WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments is an international study which has taken place in 12 centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, κ) were very good for dependence disorders (0.7–0.9), but were somewhat lower for abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.     

Use of specialty substance abuse and mental health services in adults with substance use disorders in the community

AIMS: To examine the patterns and correlates of use of specialty substance abuse and mental health services among adults with alcohol or non-alcohol drug abuse or dependence in the community. METHODS: Analyses focused on 5,568 participants with alcohol or non-alcohol drug abuse or dependence drawn from a large representative cross-sectional survey of the US general population-the 2002 US National Survey on Drug Use and Health (NSDUH). RESULTS: Only 9.7% of adults with substance use disorders used specialty substance abuse services in the past year; 22.4% used mental health services. Severity of substance use disorder and less education were associated with using substance abuse services. Whereas psychological distress and impairment in role functioning due to psychological problems were associated with mental health service use. Male gender, black race/ethnicity, and lack of health insurance acted as barriers to using mental health services but not specialty substance abuse services. Past year use of substance abuse services, but not mental health services, was associated with lower likelihood of continued use of substances in the past month. CONCLUSIONS: Individuals with substance use disorders are more likely to use mental health services than specialty substance abuse services. However, only people who use specialty substance abuse services have a lower risk of continued use of substances. Findings highlight the need for integration of substance abuse treatments in the mental health care system and attention to different barriers to the two types of services.     

Alcohol high risk drinking,abuse and dependence among tobacco smoking medical care patients and the general population

BACKGROUND: Little is known about the synergies of smoking and alcohol consumption in medical care patients. The objective, therefore, is to estimate the coincidence of hazardous and harmful alcohol consumption as well as alcohol abuse and dependence with tobacco smoking in a general hospital and general practices. METHODS: Three samples of 18-64 year olds include 510 consecutively admitted currently smoking in-patients of a general hospital, 271 patients of a randomized sample of general practices, and 1567 current smokers from a regional population in Germany. Data include the number of cigarettes and a diagnosis of alcohol dependence and abuse (DSM), harmful or hazardous alcohol use. RESULTS: The rates of current daily cigarette smokers with an alcohol dependence or abuse, harmful or hazardous alcohol consumption are 47.1% in the general hospital and 32.1% in the general practice sample compared with 18.4% in the general population. The rates increase from nonsmokers to smokers and with the number of cigarettes. CONCLUSIONS: The findings fit into the evidence about alcohol and tobacco interactions in morbidity and mortality. General medical care settings are appropriate for the detection of alcohol dependence or abuse via smoking.     

Prevalence and correlates of past-year substance use, abuse, and dependence in a suburban community sample of high-school students

To assess the severity of substance use, abuse and dependence in a community sample of high school students, a cross-sectional survey was conducted in a suburban New Jersey community. Participants, a sample of 9th to 12th graders from six high schools (N=1044), completed a self-administered questionnaire after obtaining active parental consent. The measure of substance use disorders was based on 27 specially designed questions that approximate the DSM-IV criteria for abuse and dependence. Equivalent multivariate logit models were used to estimate the significant correlates for both use and dependence/abuse. The prevalence of drug use in this sample was similar to the national average for all drugs except alcohol. A total of 16.4% of the surveyed students reported either abuse or dependence symptoms with alcohol in the past year. The rates of abuse/dependence for marijuana and other illicit drugs were 13.4% and 3.9%. The rate of nicotine dependence was 8.0%. The logit models designed to examine the correlates of substance use showed minimal predictive or correlative value in explaining substance abuse or dependence in adolescence. More research is needed to identify and understand the factors leading adolescents from drug use to abuse or dependence.     

Past year treatment status and alcohol abuse symptoms among US adults with alcohol dependence

Objective

We tested whether the number and type of alcohol abuse symptoms were associated with an increased likelihood of treatment seeking among respondents with alcohol dependence.

Methods

Data from 4027 adult respondents from 2006 and 2007 National Survey on Drug Use and Health (NSDUH) who met DSM-IV criteria for the past year alcohol dependence were used. Respondents were classified according to the number of past year alcohol abuse symptoms endorsed, as well as type of abuse symptom. Associations were estimated using weighted multivariate logistic regressions that controlled for severity of alcohol dependence, other drug use disorders and other characteristics.

Results

Twenty-eight percent of individuals with alcohol dependence had one alcohol abuse symptom, 20% had two and 19% had three or four. Individuals with more alcohol abuse symptoms differed from those without alcohol abuse symptoms in a number of sociodemographic characteristics and severity of alcohol and drug dependence. Even after adjusting for these factors, individuals with three or four alcohol abuse symptoms had 2.67 times increased odds of treatment seeking, as compared to those without alcohol abuse symptoms [95% CI = 1.65–4.30]. However, individuals with one or two alcohol abuse symptoms were no more likely to seek treatment than those without alcohol abuse symptoms. Majority of those with one or two alcohol abuse symptoms endorsed the hazardous abuse symptom.

Conclusion

Alcohol abuse symptoms are important factors for treatment seeking in individuals with alcohol dependence, but only among certain subset of individuals with three or four alcohol abuse symptoms. Examining structural and psychosocial differences across these subgroups may help inform and reduce barriers to treatment seeking among this population.     

DSM-IV alcohol abuse: investigation in a sample of at-risk drinkers in the community

OBJECTIVE: Although a category for alcohol abuse has been included in the major nomenclatures since DSM-III, many questions have been raised about the definitions and validity of this category. METHOD: We investigated DSM-IV alcohol abuse in 628 at-risk drinkers residing in households who never met criteria for DSM-IV alcohol dependence at the time of a baseline interview. Cross-sectional and prospective longitudinal information were used. RESULTS: Subjects most often met criteria for abuse with the single criterion, recurrent hazardous use (usually driving after drinking too much, on average 4.5 times per year). Younger and white subjects were more likely to receive the abuse diagnosis at baseline, as were drug users and those who drank five or more drinks per occasion frequently. Very few subjects received a diagnosis of DSM-IV alcohol dependence at follow-up, and those who did were equally likely to come from the abuse and non-abuse baseline groups. A current abuse diagnosis at baseline strongly and significantly predicted an abuse diagnosis at follow-up, although a past-only (remitted) abuse diagnosis at baseline was not clearly predictive of abuse at follow-up. CONCLUSIONS: The DSM-IV alcohol abuse category has some predictive validity. However, given the manner in which respondents met criteria for the disorder, its merits as a diagnostic category remain in question. Researchers should be cautious about combining alcohol dependence and abuse into the same category.     

The structure of alcohol dependence in the community

BACKGROUND: Although dependence on alcohol appears to be a reliable unitary construct, abuse has not found a similar level of support as a separate construct. This paper describes a confirmatory factor analysis of the DSM-IV alcohol abuse and dependence criteria in a general population sample. METHODS: Data from alcohol drinkers (n = 7746) were obtained from a cross-sectional study of a large, representative sample of the Australian general population. One- and two-factor solutions for the DSM-IV criteria for abuse and dependence (assessed by CIDI-Auto) were compared using confirmatory factor analysis. RESULTS: Approximately 74% of Australians had used alcohol 12 or more times in the past year and 19% met at least one DSM-IV alcohol abuse or dependence criterion. Overall 6% met criteria for an alcohol use disorder (1.9% abuse, 4.1% dependence). More men than women met criteria for an alcohol use disorder and the prevalence of alcohol use disorders decreased with increasing age. Both one- and two-factor solutions from the confirmatory factor analyses provided an adequate fit to the data for the overall sample. The correlation between the abuse and dependence factors in the two-factor model was extremely high (0.95). CONCLUSION: Alcohol abuse and dependence criteria were most parsimoniously described by a single continuous construct incorporating all eleven abuse and dependence criteria.     

'Diagnostic orphans' among young adult cannabis users: persons who report dependence symptoms but do not meet diagnostic criteria

OBJECTIVE: To examine the characteristics of 'diagnostic orphans' among cannabis users-those who report one or two symptoms of DSM-IV dependence but do not meet diagnostic criteria for DSM-IV abuse or dependence. METHOD: Data were collected from a representative population cohort of 1601 young adults aged 20-21 years. Those who reported that they had used cannabis at least weekly at some point within the past year were assessed for symptoms of DSM-IV cannabis abuse and dependence using the Composite International Diagnostic Interview. RESULTS: Approximately 2.8% of the cohort could be classified as diagnostic orphans, with another 3.0 and 7.5% meeting criteria for abuse and dependence, respectively. Diagnostic orphans were: similar to those who met criteria for cannabis abuse or dependence in terms of demographic characteristics; similar to those who met criteria for cannabis abuse in terms of cannabis use patterns; and similar to those who met criteria for abuse and dependence in their rates of heavy alcohol use and DSM-IV alcohol dependence. However, they did not appear to have elevated rates of illicit drug use or mental health problems compared to non users. CONCLUSIONS: Diagnostic orphans reported using cannabis in a manner similar to persons meeting criteria for cannabis abuse, and had similar rates of alcohol dependence and other illicit drug use. Strict adherence to DSM-IV diagnoses of abuse and dependence may overlook a substantial proportion of young persons who experience cannabis-related problems. There is a need to consider (a) subthreshold levels of cannabis-related problems among those seeking treatment for other problems; and (b) interventions for this group to prevent escalation of such problems.     

Nosological comparisons of alcohol and drug diagnoses: a multisite,multi-instrument international study

International nosological research was conducted to determine cross-system agreement on alcohol and drug dependence and harmful use (abuse). ICD-10, DSM-IV and DSM-III-R diagnoses were compared in 1811 subjects from a variety of treatment and other types of settings from 12 sites around the world. Three diagnostic instruments were used: the Alcohol Use Disorders and Associated Disabilities Interview Schedule—Alcohol/Drug-Revised (AUDADIS-ADR), the composite international diagnostic interview (CIDI), and the schedules for clinical assessment in neuropsychiatry (SCAN). At seven of the study sites, two or more of these instruments were used. Results for dependence diagnoses showed excellent cross-system agreement across sites and instruments, especially for current diagnoses. Cross-system agreement for harmless use (abuse) was much lower and less consistent. Geographic location or culture appeared to have little influence on the results for either dependence or harmful use.     

Performance of Screening Instruments for Alcohol Use Disorders in Emergency Department Patients in Argentina

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.     

Performance of screening instruments for alcohol use disorders in emergency department patients in Argentina

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.     

Substance Dependence Severity Scale: reliability and validity for ICD-10 substance use disorders.

The Substance Dependence Severity Scale (SDSS) is a semistructured interview that assesses the severity of the DSM-IV diagnoses of dependence and abuse and the ICD-10 diagnoses of substance dependence and harmful use across a wide range of substances. Previous research has demonstrated that the SDSS' DSM-IV dependence scales are reliable and valid indicators of diagnostic severity. However, the ICD-10 scales have not been psychometrically tested. This study investigated the test-retest reliability, internal consistency, diagnostic concordance, and concurrent validity of the SDSS' ICD-10 dependence and harmful use scales in 180 (112 male and 68 female) treated substance users. Test-retest reliabilities for the ICD-10 dependence scales ranged from good to excellent for alcohol, cocaine, heroin, and cannabis. Test-retest reliabilities for the SDSS' ICD-10 harmful use scales were in the good range for alcohol, cocaine, and heroin and the poor to fair range for cannabis. Internal consistency, diagnostic concordance, and concurrent validity results were comparable to the test-retest findings. These results support the use of the SDSS for assessing the severity of the ICD-10 dependence and harmful use diagnoses.     

Recent cannabis use among Veterans in the United States: Results from a national sample

BackgroundCompared to civilians, little is known about cannabis use among Veterans in the general United States (US) population. This study aimed to examine the prevalence and correlates of recent medical and non-medical cannabis use among this important US sub-population.MethodData came from the 2014 National Survey on Drug Use and Health. Bivariate and multivariable analyses were conducted that were weighted to account for the complex survey design.ResultsApproximately 9% of Veterans in the US reported past year cannabis use. Older, and female, Veterans had lower odds of past year cannabis use. Veterans who were unmarried, out of the work force, had greater functioning disability, nicotine dependence, heavy episodic alcohol use, alcohol use disorder, and drug use had greater odds of past year cannabis use. In states where medical cannabis was legal in 2014, approximately 41% of Veterans who used cannabis in the past year used medically. Those who used medically were older and less likely to engage in recent heavy episodic drinking or to meet criteria for alcohol abuse/dependence, compared to Veterans using non-medically.ConclusionCompared to non-Veterans in the US general population, recent cannabis use was similar or slightly lower among Veterans. However, among those with past year use, the proportion of those using medically was more than double that of the general population. Because only non-medical cannabis use was associated with higher rates of heavy episodic alcohol use and alcohol use disorder, it may be important to address problematic alcohol consumption among this high-risk group.     

Are drunk-driving offenders referred for screening accurately reporting their drug use?

Several studies report that a substantial percentage of offenders arrested for impaired driving test positive for drugs of abuse besides alcohol. Current guidelines recommend screening offenders for both alcohol and other drug use, yet little is known about the accuracy of self-reports of drug use in this population. We compared drug abuse and dependence DSM-III-R diagnoses from an initial, court-ordered screening evaluation of 583 female and 495 male convicted drunk-driving offenders with diagnoses obtained via a voluntary, non-coerced interview 5 years later. At initial screening, fewer than 6% of offenders were diagnosed with drug abuse or dependence. Among offenders who did not receive an initial drug diagnosis, 28% subsequently reported having experienced drug use problems consistent with a retrospective diagnosis of drug abuse or dependence by the age at which they were screened. Half of those with a retrospective diagnosis of drug dependence reported their initial screening responses were "very accurate". We conclude that, although many drunk-driving offenders undergoing screening have diagnosable drug problems, a high proportion under-report their drug use. We suggest that certain modifications to screening procedures, such as urine drug screening, reducing barriers to treatment, and training counselors in motivational interviewing techniques, may increase accurate identification of drug use problems in this population.     

Agreement between DSM-IV and ICD-10 criteria for opioid use disorders in two Iranian samples

The aim of this study was to determine the agreement between the two systems in opioid users in the general population and a clinical sample. Two series of data were used in this study. The first was the data of 236 home-residing opioid abusers aged 15–64, who had previously participated in the Iran Mental Health Survey (IranMHS) in 2011, and the second was the data of 104 general psychiatry patients from inpatient or outpatient wards of two psychiatry hospitals in Tehran. Opioid use disorders were evaluated with CIDI-version 2.1. The disorders were assessed in all participants who used opioid substances for at least 5 times during the past 12 months. In the sample from the general population, the agreement between the two systems on the diagnosis of dependence was excellent (0.81). The agreement between the two systems on the diagnosis of abuse and harmful use was 0.41. In the clinical sample, the agreement between the two systems on the diagnosis of dependence or any opioid use disorder was 0.96 and 0.93, respectively. The agreement between abuse and harmful use was 0.9 and − 0.02 with and without regarding hierarchy, respectively. The inter-rater reliability of both DSM-IV and ICD-10 systems for all diagnosis was more than 0.95. The results of the diagnosis of dependence in the two systems had a weak concordance with treatment. The diagnostic criteria of DSM-IV and ICD-10 regarding dependence are very similar and the diagnosis produced by each system is concordant with the other system. However, the two systems have noticeable discrepancies in the diagnosis of abuse and harmful use. The discrepancies result from their conceptual differences and necessitate further revision in the definition of these disorders in the two systems.     

The Impact of Abuse Trauma on Alcohol and Drug Use: a Study of High-Risk Incarcerated Girls

ABSTRACT

This study examines the impact of abuse trauma (physical and sexual) on alcohol and drug use of high-risk girls (12 to 18 years of age) who were surveyed within the first two weeks of their incarceration. One-way ANOVA analyses and Tukey post hoc tests indicate physical abuse with a weapon was associated with higher marijuana use and number of drugs used. Sexual abuse, especially within the past year, increased marijuana use, alcohol use, number of drugs used, and alcohol and other drug (AOD) problems. Policy implications reflect the need for treatment protocols within substance abuse programs to address abuse trauma, particularly forced sex which has occurred within the past year.     

Alcohol Use Behaviors Among Pharmacy Students

Objective. To identify reasons for drinking, determine the patterns of alcohol abuse, and explore relationships between drinking motives and alcohol abuse patterns in pharmacy students.Methods. A cross-sectional anonymous, voluntary, self-administered paper survey instrument was administered to first-year (P1) through third-year (P3) pharmacy students as part of a professional seminar.Results. Survey instruments were completed by 349 pharmacy students (95.9% cooperation rate). Using the Alcohol Use Disorders Identification Test criteria, 23.2% of students reported hazardous or harmful use and 67.2% of students reported consuming alcohol at hazardous levels during the past year. Students who were male (37.0%), single (25.3%), and attended the main campus (26.2%) were more likely than their counterparts to report hazardous or harmful alcohol use. Pharmacy students reported social motives as the most common reason for drinking; however, coping and enhancement motives were more predictive of harmful or hazardous alcohol use.Conclusion. Approximately 1 in 4 pharmacy students (23%) reported hazardous or harmful alcohol use. Education about the dangers of alcohol abuse and intervention programs from colleges and schools of pharmacy are recommended to help address this issue.     

The role of alcohol in adolescent relapse and outcome

Although adolescents entering treatment for substance abuse typically use several substances, alcohol is seldom the drug of choice. Given alcohol's role as a gateway substance in the initiation of substance misuse, the authors hypothesize that alcohol is substantially involved in adolescent relapse following substance abuse treatment. One hundred fifty-seven youths (39.5% female, mean age 15.91 years) were recruited from adolescent inpatient alcohol and drug treatment centers and assessed at six and 12 months after discharge. Of the youths studied, 79% had used one or more substances by 12-month follow-up. Although only 1% reported alcohol as their substance of choice while hospitalized, alcohol was involved in 46% of initial posttreatment use episodes. Almost a quarter (23%) of initial posttreatment substance use events involved multiple substances. Initial posttreatment use episodes involving multiple substances and preferred substances were associated with poorer outcomes during the year following treatment both in terms of rate of return to and severity of substance involvement. Youths who initially used only alcohol were also likely to resume harmful levels of substance involvement by one year after treatment. Results suggest two routes, gateway and preferred substance, for adolescents in the resumption of harmful substance use following treatment. This gateway role merits consideration by adolescent substance abuse treatment providers and families of treated youths.     

Past 12-month and lifetime comorbidity and poly-drug use of ecstasy users among young adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND: Ecstasy use is prevalent among young people and often co-occurs with other drug use, but little is known about the past 12-month and lifetime psychiatric comorbidity and specific additional drug abuse among young adult ecstasy users in the general population. To provide this information, we compared current ecstasy users to former users, other illicit drug users, and non-illicit drug users. METHOD: Data were gathered in a face-to-face survey of the United States conducted in the 2001-2002 (NESARC). Participants were household and group quarters residents aged 18-29 years (n=8666). We measured current ecstasy use defined as any use in the past year; former ecstasy use as use prior to the past year only; other lifetime drug use included any drug other than ecstasy; lifetime non-illicit drug use as no illicit drug use. Associations were determined for nine other classes of illicit drugs, eight personality disorders, and seven mood and anxiety disorders. RESULTS: Of current ecstasy users, 44% used >3 other classes of illicit drugs in the past year, compared to 1.6% of non-ecstasy drug users. Current ecstasy use was associated with current anxiety (OR=3.7), specifically panic disorder (OR=7.7) and specific phobia (OR=4.1), also alcohol abuse (OR=21.6) and dependence (OR=4.1) and any personality disorder (OR=5.1) compared to non-illicit drug users. CONCLUSIONS: Results indicate important differences in comorbidities of current and former ecstasy users compared to other drug users and lifetime non-illicit drug users that may affect phenotype definitions and etiologic studies. Ecstasy use may represent a distinct population of drug users for which unique treatments may be necessary.     

Alcohol use and HIV risk behaviors among HIV-infected hospitalized patients in St. Petersburg, Russia

PURPOSE: Russia has high per capita alcohol consumption and an injection-drug-use-driven HIV epidemic. However, the role of alcohol in the spread of HIV infection in Russia is largely unexplored. Thus, we assessed recent alcohol use and associated HIV risk behaviors among HIV-infected persons in St. Petersburg, Russia. METHODS: We recruited HIV-infected hospitalized patients from the Botkin Infectious Disease Hospital between June 2001 and March 2002. Interviewers assessed alcohol and drug use with the addiction severity index (ASI) and sex- and drug-risk behaviors with the risk assessment battery (RAB). Lifetime abuse or dependence diagnoses for alcohol and drugs were established by a physician with addiction medicine training. RESULTS: Among 201 subjects, diagnoses of abuse or dependence (AB/DEP) were common: 9% (19/201) had only alcohol AB/DEP; 39% (78/201) had alcohol and drug AB/DEP; 47% (95/201) had only drug AB/DEP; and 4% (9/201) had no diagnosis of alcohol or drug AB/DEP. Sex- and drug-risk behaviors varied significantly by substance use diagnosis. Subjects with any alcohol AB/DEP had higher sex-risk RAB scores than those with drug only AB/DEP (6.1 versus 3.9, p<.0001). Among subjects with any diagnosis of drug AB/DEP, having in addition an alcohol diagnosis was associated with unclean needle use in the last six months (33% (26/78) versus 21% (20/95), p=0.08). CONCLUSIONS: Lifetime alcohol diagnoses of abuse or dependence were present in nearly one-half of hospitalized HIV-infected patients in St. Petersburg, Russia and were associated with significantly higher sex-risk behaviors and borderline significantly higher drug-risk behaviors. As HIV infection spreads rapidly in Russia and Eastern Europe, these data support the need for HIV risk-reduction interventions in alcohol abusing populations and raise the potential of benefit by addressing alcohol use in HIV-infected populations.