Drinking pattern and alcohol-related medical disorders.

Although heavy alcohol intake is known to be one of the most common causative factors of liver disease, pancreatitis, upper gastrointestinal and neurological disorders, the influence of the drinking pattern is largely unknown. The study investigated the relationship of alcohol-related medical disorders in alcoholics and their drinking pattern. Two hundred and forty-one chronic alcoholics were referred consecutively for detoxification and their drinking pattern was sufficient for them to be included in this study. History of alcohol abuse as well as drinking behaviour in the last 6 months were assessed by a semi-structured interview. Findings included intensive clinical examination with abdominal ultrasound in most subjects. Heavy drinking with frequent inebriation was most often found in our sample (44.4%), whereas continuous heavy alcohol consumption without intoxication (33.6%), and an episodic drinking style (22.0%) were less frequent. The heavy drinkers suffered more often from pancreatitis, oesophageal varices, polyneuropathy or erectile dysfunction than episodic drinkers. They also showed more upper gastrointestinal disorders, although the estimated life-time alcohol intake was comparable to continuous drinkers. No difference relating to withdrawal delirium or seizures could be found between the groups of alcoholics. Frequent heavy drinkers showed a trend to more alcohol-related medical disorders than alcoholics with a different drinking pattern, although they were younger and their estimated life-time alcohol intake was comparable to that of continuous drinkers. Thus, the drinking pattern, particularly frequent inebriation, has an influence on the occurrence of alcohol-related disorders.     

The health and health behaviors of people who do not drink alcohol

BACKGROUND: Compared to abstention, moderate drinking has been linked to better health, and heavy and hazardous drinking to increased morbidity and mortality. Many studies have failed to account for heterogeneity in health and drinking history among nondrinkers, however. If former drinkers quit in response to ill health, this could increase the risk in the nondrinker category and underestimate the effects of alcohol if illnesses leading to abstention are alcohol-related. In addition, health behaviors may vary with drinking status, affecting health outcomes often attributed to drinking. METHODS: Survey data were collected from a probability sample of a large health maintenance organization's membership. Regression analyses assess the relationship between drinking status (adjusting for covariates), mental and physical health and functioning, and health behaviors. RESULTS: Former drinkers and lifelong abstainers had worse health and functioning than current drinkers and, comparatively, former drinkers had worse health than lifelong abstainers. Former drinkers did not differ from light-to-moderate drinkers in regard to health behaviors (except for smoking), although lifelong abstainers and heavier drinkers were less likely to use preventive care or try to improve their health behaviors. CONCLUSIONS: Consistent with hypotheses that former drinkers may stop drinking because of poor health, former drinkers were less healthy than current drinkers and had slightly worse health than lifelong abstainers, compared to light-to-moderate drinkers. Former drinkers did not appear to be at risk because of poorer health behaviors (except smoking), but lifelong abstainers and heavier drinkers might benefit from outreach designed to increase use of preventive care and improve health behaviors.     

Receiving an alcohol enquiry from a physician in routine health care in Sweden: a population-based study of gender differences and predictors

Research has shown that the provision of brief interventions in the health care system is effective for reducing hazardous drinking. Using a telephone-administered questionnaire, this study provides a population-based investigation on the extent to which physicians address patients' alcohol habits in the Swedish health care system, whether there are gender differences in the extent to which patients receive questions about alcohol, and predictors for receiving such questions. Data were obtained from monthly telephone surveys with around 72,000 people in 2006-2009. Having received an alcohol enquiry was defined as having been asked about one's drinking habits by a physician in any health care visit in the last 12 months. Fourteen percent of the total population had received an alcohol enquiry, but there were considerable gender differences: for hazardous drinkers, 13% of the women and 17% of the men had received an alcohol enquiry; among those with sensible alcohol consumption, 10% of women and 15% of men had received an alcohol enquiry. Patients were more likely to have received an alcohol enquiry if they had self-reported alcohol-related problems, were hazardous drinkers and/or daily smokers. Some of the alcohol enquiry predictors differed by gender; social class was an important predictor for women but not for men.     

Understanding Associations Between Neighborhood Socioeconomic Status and Negative Consequences of Drinking: a Moderated Mediation Analysis

We explored how neighborhood socioeconomic status (SES) is related to negative consequences of drinking to explain why racial/ethnic minority group members are more at risk than Whites for adverse alcohol outcomes. We tested direct and indirect effects of neighborhood SES on alcohol problems and examined differences by gender and race. We used data from the 2000 and 2005 National Alcohol Surveys (N?=?7912 drinkers aged 18 and older; 49 % female) linked with data from the 2000 Decennial Census in multivariate path models adjusting for individual demographics. In the full sample, neighborhood disadvantage had a significant direct path to increased negative consequences, with no indirect paths through depression, positive affect or pro-drinking attitudes. Neighborhood affluence had significant indirect paths to increased negative consequences through greater pro-drinking attitudes and increased heavy drinking. Subgroup analyses showed the indirect path from affluence to consequences held for White men, with no effects of neighborhood disadvantage. For racial/ethnic minority men, significant indirect paths emerged from both neighborhood disadvantage and affluence to increased consequences through greater pro-drinking attitudes and more heavy drinking. For minority women, there was an indirect effect of neighborhood affluence through reduced depression to fewer drinking consequences. There were limited neighborhood effects on alcohol outcomes for White women. Interventions targeting pro-drinking attitudes in both affluent and disadvantaged areas may help reduce alcohol-related problems among men. Initiatives to improve neighborhood conditions could enhance mental health of minority women and reduce alcohol-related health disparities.     

Stress increases attentional bias for alcohol cues in social drinkers who drink to cope

AIMS: To investigate the effects of stress on alcohol craving and attentional bias for alcohol-related cues in a group of heavy social drinkers. METHOD: Forty-four heavy social drinkers were exposed to either a laboratory stressor task or a control manipulation before completing a questionnaire measure of alcohol craving and a visual probe task which measured attentional bias for alcohol-related cues. Participants were subdivided into those with high and low levels of coping motives for drinking. RESULTS: Compared to a control manipulation, the laboratory stressor task produced increases in alcohol craving (P < 0.01). The laboratory stressor task also produced a significant attentional bias for alcohol-related cues, but only among participants who had high levels of coping motives (P < 0.05). CONCLUSIONS: Findings are broadly consistent with contemporary negative reinforcement models of substance abuse, and with models of subjective craving and attentional biases for substance-related cues.     

Drinking levels, knowledge, and associated characteristics, 1985 NHIS findings

Several questions in the 1985 Health Promotion and Disease Prevention Questionnaire, which was part of the 1985 National Health Interview Survey, addressed respondents' consumption of alcohol. Sociodemographic characteristics, knowledge of health risks related to heavy drinking, health practices, and the prevalence of certain health conditions were examined in relation to drinking levels. Although cause-effect relationships should not be inferred from the associations, the findings suggest some provocative areas for prevention and research. Heavier drinkers were more commonly found among men than women. Level of drinking was associated positively with years of education and family income, but was inversely related to age. Compared with light drinkers, heavier drinkers were much more likely to drive after they had had too much to drink. While more than 90 percent of the population knew that heavier drinking increases the risk of 'liver cirrhosis, less than half knew about the increased risk of throat cancer and cancer of the mouth. Most respondents aged 18-44 years (80 percent or more) knew that heavy drinking increases the chance of adverse pregnancy outcomes, and more women than men (62 versus 49 percent) had heard of fetal alcohol syndrome (FAS). However, 70 percent or more of those who had heard of FAS described the syndrome as a newborn addicted to alcohol rather than a child born with certain birth defects. Heavier drinkers of both sexes were less likely than others to be nonsmokers, and moderate drinkers were more likely than others to exercise or play sports regularly. Moderate drinkers also tended to have lower lifetime prevalence rates than others for hypertension and heart trouble.     

Alcohol drinking among emergency patients--alcometer use and documentation

AIMS: To measure physicians' use of the alcometer (breath analysis test) and their documentation of alcohol-related findings among their patients. METHODS: Over one weekend, during which 100 adults attended the emergency clinic of a university hospital, data were collected on patients' alcohol consumption, physicians' use of an alcometer and alcohol-related documentation. Heavy drinkers were defined by the patient's response to a written questionnaire: Five-Shot total score >or=3 points, and/or >or=7 drinks per one occasion. RESULTS: The questionnaire was filled in by 96 patients; 26 (27%) were heavy drinkers. The alcometer was used in 7% of patients including 5 of 26 (19%) of the heavy drinkers. For only 12/26 (46%) heavy drinkers was there written information on alcohol use in the medical record. For 6 of the 20 patients whose visit was primarily considered by the physician to be alcohol-related, no documentation on alcohol appeared in the records. When documentation was present, drinking quantities were not usually recorded. CONCLUSIONS: It is a challenge to increase the emergency clinic staff's activity in detection and documenting alcohol abuse.     

Alcohol abuse among U.S. Navy recruits who were maltreated in childhood

AIMS: To examine relationships between childhood maltreatment and alcohol-related problems among U.S. Navy recruits. METHODS: An anonymous sample of 5697 Navy recruits completed a survey regarding their alcohol consumption, alcohol problems (binge drinking, drinking until drunk, alcohol dependence, alcohol-related arrests), and experiences of childhood physical and sexual abuse. RESULTS: Most of the recruits used alcohol, and a substantial proportion reported histories of childhood maltreatment. Recruits who had been victimized as children were more likely to use alcohol. Furthermore, among drinkers, those who had been abused were more likely to exhibit alcohol problems than were non-abused drinkers. CONCLUSION: Substantial numbers of personnel with alcohol-related problems may be using alcohol to self-medicate due to a history of childhood abuse. Attention to the association between alcohol abuse and childhood maltreatment might help improve the efficacy of military alcohol reduction programs.     

Drinking patterns and traffic casualties in Switzerland: matching survey data and police records to design preventive action

OBJECTIVE: To examine the association between drinking patterns and alcohol-related traffic casualties. STUDY DESIGN: Data linkage of cross-sectional survey data on alcohol consumption with official traffic casualty records. METHODS: Alcohol consumption measures for usual heavy drinking and risky single occasion drinking were derived for different time segments of the day from a 7-day drinking diary study of 747 current drinkers. Measures were correlated with official records of alcohol-related traffic casualties. RESULTS: There was a high correlation between alcohol-related traffic casualties and the number of risky single occasion drinkers that consumed alcohol outside their homes (r=0.92). On average, about 50% of these drinking occasions were attributed to usual moderate drinkers. The proportion of usual heavy drinkers was lowest in the time segments with the most alcohol-related casualties. CONCLUSION: Preventive countermeasures should be targeted at the general population, enforced particularly during specific periods of the week.     

Racial and ethnic differences in all-cause mortality risk according to alcohol consumption patterns in the national alcohol surveys

Previous studies have found J-shaped relations between volume of alcohol consumed and mortality risk in white Americans but not in African Americans, suggesting the need for studies in which race/ethnicity-defined subgroups are analyzed in separate comparable models. In the present study, the authors utilized mortality follow-up data (through 2006) on respondents from the 1984 and 1995 National Alcohol Surveys, including similar numbers of black, white, and Hispanic respondents by oversampling the minority groups. Cox proportional hazards models controlling for demographic, socioeconomic, mental health, and drug- and tobacco-use measures were used to estimate mortality risk from all causes. Findings indicated a protective effect of moderate alcohol drinking (2-30 drinks/month for women and 2-60 drinks/month for men) with no monthly ≥5-drink days) relative to lifetime abstention for whites only. Elevated mortality risk relative to moderate drinking was found in former drinkers with lifetime alcohol problems. Moderate drinkers who consumed ≥5 drinks in 1 day at least monthly were also found to have increased risk, suggesting the importance of identifying heavy-occasion drinking for mortality analyses. These differential results regarding lifetime abstainers may suggest bias from differential unmeasured confounding or unmeasured aspects of alcohol consumption pattern or may be due to genetic differences in the health impact of alcohol metabolism.     

Empirically based guidelines for moderate drinking: 1-year results from three studies with problem drinkers.

OBJECTIVES. The study was conducted to refine guidelines on moderate drinking for problem drinkers, persons whose alcohol use is hazardous or harmful. Information on levels of alcohol intake unlikely to cause problems is useful for health professionals, educators, and policymakers. METHODS. Based on their reports of alcohol-related problems, participants in three studies assessing interventions to reduce heavy drinking (114 men, 91 women) were categorized as "problem-free" or "problem" drinkers at follow-up. Drinking measures were examined to identify patterns separating these outcome categories. RESULTS. Analyses using 95% confidence intervals for means on drinking measures showed that guidelines should be sex-specific. Based on analyses of positive and negative predictive value, sensitivity, and specificity, it is recommended that men consume no more than 4 standard drinks in any day and 16 drinks in any week, and that women consume no more than 3 drinks in any day and 12 drinks in any week. CONCLUSIONS. These guidelines are consistent with those from several official bodies and should be useful for advising problem drinkers when moderation is a valid treatment goal. Their applicability to the general population is unevaluated.     

Women''s drinking and drinking problems: patterns from a 1981 national survey

A 1981 national survey of women's drinking interviewed 917 women in the general population, stratified on the basis of screening interviews to include 500 moderate-to-heavy drinkers. The survey found no evidence of any major recent increase in women's drinking, and no evidence of unusually heavy drinking among working wives. Adverse drinking consequences and episodes of extreme drinking were most common among women aged 21-34; women who were unmarried, divorced or separated, or cohabiting; and women with frequent drinkers as spouses or companions. Alcohol-related behavior problems and symptoms of alcohol dependence were closely related to levels of alcohol consumption. Among women averaging one ounce or more of ethanol per day, 45 per cent had driven while intoxicated in the past year, and 36 per cent reported memory lapses while drinking. Women at this consumption level were also more likely to report experiences with depression (61 per cent). Women with extremely high consumption levels were more likely to have histories of obstetrical and gynecological problems. Some women with alcohol-related problems reported periods of temporary abstention, a pattern not studied heretofore.     

Alcohol use among entrants to a Hong Kong University

AIM: This study of first year entrants to one of the major universities in Hong Kong describes the pattern of their alcohol consumption, their binge drinking, alcohol abuse, and dependence. METHODS: A retrospective cross-sectional study was conducted. A representative sample of year 1 students 2630/2968 (89%) newly admitted to the Chinese University of Hong Kong in 2003 were recruited to participate in a structured self-administered questionnaire. RESULTS: First year university students in Hong Kong have low rates of ever drinking alcohol (62%), and the rates of binge drinking and alcohol-related problems were 7 and 0.8%, respectively. The pattern of binge drinking is more common than weekly drinking (2.3%). Binge drinkers are more likely to have experienced alcohol-related interpersonal problems or (95% CI) = 6.5 (1.7-24.5). Males were more likely to drink, to binge drink, and to drink frequently. CONCLUSIONS: In contrast with students in the west, the majority of first year university students in Hong Kong are not binge or regular drinkers. However, there is a subgroup who smoke, drink more, and use alcohol as a means of coping with stress. This group may be particularly in need of a brief intervention, such as providing counseling and referral services.     

Heavy drinking and health promotion activities

Empirical evidence suggests that individuals who consume relatively large amounts of alcohol are more likely to use expensive acute medical care and less likely to use preventive or ambulatory services than other individuals. The few studies that investigated the associations between heavy drinking and health promotion activities did not try to address omitted-variable biases that may confound the relationships. To fill this void in the literature, we examined the effects of heavy alcohol use on three health promotion activities (routine physical exam, flu shot, regular seatbelt use) using the US 2006 Behavioral Risk Factor Surveillance Survey. Although specification tests indicated that omitted variable bias was not present in the majority of the single-equation probit models, we cautiously interpret our findings as evidence of strong associations rather than causal effects. Among both men and women, heavy alcohol use is negatively and significantly associated with each of our three outcomes. These findings suggest that heavy drinkers may be investing less in health promotion activities relative to abstainers and other drinkers. Policy options to address the associated externalities may be warranted.     

Prevalence and characteristics of employees reporting heavy or problem drinking

INTRODUCTION. This study examined the prevalence and demographic characteristics of chronic heavy drinkers, binge drinkers, those who report a problem with alcohol, and those at high risk for alcohol-related problems. METHODS. The sample comprised a worksite population of 18,053 employees. The study was based on responses to questions contained in a confidential health profile administered to employees at seven companies by an outside vendor (Johnson & Johnson Health Management, Inc.). RESULTS. Almost 1 in 4 participants (23.0%) was found to be at risk for alcohol-related problems. About 1 in 5 respondents (20.1%) reported binging, 1 in 10 reported chronic heavy drinking (9.8%), and 2.6% reported a drinking problem within the past month. Younger respondents were more likely to report binging but older respondents were more likely to report chronic heavy drinking. Men were more than twice as likely to report binging and almost four times as likely to report chronic heavy drinking, but only one and one-half times as likely to report a drinking problem within the past month. Other differential demographic associations with alternative measures of heavy drinking are described. CONCLUSION. The results suggest that a health profile administered at the worksite can be an effective screening tool for identifying employees at high risk for alcohol-related problems.     

Social status,gender and alcohol-related problems: the black young adult experience

Objectives. Using data from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, this study examined prevalence of drinking and related problems among five racial/ethnic groups aged 18–30.

Design. Logistic regression analyses examined influences of gender and social status on alcohol-related problems among blacks, controlling for demographics.

Results. Black drinkers were significantly less likely to be high-risk or risky/heavy episodic drinkers than all groups except Asians; and experienced lower prevalence of alcohol-related problems than whites and American Indians. Controlling for drinking, prevalence of alcohol-related problems among blacks was similar to other groups, except native Americans. Analyses of blacks revealed males, unemployed, and heaviest drinkers had highest prevalence of problems. Strong associations between drinking and problems remained consistent across black sub-groups defined by social status and gender.

Conclusion. While blacks are not as engaged in risky/heavy drinking, they are not shielded from problems conditional on drinking patterns. Focus on alcohol-related problems among black males and unemployed is indicated.     

Socio-demographic correlates of alcohol consumption in the Danish general population

AIMS: Little is known about specific Danish drinking patterns. This paper investigates how various socio-demographic factors are related to Danish alcohol consumption with special focus on age and sex. METHODS: Data come from a national telephone survey of the Danish general population conducted in 2003 with a final sample size of 2,030 cases. Measures of beverage specific current drinking, overall drinking, daily drinking, heavy episodic drinking, mean consumption, volume per drinking occasion and frequency of drinking were analysed. RESULTS: A little over 5% of the population are abstainers. Fourteen per cent of men and 9% of women are heavy drinkers; 38% of men and 18% of women are heavy episodic drinkers. Youth of both sexes drink heavily, and especially in a binge drinking style. Regular, more temperate drinking is associated with increasing age. Multivariate analyses suggest that other than age and sex, classical socioeconomic factors do not play a great a role in determining drinking patterns. Social integrative factors in particular influence women's drinking. CONCLUSIONS: With respect to the rest of Europe and North America, Danes consume high levels of alcohol with a large percentage of youth drinking in a binge pattern. Classical socioeconomic factors play a lesser role in determining drinking patterns compared to other Western countries. Longitudinal studies and studies of alcohol-related consequences in the Danish general population should be conducted to better formulate alcohol and public health policy.     

The use of preventive healthcare by Canadian women who drink alcohol

BACKGROUND: Despite established links among heavy alcohol consumption, other poor health behaviors, and poor health status, no Canadian study has specifically addressed the relationship between drinking and the use of preventive healthcare services. This study examines the relationship between drinking and female-specific preventive health service use through a secondary analysis of the 1996-1997 NPHS. METHODS: Recent use of Pap smears and mammograms was examined in relation to current alcohol consumption, using multivariate logistic regression (weighted n = 25,095). RESULTS: In general, there was a trend toward greater odds of recent service use among light and moderate drinkers than among heavy drinkers and lifetime abstainers. However, only moderate drinkers were significantly (P < 0.01) more likely than abstainers to have recently had a Pap smear. CONCLUSIONS: The trend toward lower use of preventive services by heavy drinkers is concerning considering the established harmful effects of prolonged alcohol consumption on health and the tendency for multiple risk behaviors to cluster together in the same individuals. Early detection of departures from good health may alleviate the elevated use of healthcare services among those diagnosed with alcohol use disorders.     

A cross-national trial of brief interventions with heavy drinkers. WHO Brief Intervention Study Group.

OBJECTIVES. The relative effects of simple advice and brief counseling were evaluated with heavy drinkers identified in primary care and other health settings in eight countries. METHODS. Subjects (1260 men, 299 women) with no prior history of alcohol dependence were selected if they consumed alcohol with sufficient frequency or intensity to be considered at risk of alcohol-related problems. Subjects were randomly assigned to a control group, a simple advice group, or a group receiving brief counseling. Seventy-five percent of subjects were evaluated 9 months later. RESULTS. Male patients exposed to the interventions reported approximately 17% lower average daily alcohol consumption than those in the control group. Reductions in the intensity of drinking were approximately 10%. For women, significant reductions were observed in both the control and the intervention groups. Five minutes of simple advice were as effective as 20 minutes of brief counseling. CONCLUSIONS. Brief interventions are consistently robust across health care settings and sociocultural groups and can make a significant contribution to the secondary prevention of alcohol-related problems if they are widely used in primary care.     

Poor health is associated with episodic heavy alcohol use: evidence from a National Survey

OBJECTIVES: The objective of this study was to examine the relationship between self-rated health and episodic heavy drinking in a representative sample of American adults. We also sought to determine ethnic and gender differences in the association between self-rated health and episodic heavy drinking. METHODS: Data (n=4649) from the Third US National Health and Nutrition Examination Survey were utilized for this investigation. Episodic heavy drinking was defined as the consumption of five or more and four or more alcoholic beverages on one occasion for men and women, respectively. Poor health was defined as answering fair or poor to the question: "Would you say your health in general is excellent, very good, good, fair or poor?" Odds ratio from the logistic linear regression analysis was used to estimate the risk for poor health that was associated with episodic heavy drinking. Statistical adjustments were made for age, hypertension, diabetes, current smoking, body mass index and race/ethnicity. RESULTS: Overall, episodic heavy drinking was associated with increased odds of poor self-rated health in men and women. In men, episodic heavy drinking was independently associated with 1.28 (95% CI: 1.07-1.82) increased odds of poor health. The corresponding value in women was 1.86 (95% CI: 1.05-2.28). In men, being Black was associated with approximately two-fold (OR=1.96; 95% CI: 1.33, 2.89), and being Hispanic was associated with approximately four-fold (OR=3.59; 95% CI: 2.50, 5.14) increased odds of poor self-rated health relative to being White. The corresponding odds ratios in women were 2.97 (95% CI: 1.90, 4.64) and 5.18 (95% CI: 3.23, 8.30). Associations were greater among blacks (adjusted OR=2.41; 95% CI: 1.81-3.22) and Hispanics (adjusted OR=4.15; 95% CI: 3.12-5.52) than among whites. CONCLUSIONS: Poor health is associated with episodic heavy alcohol consumption. Public health strategies to curb alcohol abuse may improve self-reported health status in these at-risk populations.