Age differences in diagnostic criteria of DSM-IV alcohol dependence among adults with similar drinking behaviour

Aims To test age differences in the prevalence of DSM‐IV alcohol dependence (AD) diagnostic criteria in the adult general population while controlling for drinking behaviour. Design and setting Cross‐sectional data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used, applying a two‐stage probability sampling design. The survey used self‐administered questionnaires and telephone interviews (mixed‐mode design; 45% response rate). Participants The analytical sample consisted of n = 6984 individuals aged 18–64 years reporting alcohol consumption within the previous year. Measurements Age effects on individual AD criteria were estimated using logistic regression models, adjusting for eight mutually exclusive drinking groups (defined in terms of average daily alcohol intake and episodic heavy drinking) and socio‐economic variables. Findings When controlling for drinking behaviour, 18–24‐year‐olds were more likely to meet the criteria ‘tolerance’, ‘larger/longer’ and ‘time spent’ relative to older age groups. In contrast, the likelihood of experiencing ‘withdrawal’ symptoms increased with age. There was no significant age effect on the diagnosis of AD. Conclusions Age differences in the prevalence of specific alcohol dependence diagnostic criteria such as ‘tolerance’, ‘drinking larger amount or for longer than intended’ and ‘time spent recovering’ cannot be fully explained by differences in drinking behaviour.     

Relative frequency of heavy drinking and the risk of alcohol dependence

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

Defining 'current drinkers' in national surveys: results of the 2000 National Alcohol Survey

Aims The purpose of this study is to determine which respondents of national surveys who report low ‘usual’ past year drinking frequency, are unsure of their drinking frequency or refuse to answer, are misclassified either as ‘current drinkers’ or as ‘ex‐drinkers.’ Design and setting The data are from the 2000 National Alcohol Survey, a national household telephone probability sample of adults in all 50 US States and Washington, DC (n = 7612). Participants A subsample of 1734 respondents who reported drinking ‘less than once a month but at least once a year’, ‘less than once a year’, ‘refused’ and ‘don’t knows’ were also asked if they had consumed a whole drink of any alcoholic beverage in the 12 months using dates to anchor the question. Measurements Five alcohol measures were used to compare groups who changed or did not change their drinking status based on the followup question: volume, mean number of days 5 +, social consequences, dependence symptoms and DSM‐IV. Findings The results indicate that only 4.6% of respondents (n = 349) changed their drinking status, and the percentages were equal in both directions. Women were more likely to change their drinking status and specifically become ex‐drinkers based on the follow‐up question. Respondents who became current drinkers drank significantly at a lower average volume than those who remained current drinkers. The prevalence rates based on the five alcohol measures were not affected by how ‘current drinker’ is defined. Conclusions Adding the follow‐up question is recommended for new alcohol surveys so that fewer respondents are misclassified.     

A dose–response perspective on college drinking and related problems

Aims In order to examine the degree to which heavy drinking contributes to risks for problems among college drinkers this paper develops and tests a dose–response model of alcohol use that relates frequencies of drinking specific quantities of alcohol to the incidence of drinking problems. Methods A mathematical model was developed that enabled estimation of dose–response relationships between drinking quantities and drinking problems using self‐report data from 8698 college drinkers across 14 campuses in California, USA. The model assumes that drinking risks are a direct monotone function of the amount consumed per day and additive across drinking days. Drinking problems accumulate across drinking occasions and are the basis for cumulative reports of drinking problems reported by college drinkers. Results Statistical analyses using the model showed that drinking problems were related to every drinking level, but increased fivefold at three drinks and more gradually thereafter. Problems were associated most strongly with occasions on which three drinks were consumed, and more than half of all reported problems were related to occasions on which four or fewer drinks were consumed. There were some important differences in dose–responsiveness between men and women and between different groups of ‘light’, ‘moderate’ and ‘heavier’ drinkers. Conclusion Many problems among college students are associated with drinking relatively small amounts of alcohol (two to four drinks). Programs to reduce college drinking problems should emphasize risks associated with low drinking levels.     

Combined Alcohol and Energy Drink Use: Hedonistic Motives,Adenosine, and Alcohol Dependence

Consumption of alcohol mixed with energy drinks (AmED) has been associated with both short‐ and long‐term risks beyond those observed with alcohol alone. AmED use has been associated with heavy episodic (binge) drinking, risky behaviors, and risk of alcohol dependence. Laboratory research has demonstrated that AmED beverages lead to greater motivation to drink versus the same amount of alcohol consumed alone. However, the reason consumers find AmED beverages particularly appealing has been unclear. A recent report by Droste and colleagues (Alcohol Clin Exp Res 2014; 38:2087–2095) is the first study to investigate motivations related to AmED consumption and to determine which motives predict AmED consumption patterns, experience of drinking‐related harms, and risk of alcohol dependence. The findings of this study significantly enhance our understanding of why AmED consumption is related to the risk of alcohol dependence and change our understanding of why consumers choose AmED beverages. The authors report that hedonistic motives strongly predicted AmED use and the harms associated with use. While intoxication‐reduction motives predicted self‐reported accidents and injuries, these motives did not predict AmED consumption patterns and risk of dependence. The risk of alcohol dependence may arise from repeated experiences when drinking alcohol is more pleasurable when energy drinks are consumed with the alcohol. This commentary will focus on why energy drinks might increase the rewarding properties of alcohol in social drinkers. In addition, discussion is provided explaining why more research on the neurotransmitter, adenosine, may actually inform us about the mechanisms contributing to the development of alcohol dependence.     

Types of natural recovery from alcohol dependence: a cluster analytic approach

Background Social capital and a low severity of alcohol‐related problems have been focused upon to explain the processes of natural recovery from alcohol dependence. However, studies using control groups have not found significant differences in these variables. Subtypes of natural remission which might account for this inconsistency have only been described on grounds of qualitative data. Aims To identify subtypes of natural remitters using cluster analysis. Participants One hundred and seventy‐eight media‐recruited natural remitters were interviewed personally. Several triggering mechanisms and maintenance factors of remission were assessed using standardized questionnaires. Based on age of onset and severity of dependence, adverse consequences from drinking, social pressure and social support, cluster analyses were performed. Results Cluster analyses yielded three groups of natural remitters: one cluster with a high severity of dependence, low alcohol‐related problems and low social support (‘low problems—low support’; n = 65), one group characterized by high severity of dependence, high alcohol‐related problems and medium social support (‘high problems—medium support’; n = 37), and a third group which consisted of subjects with high social support, late age of onset, low severity of dependence, and low alcohol‐related problems (‘low problems—high support’; n = 76). Cluster solutions were confirmed using discriminant analyses. Analyses of variance (ANOVAs) revealed further group differences on other triggering and maintaining factors of remission. Conclusions Failure to identify specific pointers to natural recovery in previous research might be due to heterogeneous subgroups of natural remitters. In order to build a conceptual framework for understanding the processes of natural recovery, interactions of different independent variables should be considered.     

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.     

Energy drink consumption and increased risk for alcohol dependence

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

Initial,habitual and compulsive alcohol use is characterized by a shift of cue processing from ventral to dorsal striatum

Aims During the development of drug addiction, initial hedonic effects decrease when substance use becomes habitual and ultimately compulsive. Animal research suggests that these changes are represented by a transition from prefrontal cortical control to subcortical striatal control and within the striatum from ventral to dorsal domains of the striatum, but only limited evidence exists in humans. In this study we address this hypothesis in the context of alcohol dependence. Design, setting and participants Non‐abstinent heavy social drinkers (n = 21, 5.0 ± 1.5 drinks/day, 13 of them were alcohol‐dependent according to DSM‐IV) and light social drinkers (n = 10, 0.4 ± 0.4 drinks/day) were examined. Measurements We used a cue‐reactivity functional magnetic resonance imaging (fMRI) design during which pictures of alcoholic beverages and neutral control stimuli were presented. Findings In the dorsal striatum heavy drinkers showed significant higher activations compared to light drinkers, whereas light social drinkers showed higher cue‐induced fMRI activations in the ventral striatum and in prefrontal areas compared to heavy social drinkers [region of interest analyses, P < 0.05 false discovery rate (FDR)‐corrected]. Correspondingly, ventral striatal activation in heavy drinkers correlated negatively with obsessive‐compulsive craving, and furthermore we found a positive association between cue‐induced activation in the dorsal striatum and obsessive‐compulsive craving in all participants. Conclusions In line with our hypothesis we found higher cue‐induced activation of the ventral striatum in social compared to heavy drinkers, and higher dorsal striatal activation in heavy drinkers. Increased prefrontal activation may indicate that social drinkers activate cortical control when viewing alcohol cues, which may prevent the development of heavy drinking or alcohol dependence. Our results suggest differentiating treatment research depending on whether alcohol use is hedonic or compulsive.     

Effects of depression and social integration on the relationship between alcohol consumption and all-cause mortality

Aims This study was designed to assess the potentially confounding influences of social integration and depression on the form of the relationship between alcohol consumption and all‐cause mortality. Design, participants and measurement Respondents from the 1984 US National Alcohol Survey (N = 5177) were followed by searching the National Death Index (NDI) through 1995; 540 were identified as deceased. Predictor variables in a Cox proportional hazards model included gender, ethnicity, marital status, income, smoking, age and alcohol consumption (volume and patterns). Two social variables and their interactions with alcohol consumption were added, the Center for Epidemiological Studies Depression (CES‐D) scale and an eight‐item social isolation scale. Findings The J‐shaped risk curve for all‐cause mortality by volume was approximated for men but not significantly for women. In addition heavy drinking occasions independently contributed to mortality in men. Low social integration (bottom 12%) had no significant effects on mortality or on the relationship between alcohol consumption and mortality curve. Inclusion of the interaction between alcohol consumption and depression proved significant for heavy male drinkers (> six drinks on average per day) and for female former drinkers with heavy drinking occasions. In both cases, the respective subgroup, which additionally was depressed, had about four times the risk of a life‐time abstainer. Conclusions The relationship of alcohol consumption to 11‐year all‐cause mortality in a general population indicated little confounding effect of social isolation, but revealed important interactions with depression for heavy male drinkers and heavy female ex‐drinkers.     

Pattern of drinking and fatal injury: a population-based follow-up study of Finnish men

AIM: To find out how the frequency of drinking one to two drinks, three to four drinks and five or more drinks of alcohol per drinking occasion predicts injury mortality in 16 years of follow-up among the Finnish 15-69-year-old male population. DESIGN: Three alcohol surveys conducted in 1969, 1976 and 1984 were pooled and linked with mortality information from the national cause of death register. METHOD: Cox proportional hazard models were used for analysing the survival time data. FINDINGS: Drinking at the level of one to two drinks, regardless of frequency, did not elevate the risk of fatal injury, nor did drinking at the level of three to four drinks. Drinking five or more drinks at a time significantly increased the risk of fatal injury in graded relation, compared with those who never drank at that level. The risk was highest for those who drank five or more drinks at a time at least weekly (RR = 5.78, 95% CI = 2.80-11.94), when adjusted for possible confounders. CONCLUSIONS: We found that besides the total volume of consumption, a drinking pattern that involves drinking occasions when consumption exceeds four drinks of alcohol at a time leads to a significant increase in the risk of fatal injury among Finnish men. The risk is highest among those who have the highest annual number of heavy drinking occasions. The finding does not support the hypothesis that alcohol tolerance would lower the risk of fatal injuries among frequent heavy drinkers.     

Retraining automatic action‐tendencies to approach alcohol in hazardous drinkers

Aims The main aim of this study was to test whether automatic action‐tendencies to approach alcohol can be modified, and whether this affects drinking behaviour. Design and participants Forty‐two hazardous drinkers were assigned randomly to a condition in which they were implicitly trained to avoid or to approach alcohol, using a training variety of the alcohol Approach Avoidance Test (AAT). Participants pushed or pulled a joystick in response to picture‐format (landscape or portrait). The pictures depicted alcoholic or non‐alcoholic drinks. Participants in the avoid‐alcohol condition pushed most alcoholic and pulled most non‐alcoholic drinks. For participants in the approach‐alcohol condition these contingencies were reversed. After the implicit training, participants performed a taste test, including beers and soft drinks. Automatic action tendencies at post‐test were assessed with the AAT, including both trained and untrained pictures, and with a different test (Implicit Association Test, IAT). We further tested effects on subjective craving. Results Action tendencies for alcohol changed in accordance with training condition, with the largest effects in the clinically relevant avoid‐alcohol condition. These effects occurred outside subjective awareness and generalized to new pictures in the AAT and to an entirely different test using words, rather than pictures (IAT). In relatively heavy drinking participants who demonstrated changed action tendencies in accordance with their training condition, effects were found on drinking behaviour, with participants in the approach‐alcohol condition drinking more alcohol than participants in the avoid‐alcohol condition. No effect was found on subjective craving. Conclusions Retraining automatic processes may help to regain control over addictive impulses, which points to new treatment possibilities.     

Women ending marriage to a problem drinking partner decrease their own risk for problem drinking

Aims Marital dissolution is associated with increased risk of problematic drinking. However, marriage to a problem drinker also increases this risk, and ending this type of relationship may actually decrease risk of problematic drinking. This study tested whether women ending their marriage to a problem drinker exhibited improvements in drinking. Design National Epidemiologic Survey on Alcohol and Related Conditions, a two‐wave nationally representative survey of the US adult population. Setting In‐person interviews conducted in US households. Participants Females married or living as if married at wave 1 at least 18 years of age. Measurements Socio‐demographics, drinking frequency, drinking quantity, alcohol use disorders, problem drinking, partner problem drinking and relationship dissolution. Findings Ending marriage to a non‐problem drinker predicted increased frequency of drinking [risk ratio (RR) = 1.55; 95% confidence interval (CI) = 1.43, 1.67], heavier drinking (RR = 1.30; 95% CI = 1.71, 1.45), more problematic drinking (RR = 2.45; 95% CI = 2.17, 2.77) and a greater likelihood of use disorder diagnosis [odds ratio (OR) = 2.2; 95% CI = 1.67, 2.91]. Ending a relationship with a problem drinker predicted less frequent drinking (RR = 0.94; 95% CI = 0.90, 0.98), less heavy drinking (RR = 0.84; 95% CI = 0.78, 0.90) and fewer alcohol‐related problems (RR = 0.77; 95% CI = 0.62, 0.95). Conclusions Ending a marriage with a husband who drinks problematically may decrease risk of alcohol‐related problems among women, substantiating the need for alcohol treatments to address a problem drinking partner.     

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

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

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.     

The Relationships Between States’ DUI Penalties and HIV-Positive Adults’ Drinking Behaviors

Evidence that persons with HIV who reside in states with stricter DUI penalties drink less might suggest that changes to alcohol policy might improve the health of persons with HIV and reduce the rate of new infections. Using multi-level modeling and data from the national HIV Cost and Services Utilization Study, we examined how states’ DUI-related fines, jail time, license suspension, and court-referred treatment/education policies were related to past month drinking/not (n = 2,255) and among drinkers (n = 1,117), drinking frequency, drinks per occasion, and engagement in frequent heavy drinking. Fine strictness was negatively related to all outcomes. Residents in states with court-referred treatment/education had more current drinkers. Results suggested that punitive DUI policies might curb a variety of drinking behaviors whereas harm reduction DUI policies (e.g., court treatment programs) might have been established in response to higher drinking rates.     

Age‐Related Changes in Drinking Patterns From Mid‐ to Older Age: Results From the Wisconsin Longitudinal Study

Background: Drinking has generally been shown to decline with age in older adults. However, results vary depending on the measure of alcohol consumption used and the study population. The goals of this study were to (i) describe changes in drinking in a current cohort of older adults using a variety of measures of drinking and (ii) examine a number of different possible predictors of change. Methods: This is a longitudinal study of a community‐based sample surveyed at 2 time points, ages 53 and 64 years. We estimated a series of logistic regressions to predict change and stability in drinking categories of nondrinking, moderate drinking, and heavy drinking. Linear regressions were used to predict change in past‐month drinking days, past‐month average drinks per drinking day, and past‐month total drinks. Results: From age 53 to 64, average drinks per drinking day and heavy drinking decreased. Frequency of drinking increased for men and women, and total drinks per month increased for men. The most consistent predictors of drinking changes were gender, health, and education. Other factors predicted drinking change but were not consistent across drinking measures including: adolescent IQ, income, lifetime history of alcohol‐related problems, religious service attendance, depression, debt, and changes in employment. Conclusions: Heavy drinking decreases with age, but we may see more frequent moderate drinking with current and upcoming cohorts of older adults. Components of quantity and frequency of drinking change differently. Composite measures of total alcohol consumption may not be adequate for describing relevant changes in drinking over time. A number of factors predicted patterns of change in drinking and warrant further exploration.     

Attentional re-training decreases attentional bias in heavy drinkers without generalization

Aims To examine whether alcohol‐related attentional bias (AB) can be reduced by training heavy drinkers to attend to soft drinks as an alternative to alcohol. Diminishing AB is important because AB has been suggested to be a significant factor in the development, maintenance and relapse of addictive behaviours. AB was trained in a clinically relevant design, and we studied the generalization of this training. Design, participants and intervention We assigned randomly 106 heavy drinking male college and university students to the attentional re‐training (AR; modified visual‐probe task) or control condition (standard visual‐probe task). Setting Laboratory at Maastricht University. Measurements We measured the effects of AR on the visual‐probe task with stimuli that were presented in the AR and with new stimuli, and on an alternative measure of AB, the flicker paradigm. We further measured effects on craving and preference for either an alcohol beverage or a soft drink. Findings After AR, participants had learned to avoid alcohol stimuli and had developed an AB for soft drinks. This effect was restricted to stimuli used in the AR. The flicker task, where AB for alcohol was found in both the AR and control groups, was not affected by the AR. No effect was found on craving and the preference task. Conclusions Although heavy drinkers can learn to attend selectively to an alternative category for alcohol, a single AR is not sufficient to decrease symptoms of problem drinking.     

Subdiagnostic alcohol use by depressed men and women seeking outpatient psychiatric services: consumption patterns and motivation to reduce drinking

Background: This study examined alcohol use patterns among men and women with depression seeking outpatient psychiatric treatment, including factors associated with recent heavy episodic drinking and motivation to reduce alcohol consumption. Methods: The sample consisted of 1,183 patients aged 18 and over who completed a self‐administered, computerized intake questionnaire and who scored ≥10 on the Beck Depression Inventory‐II (BDI‐II). Additional measures included current and past alcohol questions based on the Addiction Severity Index, heavy episodic drinking (≥5 drinks on 1 or more occasions in the past year), alcohol‐related problems on the Short Michigan Alcoholism Screening Test (SMAST), and motivation to reduce drinking using the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Results: Among those who consumed any alcohol in the past year (73.9% of the sample), heavy episodic drinking in the past year was reported by 47.5% of men and 32.5% of women. In logistic regression, prior‐year heavy episodic drinking was associated with younger age (p = 0.011), male gender (p = 0.001), and cigarette smoking (p = 0.002). Among patients reporting heavy episodic drinking, motivation to reduce alcohol consumption was associated with older age (p = 0.008), greater usual quantity of alcohol consumed (p < 0.001), and higher SMAST score (p < 0.001). Conclusions: In contrast to prior clinical studies, we examined subdiagnostic alcohol use and related problems among psychiatric outpatients with depression. Patients reporting greater drinking quantities and alcohol‐related problems also express more motivation to reduce drinking, providing intervention opportunities for mental health providers that should not be overlooked.     

A Double‐Blind,Placebo‐Controlled Study With Quetiapine as Adjunct Therapy With Lithium or Divalproex in Bipolar I Patients With Coexisting Alcohol Dependence

Background: This study evaluated the efficacy of quetiapine versus placebo as an adjunct to lithium or divalproex in reducing alcohol consumption in patients with bipolar I disorder and coexisting alcohol dependence. Methods: Male and female outpatients (21 to 60 years) with a history of bipolar I disorder and alcohol dependence were included in this 12‐week, placebo‐controlled study. Patients treated with lithium or divalproex (ongoing or assigned at screening) were randomized to receive quetiapine (dosed up to 400 mg/d over 7 days, followed by 300 to 800 mg/d flexible dosing until study end) or placebo. The primary outcome measure was the change in the proportion of heavy drinking days from baseline to Week 12 (as derived from the Timeline Followback method). Secondary outcome measures included time to the first consecutive 2 weeks of abstinence, changes from baseline to Week 12 in the proportion of nondrinking days, mean number of standardized drinks per day, and Clinical Global Impressions‐Severity of Illness score. Results: Of 362 enrolled patients (mean 38.6 years), 176 were randomized to receive quetiapine and 186 to placebo. The mean proportion of heavy drinking days at baseline was 0.66 in the quetiapine group and 0.67 in the placebo group. At Week 12, the mean change in the proportion of heavy drinking days was ?0.36 with quetiapine and ?0.36 with placebo (p = 0.93). No statistically significant differences in any of the secondary outcome measures were noted between the quetiapine and placebo groups. The incidence of adverse events was consistent with the previously known tolerability profile of quetiapine. Conclusions: The efficacy of quetiapine in the treatment of bipolar disorder is already well established. In this study, however, quetiapine added to lithium or divalproex did not result in significantly greater improvement compared with placebo in measures of alcohol use and dependence in patients with bipolar I disorder and alcohol dependence.