AN OBSERVATIONAL STUDY OF YOUNG ADULTS' DRINKING GROUPS -- I. DRINK PREFERENCES, DEMOGRAPHIC AND STRUCTURAL VARIABLES AS PREDICTORS OF ALCOHOL CONSUMPTION

Two hundred groups were observed in bars catering for youngadults. Demographic, structural and drink preference factorsaccounted for about 30% of the variance in alcohol consumptionand about 20% of the variance in drinking rates. Among these,drink preferences were the best predictors — especiallyamong females. Female heavier drinkers tended to have drinkpreferences which are usually associated with males. Femaleswho consumed beer/lager — particularly those who consumedbeer/lager and spirits — tended to consume more alcoholand tended to have higher drinking rates than females who consumedspirits only. Other factors are also described and discussed. For example,members of same-sex groups tended to consume more alcohol; and,among males, group size was positively associated with alcoholconsumption and drinking rate. Suggestions that the ‘facilitatoryeffects’ of such structural factors are as important as‘drinking history’ in determining alcohol consumptionare questioned. Time spent in the bar accounted for 49% of the variance in alcoholconsumption. The art of appointing time and gracefully leavingbars may be an important skill.     

PATTERNS OF ALCOHOL USE AMONG UNIVERSITY STUDENTS IN SPAIN

A total of 545 university students in Valladolid, Burgos andPalencia (Spain) were surveyed in 1985 with regard to theirconsumption of alcohol. Alcoholic drinks were taken frequently(daily, 13.6% of the subjects; weekly, 66.2%; monthly, 71.3%),the per capita consumption being 8.4 litres of pure alcoholper year. Consumption was higher among males and during theweekend. Beer, wine and, among spirits, gin, were the favourites.Most students started drinking before the age of 18 (81.2%),most commonly taking alcoholic drinks when ‘going outin the evening’ (62.2%); their principal reason for drinkingwas ‘because the people I am with are drinking’(71.6%) and 52.8% admitted to having been drunk within their‘lifetime’. Most of the differences in patternsof alcohol consumption were related to sex, and more infrequentlywere related to the different faculties, cities and academicyears.     

SEVERITY OF ALCOHOL DEPENDENCE IN THE EAST END OF GLASGOW

A survey of 100 consecutive admissions for alcohol abuse in1990 highlights the severity of alcohol dependence in the EastEnd of Glasgow. The survey identifies a specific sub-group ofheavy drinkers who consume strong lager, usually in open spaces,referred to locally as ‘garden parties’. In thetotal population, males outnumbered females 3:1 with a meanconsumption of 268 and 230 units of alcohol per week, respectively.The severity of alcohol abuse was reflected in their social,physical and central nervous system complications. Two-thirdsof the population had a family history of alcohol abuse. Overthree-quarters of the population showed self neglect with nearlyhalf the males ascribing their marital breakdown or family neglectdirectly to their drinking problem. Both sexes showed a highprevalence of history of paraesthesiae, while half the malepopulation had clear signs of peripheral neuropathy on admission.A history of delirium tremens in over 50% of the populationwith a history of seizures in 21% of males and 35% of femalesindicates central nervous system involvement. Three sub-groupswere identified: history of delirium tremens, history of persecutoryideation and history of serious criminality. All three sub-groupshad a shorter length of drinking with higher consumption andincreased frequency of ‘garden parties’ than thegroup as a whole. This survey reinforces the need for appropriatein-patient detoxification and rehabilitation facilities forpatients with severe alcohol dependence, to reduce their impacton other health, social work and criminal justice services.     

PATTERNS OF ALCOHOL CONSUMPTION AMONG THE GENERAL POPULATION OF CASTILE AND LEON (SPAIN

A total of 2500 individuals, aged 14–70, who live in Castileand Leon (Spain), were surveyed in the spring of 1989 with regardto their alcohol consumption and its patterns. Among those surveyed26.2% were 'daily' drinkers and 66.0% ‘weekly’ drinkers.Differences of alcohol use (frequency) and intake were reviewedwith regard to sociodemographic factors such as gender, age,and marital status. Beer (52.6%) was the favourite drink, withwine (20.6%) the second most commonly consumed alcohol beverage.Most of those surveyed (54.6%) were ‘light’ drinkers(1–39 g/day of pure alcohol), while 3.0% had an intakeof over 80 g/day (‘heavy’ drinkers). The averageage at which they started drinking was 16 2 years The resultsallow a better understanding of the pattern of alcohol consumptionin Spain.     

ALCOHOL CONSUMPTION AND THE PERCEIVED SITUATIONAL APPROPRIATENESS OF CONSUMING DIFFERENT TYPES OF ALCOHOLIC BEVERAGES

Based on a 1986 national probability sample of 2401 Americansaged 21 years and over (1069 of whom were deemed ‘drinkers’on the basis of having drunk at least one alcoholic beveragein the past seven days), this study analyses the relationshipbetween respondents' perceptions of how appropriate it is toconsume either beer, wine, distilled spirits, or wine coolersin each of six social contexts (namely, at a bar, at a bailgame,‘when the party's really rolling’, at a celebration,as a perfect complement to a nice dinner, and after a particularlyrough, i.e. difficult, day) and subsequent alcohol consumptionby these same individuals. It was hypothesized that people who considered it appropriateto drink a given beverage type would drink more of that beveragethan those individuals who deemed consumption of that type ofalcohol to be inappropriate. Results indicated that this isvalid for certain of the social occasions, in terms of the useof beer, distilled spirits and wine. Wine cooler consumption,however, was found to be unrelated to people's perceptions ofhow appropriate it is to drink in different social situations.     

OUT-PATIENT ALCOHOL DETOXIFICATION--OUTCOME AFTER 2 MONTHS

We assessed the outcome after 2 months of 28 alcohol-dependentsubjects following out-patient detoxification using an uncontrolledfollow-up study with data collected at the time of detoxification(T1) and after 2 months (T2). We also determined the cost ofout-patient versus in patient detoxification. The setting wasa psychiatric emergency clinic at a South West London UniversityHospital. Self-reported alcohol consumption in the week beforeT1 and T2, score on the ‘Alcohol Problems Inventory’measuring alcohol-related relational, occupation, legal andmedical problems in the 2 months prior to T1 and T2, mean corpuscularvolume and gamma-glutamyl transferase at T1 and T2 were usedas outcome measures. Eight subjects had a ‘good’outcome (seven were abstinent and one only drank four unitson one day). Nine subjects were ‘improved’ by eitherhalving their alcohol consumption, or halving their ‘AlcoholProblems Inventory’ score at T2. ‘Good’ and‘improved’ outcome were confirmed by mean corpuscularvolume and gamma-glutamyl transference results. Eleven subjectswere ‘not improved’. Engagement following detoxificationwith voluntary alcohol agencies was associated with a betteroutcome. In-patient detoxification is calculated to be six timesmore expensive than out-patient detoxification. Out-patientdetoxification is a cost-effective step in the treatment ofalcohol-dependent patients.     

FETAL ALCOHOL SYNDROME: THE 'AMERICAN PARADOX'

Nearly all cases of fetal alcohol syndrome (FAS) identifiedin prospective epidemiological studies have been conducted inthe United States of America. The very high incidence rate forFAS in the USA and the relatively low rate in other countriesdoes not correspond to measures of alcohol consumption. By analogywith the ‘French paradox’, we have termed the highrate of FAS in the USA coupled with its relatively low levelof alcohol consumption, the ‘American paradox’.     

PREVENTION OF ALCOHOL ABUSE-RELATED BIRTH EFFECTS -- I. PUBLIC EDUCATION EFFORTS

Maternal alcohol abuse during pregnancy can result in a patternof anomalies in children called ‘fetal alcohol syndrome’(FAS) and more recently, ‘fetal alcohol abuse syndrome(FAAS)’. FAAS as well as individual alcohol-related anomalies,called ‘alcohol abuse-related birth effects’ (AARBEs),are widely considered to be totally preventable, because theystem from a behaviour that is presumably modifiable. However,current strategies to reduce their occurrence are more palliativethan preventive, because their underlying premise, viz, thatraising public awareness of the potential dangers of commonlyused substances such as alcohol is enough to reduce their use,lacks empirical support. Moreover, in some cases they are alsocounter-productive. After considenng the relevant literature,this review contends that ‘universal’ public educationefforts will only be effective in reducing FAAS and AARBEs ifthey focus on the cause of these disorders, which is alcoholabuse rather than the currently open-ended message that anyamount of alcohol consumption during pregnancy constitutes adanger to an unborn child. This argument lays the ground workfor an alternative and more pragmatic strategy set forth inthe following paper for preventing FAAS and AARBEs.     

Using the Theory of Planned Behavior to Explain the Drinking Motivations of Social,High-Risk,and Extreme Drinkers on Game Day

This study assessed the extent to which the Theory of Planned Behavior (TPB) correctly predicted college student’s motivation to consume alcohol on game day based on alcohol consumption rates. Three cohorts of 1,000 participants each (N = 3,000) were randomly selected and invited to complete an anonymous web-based survey the Monday following one of three designated college home football games. Path analyses were conducted to determine which of the TPB constructs were most effective in predicting Behavioral Intention and alcohol consumption among social, high-risk, and extreme drinkers. Social drinkers, high-risk, and those drinkers who engage in Extreme Ritualistic Alcohol Consumption (ERAC) were defined as males who consumed 1–4, 5–9, or 10 or more drinks on game day (1–3, 4–8, or nine or more drinks for females), respectively. Attitude Towards the Behavior and Subjective Norm constructs predicted participant’s intentions to consume alcohol and corresponding behavior among all three classifications of drinkers; whereas the Perceived Behavioral Control (PBC) construct inconsistently predicted intention and alcohol consumption. Based on Behavioral Intention, the proportion of variance the TPB model explained decreased as participants alcohol consumption increased. It appears that the TPB constructs Attitude Toward the Behavior and Subjective Norm can effectively be utilized when designing universal prevention interventions targeting game day alcohol consumption among college students. However, the applicability of the PBC construct remains in question. While select constructs in the TPB appear to have predictive ability, the usefulness of the complete theoretical framework is limited when trying to predict high-risk drinking and ERAC. These findings suggest that other behavioral theories should be considered when addressing the needs of high-risk and extreme drinkers.     

A GOOD MAN'S FAULT: ALCOHOL AND IRISH PEOPLE AT HOME AND ABROAD

Long-standing stereotypes portray Irish people as prone to usealcohol to excess. This review traces the historical originsof those stereotypes, and examines evidence drawn from a rangeof secondary sources in Ireland and Britain about alcohol consumption,attributed hospital admissions and mortaliiy. The availabledata indicate that the ‘problem’ of Irish drinkingand Irish attitudes to alcohol are not as straightforward astraditionally supposed. Far from the stereotypical image ofthe Irish embodied in the ubiquitous drunk male labourer, ratesof abstinence from alcohol are higher in Ireland than in Britain.Amongst migrants, the Irish are no more likely to consume alcoholthan the indigenous population. However, those Irish peoplewho do drink alcohol do so at generally higher levels than theirBritish bom counterparts. Analysis of combined years' data fromthe General Household Survey indicates first that people ofIrish birth or parentage are no more likely than the Britishborn to use alcohol at all. However, if they make use of alcoholat all, members of the Irish groups were more likely than theBritish born to consume alcohol at levels greater than 14 or21 units per week. Both the review and the data presented suggestthat a more complex understanding of the dynamics and natureof Irish drinking needs to be developed.     

WHEN ALCOHOLICS DRINK AFTERSHAVE: A STUDY OF NONBEVERAGE ALCOHOL CONSUMERS

A one-year prospective study was conducted to describe nonbeveragealcohol (NBA) consumption (the use of substitutes for traditionalforms of ethanol) among alcoholics. It was found that 11% ofinpatient alcoholics at a veterans' hospital and 8.6% of alcoholicsat a community hospital had consumed NBA. Substances consumedranged from toiletries to organic solvents, often in quantitiesexceeding the theoretical lethal dose. ‘Ready availability’was cited as the primary reason for consumption. Social, demographicand psychiatric parameters were then compared between 48 VAalcoholics who used NBA and 48 nonusing alcoholics. No socialor demographic differences were found, but NBA drinkers drankmore alcohol (P < 0.0001), had higher global alcoholic severityscores (P < 0.0001), more severe withdrawal symptoms (P <0.0001), and a higher frequency of antisocial personality disorder(P = 0.009) and drug abuse (P = 0.005). When NBA drinkers weresubdivided by quantity of NBA consumption and recency of latestingestion, no social or psychological differences were foundbetween groups, except for more frequent and heavier illicitdrug use among ‘heavy’ NBA consumers (P < 0.0001).     

PREVALENCE OF ALCOHOL PROBLEMS IN GENERAL PRACTICE: AN EXPERIENCE FROM SOUTHERN ITALY

The Michigan Alcoholism Screening Test (MAST) and the responseto a question about heavy alcohol consumption were used to assessthe prevalence of alcohol problems in consecutive patients (77males and 46 females) consulting a general practitioner in anurban area in the South of Italy (Castellammare di Stabia).Alcohol problems, which were defined by a cut-off score of 5on the MAST and/or by heavy alcohol consumption (correspondingto at least 60 g of ethanol daily for males and 36 g of ethanoldaily for females for at least 2 years), were identified in54 patients [43.9%: 95% confidence interval (CI) 35.0–53.1%].45 males (58.4%. 95% Cl 46.6–69.6%) and nine females (19.6%.95% CI 9.4–33.9%). The prevalence of MAST positive patientswas 32.5% (95% CI 24. 4–41.6%) in the total patient sample.45.5% (95% CI 34.1–57.2%) among males and 10.9% (95% CI3.6–23.6%) among females. The question about heavy alcoholconsumption had a predictive negative value of 97.2% (95% CI90.2–99.7%) and a predictive positive value of 73.1 %(95% CI 59.0–84.4%) in relation to MAST positive patients.It is suggested that general practitioners should incorporatethis question about heavy alcohol consumption as a screeningquestion in order to detect alcohol problems and give adviceregarding reduction of alcohol consumption.     

RACIAL DIFFERENCES IN ALCOHOL SENSITIVITY

The existence of racial differences in alcohol sensitivity betweenOriental and Caucasian populations has been well documented.The primary manifestation is a highly visible facial flushing(47–85% in Orientals vs 3–29% in Caucasians) accompaniedby other objective and subjective symptoms of discomfort. Evenamong different Oriental groups, subtle differences in the flushingresponse and alcohol consumption can exist. North and SouthAmerican Indian populations differ in phenotypes for alcoholdehydrogenase and aldehyde dehydrogenase, but systematic studiescomparing degree of flushing, alcohol elimination rates andblood acetaldehyde levels in these populations are lacking.Although flushing does not automatically ‘immunize’an individual against alcohol use, those susceptible tend toconsume less alcohol, at least in Orientals. However, the flushingphenomenon cannot be the sole explanation for differences inincidences of alcoholism among different racial groups. Socio-cultural,environmental and genetic factors also have to be considered.An increased incidence of flushing has been found to associatewith a familial risk of development of future alcoholism ina Caucasian population. It remains to be determined whetherthe same is true in Orientals. Most biochemical investigationsof the flushing phenomenon have focused on aspects of alcoholmetabolism. Based on recent findings, a convincing mechanismis the higher accumulation of acetaldehyde in flushing subjectsbecause they have an unusual, less-active liver aldehyde dehydrogenaseisozyme (ALDHI). The possibility that an ‘atypical’alcohol dehydrogenase, which is present in 85–90% of Orientalsubjects, can contribute to increased blood acetaldehyde levelsin flushing subjects cannot be ruled out. Based on results ofa small number of pedigree studies which demonstrated familialresemblances in flushing, a pharmacogenetic defect in ALDHIhas been proposed to be responsible for flushing. Other possiblebiochemical mechanisms (e.g. prostaglandins) and genetic defectsneed to be investigated.     

LONGITUDINAL COMPARISON OF CARBOHYDRATE-DEFICIENT TRANSFERRIN AND GAMMA-GLUTAMYL TRANSFERASE: COMPLEMENTARY MARKERS OF EXCESSIVE ALCOHOL CONSUMPTION

The utility of carbohydrate-deficient transferrin (CDT) andgamma-glutamyl transferase (GGT) as biochemical markers of excessivealcohol consumption was studied in alcohol-dependent subjects.Serum samples were collected once weekly from 10 male out-patientsundergoing a 6-month alcohol treatment programme. Frequencyof relapse into drinking (defined as any intake of alcoholicbeverage) was assessed by self-reports during patient interviewsthree times per week and by daily determination of the 5-hydroxytryptophollevel in urine. A marked decrease in mean CDT and GGT valueswas observed during the initial month. Only one patient remainedtotally abstinent throughout the observation period, while fourhad sporadic relapses (2–5 days with alcohol consumption).Both CDT and GGT remained below the respective reference limitsin those patients. The other five patients drank more frequently(range 22–57 days) and increased their mean levels ofCDT and GGT after the initial decrease. As determined from thevalues at admission and during the course of the study, CDTappeared to be the most sensitive marker in six out of the 10patients. In one patient, both markers were affected in a parallelway, whereas two of those with frequent relapses responded toalcohol consumption with a marked increase in GGT, but withno or only a slight increase in CDT. One patient did not showany abnormal CDT or GGT values. In 54 female and 60 male serumsamples collected at random from patients during admission atan alcohol detoxification unit, 35% and 58% of the CDT valuesexceeded the reference limits for females and males, respectively.For GGT, 59% of the female and 67% of the male values were abovecut-off. Carbohydrate-deficient transferrin and GGT were notsignificantly correlated. Taken together, the present resultsindicate that measurement of both CDT and GGT will increasethe possibility of identifying excessive alcohol consumption.By following changes in CDT and GGT values during a period ofalcohol withdrawal, the most sensitive individual marker canbe determined. This in turn allows for improved detection ofrelapse into heavy drinking dunng long-term monitoring of out-patients.     

Reported alcohol consumption, and attitudes of managerial and non-managerial employees, in a study of five industries on Clydeside

In a study of five major employers on Clydeside, individualinterviews were conducted with 576 employees. During each interview,the respondent filled in two self-completion questionnaires,each employing the same twelve semantic-differential items.In the first questionnaire, respondents described the peoplewho worked at the same level in the firm as themselves. In thesecond, those in management positions described the lower workforce,and these latter described those in management positions. Answerswere subjected to principal components analysis followed byVarimax rotation; then factor scores were derived for five ‘drinking’groups according to reported alcohol consumption. Results suggestedthat managers who drank most heavily tended to make the mostfavourable judgements of the lower workforce, and also ratedthe lower workforce as not especially tough. On the other hand,a group of abstinent managers made certain unfavourable judgementsof the lower workforce, and also made the most extreme ‘toughness’judgements. If such findings were found to be general, a possibleconclusion is that any alcoholism campaign in industry mightbenefit from the recruitment of at least some heavy-drinkingmanagers, since these seem to be favourably disposed to thelower workforce. Because the study possibly has broader implicationsfor industry generally, replication studies in different geographicalareas are of considerable importance.In a study of five majoremployers on Clydeside, individual interviews were conductedwith 576 employees. During each interview, the respondent filledin two self-completion questionnaires, each employing the sametwelve semantic-differential items. In the first questionnaire,respondents described the people who worked at the same levelin the firm as themselves. In the second, those in managementpositions described the lower workforce, and these latter describedthose in management positions. Answers were subjected to principalcomponents analysis followed by Varimax rotation; then factorscores were derived for five ‘drinking’ groups accordingto reported alcohol consumption. Results suggested that managerswho drank most heavily tended to make the most favourable judgementsof the lower workforce, and also rated the lower workforce asnot especially tough. On the other hand, a group of abstinentmanagers made certain unfavourable judgements of the lower workforce,and also made the most extreme ‘toughness’ judgements.If such findings were found to be general, a possible conclusionis that any alcoholism campaign in industry might benefit fromthe recruitment of at least some heavy-drinking managers, sincethese seem to be favourably disposed to the lower workforce.Because the study possibly has broader implications for industrygenerally, replication studies in different geographical areasare of considerable importance.     

BIOCHEMICAL MARKERS OF ALCOHOL USE AND ABUSE: EXPERIENCES FROM THE PILOT STUDY OF THE WHO/ISBRA COLLABORATIVE PROJECT ON STATE AND TRAIT MARKERS OF ALCOHOL

The development of reliable diagnostic tools for assessing alcoholismand harmful alcohol consumption is an utmost necessity for thesuccess of efforts to prevent and treat alcohol-induced damageto both individuals and to society. A multinational study isunderway to aid in the development of biological screening tools(state markers) which can, with good sensitivity and specificity,identify problem drinkers. To attain this goal information needsto be available on an individual's drinking history and habitsand related factors. A detailed instrument has been developedto obtain this information. The second goal of the study wasto begin to develop diagnostic ‘trait markers’ whichprovide biological information on genetically determined predisposingand protective factors in the development of alcoholism. Thedeveloped questionnaire also provides background informationon subject characteristics necessary for the development oftrait markers. Centres will assay the obtained biological samplesfor ‘traditional’ and newly identified state markersof excessive alcohol consumption. These will include methanolmeasurements, gamma-glutamyltransferase, aspartate aminotransferase,carbohydrate-deficient transferrin, serotonin metabolite ratios,and erythrocyte aldehyde dehydrogenase. DNA obtained from thelymphocytes of subjects will be assayed for polymorphisms ofalcohol- and aldehyde-metabolizing enzymes and dopaminc receptorpolymorphisms which can provide insights into protective andpredisposing factors in alcoholism. The platelet enzymes, monoamineoxidase and adenylyl cyclase, will be assayed to assess therelationships between these putative trait markers and the geneticand environmental factors contributing to the aetiology of alcoholism.The current report is meant to introduce the study design andpresent a portion of the preliminary data gathered in the processof establishing this research programme.     

ALCOHOL CONSUMPTION OF UNDERGRADUATES AT OXFORD UNIVERSITY

At the end of the fourth week of the spring term 1982, 734 femaleand 754 male undergraduates at Oxford University were sent aquestionnaire inquiring about their alcohol consumption. Ofthe 561 women and 522 men who replied, 80% and 85% respectivelyhad drunk alcohol during the previous four days. The mean consumptionover the four days was 8 units (equivalent to four pints ofbeer) for the women and 15 units (equivalent to eight pintsof beer) for the men. Two-fifths of the alcohol consumed bywomen was in the form of wine and three-fifths consumed by menwas in the form of beer. Sixteen per cent of female drinkersand 28% of male drinkers did try to limit or cut down theirdrinking although only four women and seven men consulted adoctor or a counsellor about their alcohol consumption. Studenthealth services should be aware that alcohol may play a partin health or personal problems. Undergraduates might appreciatehealth education literature on alcohol.     

ASSESSING ALCOHOL CONSUMPTION IN GENERAL PRACTICE PATIENTS--A COMPARISON BETWEEN QUESTIONNAIRE AND INTERVIEW (FINDINGS OF THE MEDICAL RESEARCH COUNCIL'S GENERAL PRACTICE RESEARCH FRAMEWORK STUDY ON LIFESTYLE AND HEALTH)

A self-administered questionnaire, the Health Survey Questionnaire(HSQ) was distributed to patients registered with 47 group generalpractices. The HSQ assesses alcohol consumption using a quantityfrequency scale and includes the four CAGE questions and a questionon whether respondents think they have an alcohol problem. Arandom stratified sample of those patients who returned an HSQ(2666 men and 1537 women) were subsequently invited to attendtheir general practice for an interview with the practice nurse,where weekly alcohol consumption was estimated using both aquantity frequency scale and a systematic enquiry about alcoholconsumption for the week immediately preceding the interview.The latter method was taken as the ‘gold standard’.Excessive drinkers were defined as men whose weekly consumptionby this method was not less than 35 units per week and womendrinking at least 21 units per week. After weighting the results to take account of the samplingbias in favour of the excessive drinkers, 11.7% of men and 2.9%of women were excessive drinkers according to the estimate ofalcohol consumption at interview. This compares with the 7.6%of men and 2.7% of women who were heavy drinkers by the HSQquantity frequency scale. The two interview estimates were comparable but in general theHSQ tended to underestimate consumption compared with theseestimates. The questionnaire was found to be most effective in screeningfor excessive drinkers if all the patients who indicated concernabout their drinking (i.e. those who were with CAGE positiveor had a self-assessed drinking problem), as well as all ofthose who were above the limits for the trial on the quantityfrequency scale, were selected as being potentially excessivedrinkers. In the weighted sample, 14.8% of men and 6.9% of womenwere in this group. Using these selection critena and takingthe interview as the standard for determining the excessivedrinkers a sensitivity of 58.6% and specificity of 91.08% wasobtained for men, with a positive predictive value of 46.1%and a negative predictive value of 94.3%. For women the testwas more sensitive (69.7%) and more specific (95.0%) and hada better negative predictive value (99.1%) than for men. Thepositive predictive value for women at 29.6% was not as goodas that obtained for men. This analysis shows that the HSQ is a fairly effective toolfor detecting excessive drinkers in general practices with asmall proportion of false positive results. It is both economicaland acceptable to patients in a wide range of practice settings.     

THIAMINE DEFICIENCY AS PREDISPOSITION TO, AND CONSEQUENCE OF, INCREASED ALCOHOL CONSUMPTION

It was found that the activity of the marker thiamine-dependentenzyme, transketolase (TK), was decreased (down to 61–79%of control) in blood, liver and brain of inbred rats followinga 6-month consumption of 15% ethanol as their only source ofdrinking fluid. After ethanol withdrawal, the enzyme activitywas gradually restored, but did not reach the control valuesuntil 1 month following cessation of alcohol consumption. Moreover,in rats preferring ethanol, the decrease of TK activity wasmore pronounced than in water-preferring rats. Another experimentshowed that thiamine deficiency induced by the thiamine antagonist,oxythiamine (200mg/kg), led to a prolonged increase of the preferentialintake of ethanol solutions in inbred rats. Significantly lowerliver TK activities and thiamine pyrophosphate content werefound in Finnish AA line rats as opposed to ANA line rats whichhad been obtained by selective outbreeding for high and lowvoluntary alcohol intake, respectively. Significantly lowerTK activity was also found in the whole brain (89%), cerebellum(79%) and pons-medulla oblongata (87%) of AA rats as comparedto ANA animals. Our own findings and the literature data confirmthe hypothesis that thiamine deficiency can be both predisposingto, and a consequence of, increased alcohol consumption.     

THE SWEDISH ALCOHOL USE INVENTORY (AVI), A SELF-REPORT INVENTORY FOR DIFFERENTIATED DIAGNOSIS IN ALCOHOLISM

AVI is a self-report inventory intended for standardized anddifferentiated assessment and diagnosis in alcoholism; it includes75 items adapted from Horn and Wanberg's Alcohol Use Inventory(AUI) and an assessment of the alcohol intake during a typicalweek of heavy drinking. The drinking profile is presented infive second-order factor scales: ‘alcohol abuse’,‘psychological benefits’, ‘interpersonal complications’,‘social drinking’ and ‘daily drinking’and in 17 first-order factor scales. The reliability and specificityof the scales are satisfactory. Preliminary norms based on asample of more than 600 alcoholic patients are available. Usingthe original American scoring and norms the results indicateimportant similarities in the alcoholism pattern between Swedenand the U.S.A.