Beer and bongs: differential problems experienced by older adolescents using alcohol only compared to combined alcohol and marijuana use

Alcohol and other drug problems experienced by adolescents who use only alcohol compared to those who use both alcohol and marijuana (A + M) is studied. Using the national longitudinal survey of youth 1994 data, forward multiple regression analyses revealed that impulsivity, A + M use (compared to alcohol-only use), age, sex, religiosity, frequency of substance use were associated with a higher number of behavioral problems. Youth with more alcohol problems were found to be binge drinkers, impulsive, more frequent alcohol users, and nonHispanic. Implications and future research needs are discussed.     

Course of alcohol problems in treated adolescents

Knowledge of the clinical course in treated adolescents is fundamental to determining the influence of treatment on long-term functioning and the factors associated with change in the severity of alcohol problems over time. This symposium, held at the 2002 annual Research Society on Alcoholism meeting and organized by Tammy Chung and Christopher S. Martin, presented research on the course of alcohol-related problems in treated adolescents who were followed prospectively for 1 to 8 years. Presentations included (1) Alcohol use outcomes at 1 year among adolescents in the drug abuse treatment outcomes studies (DATOS-A), by Christine E. Grella; (2) Pathways and predictors of the course of adolescent alcohol problems across 1- and 3-year follow-ups, by Tammy Chung; (3) Young adult outcomes of an adolescent clinical sample at 5-year follow-up, by Ken C. Winters; and (4) Trajectories of alcohol involvement following addiction treatment through 8-year follow-up in adolescents, by Ana M. Abrantes, Denis M. McCarthy, Gregory A. Aarons, and Sandra A. Brown. Sandra A. Brown, discussant, commented on the presentations. Results from these studies indicate multiple pathways of change, distinguished by fluctuations in the chronicity and severity of alcohol problems. Across studies, most adolescents showed reductions in alcohol use and problems after treatment, with concurrent improvements in psychosocial functioning. Findings highlight the influence of other drug use on posttreatment patterns of alcohol involvement and the need to consider the effect of normative developmental transitions on the course of adolescent-onset substance use disorders.     

Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems

Aims The study investigates severity of alcohol dependence among drug misusers. Specifically, it investigates the inter‐relationship of alcohol and drug dependence and associations with alcohol consumption, drug consumption and substance‐related problems. Design, setting, participants The sample comprised 735 people seeking treatment for drug misuse problems, who were current (last 90 days) drinkers. Measurements Data were collected by structured face‐to‐face interviews. Dependence upon illicit drugs and upon alcohol was measured by the Severity of Dependence Scale (SDS). Findings Three groups of drinkers were identified: non‐alcohol‐dependent drug misusers (63%); low‐dependence (19%); and high‐dependence (18%). Many drug misusers were drinking excessively and alcohol dependence was related to patterns of alcohol and drug consumption. High‐dependence drinkers were more likely to drink extra‐strength beer; they were less frequent users of heroin and crack cocaine but more frequent users of benzodiazepines, amphetamines and cocaine powder; they reported more psychological and physical health problems. The SDS was found to have good reliability and validity as a measure of alcohol dependence. SDS scores for alcohol and drug dependence were unrelated. Conclusions Alcohol use is an important and under‐rated problem in the treatment of drug misusers. A comprehensive assessment of alcohol use among drug misusers should include separate assessments of alcohol consumption, alcohol‐related problems and severity of alcohol dependence.     

The relationship between patterns of alcohol use and mental and physical health disorders in two American Indian populations

AIMS: First, define alcohol use categories among two reservation-based American Indian (AI) populations based on the relationship between alcohol consumption and dependence. Secondly, examine associations between the alcohol use categories and other indicators of health status. DESIGN, PARTICIPANTS AND MEASUREMENTS: Epidemiological data on 1287 AIs aged 18-57 years who consumed alcohol during the past year. CHAID tree analysis, a hierarchical partitioning method, was used to analyze alcohol quantity (highest number of drinks consumed during 1 day) and frequency (number of days drank during the past month) data to define quantity-frequency categories distinguished by differing rates of alcohol dependence. Multivariate analyses assessed relationships between the alcohol use categories thus identified and a number of health outcomes. FINDINGS: People who reported drinking 12 or more drinks during 1 day and more than 4 days a month had the highest prevalence of alcohol dependence. Among the males who drank > 18 drinks the prevalence was 42.12% and among females who drank 12 or more drinks, 44.58%. The prevalence among males who drank > 18 drinks yet drank less frequently was also high (24.06%). Although findings differed by gender, drinkers in the highest risk category for alcohol dependence were most likely to report drug use disorders, mood/anxiety disorders, alcohol-related physical disorders and lower quality of life. CONCLUSIONS: The quantity thresholds defined to identify AIs at highest risk for alcohol dependence in this study differed by gender and were higher than typically reported for non-AIs. They are consistent with previous findings regarding the pattern of high-quantity, low-frequency alcohol consumption among AIs residing on reservations.     

Alcohol consumption and antiretroviral adherence among HIV-infected persons with alcohol problems

BACKGROUND: Alcohol abuse has been associated with poor adherence to highly active antiretroviral therapy (HAART). We examined the relative importance of varying levels of alcohol consumption on adherence in HIV-infected patients with a history of alcohol problems. METHODS: We surveyed 349 HIV-infected persons with a history of alcohol problems at 6-month intervals. Of these subjects, 267 were taking HAART at one or more time periods during the 30-month follow-up period. Interviews assessed recent adherence to HAART and past month alcohol consumption, defined as "none", "moderate", and "at risk". We investigated the relationship between adherence to HAART and alcohol consumption at baseline and at each subsequent 6-month follow-up interval using multivariable longitudinal regression models, while controlling for potential confounders. RESULTS: Among the 267 HIV-infected persons with a history of alcohol problems who were receiving HAART, alcohol consumption was the most significant predictor of adherence (p < 0.0001), with better adherence being associated with recent abstinence from alcohol, compared with at-risk level usage (odds ratio = 3.6, 95% confidence interval = 2.1-6.2) or compared with moderate usage (odds ratio = 3.0, 95% confidence interval = 2.0-4.5). CONCLUSIONS: Any alcohol use among HIV-infected persons with a history of alcohol problems is associated with worse HAART adherence. Addressing alcohol use in HIV-infected persons may improve antiretroviral adherence and ultimately clinical outcomes.     

An empirical study of alcohol consumption by patients considering HCV treatment

Background: Alcohol accelerates the course of hepatitis C (HCV) infection and liver damage. Little is known about recency of alcohol use among patients with HCV. Objectives: Alcohol consumption recency was compared among HCV patients with and without alcohol use disorders and current and lifetime alcohol use histories. Methods: Patients considering antiviral treatment for HCV (n?=?309) recruited from university-affiliated and VA liver and infectious disease clinics were assessed for lifetime and current-year psychiatric disorders and alcohol-use patterns. Full diagnostic interviews, self-report surveys, medical record review, and urine screening for recent alcohol and drug use were conducted. Results: 60% used alcohol in the last year. Besides alcohol history, those who stopped using alcohol in the past year differed from those with no lifetime use only in gender (60% vs. 22%); however, patients no longer using alcohol in the last year were less likely than those still using to have a current drug use disorder (16% vs. 3%) or last-month drug use (52% vs. 30%), and had fewer current risky behaviors (1.3 vs. 0.6). Among patients with last-year alcohol use, those with past alcohol use disorders differed from those without only by higher prevalence of drug use disorder (84% vs. 47%) and drug use after HCV diagnosis (67% vs. 43%). Conclusions: Patients who had stopped using alcohol for at least a year were much like those who never used alcohol in regard to other drug use, psychiatric history, smoking, and risky behaviors. These findings indicate that HCV patients with at least a year of abstinence from alcohol, including those with a history of alcohol use disorder, should be considered HCV treatment candidates.     

Long-term influence of duration and intensity of treatment on previously untreated individuals with alcohol use disorders

Aims This study examined the influence of the duration and intensity of the first episode of treatment for previously untreated individuals with alcohol use disorders on short‐term and long‐term outcomes, and the effect of additional treatment and delayed treatment on outcomes. Design, setting, participants A sample of alcoholic individuals (n = 473) was recruited at alcoholism information and referral centers and detoxification units and was surveyed at baseline and 1 year, 3 years and 8 years later. Measurements At each contact point, participants completed an inventory that assessed their treatment utilization since the last assessment and their current alcohol‐related, psychological and social problems. Findings Compared with individuals who remained untreated, individuals who entered treatment relatively quickly and who obtained a longer duration of treatment had better short‐ and long‐term alcohol‐related outcomes and better short‐term social functioning. Individuals who obtained a longer duration of additional treatment had better alcohol‐related outcomes than individuals who obtained no additional treatment but, among individuals who delayed treatment entry, the duration of treatment was not associated with treatment outcomes. In general, the intensity of treatment was not related to better outcomes. Conclusions Rapid entry into treatment and the duration of treatment for alcohol use disorders may be more important than the intensity of treatment. Treatment providers should consider structuring their programs to emphasize continuity, rather than intensity of care.     

Working hours and alcohol problems in early adulthood

Aims To examine the associations between working hours and alcohol‐related problems during early adulthood. Design and setting Longitudinal study of a birth cohort born in Christchurch, New Zealand in 1977 and studied to age 30. Participants A total of 1019 participants with data available for working hours and alcohol‐related problems at either age 25 or 30. Measurements Weekly working hours in paid employment; frequent alcohol use; diagnosis of alcohol abuse/dependence; number of symptoms of alcohol abuse/dependence. Associations between working hours and alcohol‐related problems were adjusted for covariates including measures of: parental and family background; personality and behaviour; IQ and educational achievement; recent negative life events; recent mental health problems; and current partner and family circumstances. Findings Longer work hours were associated significantly with more frequent alcohol use (P < 0.0001), higher rates of alcohol abuse/dependence (P = 0.0001) and a greater number of alcohol abuse/dependence symptoms (P = 0.01). These associations were adjusted for a wide range of confounding factors. After adjustment there remained significant (P < 0.05) associations between working hours and alcohol‐related problems, with those working 50 or more hours per week having rates of alcohol‐related problems 1.8–3.3 times higher than those who were not working. The associations between work hours and alcohol use were similar for males and females. Conclusions Longer work hours appear to be associated with higher rates of alcohol‐related problems, including more frequent alcohol use, higher rates of alcohol abuse/dependence and a greater number of alcohol abuse/dependence symptoms. These associations remain even after extensive adjustment for confounding.     

Timing of first alcohol use and alcohol dependence: evidence of common genetic influences

Aims   To estimate the magnitude of genetic and environmental influences on timing of first alcohol use and alcohol dependence (AD) and to quantify the overlap in these influences across the two alcohol-related outcomes.
Participants    The sample consisted of 5382 twins (2691 complete pairs), aged 24–36 years, from the Australian Twin Registry.
Measurements   History of alcohol use and DSM-IV alcohol dependence were assessed by structured telephone interview.
Findings   In both sexes, the relationship between age at first alcohol use and risk for AD followed a linear trend, such that the highest rates of AD were observed in individuals who began drinking at an earlier than average age (14 years or younger). Heritability estimates for timing of first alcohol use and AD were 36% and 53%, respectively. Shared environmental factors accounted for 15% of variance in initiation. There was no evidence of shared environmental influences on AD. The genetic correlation between timing of first alcohol use and AD was 0.59.
Conclusions   Findings highlight the substantial role of genetics in the development of AD and the early manifestation of that genetic risk in the timing of alcohol use initiation which, unlike AD, is also influenced to a modest degree by shared environmental factors. The considerable overlap in heritable influences—and the virtual absence of overlap in individual-specific environmental influences—on initiation of alcohol use and AD indicates that the association between age at first drink and AD is attributable in large part to common genetic sources of variance.     

Risky drinking and alcohol use patterns in a national sample of women of childbearing age

AIMS: We examined risky drinking and alcohol use patterns associated with prenatal effects of alcohol exposure in women of childbearing age, using various definitions of low-risk drinking. DESIGN: Computer-assisted telephone interview (CATI) methodology was used to gather information in a cross-sectional survey on alcohol use and problems, pregnancy and likelihood of future pregnancy. SETTING: Participants were respondents in the 2000 National Alcohol Survey (NAS, N10, response rate 58%) which includes men and women from all 50 states of the United States and the District of Columbia. PARTICIPANTS: A total of 1504 women aged 18-39 years were included; 72 were pregnant, 511 were currently not pregnant but reported being likely to be pregnant in the next 5 years, and 921 women were neither pregnant nor likely to be in the next 5 years. MEASUREMENTS: Various alcohol use patterns in the past 12 months including average volume, amount per session, drinking with food and time spent drinking were assessed. FINDINGS: Seven per cent of childbearing age women exceeded guidelines used to classify women as risky drinkers in the past month. Thirty per cent were classified as risky drinkers when these guidelines were extended to past-year drinking. Examination of specific alcohol use patterns revealed that while under 10% of risky drinkers reported past-month heavy episodic drinking, 30% or more reported heavy episodic drinking and exceeding daily limits for alcohol consumption in the past year. CONCLUSIONS: Public health professionals should note that past-year drinking in a significant proportion of women of childbearing age exceeds guidelines for alcohol use. When targeting such prevention efforts, they should thus include assessment of past-year alcohol use patterns.     

The dimensionality of alcohol use disorders and alcohol consumption in a cross‐national perspective

Aims To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. Design Cross‐sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM‐IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. Setting Participants were 5195 injured and non‐injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995–2001). Findings Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear‐cut distinction between the criteria for dependence and abuse in all sites. Results from item response theory analyses showed that the current DSM‐IV criteria tap people in the middle–upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM‐IV diagnostic criteria to help tap the middle–lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. Conclusions DSM‐IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.     

More Canadian students drink but American students drink more: comparing college alcohol use in two countries

Aims  To compare alcohol use among US and Canadian college students.
Design  Results of the 1999 College Alcohol Study and the 1998 Canadian Campus Survey are compared.
Setting  One hundred and nineteen nationally representative US 4-year colleges and universities in 40 states and 16 nationally representative Canadian 4-year universities.
Participants  Randomly selected students under 25 years (12 344 US and 6729 Canadian).
Measurements  Self-reports of alcohol use and heavy alcohol use.
Findings  The prevalence of life-time and past year alcohol use is significantly higher among Canadian students than US students (92% versus 86%, 87% versus 81%). The prevalence of heavy alcohol use (typically consuming five or more drinks in a row for males/four or more for females) among past-year and past-week drinkers is significantly higher among US students than Canadian students (41% versus 35%, 54% versus 42%). In both countries younger students and students living at home with their parents are less likely to be heavy drinkers; students who report first drunkenness before the age of 16 are more likely to be heavy drinkers in college.
Conclusion  Programs aimed at students' heavy alcohol use should target freshman at entry or earlier. Since students living with their parents are less likely to be heavy drinkers, parents may play a potentially important role in prevention efforts. The patterns of drinking in both countries may be influenced by the legal minimum drinking age. However, the relationship is complex and must be viewed in the context of other variables such as chronological age.     

An evaluation of the proposed DSM-5 alcohol use disorder criteria using Australian national data

Aims To evaluate the proposed revisions to the DSM‐IV alcohol use disorder criteria using epidemiological data. Design, setting and participants Data came from the 1997 Australian National Survey of Mental Health and Well‐Being. The sample consisted of 10 641 participants aged 18 years and over. Measurements Alcohol use disorders were assessed using a revised version of the CIDI version 2.0. Alcohol use disorders were assessed in all respondents who indicated that they had used alcohol more than 12 times in the previous 12 months (n = 7746). Findings The proposed introduction of a single alcohol use disorder was supported by confirmatory factor analysis (CFA). DSM‐5 criteria were all indicators of a single underlying disorder. Under DSM‐5, the prevalence of alcohol use disorders would increase by 61.7% when compared with those diagnosed under DSM‐IV. When investigating the most appropriate diagnostic threshold, the 3+ threshold maximized agreement between DSM‐IV and DSM‐5 diagnoses, and produced similar prevalence estimates to those yielded by DSM‐IV. Item response theory (IRT) analyses supported the removal of the legal criterion while provided equivocal results for the craving criterion. Conclusions Under the proposed DSM‐IV revisions for alcohol use disorders, estimates of the prevalence in the general population would increase substantially. Whereas evidence supports some of the revisions such as a single underlying disorder, others such as the 2+ threshold for diagnosis of alcohol use disorder and the inclusion of a ‘craving’ criterion may be problematic.     

Parental drug use, early adversities, later childhood problems and children's use of tobacco and alcohol at age 10: birth cohort study

Aims To estimate the prevalence of alcohol and tobacco use among children at age 10 years and to investigate possible influences on this. Design Birth cohort study. Setting England. Participants A total of 6895 children provided data at age 10. Measurements Parental tobacco, alcohol and cannabis use, parental social position, children's intelligence, behavioural and emotional problems, children's tobacco and alcohol use at age 10. Findings A total of 1.3% of children reported smoking and 1.8% reported drinking alcohol, with boys reporting higher use than girls. Parental social disadvantage was the strongest predictor of children's smoking and also predicted children's alcohol use. Some of this association appeared to be mediated through the greater experience of childhood behavioural and cognitive problems among the disadvantaged. Parental smoking and paternal alcohol use had little independent influence on offspring drug use. Postnatal, rather than prenatal, maternal alcohol use predicted children's alcohol use. Conclusions Strategies to prevent early initiation of tobacco and alcohol use should focus upon the reduction of childhood social disadvantage and the behavioural and cognitive problems associated with this.     

A social learning perspective: a model of parenting styles, self-regulation, perceived drinking control, and alcohol use and problems

BACKGROUND: This investigation sought to determine how different parenting styles are related to general self-regulatory processes that are linked to alcohol use and abuse. Self-regulation and, more specifically, thoughts of control over drinking are forms of positive self-control mechanisms. Parenting styles are known determinants of both negative and positive self-control mechanisms in offspring. According to social learning theory, stronger relationships between parenting style and self-regulatory processes would be expected from the parent who is the same sex as the respondent. METHODS: A total of 144 female and 107 male college students currently using alcohol were administered a questionnaire on their alcohol use and problems, perceived style of parenting (authoritarian, permissive, or authoritative) of their parents, self-regulation, and perceived control of drinking. A model linking parenting styles, self-regulatory processes, and control over drinking with alcohol use and alcohol problems was tested across sex groups by using structural equation modeling. RESULTS: In general, the parenting style of the parent of the same sex as the respondent's was found to be significantly related to self-regulation, which is known to be protective against alcohol use and abuse. A permissive parent of the same sex as the respondent was negatively associated with good self-regulatory processes for both men and women. Having an authoritative mother was also shown to be related to higher levels of self-regulation for women. CONCLUSIONS: Self-regulation mediated the pathway from a permissive parenting style to perceived drinking control, which, in turn, mediated the pathway from self-regulation to alcohol use and problems. Finally, self-regulation mediated the positive pathway from an authoritative mother to perceived control over drinking for women.     

Comparison of the adaptive functioning of children prenatally exposed to alcohol to a nonexposed clinical sample

BACKGROUND: Several studies show impairments in the social and adaptive behaviors of children prenatally exposed to alcohol. However, there remains limited consensus on whether the alcohol exposure directly affects social functioning or whether its effect is mediated by deficits in IQ. In addition, no studies have investigated whether deficits in social functioning are significantly more pronounced in children prenatally exposed to alcohol than in children referred to psychiatric treatment who were not prenatally exposed. We explored the effect of alcohol exposure on social and adaptive functioning and explored whether or not social and adaptive functioning are significantly more impaired in children prenatally exposed to alcohol than in a clinical sample of children. METHODS: A sample of 33 alcohol-exposed children was compared with a sample of 33 clinic-referred nonexposed children. The groups were compared on measures of communication, daily living skills, and socialization. The groups were matched on sex, age, IQ, and outpatient or inpatient status. RESULTS: Analyses revealed that the prenatally alcohol-exposed children did not differ significantly from the nonexposed children in any of the domains of adaptive functioning. However, with age, exposed children showed a more rapid decline in socialization standard scores compared with the nonexposed clinical sample. CONCLUSIONS: Young children who were exposed to alcohol prenatally show deficits in all domains of adaptive functioning. Although these deficits do not seem to differ from those exhibited by young children with psychiatric problems but no prenatal exposure, deficits in socialization behavior of prenatally exposed children may become more significant with age.     

UPPS-P facets of impulsivity and alcohol use patterns in college and noncollege emerging adults

Background: Alcohol use and related problems reach a peak in emerging adulthood. Impulsivity is a multifaceted construct known to be involved in emerging adult alcohol use. Few studies have examined impulsivity and alcohol use across both college attending and noncollege attending emerging adults. Objectives: To clarify the multifaceted nature of impulsivity and its links to emerging adult alcohol use, this study investigated whether the five distinct facets of the UPPS-P model of impulsivity were predictive of three different behavioral outcomes: alcohol intake, alcohol related problems and binge drinking. In addition, the moderating effects of college attendance were tested. Methods: A community sample comprising 273 Australian college and noncollege attendees (58.6% women; 41.4% men) aged between 18 and 30 years (M_age = 23.71, SD = 2.81). Results: Multiple regression analyses demonstrated that lack of premeditation predicted alcohol intake and binge drinking behavior, whilst positive and negative urgency predicted alcohol related problems. Moderation analyses revealed that the effects of impulsivity on alcohol patterns were consistent for college and noncollege attending emerging adults. Conclusion: These findings highlight the importance of impulsive urgency (both positive and negative) in emerging adult problematic alcohol use, and support the generalizability of college samples to broader emerging adult populations. Emerging adults may use alcohol to avoid negative mood states and further enhance positive mood states. Improved emotional regulation may help both college and non-college emerging adults reduce their alcohol use.     

Exploring the emergence of alcohol use disorder symptoms in the two years after onset of drinking: findings from the National Surveys on Drug Use and Health

Aims This study investigates the occurrence of clinical features of alcohol dependence and socially maladaptive drinking during the first 24 months after the onset of alcohol use. Design Data for this study are from the nationally representative 2004–07 National Surveys on Drug Use and Health (NSDUH). Setting General population of the United States, aged 12 years and older. Participants New‐onset alcohol users (NOAUs) were drinkers who started to drink alcohol within 24 months of the NSDUH assessment and consumed alcohol during the last 12 months. Measurements The NSDUH assessed for clinical features of alcohol dependence and socially maladaptive drinking, consistent with the DSM‐IV. Findings NOAUs frequently experienced problems relating to self‐reported tolerance, spending a great deal of time recovering from the effects of alcohol and unsuccessful attempts at cutting down on drinking. The likelihood of experiencing the clinical features increased steadily in the first 9 months after use, but appeared to plateau or only gradually increase thereafter. Strong evidence emerged that the clinical features measured a single latent dimensional of ‘alcohol use disorder’ (AUD) in this sample. The majority of the clinical features were good indicators of the underlying AUD continuum in the 2 years after first drinking onset. Conclusions There may be a period of time during the second year of alcohol use, when level of alcohol use disorder fluctuates rather than increases. Public health and safety efforts designed to target problematic alcohol use in the earliest stages of alcohol involvement could be useful in preventing the escalation of alcohol problems in this group of drinkers.     

Clinical practice characteristics and preconception counseling strategies of health care providers who recommend alcohol abstinence during pregnancy

OBJECTIVE: National initiatives on fetal alcohol syndrome in Canada and the United States aimed at prevention, identification, and treatment of individuals who are affected by alcohol exposure in utero recommend that women abstain from consuming alcohol during pregnancy. Health care providers are key educators regarding appropriate alcohol use. The objective of this study was to describe characteristics of physicians who recommend alcohol abstinence during pregnancy with regard to knowledge of fetal alcohol syndrome and preconception counseling strategies. METHODS: A survey was mailed to Canadian physicians and midwives between 2001 and 2002. Participants consisted of a national random sample of 1090 Canadian obstetricians and gynecologists, midwives, and family physicians who were current members of provincial and national professional organizations. The main outcome measure was questionnaire responses to knowledge, prevention, and diagnosis of issues related to alcohol use during pregnancy. RESULTS: Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Overall, 91.2% of providers recommended abstinence from alcohol during pregnancy. These providers were significantly more likely to believe that there is sufficient information about alcohol use and that clients were interested in discussing alcohol (p < 0.05). They were also significantly more likely to discuss depression, personal alcohol use, partner's use of alcohol, and family history of alcohol misuse with women of childbearing age (p < 0.05). Once a patient became pregnant, fewer practice differences were noted, although those who recommended alcohol abstinence were significantly more likely to take clinical action when pregnant patients were consuming moderate amounts of alcohol (p < 0.05). CONCLUSIONS: It is encouraging that almost 90% of Canadian health care providers recommend abstinence from alcohol during pregnancy. However, differences in clinical practice exist between providers who recommend alcohol abstinence during pregnancy as compared with those who recommend a "glass in moderation."     

The impact of comorbid anxiety and depression on alcohol treatment outcomes

AIMS: This study examines the impact of comorbid Diagnostic and Statistical Manual version IV (DSM-IV) anxiety and/or depression on out-patient treatment for alcohol problems. DESIGN: A prospective correlational design. PARTICIPANTS AND SETTINGS: Seventy-one clients seeking alcohol out-patient treatment at two treatment sites were interviewed at commencement of a treatment episode for alcohol problems and reinterviewed using the same measures 3 months later. Comorbid DSM-IV anxiety and/or depression were measured by the Composite International Diagnostic Interview (CIDI), a comprehensive interview developed by the World Health Organization to assess current and life-time prevalence of mental disorders. Outcome measures included standardized measures of disability [the short form (SF)-12 Mental Health Summary Score and the number of days taken out of role] and the average amount of alcohol consumed. Clients were also asked to rate their satisfaction with the services received. FINDINGS: Participants with comorbid DSM-IV anxiety and/or depressive disorders were more disabled and drank more heavily than those without these comorbid disorders at entry to treatment. At 3-month follow-up both groups of participants (i.e. those with and without DSM-IV comorbid anxiety and/or depression) were significantly less disabled and also drank significantly less alcohol on an average drinking occasion than at baseline. Despite this, the comorbid group remained more disabled and drank more heavily than the non-comorbid group at follow-up. CONCLUSIONS: Further research is needed to determine the most appropriate model of care for alcohol treatment seekers with comorbid DSM-IV anxiety and/or depression.