Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations

Brief interventions for alcohol use disorders have been the focus of considerable research. In this meta-analytic review, we considered studies comparing brief interventions with either control or extended treatment conditions. We calculated the effect sizes for multiple drinking-related outcomes at multiple follow-up points, and took into account the critical distinction between treatment-seeking and non-treatment-seeking samples. Most investigations fell into one of two types: those comparing brief interventions with control conditions in non-treatment-seeking samples ( n = 34) and those comparing brief interventions with extended treatment in treatment-seeking samples ( n = 20). For studies of the first type, small to medium aggregate effect sizes in favor of brief interventions emerged across different follow-up points. At follow-up after >3–6 months, the effect for brief interventions compared to control conditions was significantly larger when individuals with more severe alcohol problems were excluded. For studies of the second type, the effect sizes were largely not significantly different from zero. This review summarizes additional positive evidence for brief interventions compared to control conditions typically delivered by health-care professionals to non-treatment-seeking samples. The results concur with previous reviews that found little difference between brief and extended treatment conditions. Because the evidence regarding brief interventions comes from different types of investigation with different samples, generalizations should be restricted to the populations, treatment characteristics and contexts represented in those studies.     

Evaluating Competing Models of Alcohol-Related Harm

This paper summarizes "Evaluating Competing Models of Alcohol-Related Harm" of the International Workshop on Consumption Measures and Models for Use in Policy Development and Evaluation, May 12-14, 1997, Bethesda, MD. The session chair was Thomas Greenfield; presenters were Gerald Williams, Thomas Greenfield, Lorraine Midanik, Kathryn Graham, Jürgen Rehm, Anders Romelsjö, Deborah Dawson, Klaus Mäkelä, Tim Stockwell, and Paul Gruenewald; and discussants were Tim Stockwell, Timo Alanko, and Eric Single.     

Alcohol-Related Mortality in Spain

Alcohol-related mortality and years of potential life lost in Spain in 1986 have been studied according to the official statistics with regard to the population mortality in our country. 6.1% of the deaths in Spain in 1986 were related to alcohol consumption, mainly caused by malignant neoplasm (26.0%), digestive diseases (23.6%), and unintentional injuries (21.1%). Mean potential years of life lost for alcohol-related deaths until 65 was 7.3. Unintentional injuries were responsible for the greater part (61.2%) of alcohol-related years of potential life lost. The present study shows the high mortality rate associated with alcohol consumption in our country, as well as its importance in premature death.     

Disparities in Alcohol-Related Problems Among White, Black, and Hispanic Americans

Background: This study assesses racial/ethnic disparities in negative social consequences of drinking and alcohol dependence symptoms among white, black, and Hispanic Americans. We examine whether and how disparities relate to heavy alcohol consumption and pattern, and the extent to which social disadvantage (poverty, unfair treatment, and racial/ethnic stigma) accounts for observed disparities. Methods: We analyzed data from the 2005 U.S. National Alcohol Survey, a nationally representative telephone‐based survey of adults ages 18 and older (N = 6,919). Given large racial/ethnic differences in abstinence rates, core analyses were restricted to current drinkers (N = 4,080). Logistic regression was used to assess disparities in alcohol‐related problems at 3 levels of heavy drinking, measured using a composite variable incorporating frequency of heavy episodic drinking, frequency of drunkenness, and maximum amount consumed in a single day. A mediational approach was used to assess the role of social disadvantage. Results: African American and Hispanic drinkers were significantly more likely than white drinkers to report social consequences of drinking and alcohol dependence symptoms. Even after adjusting for differences in heavy drinking and demographic characteristics, disparities in problems remained. The racial/ethnic gap in alcohol problems was greatest among those reporting little or no heavy drinking, and gradually diminished to nonsignificance at the highest level of heavy drinking. Social disadvantage, particularly in the form of racial/ethnic stigma, appeared to contribute to racial/ethnic differences in problems. Conclusions: These findings suggest that to eliminate racial/ethnic disparities in alcohol‐related problems, public health efforts must do more than reduce heavy drinking. Future research should address the possibility of drink size underestimation, identify the particular types of problems that disproportionately affect racial/ethnic minorities, and investigate social and cultural determinants of such problems.     

Extreme College Drinking and Alcohol-Related Injury Risk

Background: Despite the enormous burden of alcohol‐related injuries, the direct connection between college drinking and physical injury has not been well understood. The goal of this study was to assess the connection between alcohol consumption levels and college alcohol‐related injury risk. Methods: A total of 12,900 college students seeking routine care in 5 college health clinics completed a general Health Screening Survey. Of these, 2,090 students exceeded at‐risk alcohol use levels and participated in a face‐to‐face interview to determine eligibility for a brief alcohol intervention trial. The eligibility interview assessed past 28‐day alcohol use and alcohol‐related injuries in the past 6 months. Risk of alcohol‐related injury was compared across daily drinking quantities and frequencies. Logistic regression analysis and the Bayesian Information Criterion were applied to compute the odds of alcohol‐related injury based on daily drinking totals after adjusting for age, race, site, body weight, and sensation seeking. Results: Male college students in the study were 19% more likely (95% CI: 1.12–1.26) to suffer an alcohol‐related injury with each additional day of consuming 8 or more drinks. Injury risks among males increased marginally with each day of consuming 5 to 7 drinks (odds ratio = 1.03, 95% CI: 0.94–1.13). Female participants were 10% more likely (95% CI: 1.04–1.16) to suffer an alcohol‐related injury with each additional day of drinking 5 or more drinks. Males (OR = 1.69, 95% CI: 1.14–2.50) and females (OR = 1.81, 95% CI: 1.27–2.57) with higher sensation‐seeking scores were more likely to suffer alcohol‐related injuries. Conclusions: College health clinics may want to focus limited alcohol injury prevention resources on students who frequently engage in extreme drinking, defined in this study as 8+M/5+F drinks per day, and score high on sensation‐seeking disposition.     

Occupational Stress, Psychological Vulnerability and Alcohol-Related Problems over Time in Future Physicians

This paper elaborates the conceptual frameworks and major results to date from an ongoing longitudinal study of alcohol problems in male and female future physicians. A medical student cohort was surveyed at medical school entrance and in the 2nd and 3rd years of training. Relative to life span developmental orientations, a sizable proportion of premedical school problem drinkers "matured out" of their earlier patterns after entrance into occupational training roles. Relative to occupational selection versus stress perspectives, medical school problem drinkers were equally divided between those manifesting onset prior to the initiation of training versus those manifesting onset during medical training. Overall, both male and female problem drinking declined during the preclinical years (in contrast to premedical school levels) but manifested a trend in the direction of a reversal of the previous decline after the initiation of clinical training. The major psychosocial predictor of alcohol abuse during clinical training involved social-relational deficits or narcissistic personality styles. Moreover, this relationship was mediated by social support deficits and patient care-related stressors. This cohort is currently being re-surveyed in the last year of medical school and will be followed again during residency training.     

Is Alcohol-Related Flushing a Protective Factor for Alcoholism in Caucasians?

Although alcohol-related flushing seems to be a genetically influenced protective factor for alcoholism in some Asian groups, little is known about whether this is true for Caucasians. The evidence for alcohol-related flushing as a protective factor for the development of alcoholism was examined in a sample of 5831 Australian twins (2041 men, 3790 women) who were administered a structured psychiatric interview. Twin correlations for self-reported adverse alcohol reactions (e.g., "flushing or blushing" and "feeling very sleepy" after drinking 1 or 2 drinks) were modest, suggesting minimal contribution of genetic factors, but when corrected for reliability of measurement, were consistent with moderate heritabilities. In accord with studies examining Asian samples, we found that individuals who experienced adverse reactions after drinking small amounts of alcohol drank less often and slightly less per drinking occasion than those who did not experience adverse reactions. However, those who experienced adverse reactions were more likely to have symptoms of alcoholism and to report a parental history of alcohol problems. We conclude that self-reported alcohol-related flushing is not a protective factor for alcoholism in Caucasians and may be a risk factor.     

Associations of ALDH2 and ADH1B Genotypes With Alcohol-Related Phenotypes in Asian Young Adults

Background:  Associations of ALDH2 and ADH1B genotypes with alcohol use have been evaluated largely using case–control studies, which typically focus on adult samples and dichotomous diagnostic outcomes. Relatively fewer studies have evaluated ALDH2 and ADH1B in relation to continuous drinking outcomes or at different developmental stages. This study examined additive and interactive effects of ALDH2 and ADH1B genotypes on drinking behavior in a mixed-gender sample of Asian young adults, focusing on continuous phenotypes (e.g., heavy episodic and hazardous drinking, alcohol sensitivity, drinking consequences) whose expression is expected to precede the onset of alcohol use disorders.
Methods:  The sample included 182 Chinese- and Korean-American young adults ages 18 years and older (mean age = 20 years). Effects of ALDH2 , ADH1B and ethnicity were estimated using generalized linear modeling.
Results:  The ALDH2*2 allele predicted lower reported rates of alcohol use and drinking consequences as well as greater reported sensitivity to alcohol. There were significant ethnic group differences in drinking outcomes, such that Korean ethnicity predicted higher drinking rates and lower alcohol sensitivity. ADH1B status was not significantly related to drinking outcomes.
Conclusions:  Ethnicity and ALDH2 status, but not ADH1B status, consistently explained significant variance in alcohol consumption in this relatively young sample. Results extend previous work by showing an association of ALDH2 genotype with drinking consequences. Findings are discussed in the context of possible developmental and population differences in the influence of ALDH2 and ADH1B variations on alcohol-related phenotypes.     

Metabolic and Ethnic Determinants of Alcohol Drinking Habits and Vulnerability to Alcohol-Related Disorder

This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The chairs were Shoji Harada and Dharam P. Agarwal. The presentations were (1) Mutations in the exons, exon-intron junctions, and promoter regions of human CYP2E1 gene and alcoholism, by Fumio Nomura; (2) Genetic variability in alcohol metabolism and drinking habits in Japanese, by Shoji Harada; (3) Genetic studies of alcohol dependence using alcoholics with inactive ALDH2 , by Susumu Higuchi; and (4) Alcohol consumption, apolipoprotein polymorphisms, and cardiovascular disorders, by Dharam P. Agarwal.     

Alcohol Availability and Intimate Partner Violence Among US Couples

Objectives: We examined the relation between alcohol outlet density (the number of alcohol outlets per capita by zip code) and male‐to‐female partner violence (MFPV) or female‐to‐male partner violence (FMPV). We also investigated whether binge drinking or the presence of alcohol‐related problems altered the relationship between alcohol outlet density and MFPV or FMPV. Methods: We linked individual and couple sociodemographic and behavioral data from a 1995 national population‐based sample of 1,597 couples to alcohol outlet data and 1990 US Census sociodemographic information. We used logistic regression for survey data to estimate unadjusted and adjusted odds ratios between alcohol outlet density and MFPV or FMPV along with 95% confidence intervals (CIs) and p‐values. We used a design‐based Wald test to derive a p‐value for multiplicative interaction to assess the role of binge drinking and alcohol‐related problems. Results: In adjusted analysis, an increase of one alcohol outlet per 10,000 persons was associated with a 1.03‐fold increased risk of MFPV (p‐value for linear trend = 0.01) and a 1.011‐fold increased risk of FMPV (p‐value for linear trend = 0.48). An increase of 10 alcohol outlets per 10,000 persons was associated with 34% and 12% increased risk of MFPV and FMPV respectively, though the CI for the association with FMPV was compatible with no increased risk. The relationship between alcohol outlet density and MFPV was stronger among couples reporting alcohol‐related problems than those reporting no problems (p‐value for multiplicative interaction = 0.01). Conclusions: We found that as alcohol outlet density increases so does the risk of MFPV and that this relationship may differ for couples who do and do not report alcohol‐related problems. Given that MFPV accounts for the majority of injuries related to intimate partner violence, policy makers may wish to carefully consider the potential benefit of limiting alcohol outlet density to reduce MFPV and its adverse consequences.     

Common Quantitative Trait Loci for Alcohol-Related Behaviors and CNS Neurotensin Measures: Voluntary Ethanol Consumption

The C57BL/6, DBA/2, and recombinant inbred (RI) strains derived from them (B × D RIs) are the most frequently studied mouse strains with regard to genetic regulation of voluntary ethanol consumption (VEC). We have studied VEC in an alternate genetic model provided by the LS × SS RIs. These RI strains exhibit phenotypic extremes in VEC comparable to the C57BL/6 and DBA/2 mice and genotype-dependent sex differences in drinking behavior. A correlational analysis between various ethanol-related behaviors suggests genetic independence of VEC from high-dose neurosensitivity (sleep time), acute ethanol tolerance, hypothermia, and low-dose locomotor activity. A search for quantitative trait loci identified a number of putative quantitative trait loci (QTL), three of which are identical to those previously reported for 10% ethanol drinking in the B × D RIs. We also find a significant correlation between low-affinity neurotensin receptor densities (NTRJ in the frontal cortex and VEC, and more common QTL between these two phenotypes than expected by chance. This suggests a role for frontal cortex NTR_L in regulating voluntary ethanol intake     

The Impact of Underage Drinking Laws on Alcohol-Related Fatal Crashes of Young Drivers

Background: This study used a pre‐ to post‐design to evaluate the influence on drinking‐and‐driving fatal crashes of 6 laws directed at youth aged 20 and younger and 4 laws targeting all drivers. Methods: Data on the laws were drawn from the Alcohol Policy Information System data set (1998 to 2005), the Digests of State Alcohol Highway Safety Related Legislation (1983 to 2006), and the Westlaw database. The Fatality Analysis Reporting System data set (1982 to 2004) was used to assess the ratio of drinking to nondrinking drivers involved in fatal crashes [fatal crash incidence ratio (CIR)]. The data were analyzed using structural equation modeling techniques. Results: Significant decreases in the underage fatal CIR were associated with presence of 4 of the laws targeting youth (possession, purchase, use and lose, and zero tolerance) and 3 of the laws targeting all drivers (0.08 blood alcohol concentration illegal per se law, secondary or upgrade to a primary seat belt law, and an administrative license revocation law). Beer consumption was associated with a significant increase in the underage fatal CIR. The direct effects of laws targeting drivers of all ages on adult drinking drivers aged 26 and older were similar but of a smaller magnitude compared to the findings for those aged 20 and younger. It is estimated that the 2 core underage drinking laws (purchase and possession) and the zero tolerance law are currently saving an estimated 732 lives per year controlling for other exposure factors. If all states adopted use and lose laws, an additional 165 lives could be saved annually. Conclusions: These results provide substantial support for the effectiveness of under age 21 drinking laws with 4 of the 6 laws examined having significant associations with reductions in underage drinking‐and‐driving fatal crashes. These findings point to the importance of key underage drinking and traffic safety laws in efforts to reduce underage drinking‐driver crashes.     

Group-Delivered Brief Intervention versus Standard Care for Mixed Alcohol/Other Drug Problems

Abstract

This study compared a Motivational Interviewing inspired group intervention with standard care in naturalistic alcohol/other drug abuse samples. A community-recruited alcohol/other drug abuse or dependent sample (N = 67) was provided up to four sessions of groupadapted Motivational Interviewing (GAMI). Newly admitted patients (N = 64) in two multimodal treatment settings were also recruited. Quasi-experimental comparison of outcomes from GAMI versus real-world standard care (SC) indicated significant within-group improvement on all main outcomes in both groups. SC was associated with significantly more abstinence days, and better family and social outcomes at six-month posttreatment compared to GAMI. Differences in reductions in alcohol or drug-related dysfunction were not detected. Thus, group-delivered MI intervention was associated with significant improvements in alcohol/other drug use outcomes. However, consideration of group-delivered MI as a replacement for more intensive standard care is, for the moment, uncertain.