement those methods.     

Predictors of Reported Current and Lifetime Substance Abuse Problems Among a National Sample of U.S. Homeless

Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), this study examined predictors of alcohol and drug problems among a national probability sample of homeless and previously homeless adults in the United States. Consistent with research, about one third and one quarter of the respondents reported a current alcohol and drug problem, respectively. A larger proportion reported lifetime substance abuse problems. As hypothesized, males, younger respondents, veterans, and those with mental and physical health problems were at greater risk. Results reveal that substance abuse treatment and prevention programs for the homeless should take into consideration these characteristics to maximize effectiveness.     

Predictors of reported current and lifetime substance abuse problems among a national sample of U.S. homeless

Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), this study examined predictors of alcohol and drug problems among a national probability sample of homeless and previously homeless adults in the United States. Consistent with research, about one third and one quarter of the respondents reported a current alcohol and drug problem, respectively. A larger proportion reported lifetime substance abuse problems. As hypothesized, males, younger respondents, veterans, and those with mental and physical health problems were at greater risk. Results reveal that substance abuse treatment and prevention programs for the homeless should take into consideration these characteristics to maximize effectiveness.     

Childhood Maltreatment,Emotional Lability,and Alcohol Problems in Young Adults At-Risk for ADHD: Testing Moderation and Moderated Moderation

Childhood maltreatment and alcohol problems are common among young adults with attention-deficit hyperactivity disorder (ADHD). However, little is known about the degree to which maltreatment and alcohol problems are associated; potential pertinent mediating or moderating mechanisms, such as emotional lability; and whether this association varies by sex. We examined, in a sample of adults at risk for ADHD (N = 122, 37% male), the association between childhood maltreatment and alcohol problems, whether emotional lability mediated or moderated this association, and whether either role of emotional lability differed between men and women. Emotional lability moderated the association between emotional neglect and alcohol problems; maltreatment increased risk for alcohol problems for those scoring high tovery high on emotional lability, but not for those with very low-moderate levels. The association between emotional abuse and alcohol problems depended both on emotional lability and sex; emotional abuse decreased the risk for alcohol problems among men very low/low on emotional lability, but not for men who were moderate to very high on emotional lability, or for women. These findings have implications for the way in which targeting maltreatment and emotional lability may be incorporated into prevention and intervention programs to prevent alcohol problems among men and women at risk for ADHD.     

Drinking patterns and alcohol problems among Hispanics in the U.S.: a review

The literature on drinking patterns and alcohol problems among Hispanic Americans is critically reviewed. The picture provided by studies which have been examined indirect indicators of alcohol problems is contradictory. Some results suggest that Hispanics in the U.S.A. are over-represented among alcohol-related deaths and among those arrested for drunk driving and in treatment in alcoholism programs. Other studies do not provide evidence of over-representation. Studies in the general population indicate that there is more heavy drinking and alcohol-related problems among Hispanics than among other ethnic groups in the U.S.A. general population. However, very few of these studies were specifically designed to evaluate alcohol use and problems among this ethnic group, and these results are based on the analysis of a small number of Hispanic respondents. In the conclusions this and other methodological limitations are discussed and new areas for study are proposed.     

Unravelling the preventive paradox for acute alcohol problems

Kreitman's discussion of the preventive paradox in relation to the prevention of alcohol problems has had profound implications for alcohol policy and has generated considerable controversy [1]. It is argued here that although Kreitman should be credited with the important observation that alcohol-related harm is not confined to a few dependent drinkers, none the less an apparent paradox is not an ideal platform from which to recommend policy. Furthermore, Kreitman's own data and data from an Australian survey of drinking are used to demonstrate that a commonplace truth underlies his apparently paradoxical findings. It is shown that the preventive paradox disappears when consideration is given to the amount of alcohol consumed on either (i) the day of highest alcohol intake out of the last four, or (ii) the day on which acute alcohol-related harm occurred. Episodic heavy consumption by people whose average alcohol intake can be classified as 'low' or 'medium' risk contributes to the bulk of such experiences of harm. It is suggested that the importance of intoxication as a public health and safety issue has been neglected. This neglect is compounded when public education campaigns and prevention policy are only based on average rates of alcohol consumption. Advice regarding the low risk levels of consumption for different types of harm should form one component of a comprehensive harm reduction policy. Other elements of such a policy should include a variety of other measures of proven effectiveness in relation to reducing levels of intoxication and related problems.     

Mixed messages: Contributions to adolescent drinking and driving

This qualitative study focused on the discrepancies in messages concerning alcohol use presented by adults to young people. The purpose was to investigate how these discrepancies might impact adolescents’ drinking, and drinking and driving behavior. The data consisted of semi-structured interviews with 44 adolescents who in a previous survey had admitted having been involved in drinking and driving, riding with a drunk driver, or both. The analysis of the interviews focused on the discrepancies between messages presented by adult authorities and the respondents’ experience of actual behavior from these authorities. The findings indicate that there are serious problems in the communication between adult authorities and adolescents. Parents, schools, and police are not consistent and persistent in their communication with adolescents concerning alcohol and drinking and driving. This inconsistency seems to prevent teenagers from understanding the extent of the problem of drinking and driving. Implications for research and prevention are discussed.     

Alcohol Expectancies Mediate the Relationship Between Age of First Intoxication and Drinking Outcomes in College Binge Drinkers

Background: While prior research has shown that age of first intoxication (AI) is associated with negative alcohol outcomes, limited research has examined factors accounting for this relationship. Alcohol expectancies, or beliefs about the effects of alcohol, may explain such associations as both positive and negative expectancies have been shown to be key predictors of drinking outcomes. Objective: The present study examined expectancies as mediators between early AI and alcohol-related outcomes. Method: Data collection occurred in 2012 and 2013. Participants were college students (N = 562, 65.8% women) who completed an online survey including measures of alcohol use history, alcohol expectancies, typical alcohol consumption, and alcohol-related problems. Structural equation modeling was used to test the hypothesized model. Results: Our findings support a model whereby AI is associated with drinking through its influence on both positive and negative expectancies. Specifically, an earlier AI was associated with stronger alcohol expectancies, which in turn, was associated with heavier alcohol use and alcohol-related problems. Conclusions/Importance: These findings are consistent with expectancy theory and previous research suggesting that more experienced drinkers hold stronger drinking-related beliefs, be it positive or negative, and these expectancies ultimately explain variability in alcohol use and problems. Our findings further support that expectancies play an important role in the initiation of drinking behavior.     

Culture and environment as predictors of alcohol abuse/dependence symptoms in American Indian youths

This study utilizes Bronfenbrenner's ecological model (1979) to examine multiple and interactive environmental (familial, social, and cultural) predictors of adolescent alcohol abuse/dependence symptoms. A stratified random sample of 401 American Indian youths was interviewed in 2001. The findings showed that family members' substance problems, peer misbehaviors, and participation in generic cultural activities positively predicted adolescent alcohol symptoms. Conversely, cultural pride/spirituality predicted fewer alcohol symptoms, and, importantly, religious affiliation moderated the effects of problematic peers and family members on adolescent alcohol symptoms. The findings suggest further study of intervention and prevention efforts regarding the benefits from consideration of the complex relationships among multiple environmental variables.     

Curiosity killed the cocktail? Curiosity,sensation seeking,and alcohol-related problems in college women

Curiosity, composed of two factors: exploration and absorption, has been previously associated with life satisfaction, life meaningfulness, and enhanced positive affect. It also shares some overlap with sensation seeking, which has been linked to alcohol use and other addictive behaviors. The present research explored the association between curiosity and college women's problematic drinking in the context of sensation seeking. Participants (79 women) completed questionnaires measuring curiosity, sensation seeking, alcohol consumption, and consequences related to alcohol consumption. A zero-inflated negative binomial model indicated that curiosity and sensation seeking accounted for unique variance in alcohol-related problems after controlling for drinking. The curiosity factors had opposing relationships to alcohol-related problems: higher scores on absorption were associated with more alcohol-related problems whereas higher scores on exploration were associated with fewer alcohol-related problems. Should findings be replicated, the curiosity factors may represent additional prevention and intervention targets. Future directions for research about curiosity and drinking and for the inclusion of positive psychology constructs in addictive behaviors research are discussed.     

Alcohol and drug use among deaf and hard-of-hearing individuals: A secondary analysis of NHANES 2013–2014

Background: Within the field of behavioral health research, one of the most understudied populations is the US deaf and hard-of-hearing (D/HH) population—a diverse group of individuals with hearing loss that have varied language and communication preferences, community affiliations, and sociocultural norms. Recent research identified concerning behavioral health disparities experienced by the D/HH population; yet, little research has been conducted to extend these findings to the topic of substance use disorder. Methods: To begin to fill this gap, the authors conducted a secondary analysis of data from the 2013–2014 administration of the National Health and Nutrition Examination Survey, comparing alcohol and drug use between participants based on their reported hearing status, i.e., D/HH or hearing. Results: Findings suggest that the overall lifetime prevalence of alcohol and drug use does not differ based on hearing status, and that D/HH and hearing adolescents begin using cannabis on a similar timeline. However, findings also revealed that D/HH respondents were more likely to have been regular cannabis users and heavy alcohol users than hearing respondents. In other words, when D/HH individuals use substances, they tend to be heavy users. Conclusions: These findings stress the importance of directing resources to the prevention and treatment of heavy alcohol use in the D/HH population, given that binge drinking is associated with a number of health problems and social consequences. Additionally, the continuation of this empirical work is rather urgent given recent legislative changes regarding cannabis use. D/HH individuals possess a number of risk factors for substance use disorder and, as such, may be more greatly impacted by these legislative changes than individuals from the general US population. It is imperative that this impact be captured by future research efforts in order to inform the development of prevention and intervention efforts for the traditionally underserved D/HH population.     

Familial alcoholism and problem drinking in a national drinking practices survey

This study examined the prevalence of alcoholism and problem drinking among the first degree relatives of respondents in a national survey. A stratified area-probability sample of adults 18 years of age or older living in households in the U.S. was used for this analysis. Data were collected on familial alcoholism/problem drinking as well as the prevalence of alcohol problems and depressive symptoms of the respondents themselves. Overall, women reported more alcoholic/problem drinking first degree relatives than men. This relationship was emhanced for women with alcohol problems alone or in conjunction with depressive symptoms. However, rates of reported familial alcoholism/problem drinking among men and women who had depressive symptoms only were quite similar. The implications of these findings are discussed.     

Community prevention of alcohol problems

Local communities have begun using policy to affect the drinking environment itself as an approach to reducing alcohol involved trauma. That is, policy is used to produce structural changes in the drinking environment. In turn, changes in the environment effect changes in drinking behavior. This paper describes an effort in three communities in two states to reduce alcohol problems at the community level, "Preventing Alcohol Trauma: A Community Trial." This trial was a 5-year research project with a goal to reduce local alcohol-involved injuries and deaths in three experimental communities with populations of approximately 100,000 each (one in northern California, one in southern California, and one in South Carolina). The communities contained racial and ethnic diversity as well as a mix of urban, suburban, and rural settings. Each of these three communities had a control community that did not receive the prevention interventions. The project used an environmental policy approach to prevention and five mutually reinforcing components were implemented: (1) community mobilization to develop community organization and support, (2) responsible beverage service to establish standards for servers and owners/managers of on-premise alcohol outlets to reduce their risk of having intoxicated and/or underage customers in bars and restaurants. (3) a drinking and driving component to increase local drunk-driving enforcement efficiency and to increase the actual and perceived risk that drinking drivers would be detected, (4) an underage drinking component to reduce retail availability of alcohol to minors, and (5) an alcohol access component to use local zoning powers and other municipal controls of outlet numbers and density to reduce availability of alcohol. Results show that the project reduced alcohol-involved crashes, lowered sales to minors, increased the responsible alcohol serving practices of bars and restaurants, and increased community support and awareness of alcohol problems.     

Alcohol consumption of matched and unmatched adolescents in a longitudinal study

Abstract

This paper presents a comparison between matched and unmatched respondents in a longitudinal study on alcohol use. Nineteen hundred high school students were twice tested for alcohol use twelve months apart. The questionnaires of 1,446 respondents (76% of the respondents) were successfully matched up by means of a self‐generated code. Four hundred fifty‐four (24%) subjects have dropped out. Prevalence and incidence of alcohol use were assessed by two indices: ever (life time) use and current (last month) use. The major findings were as follows: Dropouts consumed all types of alcoholic beverages at rates considerably exceeding those found among the matched subjects. Also, significant differences were found between dropouts and matched subjects in their sociodemographic background. However, in spite of the differences in alcohol consumption, the same variables‐sensation seeking, gender and age‐explained alcohol use among both groups. The results are discussed in relation to prevention.     

Substance-misusing Patients in Primary Care: incidence,services provided and problems. A survey of general practitioners in Wiltshire

This research aimed to discover the monthly incidence of patients misusing illicit drugs or alcohol seen by general practitioners; services provided; difficulties encountered; and general practitioner willingness. The total population of general practitioners (n = 210) in the Health Commission for Wiltshire was sent a postal questionnaire: 49% responded (n = 103), and 10% of respondents were interviewed. The number of alcohol-misusing patients seen per month was much higher than illicit drug-misusing patients: 46% of respondents saw fewer than one patient for prescribed opiates, and 71% saw fewer than one solvent misuser, per month; in contrast, only 7% of respondents saw fewer than one alcohol-misusing patient per month. Ninety-two per cent of general practitioners provided general medical services for alcohol misusers, and 86% for illicit drug misusers. Fifty-four per cent of respondents provided substitute medication for illicit drugs, while 42% provided detoxification medication for illicit drugs. Sixty-five per cent provided medication for alcohol detoxification. Difficulties encountered included missed appointments, time-wasting, aggressive behaviour, communication difficulties and upset to other patients. Twelve per cent of general practitioners were willing to provide more services for illicit drug users, compared with 27% for alcohol users. The greater unwillingness to work with illicit drug users appeared disproportionate to the number previously encountered. Interventions to improve the situation for general practitioners and substance-misusing patients are discussed.     

Substance-misusing Patients in Primary Care: incidence, services provided and problems. A survey of general practitioners in Wiltshire

This research aimed to discover the monthly incidence of patients misusing illicit drugs or alcohol seen by general practitioners; services provided; difficulties encountered; and general practitioner willingness. The total population of general practitioners (n = 210) in the Health Commission for Wiltshire was sent a postal questionnaire: 49% responded (n = 103), and 10% of respondents were interviewed. The number of alcohol-misusing patients seen per month was much higher than illicit drug-misusing patients: 46% of respondents saw fewer than one patient for prescribed opiates, and 71% saw fewer than one solvent misuser, per month; in contrast, only 7% of respondents saw fewer than one alcohol-misusing patient per month. Ninety-two per cent of general practitioners provided general medical services for alcohol misusers, and 86% for illicit drug misusers. Fifty-four per cent of respondents provided substitute medication for illicit drugs, while 42% provided detoxification medication for illicit drugs. Sixty-five per cent provided medication for alcohol detoxification. Difficulties encountered included missed appointments, time-wasting, aggressive behaviour, communication difficulties and upset to other patients. Twelve per cent of general practitioners were willing to provide more services for illicit drug users, compared with 27% for alcohol users. The greater unwillingness to work with illicit drug users appeared disproportionate to the number previously encountered. Interventions to improve the situation for general practitioners and substance-misusing patients are discussed.     

Reports of alcohol‐related problems and alcohol dependence for demographic subgroups using interactive voice response versus telephone surveys: The 2005 US National Alcohol Survey

Introduction and Aims. Interactive voice response (IVR), a computer‐based interviewing technique, can be used within a computer‐assisted telephone interview (CATI) survey to increase privacy and the accuracy of reports of sensitive attitudes and behaviours. Previous research using the 2005 National Alcohol Survey indicated no overall significant differences between IVR and CATI responses to alcohol‐related problems and alcohol dependence. To determine if this result holds for demographic subgroups that could respond differently to modes of data collection, this study compares the prevalence rates of lifetime and last‐year alcohol‐related problems by gender, ethnicity, age and income subgroups obtained by IVR versus continuous CATI interviewing. Design and Methods. As part of the 2005 National Alcohol Survey, subsamples of English‐speaking respondents were randomly assigned to an IVR group that received an embedded IVR module on alcohol‐related problems (n = 450 lifetime drinkers) and a control group that were asked identical alcohol‐related problem items using continuous CATI (n = 432 lifetime drinkers). Results. Overall, there were few significant associations. Among lifetime drinkers, higher rates of legal problems were found for white and higher income respondents in the IVR group. For last‐year drinkers, a higher percentage of indicators of alcohol dependence was found for Hispanic respondents and women respondents in the CATI group. Discussion and Conclusion. Data on alcohol problems collected by CATI provide largely comparable results to those from an embedded IVR module. Thus, incorporation of IVR technology in a CATI interview does not appear strongly indicated even for several key subgroups.[Midanik LT, Greenfield TK. Reports of alcohol‐related problems and alcohol dependence for demographic subgroups using interactive voice response versus telephone surveys: The 2005 US National Alcohol Survey. Drug Alcohol Rev 2010]     

Alcohol intoxication and sexual risk behaviors among rural-to-urban migrants in China

BACKGROUND: The migrant population in China is at high risk for sexual risk behavior and alcohol intoxication. Information about the prevalence of alcohol intoxication and its association with sexual risk behavior among migrants is needed for designing effective intervention prevention programs for reduction in alcohol abuse and HIV infection. METHODS: Cross-sectional data were collected from 2153 sexually experienced young rural-to-urban migrants in Beijing and Nanjing, China, in 2002. RESULTS: Approximately one-third of the participants had been intoxicated with alcohol at least once during the previous month, with more males than females reporting intoxication (40.2% versus 23.7%, p<0.001). Compared to non-intoxicated participants, respondents with alcohol intoxication in previous 30 days reported more psychological problems, including higher depression scores, lower levels of satisfaction with life and work, and higher perception of peer involvement in risk behavior. Intoxicated respondents were more likely to engage in premarital sex than non-intoxicated respondents (76% versus 60.2%, p<0.001), have multiple sexual partners (13.4% versus 5.2%, p<0.001), purchase sex (12.6% versus 4.9%, p<0.001), and sell sex (10.1% versus 3.7%, p<0.001). However, there was no association between alcohol intoxication and inconsistent/non-use of condoms. Multivariate analysis controlling for depression, peer risk involvement, age, gender, and other socio-demographic variables indicated that alcohol intoxication was independently correlated with premarital sex, multiple sexual partners, and buying and selling sex. CONCLUSIONS: Compared to the general Chinese population, levels of intoxication were elevated among Chinese rural-to-urban migrants. Alcohol intoxication was associated with sexual risk behaviors. HIV/AIDS prevention and intervention efforts should include components of alcohol use/abuse prevention for an effective reduction of sexual risk among young rural-to-urban migrants in China.