Alcohol-related problems and fitness to drive

This paper analyses the alcohol consumption patterns in Spanish drivers, the incidence of alcohol-related problems and attempts to ascertain whether, in the end, drivers with alcohol-related problems are considered fit or unfit to drive. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from alcohol-related problems. A medical, psychological and eyesight evaluation was performed to test the driving fitness of 8043 drivers attending 25 Medical Driving Test Centres on a national scale. Among other things, information was collected on the patterns of alcohol consumption, the AUDIT and CAGE tests, the incidence of alcohol-related problems (DSM-IV criteria for abuse, dependence and alcohol-induced disorder), as well as an evaluation of their fitness to drive. In all, 60.3% of drivers drink alcohol on a regular basis; 7.3% of drivers scored > or = 8 points in the AUDIT test, and 2% met criteria for DSM-IV alcohol abuse, dependence or induced disorder. Drivers with alcohol-related problems have been involved in traffic accidents (23.2%) and have infringed driving regulations (18.7%) more frequently (P < 0.0001) than those without alcohol-related problems. Of those with alcohol-related problems, 72.2% were considered fit to drive. The study reveals that alcohol consumption is common among drivers, that a significant number of drivers have alcohol-related problems, and that three in four of the latter were considered fit to drive.     

Researching and preventing alcohol problems at work: toward an integrative model

PURPOSE OF PROPOSAL. A consolidated framework is proposed to highlight modifiable factors in work organizations that may contribute to alcohol-related problems. This research model serves to organize existing knowledge, highlight pathways for new research initiatives, and offer insights into the design of primary and secondary preventive strategies. CONTRIBUTING INFLUENCES. Current research on problem drinking in the workplace either locates problems in individual drinkers or looks to the social environment to understand how drinking problems unfold. There is a clear need for a more complete theoretical model which incorporates social, cultural, organizational, and personal factors. PROPOSAL SUMMARY. This article elaborates on a model for examining problem drinking at work which integrates policy, normative, and psychosocial influences. It emphasizes the structures within which health-related decisions and actions are contained and constrained. The focus here on the connections between alcohol use and work builds on the premise that health is socially produced.     

APPROACHES TO THE ALCOHOL PROBLEM IN THE WORKPLACE

The main problem areas posed by either alcohol or alcoholismin the workplace are identified as alcohol-related accidents,reduced work performance and loss of working time. In additionto the heavy costs of these problems for industry, it is suggestedthat a further and generally ignored burden comes from the prematuredeath in middle life of alcoholics who will include a disproportionatelylarge number of top management and more skilled employees. Acomparison with the history of alcohol-related road trafficaccidents suggests that there is scope for large savings froman effective campaign to reduce the incidence of alcohol-relatedproblems in the workplace. An outline is given of the managerial steps involved in settingup and running a company alcohol programme and North Americanand early U.K. experience is assessed to indicate the approachesmost likely to lead to effective prevention. An analysis isattempted of the conditions needed for effectiveness and thereasons for the reported high success rate of many existingprogrammes. Background information is provided of the resourcesavailable to assist such a project, including specialist organizations,publications, videos and facilities for staff training.     

EXTENT AND COSTS OF ALCOHOL PROBLEMS IN EMPLOYMENT: A REVIEW OF BRITISH DATA

In Britain about 9% of males experience alcohol problems atwork. Although heavy drinkers have a higher rate, the majorityof work problems occur in light or moderate drinkers as theseare more numerous. Some data are given on impairment of skills,hangover rates, alcohol-related accidents and lunchtime drinking.Due to extrapolation from the present limited data, there aregreat difficulties in calculating economic costs; estimateshave varied from £60 million to £2 billion a year.In view of the human and economic costs a number of bodies arenow making efforts to encourage alcohol policies in the workplace.Further research is required on many aspects of the problem.     

Pathology of alcoholic liver disease

The history of alcohol consumption has been nearly as long as the history of mankind. Alcohol-related diseases represent a serious problem all over the world and they show a gradually increasing tendency. It can be stated that the frequency of occurrence, severity and mortality of alcohol-related hepatic diseases are in direct correlation with the amount of alcohol consumed. The direct hepatotoxic effect of alcohol and its metabolites has become obvious by now. In addition to this, other mechanisms also play a part in the development of hepatic diseases: their occurrence and severity are significantly influenced by genetic and environmental factors. The rather wide spectrum of alcohol-related hepatic diseases includes steatosis, perivenular fibrosis, alcohol-related hepatitis, occlusive venous lesions, cirrhosis and hepatocellular cancer. All of these disorders are characterized by clearly defined, characteristic but non-specific changes, which need to be supplemented by histological diagnostic criteria. Cirrhosis, which must still be regarded as an irreversibly lethal condition, is thought to develop in two ways. A well-known and widely accepted assumption is that episodes of alcohol-related hepatitis aggravated by progressive fibrosis sooner or later lead to cirrhosis. Another possible explanation is that steatosis facilitating the development and spreading of perivenular fibrosis--even without episodes of hepatitis--may lead to cirrhosis. Thus, alcohol-related hepatic conditions have characteristic pathohistological features, none of which, however, are pathognomonic at the same time. Therefore, the definitive diagnosis of any form of alcohol-related hepatic disorders needs to take evidence of alcohol consumption into account.     

Towards a global alcohol policy: alcohol, public health and the role of WHO

In 1983 the World Health Assembly declared alcohol-related problems to be among the world's major health concerns. Since then, alcohol consumption has risen in developing countries, where it takes a heavy toll. Alcohol-related problems are at epidemic levels in the successor states of the Soviet Union and are responsible for 3.5% of disability-adjusted life years (DALYs) lost globally. Substantial evidence exists of the relationship between the levels and patterns of alcohol consumption on the one hand and the incidence of alcohol-related problems on the other. Over the past 20 years, research has demonstrated the effectiveness of public policies involving, for example, taxation and restrictions on alcohol availability, in reducing alcohol-related problems. In the wake of rapid economic globalization, many of these policies at national and subnational levels have been eroded, often with the support of international financial and development organizations. Development agencies and international trade agreements have treated alcohol as a normal commodity, overlooking the adverse consequences of its consumption on productivity and health. WHO is in a strong position to take the lead in developing a global alcohol policy aimed at reducing alcohol-related problems, providing scientific and statistical support, capacity-building, disseminating effective strategies and collaborating with other international organizations. Such leadership can play a significant part in diminishing the health and social problems associated with alcohol use.     

Smoking intervention in the workplace: review and recommendations

Growing interest has been expressed by the business community concerning intervention against smoking in the workplace. As most adult smokers are unlikely to have access to smokers' clinics or other treatment facilities outside the workplace, the workplace itself could be an ideal location for the provision of treatment programs. If the interest of the business community can be translated into action, large populations of smokers would become accessible to workplace treatment programs. Despite this possibility, the potential of the workplace for smoking intervention remains largely unexplored. In this review, the main reasons for workplace smoking intervention are discussed, and the available evidence for the main strategies (prohibition, incentives, treatment, and multicomponent) is reviewed and critically evaluated. The current emphasis in treatment studies is still on physician counseling, and the quality of reported work uneven. Many published studies not intended as evaluations, and many of those which are, have severe procedural or methodological flaws. The particular problems of evaluating workplace studies are discussed and the current research position is summarized. Because the number of evaluative studies is small, the recommendations that can be based on them are fairly limited. In conclusion, it is argued that a body of well-controlled evaluations is needed before the unique characteristics of the workplace can be assessed and exploited in smoking interventions.     

College Students’ Drinking and Posting About Alcohol: Forwarding a Model of Motivations,Behaviors, and Consequences

College drinking continues to remain a public health problem that has been exacerbated by alcohol-related posts on social networking sites (SNSs). Although existing research has linked alcohol consumption, alcohol posts, and adverse consequences to one another, comprehensive explanations for these associations have been largely unexplored. Thus, we reasoned that students’ personal motivations (i.e., espousing an alcohol identity, needing entertainment, and adhering to social norms) influence their behaviors (i.e., alcohol consumption and alcohol-related posting on SNSs), which can lead to alcohol problems. Using structural equation modeling, we analyzed data from 364 undergraduate students and found general support for our model. In particular, espousing an alcohol identity predicted alcohol consumption and alcohol-related SNS posting, needing entertainment predicted alcohol consumption but not alcohol-related SNS posting, and adhering to social norms predicted alcohol-related SNS posting but not alcohol consumption. In turn, alcohol consumption and alcohol-related SNS posting predicted alcohol problems. It is surprising that alcohol-related SNS posting was a stronger predictor of alcohol problems than alcohol consumption. We discuss the findings within their applied applications for college student health.     

Alcoholism--how it affects health and working capacity

Alcoholism is a growing medical and public health issue both in adult and in younger populations. It is a multi-aetiological phenomenon influenced by genetic, psychological, cultural and other factors. Alcoholic beverages have traditionally been prepared from various ingredients, such as grapes, malt, and rice. Drinking prevalence has varied and is more pronounced in women and the youth. Alcoholism is shown to be of neurophysiologic origin and may lead to the impairment of all human body systems. The most frequent cause of death in alcoholics are the diseases of the cardiovascular system. Alcoholism at workplace is a very important issue as it affects health, reduces productivity, and may lead to accidents, injuries and decreased working capacity. Alcohol-related difficulties develop much earlier than the clinical picture. The diagnosis of alcoholism includes early detection of alcohol-related problems, so it is necessary to orient the healthcare services towards primary prevention and early intervention.     

Lessons learned from evaluating Maryland's anti-drunk driving campaign: assessing the evidence for cognitive, behavioral, and public health impact

The evidence concerning Maryland's anti-drunk driving program, Checkpoint Strikeforce, is reviewed. To date, there is no evidence to indicate that this campaign, which involves a number of sobriety checkpoints and media activities to promote these efforts, has had any impact on public perceptions, driver behaviors, or alcohol-related motor vehicle crashes and injuries. This conclusion is drawn after examining statistics for alcohol-related crashes, police citations for impaired driving, and public perceptions of alcohol-impaired driving risk. Comparisons are also made with other states in the mid-Atlantic region, where similar campaign activities have occurred. Reasons for this failure in Maryland include insufficient levels of enforcement (e.g., too few sobriety checkpoints and vehicle contacts occurred to raise public perceptions of risk pertaining to impaired driving) and inadequate publicity surrounding this campaign. Suggestions for overcoming these problems are offered.     

Alcohol: a review of the impact of worksite interventions on health and behavioral outcomes

PURPOSE: To review, evaluate, and summarize research published in scientific journals linking alcohol-related interventions in the worksite to either individual or organizational outcomes. METHODS: A review of the literature published in peer-review journals between 1970 and 1995 identified 24 articles that reported the results of studies on the impact of worksite programs on alcohol control on health and behavioral outcomes. IMPORTANT FINDINGS: There is strong suggestive evidence and some conclusive evidence that worksite interventions including core components of employee assistance programs are effective in rehabilitating employees with alcohol problems. There is suggestive and conclusive evidence that worksite training oriented toward alcohol problems affects the attitudes of supervisors and employees for reasonable periods after the completion of training. CONCLUSIONS: Investment in worksite interventions directed at reducing alcohol-related problems appears to be a sound strategy, although considerably more research is needed. This research should include broad representation of appropriate worksite populations. Similar measurements should be used across studies. To the extent possible, randomized control group designs should be employed. Without significant external sponsorship, it is not likely that such an improved body of research data will emerge.     

Windows of Opportunity: Fundamental Concepts for Understanding Alcohol-Related Disparities Experienced by Young Blacks in the United States

This paper presents a theoretical framework for conceptualizing alcohol-related disparities experienced by young Blacks in the United States. The framework highlights areas of risk and opportunity as they relate to the development of alcohol use and alcohol-related problems. In this paper, life course development theory serves as a guide for identifying a critical period in the development of alcohol-related disparities and it serves to guide the identification of opportunities to prevent or attenuate this health outcome. We also highlight concepts from ecosocial theory, resilience theory, and prevention science that advance our understanding of risk and protective factors for the social problems that young Blacks experience related to alcohol use.We conclude with suggestions for designing studies that range from etiology to preventive interventions. We also recommend methodologies that allow for more nuanced understandings of the etiology and prevention of alcohol use and alcohol-related problems experienced by young Blacks than have been available to date.     

A cohort study of drink-driving motor vehicle crashes and alcohol-related diseases

OBJECTIVES: To elicit whether drivers involved in alcohol-related motor vehicle crashes are more likely to have future alcohol-related hospital admissions. METHOD: A population-based cohort study of 3,286 drivers involved in a motor vehicle crash between 1988 and 1992 were followed over an eight to 13-year period. RESULTS: The findings from the study suggest a twofold increased risk associated with an alcohol-related motor vehicle crash and future alcohol-related hospital admission. The average time between an alcohol-related motor vehicle crash and future alcohol-related hospital admission was 12 years. Men and indigenous Australian drivers were more likely to have a future alcohol-related hospital admission. CONCLUSION: It is evident from this study that drink-driving resulting in a motor vehicle crash and hospitalisation could be considered an indicator of a less overt problem of alcohol dependency. IMPLICATIONS: It is important that penalties for drink-driving go beyond merely punitive action and provide rehabilitation.     

Evidence-based alcohol policy in the Americas: strengths, weaknesses, and future challenges.

The objectives of this article are to describe the evidence base for alcohol policy in the Americas, to evaluate the extent to which national policies are likely to have an impact on public health, and to identify areas where alcohol policies could be improved. The paper begins with a brief review of epidemiological surveys of the prevalence of alcohol problems in the Americas. This is followed by an analysis of 32 prevention strategies and interventions in terms of the evidence for their effectiveness, amount of research support, cost to implement, and other feasibility issues. Overall, the strategies and interventions with the greatest amount of empirical support are low blood alcohol concentration levels for driving while intoxicated, controls on alcohol availability, age limits on alcohol purchases, and relatively high alcohol prices. The implications of the evidence are next discussed in relation to alcohol policy initiatives in the Americas, based on an analysis of the extent to which strategies and interventions currently used in 25 countries of the Americas are likely to have a public health impact on alcohol-related problems. The countries that have adopted the policies with the highest expected impact overall are Colombia, Costa Rica, Venezuela, and El Salvador. Nevertheless, the analysis indicates that almost all the countries of the Americas could improve the likelihood of preventing alcohol-related problems. Policy efforts in the developing countries of Latin America should focus on improving countermeasures against driving while intoxicated, measures that alter the drinking context, and limits on physical availability. For the developed, high-income countries of North America the goal should be to prevent deterioration of current drinking patterns and to reduce the overall volume of drinking. Given the low to moderate cost of many of the policies reviewed in this article, it now seems possible for communities and nations to substantially reduce the alcohol-related burden of illness in the Americas.     

Asian American Women and Alcohol-Related Problems: The Role of Multidimensional Feminine Norms

Increasing rates of heavy episodic drinking (HED; four or more drinks in one sitting) and alcohol use disorders among young adult Asian American women signify the need to identify the risk and protective factors for HED and alcohol-related problems in this demographic. Multidimensional feminine norms, or the beliefs and expectations of what it means to be a woman, are theoretically relevant factors that may help elucidate within-group variability in HED and alcohol-related problems. The present study examined associations between nine salient feminine norms, HED, and alcohol-related problems among 398 second-generation Asian American college women. Our findings reveal that certain feminine norms are protective of HED and alcohol-related problems, while others are risk factors, even when controlling for well-established correlates of HED and alcohol-related problems, such as perceived peer drinking norms. The results elucidate the importance of multidimensional feminine norms and their relationship to HED and alcohol-related problems among the increasingly at-risk group, Asian American college women.     

Alcohol-related public policies

The article is a review of studies on alcohol-related problems and public policies for consumption reduction addressing recent national and international scientific evidences. In this way, literature review was carried out on alcohol-related public policies through searches in MEDLINE, SCiELO and LILACS databases. Policies for alcohol consumption reduction have been implemented in different countries to minimize its effects on people's health and safety but only recently such strategies and interventions have been scientifically evaluated. It is discussed better cost-effectiveness policies for reducing harmful effects and socioeconomic costs associated with alcohol use through the development of strategies favoring changes in behavior and harmful consumption contexts that can be applicable to different communities.     

Cross-border health and productivity effects of alcohol policies

This paper studies the cross-border health and productivity effects of alcohol taxes. We estimate the effect of a large cut in the Finnish alcohol tax on mortality, alcohol-related illnesses and work absenteeism in Sweden. This tax cut led to large differences in the prices of alcoholic beverages between these two countries and to a considerable increase in cross-border shopping. The effect is identified using differences-in-differences strategy where changes in these outcomes in regions near the Finnish border are compared to changes in other parts of northern Sweden. We use register data where micro level data on deaths, hospitalisations and absenteeism is merged to population-wide micro data on demographics and labour market outcomes. Our results show that the Finnish tax cut did not have any clear effect on mortality or alcohol-related hospitalisations in Sweden. However, we find that workplace absenteeism increased by 9% for males and by 15% for females near the Finnish border as a result of the tax cut.     

Treatment setting and treatment outcome in alcohol dependency: residential and day-care options compared

When empowered to select either a residential or a day care treatment programme for problem drinking, more patients favour the latter option. Those completing the full programme, which was similar in content in both settings, were followed up at ≈ 9 months after initial engagement in treatment. Attrition was a major problem, particularly in the day-patient sample. Of the 103 patients who began each programme, 91 completed the residential option but only 23 completed all sessions in the day-patient course. Day-care completers tended to have less severe alcohol-related problems than in-patient completers. They were also older, had experienced fewer episodes of alcohol-related admissions in the past and were less likely to show biochemical evidence of alcohol-related physical damage. Both groups showed positive changes in drinking intake, drink-related problems, the use of adjunct services and the self-ratings of improvement throughout the follow-up period. Outcome in the day programme completers group was, however, generally better than that shown by the in-patients. The results should be interpreted with caution owing to the significant inter-group differences at the start of treatment and the considerably higher non-attendance and attrition rates for the day-care programme. A cognitive-behavioural in-patient programme for alcohol dependent patients can be provided in a day-care setting. For some patients, this option is both attractive and effective.     

DOWN THE ROAD TO DEREGULATION

A recent preliminary ruling by the European Court of Justice,that would have ended the Swedish state retail alcohol monopolyon grounds of European law on free movement of goods, highlightsthe international pressure on countries to deregulate furthertheir alcohol markets. However, those countries that have recentlytaken the road to deregulation have not been able to preventthe alcohol industry encouraging people to drink more and theyare experiencing increased alcohol-related problems. The internationaldebates about tradable commodities rarely take account of theconsequences for public health. Alcohol is one such commoditythat is also an important cause of premature death. It is essentialthat this is not overlooked in the race to promote free trade.     

The Employee Stress and Alcohol Project: The development of a computer-based alcohol abuse prevention program for employees

The Employee Stress and Alcohol Project (ESAP) developed an interactive computer-based alcohol abuse prevention and early intervention program accessible to employees over the Internet. Behavioral health research recommends that specialists develop and provide comprehensive yet cost-effective approaches to alcohol abuse prevention, early intervention, and treatment within the context of workplace managed care. ESAP is implementing this web site for a diverse 8,567-employee work site. ESAP's web site enables employees to self-assess their stress levels, coping styles, and risk for alcohol-related problems. It provides personalized feedback, recommendations, mini-workshops, a drinking journal, links to other online resources, and an interactive forum for direct participant-to-participant communication. ESAP's web site provides resources for employees who are concerned about another individual's drinking as well as information about adolescent alcohol use. This article discusses the implications of incorporating the ESAP web site into worksite alcohol abuse prevention and early intervention programming.