Harm minimization in school drug education: final results of the School Health and Alcohol Harm Reduction Project (SHAHRP)

AIMS: The School Health and Alcohol Harm Reduction Project (SHAHRP study) aimed to reduce alcohol-related harm in secondary school students. DESIGN: The study used a quasi-experimental research design in which randomly selected and allocated intervention and comparison groups were assessed at eight, 20 and 32 months after baseline. SETTING: Metropolitan, government secondary schools in Perth, Western Australia. PARTICIPANTS: The sample involved over 2300 students. The retention rate was 75.9% over 32 months. INTERVENTION: The evidence-based intervention, a curriculum programme with an explicit harm minimization goal, was conducted in two phases over a 2-year period. MEASURES: Knowledge, attitude, total alcohol consumption, risky consumption, context of use, harm associated with own use and harm associated with other people's use of alcohol. FINDINGS: There were significant knowledge, attitude and behavioural effects early in the study, some of which were maintained for the duration of the study. The intervention group had significantly greater knowledge during the programme phases, and significantly safer alcohol-related attitudes to final follow-up, but both scores were converging by 32 months. Intervention students were significantly more likely to be non-drinkers or supervised drinkers than were comparison students. During the first and second programme phases, intervention students consumed 31.4% and 31.7% less alcohol. Differences were converging 17 months after programme delivery. Intervention students were 25.7%, 33.8% and 4.2% less likely to drink to risky levels from first follow-up onwards. The intervention reduced the harm that young people reported associated with their own use of alcohol, with intervention students experiencing 32.7%, 16.7% and 22.9% less harm from first follow-up onwards. There was no impact on the harm that students reported from other people's use of alcohol. CONCLUSIONS: The results of this study support the use of harm reduction goals and classroom approaches in school drug education.     

Internet‐based prevention for alcohol and cannabis use: final results of the Climate Schools course

Aims To establish the long‐term efficacy of a universal internet‐based alcohol and cannabis prevention programme in schools. Methods A cluster‐randomized controlled trial was conducted to assess the effectiveness of the Climate Schools: Alcohol and Cannabis Course. The evidence‐based course, aimed at reducing alcohol and cannabis use, is facilitated by the internet and consists of 12 novel and curriculum consistent lessons delivered over 6 months. Participants A total of 764 year 8 students (13 years) from 10 Australian secondary schools were allocated randomly to the internet‐based prevention programme (n = 397, five schools), or to their usual health classes (n = 367, five schools). Measures Participants were assessed at baseline, immediately post, and 6 and 12 months following completion of the intervention, on measures of alcohol and cannabis knowledge, attitudes, use and related harms. Results This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12‐month follow‐up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol‐ and cannabis‐related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools. Conclusions Internet‐based prevention programs for school‐age children can improve student's knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.     

A school-based harm minimization smoking intervention trial: outcome results

AIMS: To determine the impact of a school-based harm minimization smoking intervention compared to traditional abstinence-based approaches. DESIGN, SETTING AND PARTICIPANTS: A school-based cluster randomized trial was conducted in Perth, Western Australia in 30 government high schools from 1999 to 2000. Over 4000 students were recruited to participate and schools were assigned randomly to either the harm minimization intervention or a standard abstinence-based programme. INTERVENTION: The harm minimization intervention comprised eight 1-hour lessons over 2 years, quitting support from school nurses and enactment of policies to support programme components. Comparison schools implemented standard abstinence-based programmes and policies. MEASURES: Cigarette smoking was categorized at two levels: regular smoking, defined as smoking on 4 or more days in the previous week; and 30-day smoking as any smoking within the previous month. FINDINGS: At immediate post-test (20 months post-baseline), after accounting for baseline differences, school-level clustering effects, socio-economic status, gender and family smoking, intervention students were less likely to smoke regularly [OR = 0.51, 95% confidence interval (CI) = 0.36, 0.71] or to have smoked within the previous 30 days (OR = 0.69, 95% CI = 0.53, 0.91). CONCLUSION: The school-based adolescent harm minimization intervention appears to have been more effective than the abstinence-based social influences programme at reducing regular smoking.     

The effects of drug abuse prevention at school: the 'Healthy School and Drugs' project

Aims To examine the effects of the ‘Healthy School and Drugs’ project, a Dutch school‐based drug prevention project that was developed in the late 1980s and disseminated during the 1990s. This programme is currently being used by 64–73% of Dutch secondary schools and it is estimated that at least 350 000 high school students receive this intervention each year. Design, setting and participants A quasi‐experimental study in which students of nine experimental (N = 1156) schools were compared with students of three control schools (N = 774). The groups were compared before the intervention, 1 year later, 2 years later and 3 years later. Measurements Self‐report measures of tobacco, alcohol and marijuana use, attitudes towards substance use, knowledge about substances and self‐efficacy. Findings Some effects on the use of tobacco, alcohol and cannabis were found. Two years after the intervention, significant effects could still be shown on alcohol use. Effects of the intervention were also found on knowledge, but there was no clear evidence for any effects on attitude towards substance use and on self‐efficacy. Conclusions This study shows the Healthy School and Drugs project as implemented in Holland may have some effect on drug use in the children exposed to it.     

Revising the preventive paradox: the Swiss case

Aims. To examine Kreitman's preventive paradox of alcohol consumption and its revisions by Stockwell and colleagues and by Skog, with regard to alcohol‐related social harm in Switzerland, and to shed light on the reporting of alcohol‐related social harm in the low‐volume drinking, non‐bingeing subpopulation. The paper compares occurrence and severity of social harm in four subgroups defined by average consumption (volume) and binge drinking. Stage‐of‐change membership was used to further distinguish low‐risk drinkers who might have changed their drinking patterns from those who had not. Design, setting, and participants. Telephone interviews were conducted with 1256 current drinkers of a probabilistic two‐stage sample of the general population of Switzerland. Moderate and hazardous mean consumption (volume) was defined by means of a quantity‐frequency instrument. Daily average consumption of 20 g was set as the cut‐off point for women, and 30 g for men. Binge drinking was defined as taking four or more drinks on an occasion for women, and five or more for men. Structural equation modelling was used to construct a severity scale of six alcohol‐related consequences: work problems, accidents and problems with the police, with friends, with a partner or with the family. Explanatory factor analysis was used to assign drinkers to motivational stages of change. Findings. Moderate drinkers in terms of volume reported more problems than hazardous drinkers, which confirms Kreitman's view. Binge drinkers reported more problems than non‐binge drinkers, confirming the view of Stockwell and colleagues. Binge drinkers were more numerous in the moderate drinking group, which constituted the majority of drinkers, in accordance with Skog's view. Binge drinkers in the moderate‐volume and hazardous‐volume drinking groups did not differ significantly as to either severity or number of problems. Approximately 40% of moderate‐volume, non‐binge drinkers who reported alcohol‐related social harm had already changed their consumption pattern, which indicated that reported harm was related to an earlier drinking pattern. Conclusions. As Skog has pointed out, the second‐order preventive paradox of binge drinking reappeared, in that most binge drinkers were found to occur in the drinker group with low average consumption. Findings also indicate that, with respect to social harm, a preventive strategy aimed at the majority of the population, but on heavy‐drinking occasions rather than on mean consumption, may be valuable.     

The long-term effectiveness of brief interventions for unsafe alcohol consumption: a 10-year follow-up

Aims To examine the long‐term impact of brief and early interventions for hazardous and harmful alcohol consumption. Design A 9‐month and 10‐year follow‐up of subjects recruited into a randomized controlled trial of a range of alcohol‐related brief interventions. Setting General practices, the outpatient or acute care services of a major city hospital, and a privately run health screening programmeme. Participants The cohort of 554 (non‐dependent) hazardous and harmful drinkers recruited into the Australian arm of the Phase II World Health Organization collaborative project on identification and treatment of persons with harmful alcohol consumption. Intervention The effectiveness of three forms of intervention, ranging from 5 to 60 minutes in duration, were compared with a no‐treatment control condition. Measurements Included drinking behaviour and biological markers of alcohol use. In addition, at 10 years subjects were asked about symptoms of diagnosable alcohol use disorders and their experience of alcohol‐related psychological, social and physical harm. Mortality was also assessed. Findings Results provide further evidence for the short‐term effectiveness of alcohol‐related brief interventions. In comparison to controls, subjects offered intervention: (1) report significantly lower consumption; and (2) less unsafe drinking at 9‐month follow‐up. The intensity of intervention was not related to the amount of change in drinking behaviour. Analysis at 10 years failed to find any differences in outcomes between intervention and control groups in median consumption, mean reduction in consumption from baseline to follow‐up, mortality and ICD‐10 diagnoses of alcohol dependence or harmful alcohol use. Conclusions This study failed to find evidence that brief advice and counselling without regular follow‐up and reinforcement can sustain significant long‐term reductions in drinking behaviour at 10‐year follow‐up.     

Impact of motivational changes on drinking outcomes in pharmacobehavioral treatment for alcohol dependence

Background: Psychological factors such as motivation to change and self‐efficacy influence drinking outcomes in alcohol‐dependent individuals who are enrolled in pharmacobehavioral studies. Previous results from our research clinic indicated that initial stage of change of heavy drinkers enrolled in a pharmacobehavioral trial was significantly associated with alcohol consumption. However, overall empirical findings regarding the consistency and extent of the connection between motivational factors and behavior are mixed. This may be in part because of the impact of changes in motivation over the course of treatment and/or characteristics of the individuals receiving the intervention. Our goal in the present study was to examine the extent to which levels of motivation and self‐efficacy changed during the treatment phase of a pharmacobehavioral treatment trial, and the extent to which these variables affected drinking behavior in subsets of alcohol‐dependent individuals. Methods: We conducted an exploratory evaluation of changes in motivation, temptation to drink, confidence to abstain, and drinking behavior over time during the treatment phase of a pharmacobehavioral study involving 321 alcohol‐dependent individuals. We also examined the extent to which individual variables such as initial drinking severity, onset of alcohol dependence, and medication status influenced changes in motivation, self‐efficacy, and drinking behavior. Results: Participants reported improvements in motivation to change, self‐efficacy for change, and drinking behaviors over the course of treatment. As hypothesized, motivation to change and self‐efficacy for change were related to specific dimensions of posttreatment drinking. Heavy drinkers reported more improvement in drinking behaviors than did nonheavy drinkers. Early‐onset drinkers who were on medication reduced their drinking more than those on placebo, and these drinking changes appear to be partially mediated by reductions in temptation. Conclusions: Reductions in drinking occur and are predicted by increased motivation to change, reduced temptation to drink, and increased confidence to abstain in this population of alcoholic‐dependent individuals. Early and late onset and heavy drinkers and those taking medications displayed differential changes in drinking behavior, some of which were explained by the mediating effects of self‐efficacy. This is a first step in understanding more about which alcoholic individuals respond best to treatment and what mechanisms may be involved in the changes in drinking and drinking‐specific changes in frequency and intensity of drinking.     

The distribution of alcohol consumption and the prevention paradox in Brazil

Aims To examine the proportion of self‐reported alcohol consumed by different gender and age groups in Brazil over the past year, and to examine whether the ‘prevention paradox’ applies to Brazilian data on alcohol‐related problems. Design A multi‐stage cluster sample, representative of the Brazilian household population. Setting This study was conducted in Brazil between November 2005 and April 2006. Participants Respondents were aged ≥ 14 years (n = 3007). Measurements Measures included past year estimates of (i) number of standard drinks, (ii) frequency of binge drinking, and (iii) alcohol‐related problems. Findings The survey response rate was 66.4%. The top 2.5% of the drinkers by volume consume 14.9%, the top 5% consume 27.4% and the top 10% consume 44.2% of all alcohol consumed in Brazil. Men consume 77.8% of the total alcohol, and 18–29‐year‐olds consume 40.3%. Individuals below risky drinking guidelines for weekly volumetric intake account for 49–50% of all problem drinkers and 45–47% of all problem types reported. Individuals who do not binge or who binge infrequently (1–3 times/year) account for 50–51% of all problem drinkers and 45–46% of all reported problem types. Most binge drinkers are low‐volume drinkers. Conclusions Consistent with the prevention paradox literature, most drinking problems in Brazil are associated with low or moderate drinking. Binge drinking accounts more clearly for the distribution of alcohol problems than total volume consumed.     

German medical students lack knowledge of how to treat smoking and problem drinking

Aim To assess the extent of undergraduate medical training on alcohol use disorders (AUD) and smoking, and medical students' perceived knowledge regarding consequences of, and treatment options for, these disorders compared with other chronic conditions. Design Cross‐sectional survey assessing teaching and perceived knowledge of health consequences and treatment options for AUD and smoking compared with diabetes and hypertension. Setting Medical schools in Germany. Participants Twenty‐five of 36 medical school offices (response rate 69.4%) and 19 526 of 39 358 students from 27 medical schools (response rate 49.6%). Measurement Medical schools were asked to provide information on curricular coverage of the four conditions. Students reported their year of study and perceived knowledge about the consequences of all four disorders and perceived knowledge of treatment options. Findings Courses time‐tabled approximately half as many teaching hours on AUD and tobacco as on diabetes or hypertension. Final‐year students reported high levels of knowledge of consequences of all four conditions and how to treat diabetes and hypertension, but only 20% believed they knew how to treat alcohol use disorders or smoking. Conclusions Curriculum coverage in German medical schools of alcohol use disorders and smoking is half that of diabetes and hypertension, and in the final year of their undergraduate training most students reported inadequate knowledge of how to intervene to address them.     

Brief alcohol interventions for mandated college students: comparison of face-to-face counseling and computer-delivered interventions

Aims College students who violate alcohol policies are often mandated to participate in alcohol‐related interventions. This study investigated (i) whether such interventions reduced drinking beyond the sanction alone, (ii) whether a brief motivational intervention (BMI) was more efficacious than two computer‐delivered interventions (CDIs) and (iii) whether intervention response differed by gender. Design Randomized controlled trial with four conditions [brief motivation interventions (BMI), Alcohol 101 Plus?, Alcohol Edu for Sanctions^®, delayed control] and four assessments (baseline, 1, 6 and 12 months). Setting Private residential university in the United States. Participants Students (n = 677; 64% male) who had violated campus alcohol policies and were sanctioned to participate in a risk reduction program. Measurements Consumption (drinks per heaviest and typical week, heavy drinking frequency, peak and typical blood alcohol concentration), alcohol problems and recidivism. Findings Piecewise latent growth models characterized short‐term (1‐month) and longer‐term (1–12 months) change. Female but not male students reduced drinking and problems in the control condition. Males reduced drinking and problems after all interventions relative to control, but did not maintain these gains. Females reduced drinking to a greater extent after a BMI than after either CDI, and maintained reductions relative to baseline across the follow‐up year. No differences in recidivism were found. Conclusions Male and female students responded differently to sanctions for alcohol violations and to risk reduction interventions. BMIs optimized outcomes for both genders. Male students improved after all interventions, but female students improved less after CDIs than after BMI. Intervention effects decayed over time, especially for males.     

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Is the “Prevention Paradox” Applicable to Alcohol Problems Across Hispanic National Groups?

Background: The “prevention paradox,” a notion that most alcohol‐related problems are generated by nonheavy drinkers, has significant relevance to public health policy and prevention efforts. The extent of the paradox has driven debate over the type of balance that should be struck between alcohol policies targeting a select group of high‐risk drinkers versus more global approaches that target the population at‐large. This paper examines the notion that most alcohol problems among 4 Hispanic national groups in the United States are attributable to moderate drinkers. Methods: A general population survey employing a multistage cluster sample design, with face‐to‐face interviews in respondents’ homes was conducted in 5 metropolitan areas of the United States. Study participants included a total of 2,773 current drinkers 18 years and older. Alcohol consumed in the past year (bottom 90% vs. top 10%), binge drinking (binge vs. no binge), and a 4‐way grouping defined by volume and binge criteria were used. Alcohol‐related harms included 14 social and dependence problems. Results: Drinkers at the bottom 90% of the distribution are responsible for 56 to 73% of all social problems, and for 55 to 73% of all dependence‐related problems reported, depending on Hispanic national group. Binge drinkers are responsible for the majority of the social problems (53 to 75%) and dependence‐related problems (59 to 73%), also depending on Hispanic national group. Binge drinkers at the bottom 90% of the distribution are responsible for a larger proportion of all social and dependence‐related problems reported than those at the top 10% of the volume distribution. Cuban Americans are an exception. Conclusions: The prevention paradox holds when using volume‐based risk groupings and disappears when using a binge‐drinking risk grouping. Binge drinkers who drink moderately on an average account for more harms than those who drink heavily across all groups, with exception of Cuban Americans.     

Twenty-one-year trends and correlates of pressure to change drinking

Background: The vast majority of individuals with alcohol problems in the United States and elsewhere do not seek help. One policy response has been to encourage institutions such as criminal justice and social welfare systems to mandate treatment for individuals with alcohol problems (Addiction, 1997; 92 :1133). However, informal pressures to drink less from family and friends are far more common than institutional pressures mandating treatment (Addiction, 1996; 91 :643). The prevalence and correlates of these informal pressures have been minimally studied. Methods: This analysis used data from 5 Alcohol Research Group National Alcohol Surveys (NAS) collected at approximately 5‐year intervals over a 21‐year period (1984 to 2005, pooled N = 16,241) to describe the patterns of pressure that drinkers received during the past year from spouse, family, friends, physicians, police, and the workplace. Results: The overall trend of pressure combining all 6 sources across all 5 NAS data sets indicated a decline. Frequent heavy drinking and alcohol‐related harms also declined, and both were strong predictors of receiving pressure. Trends among different sources varied. In multivariate regression models, pressure from friends showed an increase. Pressure from spouse and family showed a relatively flat trajectory, with the exception of a spike in pressure from family in 1990. Conclusions: The trajectory of decreasing of pressure over time is most likely the result of decreases in heavy drinking and alcohol‐related harm. Pressure was generally targeted toward higher risk drinkers, such as heavy drinkers and those reporting alcohol‐related harm. However, demographic findings suggest that the social context of drinking might also be a determinant of receiving pressure. Additional studies should identify when pressure is associated with decreased drinking and increased help seeking.     

Defining 'current drinkers' in national surveys: results of the 2000 National Alcohol Survey

Aims The purpose of this study is to determine which respondents of national surveys who report low ‘usual’ past year drinking frequency, are unsure of their drinking frequency or refuse to answer, are misclassified either as ‘current drinkers’ or as ‘ex‐drinkers.’ Design and setting The data are from the 2000 National Alcohol Survey, a national household telephone probability sample of adults in all 50 US States and Washington, DC (n = 7612). Participants A subsample of 1734 respondents who reported drinking ‘less than once a month but at least once a year’, ‘less than once a year’, ‘refused’ and ‘don’t knows’ were also asked if they had consumed a whole drink of any alcoholic beverage in the 12 months using dates to anchor the question. Measurements Five alcohol measures were used to compare groups who changed or did not change their drinking status based on the followup question: volume, mean number of days 5 +, social consequences, dependence symptoms and DSM‐IV. Findings The results indicate that only 4.6% of respondents (n = 349) changed their drinking status, and the percentages were equal in both directions. Women were more likely to change their drinking status and specifically become ex‐drinkers based on the follow‐up question. Respondents who became current drinkers drank significantly at a lower average volume than those who remained current drinkers. The prevalence rates based on the five alcohol measures were not affected by how ‘current drinker’ is defined. Conclusions Adding the follow‐up question is recommended for new alcohol surveys so that fewer respondents are misclassified.     

A computerized harm minimization prevention program for alcohol misuse and related harms: randomized controlled trial

Aims   Hazardous alcohol use is a leading cause of death among adolescents and young adults world-wide, yet few effective prevention interventions exist. This study was the first to examine a computerized harm minimization intervention to reduce alcohol misuse and related harms in adolescents.
Design   Cluster randomized controlled trial of a six-session curriculum-integrated harm minimization prevention program. The intervention was delivered by computer in the form of a teenage drama, which provided education through alcohol-related scenarios to which young people could relate.
Setting   Schools in Australia.
Participants   A total of 1466 year 8 students (13 years) from 16 high schools in Australia were allocated randomly to a computerized prevention program ( n  = 611, eight schools) or usual classes ( n  = 855, eight schools).
Measurements   Change in knowledge, alcohol use, alcohol-related harms and alcohol expectancies.
Findings   A computerized prevention program was more effective than usual classes in increasing alcohol-related knowledge of facts that would inform safer drinking choices and decreasing the positive social expectations which students believed alcohol may afford. For females it was effective in decreasing average alcohol consumption, alcohol-related harms and the frequency of drinking to excess (more than four standard drinks; 10 g ethanol). For males the behavioural effects were not significant.
Conclusions   A harm minimization approach is effective in educating young people about alcohol-related risks and is effective in reducing risky drinking and harms among girls. Reduction of problems among boys remains a challenge.     

A profile and prediction study of problem drinking among first-year medical students

A study was conducted to determine to what extent first-year medical students are engaged in alcohol use and if specific sociocultural and self-reported behavior characteristics can be used to develop a profile and to predict potential problem drinkers. Four geographically distinct medical schools participated in the study, with a total of 341 students completing a questionnaire regarding current alcohol use and other risk-taking behaviors. Chi-square analyses, analyses of variance, and a discriminant analysis indicated that there is a high occurrence of frequent and heavy drinking among first-year medical students. Potential problem drinkers appear to be White males whose fathers are heavy drinkers. They seem prone to a nonpassive life-style and attend church infrequently. Prevention/intervention programs in medical school can utilize these results to identify high-risk individuals early in their medical career and target them for counseling.     

A randomized controlled trial of a brief intervention after alcohol-related facial injury

Aim To evaluate the effectiveness of a brief motivational intervention on alcohol consumption and misuse in young males with alcohol‐related face injury. Design Randomized controlled trial. Setting Oral and maxillofacial surgery out‐patient clinic in an urban teaching hospital. Participants One hundred and fifty‐one participants were randomized to motivational intervention and control conditions. Interventions Control was treatment as usual. The intervention was treatment as usual plus a one‐session brief motivational intervention administered by a nurse. Measurements Three sets of measurements were taken at baseline, 3‐month and 1‐year follow‐up. Collateral measurements were also taken at 1‐year follow‐up. Primary outcome measures were total alcohol consumption, typical weeks consumption and days abstinent in preceding 3 months. Other outcome measures included the Alcohol Use Disorders Identification Test, a short form of the Alcohol Problems Questionnaire, and a measure of satisfaction with social relationships. Results There was a significant decrease in 84‐day total alcohol consumption across the year (P < 0.006) and further, a significant effect for the motivational intervention was demonstrated (P < 0.029). This pattern was repeated for days abstinent and alcohol consumption in a typical week as well as alcohol‐related problems. There was a significantly greater reduction in the percentage of hazardous drinkers in the motivational intervention group (from 60% to 27%, P < 0.009) compared to the control group (from 54% to 51%, NS). Conclusion A proportion of young men change their alcohol consumption following alcohol‐related injury. A nurse‐led psychological intervention adds significantly to the proportion and magnitude of response.     

Prediction of alcohol-related harm from controlled drinking strategies and alcohol consumption trajectories

Aims To establish predictors of age 21 alcohol‐related harm from prior drinking patterns, current levels of alcohol consumption and use of controlled drinking strategies. Participants One thousand, five hundred and ninety‐six students recruited from an initial sample of 3300 during their final year of high school in 1993. Design Longitudinal follow‐up across five waves of data collection. Setting Post high school in Victoria, Australia. Measurements Self‐administered surveys examining a range of health behaviours, including alcohol consumption patterns and related behaviour. Findings Drinking behaviours at age 21 were found to be strongly predicted by drinking trajectories established through the transition from high school. Multivariate regression analysis revealed that alcohol‐related harms at age 21 were reduced where current levels of alcohol use fell within limits recommended in Australian national guidelines. After controlling for this effect it was found that the range of strategies employed by participants to control alcohol use maintained a small protective influence. Post‐high‐school drinking trajectories continued to demonstrate a significant effect after controlling for current behaviours. Findings revealed that over one quarter of males and females drank alcohol, but on a less‐than‐weekly basis. This pattern of alcohol use demonstrated considerable stability through the post‐school transition and was associated with a low level of subsequent harm at age 21. Conclusions Future research should investigate whether encouraging more Australian adolescents to drink alcohol on a less‐than‐weekly basis may be a practical intervention target for reducing alcohol‐related harms.     

Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up

Background: There is little information on the stability of abstinent and nonabstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM‐IV alcohol dependence, including rates and correlates of relapse, over a 3‐year period. Methods: This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and reinterviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM‐IV criteria for full remission from alcohol dependence. Of these, 1,772 were reinterviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM‐IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low‐risk drinkers relative to abstainers, adjusted for a wide range of potential confounders. Results: By Wave 2, 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with 27.2% of low‐risk drinkers and 7.3% of abstainers. Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were 14.6 times as great for asymptomatic risk drinkers and 5.8 times as great for low‐risk drinkers. The proportions of individuals who had experienced the recurrence of dependence were 10.2, 4.0, and 2.9%, respectively, and the adjusted odds ratios relative to abstainers were 7.0 for asymptomatic risk drinkers and 3.0 for low‐risk drinkers. Age significantly modified the association between type of remission and relapse. Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse. Conclusions: Abstinence represents the most stable form of remission for most recovering alcoholics. Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.     

Alcohol intake in the healthy elderly. Changes with age in a cross-sectional and longitudinal study

Several cross-sectional studies have shown a decline in alcohol intake with increasing age. Longitudinal studies have failed to confirm this trend, which suggests that cohort effects may account for the reported decline. To address this, both cross-sectional and longitudinal analyses of alcohol use in 270 healthy elderly persons over a seven-year period (1980-1987) were performed. Alcohol consumption was assessed by three-day diet records. One hundred sixty-five subjects (61.1%) remained in the study until 1987; 143 (53%) completed diet records for every year. Longitudinal analysis showed a statistically significant decline in the percent of subjects consuming any alcohol over time (slope = -2% per year; 95% confidence interval -2.8, -1.1%). A cross-sectional analysis of the 1980 data revealed a similar decline in percent drinkers with increasing age (slope = -2.7% per year; 95% confidence interval -4.4, -1.1%). Mean alcohol intake for those who continued to drink did not change over time except among heavy drinkers (consumption of greater than 30 g per day in 1980), who did show a significant decline in mean alcohol intake (P = .02). Thus, in our population the decline in percent of drinkers with age found by a cross-sectional analysis was confirmed in longitudinal analyses, suggesting that this represents a true age-related decline rather than a cohort effect.     

High risk drinking settings: the association of serving and promotional practices with harmful drinking

A household survey of 1160 Western Australian adults was used as a basis for exploring drinkers' reports about the settings in which they drank alcohol and their experiences of alcohol related harm. Of the 873 drinkers identified, 7.9% had experienced some form of acute alcohol related harm over the previous 3 months. Violent incidents were the mat common of these and drink-driving offences the least. Such harm was significantly more likely among drinkers who variously drank ‘heavily’, mere male, single, under 25 years of age and/or who drank on licensed premises. Regression analyses revealed that even when demographic characteristics of the drinkers were controlled for licensed premises were significantly more likely to be the settings used prior W harm occurring. Barstaff continuing to serve ‘obviously intoxicated’ customers was the most powerful predictor of harm. Premises which offered discounted drinks or permitted crowding also tended to be those where intoxication was permitted but these variables were not directly associated with an increased risk of harm. These findings lend further weight to the view that prevention efforts should focus on licensed drinking environments and, in particular, the practice of continuing to serve obviously intoxicated customers.