Signs of intoxication and server intervention among 18-39-year-olds drinking at licensed premises in New South Wales,Australia

Aims To estimate the extent of responsible service of alcohol (RSA) practice to young adults showing signs of alcohol intoxication on licensed premises in New South Wales. Design Telephone‐based cross‐sectional survey. Setting New South Wales, Australia. Participants A total of 1090 people aged 18–39 years old. Findings Seventy‐five per cent of males and 64% of females reported that they had consumed at levels for acute alcohol‐related harm during the previous 12 months, with 34% of males and 24% of females reporting doing so weekly; 54% (95% CI: 51–58%) of both males and females who had consumed at acute‐risk levels, reported that this last drinking occasion occurred at a licensed premises. Of these, 56% (95% CI: 51–61%) reported that they had exhibited at least one sign of overt alcohol intoxication, while 19% (95% CI: 15–23%) reported showing three or more signs of intoxication. Among those reporting at least one sign of intoxication, only 10% (95% CI: 7–15%) reported that the licensed premises staff had provided at least one of seven different responsible service initiatives, while 55% (95% CI: 48–61%) reported that they were continued to be served alcohol. While these results suggest that intoxicated patrons are not being refused service as often as they should, there was evidence for some degree of responsible service provision with around half of the ‘non‐intoxicated’ patrons reporting that they had seen licensed premises staff intervene in some way with other ‘intoxicated’ patrons. Conclusions While the majority of 18–39‐year‐olds report showing signs of intoxication while drinking at licensed premises in NSW, only a small minority report experiencing RSA initiatives from bar staff in response to these signs.     

Effects of a community intervention to reduce the serving of alcohol to intoxicated patrons

Aims To assess the effects of an alcohol prevention programme to reduce the serving of alcoholic beverages to intoxicated clients on licensed premises. Research design A controlled pre‐ (2004) and post‐intervention study (2006) design. Intervention A community‐based programme combining law enforcement, responsible beverage service training, information campaigns and policy initiatives in one Finnish town (Jyväskylä). Participants and measurements A male actor pretended to be clearly under the influence of alcohol and tried to buy a pint of beer at licensed premises. For the baseline measurement, every bar and nightclub was visited in the intervention and the control areas (94 licensed premises in total). Post‐intervention data were gathered with the same principles (100 licensed premises in total). A researcher observed every visit and documented the results. Results In the post‐intervention study there was a statistically significant increase in refusals to serve denials alcohol to the actor in the intervention area (from 23% to 42% of the licensed premises) compared to refusals in the control area (from 36% to 27% of the licensed premises). Conclusion Previous research has documented that multi‐component community‐based interventions can have a significant impact on over‐serving of alcohol when training and house policies are combined with effective law enforcement. The present findings also demonstrate that comprehensive Responsible Beverage Service (RBS) interventions applied at a local community level can be effective in decreasing service to intoxicated clients in a Nordic context.     

Policy implications of the widespread practice of ‘pre‐drinking’ or ‘pre‐gaming’ before going to public drinking establishments—are current prevention strategies backfiring?

Aim   To describe the research, policy and prevention implications of pre-drinking or pre-gaming; that is, planned heavy drinking prior to going to a public drinking establishment.
Methods   The authors describe the phenomenon of pre-drinking, motivations for pre-drinking and its associated risks using available research literature, media and popular internet vehicles.
Results   Heavy drinking prior to going out has emerged as a common and celebrated practice among young adults around the world. Apparent motivations are: (i) to avoid paying for high priced drinks at commercial drinking establishments; (ii) to achieve drunkenness and enhance and extend the night out; and (iii) to socialize with friends, reduce social anxiety or enhance male group bonding before going out. Limited existing research on pre-drinking suggests that it is associated with heavy drinking and harmful consequences. We argue that policies focused upon reducing drinking in licensed premises may have the unintended consequence of displacing drinking to pre-drinking environments, possibly resulting in greater harms.
Conclusions   Effective policy and prevention for drinking in licensed premises requires a comprehensive approach that takes into account the entire drinking occasion (not just drinking that occurs in the licensed environment), as well as the 'determined drunkenness' goal of some young people.     

Acute alcohol intoxication: significance of the amylase level

To evaluate the effects of acute alcohol intoxication on serum amylase and isoamylase levels, 58 clinically intoxicated patients with blood alcohol levels greater than 100 mg/dL were studied. Comparisons were made to normal control and a sober chronic alcoholic group. Admitting serum isoamylase levels were determined by cellulose acetate membrane electrophoresis and serum amylase levels measured by the Amylochrome technique. The average blood alcohol level in the intoxicated group was 301 +/- 99 mg/dL. Thirty of the 58 patients had hyperamylasemia (greater than 207 IU). Twenty-five of these 30 patients had hyperamylasemia from nonpancreatic sources (increased salivary isoamylase). Two of the 30 patients had pancreatic hyperamylasemia and three patients had elevated levels of both isoamylases. Neither of the patients with pancreatic hyperamylasemia had clinical evidence of acute pancreatitis. Although nine of the 58 patients had abdominal pain and clinical symptoms suggestive of acute pancreatitis, none of these patients had elevated pancreatic isoamylase. The finding of hyperamylasemia in acutely intoxicated patients is common. This is most frequently due to a rise in the salivary (nonpancreatic) isoamylase. The reliability of the total serum amylase as an indication of pancreatic disease in the intoxicated patient is questioned.     

Tailoring AIDS prevention: differences in behavioral strategies among heterosexual and gay bar patrons in San Francisco

Three groups of San Francisco bar patrons (heterosexual men, heterosexual women, and gay men) were compared on four sexual risk reduction strategies for AIDS: safer sex practices (particularly adoption of the use of condoms), reducing the number of sexual partners, taking the HIV antibody test, and determining the characteristics of a potential sexual partner. Heterosexuals reported fewer sex partners and were more likely than gay men to interview potential partners. Gay men were more likely to use condoms and the HIV antibody test than their heterosexual counterparts. These findings encourage the design of interventions that take advantage of shaping and reinforcing strategies already in use in each group, and suggest when it is necessary to teach new strategies.     

Changing perceptions of riskiness in drinking, drugs, and driving: An emergency department-based alcohol and substance abuse prevention program

For the last three years, the University of New Mexico School of Medicine/Division of Emergency Medicine has sponsored an Alcohol and Substance Abuse Prevention Program (ASAP). The program's objectives were to expose youth to the "real-life" social and medical consequences of alcohol and substance abuse through visits and interviews with patients and their families at the University of New Mexico Emergency Department and Trauma Center. A pretest, post-test, and eight-month follow-up evaluation design was used to assess the program's effects. Questionnaires were administered to randomly selected experimental and control groups of seventh grade students (n = 27). Repeated-measures analysis of variance detected a significant experimental/control condition x time crossover interaction effect for stated perception of riskiness, F (2, 31) = 3.20, P = .049. The data indicated that, over time, the experimental group perceived the riskiness of driving under the influence of drugs or alcohol to be greater, while the control group perceived such behavior to be less risky.     

Reducing youth alcohol drinking through a parent-targeted intervention: the Orebro Prevention Program

Aims To evaluate a 2.5‐year prevention programme working through parents, targeting drinking among 13–16‐year‐olds. Design Quasi‐experimental using matched controls with a pre–post, intention‐to‐treat design. Setting Schools located in inner city, public housing and small town areas. Participants A total of 900 pupils entering junior high school and their parents, followed longitudinally. Intervention Parents received information by mail and during parent meetings in schools urging them to: (i) maintain strict attitudes against youth alcohol use and (ii) encourage their youth's involvement in adult‐led, organized activities. Measurements Evaluation of the implementation used measures of parental attitudes against underage drinking and youths' participation in organized activities. Outcomes were youths' drunkenness and delinquency. Findings The implementation successfully influenced parents' attitudes against underage drinking, but not youth participation in organized activities. At post‐test, youths in the intervention group reported less drunkenness and delinquency. Effect sizes were 0.35 for drunkenness and 0.38 for delinquency. Findings were similar for boys and girls and for early starters. Effects were not moderated by community type. Conclusions Working via parents proved to be an effective way to reduce underage drinking as well as delinquency.     

The impact of later trading hours for hotels on levels of impaired driver road crashes and driver breath alcohol levels

AIM: To examine the impact of later trading hours for licensed hotels in Perth, Western Australia on levels of associated impaired driver road crashes and driver breath alcohol levels (BALs). DESIGN: Police data on the "last place of drinking" for impaired drivers involved in road crashes and their corresponding BALs were examined to identify those associated with Perth hotels between 1 July 1990 and 30 June 1997. During this period, 43 (23%) of the 186 hotels meeting study criteria were granted an Extended Trading Permit for 1 a.m. closing (ETP hotels), while the rest continued to close at midnight (non-ETP hotels). Time-series analyses employing multiple linear regressions were applied to determine whether an association existed between the introduction of extended trading and (i) monthly levels of impaired driver road crashes associated with ETP hotels and (ii) driver BALs associated with ETP hotels. Trends associated with non-ETP hotels were included as controls and possible confounders were considered. FINDINGS: After controlling for the trend in crash rates associated with non-ETP hotels and the introduction of mobile police breath testing stations to Perth freeways, a significant increase in monthly crash rates for ETP hotels was found. This relationship was largely accounted for by higher volumes of high-alcohol content beer, wine and spirits purchased by ETP hotels. No relation was found between driver BALs and the introduction of ETPs. CONCLUSIONS: Late trading was associated with increased levels of impaired driver road crashes and alcohol consumption, particularly high-risk alcoholic beverages. Greater numbers of patrons and characteristics specific to clientele of hotels which applied for late trading hours (i.e. younger age, greater propensity to drunk-drive, preference for high-risk beverages) were suggested as having contributed to this increase.     

Commentary on Rossheim and Thombs (2011): artificial sweeteners, caffeine, and alcohol intoxication in bar patrons

Background: This commentary discusses the paper by Rossheim and Thombs (Alcohol Clin Exp Res 35, 2011), which examined the relationship between type of alcohol mixer (regular caffeinated cola, diet caffeinated cola, energy drink, or no mixer) and breath alcohol readings in bar patrons. Methods: The significance of the findings of this study and new unaddressed questions for the field are discussed. Results: Rossheim and Thombs (2011) reported that breath alcohol concentration readings were highest when patrons reported the consumption of caffeine mixers that were artificially sweetened (i.e., diet cola), after adjusting for potential confounds. Women were more likely to consume diet cola‐caffeinated mixed drinks. Conclusions: The findings from this field study raise several new interesting questions. Given the reported gender difference in consumption of diet cola‐caffeinated mixed drinks, more research is needed regarding gender differences in gastric emptying time for alcoholic beverages mixed with artificially sweetened versus sucrose sweetened caffeinated drinks. In addition, the recent explosion in the energy drink market has resulted in the availability of sugar‐free or diet versions of most energy drink products. The implications of mixing diet energy drinks with alcohol are unknown.