Energy drink consumption and increased risk for alcohol dependence

Background: Energy drinks are highly caffeinated beverages that are increasingly consumed by young adults. Prior research has established associations between energy drink use and heavier drinking and alcohol‐related problems among college students. This study investigated the extent to which energy drink use might pose additional risk for alcohol dependence over and above that from known risk factors. Methods: Data were collected via personal interview from 1,097 fourth‐year college students sampled from 1 large public university as part of an ongoing longitudinal study. Alcohol dependence was assessed according to DSM‐IV criteria. Results: After adjustment for the sampling design, 51.3%_wt of students were classified as “low‐frequency” energy drink users (1 to 51 days in the past year) and 10.1%_wt as “high‐frequency” users (≥52 days). Typical caffeine consumption varied widely depending on the brand consumed. Compared to the low‐frequency group, high‐frequency users drank alcohol more frequently (141.6 vs. 103.1 days) and in higher quantities (6.15 vs. 4.64 drinks/typical drinking day). High‐frequency users were at significantly greater risk for alcohol dependence relative to both nonusers (AOR = 2.40, 95% CI = 1.27 to 4.56, p = 0.007) and low‐frequency users (AOR = 1.86, 95% CI = 1.10, 3.14, p = 0.020), even after holding constant demographics, typical alcohol consumption, fraternity/sorority involvement, depressive symptoms, parental history of alcohol/drug problems, and childhood conduct problems. Low‐frequency energy drink users did not differ from nonusers on their risk for alcohol dependence. Conclusions: Weekly or daily energy drink consumption is strongly associated with alcohol dependence. Further research is warranted to understand the possible mechanisms underlying this association. College students who frequently consume energy drinks represent an important target population for alcohol prevention.     

Effects of energy drinks mixed with alcohol on behavioral control: risks for college students consuming trendy cocktails

Background: There has been a dramatic rise in the consumption of alcohol mixed with energy drinks (AmED) in young people. AmED have been implicated in risky drinking practices and greater accidents and injuries have been associated with their consumption. Despite the increased popularity of these beverages (e.g., Red Bull and vodka), there is little laboratory research examining how the effects of AmED differ from alcohol alone. This experiment was designed to investigate if the consumption of AmED alters neurocognitive and subjective measures of intoxication compared with the consumption of alcohol alone. Methods: Participants (n = 56) attended 1 session where they were randomly assigned to receive one of 4 doses (0.65 g/kg alcohol, 3.57 ml/kg energy drink, AmED, or a placebo beverage). Performance on a cued go/no‐go task was used to measure the response of inhibitory and activational mechanisms of behavioral control following dose administration. Subjective ratings of stimulation, sedation, impairment, and level of intoxication were recorded. Results: Alcohol alone impaired both inhibitory and activational mechanisms of behavioral control, as evidenced by increased inhibitory failures and increased response times compared to baseline performance. Coadministration of the energy drink with alcohol counteracted some of the alcohol‐induced impairment of response activation, but not response inhibition. For subjective effects, alcohol increased ratings of stimulation, feeling the drink, liking the drink, impairment, and level of intoxication, and alcohol decreased the rating of ability to drive. Coadministration of the energy drink with alcohol increased self‐reported stimulation, but resulted in similar ratings of the other subjective effects as when alcohol was administered alone. Conclusions: An energy drink appears to alter some of the objective and subjective impairing effects of alcohol, but not others. Thus, AmED may contribute to a high‐risk scenario for the drinker. The mix of impaired behavioral inhibition and enhanced stimulation is a combination that may make AmED consumption riskier than alcohol consumption alone.     

The Role of the Flushing Response in the Relationship Between Alcohol Consumption and Insulin Resistance

Background: Facial flushing responses to drinking, because of intolerance to alcohol, are observed in some people, especially Asians. This study examined the role of flushing responses in the relationship between alcohol consumption and insulin resistance (IR). Methods: Participants in this cross‐sectional analysis included 624 Korean men (80 nondrinkers, 306 nonflushing drinkers, and 238 flushing drinkers) who were free of cardiovascular disease and diabetes. Data on the flushing response to drinking and alcohol consumption were collected from medical records. IR was estimated using the Homeostasis Model Assessment (HOMA_IR). On the basis of comparisons with nondrinkers, the risk of IR according to the quantity of alcohol consumed per week was analyzed among nonflushers and flushers. Results: After adjusting for age, exercise status, smoking status, BMI, waist circumference, blood pressure, high‐density lipoprotein cholesterol, and triglycerides using a logistic regression model, we found a low risk of IR among nonflushers who consumed ≤4 drinks (1 drink = 14 g of alcohol) per week (OR = 0.3). In contrast, a higher risk of IR was associated with nonflushers who consumed >20 drinks per week (OR = 3.5). On the other hand, only a higher risk of IR was associated with flushers who consumed >12 drinks per week (>12 to 20 drinks: OR = 4.7; >20 drinks: OR = 3.5). Conclusions: The amount of drinking associated with the development of IR in flushers was lower than in nonflushers. Additionally, no positive effect of moderate drinking on IR was observed in flushers. The findings support acetaldehyde‐derived mechanisms in the development of alcohol‐related IR.     

The Impact of Alcohol and Energy Drink Consumption on Intoxication and Risk‐Taking Behavior

Background

It has been argued that consuming alcohol mixed with energy drinks (AmED) causes a subjective underestimation of intoxication and an increased level of risk‐taking behavior. To date, however, there is mixed support for AmED‐induced reductions in perceived intoxication, and no objective assessment of risk‐taking following AmED consumption. Consequently, the present study aimed to determine the effect of alcohol and energy drink (ED) consumption on subjective measures of intoxication and objective measures of risk‐taking.

Methods

Using a placebo‐controlled, single‐blind, cross‐over design, participants (n = 28) attended 4 sessions in which they were administered, in counterbalanced order: 0.5 g/kg alcohol, 3.57 ml/kg ED, AmED, and a placebo beverage. Participants completed the Biphasic Alcohol Effects Scale and a Subjective Effects Scale at baseline and 30 and 125 minutes postbeverage administration; risk‐taking was measured using the Balloon Analogue Risk Task (BART).

Results

Participants reported greater subjective intoxication, impairment, and sedation after active relative to placebo alcohol consumption, with no interactive AmED effects. However, a significant moderate magnitude increase in stimulation ratings was observed in the AmED relative to alcohol, ED, and placebo conditions. There was no independent effect of alcohol, or interactive effect with ED, on the BART. A significant, yet small magnitude, increase in risk‐taking was evident in active relative to placebo ED conditions.

Conclusions

The interactive effect of AmED appears restricted to perceived stimulation, with alcohol‐induced increases in subjective intoxication occurring regardless of presence or absence of ED. Engagement in risk‐taking behavior was only increased by ED consumption; however, this effect was only of small magnitude; at these doses, alcohol consumption, with or without EDs, did not affect risk‐taking. Further research assessing the dose‐dependent effects of AmED on objectively measured risk‐taking behavior could clarify whether the ED effect increases with higher doses and whether an interactive effect is observed with higher alcohol doses.     

Alcohol Price and Intoxication in College Bars

Background:  Many population studies find that alcohol prices are inversely related to alcohol consumption and alcohol-related problems, including among college students and young adults. Yet, little is known about the "micro-level" effects of alcohol price on the behavior of individual consumers in natural drinking settings such as college bars. Therefore, we assessed patron's cost per gram of ethanol consumed at on-premise drinking establishments and its association with intoxication upon leaving an establishment.
Methods:  On 4 consecutive nights during April 2008, data were collected from 804 patrons exiting 7 on-premise establishments in a bar district located adjacent to a large university campus in the southeastern United States. Anonymous interview and survey data were collected as well as breath alcohol concentration (BrAC) readings. We calculated each patron's expenditures per unit of ethanol consumed based on self-reported information regarding the type, size, number, and cost of consumed drinks.
Results:  A multivariable model revealed that a 10-cent increase in cost per gram of ethanol at on-premise establishments was associated with a 30% reduction in the risk of exiting an establishment intoxicated (i.e., BrAC ≥ 0.08 g/210 l).
Conclusions:  The results are consistent with economic theory and population-level research regarding the price elasticity of alcoholic beverages, which show that increases in alcohol prices are accompanied by less alcohol consumption. These findings suggest that stricter regulation of the drink discounting practices of on-premise drinking establishments would be an effective strategy for reducing the intoxication levels of exiting patrons.     

Artificial sweeteners, caffeine, and alcohol intoxication in bar patrons

Background: Previous laboratory research on alcohol absorption has found that substitution of artificially sweetened alcohol mixers for sucrose‐based mixers has a marked effect on the rate of gastric emptying, resulting in elevated blood alcohol concentrations. Studies conducted in natural drinking settings, such as bars, have indicated that caffeine ingestion while drinking is associated with higher levels of intoxication. To our knowledge, research has not examined the effects of alcohol mixers that contain both an artificial sweetener and caffeine, that is, diet cola. Therefore, we assessed the event‐specific association between diet cola consumption and alcohol intoxication in bar patrons. We sought to determine whether putative increases in blood alcohol, produced by accelerated gastric emptying following diet cola consumption, as identified in the laboratory, also appear in a natural setting associated with impaired driving. Methods: We conducted a secondary analysis of data from 2 nighttime field studies that collected anonymous information from 413 randomly selected bar patrons in 2008 and 2010. Data sets were merged and recoded to distinguish between energy drink, regular cola, diet cola, and noncaffeinated alcohol mixers. Results: Caffeinated alcohol mixers were consumed by 33.9% of the patrons. Cola‐caffeinated mixed drinks were much more popular than those mixed with energy drinks. A large majority of regular cola‐caffeinated mixed drink consumers were men (75%), whereas diet cola‐caffeinated mixed drink consumers were more likely to be women (57%). After adjusting for the number of drinks consumed and other potential confounders, number of diet cola mixed drinks had a significant association with patron intoxication (β = 0.233, p < 0.0001). Number of drinks mixed with regular (sucrose‐sweetened) cola and energy drinks did not have significant associations with intoxication (p > 0.05). Conclusions: Caffeine’s effect on intoxication may be most pronounced when mixers are artificially sweetened, that is, lack sucrose which slows the rate of gastric emptying of alcohol. Risks associated with on‐premise drinking may be reduced by greater attention given to types of mixers, particularly diet colas.     

Alcohol consumption and abnormalities of brain structure and vasculature

Research on how alcohol consumption influences the structure and blood supply of the brain has generally focused on two primary areas of interest: the atrophic effect of heavy drinking on brain structure and the effects of moderate and heavy drinking on the risk of stroke. Heavy alcohol consumption results in atrophy of gray and white matter, particularly in the frontal lobes, cerebellum, and limbic structures. Heavy drinking also raises the risk of ischemic and hemorrhagic stroke, while light drinking is associated with a lower risk of ischemic stroke. Recently, the author and his colleagues studied alcohol consumption and prevalence of subclinical abnormalities detected by magnetic resonance imaging of the brain among 3376 older adults enrolled in the Cardiovascular Health Study. They found that alcohol consumption was positively associated with measures of brain atrophy and inversely associated with subclinical infarcts in a dose-dependent manner. Alcohol consumption and white matter lesions had a U-shaped relationship, with the lowest prevalence among those who consumed 1–6 drinks per week. Further research is needed to determine how these associations interact to influence overall brain function.     

Risky alcohol use in adolescence: the role of genetics (DRD2, SLC6A4) and coping motives

Background: Drinking to cope (i.e., drinking to forget or alleviate negative feelings) has been found to be associated with adolescents’ heavy drinking and alcohol‐related problems. Additionally, it is widely accepted that genetic factors are involved in alcohol use and dependence. Studies are only beginning to reveal, however, which specific genotypes are related to drinking behaviors, and it is unknown whether they may interact with coping motives in predicting adolescents’ risky drinking. The aim of this study was to examine relationships between the dopamine D2 receptor gene (DRD2) Taq1A polymorphism (rs1800497), a serotonin transporter gene (SLC6A4) polymorphism (5‐HTTLPR), coping motives, and adolescents’ binge drinking and alcohol‐related problems. Methods: Participants in this cross‐sectional study were 282 Dutch adolescents (mean age 17.4, 47% men) who had consumed alcohol at least once in their life. Results: Coping motives were positively related to both binge drinking and alcohol‐related problems, while DRD2 and SLC6A4 genotypes were not. DRD2, but not the SLC6A4 genotype, interacted with coping motives. The link between coping motives and alcohol outcomes was stronger among those carrying the DRD2 risk (A1) allele. Conclusions: This study extends the present literature by providing additional insight into the etiological factors of adolescent drinking behavior. An interaction between a vulnerability gene (DRD2) and a cognitive factor (coping drinking) was found to be related to adolescents’ binge drinking and alcohol‐related problems.     

Is alcopop consumption in Switzerland associated with riskier drinking patterns and more alcohol‐related problems?

OBJECTIVES: To examine (a) whether consumers of alcopops compared to consumers of other alcoholic beverages but not alcopops have riskier drinking patterns and more alcohol-related consequences (e.g. truancy, scuffles, problems with parents) and (b) whether the amount of alcopops consumed is associated independently with risky drinking patterns and alcohol-related consequences over and above those associated with the amount of other alcoholic beverages consumed. SAMPLE: As part of the ESPAD international study, a cross-sectional national representative sample of 5,444 drinkers aged 13-16 years was interviewed by means of an anonymous, self-report questionnaire administered in a classroom setting. RESULTS: Earlier initiation of consumption, more frequent risky single occasion drinking (RSOD), and a higher likelihood of negative consequences for consumers than for non-consumers of alcopops were due mainly to higher overall consumption. Other alcoholic beverages had similar effects, and whether the same amount of alcohol was consumed as alcopops or as any conventional alcoholic beverage made no difference. CONCLUSIONS: Alcopops in Switzerland do not seem to be linked to specific riskier drinking patterns or consequences per se. Like all alcoholic beverages, they add to the problems caused by drinking and seem to be consumed in addition to conventional alcoholic beverages without replacing them. As the alcohol industry will continue to launch new beverages, prevention targeting alcohol consumption in general might be more effective than focusing on new beverages only.     

Relative frequency of heavy drinking and the risk of alcohol dependence

Data from a national representative sample of US adults were analyzed to determine the association between the relative frequency of heavy drinking (the proportion of drinking occasions on which 5 + drinks were consumed) and past-year alcohol dependence, adjusting for the influences of average ethanol intake and sociodemographic factors. Fifty-seven percent of current drinkers reported never drinking 5 + drinks, and 21% drank 5 + drinks at least once but on less than 10% of all drinking occasions. Nine percent reported drinking 5 + drinks on at least half of all drinking occasions. Average daily intake was positively correlated with the relative frequency of heavy drinking, and both consumption measures were positively associated with the risk of alcohol dependence. Increases in either relative frequency of heavy drinking or average ethanol intake reduced, but did not eliminate, the effect of the other on the risk of dependence. The excess risk of dependence associated with frequent heavy drinking varied among population subgroups and was increased by age, education, and female gender.     

Alcohol consumption and heart failure in hypertensive US male physicians

Although alcohol drinking increases blood pressure and heavy drinking has been associated with alcoholic cardiomyopathy, little is known about the association between light to moderate drinking and risk of heart failure (HF) in hypertensive subjects. Thus, the association between light to moderate drinking and incident HF in 5,153 hypertensive male physicians who were free of stroke, myocardial infarction, or major cancers at baseline was prospectively examined. Alcohol consumption was self-reported and classified as <1, 1 to 4, 5 to 7, and >or=8 drinks/week. HF was ascertained using follow-up questionnaires and validated using Framingham criteria. Average age was 58 years, and about 70% of subjects consumed 1 to 7 drinks/week. A total of 478 incident HF cases occurred in this cohort during follow-up. Compared with subjects consuming <1 drink/week, hazard ratios for HF were 0.89 (95% confidence interval [CI] 0.70 to 1.12), 0.72 (95% CI 0.57 to 0.91), and 0.38 (95% CI 0.20 to 0.72) for alcohol consumption of 1 to 4, 5 to 7, and >or=8 drinks/week after adjustment for age, body mass index, smoking, randomization group, use of multivitamins, vegetable consumption, breakfast cereal, exercise, and history of atrial fibrillation, respectively (p for trend <0.001). Similar results were obtained for subjects with HF with and without antecedent myocardial infarction and those without diabetes mellitus. In conclusion, our data suggested that light to moderate alcohol consumption was associated with a lower risk of HF in hypertensive male physicians.     

A Comparison of Two Single‐Item Screeners for Hazardous Drinking and Alcohol Use Disorder

Background: There is increasing interest in and physician support for the use of single‐item screeners for problem drinking. Methods: In a representative sample of U.S. adults (n = 43,093) and within selected subgroups, past‐year frequency of drinking 5+/4+ drinks and maximum drinks consumed on any day were evaluated as screeners for past‐year alcohol dependence, any alcohol use disorder (AUD), and any AUD or hazardous drinking, using standard measures of screening performance. AUDs were defined according to DSM‐IV criteria. Hazardous drinking was defined as consuming >14 drinks/wk or 5+ drinks on any day for men and >7 drinks/wk or 4+ drinks on any day for women. Results: Optimal cutpoints for both screeners varied across population subgroups, and these variations should be taken into account in order to maximize screening performance. At the optimal cutpoints for the total population, the sensitivity and specificity of maximum drinks were 89% and 82% for dependence at ≥5 drinks, 90% and 79% for any AUD at ≥4 drinks, and 90% and 96% for any AUD or hazardous drinking at ≥4 drinks. Comparable values of sensitivity and specificity for 5+/4+ frequency were 90% and 83% at ≥3 times a year, 87% and 82% at ≥once a year, and 88% and 100% at ≥once a year, respectively. Specificity was lower when only past‐year drinkers were considered. The 5+/4+ frequency screener yielded fairly low sensitivity in predicting alcohol problems among the elderly and among Blacks. Results supported a past‐year reference period for frequency of 5+/4+ drinks and substantiated gender‐ and age‐specific thresholds for defining risk drinking. Conclusions: Both of the single‐item screeners performed nearly on a par with the AUDIT‐C and have potential for use in primary and emergency care settings.     

Drinking Patterns and Myocardial Infarction: A Linear Dose–Response Model

Background: The relation of alcohol intake to cardiovascular health is complex, involving both protective and harmful effects, depending on the amount and pattern of consumption. Interpretation of data available on the nature of these relations is limited by lack of well‐specified, mathematical models relating drinking patterns to alcohol‐related consequences. Here we present such a model and apply it to data on myocardial infarction (MI). Methods: The dose–response model derived assumes: (1) each instance of alcohol use has an effect that either increases or decreases the likelihood of an alcohol‐related consequence, and (2) greater quantities of alcohol consumed on any drinking day add linearly to these increases or decreases in risk. Risk was reduced algebraically to a function of drinking frequency and dosage (volume minus frequency, a measure of the extent to which drinkers have more than 1 drink on days when they drink). In addition to estimating the joint impact of frequency and dosage, the model provides a method for calculating the point at which risk related to alcohol consumption is equal to background risk from other causes. A bootstrapped logistic regression based on the dose–response model was conducted using data from a case‐control study to obtain the predicted probability of MI associated with current drinking patterns, controlling for covariates. Results: MI risk decreased with increasing frequency of drinking, but increased as drinking dosage increased. Rates of increasing MI risk associated with drinking dosage were twice as high among women as they were among men. Relative to controls, lower MI risk was associated with consuming < 4.55 drinks per drinking day for men (95% CI: 2.77 to 7.18) and < 3.08 drinks per drinking day for women (95% CI: 1.35 to 5.16), increasing after these cross‐over points were exceeded. Conclusions: Use of a well‐specified mathematical dose–response model provided precise estimates for the first time of how drinking frequency and dosage each contribute linearly to the overall impact of a given drinking pattern on MI risk in men and women.     

Routine Activities and Alcohol Use: Constraints on Outlet Utilization

Studies of consumers' use of alcohol beverage outlets have provided a basis for understanding drinking behaviors in different drinking environments. These studies have shown that drinking environments are related to both demographic and drinking pattern measures. Absent from these studies has been a theoretical basis on which to make predictions regarding drinking patterns and choices of drinking environments under the various social, economic, and environmental constraints typically confronting alcohol consumers. This study presents one such theoretical approach.
The approach assumes that, in the context of individual preferences for alcohol, drinking choices are constrained by consumers' economic and time-energy budgets for consumption. All other things being equal, it is suggested that greater budgets for consumption will be related to greater alcohol use, quality of beverages purchased, amenity values of purchase locations, or all three. Because on-premise drinking entails greater economic costs, greater drinking levels will be related to lower utilization of on-premise establishments.
The predictions of this approach were tested using data obtained from telephone surveys of consumers conducted in 1990 and 1991. The results showed that controlling for income, variables related to greater time-energy budgets for consumption (i.e., marital status and household composition) were related to greater consumption levels and greater utilization of on-premise establishments. Controlling for demographic measures, greater income was related to greater utilization of restaurants and increased beverage quality. Controlling for all other measures, frequencies of consumption were inversely related to consumption at on-premise establishments, reflecting the expected moderation in costs for heavier consumers on a limited alcohol budget.     

Event-Level Associations Among Drinking Motives,Alcohol Consumption,and Condomless Anal Sex in a Sample of Young Men Who Have Sex With Men

Young men who have sex with men (YMSM) are at increased risk for HIV and problematic alcohol use. Drinking motives are associated with alcohol use in cross-sectional studies, but their associations with alcohol use and condomless anal sex (CAS) at the event-level remain unclear. The current study examined these event-level associations in a sample of 189 YMSM who completed self-report measures on a daily or weekly basis for two months. Participants were recruited between August 2014 and April 2015 for a randomized trial designed to study behavioral reactivity in diary studies. YMSM consumed more alcohol on days when they drank to cope, to enhance pleasure, or to be more social. CAS with casual partners was more likely on days when they consumed more alcohol. Drinking motives were not associated with CAS. Interventions may benefit from addressing drinking motives and the influence of alcohol use on CAS in different types of relationships.     

Phosphatidylethanol and Alcohol Consumption in Reproductive Age Women

Background: Fetal alcohol disorders are preventable, but self‐reported alcohol consumption can be misleading and impede effective treatment. Biomarkers represent an alternative method for assessing alcohol use, and this study evaluated the relationship between blood phosphatidylethanol (PEth) and alcohol use in a sample of reproductive age women. Methods: Alcohol use was estimated by validated self‐report methods in 80 nonpregnant women ages 18 to 35. PEth was measured by a contracted laboratory using a liquid chromatography‐tandem mass spectrometry assay. Regression methods appropriate for the distribution of PEth were used to define its relationship to alcohol consumption during the prior 2 weeks and explore the effects of drinking patterns on this association. Receiver operating characteristic analysis was used to estimate the sensitivity of PEth for various drinking levels at 95% specific cutoffs. Results: PEth had a positive linear association with grams of alcohol consumed (p < 0.001), and was detectable in 93% of subjects consuming an average of 2 or more drinks per day. The relationship between total alcohol consumption and PEth may be stronger in women with recent heavy drinking days. The relationship between drinking and PEth varied considerably between individuals, and sensitivity for a certain amount of drinking was low at a highly specific cutoff concentration. Conclusions: PEth is a highly sensitive indicator of moderate and heavy alcohol consumption in reproductive age women and may complement the use of self‐report alcohol screens when additional objective markers of alcohol use are desirable. However, choosing a highly valid cutoff concentration for PEth to differentiate various levels of alcohol consumption may not be feasible.     

Alcohol and injury: a risk function analysis from the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP)

While emergency room (ER) studies have documented a strong association of alcohol and injury, less is known about the level of risk at which various quantities of alcohol or particular patterns of drinking place the individual for injury. Comparative risk function analyses are carried out in ER samples in seven countries that cover sites in 14 studies included in the Emergency Room Collaborative Alcohol Analysis Project (ERCAAP). Risk of injury is analyzed for the mean number of drinks consumed per day and the number of occasions in which 5 or more drinks were consumed at one time (5+) during the last year. All countries showed similar increases in injury risk to an average volume of about 2 drinks per day, with a leveling off of risk at higher average daily volumes, with the exception of Italy. Risk of injury increased to 12 or more 5+ days for the USA, Canada and Mexico, but leveled off after only 3 5+ days for Argentina and Spain. Poland showed increased risk to 30 5+ days. Similar risk curves were found for both males and females, although females were at lower risk of injury in all countries expect Spain and Poland. In low detrimental drinking pattern societies, risk curves showed higher risk for any drinking and any frequency of 5+ but at higher levels of each, risk levels decreased nearly to levels found for abstainers. Risk functions were also consistent across gender and age groups in low detrimental drinking pattern societies, with higher risk for males and those <30. For those countries with high detrimental drinking patterns, injury risk increased with volume and 5+ drinking primarily among males. This ER-based risk function analysis suggests that risk of injury increases proportionally with increased alcohol consumption at lower consumption levels, but a threshold effect is achieved at relatively low levels of mean daily consumption and higher consumption times. Risk may be culturally specific, dependent, in part, on the manner in which alcohol is used in the culture.     

The relationship between patterns of alcohol use and mental and physical health disorders in two American Indian populations

AIMS: First, define alcohol use categories among two reservation-based American Indian (AI) populations based on the relationship between alcohol consumption and dependence. Secondly, examine associations between the alcohol use categories and other indicators of health status. DESIGN, PARTICIPANTS AND MEASUREMENTS: Epidemiological data on 1287 AIs aged 18-57 years who consumed alcohol during the past year. CHAID tree analysis, a hierarchical partitioning method, was used to analyze alcohol quantity (highest number of drinks consumed during 1 day) and frequency (number of days drank during the past month) data to define quantity-frequency categories distinguished by differing rates of alcohol dependence. Multivariate analyses assessed relationships between the alcohol use categories thus identified and a number of health outcomes. FINDINGS: People who reported drinking 12 or more drinks during 1 day and more than 4 days a month had the highest prevalence of alcohol dependence. Among the males who drank > 18 drinks the prevalence was 42.12% and among females who drank 12 or more drinks, 44.58%. The prevalence among males who drank > 18 drinks yet drank less frequently was also high (24.06%). Although findings differed by gender, drinkers in the highest risk category for alcohol dependence were most likely to report drug use disorders, mood/anxiety disorders, alcohol-related physical disorders and lower quality of life. CONCLUSIONS: The quantity thresholds defined to identify AIs at highest risk for alcohol dependence in this study differed by gender and were higher than typically reported for non-AIs. They are consistent with previous findings regarding the pattern of high-quantity, low-frequency alcohol consumption among AIs residing on reservations.     

Alcohol use and mortality in older men and women

Aims To compare the effect of alcohol intake on 10‐year mortality for men and women over the age of 65 years. Design, setting and participants Two prospective cohorts of community‐dwelling men aged 65–79 years at baseline in 1996 (n = 11 727) and women aged 70–75 years in 1996 (n = 12 432). Measurements Alcohol was assessed according to frequency of use (number of days alcohol was consumed per week) and quantity consumed per day. Cox proportional hazards models were compared for men and women for all‐cause and cause‐specific mortality. Findings Compared with older adults who did not consume alcohol every week, the risk of all‐cause mortality was reduced in men reporting up to four standard drinks per day and in women who consumed one or two drinks per day. One or two alcohol‐free days per week reduced this risk further in men, but not in women. Similar results were observed for deaths due to cardiovascular disease. Conclusions In people over the age of 65 years, alcohol intake of four standard drinks per day for men and two standard drinks per day for women was associated with lower mortality risk. For men, the risk was reduced further if accompanied with 1 or 2 alcohol‐free days per week.