The importance of drinking frequency in evaluating individuals' drinking patterns: implications for the development of national drinking guidelines

Aims   This paper examines the relationship between frequency of drinking, usual daily consumption and frequency of binge drinking, taking into consideration possible age and gender differences.
Participants and design   Subjects were 10 466 current drinkers (5743 women and 4723 men) aged between 18 and 76 years, who participated in the GENACIS Canada (GENder Alcohol and Culture: an International Study) study.
Setting   Canada.
Measurements   The independent variable was the annual drinking frequency. The dependent variables were the usual daily quantity consumed, annual, monthly and weekly frequency of binge drinking (five drinks or more on one occasion).
Findings   Logistic regressions show (i) that those who drink less than once a week are less likely than weekly drinkers to take more than two drinks when they do drink; (ii) that the usual daily quantity consumed by weekly drinkers is not related to their frequency of drinking; but that (iii) the risk and frequency of binge drinking increase with the frequency of drinking.
Conclusions   Given that risk and frequency of binge drinking among Canadians increases with their frequency of drinking, any public recommendation to drink moderately should be made with great caution.     

Measuring average alcohol consumption: the impact of including binge drinks in quantity-frequency calculations

AIMS: Average daily alcohol consumption is usually calculated based on self-reports of the quantity (number of drinks consumed per drinking-day) and frequency (number of drinking-days) of alcohol consumption within a given time period. However, this method may underestimate average daily alcohol consumption (and in turn, the prevalence of heavy drinking), because studies demonstrate that respondents do not typically include binge drinking occasions in estimates of their 'usual' or 'average' daily alcohol consumption. DESIGN: We used the Behavioral Risk Factor Surveillance System (BRFSS), an annual random-digit telephone survey of US adults aged 18 years or older, to estimate average daily alcohol consumption using standard quantity-frequency questions, and then recalculated this measure by including self-reports of binge drinking. The proportion of respondents who met a standard, sex-specific definition of heavy drinking based on average daily alcohol consumption was then assessed nationally and for each state. FINDINGS: Compared to standard quantity-frequency methods, including binge drinks in calculations of average daily alcohol consumption increased the relative prevalence of heavy drinking among all adults by 19% to 42% (depending on the method used to estimate the number of drinks per binge). Among binge drinkers, the overall prevalence of heavy drinking increased 53% relative to standard quantity-frequency methods. As a result, half of women binge drinkers and half of binge drinkers aged 55 or older met criteria for heavy drinking. CONCLUSIONS: Including binge drinks (especially the application of age- and sex-specific estimates of binge drinks) in the calculation of average daily alcohol consumption can improve the accuracy of prevalence estimates for heavy drinking among US adults, and should be considered to increase the usefulness of this measure for alcohol surveillance.     

Alcohol-related negative consequences among drinkers around the world

Aims This paper examines (i) gender and country differences in negative consequences related to drinking; (ii) relative rates of different consequences; and (iii) country‐level predictors of consequences. Design, setting and participants Multi‐level analyses used survey data from the Gender, Alcohol, and Culture: An International Study (GENACIS) collaboration. Measurements Measures included 17 negative consequences grouped into (i) high endorsement acute, (ii) personal and (iii) social. Country‐level measures included average frequency and quantity of drinking, percentage who were current drinkers, gross domestic product (GDP) and Human Development Index (HDI). Findings Overall, the three groupings of consequences were reported by 44%, 12% and 7% of men and by 31%, 6% and 3% of women, respectively. More men than women endorsed all consequences, but gender differences were greatest for consequences associated with chronic drinking and social consequences related to male roles. The highest prevalence of consequences was in Uganda and lowest in Uruguay. Personal and social consequences were more likely in countries with higher usual quantity, fewer current drinkers and lower scores on GDP and HDI. However, significant interactions with individual‐level quantity indicated a stronger relationship between consequences and usual quantity among drinkers in countries with lower quantity, more current drinkers and higher scores on GDP and HDI. Conclusions Both gender and country need to be taken into consideration when assessing adverse drinking consequences. Individual measures of alcohol consumption and country‐level variables are associated with experiencing such consequences. Additionally, country‐level variables affect the strength of the relationship between usual quantity consumed by individuals and adverse consequences.     

The distribution of alcohol consumption and the prevention paradox in Brazil

Aims To examine the proportion of self‐reported alcohol consumed by different gender and age groups in Brazil over the past year, and to examine whether the ‘prevention paradox’ applies to Brazilian data on alcohol‐related problems. Design A multi‐stage cluster sample, representative of the Brazilian household population. Setting This study was conducted in Brazil between November 2005 and April 2006. Participants Respondents were aged ≥ 14 years (n = 3007). Measurements Measures included past year estimates of (i) number of standard drinks, (ii) frequency of binge drinking, and (iii) alcohol‐related problems. Findings The survey response rate was 66.4%. The top 2.5% of the drinkers by volume consume 14.9%, the top 5% consume 27.4% and the top 10% consume 44.2% of all alcohol consumed in Brazil. Men consume 77.8% of the total alcohol, and 18–29‐year‐olds consume 40.3%. Individuals below risky drinking guidelines for weekly volumetric intake account for 49–50% of all problem drinkers and 45–47% of all problem types reported. Individuals who do not binge or who binge infrequently (1–3 times/year) account for 50–51% of all problem drinkers and 45–46% of all reported problem types. Most binge drinkers are low‐volume drinkers. Conclusions Consistent with the prevention paradox literature, most drinking problems in Brazil are associated with low or moderate drinking. Binge drinking accounts more clearly for the distribution of alcohol problems than total volume consumed.     

Binge Drinking and Suboptimal Self‐Rated Health Among Adult Drinkers

Background: Binge drinking accounts for more than half of the 79,000 annual deaths in the United States that are owing to excessive drinking. The overall objective of our study was to examine the prevalence of binge drinking and consumption levels associated with suboptimal self‐rated health among the general population of adult drinkers in all 50 states and territories in the United States. Methods: The study included a total of 200,587 current drinkers who participated in the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey. We estimated the prevalence of binge drinking (i.e., ≥5 drinks on 1 occasion for men or ≥4 drinks on 1 occasion for women) and heavy drinking (i.e., an average of >14 drinks per week for men or >7 drinks per week for women), as well as the average number of binge episodes per person during a 30‐day period. Odds ratios were produced with multivariate logistic regression models using binge‐drinking levels as a predictor; status of suboptimal self‐rated health was used as an outcome variable while controlling for sociodemographic, health, and behavioral risk factors. Results: We estimate that 34.7 million adult drinkers in the United States engaged in binge drinking in 2008, including an estimated 42.2% who reported either heavy drinking or at least 4 binge‐drinking episodes in a 30‐day period. Binge drinking with such levels was associated with a 13–23% increased likelihood of reporting suboptimal self‐rated health, when compared to the nonbinge drinkers. Conclusions: Binge drinking continues to be a serious public health concern. Frequent binge drinkers or binge drinkers who consume alcohol heavily are especially at risk of suboptimal self‐rated health. Our findings underscore the importance of broad‐based implementation in health care settings of screening for and brief interventions to address alcohol misuse, as well as the continuing need to implement effective population‐based prevention strategies to reduce alcohol‐related morbidity and mortality.     

Adolescent drinking level and adult binge drinking in a national birth cohort

AIMS: To assess (i) continuities in binge drinking across adulthood and (ii) the association between adolescent drinking level and adult binge drinking. DESIGN: Population-based prospective birth cohort. SETTING: England, Scotland and Wales. PARTICIPANTS: All births during one week in March 1958 (n = 8520 in analysis). MEASUREMENTS: Alcohol consumption reported at 16, 23, 33 and 42 years. Binge drinkers were identified by dividing number of units of alcohol consumed in the last week by usual drinking frequency, with limits of >/=10 units/occasion for men and >/=7 for women. FINDINGS: Four in five cohort members drank alcohol at least twice a month. Prevalences of binge drinking at 23, 33 and 42 years among men were 37%, 28% and 31% and among women 18%, 13% and 14%. Most binge drinkers in adulthood changed drinking status during this period. Nevertheless, binge drinking at age 23 increased the odds of binge drinking at 42 years: odds ratio (OR) 2.10 (95% CI 1.85, 2.39) for men; OR 1.56 (95% CI 1.29,1.89) for women. Women who rarely or never drank aged 16 were less likely than light drinkers (0-2 units/week) to binge drink as adults, OR at 23 years 0.65 (95% CI 0.55, 0.77). Men who were heavier drinkers (>/=7 units/week) at 16 years were more likely than light drinkers to binge drink throughout adulthood; at 42 years, OR 1.64 (95% CI 1.33, 2.08). CONCLUSIONS: Binge drinking is common in British men and women throughout adulthood with continuities between the 20s and 40s. Adolescent drinking has a modest although important association with adult binge drinking.     

Alcohol and Self-Rated Health in a Mediterranean Country: The Role of Average Volume, Drinking Pattern, and Alcohol Dependence

Background: The association between average alcohol consumption and self‐rated ill‐health is “J‐shaped” in Scandinavian and Anglo‐Saxon countries, but it has shown an inverse linear relationship in the few studies conducted in Mediterranean countries, based on average volume solely. Objective: To examine the relationship between alcohol and self‐rated health in the general population of a Mediterranean country, by simultaneously taking into account average volume, drinking pattern, and alcohol abuse. Methods: From 2000 to 2005, we conducted telephone interviews on 12,037 persons, representative of the population aged 18 to 64 years in Madrid, Spain. The drinking pattern encompassed binge drinking, beverage preference, and drinking at mealtimes. Alcohol abuse was estimated by the CAGE test. The association between each alcohol‐related variable and self‐rated suboptimal (fair, poor, or very poor) health was estimated from logistic regression, with adjustment for the remaining alcohol‐related variables and other potential confounders. Results: In comparison with never‐drinkers, suboptimal health was less frequent among occasional drinkers [odds ratio (OR) 0.72; 95% confidence interval (CI): 0.61 to 0.86], average moderate drinkers (OR 0.57; 95% CI: 0.48 to 0.69), and excessive drinkers (OR 0.51; 95% CI: 0.36 to 0.72), but more frequent among former drinkers with ≥1 year of abstinence (OR 1.30; 95% CI: 1.03 to 1.64). Frequency of suboptimal health was likewise higher in subjects with ≥3 episodes of binge drinking (OR 1.55; 95% CI: 1.12 to 2.14) or alcohol abuse (OR 1.47; 95% CI: 1.22 to 1.76). No differences were observed in suboptimal health according to beverage preference or drinking at mealtimes. Results in each gender were similar to those for total study participants. Conclusions: Occasional, moderate, and excessive consumption of alcohol are associated with better self‐rated health, even after adjustment for drinking pattern and alcohol abuse. In contrast, former‐drinking, frequent binge drinking, and alcohol abuse are all associated with suboptimal self‐rated health.     

Increased drinking in a metropolitan city in China: a study of alcohol consumption patterns and changes

AIMS: To investigate alcohol drinking among urban Chinese and any changes between 2002 and 2005. DESIGN: Two identical face-to-face interviews were carried out with two random samples with 2327 and 2613 respondents, respectively. SETTING: Respondents were selected randomly from Wuhan City, Hubei province, China, between May and June 2002, and June and August 2005. PARTICIPANTS: Fifteen to 65-year-old urban Chinese adults. MEASUREMENTS: Prevalence of drinking, frequency of drinking, typical occasion quantity, volume of annual consumption and heavier drinking were the main measures. FINDINGS: Nearly three-quarters (90% for men and 55% for women) were current alcohol drinkers in 2005, and the prevalence of drinking alcohol had increased significantly since 2002 among both men and women; the largest increases occurred in the younger group (18-19 years) and among older women. There was no change in the frequency of drinking, the average quantities consumed by drinkers and the volume of absolute alcohol consumed by drinkers over this 3-year period. However, reflecting the increased prevalence of drinkers, the median volumes of absolute alcohol consumed in the sample as a whole had increased significantly. Older males were more likely to be categorized as larger-quantity drinkers: 30-65-year-old men accounted for 63%. There was also an increase over time in the proportion of larger-quantity drinkers: the proportion of male larger-quantity drinkers increased from 27% in 2002 to 35% in 2005. CONCLUSIONS: In the urban setting of Wuhan, over the time-period 2002-05, there was an increase in prevalence of drinkers, particularly among younger people and older women. The average frequency and quantities consumed by drinkers did not change over this period; among drinking men the volumes of alcohol consumed were comparable to those in much more saturated commercial alcohol markets. The results did, however, show an increase over time in the proportion of older men who were engaged in heavier drinking and, in 2005, the proportion exceeded that in more saturated markets. These data suggest that, given the relatively high levels of consumption among established drinking groups, increases in the prevalence of drinkers over time may result in increases in harm if effective policies are not implemented.     

Defining “Binge” Drinking as Five Drinks per Occasion or Drinking to a .08% BAC: Which Is More Sensitive to Risk?

Heavy episodic or "binge" drinking is commonly defined as drinking 4-5 drinks per occasion (5/4 definition) or drinking that results in a blood alcohol concentration (BAC) of .08%. The present study compared the validity of each binge definition as an indicator of at-risk, problem drinking. Two hundred and fifty-one college students were classified as nonbinge drinkers or as binge drinkers based on the 5/4 definition or the .08% BAC definition. The two definitions of binge drinking were examined in terms of their sensitivity and specificity as indicators of alcohol-related problems as determined by scores on the Alcohol Use Disorders Identification Test (AUDIT). Over half the sample (56%) were at-risk drinkers according to the AUDIT. The .08% definition detected only one-half of these individuals. Gender differences were also evident. Female binge drinkers actually achieved significantly higher estimated BACs per episode than their male binge drinking counterparts. The findings suggest that drinking to a subthreshold BAC (ie, <.08%) is not sufficient to avoid alcohol-related problems, and that total quantity (ie, total standard drinks) per occasion might contribute to risk independent of the BAC achieved during drinking episodes. The findings also highlight the importance of considering frequency of consumption in determining risky drinking versus relying solely on quantity measures.     

The prevalence of alcohol use disorders among night-time weekend drivers

Aims The objective of this study was to establish the extent of alcohol use disorders (AUDs) among drivers at risk for alcohol‐related crashes. The prevalence of drivers with AUDs on US roads on weekend evenings when alcohol‐related crashes are most frequent is unknown. This study will inform laws and programs designed to reduce alcohol‐involved crashes. Design Interviews using a 15‐item AUD questionnaire with a stratified random sample of non‐commercial drivers at 60 primary sampling locations in the 48 contiguous states on Fridays and Saturdays between 10 p.m. and 3 a.m. from July to November 2007. Setting Off‐road locations into which a police officer directed a random selection of motorist passing the site. Participants A total of 4614 drivers of non‐commercial vehicles. Measurements AUDs, including heavy drinking, alcohol abuse, and alcohol dependence. Findings Of the participating drivers, 73.7% were current drinkers (reported drinking in the last year). Among those drinkers, 14% were classifiable either as dependent drinkers or as abusive drinkers based on self‐reports of drinking. Another 10% of the drivers were classified as heavy drinkers. Nearly half of the drivers in the survey who had blood alcohol concentrations (BACs) at or higher than the 0.08 g per deciliter legal limit fell into one of those three AUD categories. Conclusions Survey data suggest that the majority of high‐blood alcohol concentration drivers on US roads show no clinical signs of an alcohol use disorder, but they are categorized as heavy drinkers. This suggests that environmental programs directed at reducing heavy drinking and brief behavioral interventions aimed at reducing episodes of excessive consumption have promise for reducing alcohol‐related crashes.     

Different measures of alcohol consumption and risk of coronary heart disease and all-cause mortality: 11-year follow-up of the Whitehall II Cohort Study

Aims To investigate the relationship between three measures of alcohol consumption obtained simultaneously in a large cohort and the validated risk of coronary heart disease and all‐cause mortality during follow‐up. Design Prospective cohort study with median follow‐up of 11 years. Setting The Whitehall II Cohort Study: London‐based civil service. Participants A total of 10 308 (33% female) civil servants aged 35–55 years at baseline (1985–88). Measurements Self‐reported volume of alcohol consumed during past week, frequency of drinking over past year, usual amount consumed per drinking session. Main outcome measures Coronary heart disease and all‐cause mortality until 1999. Findings A U‐shaped relationship was found between volume of alcohol consumed per week and outcome. Compared to those who drank moderately (10–80 g alcohol per week), non‐drinkers and those drinking more than 248 g per week had approximately a twofold increased risk of mortality. The optimal frequency of drinking was between once or twice a week and daily, after adjustment for average volume consumed per week. Those drinking twice a day or more had an increased risk of mortality (male hazard ratio 2.44 95% CI 1.31–4.52) compared to those drinking once or twice a week. Drinking only once a month or only on special occasions had a 50% increased risk of mortality. The usual amount consumed per drinking session was not indicative of increased health risk in this cohort. Conclusions Epidemiological studies should collect information on frequency of drinking in addition to average volume consumed in order to inform sensible drinking advice.     

Efficacy of Physician-delivered Brief Counseling Intervention for Binge Drinkers

Background

Binge drinking is a common pattern of alcohol use in the US. However, no studies have evaluated the effectiveness of brief interventions targeting only binge drinkers.

Methods

Randomized controlled clinical trial with a 12-month follow-up period conducted from March 1, 2003 to March 1, 2006 in Spain. Of a screened population of 15,325 patients seeking routine medical care from their primary care providers, patients who met inclusion criteria were randomized into an experimental group (n = 371) or a control group (n = 381). The primary outcome measures were the frequency of binge drinking episodes and weekly alcohol intake.

Results

There were no significant differences at baseline between groups in alcohol use and demographic variables. At the end of the 12-month follow-up period, there were significant reductions in binge-drinking status (52.2% vs 67.2%, P <.001), number of episodes of binge drinking (1.14 vs 1.56, P <.001), number of drinks weekly (19.2 vs 22.4, P <.001), and frequency of excessive alcohol intake in 7 days (47.9% vs 66.6%, P >.001).

Conclusions

This study provided evidence that screening and brief counseling delivered by a primary care physician as part of regular health care significantly reduced binge drinking episodes in binge drinkers.     

The joint association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes

BACKGROUND: Previous studies on alcohol-related road safety have not assessed the joint impact of average volume of alcohol and binge drinking. AIM: To examine the joint and separate association of average volume of alcohol and binge drinking with hazardous driving behaviour and traffic crashes. METHODS: Data were drawn from telephone interviews conducted in the period 2000-2005, with 12 037 individuals representative of the population aged 18-64 years in the Madrid region, Spain. The threshold between average moderate and heavy volumes was 40 g of alcohol/day in men and 24 g/day in women. Binge drinking was defined as intake of >or= 80 g of alcohol in men and >or= 60 g in women, during any drinking occasion in the preceding 30 days. Individuals were classified into the following categories: (i) non-drinkers; (ii) moderate drinkers with no binge drinking (MDNB); (iii) moderate drinkers with binge drinking (MDB); (iv) heavy drinkers with no binge drinking (HDNB); and (v) heavy drinkers with binge drinking (HDB). Analyses were performed using logistic regression, with adjustment for sex, age and educational level. FINDINGS: Frequency of inadequate seat-belt use increased progressively across categories of alcohol consumption, with odds ratio (OR) 1 in non-drinkers, 1.19 [95% confidence interval (CI) 1.06-1.33] in MDNB, 1.69 (1.41-2.03) in MDB, 1.68 (1.24-2.29) in HDNB and 2.41 (1.83-3.18) in HDB (P for trend <0.001). Compared with MDNB, alcohol-impaired driving was also more frequent in MDB (OR 7.43; 95% CI: 5.52-10.00), HDNB (OR 7.31; 95% CI: 4.37-12.25) and in HDB (OR 15.50; 95% CI: 10.62-22.61). Lastly, compared with non-drinkers, frequency of traffic crashes increased progressively across categories of alcohol consumption (P for trend=0.028), although it only reached statistical significance in HDB (OR 2.01; 95% CI: 1.00-4.09). CONCLUSIONS: Self-reported average volume of alcohol and binge drinking are both associated with self-reported hazardous driving behaviour and traffic crashes. The strength of the association is greater when average heavy consumption and binge drinking occur jointly.     

Many college freshmen drink at levels far beyond the binge threshold

BACKGROUND: Binge drinking is a dichotomous variable that allows researchers to sort students into categories based upon a specific threshold of consumption, commonly 4 (females) or 5 (males) drinks. Crossing the binge threshold increases the risk of negative alcohol-related consequences. The use of such thresholds has played a vital role in the study of college drinking. While extremely valuable, the dichotomous nature of binge drinking variables removes information about how heavily students actually drink, leaving the characterization of college drinking incomplete. The present study examined patterns of alcohol use beyond the binge threshold. METHODS: The data set consisted of self-reported 2-week drinking histories from 10,424 first-semester freshmen at 14 schools across the United States during the fall of 2003. The number of students who reached the 4+/5+ binge-drinking threshold was calculated, as was the number who reached 2 times (8+/10+ drinks) or 3 times (12+/15+ drinks) the binge threshold. Logistic regression analyses were used to explore gender differences and to assess whether frequent binge drinkers (3+ binges per 2 weeks) were more likely than infrequent binge drinkers (1-2 binges per 2 weeks) to reach high peak levels of consumption. RESULTS: Roughly 1 of 5 males consumed 10+ drinks and 1 of 10 females consumed 8+ drinks, twice the binge threshold, at least once in the previous 2 weeks. Gender differences were observed at every drinking level and were particularly large at higher peak levels. Frequent binge drinkers were more likely than infrequent binge drinkers to consume 2 or 3 times the binge threshold. DISCUSSION: A surprisingly large percentage of students, particularly males, drink at peak levels well beyond the binge threshold. Such findings suggest that schools might make additional progress in the battle against alcohol misuse by focusing on extreme drinking practices in addition to binge drinking per se.     

Controlled study of brief personalized assessment-feedback for drinkers interested in self-help

AIMS: Brief alcohol interventions typically have been directed to heavy-drinking patients seeking primary health care and college students. This study examined the efficacy of mailing brief personalized assessment-feedback to interested drinkers recruited from the general public. We hypothesized that problem drinkers would benefit more from the intervention than individuals who were not problem drinkers. DESIGN: A two-arm, double-blinded, community-based randomized controlled trial with 6-month follow-up. SETTING AND PARTICIPANTS: A screening interview was administered to a stratified random sample of 10 014 Canadians 18 years of age and older (5621 women and 4393 men; M age = 43.3 years, SD = 15.99; response rate = 65.4%). INTERVENTION: Current drinkers interested in receiving alcohol self-help materials (n = 1727) were assigned randomly to receive brief personalized assessment-feedback on male and female population drinking norms by mail, or to a delayed-treatment control group, and were contacted 6 months later (76% retention rate). MEASUREMENTS: Problem drinking status at baseline [using sex-specific Alcohol Use Disorders Identification Test (AUDIT) cut scores], and frequency and quantity of alcohol use at follow-up. FINDINGS: Analysis of covariance identified the hypothesized interaction of baseline problem drinking status and treatment condition (P < 0.01). Among problem drinkers identified at baseline the intervention caused a 10.1% reduction in per-occasion binge drinking compared to controls, whereas there was no difference in binge drinking across conditions for non-problem drinkers. CONCLUSIONS: The continuum of care for alcohol problems can be broadened by providing brief interventions to interested drinkers in the general population.     

Density of alcohol outlets and teenage drinking: living in an alcogenic environment is associated with higher consumption in a metropolitan setting

Aim This study examines the relationship between physical, socio‐economic and social environments and alcohol consumption and drunkenness among a general population sample of drinkers aged 12–17 years. Design, setting, participants and measures The study was conducted in Auckland, New Zealand. The design comprised two components: (i) environmental measures including alcohol outlet density, locality‐based measure of willingness to sell alcohol (derived from purchase surveys of outlets) and a locality‐based neighbourhood deprivation measure calculated routinely in New Zealand (known as NZDEP); and (ii) the second component was a random telephone survey to collect individual‐level information from respondents aged 12–17 years including ethnicity, frequency of alcohol supplied socially (by parents, friends and others), young person's income; frequency of exposure to alcohol advertising; recall of brands of alcohol and self‐reported purchase from alcohol outlets. A multi‐level model was fitted to predict typical‐occasion quantity, frequency of drinking and drunkenness in drinkers aged 12–17 years. Findings Typical‐occasion quantity was predicted by: frequency of social supply (by parents, friends and others); ethnicity and outlet density; and self‐reported purchasing approached significance. NZDEP was correlated highly with outlet density so could not be analysed in the same model. In a separate model, NZDEP was associated with quantity consumed on a typical drinking occasion. Annual frequency was predicted by: frequency of social supply of alcohol, self‐reported purchasing from alcohol outlets and ethnicity. Feeling drunk was predicted by frequency of social supply of alcohol, self‐reported purchasing from alcohol outlets and ethnicity; outlet density approached significance. Age and gender also had effects in the models, but retailers' willingness to sell to underage patrons had no effects on consumption, nor did the advertising measures. The young person's income was influential on typical‐occasion quantity once deprivation was taken into account. Conclusion Alcohol outlet density was associated with quantities consumed among teenage drinkers in this study, as was neighbourhood deprivation. Supply by family, friends and others also predicted quantities consumed among underage drinkers and both social supply and self‐reported purchase were associated with frequency of drinking and drunkenness. The ethnic status of young people also had an effect on consumption.     

Binge drinking in Madrid, Spain

BACKGROUND: In Mediterranean countries, the information on the prevalence of binge drinking and associated socio-demographic variables is very scarce. Moreover, there are no reported data on the amount of alcohol ingested and the type of beverage consumed during drinking episodes. This study describes the prevalence and characteristics of binge drinking in the adult population of Madrid, Spain. METHODS: Data were taken from a telephone survey conducted during the period 2000 to 2005 on 12,037 persons, representative of the population aged 18 to 64 years in the Madrid Region. Binge drinking was defined as the intake of >or=80 g of alcohol in men or >or=60 g in women, during any drinking session in the preceding 30 days. In this analysis, the threshold between moderate and heavy average weekly alcohol consumption was set at 40 g/d for men and 24 g/d for women. RESULTS: Prevalence of binge drinking was 14.4% (95% confidence interval, CI: 13.5 to 15.3%) in men and 6.5% (95% CI: 5.8 to 7.1%) in women. Prevalence was higher among persons: in the youngest age group (30.8% among men and 18.2% among women aged 18 to 24 years); having the highest educational level (14.5% in male and 9.2% in female university graduates); and with a heavy average consumption of alcohol (55.3% in men and 50.0% in women). However, 3 of 4 binge drinkers of both sexes showed a moderate average consumption. Among binge-drinkers, average monthly episodes of binge drinking were 3.2 in men and 2.6 in women, with 5.4 and 2 episodes/person/year, respectively. During each episode, a mean of 119 g of alcohol was ingested by men and 83 g by women, with spirits accounting for 72% of total alcohol intake. CONCLUSIONS: Prevalence of binge drinking is high in Madrid, particularly among younger men with higher education, and heavy average alcohol consumption. Binge drinking is characterized by frequent episodes, where large amounts of alcohol are ingested, mainly from spirits.     

Injury and repeated injury - what is the link with acute consumption, binge drinking and chronic heavy alcohol use?

OBJECTIVES: First, to test whether current injury is more closely related to acute intake than to usual consumption patterns, and second, to test whether repeated injury is more closely related to general consumption patterns than to acute intake. METHODS: Screening of alcohol consumption of 7,872 patients enrolling between January 1, 2003 and June 30, 2004 in an emergency department (ED) in Lausanne, Switzerland. General consumption patterns were measured as usual volume (in drinks per week) and binge drinking (5+ drinks for men; 4+ drinks for women) at least once monthly. Acute intake was measured through number of drinks in the 24-hour period prior to attending the ED. Separate logistic regression models of current injury and repeated injury on alcohol consumption patterns were estimated. RESULTS: Acute intake and binge drinking dominated the association with current injury, while general consumption patterns were predictive of repeated alcohol-related injury. CONCLUSIONS: Acute intake is associated with current injury in a dose-response relationship and with binge drinking. Because acute intake can be found among moderate volume drinkers as well as among chronic heavy drinkers, for current injury usual volume adds little predictive value over the effects of acute intake. Repeated injuries occur more often among chronic heavy drinkers, and thus general consumption patterns are more closely associated with injury "recidivism" than with acute intake. A screening question assessing prior injury may be a useful tool in the ED for distinguishing between chronic heavy drinkers and usually moderate drinkers with heavy drinking episodes, and thus prove helpful when creating preventive efforts tailored to different types of drinker.     

Brief alcohol intervention and alcohol assessment do not influence alcohol use in injured patients treated in the emergency department: a randomized controlled clinical trial

Aims To evaluate the effectiveness of brief alcohol intervention (BAI) in reducing alcohol use among hazardous drinkers treated in the emergency department (ED) after an injury; in addition it tests whether assessment of alcohol use without BAI is sufficient to reduce hazardous drinking. Design Randomized controlled clinical trial with 12‐month follow‐up conducted between January 2003 and June 2005. Setting Urban academic emergency department (ED) of the Lausanne University Hospital, Lausanne, Switzerland. Participants A total of 5136 consecutive patients attending ED after an injury completed a seven‐item general and a three‐item alcohol screen and 1472 (28.7%) were positive for hazardous drinking according to the National Institute on Alcohol Abuse and Addiction definition; of these 987 (67.1%) were randomized into a BAI group (n = 310) or a control group with screening and assessment (n = 342) or a control group with screening only (n = 335) and then a total of 770 patients (78.0%) completed the 12‐month follow‐up procedures. Intervention A single 10–15‐minute session of standardized BAI conducted by a trained research assistant. Measurements Percentage of participants who have changed to low‐risk drinking at follow‐up. Findings Data obtained at 12 months indicated that similar proportions were low‐risk drinkers in BAI versus control groups with and without assessment (35.6%, 34.0%, 37.0%, respectively, P = 0.71). Data also indicated similar reductions in drinking frequency, quantity, binge drinking frequency and Alcohol Use Disorders Identification Test (AUDIT) scores across groups. All groups reported similar numbers of days hospitalized and numbers of medical consults in the last 12 months. A model including age groups, gender, AUDIT and injury severity scores indicated that BAI had no influence on the main alcohol use outcome. Conclusions This study provides the evidence that a 10–15‐minute BAI does not decrease alcohol use and health resource utilization in hazardous drinkers treated in the ED, and demonstrates that commonly found decreases in hazardous alcohol use in control groups cannot be attributed to the baseline alcohol assessment.     

Alcohol use,heavy episodic drinking and subsequent problems among adolescents in 23 European countries: does the prevention paradox apply?

Aims According to the prevention paradox, a majority of alcohol‐related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol‐related problems among adolescents in 23 European countries. Design and setting Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16‐year‐old students were analysed. Participants A total of 38 370 alcohol‐consuming adolescents (19 936 boys and 18 434 girls) from 23 European countries were included. Measurements The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol‐related problems. Findings Although the mean levels of consumption and alcohol‐related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol‐related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems. Conclusions The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.