Patterns of alcohol consumption and social consequences. Results from an 8-year follow-up study in Switzerland

Aims. (1) To estimate the impact of drinking patterns on negative social (behaviour) consequences. (2) To test for the additional impact of overall volume of alcohol consumed on these social consequences. (3) To explore whether the impact on social consequences of drinking patterns is comparable for measures that do and do not explicitly mention alcohol consumption. Design and setting. An 8-year follow-up to a 1987 study of the Swiss general population carried out through face-to-face interviews; the follow-up data presented in this article was collected in 1995 through a mailed questionnaire. Participants. Nine hundred and fifty-three respondents from the 1987 survey who also completed the mailed questionnaire in 1995. Measurements. Variables used were as follows: volume of drinking, eight drinking patterns differentiated by volume and frequency, four social consequences without mention of alcohol and six with mention of alcohol. All multivariate analyses control for sex, age and linguistic region. Findings. High volumes of drinking per occasion predicted negative social consequences independently of overall drinking volume. This finding was independent of explicit mention of alcohol in item formulation. For unemployment and accidents, if assessed independently of alcohol consumption, no significant relationship with either overall volume of drinking or drinking pattern was observed. Conclusions. Patterns of alcohol consumption are an important determinant of social problems. Future research with better design is necessary to establish their exact risk relations with different social consequences.     

Drinking games and contextual factors of 21st birthday drinking

Background: 21st birthday celebrations are among the highest risks for alcohol use throughout emerging adulthood and celebrants often experience a range of alcohol-related consequences. Objectives: The present research considered what happens when drinking games are paired with an already high-risk event (i.e., 21st birthday celebrations) and how drinking games compare with other contextual factors on 21st birthdays. Methods: Approximately four days after turning 21, 1124 college students (55% women) completed an online survey assessing alcohol use and related consequences experienced during their birthday celebrations. Participants were also asked whether drinking games and other contextual factors were associated with their celebrations. Results: Overall, 18% of participants reported playing drinking games during their 21st birthday celebrations. These individuals reported consuming more alcohol, had higher estimated BACs, and experienced more negative consequences than those who did not play drinking games. The association between playing drinking games and alcohol use and negative consequences was stronger for men. The effect of drinking games on negative consequences was mediated through elevated BAC levels. Receiving bar specials, having drinks purchased, playing drinking games, and loud music were uniquely and significantly associated with all alcohol outcomes. Conclusion: Together, these results suggest that drinking games are part of a larger context of risk contributing to extreme drinking on 21st birthdays. Furthermore, these results will help to facilitate interventions that are more individually tailored to target specific contextual risks, behaviors, and events.     

Drinking game play among first-year college student drinkers: An event-specific analysis of the risk for alcohol use and problems

Background: College students who play drinking games (DGs) more frequently report higher levels of alcohol use and experience more alcohol-related harm. However, the extent to which they are at risk for increased consumption and harm as a result of DG play on a given event after accounting for their typical DG participation, and typical and event drinking, is unclear. Objectives: We examined whether first-year students consumed more alcohol and were more likely to experience consequences on drinking occasions when they played DGs. Methods: Participants (n?=?336) completed up to six web-based surveys following weekend drinking events in their first semester. Alcohol use, DG play, and consequences were reported for the Friday and Saturday prior to each survey. Typical DG tendencies were controlled in all models. Typical and event alcohol use were controlled in models predicting risk for consequences. Results: Participants consumed more alcohol on DG versus non-DG events. All students were more likely to experience blackout drinking consequences when they played DGs. Women were more likely to experience social-interpersonal consequences when they played DGs. Conclusion: DG play is an event-specific risk factor for increased alcohol use among first-year students, regardless of individual DG play tendencies. Further, event DG play signals increased risk for blackout drinking consequences for all students, and social-interpersonal consequences for women, aside from the amount of alcohol consumed on those occasions as well as typical drinking behaviors. Prevention efforts to reduce high-risk drinking may be strengthened by highlighting both event- and person-specific risks of DG play.     

Age,Alcohol Consumption and the Experiencing of Negative Consequences of Drinking in Four Scandinavian Countries1

Based on data from a comparative survey of drinking in four Scandinavian countries (Finland, Iceland, Norway and Sweden), use of alcohol and negative consequences of drinking were studied in relation W age. Clear differences were found between age-groups as regards experiencing such negative consequences in respect of both men and women. These differences were to a large extent a reflection of similar differences between the age-groups in regard to alcohol consumption and intoxication frequency. However, it was also found that when both alcohol consumption and intoxication frequency were maintained at a constant level, age in itself seemed to influence the experiencing of negative consequences. The study also indicates that in all age-groups there are national differences in drinking patterns and thus in the experiencing of negative consequences of drinking which do not reflect the national differences in total alcohol consumption.     

Adverse Drinking-Related Consequences Among Lower Income, Racial, and Ethnic Minority Drinkers: Cross-Sectional Results

Objective:  To examine factors associated with adverse consequences of alcohol consumption among a community sample of drinkers in a low-income, racial, and ethnic minority community.
Methods:  A sample of 329 drinkers was recruited from 17 randomly selected off-sell alcohol outlets in South Los Angeles. Respondents were interviewed by trained research personnel on their demographic characteristics, income, drinking patterns and preferences, and alcohol-related adverse consequences (using the Drinkers Inventory of Consequences—DrInC), among other items. We developed logistic regression models predicting high scores on DrInC total score and subscales (impulse control, interpersonal, intrapersonal, physical, and social responsibility).
Results:  In this sample, we found drinking patterns—bingeing, drinking outdoors, drinking in the morning—to be significantly associated with total DrInC scores and some subscales. Malt liquor beverage (MLB) use was significantly associated with total DrInC score and interpersonal and social responsibility subscales. Previous alcohol treatment predicted all but 1 DrInC subscale and total score.
Conclusions:  A diverse array of factors predicted high DrInC total and subscale scores. More research on the association between MLB use and consequences is required. In addition, studies with community samples are likely to further enrich our understanding of the interactions between drinking patterns and preferences, settings, and negative consequences.     

The association between drinking motives and alcohol‐related consequences – room for biases and measurement issues?

Aims To investigate whether the predominant finding of generalized positive associations between self‐rated motives for drinking alcohol and negative consequences of drinking alcohol are influenced by (i) using raw scores of motives that may weight inter‐individual response behaviours too strongly, and (ii) predictor‐criterion contamination by using consequence items where respondents attribute alcohol use as the cause. Design Cross‐sectional study within the European School Survey Project on Alcohol and other Drugs (ESPAD). Setting School classes. Participants Students, aged 13–16 (n = 5633). Measurements Raw, rank and mean‐variance standardized scores of the Drinking Motives Questionnaire—Revised (DMQ‐R); four consequences: serious problems with friends, sexual intercourse regretted the next day, physical fights and troubles with the police, each itemized with attribution (‘because of your alcohol use’) and without. Findings As found previously in the literature, raw scores for all drinking motives had positive associations with negative consequences of drinking, while transformed (rank or Z) scores showed a more specific pattern: external reinforcing motives (social, conformity) had negative and internal reinforcing motives (enhancement, coping) had non‐significant or positive associations with negative consequences. Attributed consequences showed stronger associations with motives than non‐attributed ones. Conclusion Standard scoring of the Drinking Motives Questionnaire (Revised) fails to capture motives in a way that permits specific associations with different negative consequences to be identified, whereas use of rank or Z‐scores does permit this. Use of attributed consequences overestimates the association with drinking motives.     

Gender differences in the relationships between multiple measures of alcohol consumption and physical and mental health

BACKGROUND: Epidemiological research examining health consequences of alcohol consumption generally relies on average volume consumed, yet examinations of drinking patterns show different dimensions of use associated with different health outcomes. Gender differences in metabolism and body composition may lead to gender-specific consequences of drinking frequency, quantity consumed per occasion, average amount consumed, and drinking pattern. Inconsistent results suggest gender differences are not well understood. METHODS: Participants were 3069 male and 2600 female health maintenance organization survey respondents. Gender differences in relationships between alcohol consumption and health were examined using analyses of covariance adjusting for age alone and for age, ethnicity, marital status, body water index, and smoking. Past-year alcohol consumption (frequency, quantity per occasion, average drinks per month, and drinking pattern) and health measures (Short Form-36 general health, physical functioning, mental health subscales) were examined. RESULTS: Gender x drinking frequency and drinking quantity interactions were significant in age-adjusted and fully adjusted models of general health and physical functioning. Gender interactions for drinking pattern were significant in the age-adjusted model and marginally significant in the fully adjusted model. No gender x drinking measure interactions were found for mental health. Fully adjusted models attenuated but did not eliminate gender differences for health and magnified relationships for functioning, the latter after adjusting for body water. For both genders, light to moderate consumption and more frequent drinking were associated with better health and functioning; relationships were stronger among women than men. CONCLUSIONS: Gender x drinking measure interactions in health outcomes suggest analyses should include such interactions except, possibly, for mental health. Adjusting for potential confounders can attenuate (general health) or magnify (physical functioning) gender differences. Functional status appears a sensitive measure for evaluating gender differences in alcohol's health effects, adjusting for body water. Women's health may benefit proportionally more from moderate drinking than men's.     

Predictors and outcomes of variability in subjective alcohol intoxication among college students: an event-level analysis across 4 years

Background: Individual differences in subjective alcohol intoxication, as measured by laboratory‐based alcohol challenge, have been identified as a phenotypic risk factor for alcohol use disorders. Further, recent evidence indicates that subjective alcohol response is also associated with event‐level physiological consequences among college students, including blackouts and hangovers. Methods: The current investigation tested predictors of and outcomes associated with subjective intoxication in the natural drinking environment. In a preliminary laboratory alcohol‐challenge study (n = 53), we developed a brief measure of subjective alcohol intoxication for use in event‐level research. Participating students in the principal study (n = 1,867; 63% women; 54% Caucasian) completed 30 days of Web‐based self‐monitoring in each of the 4 college years. Results: In the principal study, generalized estimating equation analyses revealed that both lighter drinking and a family history of alcohol problems predicted greater subjective intoxication after accounting for estimated blood alcohol concentration (eBAC). Moreover, greater subjective intoxication during a given drinking episode was associated with negative alcohol‐related consequences, illicit drug use, and unsafe sex, and at higher eBACs, was associated with aggression, sex, and property crime. Students who on average experienced greater subjective intoxication were also more likely to experience negative consequences and engage in illicit drug use, sex, unsafe sex, and aggression. Conclusions: These findings suggest that both within‐person variability and between‐person individual differences in subjective intoxication may be risk factors for adverse drinking outcomes at the event level. Intervention efforts aimed at reducing problems associated with collegiate drinking may benefit from consideration both of who experiences greater subjective intoxication and of the situations in which they are more likely to do so.     

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

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

Cognitive processes in adolescent drug use: the role of positivity bias and implications for prevention policy

Recent investigations of the role of expectations about the effects of alcohol in drinking behavior suggest that there is a functional relationship between expectancies and alcohol use. Specifically, greater positive expectancies are related to heavier drinking patterns. In contrast, expectations about the negative consequences of alcohol use seem to be unrelated to drinking behavior. These differential roles of positive and negative expectancies as mediators of alcohol use reflect the robust phenomenon of positivity bias in human information processing. The theoretical and clinical implications of this phenomenon with respect to adolescent drug use are discussed.     

Alcohol dosing and the heart: updating clinical evidence

The consequences of heavy or irregular alcohol drinking have long been known. Recently, consistent information has been provided in support of an association between light/moderate alcohol consumption and protection from vascular and all-cause mortality, ischemic stroke, peripheral arterial disease, congestive heart failure, and recurrence of ischemic events. After reviewing the information with respect to major aspects of cardiovascular pathophysiology, to potential confounders and to underlying mechanisms, several concepts emerge. First, the recommended amounts of "safe alcohol drinking" in healthy individuals are up to two standard drinks (~20 g/d) for a man and up to one drink (10 g/d) for a nonpregnant woman. The overall balance for young premenopausal women, but not for older women, would be unfavorable for drinking. The risk of cancer would not outweigh potential benefits of alcohol on heart disease. Second, within the frame of a balanced pattern of dietary energy intake, patients with cardiovascular disease who drink alcohol should not exceed one or two standard drinks per day for women or up to two or three drinks per day for men. Third, the low rates of coronary heart disease among the Mediterranean people may be related to their pattern of drinking wine every day during meals. Regular drinking is associated with better outcomes than occasional (binge)/weekly drinking. Fourth, wine (ethanol with antioxidants) exhibits significantly higher anti-inflammatory effects than gin (ethanol without polyphenols), and thus in general wine should be preferred to liquor or beer.     

Alcoholism and aging. 1. Epidemiology, clinical aspects and treatment

Demographic trends reveal the elderly to be the fastest growing segment of the population. Physicians can therefore anticipate to be faced with a growing number of older patients with alcohol-related problems. It is now being increasingly recognized that alcoholism does not only concern the young population, but can appear for the first time late in life. One third of older alcoholic people develop a problem with alcohol in later life, while the other two thirds grow older with the medical and psychosocial sequelae of early-onset alcoholism. In addition, as the number of the elderly increases, clinicians are more faced with patients who began drinking earlier in life and who continue to do so late on life. Furthermore, increasing age is associated with a higher prevalence of chronic disease and use of medication that may interact to amplify the effects of alcohol. Alcohol may cause or worsen chronic illnesses or symptoms such as insomnia, depression, and hypertension. On the other hand, older drinkers are therefore more likely to have adverse consequences of drinking at lower levels of alcohol consumption, and these consequences are likely to be more severe. In this paper, we review the prevalence of geriatric alcoholism, the drinking pattern seen in the elderly i.e., early vs. late onset alcoholism, and we expose the danger of alcohol problems underdiagnosis. In addition, we review the comorbidities associated with alcohol use and finally we discuss treatment options.     

Immune activation and neuroinflammation in alcohol use and HIV infection: evidence for shared mechanisms

Background: Emerging research points to innate immune mechanisms in the neuropathological and behavioral consequences of heavy alcohol use. Alcohol use is common among people living with HIV infection (PLWH), a chronic condition that carries its own set of long-term effects on brain and behavior. Notably, neurobiological and cognitive profiles associated with heavy alcohol use and HIV infection share several prominent features. This observation raises questions about interacting biological mechanisms as well as compounded impairment when HIV infection and heavy drinking co-occur. Objective and Method: This narrative overview discusses peer-reviewed research on specific immune mechanisms of alcohol that exhibit apparent potential to compound the neurobiological and psychiatric sequelae of HIV infection. These include microbial translocation, systemic immune activation, blood-brain barrier compromise, microglial activation, and neuroinflammation. Results: Clinical and preclinical evidence supports overlapping mechanistic actions of HIV and alcohol use on peripheral and neural immune systems. In preclinical studies, innate immune signaling mediates many of the detrimental neurocognitive and behavioral effects of alcohol use. Neuropsychopharmacological research suggests potential for a feed-forward cycle in which heavy drinking induces innate immune signaling, which in turn stimulates subsequent alcohol use behavior. Conclusion: Alcohol-induced immune activation and neuroinflammation are a serious health concern for PLWH. Future research to investigate specific immune effects of alcohol in the context of HIV infection has potential to identify novel targets for therapeutic intervention.     

A critical review of front-loading: A maladaptive drinking pattern driven by alcohol's rewarding effects

Front-loading is a drinking pattern in which alcohol intake is skewed toward the onset of reward access. This phenomenon has been reported across several different alcohol self-administration protocols in a wide variety of species, including humans. The hypothesis of the current review is that front-loading emerges in response to the rewarding effects of alcohol and can be used to measure the motivation to consume alcohol. Alternative or additional hypotheses that we consider and contrast with the main hypothesis are that: (1) front-loading is directed at overcoming behavioral and/or metabolic tolerance and (2) front-loading is driven by negative reinforcement. Evidence for each of these explanations is reviewed. We also consider how front-loading has been evaluated statistically in previous research and make recommendations for defining this intake pattern in future studies. Because front-loading may predict long-term maladaptive alcohol drinking patterns leading to the development of alcohol use disorder (AUD), several future directions are proposed to elucidate the relationship between front-loading and AUD.     

On the emerging paradigm of drinking patterns and their social and health consequences

Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption. This paper presents recommendations for research in the area based on the presentations and discussions of the first “International Conference on Social and Health Effects of Different Drinking Patterns” held in Toronto in November 1995. In particular, the social dimension in pattern research, and the relationship between patterns of drinking and causalities as well as social harm, are stressed. The paper also argues for better theories, incorporating knowledge from related basic disciplines. In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns. Finally, implications of research on drinking patterns for polity and programme development are discussed.     

The Effects of Husband’s Alcohol Consumption on Married Women in Three Low-Income Areas of Greater Mumbai

Gender-based violence rooted in norms, socialization practices, structural factors, and policies that underlie men’s abusive practices against married women in India is exacerbated by alcohol. The intersection of domestic violence, childhood exposure to alcohol and frustration, which contribute to drinking and its consequences including forced sex is explored through analysis of data obtained from 486 married men living with their wives in a low-income area of Greater Mumbai. SEM shows pathways linking work-related stress, greater exposure to alcohol as a child, being a heavy drinker, and having more sexual partners (a proxy for HIV risk). In-depth ethnographic interviews with 44 married women in the study communities reveal the consequences of alcohol on women’s lives showing how married women associate alcohol use and violence with different patterns of drinking. The study suggests ways alcohol use leads from physical and verbal abuse to emotional and sexual violence in marriage. Implications for gendered multi-level interventions addressing violence and HIV risk are explored.     

Influence of pretreatment coping strategies on the outcome of outpatient treatment of Danish alcohol abusers

An important issue regarding treatment for alcohol abuse is the high rate of relapse following treatment. In the research on treatment of alcohol abuse, the concept of coping has been proposed as a relevant factor in the relationship between relapse crises and treatment outcome. The present study investigated the role of pretreatment coping strategies in outcome of outpatient treatment for alcohol abuse. The pretreatment coping strategies of 136 clients receiving outpatient treatment for alcohol abuse were examined as a predictor of drinking pattern after treatment. The pretreatment coping strategies were assessed by the COPE questionnaire. Drinking pattern after treatment was assessed at follow-up one year after treatment was entered. Results indicated that some pretreatment coping strategies are identifiable as adaptive and maladaptive coping strategies, respectively, regarding successful treatment for alcohol abuse. Restraint coping was found predictive of a positive drinking pattern at follow-up while the use of alcohol to cope was found predictive of a negative drinking pattern. Furthermore, the results showed tendencies towards the possibility that some coping strategies co-operated differently with types of treatment methods.     

Pharmacotherapy for Addictions: Partnering with Contingency Management

ABSTRACT

Background: Problem drinking in college places students at an increased risk for a wealth of negative consequences including alcohol use disorders. Most research has shown that greater emotion regulation difficulties are related to increased problem drinking, and studies generally assume that drinking is motivated by efforts to cope with or enhance affective experiences. However, there is a lack of research specifically testing this assumption. Objectives: The current study sought to examine the mediating potential of drinking motives, specifically coping and enhancement, on the relationship between emotion regulation and problem drinking. Method: College participants (N = 200) completed an online survey, consisting of a battery of measures assessing alcohol use behaviors and related variables. Results: Coping drinking motives fully mediated the emotion regulation/problem drinking relationship, and enhancement motives partially mediated this relationship. Exploratory analyses indicated that all four drinking motives (i.e. coping, enhancement, social, and conformity) simultaneously mediated the relationship between emotion regulation and quantity/frequency of alcohol use. However, only coping and enhancement significantly mediated the relationship between emotion regulation and alcohol-related consequences (e.g. alcohol dependence symptoms, alcohol-related injuries). Conclusion: The current results offer direction for potentially modifying brief alcohol interventions in efforts to reduce students’ engagement in problem drinking behaviors. For example, interventions might incorporate information on the risks of using alcohol as a means of emotion regulation and offer alternative emotion regulation strategies.     

The experiencing of positive consequences of drinking in four Scandinavian countries1

Based on data from a comparative survey of drinking in four Scandinavian countries (Finland, Iceland, Norway and Sweden), the experiencing of positive consequences of drinking was studied in relation to alcohol consumption, intoxication frequency and the experiencing of negative consequences of drinking. In all four countries a substantial portion–both of the men and of the women–reported having experienced various positive effects of drinking during the last 12 months. The positive consequences clearly correlated with yearly alcohol consumption and even more with intoxication frequency. A strong link between the experiencing of positive and negative consequences of drinking was also found. The study also indicates that there are national differences in the experiencing of positive consequences of drinking which do not reflect the national differences in total alcohol consumption.     

The importance of amount and location of drinking for the experience of alcohol-related problems

People's self report of a variety of alcohol-related problems was collected as part of a national survey carried out in New Zealand in 1988. These problems included self perception of adverse effects of drinking on a number of life areas such as health, friendships and financial position; items covering tangible consequences of alcohol use and items suggestive of alcohol dependence. The experience of these problems was predicted from a number of socio-demographic variables and respondent's reports of their typical drinking behaviour. Of the socio-demographic variables only age was found to relate strongly to experience of problems. The overall frequency of drinking relatively large amounts and the typical quantity drunk in certain licensed premises (hotels, taverns and clubs) and the typical quantity drunk in others' homes predicted the experience of problems. These findings are similar to research from other countries using different methodologies and support the likely effectiveness of prevention strategies which reduce the access of young people to alcohol and which aim to influence the amounts consumed in drinking sessions on licensed premises.