Different variables are associated with help-seeking patterns and long-term outcomes among problem drinkers

This study investigated variables associated with help-seeking for drinking problems and with long-term drinking outcomes. In a 3 x 2 design, problem drinkers (N=167) were selected according to their help-seeking history [no assistance (NA), Alcoholics Anonymous (AA) only, or treatment plus AA (TxAA)] and current drinking status [resolved abstinent (RA) for >2 years or non-resolved (NR) active drinkers]. Drinking practices and problems, influences on help-seeking, and life events were assessed retrospectively during structured interviews. Participant reports were verified through collateral or reliability interviews. Stable resolution was associated with heavier drinking and greater negative life events before resolution. Seeking help, especially from treatment, was associated with greater psychosocial problems and higher dependence levels. The results indicate that different dimensions of drinking problems are associated with help-seeking and drinking outcomes, and suggest ways to increase help-seeking.     

Heavy drinking and problems among wine drinkers.

OBJECTIVE: The purpose of this study was to see whether adults who drank wine exclusively would have lower quantity-frequency scores, less intoxication and fewer alcohol-related problems than those who drank other types of alcohol. METHOD: Data were analyzed from a national survey of the use of alcohol and other drugs conducted in Canada in 1994 (N = 8,758). RESULTS: Wine only drinkers were less often intoxicated than other drinkers. They also had lower quantity-frequency scores and reported fewer alcohol-related problems than other drinkers. These results were maintained when age, gender and quantity-frequency were taken into account. CONCLUSIONS: Wine only drinkers drink less than other types of drinkers and have fewer problems. As wine is often drunk with meals there is probably more social control over drinking. Also, since wine drinkers drink with meals their blood alcohol concentrations may be lower.     

Family history of problem drinking among young male social drinkers: behavioral effects of alcohol

Two experiments examined the behavioral effect of alcohol on male social drinkers aged 19-25, who differed in their family histories of problem drinking--21 reported a problem drinker in their immediate family (FH+) and 22 had no such family history (FH-). These groups did not differ in age, weight or absolute alcohol per kg of body weight typically consumed on social occasions. After drinking absolute alcohol (0.83 ml/kg), subjects performed bead stringing and hand steadiness tasks when their blood alcohol levels (BALs) averaged 63 mg/dl on the rising and the declining limb of the BAL curve. The experiments consistently demonstrated that FH+ individuals displayed a greater degree of impairment on the tasks. One of the experiments also explored subjective ratings of the effects of alcohol at matching BALs and found no significant group differences. The greater behavioral sensitivity to alcohol of FH+ subjects and their apparent absence of a concomitant enhanced perception of its effects were discussed as a potential component of their higher risk of developing problem drinking.     

Family history of problem drinking among young male social drinkers: reliability of the Family Tree Questionnaire

The test-retest reliability of the Family Tree Questionnaire to detect drinking problems of family members was examined in a sample of 60 male volunteer university undergraduates. The Questionnaire was completed twice. The first occasion employed a group administration procedure, and an average of 4 months later it was readministered on an individual basis. Thus the length of time and the different administration procedures provided an extreme test of the reliability of the Questionnaire. Test-retest scores of the number of problem drinkers reported by a subject were significantly correlated for first degree and for second degree relatives. The reliability of the classification of an individual family member was also satisfactory. The Family Tree Questionnaire thus appears to be a potentially useful, reliable tool for assessing the incidence of problem drinkers within families of young male social drinkers.     

Prevalence of problem drinkers among dental students]

In 1997 and 1998 we statistically studied fourth-year dental students for their drinking and smoking habits. The subjects numbered 103 (65 males, 38 females) in 1997 and 127 (79 males, 48 females) in 1998, totaling 230. The questionnaire included the Kurihama Alcoholism Screening Test (KAST), the Adolescent Alcohol Involvement Scale (AAIS), and the Fagerstr?m Tolerance Questionnaire (FTQ). Problem drinkers as defined by KAST, scoring at least 2 points, represented 12.6% of the total in 1997 and 13.4% in 1998, exceeding 10% in both years. Alcoholic misusers, with at least 42 point on the AAIS, stood at 19.4% in 1997 and 17.3% in 1998. The incidence of students assessed as having 6 points on the Quantity-Frequency Scale (QF Scale) stood at 18.4% in 1997 and 10.2% in 1998. Compared between two sexes, KAST detected no significant difference between the two groups: 13.9% for males and 11.6% for females. Alcoholic abusers on the AAIS, however, were estimated at 22.9% in males and 9.3% in females, the ratio for males being more than twice as high as that for females. It was also found that 47.9% of the male students and 33.7% of their female counterparts drank every weekend and that 31.3% of the males and 5.8% of the females kept drinking until they were drunk. Female students thus appeared to drink more frequently, though they consumed smaller amounts of alcohol at a time. The smoking rate was lower than the average in the Japanese for both groups; nicotine dependence was also lower in dental students. It was demonstrated that dental students drink more alcohol more frequently, with a higher incidence of problem drinkers.     

Organizational contexts of primary care approaches for managing problem drinking

Little is known about the organizational contexts associated with different primary care (PC) approaches to managing PC patients with drinking problems. Relying upon the Chronic Care Model and a theoretically based taxonomy of health care systems, we identified organizational factors distinguishing PC practices using PC-based approaches (managed by PC providers, mental health specialists, or jointly with specialty services) versus referral-based management in the Veterans Affairs health care system. Data were obtained from a national survey of 218 PC practices characterizing usual management approaches as well as practices' leadership, delivery system design, information system, and decision support characteristics and from a national survey of substance use disorder specialty programs. PC- and referral-based practices did not differ on the sufficiency of their structural resources, physician staffing, or on the availability of specialty services. However, PC-based practices were found to take more responsibility for managing patients' chronic conditions and had more staff for decision support activities.     

Understanding older problem drinkers: The role of drinking to cope

Introduction and aimsDespite a common perception that older adults drink less than younger adults, drinking frequency increases with age. The aim of this study was to examine the types of coping motives associated with problem drinkers in addition to the types of specific drinking problems most commonly endorsed by older drinkers. The study also sought to investigate the role of individual drinking to cope motives in problem drinking.MethodParticipants were 288 community dwelling older adults aged who consumed alcohol, and were drawn from a larger study of health and aging in rural areas of Australia. Participants completed a postal questionnaire comprising the Drinking Problems Index, Drinking Motives Questionnaire, The AUDIT-C, and the Centre for Epidemiological Studies Depression Scale.ResultsOverall, 22.2% of the sample were problem drinkers, with a higher prevalence for men (30.4%) than women (15.6%). Problem drinkers were significantly more likely to consume alcohol according to several indices of risky drinking. The most common drinking problems experienced were becoming intoxicated, spending too much money on drinking, feeling confused after drinking, and skipping meals. Drinking to cope motives to relax, to manage physical symptoms and to feel more self-confident increased the odds of problem drinking.ConclusionsProblem drinking is highly prevalent in older adults. Given the potential adverse consequences of problem drinking on the health of older adults it is imperative that health professionals pay attention to drinking behaviours as part of routine practice.     

Dose-related effects of alcohol among male alcoholics, problem drinkers and nonproblem drinkers

Cognitive variables, such as expectancies regarding the usefulness of alcohol, have been receiving increased attention in recent years because these expected effects can influence decisions to drink and mediate responses to alcohol. In the present study, alcohol expectancies were assessed using the Alcohol Beliefs Scale, a measure that yields dose-related data on expected effects of alcohol. The subjects were male alcoholics, problem drinkers and nonproblem drinkers. The central finding was that drinker group membership and rated dose level interacted in predicting subjects' estimates of the usefulness of alcohol for them. On the "useful for feeling better" factor, the greatest benefit was expected from a moderate dose, particularly among alcoholics. On the "useful for relieving emotional distress" factor, usefulness ratings increased with dose, with alcoholics expecting the greatest rate of increase. A similar pattern was found for the "useful for feeling in charge" factor, except that the ratings for problem drinkers and alcoholics paralleled each other. These findings have implications for our efforts to understand drinkers' motivations to initiate and continue drinking.     

Behavioural self-management with problem drinkers: One-year follow-up of a controlled drinking group treatment approach

The present study tested the effectiveness of a German behavioural self-control training (BSCT) for subgroups of drinkers differentiated by sex, ICD-10 diagnosis, and severity of dependence. Hazardous, harmful, and dependent drinkers were recruited through local mass media or referred by other treatment agencies. N?=?53 subjects (60% men, mean age 48.9 years, 76% employed, 64% alcohol dependent) participated in 10 weekly group treatment sessions and were assessed at intake, end of treatment, and 1-year follow-up (with 81% successfully contacted). Improvements made during BSCT remained stable over the 1-year follow-up period with 52% of subjects classified as improved (8% abstinent, 44% with a decline in alcohol consumption of at least 30%). In women, alcohol abusers and low dose drinkers (<800?g?ethanol/w), alcohol intake had declined less than in men, alcohol dependent subjects, and high dose drinkers (>800?g/w). This study, as others, indicates that alcohol dependence in itself is no contraindication for controlled drinking (CD) treatment.     

The social contexts of drinking among Irish men in London

The article reports the alcohol-related findings of a qualitative study that examined health beliefs and behaviours among Irish people in London. The findings elicited though key informant and lay focus groups and semi-structured interviews, illuminated the social and socioeconomic background to excessive alcohol use among middle-aged Irish men who left Ireland in the 1960s and 1970s. The findings describe the economic role of the pub and alcohol for men in the construction industry as well protecting them from homesickness, isolation and alienation in an unwelcoming and hostile environment. They illustrate the use of alcohol later in life to cope with physical and psychological pain, social stress and the symptoms of mental illness. The use of alcohol as a culturally sanctioned coping strategy is considered, exploring the ambivalent culture of alcohol in Ireland and in particular the tolerance of excessive consumption among men. The article explores the possibility that tolerant attitudes to alcohol in Ireland persist on migration to Britain and are then confounded by a culture of binge drinking among young people in general. The conclusion argues for further research and for culturally sensitive healthcare and health promotion strategies that take account of cultural and structural factors impacting on young Irish men in Britain. Current NHS policies on equality, alcohol and suicide offer timely opportunities to address alcohol misuse in order to improve physical and mental health and reduce the incidence of suicide among Irish men in Britain.     

Temporal sequencing of alcohol-related problems,problem recognition,and help-seeking episodes

Little is known about temporal relations between the development of alcohol-related problems, self-recognition of problems, and help seeking from professional and lay sources. The sequencing of these events was investigated retrospectively using a community sample of male and female problem drinkers (N= 101) who varied in their help-seeking histories [no assistance, Alcoholics Anonymous (AA)-only, or treatment-plus-AA] and current drinking status (resolved abstinent or nonresolved). The rank-order of events was similar across groups and gender. Problem recognition typically occurred early with the onset of pathological drinking and related psychosocial problems. Health problems and help seeking were late developments, if they occurred at all. Although the sequence order was similar across groups, the latency to help seeking varied; help seeking was more rapid among women, resolved participants, and participants who had sought help from both treatment and AA. The findings question conventional views that denial deters help seeking and suggest opportunities for screening and early intervention.     

Reinforcement expectancies for studying predict drinking problems among college students: approaching problem drinking from an expectancies choice perspective

Molar behavioral choice theories point to the important role reinforcement for alternative behaviors may play in reducing problem drinking [Psychol. Addict. Behav. 9 (1995) 223.]. A similar molar choice perspective may apply to a cognitive mediational level of analysis: the molecular link between alcohol expectancies and drinking behavior depends on expectancies for alternative behaviors. In this study, 82 college students completed the Alcohol Effects Questionnaire (AEFQ), the Rutgers Alcohol Problem Index (RAPI), a self-report measure of drinking quantity and frequency, and a five-item studying expectancies questionnaire devised for the current study. Analyses indicated that, among students who hold high alcohol expectancies, those who reported high studying expectancies drink less and develop significantly fewer drinking problems than those who hold low studying expectancies. Future research may address the possibility of reducing drinking problems among college students by enhancing studying expectancies.     

Assessing motivation to change among problem drinkers with and without co-occurring major depression

The University of Rhode Island Change Assessment Scale (URICA) is a widely used measure of readiness to change. To evaluate the URICA's ability to discriminate among alcohol abusers with and without co-occurring major depression, the authors administered it to 193 outpatients court-referred for alcohol treatment. Estimates of internal consistency suggest that scoring the URICA using its traditional factors, as well as using the newer Readiness to Change index, produced variable yet adequately reliable scores. Further, the URICA detected statistically significant differences in motivation to change an alcohol problem between an alcohol use disorder group (AD; n = 131) and an alcohol use disorder with co-occurring depression group (AD/D; n = 62) with the AD/D group showing greater readiness to change. For the AD/D group, separate URICAs were given for alcohol use and depressed mood. Confirming previous findings, results suggest the URICA may lack sensitivity to discriminate among two simultaneously occurring psychological disorders.     

Behavioral economic analysis of natural resolution of drinking problems using IVR self-monitoring

This study investigated whether a behavioral economic index of the value of rewards available over different time horizons predicted patterns of alcohol consumption shortly after natural resolution when the risk of relapse is high. Using a computerized interactive voice response (IVR) telephone system, untreated problem drinkers (n = 41) self-monitored their daily drinking, monetary expenditures, and surrounding contexts over intervals that ranged from a maximum of 42 to 128 days. Expanded Timeline Followback interviews were conducted before and after the IVR interval and 1 year after the baseline assessment. Stable resolutions generally and moderation resolutions specifically were associated with proportionally more preresolution expenditures on savings and less on alcohol compared to heavy drinking outcomes. The findings replicated and extended earlier research and suggested that the extent to which problem drinkers organized their behavior over longer intervals, even when drinking abusively, helped identify who resolved, including who transitioned to stable moderation.