Social and Financial Resources and High‐Risk Alcohol Consumption Among Older Adults

Background: This study examined long‐term mutual predictive associations between social and financial resources and high‐risk alcohol consumption in later life. Method: A sample of 55‐ to 65‐year‐old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption. Results: Over the 20‐year interval, there was evidence of both social causation and social selection processes in relation to high‐risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends’ approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high‐risk alcohol consumption. Conversely, indicating the presence of social selection, high‐risk alcohol consumption was associated with subsequent higher levels of friends’ approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members. Conclusions: These findings reflect mutual influence processes in which older adults’ social resources and high‐risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late‐life social factors may amplify their excessive alcohol consumption.     

Adherence to Drinking Guidelines and Reasons for Alcohol Consumption Cessation in the Southern Cone of Latin America – Findings from the CESCAS Study

Introduction:Alcohol consumption is a risk factor for morbidity and mortality globally. Consumption levels in Southern Latin America are among the highest in the world.Objectives:To describe consumption patterns and adherence to guidelines in the general adult population of Southern Latin America, as well as exploration of reasons for alcohol cessation and the advising role of the health worker in this decision.Methods:In 7,520 participants from the Centro de Excelencia en Salud Cardiovascular para el America del Sur (CESCAS) cohort, consumption patterns were described and the proportion excessive drinkers (i.e. >7 units/week for women and >14 for men or binge drinking: >4 (women) or >5 (men) units at a single occasion) was calculated. Former drinkers were asked if they had quit alcohol consumption on the advice of a health worker and/or because of health reasons. Furthermore, among former drinkers, multivariable logistic regression analysis was performed to assess which participant characteristics were independently associated with the chance of quitting consumption on a health worker’s advice.Results:Mean age was 54.8 years (SD = 10.8), 42% was male. Current drinking was reported by 44.6%, excessive drinking by 8.5% of the population. In former drinkers, 23% had quit alcohol consumption because of health reasons, half of them had additionally quit on the advice of a health worker. The majority of former drinkers however had other, unknown, reasons. When alcohol cessation was based on a health worker’s advice, sex, country of residence, educational status and frequency of visiting a physician were independent predictors.Conclusion:In this Southern American population-based sample, most participants adhered to the alcohol consumption guidelines. The advising role of the health worker in quitting alcohol consumption was only modest and the motivation for the majority of former drinkers remains unknown. A more detailed assessment of actual advice rates and exploration of additional reasons for alcohol cessation might be valuable for alcohol policy making.     

Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption

Aims This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high‐risk alcohol consumption and identifies predictors of changes in concordance and high‐risk consumption. Design, Participants, Measurements Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low‐risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high‐risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high‐risk alcohol consumption and the other partner did not (n = 75). At each follow‐up, husbands and wives completed an inventory that assessed their personal, family and social functioning. Findings Compared to the low‐risk concordant group, husbands and wives in the high‐risk concordant group were more likely to rely on tension‐reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high‐risk drinking included tension‐reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking. Conclusions High‐risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long‐term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high‐risk drinking.     

ALDH2*2 and peer drinking in East Asian college students

Background: The ALDH2*2 allele (A-allele) at rs671 is more commonly carried by Asians and is associated with alcohol-related flushing, a strong adverse reaction to alcohol that is protective against drinking. Social factors, such as having friends who binge drink, also contribute to drinking in Asian youth. Objectives: This study examined the interplay between ALDH2*2, peer drinking, and alcohol consumption in college students. We hypothesized that the relationship between ALDH2*2 and standard grams of ethanol per month would vary based on the level of peer drinking. Methods: Subjects (N = 318, 63.25% female) were East Asian college students in the United States who reported drinking alcohol. Data were from the freshman year of a university survey that included a saliva DNA sample. ALDH2*2 status was coded ALDH2*2(+) (A/G and A/A genotypes) and ALDH2*2(?) (G/G genotype). Peer drinking was students’ perception of how many of their friends “got drunk”. Results: Main effects of ALDH2*2(?) and having more friends who got drunk were associated with greater alcohol consumption. The ALDH2*2 × peer drunkenness interaction showed a stronger positive association with alcohol consumption for ALDH2*2(?) versus ALDH2*2(+) at increasing levels of peer drunkenness. Follow-up comparisons within each peer drunkenness level identified significantly higher alcohol consumption for ALDH2*2(?) compared to ALDH2*2(+) at the all friends got drunk level.

Conclusion: There was evidence of a stronger effect for ALDH2*2(?) compared to ALDH2*2(+) with greater alcohol use when students were more exposed to peer drinking. Findings contribute to a growing literature on the interrelationships between genetic influences and more permissive environments for alcohol consumption.     

A Complex Relationship Between Co‐occurring Social Anxiety and Alcohol Use Disorders: What Effect Does Treating Social Anxiety Have on Drinking?

Background: Individuals with social anxiety disorder and co‐occurring alcohol problems report using alcohol to cope with anxiety symptoms. Interventions that reduce both social anxiety and drinking are needed. Paroxetine, an FDA‐approved medication to treat social anxiety disorder, reduces anxiety in individuals with co‐occurring alcohol problems. Objectives: To examine whether effective treatment of social anxiety with paroxetine reduces drinking in dual‐diagnosed individuals who endorse using alcohol to cope. Methods: A 16‐week, double‐blind, randomized controlled trial of paroxetine was conducted. Participants (placebo n = 22; paroxetine n = 20) met DSM‐IV diagnostic criteria for social anxiety disorder and alcohol abuse or dependence. Participants were seeking treatment for social anxiety, not for the alcohol problem. Alcohol use outcomes were measured with conventional quantity/frequency measures and novel measures of drinking to cope. Results: Paroxetine improved social anxiety more than placebo. Paroxetine reduced self‐reported reliance on alcohol for self‐medication purposes, but was not different than placebo in changing quantity and frequency drinking or the proportion of drinking days that were identified as coping‐related. Exploratory analyses revealed that for the placebo group, drinking during the trial was correlated with social anxiety severity, whereas for the paroxetine‐treated group, drinking was uncoupled from social anxiety severity. Conclusions: Successfully treating social anxiety symptoms with paroxetine does not reduce drinking in dual‐diagnosed individuals who are not seeking treatment for alcohol problems. Paroxetine does, however, reduce reliance on alcohol to engage in social situations, and may change the reasons why one drinks (such that drinking occurs for other reasons besides coping with anxiety). These results have implications for staging of social anxiety and alcohol treatment in individuals with the co‐occurring disorders presenting to a mental health or primary care provider.     

Associations between self-reported illness and non-drinking in young adults

Aims This study investigated associations between self‐reported illness, social factors and health behaviours and non‐drinking among young people aged 18–34 years. Design Logistic regression analysis of cross‐sectional national survey data, collected from the Health Survey for England 2006 and 2008. Data were collected through face‐to‐face interviews and are self‐reported. Participants and settings A total of 2826 male and 3618 females aged 18–34 years drawn from a nationally representative multi‐stage stratified probability sampling design across England. Measurements Non‐drinkers were based on those who reported ‘no’ to drinking alcohol currently. Exposure measures included self‐reports of having a limiting long‐standing illness, long‐standing illness or self‐reported poor health. We adjusted for ethnicity, income, education, general physical activity and other factors. Findings Having a limiting long‐standing illness during early adulthood increased the odds of being a non‐drinker 1.74 times for men (P < 0.01) and 1.45 times for women (P < 0.01). In both men and women belonging to the lowest income quintile or having no qualifications was associated with increased odds of being a non‐drinker (P < 0.001), indicating that the social gradient in non‐drinking begins at an early age. Men and women aged 18–34 years with the lowest activity levels were also more likely to be non‐drinkers (P < 0.01). Conclusion Young adults who have a limiting long‐standing illness are more likely not to drink alcohol even after adjusting for a range of social and demographic measures. Studies on the putative health benefits of moderate alcohol consumption later in life need to take account of early life history.     

Alcohol in older people: systematic reviews of interventions and context

BackgroundHarmful alcohol consumption is increasing in older people because of an ageing population and heavier consumption in the generation now reaching older age. This work was part of a comprehensive evidence synthesis of preventive health behaviour interventions to inform policy and identify evidence gaps relating to ageing well and cognitive health.MethodsThree systematic reviews in older populations were done to identify interventions to prevent or reduce excessive alcohol consumption, to identify the same type of interventions that also report cognitive and dementia outcomes, and to identify barriers and facilitators. Treatment for alcohol dependence was excluded. Multiple databases (Medline, Embase, PsycINFO, CINAHL, CENTRAL, Social Sciences Citation Index, and grey literature) were searched for studies published from 2000 in English, from Organisation for Economic Co-operation and Development countries. MeSH terms and text words relating to alcohol consumption and behaviour were used combined with older age terms (appendix). Risk of bias was assessed with National Institute for Health and Care Excellence methodology.Findings12 intervention studies targeting prevention or reduction of excessive alcohol consumption and 11 qualitative studies reporting barriers and facilitators were identified, but none with cognitive or dementia outcomes. Only three studies related to prevention; and nine aimed to reduce alcohol in harmful or hazardous drinkers in primary care. A complex range of intervention types, intensity, and delivery was found. Five studies that compared one type of intervention with another or compared more intensive interventions with minimal intervention found no differences, although both groups markedly reduced alcohol consumption. Limited evidence (three studies) suggested that more intensive interventions that include personalised feedback could have the greatest effects in older hazardous drinkers. However, some evidence suggested that simple interventions including brief interventions, leaflets, and alcohol assessments with advice to reduce drinking can also have a positive effect. From qualitative studies, drinking in some older people was strongly linked to social engagement and enjoyment of life and there was scepticism about the health risks of alcohol. Conversely, drinking was also linked to difficulties such as social isolation, stress, illness, or bereavement. Emphasis on the experience of older people to drink wisely in a positive controlled way could be a facilitator.InterpretationAlcohol interventions in older people can be effective. Messages might need to consider the impact on social engagement in light of potential benefits of social participation for cognitive health.FundingNational Institute for Health Research (NIHR) School for Public Health Research and NIHR Collaboration for Leadership in Applied Health Research East of England.     

Drinking Game Behaviors among College Students: How Often and How Much?

Background: Participation in drinking games (DG) has been identified as a common health-risk behavior among college students. However, research suggests that the frequency of DG participation alone may not pose a significant health risk; rather, gaming may be most hazardous when large amounts of alcohol are consumed. Objectives: The present study was designed to examine whether specific gaming behaviors (frequency of play and amount of consumption) place gamers at elevated risk for negative drinking outcomes. Method: Students from 30 U.S. colleges completed self-report questionnaires via the Internet about their drinking attitudes and behaviors. Four groups of student gamers (N = 2,230) were examined: low frequency/low consumption (n = 1,047), low frequency/high consumption (n = 453), high frequency/low consumption (n = 326), and high frequency/high consumption (n = 404). Results: Multilevel regression analyses indicated that the frequency x consumption interaction emerged as a significant predictor of negative drinking consequences. Follow-up analyses indicated that quantity of alcohol consumed during DG predicted negative drinking consequences for high-frequency gamers only. Conclusions/Scientific Contribution: The present results challenge the assumption that all drinking-gaming practices pose equivalent health risks for gamers. Considering only participation in or level of consumption during DG may not tell the complete story with respect to the health hazards involved with gaming behaviors among college students.     

Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence

BACKGROUND: There is evidence of a U-shaped association between alcohol consumption and physical health outcomes in older people, such that moderate drinking is associated with better outcomes than abstinence or heavy drinking, but whether moderate drinking in older people is associated with better cognition and mental health than non-drinking has not been explored. OBJECTIVE: To assess the relationship between drinking and cognitive health in middle-aged and older people. DESIGN: Prospective observational study. SETTING/PARTICIPANTS: Six thousand and five individuals aged 50 and over who participated in Wave 1 of the English Longitudinal Study of Ageing (ELSA) and who were not problem drinkers. Exposure and outcome variables: we examined cognitive function, subjective well-being, and depressive symptoms, and compared the risks associated with having never drunk alcohol, having quit drinking, and drinking at <1, <2 and >2 drinks per day. RESULTS: For both men and women, better cognition and subjective well-being, and fewer depressive symptoms, were associated with moderate levels of alcohol consumption than with never having drunk any. CONCLUSIONS: In middle-aged and older men and women, moderate levels of alcohol consumption are associated with better cognitive health than abstinence.     

Do attitudes and knowledge predict at-risk drinking among Russian women?

ABSTRACT

Background: Drinking patterns among Russian women indicate substantial risk for alcohol-exposed pregnancies. Data about women’s knowledge and attitudes related to alcohol consumption during pregnancy and the extent to which women’s knowledge and attitudes affect their alcohol use remain limited. Objectives: To describe Russian women’s knowledge and attitudes and assess whether women’s knowledge and attitudes were associated with their risky drinking. Methods: A cross-sectional survey was administered to women of childbearing age (n = 648). Participants were recruited at women’s health clinics and asked about their alcohol consumption, pregnancy status, attitudes, and knowledge about effects of alcohol and Fetal Alcohol Syndrome (FAS). Results: 40% of the women surveyed believed or were uncertain whether alcohol consumption during pregnancy was acceptable. Although 34% had heard of FAS, only 8% possessed accurate knowledge. Correct knowledge was associated with decreased alcohol consumption among pregnant women, but there was no association between knowledge and risky drinking in nonpregnant women, including those who were at risk for an unplanned pregnancy or were trying to conceive. However attitudes were strongly associated with risky drinking by nonpregnant women across levels of knowledge about FAS and any alcohol use by pregnant women. Conclusions: Russian women had limited knowledge and several misconceptions about the effects of alcohol on the fetus, and risky alcohol consumption was strongly associated with women’s attitudes and knowledge. The study provides strong evidence to support continuing public health education about effects of alcohol use during pregnancy. Correcting specific misconceptions and targeting the preconceptional period in health communications are necessary to reduce at-risk drinking and the risk for alcohol-exposed pregnancies.     

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.     

Anxiety and depression among abstainers and low-level alcohol consumers. The Nord-Trøndelag Health Study

Aims The aim of this study was to examine the levels of anxiety and depression among individuals consuming low levels of alcohol. Design Prospective and cross‐sectional population‐based study. Setting and participants This study employed data from the Nord‐Trøndelag Health Survey (HUNT‐2, n = 38 930). Measurements Alcohol consumption was measured by self‐report of usual alcohol consumption during a 2‐week period. Low‐level alcohol consumption was defined as self‐reported abstainers and non‐abstainers currently consuming no alcohol. Anxiety and depression were measured using the Hospital Anxiety and Depression Rating Scale. Potential explanatory variables included somatic illness and symptoms, health‐related behaviour, socio‐economic status and social activity. In a subsample (n = 20 337), we also looked at the impact of previous heavy drinking among abstainers ('sick‐quitting'). Findings A U‐shaped association between alcohol consumption and the risk of anxiety and depression was found. Abstention was related to increased odds for both case‐level anxiety [1.34, 95% confidence interval (CI) 1.19–1.52] and depression (1.52, 95% CI 1.30–1.77). This association was accounted for partly by adjustments for socio‐economic status, social network, somatic illness, age (depression only), gender (anxiety only) and ‘sick‐quitting’. We also identified significant differences between participants who label themselves as abstainers compared to those who report no usual alcohol consumption, but who do not label themselves as abstainers. Conclusions The risk of case‐level anxiety and depression is elevated in individuals with low alcohol consumption compared to those with moderate consumption. Individuals who label themselves as abstainers are at particularly increased risk. This increased risk cannot fully be explained by somatic illness, social activity or ‘sick‐quitting’.     

Tracking drinking behaviour from age 15-19 years

Aims The aim of this paper was to assess (1) changes in drinking behaviour over time among Danish adolescents and (2) use of which alcoholic beverages and what drinking patterns would have the strongest predictive effect on later alcohol consumption. Design, setting, participants The population was a random sample of 15‐year‐olds (baseline 1990, response rate 86%, n= 847) with a first follow‐up 4 years later (response rate 85%, n= 729). Measurements Alcohol intake was assessed by experience of drunkenness, quantity and frequency of consumption. Thresholds recommended by the Danish National Board of Health were used to discriminate high from low intake. Findings At 19 years of age at least 80% drank alcohol monthly, and 24% of the men and 11% of the women had an alcohol intake above the recommended national limits, i.e. 21 weekly units of alcohol for men and 14 for women. Consumption of alcoholic beverages at age 15 increased the risk of drinking alcohol weekly at the age of 19 [odds ratio (OR)‐values from 1.11 to 3.53]. Drunkenness among the 15‐year‐old boys and the use of spirits of the 15‐year‐old girls showed the strongest predictive relationship with excessive consumption at age 19 [OR = 2.44, confidence interval (CI): 1.38–4.29, respectively, OR = 1.97, CI: 1.15–3.38]. Conclusions Alcohol consumption as early as the age of 15 predicted weekly alcohol consumption and alcohol intake exceeding the recommended amount 4 years later. Young teenagers’ high alcohol consumption was not just a passing phenomenon. It was a behaviour that tracked into young adulthood, leaving the adolescents at increased risk of being long‐term, large‐scale consumers.     

Subdiagnostic alcohol use by depressed men and women seeking outpatient psychiatric services: consumption patterns and motivation to reduce drinking

Background: This study examined alcohol use patterns among men and women with depression seeking outpatient psychiatric treatment, including factors associated with recent heavy episodic drinking and motivation to reduce alcohol consumption. Methods: The sample consisted of 1,183 patients aged 18 and over who completed a self‐administered, computerized intake questionnaire and who scored ≥10 on the Beck Depression Inventory‐II (BDI‐II). Additional measures included current and past alcohol questions based on the Addiction Severity Index, heavy episodic drinking (≥5 drinks on 1 or more occasions in the past year), alcohol‐related problems on the Short Michigan Alcoholism Screening Test (SMAST), and motivation to reduce drinking using the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results: Among those who consumed any alcohol in the past year (73.9% of the sample), heavy episodic drinking in the past year was reported by 47.5% of men and 32.5% of women. In logistic regression, prior‐year heavy episodic drinking was associated with younger age (p = 0.011), male gender (p = 0.001), and cigarette smoking (p = 0.002). Among patients reporting heavy episodic drinking, motivation to reduce alcohol consumption was associated with older age (p = 0.008), greater usual quantity of alcohol consumed (p < 0.001), and higher SMAST score (p < 0.001). Conclusions: In contrast to prior clinical studies, we examined subdiagnostic alcohol use and related problems among psychiatric outpatients with depression. Patients reporting greater drinking quantities and alcohol‐related problems also express more motivation to reduce drinking, providing intervention opportunities for mental health providers that should not be overlooked.     

Density of alcohol outlets and teenage drinking: living in an alcogenic environment is associated with higher consumption in a metropolitan setting

Aim This study examines the relationship between physical, socio‐economic and social environments and alcohol consumption and drunkenness among a general population sample of drinkers aged 12–17 years. Design, setting, participants and measures The study was conducted in Auckland, New Zealand. The design comprised two components: (i) environmental measures including alcohol outlet density, locality‐based measure of willingness to sell alcohol (derived from purchase surveys of outlets) and a locality‐based neighbourhood deprivation measure calculated routinely in New Zealand (known as NZDEP); and (ii) the second component was a random telephone survey to collect individual‐level information from respondents aged 12–17 years including ethnicity, frequency of alcohol supplied socially (by parents, friends and others), young person's income; frequency of exposure to alcohol advertising; recall of brands of alcohol and self‐reported purchase from alcohol outlets. A multi‐level model was fitted to predict typical‐occasion quantity, frequency of drinking and drunkenness in drinkers aged 12–17 years. Findings Typical‐occasion quantity was predicted by: frequency of social supply (by parents, friends and others); ethnicity and outlet density; and self‐reported purchasing approached significance. NZDEP was correlated highly with outlet density so could not be analysed in the same model. In a separate model, NZDEP was associated with quantity consumed on a typical drinking occasion. Annual frequency was predicted by: frequency of social supply of alcohol, self‐reported purchasing from alcohol outlets and ethnicity. Feeling drunk was predicted by frequency of social supply of alcohol, self‐reported purchasing from alcohol outlets and ethnicity; outlet density approached significance. Age and gender also had effects in the models, but retailers' willingness to sell to underage patrons had no effects on consumption, nor did the advertising measures. The young person's income was influential on typical‐occasion quantity once deprivation was taken into account. Conclusion Alcohol outlet density was associated with quantities consumed among teenage drinkers in this study, as was neighbourhood deprivation. Supply by family, friends and others also predicted quantities consumed among underage drinkers and both social supply and self‐reported purchase were associated with frequency of drinking and drunkenness. The ethnic status of young people also had an effect on consumption.     

Alcohol consumption, problem drinking, abstention and disability pension award. The Nord-Trøndelag Health Study (HUNT)

Aims To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption (‘sick‐quitting’) could explain some of the increased risk for DP among abstainers. Design Prospective population‐based study. Setting and participants Data were from two waves of the Nord‐Trøndelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37 729 (alcohol consumption) and 34 666 (problem drinking) participants. Measurements Alcohol consumption was measured by self‐reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye‐opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health‐related behaviour, socio‐economic status and social activity. Findings Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92–1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08–3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48–2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01–2.74) were at higher risk for DP than constant abstainers. Conclusions Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by ‘sick‐quitting’.     

Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men

Aims To evaluate the effectiveness of a brief intervention in hospitalized Taiwanese men to reduce unhealthy alcohol consumption. Design Randomized controlled trial. Setting Medical/surgical wards of a medical centre in Taipei, Taiwan. Participants Of 3669 consecutive adult male in‐patients, 616 were identified as unhealthy alcohol users (>14 drinks/week) and assigned randomly to either usual care (n = 308) or a brief intervention (n = 308). Measurements Primary outcomes were changes in alcohol consumption at 4, 9 and 12 months, including self‐reported weekly alcohol consumption, drinking days and heavy drinking episodes assessed by 7‐day time‐line follow‐back. Secondary outcomes were (i) self‐reported alcohol problems, (ii) health‐care utilization (hospital days and emergency department visits), (iii) self‐reported seeking of speciality treatment for alcohol problems and (iv) 3‐month Quick Drinking Screen. Findings Based on intention‐to‐treat analyses, the intervention group consumed significantly less alcohol than the control group among both unhealthy drinkers and the subgroup of alcohol‐dependent participants over 12 months, on both 7‐day and 3‐month assessments. Adjunctive analyses of only those who completed all assessments found that total drinks consumed did not remain significant. Significantly more participants with alcohol use disorders in the intervention than in the control group (8.3%, 19 of 230 versus 2.1%, four of 189) consulted specialists by 12 months (P = 0.01). However, alcohol‐related problems and health‐care utilization did not differ significantly in the two groups during follow‐up. Conclusions Data from Taiwan confirm that brief in‐hospital intervention can result in a reduction in alcohol intake by men who drink heavily or are diagnosed with an alcohol use disorder.     

The alcohol-related problems survey: identifying hazardous and harmful drinking in older primary care patients

OBJECTIVES: Older adults can incur problems at low levels of alcohol consumption because of age-related physiological changes, declining health and functional status, and medication use. We have developed and tested a screening measure specifically for older people, the Alcohol-Related Problems Survey (ARPS), to identify older adults with these risks. DESIGN: Survey. SETTING: Academic and community primary care clinics. PARTICIPANTS: Five hundred forty-nine current drinkers aged 65 and older, mostly white with high school or more education. MEASURES: Alcohol use was classified as harmful, hazardous, or nonhazardous depending upon consumption alone or combined with selected comorbidities and medication use. Harmful drinking (including alcohol abuse or dependence) means the presence of problems (e.g., hypertension, adverse drug events, legal problems) due to drinking. Hazardous drinking means risks for problems are likely. Nonhazardous drinking poses no known risks for problems. RESULTS: Eleven percent of subjects were harmful drinkers and 35% were hazardous drinkers. Harmful drinking was more common in men than women and in persons younger than 75 than those aged 75 and older. Similar proportions of men and women and younger and older age groups were hazardous drinkers. Most harmful drinkers were identified by their use of alcohol with their comorbidity, whereas most hazardous drinkers were identified by their use of alcohol with medications. Test-retest reliability was substantial (kappa = 0.65). CONCLUSION: Physicians are urged to screen for alcohol-related problems in older persons. The ARPS reliably identifies harmful, hazardous, and nonhazardous drinking in older adults resulting most often from the interaction between alcohol and disease and medication use.     

Lifetime drinking history in patients with alcoholic liver disease and patients with alcohol use disorder without liver disease

Objective: To determine the differences in lifetime alcohol intake (LAI) and drinking patterns between patients with alcoholic liver disease (ALD) and alcohol use disorder (AUD) without notable liver injury and between males and females with ALD.

Methods: Alcohol drinking patterns were assessed using the Lifetime Drinking History (LDH) a validated questionnaire, during an outpatient visit. Patients with AUD, currently in addiction treatment, were matched for gender and age (±5 years) with the ALD group.

Results: A total of 39 patients with ALD (26 males and 13 females; median age 58) and equal number of AUD patients were included (median age 56 years). The onset age for alcohol drinking and duration of alcohol consumption was similar in ALD and AUD. The number of drinking days was higher in women with ALD than in women with AUD: 4075 [(3224–6504) versus 2092 (1296–3661), p?=?.0253]. The LAI and drinks per drinking day (DDD) were not significantly different between patients with ALD and AUD. Females with ALD had lower LAI than males with ALD: 32,934 (3224–6504) versus 50,923 (30,360–82,195), p?=?.0385, fewer DDD (p?=?.0112), and lower proportion of binge drinking as compared to males with ALD (p?=?.0274).

Conclusions: The total LAI was similar in patients with ALD and AUD. The number of drinking days over the lifetime was associated with the development of ALD in females. Females with ALD had significantly lower alcohol consumption than men with ALD despite similar duration in years of alcohol intake which supports the concept of female propensity of ALD.     

Alcohol Consumption Among Older Adults in Primary Care

Background Alcohol misuse is a growing public health concern for older adults, particularly among primary care patients. Objectives To determine alcohol consumption patterns and the characteristics associated with at-risk drinking in a large sample of elderly primary care patients. Design Cross-sectional analysis of multisite screening data from 6 VA Medical Centers, 2 hospital-based health care networks, and 3 Community Health Centers. Participants Patients, 43,606, aged 65 to 103 years, with scheduled primary care appointments were approached for screening; 27,714 (63.6%) consented to be screened. The final sample of persons with completed screens comprised 24,863 patients. Measurements Quantity and frequency of alcohol use, demographics, social support measures, and measures of depression/anxiety. Results Of the 24,863 older adults screened, 70.0% reported no consumption of alcohol in the past year, 21.5% were moderate drinkers (1–7 drinks/week), 4.1% were at-risk drinkers (8–14 drinks/week), and 4.5% were heavy (>14 drinks/week) or binge drinkers. Heavy drinking showed significant positive association with depressive/anxiety symptoms [Odds ratio (OR) (95% CI): 1.79 (1.30, 2.45)] and less social support [OR (95% CI): 2.01 (1.14, 2.56)]. Heavy drinking combined with binging was similarly positively associated with depressive/anxiety symptoms [OR (95%): 1.70 (1.33, 2.17)] and perceived poor health [OR (95% CI): 1.27 (1.03, 1.57)], while at-risk drinking was not associated with any of these variables. Conclusions The majority of participants were nondrinkers; among alcohol users, at-risk drinkers did not differ significantly from moderate drinkers in their characteristics or for the 3 health parameters evaluated. In contrast, heavy drinking was associated with depression and anxiety and less social support, and heavy drinking combined with binge drinking was associated with depressive/anxiety symptoms and perceived poor health.