天津市城市居民对酒精滥用或依赖的认识

目的了解天津市城市居民对酒精滥用或依赖的认识情况。方法采用整群随机抽取720名城市社区居民,使用北京回龙观医院流行病学教研室编制的《公众自杀态度问卷》,调查居民对酒精滥用或依赖的认识。结果 520名居民完成了有效调查。其中75.9%听说过酒精滥用或依赖,43.7%认为该类患者是精神障碍,43.5%认为他们会自杀。不同性别、年龄、受教育年限在"是否听说过酒精滥用或依赖"及"对该类患者自杀的态度"等比较有显著性差异(P0.05)。结论城市居民对酒精滥用或依赖患者自杀危险认识不足,尚未充分认识到它是一种可以治疗的精神疾病。     

Assessing the ties of socioeconomic background and gender on the frequency and the type of alcoholic beverages consumed by French adolescents

Background: This study investigates the association of gender and standard of living with the consumption of alcoholic beverages by French adolescents.

Methods: Data were examined from a national survey conducted in 2005 on a representative group of French 17-year-olds (n?=?29?393). Three outcomes were considered: the frequency of alcohol consumption during the month prior the survey; the 14 alcoholic beverage types consumed, recoded into four major types (beer, wine, strong liquor, and other); and the different types of alcoholic beverages consumed. Standard of living was assessed using family occupational status (FOS) to determine the highest parental occupational category.

Results: Boys reported consuming a more diverse range of alcoholic beverages than girls and showed a greater propensity for beer and strong liquor. The gender difference tends to narrow with wine and champagne. Adolescents from higher FOS were less exposed to frequent drinking but reported greater diversity in alcoholic beverages consumed. Results support the concept of a social gradient for all considered beverage types. Adolescents from higher FOS levels favor wine consumption, which tends to be moderate.

Conclusion: The patterns of adolescent alcoholic beverage consumption precociously reflect those observed in the adult population. Prevention policies should take both socioeconomic and beverage types into consideration.     

Seizures in the alcohol-dependent patient: a diagnostic and therapeutic dilemma

Seizures are a common occurrence in patients who are dependent on alcohol. Diagnosis of the etiology of seizures in the alcohol-dependent patient is a difficult diagnostic problem. This paper reviews the diagnostic and therapeutic approach to seizures in the alcohol-dependent patient in the emergency department.     

Predictors of Alcohol Misuse and Abuse in Older Women

PURPOSE: To determine the predictive ability of self-report questions, physical measures, and biomarkers to detect alcohol misuse and abuse among older women. DESIGN AND METHODS: Healthy women volunteers age 60 and older who fit selection criteria were enrolled. The 135 participants were divided into nondrinkers (ND; n = 63) and drinkers (D; n = 72) based on self-reports of quantity and frequency of standard drinks consumed per month. The mean ages for the groups were 69.2 (ND) and 69.6 (D). FINDINGS: The best predictor was a score >0 on the T-ACE, a four-item instrument to detect alcohol abuse. Other significant predictors were: (a) behaviors: smoking, mixing over-the-counter (OTC) drugs with alcohol, heavy coffee drinking, using alcohol to sleep, and less sleep latency; and (b) biomarkers: higher mean corpuscular volume (MCV), hemoglobin (Hgb), hematocrit (Hct), and high-density lipoprotein cholesterol (HDL). The heaviest drinker subgroup had more physical stigmata, including broken blood vessels in nose and larger liver spans. CONCLUSIONS: The "best predictor model" showed that older women who were at risk for alcohol misuse or abuse had T-ACE scores of 1 or higher, used two or more OTC drugs regularly, drank large amounts of coffee, used alcohol to fall asleep, and had less sleep latency. Because positive T-ACE scores have high sensitivity and specificity for alcohol abuse, scores of 1 or greater should be addressed in clinical settings, e.g., referrals for more definitive diagnoses and relevant treatment.     

The alcohol expectancy construct: Overview and clinical applications

Recently there has been much research on cognitive factors in decisions to drink and responses to alcohol. Most of this research has concerned expectancies regarding alcohol effects, but much less attention has been paid to applying these data to clinical practice. In this paper, the potential clinical applications of current knowledge regarding expectancies, with emphases on assessment and intervention, are discussed. Problems of assessment are determining the nature and strength of alcohol expectancies, including their domains, situation specificity, and dose-related influences. Along these lines, representative scales are described. Three aspects of intervention, each pertaining to a phase of drinking behavior, are presented. The first area is initiation of drinking, when drinking decisions are presumed to be motivated by alcohol expectancies. Strategies for (a) attempting to change expectancies and (b) engaging in alternative behaviors to achieve desired, or expected, outcomes are described. The second area concerns the assessment and labeling of drinking effects, with a focus on tracking the relationship between alcohol use and expectancies over the course of a drinking event. The third area deals with subsequent drinking and clinically revolves around the application of altered expectancies to subsequent drinking in that episode or in future drinking situations. The relevance of alcohol expectancies to the maintenance of treatment gains and to the prevention of relapse also is discussed. Finally, throughout this paper there is an emphasis on identifying strategies for investigating clinically relevant questions about alcohol-related expectancies and drinking patterns.     

Where do adolescent recent drinkers obtain and use alcohol?

Background: Alcohol use among adolescents is a serious health issue in the United States. The purpose of the study is to determine factors associated with the locations and sources of last alcoholic beverages drank by adolescent recent drinkers. Method: A secondary data analysis of the NSDUH 2012 was performed including a sample of 2,321 recent alcohol users of 12–17 years of age nationwide. Results: Findings indicate someone else’s home was the top location for recent drinkers’ last alcoholic beverage. Regarding source, recent users report obtaining their last alcoholic beverage from someone not related to them who was older than 21 years. Several differences in location and source were found based on study variables. Discussion: Several variables were found to be associated with source and location of alcohol among adolescents. Expanding existing educational and social hosting programs to adults may be an important method of reducing adolescent access to alcohol.     

Lack of effect on blood alcohol level of swabbing venepuncture sites with 70% isopropyl alcohol

Objective: It is standard practice to clean the skin using a non‐alcohol‐containing swab before forensic blood alcohol sampling, because of the belief that the use of an alcohol‐containing swab will contaminate the sample. The present study aimed to determine whether cleaning the skin with 70% isopropyl alcohol swabs, before venepuncture, alters measured blood alcohol level (BAL). Methods: Volunteers aged >18 years had paired venous blood tests, which were drawn within 2 min of each other. One arm was swabbed with a 70% isopropyl alcohol swab and allowed to dry before venepuncture. The other was swabbed with saline, and these concurrent samples were used as controls. BAL was tested using the enzymatic method. Pathologists analysing the samples were blinded to the swabbing technique used. The mean differences and standard deviations of each of the paired samples were analysed using Student's t‐test. Results: Fifty‐six paired venous blood samples were obtained from volunteers. Mean BAL in the isopropyl alcohol‐swabbed group was 3.27 mg/dL with a standard deviation of 1.14 mg/dL. Mean BAL in the saline‐swabbed group was 3.41 mg/dL with a standard deviation of 1.11 mg/dL. The mean difference was 0.14 mg/dL, with a standard error of 0.157. There was no statistically significant difference between the groups. Conclusions: The present study demonstrated that the use of 70% isopropyl alcohol swabs does not significantly affect BAL when used before venepuncture. This has implications that challenge current forensic blood alcohol sample acquisition.     

To drink or not to drink: The differential role of alcohol expectancies and drinking refusal self-efficacy in quantity and frequency of alcohol consumption

Structural equation modeling was used to examine the relationships between alcohol expectancies (AE) and drinking refusal self-efficacy (DRSE) beliefs on the one hand, and quantity and frequency aspects of alcohol consumption on the other, in a sample of 118 undergraduate students. Specific expectancies that alcohol increases assertiveness and that the subject would have poor control over drinking were directly related to the consumption of larger quantities of alcohol per drinking occasion. Drinking refusal self-efficacy was related inversely to frequency of drinking: Subjects with high opportunistic DRSE and high social pressure DRSE drank less frequently. Females drank less per drinking occasion, drank less frequently, had a lower expectancy that alcohol increases assertiveness, expected to have greater control over their drinking, and had higher opportunistic DRSE than did males. The findings indicate that AE and DRSE play different roles in influencing the frequency and quantity of alcohol consumption. The implication of these findings for future research is discussed.We would like to acknowledge the expert statistical assistance given by Dr. David Chant and the support given by Ms Gabrielle Crook in the preparation of this paper.     

Breath analyzer screening of emergency department patients suspected of alcohol intoxication

Background

Acute alcohol intoxication is a frequent cause of emergency department (ED) visits. Evaluating a patient’s alcohol intoxication is commonly based on both a physical examination and determination of blood alcohol concentration (BAC).

Objective

To demonstrate the feasibility and usefulness of using a last-generation infrared breath analyzer as a non-invasive and rapid screening tool for alcohol intoxication in the ED.

Methods

Adult patients suspected of acute alcohol intoxication were prospectively enrolled over 10 days. Breath alcohol concentrations (BrAC) were measured using a handheld infrared breath analyzer. BAC was determined simultaneously by automated enzymatic analysis of a venous blood sample. The relationship between BAC and BrAC values was examined by both linear regression and Bland-Altman analysis.

Results

The study included 54 patients (mean age 40 ± 14 years, sex ratio M/F of 3/1). Breath and blood alcohol concentrations ranged from 0 to 1.44 mg/L and from 0 to 4.40 g/L (0–440 mg/dL), respectively. The mean individual BAC/BrAC ratio was 2615 ± 387, 95% confidence interval 2509–2714, which is 30% higher than the legal ratio in France (2000). The correlation between both measurements was excellent: r = 0.95 (0.92–0.97). Linear regression revealed BAC = 0.026 + 1.29 (BrAC × 2000) and BAC = 0.026 + 0.99 (BrAC × 2615). Mean BAC-BrAC differences and limits of agreement were 0.49 g/L [−0.35, 1.34] (or 49 mg/dL [−35, 134] and 0.01 g/L [−0.68, 0.71] (or 1 mg/dL [−68, 71]), for the 2000 and 2615 ratios, respectively.

Conclusion

The calculated conversion coefficient provided a satisfactory determination of blood alcohol concentration. Breath alcohol testing, using appropriate BAC/BrAC conversion, different from the legal BAC/BrAC, could be a reliable alternative for routine screening and management of alcohol intoxication in the ED.     

The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome

Objective: The goal of this review is to evaluate the efficacy and safety of carbamazepine and oxcarbazepine in treatment of alcohol withdrawal syndrome (AWS) and determine the role in therapy of both agents. Methods: Relevant literature was identified through a search of MEDLINE (1966–June 2008), PubMed (1966–June 2008); Cochrane database was performed to identify English‐language publications. Search terms included carbamazepine, oxcarbazepine, AWS, alcoholism, substance syndrome withdrawal. Results: In seven studies, including 612 patients, carbamazepine demonstrated significant reduction in alcohol withdrawal scores. However, in comparative trials with a benzodiazepine agent, carbamazepine’s ability to prevent alcohol withdrawal seizures (OR = 0·93; 95% CI = 0·06–14·97, P = NS) and delirium tremens (DTs; OR = 1·25; 95% CI = 0·28–5·64, P = NS) was uncertain as a result of insufficient patient enrolment. In three trials, carbamazepine failed to reduce alcohol withdrawal symptoms possibly as a result of delayed administration, inadequate dosage or inadequate sample size. At daily doses of 800 mg either fixed or tapered over 5–9 days, carbamazepine was well tolerated, and safely administered when blood alcohol concentration dropped below 0·15%. The role of oxcarbazepine in AWS is undefined because of inconsistent findings in two trials. Conclusion: Carbamazepine has demonstrated safety, tolerability and efficacy in treatment of moderate to severe symptoms of alcohol withdrawal in the inpatient setting. However, trials of carbamazepine provide inconclusive evidence for prevention of alcohol withdrawal seizures and DTs in comparison with benzodiazepines. Benzodiazepines remain the primary treatment of moderate to severe AWS.     

大学生控制饮酒行为对饮酒量的影响

目的了解大学生在日常饮酒过程中控制饮酒的行为,分析这些行为对饮酒量的实际控制效果。方法在某校2005-2008级学生中选择1413名进行饮酒情况及控制饮酒行为的问卷调查,并对调查结果进行量化评分,然后运用分层回归分析方法分析控制饮酒行为对实际饮酒量的影响。结果有近70％的学生承认在最近1个月周期内饮酒,最常采取的控制饮酒行为包括：饮酒前或饮酒中进食,记录饮酒量,避免赌酒。饮酒前或饮酒中进食、请朋友监督控制的方法不能有效控制饮酒量,而记录饮酒量、避免赌酒、尽量延长饮酒间隔时间则能对饮酒控制起到积极的作用。结论学校和社会应在加强宣传饮酒危害的同时探索一些有效方法以控制大学生的酒精摄入量,减少酒精对大学生的伤害,促进大学生建立健康的生活方式。     

Associations between alcohol-related concerns,normative perceptions of peer alcohol use,and veterans’ drinking behavior over six months

Abstract

The Veterans Health Administration (VHA) has implemented initiatives to increase rates of brief alcohol counseling (BAC). Half of eligible veterans do not receive such care. Understanding patient characteristics associated with drinking behavior may identify patients for whom BAC may be acceptable. Data collected from veterans between January 2010 and September 2011 (N?=?167) were examined. Results find that alcohol-related concerns and perceptions of peer alcohol consumption are associated with reduced drinking behavior. These findings suggests that assessing drinking concerns and perceptions of peer alcohol use may help to identify patients interested in changing drinking behavior, receiving care, and assist providers in delivering appropriate counseling.     

Prenatal alcohol consumption and knowledge about alcohol consumption and fetal alcohol syndrome in Korean women

The study investigated prenatal alcohol consumption and knowledge of alcohol risks and fetal alcohol syndrome among Korean women. The participants were 221 Korean women who attended the post-partum care centers in Seoul, Korea. The data included the participants' background characteristics, quantity-frequency typology, Student Alcohol Questionnaire, and a scale on the participants' knowledge of fetal alcohol syndrome. Alcohol was consumed during pregnancy by 12.7% of the participants. Of these, 60.7% drank alcohol with their spouse. A few participants reported that nurses identified their drinking habits and gave them information on alcohol consumption and fetal alcohol syndrome. Most of the participants did not have the opportunity for prenatal counseling about fetal alcohol syndrome. The knowledge level regarding alcohol risks and fetal alcohol syndrome among the participants was poor. Alcohol consumption before pregnancy was significantly related to prenatal alcohol consumption. Prenatal alcohol consumption was not related to knowledge about alcohol consumption and fetal alcohol syndrome. The assessment of alcohol consumption and counseling about alcohol are needed for pregnant women in order to prevent fetal alcohol syndrome.     

Population pharmacokinetics of alcohol on Chinese subjects using breath measures

What is known and Objective: Alcohol is a widely used drug. Our objective was to examine alcohol pharmacokinetics in Chinese subjects through the breath measurement of blood alcohol concentration (BAC) to identify any measurable covariates that may help explain variability between subjects. Methods: Breath‐alcohol measurements of 184 healthy Chinese subjects were collected. Compartmental models including one‐ and two‐compartment process were examined. First‐order kinetics was applied to model alcohol absorption and elimination phases. For the sake of simplicity, only the subject’s body weight, sex and stomach condition were investigated as covariates in our random effects modelling. Results and Discussion: The body as a whole behaves as a single compartment, with the suggested one‐compartment model being good enough to characterize the biological process. In line with other studies, food ingestion before/with the dose slowed down alcohol absorption into the central compartment. Female subjects exhibited a significantly higher BAC elimination rate than that of males. Body weight also contributed to the observed inter‐subject variability in alcohol clearance. What is new and Conclusion: We present a model for estimating blood–alcohol levels from breath‐alcohol measurements. The results of our study are useful particularly in relation to drink‐driving prosecutions because of the routine use of breath‐alcohol measurements as evidence in such cases through the world.     

The role of Muslim faith-based programs in transforming the lives of people suffering with mental health and addiction problems

Many countries have trouble addressing the dual problems of mental health and addiction because of their extremely conventional health care models. This is particularly true of the refugees and immigrant populations who are often part of religious minorities. The current study is based on qualitative, in-depth interviews with eight faith-based program volunteers. NVivo 10 was used to facilitate coding and analysis. The findings underscored the role of a faith-based project in making noticeable contributions that reduce the traditional stigma attached to addictions and mental health problems. This is the first study in Canada to particularly highlight addictions and mental health issues tackled by Muslims within their own community, and we capture the opinion of both practitioners and experts. As such, we build a foundation for future research in the field of substance use, harm reduction, and mental health issues in the Muslim community.     

Concept and risk factors of alcohol relapse in liver transplant recipients with alcohol-related aetiologies: A scoping review

Alcohol relapse in those who received liver transplantation (LT) for alcohol-related liver disease can lead to poor graft function, low medication adherence rates and decreased chances of survival. Numerous studies have evaluated on this topic; however, discrepancies in the meaning and measurement of ‘alcohol relapse’ lead to heterogeneous results. This scoping review aimed to explore the conceptual and operational definitions of alcohol relapse in LT recipients with alcohol-related aetiologies and to examine newly reported risk factors of alcohol relapse. Following the Arksey and O'Malley scoping review method and PRISMA guidelines, structured searches for articles published from 2012 to 2022 were conducted in PubMed, CINAHL, Embase, Cochrane and PsycINFO. Twenty-eight studies were included in the final review. Alcohol relapse was either defined as ‘any alcohol consumption’ or ‘a certain degree of alcohol drinking’ after transplantation. Discrepancies in the incidence rates persisted even within studies that shared the same conceptual definition. Commonly reported risk factors for alcohol relapse were younger age, social isolation and shorter abstinence periods before LT. Self-efficacy and post-transplant complications were newly identified risk factors in recent studies; whereas environmental factors such as external stressors were rarely included. The variance in the definition of alcohol relapse and inconsistent identification methods make it difficult to organize a structured interventional study. A standardized stratification of post-LT alcohol relapse behaviour is needed to prior to implementing interventions that employ a harm minimization approach. Cost-effective interventions promoting self-efficacy could enable the prevention and management of alcohol relapse after LT.     

Binge drinking trends in a UK community‐based sample

Aims To investigate binge drinking trends using unrelated singletons from the GENESiS sample, aged 20–60 years.

Methods The GENESiS study is a questionnaire study based in the UK and includes measures on various mental health items as well as measures of alcohol consumption. Alcohol data from 20?062 subjects were analysed with respect to binge/heavy drinking behaviour as defined by the Office for National Statistics, UK.

Results The average number of units of alcohol per week consumed was 16 for men and 8 for women. Female binge drinking (more than 6 units per drinking session) was found to be very comparable to male binge drinking (more than 8 units per drinking session) with 15% of males reporting binge drinking compared with 18% of females. Binge drinking was found to be most prevalent amongst males and females in their twenties (33% of males vs 38% of females).

Conclusions This study revealed that, for both men and women, there was evidence of substantial numbers drinking heavily and in a binge drinking pattern, particularly in young adults.     

Screening and Initial Management of Alcohol Misuse in Primary Care

Nurse practitioners play a vital role in the screening and management of alcohol use disorders in primary care. Despite the prevalence and health impact of alcohol misuse, and recommendations for use of regular screening, many providers report lack of preparation and confidence in the identification, treatment, and referral. Several validated and evidence-based screening, assessment, intervention, and treatment options are available, including the Alcohol Use Disorders Identification Test, Alcohol Use Disorders Identification Test-Consumption, and the single-question screen. Similar to screening for other adverse health behaviors, screening and brief intervention for alcohol misuse is a preventive service that nurse practitioners can provide to their patients.