Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations

Brief interventions for alcohol use disorders have been the focus of considerable research. In this meta-analytic review, we considered studies comparing brief interventions with either control or extended treatment conditions. We calculated the effect sizes for multiple drinking-related outcomes at multiple follow-up points, and took into account the critical distinction between treatment-seeking and non-treatment-seeking samples. Most investigations fell into one of two types: those comparing brief interventions with control conditions in non-treatment-seeking samples ( n = 34) and those comparing brief interventions with extended treatment in treatment-seeking samples ( n = 20). For studies of the first type, small to medium aggregate effect sizes in favor of brief interventions emerged across different follow-up points. At follow-up after >3–6 months, the effect for brief interventions compared to control conditions was significantly larger when individuals with more severe alcohol problems were excluded. For studies of the second type, the effect sizes were largely not significantly different from zero. This review summarizes additional positive evidence for brief interventions compared to control conditions typically delivered by health-care professionals to non-treatment-seeking samples. The results concur with previous reviews that found little difference between brief and extended treatment conditions. Because the evidence regarding brief interventions comes from different types of investigation with different samples, generalizations should be restricted to the populations, treatment characteristics and contexts represented in those studies.     

The use of services for alcohol problems: general practitioner and specialist alcohol clinic

A sample of 40 patients referred to a specialist alcohol clinic were given a full assessment by a clinician and then randomly allocated to one of two groups. The first group received continuing care from the clinic. The second group were returned to the management of their general practitioners who were offered specialist support in caring for their patients. Patients and general practitioners were followed-up 6 months after the clinic assessment. This paper reports on the uptake of clinic and general practice services by patients and examines the possible factors associated with continuing attendance, including patient attributes, service activity, patients' self-assessments of their drink problem and their expectations of help from services. Qualitative data is used to examine patients' perceptions and experiences of clinic and general practice-based care for drinking problems. The findings highlight some of the difficulties reported by patients in receiving help for their problems particularly from general practitioners.     

饮酒与肝病流行病学调查

为明确酒精性肝病(ALD)在我市患病率,及饮酒与患ALD的关系,我们于2000年4～6月对西安地区城乡不同职业人群进行了随机抽样调查。 1.方法:(1)将西安城乡各种职业人群作为本次调查对象,采取整群随机抽样方法,对每一调查对象按统一设计的调查表,由经过培训的专人负责询问、查体、腹部B超检查。(2)对饮酒者查肝功能、HBV标志物、抗-HCV、血糖、血脂等。(3)酒精性肝病诊断标准参考文献[1]。除外病毒感染、糖尿病、高脂血症及药物等引起的肝功损伤。(4)统计学分析用SPSS10.0统计软件包。     

The Epidemiology of Venous Thromboembolism in the Community: Implications for Prevention and Management

The epidemiology of venous thromboembolism (VTE) in the community has important implications for VTE prevention and management. This review describes the incidence, survival, recurrence, complications and risk factors for deep vein thrombosis and pulmonary embolism occurring in the community. VTE incidence among whites of European origin exceeds 1 per 1000; the incidence among persons of African and Asian origin may be higher and lower, respectively. VTE incidence over recent time remains unchanged. Survival after VTE is worse than expected, especially for pulmonary embolism where one-quarter of patients present as sudden death. Of those patients who survive, 30% develop VTE recurrence and venous stasis syndrome within 10 and 20 years, respectively. Common independent VTE risk factors include surgery, hospitalization for acute medical illness, nursing home confinement, trauma, active cancer, neurologic disease with extremity paresis, superficial vein thrombosis, central venous catheter/transvenous pacemaker, and among women, oral contraceptives, pregnancy and the puerperium, and hormone and SERM therapy. Exposures can identify populations at risk but have a low predictive value for the individual person. An acquired or familial thrombophilia may predict the subset of exposed persons who actually develop symptomatic VTE. In conclusion, VTE is a common, lethal disease that recurs frequently and causes serious long-term complications. To improve survival and prevent complications, VTE occurrence must be reduced. Better individual risk stratification is needed in order to modify exposures and target primary and secondary prophylaxis to the person who would benefit most. Funded, in part, by grants from the National Institutes of Health (HL-60279, HL-66216, AR-30582) and Centers for Disease Control and Prevention (TS-326), U.S. Public Health Service; and by Mayo Foundation     

Intergenerational effects--a review of environmentally oriented studies concerning the relationship between parental alcohol problems and family disharmony in the genesis of alcohol and other problems. I: The intergenerational effects of alcohol problems.

This paper is the first in a two-part series. In this paper the literature on the intergenerational transmission of alcohol problems is reviewed from an environmental perspective. It is concluded that there are effects of problem drinking on children, but that the long-term effects of parental problem drinking on the offspring once they reach adulthood are not so well documented. It is suggested that whether or not intergenerational continuities are found depends largely upon the source of the sample, that very little is known about adulthood outcomes other than drinking status, and that there is a striking sex bias in the literature, with most research examining the effects of problem-drinking fathers upon their male offspring. Possible mechanisms whereby parental problem drinking could affect adjustment are outlined and discussed. The notion of disturbed family relationships acting as a possible mediator for the transmission of problems is raised.     

The spatial ecology of alcohol problems: niche theory and assortative drinking

Aims This paper summarizes several theoretical perspectives that serve to explain observed associations between concentrations of alcohol outlets and alcohol‐related problems. A critique of each perspective discusses how each addresses the social etiology of these problems; that is, how, where and why these problems arise in association with alcohol outlets? Methods This theoretical work is based upon mathematical and computational models of the ecology of alcohol‐related problems developed in the ‘Ecosystems Modeling Project’, an advanced research project of the National Institute on Alcohol Abuse and Alcoholism, United States. Results Associations between outlets and problems are thought to arise from the concentration of individuals in drinking places (‘flow models’), the attraction of some places for people at risk for problems (‘gravity models’), or because outlets are located in high‐risk neighborhoods and have negative social normative effects (‘social contextual models’). None of these approaches explain how some outlets come to have more problems than others (e.g. violent outlets). An alternative social ecological model is introduced which asserts that the complementary processes of niche marketing and assortative drinking form the social dynamic that explains these relationships. Alcohol sellers ‘niche market’ to select social strata, drinkers return to establishments at which they find people like themselves, and consequent social stratification of the market‐place increases the levels of related problems in some outlets. Conclusions The proposed mechanism is very general, and suggests that over‐concentrations of outlets will lead to stratification of drinking groups and intensification of problems related to those outlets.     

Laboratory paradigms of impulsivity and alcohol dependence: a review

Impulsivity can be defined as choosing a smaller, immediate reward over a larger, delayed reward. From this perspective, addictive behaviors such as substance abuse and pathological gambling reflect a series of impulsive choices. However, impulsivity is not a homogeneous construct. Laboratory measures of impulsivity reflect two types of processes. The first is related to behavioral inhibition and refers to an individual's ability to appropriately inhibit thoughts or actions. The second is the delay of reward dimension, namely the degree to which immediate (rewarding) consequences have more control over an individual's behavior than consequences that are delayed. In this review, we describe how alcohol is associated with significant impairments in these paradigms. We also suggest that they may have a role in the development of alcohol dependence. These results are in agreement with a model in which delay of gratification might be a marker for early use and/or abuse of alcohol, whereas impairment in behavioral inhibition might be a marker for maintained use in time and, therefore, for progression towards alcohol dependence.     

The measurement of alcohol dependence and impaired control in community samples

The concept of the Alcohol Dependence Syndrome has been influential in the field of alcohol studies in the 1980s. The Severity of Alcohol Dependence Questionnaire (SADQ) is one of a generation of alcohol problem scales developed to measure degree of dependence rather than presence or absence of‘alcoholism’. This paper describes the development of a form of the SADQ for community samples of drinkers (SADQ-C) and its relationship to a brief scale designed to measure impaired control over drinking. In a sample of 52 problem drinkers, SADQ and SADQ-C correlated almost perfectly (r = 0.98). In a larger sample of 197 attenders at a controlled drinking clinic, Principal Components Analysis revealed one major factor accounting for 71.7% of the total variance. High internal reliability was indicated with a Cronbach's Alpha of 0.98. Application of this instrument in a random survey of Western Australian households is then described. It was necessary to remove items relating to‘reinstatement of dependence’for this sample. A single major factor was identified by principal components analysis, accounting for 69.1% of the total variance. In both the clinic and the community samples SADQ-C scores correlated highly with Impairment of Control scores. The findings are interpreted as supporting the view that there is a single dimension of alcohol dependence upon which all persons who drink alcohol with any regularity may be located.     

The prevalence and impact of alcohol problems in major depression: a systematic review

Major depression and alcohol problems are common in primary care, yet little is known about the prevalence of alcohol problems in patients with depression or alcohol's effect on depression outcomes. We strove to answer the following questions: How common are alcohol problems in patients with depression? Does alcohol affect the course of depression, response to antidepressant therapy, risk of suicide/death, social functioning and health care utilization? In which alcohol categories and treatment settings have patients with depression and alcohol problems been evaluated? English language studies from MEDLINE, PsychINFO, and Cochrane Controlled Trial Registry were reviewed. Studies were selected using predefined criteria if they reported on the prevalence or effects of alcohol problems in depression. Thirty-five studies met criteria and revealed a median prevalence of current or lifetime alcohol problems in depression of 16% (range 5-67%) and 30% (range 10-60%), respectively. This compares with 7% for current and 16-24% for lifetime alcohol problems in the general population. There is evidence that antidepressants improve depression outcomes in persons with alcohol dependence. Alcohol problems are associated with worse outcomes with respect to depression course, suicide/death risk, social functioning, and health care utilization. The majority of the studies, 34 of 35 (97%), evaluated alcohol abuse and dependence, and 25 of 35 (71%) were conducted in psychiatric inpatients. We conclude that alcohol problems are more common in depression than in the general population, are associated with adverse clinical and health care utilization outcomes, and that antidepressants can be effective in the presence of alcohol dependence. In addition, the literature focuses almost exclusively on patients with alcohol abuse or dependence in psychiatric inpatient settings, and excludes patients with less severe alcohol problems and primary care outpatient settings.