Are Relations Between Parental History of Alcohol Problems and Changes in Drinking Moderated by Positive Expectancies?

BACKGROUND: Risk factors of alcohol abuse generally have been examined for their additive or direct effects on the development of alcohol-related problems. This study was designed to assess the interaction between two important predictors: parental history of alcohol problems and positive expectancies regarding alcohol consumption. METHODS: The positive expectancies, reported parental alcohol problems, and alcohol use and problems of 169 first-year college students were assessed at their entrance to college, and their alcohol use and problems were assessed again approximately 3 months later. The main effects of positive family history and expectancies as well as their interaction in predicting changes in alcohol use and problems were examined in hierarchical regression analyses. RESULTS: A parental history of alcohol-related problems was related to greater alcohol problems at the two assessment times, and positive expectancies for the effects of alcohol were related to both alcohol problems and alcohol use. The parental history x positive expectancies term significantly added to the prediction of changes in alcohol problems (8% incremental increase in explained variance) even after baseline problems were entered in a prior step in the equation. Follow-up exploration revealed that the interaction was accounted for by high levels of alcohol problems at time 2 being reported by those high in positive expectancies and reporting high parental alcohol problems. The parental history x positive expectancies interaction term also added slightly to the prediction of changes in alcohol use amounts but accounted for a modest 1% incremental variance. CONCLUSIONS: Reported parental history and positive alcohol expectancies interacted to predict increases in alcohol problems over the course of the first semester of college. These results suggest that risk factors for alcohol problems may conjointly interact to confer heightened risk. Such interactive models may further assist in identifying at risk young adults. Limitations such as the reliance on self-report measures and the predominantly female sample are discussed.     

Prevalence of female alcohol dependence and abuse in Sweden

Data on prevalence of female alcoholism are scarce, especially outside North America. It is even more rare that prevalence is estimated using clinical interviews, as well as by utilizing multiple sources of information. Our sample consisted of five cohorts of adult women (n = 3130) in a mainly suburban area. In a first phase we screened for alcohol-related problems. In a second phase a strategic sample was interviewed (n = 399). Prevalence was calculated for clinical and CIDI-SAM diagnoses, both according to DSM-III-R, also taking medical record data into consideration. It was found that life-lime prevalence of alcohol dependence and abuse was 3.27% and 12-month prevalence was 1.49%. Agreement over alcohol dependence was very high for the different diagnostic methods, but lower for alcohol abuse. Prevalence of dependency/abuse was not higher in the attrition group. The alcohol abuse concept was found to be relevant, both in epidemiological research and for clinical purposes.     

Clinical implications of tolerance to alcohol in nondependent young drinkers

BACKGROUND: Ten percent of teenagers and young adults with no alcohol diagnosis and a third of those with alcohol abuse report tolerance to alcohol. However, relatively few data are available on the clinical implications of tolerance in nondependent men and women. METHODS: Data were gathered from 649 18-to-22-year-old drinking offspring from the Collaborative Study on the Genetics of Alcoholism (COGA) families. The prevalence and clinical correlates of tolerance were evaluated across subjects with no DSM-IV alcohol abuse and no tolerance, similar individuals with tolerance, subjects with alcohol abuse but no tolerance, and individuals with both alcohol abuse and tolerance. RESULTS: Tolerance was associated with an almost doubling of the number of drinks needed to feel alcohol's effects, and correlated with additional alcohol-related problems. In regression analyses, the most consistent and robust correlates of tolerance were the maximum number of drinks and alcohol problems, and tolerance remained informative after covarying for drinking quantity. CONCLUSIONS: Tolerance to alcohol may be a useful concept regarding nondependent drinkers that is not just a proxy for alcohol quantity but also reflects the presence of additional problems.     

A longitudinal twin study of effects of adolescent alcohol abuse on the neurophysiology of attention and orienting

Background: Long‐term functional brain effects of adolescent alcohol abuse remain uncertain, partially because of difficulties in distinguishing inherited deficits from neuronal effects of ethanol and by confounds associated with alcohol abuse, especially nicotine exposure. We conducted a longitudinal twin study to determine neurocognitive effects of adolescent alcohol abuse, as measured with the auditory event‐related potential (ERP) component P3, a putative marker of genetic vulnerability to alcoholism. Methods: Twin pairs (N = 177; 150 selected for intrapair concordance/discordance for alcohol‐related problems at age 18½) were recruited from ongoing studies of twins born 1975–1979 in Finland. Alcohol and tobacco use were assessed with questionnaires at ages 16, 17, 18½, and ～25, and by a structured psychiatric interview concurrent with the ERP testing at mean age 25.8. During ERP recordings, subjects were instructed to detect target tones within a train of frequent “standards” and to ignore occasional “novel” sounds. To distinguish familial factors from ethanol effects, ERP and self‐reported alcohol use measures were incorporated into hierarchical multiple regression (HMR) analysis, and intrapair differences in ERP were associated with intra‐pair differences in alcohol variables. Results: Novel‐sound P3 amplitude correlated negatively with self‐reported alcohol use in both between‐ and within‐family analyses. No similar effect was observed for target‐tone P3. HMR results suggest that twins’ similarity for novel‐sound P3 amplitude is modulated by their alcohol use, and this effect of alcohol use is influenced by genetic factors. Conclusions: Our results, from a large sample of twins selected from a population‐based registry for pairwise concordance/discordance for alcohol problems at 18½, demonstrate that adolescent alcohol abuse is associated with subtle neurophysiological changes in attention and orienting. The changes are reflected in decreased novel‐sound P3 amplitude and may be modified by genetic factors.     

Michigan assessment-screening test for alcohol and drugs (MAST/AD): evaluation in a clinical sample

In this study, we sought to evaluate a modification of the Michigan Alcohol Screening Test designed to include problems associated with other drug abuse/dependence besides alcohol. Scores of the lifetime Michigan Assessment-Screening Test/Alcohol-Drug (MAST/AD) were compared to other lifetime measures of substance abuse and dependence and to psychiatric scales reflecting current or recent symptoms. Two university medical centers with alcohol-drug programs located within departments of psychiatry hosted 520 patients with alcohol-drug-related diagnoses. Patients completed their own MAST/AD using a paper-and-pencil format. Based on interviews with the patient, a research associate rated the patients' substance-related problems on the Minnesota Substance Abuse Problem Scale (M-SAPS) and obtained information on lifetime treatment for substance abuse. An addictions psychiatrist determined abuse or dependence and made a current diagnosis of alcohol abuse/dependence only, drug abuse/dependence only, and alcohol plus drug abuse/dependence. The MAST/AD was highly correlated with the M-SAPS and several other measures of substance abuse morbidity. Patients with alcohol-only and drug-only diagnoses did not differ from one another on the MAST/AD, although both groups had lower scores than those with alcohol plus drug diagnoses. Current psychosocial morbidity as assessed by the patient and the psychiatrist was associated with the MAST/AD, although less strongly than with lifetime substance abuse measures. The lifetime MAST/AD demonstrates reliability as a severity measure for alcohol and/or drug abuse. With minor modification, this standard measure can be expanded from alcohol diagnoses to all substance diagnoses. This study in a clinical population did not demonstrate its utility as a screening instrument; additional work is needed to reveal its utility for this purpose.     

Clinical Implications of Tolerance to Alcohol in Nondependent Young Drinkers

Background: Ten percent of teenagers and young adults with no alcohol diagnosis and a third of those with alcohol abuse report tolerance to alcohol. However, relatively few data are available on the clinical implications of tolerance in nondependent men and women. Methods: Data were gathered from 649 18-to-22-year-old drinking offspring from the Collaborative Study on the Genetics of Alcoholism (COGA) families. The prevalence and clinical correlates of tolerance were evaluated across subjects with no DSM-IV alcohol abuse and no tolerance, similar individuals with tolerance, subjects with alcohol abuse but no tolerance, and individuals with both alcohol abuse and tolerance. Results: Tolerance was associated with an almost doubling of the number of drinks needed to feel alcohol's effects, and correlated with additional alcohol-related problems. In regression analyses, the most consistent and robust correlates of tolerance were the maximum number of drinks and alcohol problems, and tolerance remained informative after covarying for drinking quantity. Conclusions: Tolerance to alcohol may be a useful concept regarding nondependent drinkers that is not just a proxy for alcohol quantity but also reflects the presence of additional problems.     

Disparities in Alcohol Treatment Utilization by Race and Type of Insurance

Even though women are more likely to develop alcohol problems when drinking equivalent amounts as men, transition from regular drinking to intoxication within a shorter period of time, and develop serious problems faster, men are more likely to utilize alcohol treatment. Furthermore, little is known about factors contributing to treatment utilization by women. Data from the National Epidemiologic Survey on Alcohol and Related Conditions, Wave 1, were examined to determine what predicted alcohol treatment utilization among women. Contrary to our hypothesis, having no insurance benefits predicted greater odds of utilizing alcohol treatment compared to having private insurance. Furthermore, the only diagnosis of alcohol-use problems that predicted treatment utilization was concurrent alcohol abuse and dependence. Criteria for alcohol abuse only or dependence only did not predict whether women sought alcohol treatment.     

1994 Draft DSM-IV Criteria for Alcohol Use Disorders: Comparison to DSM-III-R and Implications

In 1994, DSM-IV will be published, with new criteria for alcohol abuse and dependence. Implications of the changes in criteria for alcohol use disorders were investigated by comparing the diagnoses made by the DSM-IV criteria and DSM-III-R criteria. The study was conducted in a sample of 424 patients in an inpatient alcohol rehabilitation unit in the New York metropolitan area. DSM-III-R and DSM-IV criteria showed similar results and high agreement for any alcohol use disorder (abuse and dependence combined). Alcohol dependence was also consistently diagnosed with DSM-III-R and DSM-IV criteria. Agreement between DSM-III-R and DSM-IV abuse diagnoses was very low. Compared with DSM-III-R, DSM-IV classified over three times as many patients as alcohol abusers, although those with alcohol dependence still overwhelmingly dominated the sample. With some fluctuations, the results were stable over Black, Hispanic, and White subgroups of patients. The direction of the findings was consistent with results from a national general population survey in that the prevalence of alcohol abuse increased in both studies. However, the clinical results alone would not have suggested the marked changes in relative prevalence of abuse and dependence that occurred in the general population when DSM-IV criteria were used in place of DSM-III-R. Research on diagnostic criteria limited to patient samples omits important information on the implications of changing aspects of the diagnostic criteria. The need for a coherent theory of alcohol abuse is highlighted.     

Neuroscience Research: How Has It Contributed to Our Understanding of Alcohol Abuse and Alcoholism? A Review

Alcohol abuse and alcoholism are the greatest substance abuse problems in the United States today and contribute to numerous medical and social problems. To deal with many of these problems, an understanding of how alcohol acts on the brain is extremely important. Advances in neuroscience research have provided significant clues about where and how alcohol works on the brain. Alcohol clearly acts on membrane function, altering such processes as ion movements and neurotransmitter interactions with their receptors. Although these alcohol-induced alterations are presumed to relate to changes in behavior, this has not been clearly established. However, alcohol research is on the threshold of making a giant leap forward in our understanding the etiology of alcoholism.     

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.     

Implications of co-occurring alcohol abuse for role impairment, health problems, treatment seeking, and early course of alcohol dependence

This article explores the nosological and clinical implications of co-occurring alcohol abuse and alcohol dependence and examines the hierarchical relationship between these diagnostic categories in the DSM-IV. Among 2,307 alcohol-dependent participants in the 2003 US National Survey on Drug Use and Health, 1,646 (68.1%) additionally met the criteria for alcohol abuse. In multivariate analyses, alcohol-dependent participants with alcohol abuse reported an earlier age of first alcoholic drink compared to those without alcohol abuse. They also reported a higher prevalence of health problems, non-alcohol drug use, impairment, treatment seeking, and early remission. The two groups had different symptom profiles. Revisions to future DSM editions are proposed to better capture these differences.     

Correlation Between Medical and Behavioral Data in the Assessment of Alcoholism

Using the Munich Alcoholism Test, this study examined the prevalence and interrelationships of medical and sociobehavioral disorders in a nonhospitalized sample of 106 males who had been referred to a medical officer for "suspected" problems related to drinking. A further objective was to evaluate measurement properties of the Munich Alcoholism Test (MALT), a new diagnostic instrument for alcoholism. Self-report items focusing on the recognition of drinking problems formed a homogeneous and quite reliable scale. However, clinical signs and symptoms of disorders related to alcohol abuse occurred with relative independence of each other. In this predominantly young group of subjects, many individuals recognized that they had sociobehavioral problems, but few had clinical or laboratory manifestations of diseases associated with chronic alcohol abuse. These findings underscored the advantages of including both biomedical and sociobehavioral data for the early identification of alcohol abuse and dependence.     

Detecting alcohol problems in HIV-infected patients: use of the CAGE questionnaire

The HIV epidemic has been consistently associated with injection drug use and crack cocaine, but alcohol problems in HIV-infected persons are less well described. Our objectives were 2-fold: (1) to assess the prevalence of alcohol problems in HIV-infected patients initiating medical care; and (2) to determine the positive predictive value of the CAGE questionnaire for alcohol abuse or dependence in HIV-infected patients. Between July 1997 and October 2000, we assessed a consecutive series of patients who were establishing primary care for HIV infection (clinic sample), using an established alcohol screening test, the CAGE questionnaire. In addition, we enrolled other HIV-infected patients, including some of the clinic sample, who had two or more positive responses to the CAGE questionnaire into a longitudinal cohort (cohort sample), performed a diagnostic interview for lifetime history of alcohol abuse and dependence, and determined the positive predictive value of CAGE for alcohol diagnoses. In the clinic sample (n = 664), 42% (276 of 664) had two or more positive responses to the four CAGE questions. In the cohort sample (n = 141), 95% (134 of 141) met DSM-IV criteria for diagnosis of lifetime alcohol abuse or dependence. For patients initiating HIV primary care, a history of alcohol problems is very common. The CAGE questionnaire identifies a lifetime history of alcohol abuse or dependence in HIV-infected patients. Routine screening for alcohol problems should be performed in all patients entering HIV medical care and the CAGE questions are useful in this setting.     

Alcohol problems,prevention and epidemiology: looking for the next questions★

The epidemiology and prevention of alcohol problems were advanced significantly by the discovery of the important relationships among alcohol availability, per capita consumption and alcohol-related problems such as cirrhosis. Recently, however, alcohol-related problems have declined in some areas more than would be predicted by changes in consumptions. These declines may represent important opportunities for understanding the prevention of alcohol problems. For example, in recent work we have observed associations between declines in cirrhosis rates and increases in treatment for alcohol abuse and AA membership. The opportunities and challenges in examining the effects of various prevention measures on aggregate problem data are discussed.     

Prevalence and recognition of alcohol abuse in a primary care population

PURPOSE: The purpose of this study was to assess the prevalence, physician recognition, and treatment of alcohol abuse among patients of 19 senior medical residents practicing in a hospital-based, primary care setting. PATIENTS AND METHODS: Interviews of 242 outpatients were conducted, and alcohol abuse and dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), were determined using the Diagnostic Interview Schedule. RESULTS: Twenty percent of the patients studied had abused or were dependent on alcohol at some time in their lives and 5 percent reported abuse or dependence within the last year. Of the techniques studied, a short screening questionnaire (Short Michigan Alcohol Screening Test [SMAST]) was the most accurate way of identifying patients who abused alcohol, and physician assessments were more accurate than laboratory tests. Although the physicians were aware of serious alcohol problems among 77 percent of their patients who met DSM-III criteria for alcohol abuse or dependence in the previous year, they identified only 36 percent of their patients with less serious problems or past alcohol abuse. They had only discussed alcohol abuse with 67 percent of the patients they identified as alcohol abusers. CONCLUSION: We conclude that a short screening questionnaire (SMAST) is an accurate means of identifying alcohol abuse. Despite the recognition of serious alcohol problems by the physicians, the problem is not addressed routinely even among patients that are recognized as alcoholic.     

The relationship between childhood sexual abuse and alcohol abuse in women - a case-control study

Aims. The aim of this paper was to examine the association between reporting childhood sexual abuse (CSA) and alcohol abuse in a community sample of women using multivariate analysis which took into account a range of potential confounding variables (such as a family history of alcoholism) and effect modifiers (such as having an alcoholic partner). Design. A two-stage retrospective case-control study was used to investigate the relationship between reporting CSA and alcohol abuse in women. Participants. Seven hundred and ten women randomly selected from the Australian federal electoral rolls. Measurements. The Alcohol Use Disorders Identification Test (AUDIT) was used to measure alcohol abuse. A series of questions based on those developed by Wyatt (1985) were used to ascertain the prevalence of CSA. Findings. The final model showed that the relationship between a history of CSA and alcohol abuse reflected a complex interaction between CSA and a range of other factors in a woman's background. CSA was not by itself a significant predictor of alcohol abuse (OR = 0.61; 95% CI = 0.31-1.20). However, a history of CSA became significant in combination with co-factors which included: having a mother who was perceived as cold and uncaring; having an alcoholic partner; and believing that alcohol is a sexual disinhibitor. Conclusion. This study indicates that CSA alone is not a causative factor in the development of alcohol abuse among women and highlights the importance of examining the family background of women with alcohol problems.     

Chronic daily ethanol and withdrawal: 2. Behavioral changes during prolonged abstinence

BACKGROUND: Our previous investigations have suggested that alcohol abuse may induce persistently compromised hypothalamo-pituitary-adrenal (HPA) function, which could increase risk for subsequent alcohol abuse. The apparent similarity of chronic alcohol abuse-induced HPA defects to the compromised HPA functions associated with posttraumatic stress disorder and atypical depression also suggest potential common mechanisms shared with varied neurobehavioral disorders. Accordingly, we have investigated persistent behavioral effects of previous repetitive daily ethanol consumption and withdrawal. METHODS: Male Sprague-Dawley rats received either daily ad libitum chow, ad libitum liquid diet containing ethanol, or pair-fed isocaloric control liquid diet. The ethanol was gradually introduced over 4 weeks, maintained at 5% w/v for four subsequent weeks, and then gradually removed over 1 week. RESULTS: Four weeks after removal of ethanol from the diet, the previously ethanol-consuming rats exhibited greater (p < 0.05) evidence of anxiety in the elevated plus-maze test and in the novel cork-gnawing test, as well as greater (p < 0.05) locomotor response to a novel environment, compared with controls. CONCLUSIONS: These results suggest that repetitive daily alcohol consumption and withdrawal can induce not only persistent defects in HPA function, but also persistent increases in anxiety and behavioral responsiveness to novelty, all consistent with characteristics of abstinent alcoholics as well as with rats that self-administer increased amounts of alcohol and other drugs of abuse. This suggests that alcohol abuse can induce persistent common or interacting changes in neuroendocrine and behavioral responses that may increase risk for subsequent abuse.     

Spouse abuse and alcohol problems among white, African American, and Hispanic U.S. Army soldiers

BACKGROUND: Prior studies suggest racial/ethnic differences in the associations between alcohol misuse and spouse abuse. Some studies indicate that drinking patterns are a stronger predictor of spouse abuse for African Americans but not whites or Hispanics, while others report that drinking patterns are a stronger predictor for whites than African Americans or Hispanics. This study extends prior work by exploring associations between heavy drinking, alcohol-related problems, and risk for spouse abuse within racial/ethnic groups as well as variations associated with whether the perpetrator is drinking during the spouse abuse incident. METHODS: Cases (N=7,996) were all active-duty male, enlisted Army spouse abusers identified in the Army's Central Registry (ACR) who had also completed an Army Health Risk Appraisal (HRA) Survey between 1991 and 1998. Controls (N=17,821) were matched on gender, rank, and marital and HRA status. RESULTS: We found 3 different patterns of association between alcohol use and domestic violence depending upon both the race/ethnicity of the perpetrator and whether or not alcohol was involved in the spouse abuse event. First, after adjusting for demographic and psychosocial factors, weekly heavy drinking (>14 drinks per week) and alcohol-related problems (yes to 2 or more of 6 alcohol-related problem questions, including the CAGE) were significant predictors of domestic violence among whites and Hispanics only. Also for the white soldiers, the presence of family problems mediated the effect of alcohol-related problems on spouse abuse. Second, alcohol-related problems predicted drinking during a spouse abuse incident for all 3 race groups, but this relation was moderated by typical alcohol consumption patterns in Hispanics and whites only. Finally, alcohol-related problems predicted drinking during a spouse abuse incident, but this was a complex association moderated by different psychosocial or behavioral variables within each race/ethnic group. CONCLUSION: These findings suggest important cultural/social influences that interact with drinking patterns.     

The relationship between parental history and substance use severity in drug treatment patients

The authors explored the relationship between the history of parental problematic alcohol and drug use and their adult children's alcohol and drug use disorders. Subjects were 347 admissions to an outpatient substance abuse program. There was a positive relationship between the number of parents affected by alcohol and/or drug problems and the percentage of probands with co-existing alcohol and drug use disorders for probands with alcohol use disorders but not for those with only drug abuse. Probands with two affected parents had significantly higher alcohol abuse scores and drug, family, and psychiatric composite test scores than those with a negative family history. This preliminary study indicates that the severity of a proband's substance use disorder may be influenced by parental substance use history.