Changes in drinking habits in middle-aged British men

The drinking behaviour of 7735 middle-aged men drawn from general practices in 24 British towns was determined in 1978-80 and five years later in 1983-85. Those with heavier initial drinking were more likely to have reduced consumption after five years. At every level of consumption manual workers showed a greater tendency to decrease drinking than non-manual workers. Of those who became non-drinkers over the five years, 12% had been moderate or heavy drinkers. Men who were told by a doctor that they had developed ischaemic heart disease during the five years were more likely to reduce their alcohol consumption than men who remained free of ischaemic heart disease. Similarly, men who were put on regular medical treatment of any kind or who acquired two or more diagnoses of illness (including ischaemic heart disease) were more likely to become occasional or non-drinkers. Nondrinkers at both reviews had higher rates of diagnosed illness than drinkers. In particular, the ex-drinkers, who comprised 70% of non-drinkers at follow up, had higher rates of ischaemic heart disease and cardiovascular-related problems, such as high blood pressure and diabetes, than drinkers.

It is essential to be aware of the tendency for moderate or heavy drinkers to reduce or stop drinking over time, particularly if illness has been diagnosed. Non-drinkers and exdrinkers should not be used as a baseline in studies relating alcohol to disease.

     

Recidivism in "controlled drinker" alcoholics: a longitudinal study

This study tested the conflicting positions which maintain that moderate drinking invariably and rapidly leads alcoholics to uncontrolled inebriacy and that alcoholics are capable of sustaining controlled drinking over long periods without special training. We obtained 3-, 6-, 9-, and 12-month control-over-drinking follow-up ratings on 42 treated alcoholics who had been identified as completely controlled drinkers. Between a fourth and a half were rated as abstinent or controlled drinkers at each follow-up, while 21% to 37% were categorized either as uncontrolled or institutionalized. No subject was completely controlled for more than two consecutive trimesters. However, only 19% reportedly regressed to completely uncontrolled consumption within 3 months of their first evaluations, which casts doubt on the contention that even limited drinking ordinarily is followed by rapid regression. At their final follow-ups, 47% were rated as abstinent or controlled drinkers and only 36% as uncontrolled or institutionalized. The findings did not support well either the abstinence or the controlled drinking position.     

Differential responses of serum gamma-glutamyltransferase to alcohol intake in Japanese males

We studied the association of gamma-glutamyltransferase (GGT) and other serum markers of liver injury with daily alcohol consumption in a healthy population of 1,043 Japanese males. A positive correlation between daily alcohol consumption and biochemical markers, such as log GGT (r = 0.432), log AST (r = 0.244) or log LAP (r = 0.246), was seen in all drinkers. However, there was a negative correlation, such as log GGT (r = -0.434), log AST (r = -0.424) or log LAP (r = -0.430), in heavy drinkers who consumed more than 70 g ethanol a day. On the other hand, a positive correlation, such as log GGT (r = 0.426), log AST (r = 0.247) or log LAP (r = 0.216) was found in moderate drinkers who consumed less than 70 g ethanol a day. Interestingly, there was a tendency toward negative association between alcohol consumption and the Tokyo University ALDH2 Phenotype Screening Test (TAST) score in the heavy drinkers, and there was a tendency toward positive association between GGT and TAST score in this group. Our results suggest that there are 2 groups of drinkers, those with elevated GGT (good responders) and those with normal GGT (poor responders) despite heavy drinking.     

Psychosocial correlates of alcohol intake among women aged 45 to 64 years: The Framingham Study

This study of 749 women, aged 45 to 64 years, investigates the psychological, behavioral, and social correlates of alcohol intake. These data from the Framingham Study are uniquely based on a community sample of women, which results in a normative study of drinking behavior in women. Two measures of alcohol intake were utilized in these analyses: (1) the frequency of alcohol intake over 1 week and (2) drinking vs abstaining from alcohol. Among this sample of women, increased socioeconomic status, worrying about aging, and being easily upset were positively associated with frequency of alcohol intake. The rigid attitude scale was the strongest discriminating variable for drinkers vs nondrinkers. Older women were more likely to be nondrinkers compared to younger women, however, among older women, being a homemaker was significantly associated with increased alcohol intake. Contrarily, younger women who were homemakers were more likely to be abstainers than women employed outside the home. As would be expected, cigarette smoking was associated with drinking alcohol.This research is dedicated in fond remembrance to our friend and colleague Joseph Stokes III, M.D.     

Epidemiologic evidence for the cardioprotective effects associated with consumption of alcoholic beverages.

The impact of alcohol intake on mortality from all causes has been described in a large number of prospective population studies from many countries. Most have shown a J-shaped relation between alcohol intake and subsequent mortality, indicating that there are both beneficial and harmful effects of ethanol on health. The risk of death from ischemic heart disease is seen to be significantly increased, and highest among abstainers, but not significantly increased among heavy drinkers. Some studies have found plausible mechanisms for the beneficial effect of light to moderate drinking. Subjects with a moderate alcohol intake have a higher level of high density lipoprotein than abstainers. Further, moderate drinkers are seen to have a lower low density lipoprotein. Also, alcohol has a beneficial effect on platelet aggregation, and thrombin level in blood is higher among drinkers than among non-drinkers. In the other end of the range of intake, the ascending leg of the U-shaped curve has been explained by the increased risk of cirrhosis, pancreatitis, and development oropharynx, oesophagus, and breast cancer. In exploring the French paradox, it has been suggested that wine may have beneficial effects additional to that of ethanol. Recently, several prospective population studies have supported this idea. It is, however, also likely that the apparent additional beneficial effect of wine on health in addition to the effect of ethanol itself is a consequence of confounding.     

Moderate alcohol intake is related to increased heart rate variability in young adults: Implications for health and well‐being

Epidemiological literature indicates that the relationship between alcohol consumption and health outcomes reflects a J‐shaped curve such that moderate alcohol consumption confers a protective effect in comparison to abstinence, while heavy consumption is associated with poorer health. While heart rate variability (HRV) may underpin the relationship between drinking and poor health in heavy drinkers, it is unclear whether HRV is increased in moderate, habitual drinkers relative to nonhabitual drinkers. HRV and drinking habits were assessed in 47 volunteers. Results supported hypotheses suggesting that moderate, habitual drinking increases HRV. Although not supported by a significant interaction between drinking group and sex, planned follow‐up analysis also revealed that these findings may be specific to males. Regardless, results highlight HRV as a candidate mechanism for the findings reported in the epidemiological literature.     

Attenuated cortisol response to alcohol in heavy social drinkers.

Individual differences in response to stress may play a role in the development and maintenance of addictive behaviors. While there is evidence that people with a biological family history for alcoholism have a blunted cortisol response to alcohol, data are lacking in other at-risk subgroups, such as heavy social drinkers. The present study examined salivary cortisol response to administration of 0.0, 0.4 (2 drink equivalent), and 0.8 g/kg (4 drink equivalent) alcohol in two groups of social drinkers: heavy drinkers (n=32) and light social drinkers (n=23). The study was conducted double-blind and drink-order was counterbalanced between groups. Salivary cortisol and subjective measures were obtained at predrink baseline, and 15, 45, 105, and 165 min after beverage consumption. Results showed a significant groupxdosextime interaction (p<0.005), with alcohol (0.8 g/kg) producing an attenuated cortisol response in heavy drinkers compared to the light drinkers during the declining phase of the BAC. This outcome remained even after controlling for the effects of smoking status, family history of alcoholism, sex, and negative affect ratings during the session. Neither placebo nor the lower dose of alcohol significantly increased cortisol levels. In sum, a relatively high dose of alcohol produced a smaller increase in cortisol in heavy drinkers compared to light drinkers. The reduced cortisol reactivity in the heavier drinkers is consistent with reports that individuals at risk for alcoholism are hyporesponsive to physical and psychological stress. Further research may help determine whether alteration in cortisol response to alcohol is a biological marker of the propensity to abuse alcohol.     

Endorsed reasons for not drinking alcohol: a comparison of college student drinkers and abstainers

Little is known about how the reasons that college student drinkers and abstainers have for choosing not to drink might differ. The present study examined this issue among a sample of 2,500 U.S. college students from 18 colleges and universities. Abstainers endorsed significantly more reasons for not drinking than drinkers, and among drinkers, light drinkers endorsed more reasons than heavy drinkers. Abstainers’ decision not to drink appeared to be a lifestyle choice that was supported by multiple reasons, including personal values, religious beliefs, not wanting the image of a drinker, and beliefs about alcohol’s effect on behavior. Heavy drinkers were more likely to endorse situational reasons such as having to drive home later or being concerned about school work or weight gain from drinking. Implications of these findings for alcohol prevention work on college and university campuses are discussed.     

Alcohol and cardiovascular health

The substantial medical risks of heavy alcohol drinking as well as the probable existence of a less harmful or safe drinking limit have been evident for centuries. Modern epidemiology studies suggest lowered risk of morbidity and mortality among lighter drinkers. Thus, defining “heavy” drinking as ≥ 3 standard drinks per day, the alcohol-mortality relationship is a J-curve with risk highest for heavy drinkers, lowest for light drinkers and intermediate for abstainers. A number of non-cardiovascular and cardiovascular problems contribute to the increased mortality risk of heavier drinkers. The lower risk of light drinkers is due mostly to lower risk of the most common cardiovascular condition, coronary heart disease (CHD). These disparate relationships of alcoholic drinking to various cardiovascular and non-cardiovascular conditions constitute a modern concept of alcohol and health. Increased cardiovascular risks of heavy drinking include: (1) alcoholic cardiomyopathy, (2) systemic hypertension (high blood pressure), (3) heart rhythm disturbances, and (4) hemorrhagic stroke. Lighter drinking is not clearly related to increased risk of any cardiovascular condition and, in observational studies, is related to lower risk of CHD, ischemic stroke, and diabetes mellitus. A protective hypothesis for CHD is supported by evidence for plausible biological mechanisms attributable to ethyl alcohol. International comparisons and some prospective study data suggest that wine is more protective against CHD than liquor or beer. Possible non-alcohol beneficial components in wine (especially red) support possible extra protection by wine, but a healthier pattern of drinking or more favorable risk traits in wine drinkers may be involved.     

Oral mucosa pigment changes in heavy drinkers and smokers

The preliminary observation that heavy drinking and smoking produced oral mucosal changes consisting of splotchy areas of depigmentation surrounded by hyperpigmentation was tested. The study population was comprised of 52 patients from an alcohol detoxification ward, who were compared with 54 patients from psychiatric inpatient and day hospital services. Structured interviewing was developed for both samples of patients who met either diagnostic criteria for alcohol abuse or dependence, or criteria for alcoholism on the Short Form of the Michigan Alcohol Screening Test, and were identified as nonsmokers or as those who smoked one to three or more packs of cigarettes a day. Photographs of the inner surface of the lips, oral mucosa, and gingivae independently were rated for severity of oral pigment change by two raters blind to a patient's alcohol or smoking history. This study demonstrates that reported observable oral pigment changes identify patients who are heavy smokers and drinkers, and may be a useful diagnostic sign.     

Effects of a brief motivational intervention with college student drinkers

This study consisted of a randomized controlled trial of a 1-session motivational intervention for college student binge drinkers. Sixty students who reported binge drinking 2 or more times in the past 30 days were randomly assigned to either a no-treatment control or a brief intervention group. The intervention provided students with feedback regarding personal consumption, perceived drinking norms, alcohol-related problems, situations associated with heavy drinking, and alcohol expectancies. At 6-week follow-up, the brief intervention group exhibited significant reductions on number of drinks consumed per week, number of times drinking alcohol in the past month, and frequency of binge drinking in the past month. Estimates of typical student drinking mediated these reductions. This study replicates earlier research on the efficacy of brief interventions with college students and extends previous work regarding potential mechanisms of change.     

Moderate-to-heavy alcohol intake is associated with differences in synchronization of brain activity during rest and mental rehearsal

In alcohol-dependent individuals, synchronization of brain activity is different from that in non-alcohol-dependent individuals as reflected by EEG differences at alpha and beta frequencies (8–30 Hz). These EEG differences may not only be related to long-term alcohol intake but also to genetic factors that are associated with alcohol dependence. Thus, it is not known what the pure effect of long-term alcohol intake on synchronization of brain activity is. Therefore, we investigated whether EEG synchronization differs between light (0.5–6 drinks per week), moderate (7–20 drinks per week), and heavy (21–53 drinks per week) drinkers. All participants (49 males and 47 females) were free of a personal and family history of alcohol dependence. Eyes-closed EEG was recorded at rest and during mental rehearsal of pictures. EEG synchronization was determined by computing Synchronization Likelihood for six frequency bands (0.5–4 Hz, 4–8 Hz, 8–12 Hz, 12–20 Hz, 20–30 Hz, 30–45 Hz). Both male and female heavy drinkers displayed a loss of lateralization in alpha (8–12 Hz) and slow-beta (12–20 Hz) synchronization. In addition, moderately and heavily drinking males had lower fast-beta (20–30 Hz) synchronization than lightly drinking males. It is concluded that both male and female drinkers who drink 21 alcoholic drinks per week or more have impaired synchronization of brain activity during rest and mental rehearsal at alpha and beta frequencies as compared to individuals who drink less. As individuals with a personal or family history of alcohol dependence were excluded, the confounding effects of genetic factors related to alcohol dependence on synchronization of brain activity were minimized.     

Harassing under the influence: the prevalence of male heavy drinking, the embeddedness of permissive workplace drinking norms, and the gender harassment of female coworkers

Drawing from the literature linking alcohol consumption and aggressive behavior, the authors examine the degree to which the risk of gender harassment toward female workers may be associated with the drinking behaviors and perceived workplace drinking norms of their male coworkers. Using multilevel analyses to examine data from 1,301 workers (including 262 women employed in 58 work units in the manufacturing, service and construction sectors), our findings indicate that, even when controlling for a variety of other demographic and unit-level factors, there is a significant association between the proportion of males in a work unit identified as being heavy or "at-risk" drinkers and the probability of gender harassment toward unit females. Our findings further indicate that this association is amplified as a function of the embeddedness of permissive workplace drinking norms among males' referent others.     

Differences of photographs inducing craving between alcoholics and non-alcoholics

Many researchers have used cue reactivity paradigm to study alcohol craving. But the difference of craving response to drinks between alcoholic patients and social drinkers was little evaluated. To investigate characteristics of alcohol-related visual cues which induce alcohol craving in alcoholism, we examined the response of subjects to alcohol-related cues considering qualitative aspects. The authors developed 27 photographs related to alcohol as candidate visual cues. Thirty five patients with alcohol dependence, 35 heavy drinkers and 35 social drinkers were shown these pictures and asked to rate these 6 pictures in order of inducing alcohol craving the most. 'A glass of Soju' and 'A Party scene' were chosen as the alcohol-related visual cues which induced craving the most in the patients and heavy drinkers, respectively. The results suggest that the patients with alcohol dependence are more absorbed by alcohol without drinking context such as an atmosphere or situation involving drinking. Heavy drinkers may experience craving in anticipation of being in a drinking situation.     

Gender differences in drinking patterns and alcohol-related problems in a community sample in São Paulo, Brazil

OBJECTIVE:

To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking.

METHODS:

A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of São Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month non-heavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender.

RESULTS:

Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages.

CONCLUSIONS:

Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level.     

Gender differences in risk factors and consequences for alcohol use and problems

Women drink less alcohol and have fewer alcohol-related problems than men. Women appear to be less likely than men to manifest certain risk factors for alcohol use and problems and are more likely to have certain protective factors against these problems: women perceive greater social sanctions for drinking; women are less likely to have characteristics associated with excessive drinking including aggressiveness, drinking to reduce distress, behavioral undercontrol, sensation-seeking and antisociality; and women are more likely to have desirable feminine traits (e.g., nurturance) protective against excessive drinking. In addition, consequences of heavy alcohol use, or alcohol use disorders, appear to be more negative for women than men, at least in some domains: women suffer alcohol-related physical illnesses at lower levels of exposure to alcohol than men, and some studies suggest women suffer more cognitive and motor impairment due to alcohol than men; women may be more likely than men to suffer physical harm and sexual assault when they are using alcohol; heavy alcohol use in women is associated with a range of reproductive problems. Implications of these findings for future research and public health education campaigns are discussed.     

Posttraumatic stress disorder,alcohol use,and physical health concerns

PTSD is a risk factor for alcohol problems and both in turn have been independently associated with increased health problems. However, it is unclear whether alcohol use moderates the relationship between PTSD and health. Participants were battered women (N = 336) recruited from local domestic violence shelters and non-shelter victim-assistance agencies. A 2 (PTSD diagnosis) × 3 (abstainer, infrequent/light, regular/heavy drinking) ANCOVA was conducted, with injuries and length of abuse as covariates and health concerns as the dependent variable. Main effects for PTSD and alcohol use were significant but not the interaction. Women with PTSD reported the greatest number of health concerns. Women who abstained from drinking and those who drank regularly/heavily reported more health concerns than the infrequent/light drinkers. Health concerns associated with PTSD do not appear to be due to problem drinking. In addition, infrequent/light drinking, even for women with PTSD, may be associated with fewer health concerns.     

A metacognitive model of problem drinking

Previous research has demonstrated significant relationships between metacognition and problem drinking. In this study, we aimed to investigate further these relationships by testing the fit of a metacognitive model of problem drinking in a sample of 174 problem drinkers from a university student population. In the model presented, it is proposed that positive metacognitive beliefs about alcohol use and negative affect lead to alcohol use as a means of affect regulation. Positive metacognitive beliefs about alcohol use are also associated with a reduction in metacognitive monitoring which further contributes to alcohol use. Once alcohol use is initiated it brings a disruption in metacognitive monitoring leading to a continuation in drinking. Following a drinking episode, alcohol use is appraised as both uncontrollable and dangerous, which in turn strengthens negative metacognitive beliefs about alcohol use. These beliefs are associated with an escalation of negative affect, which acts as a trigger for further drinking. The specified relationships among these variables were examined by testing the fit of a path model. Results of this analysis indicated a good model fit consistent with predictions. The conceptual and clinical implications of these data are discussed. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? A cognitive‐attentional model that may aid assessment, conceptualization and treatment for moderate or at risk problem drinkers.     

Erythrocyte mean cell volume--correlation to drinking pattern in heavy alcoholics

Erythrocyte mean cell volume (MCV) correlates well to alcohol intake in moderate alcoholism, but only about 50% of heavy drinkers have increased MCV. To evaluate the influence of the duration and extent of a drinking episode on MCV, 64 addictive alcoholics were investigated prospectively within two weeks after a drinking period. Their daily alcohol intake was 120-480 g and the actual drinking period has lasted for 1-104 weeks. For comparison, 21 non-active alcoholics were investigated. There was no correlation between MCV of active alcoholics and daily alcohol consumption or smoking habits, whereas a significant positive correlation was found between MCV and both duration of actual drinking episode and total alcohol intake in this period. We conclude that MCV is probably of greater value in estimating the duration and extent of actual drinking episodes in heavy alcoholics than in screening for alcoholism.     

Targeted naltrexone treatment moderates the relations between mood and drinking behavior among problem drinkers

One hundred fifty-three problem drinkers were randomly assigned to receive naltrexone 50 mg or placebo on a daily or targeted (to high-risk drinking situations) basis. Using structured nightly diaries, participants recorded negative and positive mood, desire to drink, and alcohol consumption over 8 weeks. Results indicated that individuals engaged in any drinking and heavy drinking more on days characterized by relatively higher levels of positive or negative mood states. Naltrexone attenuated the positive association between heavy drinking and both positive and negative mood, and targeted administration attenuated the positive association between heavy drinking and positive mood. There was also evidence that desire to drink mediated the effect of targeted administration on the relation between positive mood and any drinking that day. These findings underscore the utility of daily measurement for understanding the processes that underlie pharmacological interventions for problem drinking.