The Veterans Aging Cohort Study: observational studies of alcohol use, abuse, and outcomes among human immunodeficiency virus-infected veterans

This article represents the proceedings of a symposium at the 2003 annual meeting of the Research Society on Alcoholism in Fort Lauderdale, FL. The organizers/chairs were Joseph Conigliaro and Amy Justice. The presentations were (1) Introduction, by Joseph Conigliaro and Tamra Madenwald; (2) Alcohol and HIV/AIDS: the importance of integrative and translational research, by Kendall Bryant; (3) Alcohol use and abuse among patients with HIV infection, by Joseph Conigliaro and Stephan Maisto; (4) Severity of comorbid alcohol use/abuse in HIV infection, by Amy Justice and Jeffrey Samet; (5) Estimating the impact of alcohol use on long-term HIV outcomes, by Scott Braithwaite and Amy Justice; (6) Homelessness, drug & alcohol use among HIV+ veterans, by Adam Gordon and Robert Cook; and (7) Hepatitis C & alcohol in the VACS 3 study, by Shawn Fultz and Kevin Kraemer. The symposium concluded with a discussion led and facilitated by Diedra Roach.     

Pubertal development, sleep problems, and alcohol use: a commentary

Background: This commentary discussed the study conducted by Pieters et al. (2010 Alcohol Clin Exp Res in press) on the relationships among puberty dependent, sleep regulation, and alcohol use in adolescents. The goal of this commentary is to underscore the significance of the study and discuss some of the unaddressed questions in the area. Methods: The significance of the study and unaddressed questions are discussed. Results: Pieters et al. (2010 Alcohol Clin Exp Res in press) provided valuable data to understanding the relationships among puberty, sleep problems, and alcohol use. Questions regarding the relationship between puberty and sleep problems, the possible reciprocal relationships among circadian phase preference, sleep problems and alcohol use, mediators and moderators of such relationships, as well as potential gender differences on these relationships were discussed. Conclusions: To understand the relationships among pubertal development, sleep problems, and alcohol use, researchers need to be aware of the physiological changes that take place in puberty, as well as the psychosocial factors that are associated with such changes. Important mediators and moderators of the relationships among these constructs also need to be identified. Longitudinal design may be useful in this regard.     

Stress and alcohol consumption in heavily drinking men: 2 years of daily data using interactive voice response

BACKGROUND: The relationship between stress and alcohol consumption has been shown in recent research to be more complex than originally thought. Cross-sectional and short-term longitudinal studies may not provide adequate data to address subtle but important relationships that impact consumption frequency and/or quantity. METHODS: Participants were 33 males recruited from local bars who reported their alcohol consumption, stress, and other related variables every day for 2 years. Reports were provided by automated telephone to a computer-based interactive voice response (IVR) system. By closely monitoring call completion, we were able to collect over 95% of the daily calls. RESULTS: Using hierarchical linear modeling, daily stress was found to be associated with daily alcohol consumption, but in the opposite direction than would be predicted by a "drinking to cope" hypothesis. That is, same-day stress was found to be inversely related to consumption levels. Prior day's stress was not significantly associated with subsequent day's consumption; however, prior day's consumption was predictive of subsequent stress for up to 2 days. Similar analyses using week, rather than day, as the unit of measure paralleled these findings. CONCLUSIONS: This study highlights the utility of using long-term daily process data to address important research and clinical questions in the alcohol field.     

Heavy drinking, alcohol dependence, and injuries at work among young workers in the United States labor force

BACKGROUND: To determine whether heavily drinking and alcohol-dependent workers are at higher risk of occupational injury, we analyzed the nationally representative cohort of people enrolled in the National Longitudinal Survey of Youth since 1979. METHODS: This analysis was restricted to the 8569 respondents in the 1989 annual interview (age 24-32) who were employed during the 6 months before the interview. We studied occupational injuries (excluding sprains or strains) reported within 6 months of the interview in 1989 (cross-sectional analysis) and 1990 (prospective analysis). RESULTS: Among current drinkers, significant two-fold increases in the odds of injury for one or more episodes of heavy drinking were reduced to an odds ratio (OR) of 1.2 (95% confidence interval [CI] = 0.7, 2.1) in the cross-sectional analysis and an OR of 1.6 (CI 1.0, 2.8) in the prospective analysis after adjustment for confounding. No dose-response relationship with the frequency of heavy drinking was found. Alcohol-dependent respondents were not at higher risk of injury in the cross-sectional (OR = 1.1, CI 0.7, 1.8) or prospective (OR = 1.3,CI 0.8, 2.2) analyses after adjustment for confounding. CONCLUSIONS: For young U.S. workers, common occupational injuries (excluding sprains and strains) may not be strongly associated with alcohol dependence. Confounding by other risk factors may explain much of the association between being a heavy drinker and occupational injuries in this population.     

Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption

Aims This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high‐risk alcohol consumption and identifies predictors of changes in concordance and high‐risk consumption. Design, Participants, Measurements Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low‐risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high‐risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high‐risk alcohol consumption and the other partner did not (n = 75). At each follow‐up, husbands and wives completed an inventory that assessed their personal, family and social functioning. Findings Compared to the low‐risk concordant group, husbands and wives in the high‐risk concordant group were more likely to rely on tension‐reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high‐risk drinking included tension‐reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking. Conclusions High‐risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long‐term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high‐risk drinking.     

A social learning perspective: a model of parenting styles, self-regulation, perceived drinking control, and alcohol use and problems

BACKGROUND: This investigation sought to determine how different parenting styles are related to general self-regulatory processes that are linked to alcohol use and abuse. Self-regulation and, more specifically, thoughts of control over drinking are forms of positive self-control mechanisms. Parenting styles are known determinants of both negative and positive self-control mechanisms in offspring. According to social learning theory, stronger relationships between parenting style and self-regulatory processes would be expected from the parent who is the same sex as the respondent. METHODS: A total of 144 female and 107 male college students currently using alcohol were administered a questionnaire on their alcohol use and problems, perceived style of parenting (authoritarian, permissive, or authoritative) of their parents, self-regulation, and perceived control of drinking. A model linking parenting styles, self-regulatory processes, and control over drinking with alcohol use and alcohol problems was tested across sex groups by using structural equation modeling. RESULTS: In general, the parenting style of the parent of the same sex as the respondent's was found to be significantly related to self-regulation, which is known to be protective against alcohol use and abuse. A permissive parent of the same sex as the respondent was negatively associated with good self-regulatory processes for both men and women. Having an authoritative mother was also shown to be related to higher levels of self-regulation for women. CONCLUSIONS: Self-regulation mediated the pathway from a permissive parenting style to perceived drinking control, which, in turn, mediated the pathway from self-regulation to alcohol use and problems. Finally, self-regulation mediated the positive pathway from an authoritative mother to perceived control over drinking for women.     

Maternal age, alcohol abuse history, and quality of parenting as moderators of the effects of prenatal alcohol exposure on 7.5-year intellectual function

BACKGROUND: In contrast to the extensive literature documenting IQ deficits in patients with fetal alcohol syndrome, effects on IQ have not generally been reported for children with alcohol-related neurodevelopmental disorder (ARND). This study examined the role of maternal age, MAST, and quality of parenting in moderating the effects of prenatal alcohol exposure on the WISC-III IQ test in moderate-to-heavily exposed children. METHODS: A total of 337 inner-city African American children whose mothers were recruited prenatally were administered the WISC-III at 7.5 years. Alcohol exposure was assesed with a timeline follow-back interview administered at every prenatal clinic visit. Moderating effects of the three risk factors were examined by adding interaction terms to regression analyses and dichotomizing the moderators and performing separate regressions on the two groups. RESULTS: Prenatal alcohol exposure was related to WISC-III Freedom from Distractibility but not to Full Scale IQ for the sample as a whole. However, among children born to older mothers, an alcohol effect emerged on Full Scale IQ and five of seven composite IQ scores. Similarly, adverse effects were seen among children of MAST-positive mothers and children whose parents provided less optimal cognitive stimulation. Each additional ounce of absolute alcohol consumed per day during pregnancy was associated with a 2.9-point decrease in Full Scale IQ and a 5.6-point decrement on Freedom from Distractibility. CONCLUSIONS: This study is the first to demonstrate IQ effects among children with ARND born to older and MAST-positive mothers, particularly in relation to first-trimester drinking. These findings suggest that there are subgroups of more vulnerable and severely affected children whose intellectual performance is compromised. A moderate- to heavy-drinking mother who has given birth to an unaffected child when she was younger needs to be warned that her risk of having an adversely affected child increases as she grows older.     

Antisocial behavioral syndromes and DSM-IV alcohol use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND: Antisocial personality disorder (ASPD), syndromal adult antisocial behavior (AABS) without conduct disorder (CD) before age 15, and CD without progression to ASPD ("CD only") are highly prevalent among adults with alcohol use disorders (AUDs). Among patients in AUD treatment, antisocial behavioral syndromes are associated with more severe AUDs and poorer treatment outcomes. Comparative data concerning associations of antisocial syndromes with clinical characteristics of AUDs and the sociodemographic and clinical correlates of these syndromes among general population adults with AUDs have not previously been available. This study examines prevalences and correlates of antisocial syndromes among adults with lifetime Diagnostic and Statistical Manual--Version IV (DSM-IV) AUDs, and describes associations of these syndromes with clinical characteristics of AUDs, in the general U.S. population. METHODS: This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093, response rate=81%). Respondents (n=11,843) with lifetime AUDs were classified according to whether they met criteria for ASPD, AABS, "CD only," or no antisocial syndrome. Correlates of antisocial syndromes were examined using contingency table approaches and normal theory analyses of variance. Associations of antisocial syndromes with clinical characteristics of AUDs, including number of lifetime episodes, duration of longest or only episode, and alcohol consumption during period of heaviest drinking were examined using normal theory and logistic regression. RESULTS: Sociodemographic and clinical correlates of antisocial syndromes among respondents with AUDs were consistent with results from prior studies. Antisocial syndromes were significantly associated with phenomenology of AUDs, particularly ASPD with the most severe clinical presentations. Associations with AABS were similar to but more modest than those with ASPD; those with "CD only" were weaker and less consistent. Patterns of associations between antisocial syndromes and clinical characteristics of AUDs were generally similar between men and women. CONCLUSIONS: Antisocial syndromes, particularly ASPD, appear to identify a more pernicious clinical profile of AUDs among adults in the general U.S. population.     

Serotonin, impulsivity, and alcohol use disorders in the older adolescent: a psychobiological study

BACKGROUND: Alcohol use disorders (AUDs) among adolescents are associated with a high prevalence of conduct disorder (CD), much as type II alcoholism in adults is associated with impulsive-aggressive behavior and antisocial personality traits. Adults with impulsive personality disorders and AUD demonstrate diminished central serotonergic responsiveness to serotonergic agonists. Dysregulation of central serotonergic function may contribute to a vulnerability to impulsive-aggressive behavior, CD, and AUD. We studied older adolescents, both male and female, to examine the relationships between sex, dispositional impulsivity, aggressivity, CD, and responsiveness to serotonergic challenge with d,l fenfluramine (FEN) early in the development of AUD. METHODS: Thirty-six adolescents between the ages of 16 and 21 years were assessed for DSM-IV AUD and other Axis I disorders by using the Psychoactive Substance Use Disorders section of the Structured Clinical Interview for DSM III-R, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, and CD interviews. Impulsivity and aggressivity were assessed by the Barratt Impulsiveness Scale, Lifetime History of Aggression, Buss-Durkee Hostility Inventory, Eysenck Impulsiveness Questionnaire, Youth Self Report, and Multidimensional Personality Questionnaires. FEN was administered as 0.8 mg/kg to a maximum of 60 mg, and blood was sampled at fixed intervals for prolactin, cortisol, fenfluramine, and norfenfluramine levels. RESULTS: Eighteen adolescents (12 male, 6 female) with AUD scored significantly higher on all measures of impulsivity and aggressivity compared with 18 healthy controls (12 male, 6 female). There were no significant differences between groups in peak prolactin or cortisol responses (minus baseline), or area-under-the-curve determinations (AUC); however, 9 subjects with AUD and comorbid CD had significantly elevated cortisol AUC levels compared with subjects with AUD and no CD or with normal controls. In the total sample, cortisol AUC was associated positively with measures of aggression. CONCLUSIONS: Adolescents with early-onset AUD are characterized by impulsivity and aggressivity compared with healthy peers but do not demonstrate the diminished prolactin or cortisol responses to FEN characteristic of adult alcoholics with impulsive-aggression.     

Smoking, atopy, and methacholine airway responsiveness among middle-aged and elderly men. The Normative Aging Study

The interrelationships between smoking history, objective markers of allergy and inflammation, and methacholine responsiveness were examined among 778 middle-aged and elderly men (age range 41 to 86 yr). Methacholine responsiveness was analyzed using dose-response slope to describe each subject's responsiveness. Current smokers were observed to have significantly greater total serum IgE concentration ([IgE]), blood total leukocyte count, and blood eosinophil count than nonsmokers. Current smokers with at least one positive skin test reaction to common aeroallergens displayed significantly greater methacholine dose-response slope than smokers with negative skin test results (p less than 0.01). Among nonsmokers, skin test positivity was associated with slightly but not significantly greater methacholine responsiveness. Among subjects with negative skin test results, smoking was not associated with greater methacholine responsiveness. Blood eosinophil count and serum total [IgE] displayed weak but statistically significant direct relationships to methacholine dose-response slope (p less than 0.01), and these relationships were not significantly modified by smoking status. In a multivariate model, the cigarette smoking/skin test positivity interaction, total serum [IgE], and blood eosinophil count displayed significant, independent relationships to methacholine dose-response slope, although only a small portion of the variance of dose-response slope was accounted for by these covariates. These data suggest that smoking and atopy may act synergistically to increase the degree of nonspecific airway responsiveness displayed by middle-aged and elderly individuals. Allergic airway inflammation, as reflected by total serum [IgE] and blood eosinophil count, may also influence nonspecific airway responsiveness in this age group.     

Functioning of alcohol use disorder criteria among men and women with arrests for driving under the influence of alcohol

Background: Many states require screening of individuals arrested for driving under the influence (DUI) of alcohol to determine recidivism risk and the need for treatment based on severity of alcohol problems. Several screening instruments use DSM‐IV criteria for alcohol abuse and dependence to assess alcohol problems in this population, but whether they adequately measure alcohol problems in individuals with DUIs has not been examined. In addition, gender differences in DUI samples suggest that female offenders have more severe alcohol problems than male offenders. The current study examines differences in alcohol criteria functioning by DUI history and gender using an item response theory (IRT) approach. Methods: Data from diagnostic interviews with 8,605 participants in the Collaborative Study on the Genetics of Alcoholism, including 1,655 who ever reported a DUI arrest (20% women), were used to examine differences in alcohol criteria functioning between men and women with and without DUIs. The factor underlying item response was conceptualized as unidimensional, representing alcohol problem severity. Results: Social/interpersonal problems, larger/longer, and inability/persistent desire to quit displayed greater discrimination of IRT‐defined alcohol problem severity among individuals with DUIs than those without. Irrespective of DUI status, women had a higher threshold than men for time spent drinking or recovering. Women without DUIs had a higher threshold than similar men for social/interpersonal problems. Taken as a whole, the criteria yielded similar amounts of information in all groups. Conclusions: DSM‐IV criteria for alcohol abuse and dependence adequately detect alcohol problem severity in individuals with DUIs, and some are better at detecting severity in this particularly high‐risk group than in individuals without DUIs. However, the criteria as a whole are equally effective in measuring alcohol problem severity among individuals with and without DUIs and may be used with confidence in screening DUI offenders.     

Threshold and optimal cut-points for alcohol use disorders among patients in the emergency department

Background: Current research suggests that Diagnostic and Statistical Manual of Mental Disorder (DSM)‐IV alcohol abuse and dependence form a unidimensional continuum in emergency department (ED) patients in 4 countries: Argentina, Mexico, Poland, and the United States. In this continuum of alcohol use disorder (AUD), there are no clear‐cut distinctions between the criteria for dependence and abuse in the severity dimension based on prior results from item response theory (IRT) analysis. Nevertheless, it is desirable to find a threshold for identifying cases for clinical practice and cut‐points of clinical utility in this continuum to distinguish between patients more or less affected by an AUD, using a scale of symptoms count. Methods: Data from 5,193 patients in 7 ED sites in the same 4 countries (3,191 current drinkers) were used to study the structure, threshold, and possible cut‐points for the diagnoses of AUD. Results: The proposed changes in the DSM‐V, dropping the abuse item “legal problems” and adding an item on “craving,” did not impact the IRT performance and unidimensionality of AUD in this sample. With a total set of 11 items (deleting “legal problems” and adding “craving” to the current set of DSM criteria), an endorsement of 2 or more criteria can be used as the threshold to define those with an AUD in clinical practice. Furthermore, we can distinguish at least 2 levels of clinical severity, 2 to 3 criteria (moderate), and 4 or more criteria (severe). Conclusions: A dimensional approach to AUD using the proposed new set of criteria for the DSM‐V can be used to propose a threshold and levels of severity. More research in different populations and countries is needed to further substantiate a threshold and cut‐points that could be used in new formulations of substance use disorders.     

The value of CAGE, CUGE, and AUDIT in screening for alcohol abuse and dependence among college freshmen

BACKGROUND: This study attempted to (1) determine the prevalence of alcohol problems in college freshmen, (2) assess the performance of both the CAGE and the Alcohol Use Disorders Identification Test (AUDIT) questionnaires in this population, and (3) assess the possibility of improving the CAGE and/or AUDIT. METHODS: A sample of 3564 consecutive college freshmen, with a mean age of 18 years, at the Catholic University of Leuven, (Belgium) completed, during a cross-sectional study, a questionnaire assessing drinking behavior and identifying students at risk as defined by DSM-IV criteria. The questionnaire also included the CAGE questionnaire and the AUDIT. Calculations of sensitivity, specificity, negative predictive value, positive predictive value, likelihood ratios, and receiver operating characteristic curves for different scores of the CAGE and the AUDIT were performed, using DSM-IV criteria as the reference standard. RESULTS: The area under the receiver operating characteristic curve of the CAGE and the AUDIT was 0.76 and 0.85, respectively. The cutoff score of 1 for the CAGE was associated with a sensitivity of 42%, a specificity of 87%, a positive predictive value of 36%, and a negative predictive value of 90%. A score of 6 or more for the AUDIT gave a sensitivity of 80%, a specificity of 78%, a positive predictive value of 37%, and a negative predictive value of 77%. These results were related with a prevalence of 14.1% of alcohol problems. Replacing one question of the CAGE by "often driving under the influence" resulted in the CUGE (acronym for "cut down, under influence, guilty feelings, and eye opener"), with an area under the curve of 0.96, a positive likelihood ratio of 8.7, and a negative likelihood ratio of 0.04. CONCLUSIONS: Prevalence of alcohol problems in college students is confirmed to be high. When screening for alcohol problems in a college freshmen population, one question seems extremely important. The newly constructed CUGE questionnaire may improve screening efforts in students, compared with existing questionnaires.     

Self-reported alcohol consumption and the risk of alcohol-related problems: a comparative risk-curve analysis of the 3 Baltic countries, Sweden, and Italy

Background: Previous research has suggested a positive risk‐relationship between volume of consumption and adverse behavioral and social consequences of drinking. However, because the risk‐relationship may be modified by factors such as pattern of drinking, attributes of social drinking contexts, and drunken comportment, the shape of the risk‐function appear to be contingent upon the larger cultural context of drinking. Methods: In this article, I use graphical risk‐curve analyses and model estimations to assess how the risk of experiencing alcohol‐related problems is associated with self‐reported volume of alcohol consumption in the 3 Baltic countries (Estonia, Latvia, and Lithuania) as well as Sweden and Italy. The analysis utilized data from 2 general population surveys (including Sweden plus Italy and the Baltic countries, respectively) with approximately 1,000 respondents from each country. Results: The risk‐curves for the 3 Baltic countries and Sweden were fairly parallel and clearly steeper than that for Italy. In the logistic regression models, the country‐specific Baltic estimates were not entirely homogenous; for Estonia and Latvia, the estimates were similar to that for Sweden and significantly larger than that for Italy, whereas the estimate for Lithuania did not differ significantly from that for Italy. However, the negative binominal regression models suggested that increasing volume of consumption is associated with the risk of experiencing a larger number of different problems in all 3 Baltic countries and Sweden than in Italy. Overall, the result thus suggests that there is a significant relationship between volume of consumption and risk of experiencing alcohol‐related problems in all countries but that the relationship generally is stronger in the Baltic countries and Sweden than in Italy. Conclusions: The results were largely in line with the hypothesis of a European north to south gradient in the strength of the risk‐relationship, but also add that most Baltic countries may be placed alongside the Nordic countries in this context. Because only volume of consumption is considered, the results cannot be used to specify which factors and mechanisms that actually modify the shape of the risk‐function in each culture.     

Alcohol-related problems, drug use, and male intimate partner violence severity among US couples

BACKGROUND: Particularly for women, level of intimate partner violence (IPV) severity is associated with risk of injury. Previous research suggests that male drinking problems and drug use are key risk factors. Few studies, however, have examined the associations between male and female alcohol problems and drug use and risk of moderate and severe male IPV in general household population samples. METHODS: A multiethnic sample of 1615 married and cohabiting couples was obtained from the 1995 National Study of Couples, a cross-sectional study on alcohol and IPV. We assessed the contribution of past year male and female alcohol-related problems (i.e., drinking consequences and alcohol-dependence symptoms) and illicit drug use to the risk of moderate and severe male IPV. A series of generalized multinomial logit models, with adjustment for sociodemographic and psychosocial covariates, was constructed to assess these associations. RESULTS: Female and male alcohol-related problems and female drug use, were associated with increased risk of moderate and severe male IPV. Contrary to our expectation, male drug use was not associated with elevated risk for either type of male IPV. Compared with couples residing in low-unemployment neighborhoods, couples residing in high-unemployment neighborhoods were at greater risk for severe, but not moderate, male IPV. CONCLUSIONS: Alcohol-related problems among men and women and drug use among women, appear to be important correlates of male IPV severity among couples in the general population. These findings can aid in IPV screening efforts, the formulation of prevention strategies, and help inform batterer and victim treatment programs.     

Adult transition from at-risk drinking to alcohol dependence: the relationship of family history and drinking motives

Background:  Prospective studies have not previously examined whether a family history of alcoholism and drinking motives conjointly predict a diagnosed DSM-IV alcohol abuse or dependence in adults, despite a large literature that each is associated with alcohol consumption. The focus of this study is the conjoint, prospective examination of these risk factors in a 10-year longitudinal study of adults who were at-risk drinkers at baseline.
Methods:  Prospective, population-based cohort of drinkers aged 18 or older from a Northeastern U.S. area initially evaluated for history of alcohol use disorders and drinking motives in 1991 to 1992. New onset dependence was studied in those who never met the criteria for alcohol dependence at baseline ( n  = 423), and new onset abuse was studied in those who never met the criteria for alcohol abuse at baseline ( n  = 301) and who did not develop dependence during the follow-up.
Results:  Family history significantly interacted with 2 baseline drinking motives in predicting new onsets of DSM-IV alcohol dependence: drinking to reduce negative affect (OR 3.38; 95% CI 1.05, 10.9) and drinking for social facilitation (OR 3.88; CI 1.21, 12.5). Effects were stronger after conditioning the drinking motives on having a positive family history of alcoholism. In contrast, in predicting new onsets of alcohol abuse, drinking motives did not have direct effects or interact with family history.
Conclusions:  Those who drank to reduce negative affect or for social facilitation at baseline were at greater risk of alcohol dependence 10 years later if they also had a family history of alcoholism. These results suggest an at-risk group that can be identified prior to the development of alcohol dependence. Further, the findings suggest utility in investigating the interaction of drinking motives with measured genetic polymorphisms in predicting alcohol dependence.     

Nondaily smoking and alcohol use, hazardous drinking, and alcohol diagnoses among young adults: findings from the NESARC

Background: Nondaily smoking and heavy alcohol use are prevalent behaviors among young adults, with nondaily smoking occurring primarily in the context of alcohol use. Although the relationship between drinking and daily smoking has been well characterized in young adults, few epidemiological investigations have investigated the association between nondaily smoking and drinking behavior. Methods: We examined Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Grant et al., 2003b ; n = 43,093). Young adults (aged 18 to 25 years; n = 5,838) were stratified on current smoking behavior (daily, nondaily, and nonsmokers in the past 12 months) and differences in weekly quantity of alcohol use, frequency of alcohol use, frequency of binge drinking behavior, rates of NIAAA‐defined hazardous drinking, and rates of DSM‐IV alcohol diagnoses were investigated. College student status was examined. Results: Twenty‐five percent were current smokers and 7% were smoking on a nondaily basis. Seventy‐one percent were current drinkers, 39% reported binge drinking at least once a month, 41% met criteria for hazardous drinking, and 18% had alcohol use disorders. Across all measures of alcohol use, there was a significant effect of smoking status, with daily smokers having greater alcohol use patterns, compared with nondaily smokers, with nonsmokers consuming the least. Nondaily smokers were more likely to report any binge drinking in the past 12 months. However, daily smokers were more likely to report daily binge drinking. With regard to hazardous drinking and alcohol use disorders, nondaily smoking conferred the greatest risk, followed by daily smoking with nonsmoking as the reference group. Multinomial logistic regression demonstrated that the odds of being a hazardous drinker were 16 times greater (95% CI 9.46–26.48) in a nondaily smoker compared with a nonsmoker, whereas the odds for a daily smoker were increased by 7‐fold (95% CI 5.54–9.36). A similar pattern of results was demonstrated for DSM‐IV alcohol diagnoses. No differences across college student status were observed. Conclusions: The increased risk of hazardous drinking and alcohol use disorders conferred by nondaily smoking supports the findings that nondaily smoking and drinking are highly concomitant behaviors. Results such as these suggest that interventions disengaging alcohol and cigarette use patterns (e.g., smoking bans in alcohol venues) might serve to limit the occurrence of hazardous drinking among young adults at heightened risk for this behavior.     

Beer and bongs: differential problems experienced by older adolescents using alcohol only compared to combined alcohol and marijuana use

Alcohol and other drug problems experienced by adolescents who use only alcohol compared to those who use both alcohol and marijuana (A+M) is studied. Using the national longitudinal survey of youth 1994 data, forward multiple regression analyses revealed that impulsivity, A+M use (compared to alcohol-only use), age, sex, religiosity, frequency of substance use were associated with a higher number of behavioral problems. Youth with more alcohol problems were found to be binge drinkers, impulsive, more frequent alcohol users, and nonHispanic. Implications and future research needs are discussed.     

Impact of race and ethnicity on counseling for alcohol consumption: a population-based, cross-sectional survey

BACKGROUND: Counseling for alcohol use is of proven utility, but whether disparities in provision of counseling exist is uncertain. METHODS: Using the 1999 Behavioral Risk Factor Surveillance System, a population-based telephone survey, we examined participant-reported physician counseling for alcohol use among 15,498 adults in 5 U.S. states. Participants reported their usual alcohol intake, risky drinking (intake of 5 or more drinks on occasion, greater than 60 drinks per month, or driving after drinking), and whether a doctor had spoken with them about alcohol use. RESULTS: Race and ethnicity were strongly associated with reported receipt of alcohol counseling. Compared with whites, black and Hispanic adults had 2-fold higher odds of reporting receiving counseling among all participants, among problem drinkers, and among abstainers. There were modest differences according to sex, income, self-reported health, and education, but not body mass index. Multivariable adjustment and restriction to participants who reported a recent checkup did not alter these findings. No such disparity was noted for general diet counseling. CONCLUSIONS: Clear racial and ethnic differences exist in physician counseling for alcohol use, with higher prevalence estimates among racial and ethnic minority populations. Although the cause of these differences is uncertain, systematic application of preventive medical services such as alcohol screening and counseling is needed for all patients.