Alcohol use frequency as a screen for alcohol use disorders in adolescents

While screening tools have been developed to identify adolescents likely to have alcohol use disorders (AUDs), none of the available methods are optimal for general medical settings. This study explored the sensitivity and specificity of the frequency of drinking episodes in the prior month as an initial screen for AUDs. The subjects were 219 adolescents (ages 12 through 18) systematically recruited from the community, who participated in a baseline assessment as well as 1-year, 3-year, and 5-year follow-up visits. Subjects completed a self-report form indicating their frequency of use of different substances in the month prior to the assessment. DSM-IV AUD diagnoses were determined by SCID. At baseline, 10 of 219 subjects met DSM-IV criteria for an AUD. At a threshold of 3 or more drinking episodes in the past month, the screen was 90% sensitive, correctly classifying 9 of 10 AUD cases, and 83.7% specific, correctly classifying 175 of 209 cases without AUDs. The diminishing specificity of this screen over the follow-up assessments indicated that this method may be useful for adolescents, but not for young adults. These results indicate that an assessment of the frequency of alcohol use in the prior month provides an initial screen with acceptable sensitivity and specificity for use with adolescents.     

Prevalence of alcohol abuse and alcohol dependence according to DSM-IV criteria in first year university students

OBJECTIVE: To determine the prevalence of alcohol problems in first-year college students. DESIGN: Cross-sectional. METHOD: Data on the prevalence of alcohol abuse or dependence according to DSM-IV criteria were collected in the period November 1995-April 1996 among college freshmen at the Catholic University of Louvain (Belgium). 3564 consecutive students completed a questionnaire which assessed drinking behaviour (Composite International Diagnostic Interview CIDI, Section J) and identified students at risk as defined by DSM-IV criteria. Our study included a large number of college freshmen, so we were able to perform our analyses with a large statistical power. All students had the opportunity to refuse their co-operation, but there were no non-responders, so selection bias was absent. The medical ethical committee of the KU Leuven approved this study. RESULTS: Of all 3564 consecutive students 501 (14.1%; 95% confidence interval (95% CI): 12.9-15.3) met DSM-IV criteria of alcohol abuse (n = 373; 10.5%; 9.5-11.5) or of alcohol dependence (n = 128; 3.6%; 3.0-4.2). Of the male students 301 (18.5%; 16.7-20.5) met the criteria of alcohol abuse and 96 (5.9%; 4.8-7.1) of alcohol dependence, of the female students 72 (3.7%; 2.9-4.6) and 32 (1.6%; 1.2-2.3) respectively. More than 10% (12.2%; 11.1-13.3) of these freshmen operated a vehicle under influence. This contributed in a major way to the DSM-IV conclusion. CONCLUSION: In this, one of the first studies among college freshmen using DSM-IV criteria the prevalence of alcohol abuse was in excess of 10%. In addition a substantial proportion of college freshman appeared to be alcohol dependent according to DSM-IV criteria.     

Alcohol use among Swedes and a psychometric evaluation of the alcohol use disorders identification test

The Alcohol Use Disorders Identification Test (AUDIT) was completed by 997 persons randomly selected from the general Swedish population (80% response rate). Eighteen per cent of the men and 5% of the women had hazardous or harmful alcohol use according to the > or =8 score criterion. AUDIT scores decreased with increasing age in both genders. Women are more sensitive to alcohol than men and when the cut-off score was set to > or =6, the female prevalence of hazardous or harmful alcohol use increased to nearly 11%. The 'binge drinking' question explained half of the total AUDIT variance and is thus the best item indicator of hazardous or harmful alcohol use in the test. Confirmatory and exploratory factor analyses revealed two AUDIT basic factors, the first three items defining a 'hazardous consumption' factor and the other seven items an 'alcohol-related problems' factor. Both the internal and test- retest reliability of the Swedish version of AUDIT were satisfactory. A table for converting raw scores to non-normalized T-scores for each combination of gender and three age intervals is presented.     

The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: a diagnostic meta-analysis

OBJECTIVE: To perform a meta-analysis to assess diagnostic characteristics of the CAGE in screening for alcohol abuse or dependence in a general clinical population and to test a new method for pooling of ROC curves. METHODS: Medline search performed over the period 1/1/1974 to 31/12/2001. MEASUREMENT: Calculation of diagnostic values. RESULTS: We identified 35 articles using the DSM criteria as the gold standard to test the diagnostic value of the CAGE. Only 10 studies could be included for the meta-analysis. With a cutoff point > or =2, the pooled sensitivity is far better in inpatients (0.87) than in primary care patients (0.71) or ambulatory patients (0.60). The pooled specificity also differs for each group. The likelihood ratios seem to be relatively constant over the populations (overall LR+:3.44;LR-:0.18). We calculated a pooled AUC of 0.87 (95% CI 0.85-0.89). At low specificity values, the sensitivity was homogeneous over the studies, and at a low sensitivity, the specificity was heterogeneous. CONCLUSION: The diagnostic value of the CAGE is of limited value using this test for screening purposes at his recommended cutpoint of > or =2.     

Mixed abuse of alcohol and drugs in teenagers in Sweden vs a group from the general population

We compared the subsequent life and development of 182 teenagers (the controls) from the general population and 345 teenagers of the same ages (the probands) who were taken care of by the Social Service Department, all of them from Greater Stockholm. All of the probands but none of the controls abused alcohol and drugs, and the probands had more psychosocial problems than the controls. The probands had grown up in families with more abuse of alcohol and drugs, broken homes, an alcohol-abusing father and mother and had taken up their parents' concomitant drug and alcohol abuse by parental influences. There were differences in social adjustment and health status between the probands compared with the controls. Social assistance was required to a much greater extent by the probands and they were registered in the Temperance Register and the Criminal Offenders Register and were in contact with the child welfare authorities more often than the controls. The proband children were also registered for sick-leave more often than the boys and girls from the general population and accounted for a larger number of visits to the wards and outpatient clinics for somatic symptoms and to psychiatric clinics and wards. The two groups of boys and girls of the probands were like “twin” groups in that they were almost equally often involved in crimes with drugs and their social maladjustment and health status resembled each other.     

Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires

Most screening questionnaires are developed in clinical settings and there are few data on their performance in the general population. This study provides data on the area under the receiver-operating characteristic (ROC) curve, sensitivity, specificity, and internal consistency of the Alcohol Use Disorders Identification Test (AUDIT), the consumption questions of the AUDIT (AUDIT-C) and the Lübeck Alcohol Dependence and Abuse Screening Test (LAST) among current drinkers (n = 3551) of a general population sample in northern Germany. Alcohol dependence and misuse according to DSM-IV and at-risk drinking served as gold standards to assess sensitivity and specificity and were assessed with the Munich-Composite Diagnostic Interview (M-CIDI). AUDIT and LAST showed insufficient sensitivity for at-risk drinking and alcohol misuse using standard cut-off scores, but satisfactory detection rates for alcohol dependence. The AUDIT-C showed low specificity in all criterion groups with standard cut-off. Adjusted cut-points are recommended. Among a subsample of individuals with previous general hospital admission in the last year, all questionnaires showed higher internal consistency suggesting lower reliability in non-clinical samples. In logistic regression analyses, having had a hospital admission increased the sensitivity in detecting any criterion group of the LAST, and the number of recent general practice visits increased the sensitivity of the AUDIT in detecting alcohol misuse. Women showed lower scores and larger areas under the ROC curves. It is concluded that setting specific instruments (e.g. primary care or general population) or adjusted cut-offs should be used.     

Social inequalities in alcohol use and misuse in the german general population

This paper investigates social inequalities in drinking behaviour in a sample of the German general population aged 25 to 59 years. The prevalence of several indicators of alcohol use and misuse were examined by socio-economic status (SES). Odds ratios were calculated to examine the relative effect of socio-economic status on the various alcohol misuse indicators. Abstinence showed a clear negative gradient with social status. When age was controlled, no differences were found in the prevalence of hazardous drinking. In comparison with men of high SES, men of middle SES had increased odds of consuming five or more drinks per day at least weekly and of a positive score on the AUDIT hazardous use measure, while men of lower SES had higher odds for dependence symptoms. Women of middle SES had significantly lower odds for reporting items of the CAGE alcohol screening instrument and DSM-IV alcohol abuse criteria in comparison to women of high SES. Thus, women of lower and higher SES resemble each other in drinking behaviour. For men, no identifiable pattern was found. The lack of clear social inequalities among the consuming German general population may be due to the widespread integration of alcohol drinking in everyday life.     

Alcohol and drug use, abuse, and dependence among welfare recipients.

OBJECTIVES: This paper presents national estimates of heavy drinking, drug use, and alcohol and drug abuse and/or dependence among recipients of selected welfare programs. METHODS: Data from the 1992 National Longitudinal Alcohol Epidemiologic Survey were analyzed. RESULTS: The percentages of welfare recipients using, abusing, or dependent on alcohol or drugs were relatively small and consistent with the general US population and those not receiving welfare benefits. CONCLUSIONS: Although a minority of welfare recipients have alcohol or drug problems, substance abuse prevention and treatment services are needed among high-risk subgroups.     

Alcohol abuse: prevalence and detection in a general hospital

Despite a high prevalence of alcohol-related disabilities and the availability of cost-effective interventions, alcohol abuse and dependence commonly go undetected in hospital inpatients. In a university teaching hospital we compared three well validated screening methods for sensitivity and specificity-the Alcohol Use Disorders Identification Test (AUDIT, with various cut-off scores), CAGE (a four-question screening tool), and a 10-question version of the Michigan Alcoholism Screening Test (BMAST). A subset of patients also completed the DSM IV structured clinical interview for diagnosis. 1133 adult patients were randomly selected from all hospital admissions, with exclusion of day cases and patients too ill to be interviewed. Two-thirds of the patients were interviewed, most of the remainder being unavailable at the time. 30% of the men and 8% of the women met the DSM IV criteria for alcohol abuse or dependence. Sensitivities and specificities of the screening tools were as follows: AUDIT (with cut-off score >8) 89% and 91%; CAGE 77% and 99%; BMAST 37% and 100%. 255 case records of patients scoring above the cut-off on one or more questionnaires were subsequently reviewed. The admitting team recognized an alcohol problem in only 46, of whom 17 were referred for appropriate follow up. As in previous hospital surveys, alcohol abuse and dependence was not receiving proper attention. The most efficient screening tool was the CAGE questionnaire.     

Treating alcohol dependence in a district general hospital

A strategy for managing alcohol problems within the general hospital setting should involve improved recognition of acute physical complications of alcohol withdrawal and dependence. Research shows that opportunistic interventions at this stage can reduce alcohol consumption by 25% in excessive drinkers. Support should be available from a local community alcohol service.     

The readiness to change questionnaire in subjects with hazardous alcohol consumption,alcohol misuse and dependence in a general population survey

AIMS: To investigate properties and aspects of validity of the Readiness to Change Questionnaire (RCQ) when applied to hazardous drinking, alcohol-abusing or alcohol-dependent subjects sampled from the general population. METHODS: In a representative survey conducted in the general population of a region in northern Germany, participants were randomly selected from resident registration office files, contacted and interviewed personally (n = 4.075). A total of 302 subjects who showed hazardous drinking behaviour (n = 202) or met diagnostic criteria of alcohol misuse (n = 46) or alcohol dependence (n = 54) were assessed and diagnosed using the Munich Composite International Diagnostic Interview (M-CIDI) according to DSM-IV diagnostic criteria. The battery of self-report questionnaires comprised, among others, the RCQ, and two methods of allocation were used, the quick method and the refined method of allocation. According to the method of allocation used, the stages are: precontemplation (PC), contemplation (C), preparation (P) and action (A); P may only be assigned using the refined method. RESULTS: The RCQ, a brief instrument to assess stages of change in individuals sampled from the general population, gave internal consistencies of: PC = 0.68, C = 0.79, A = 0.83. Allocation to stages of change according to the quick method resulted in 67% of subjects being allocated to PC, 24% to C and 8% to A and according to the refined method in 58% to PC, 15% to C, 4% to P, 4% to A, with 19% not being classified because of non-theory-consistent scale profiles. CONCLUSIONS: Classification did not differ substantially according to the method of allocation. A three-factor solution, as reported in the literature, could not be replicated. Allocation to stages of change with the RCQ reflected predictions made from the Transtheoretical Model of behaviour change.     

A literature overview of the relationship between life-events and alcohol use in the general population

AIMS: A critical review of the evidence of effects of stressful life-events on alcohol use in the general population, with a particular focus on study design. METHODS: A literature search in Medline was conducted, covering the period from 1990 to 2005, to identify articles in which the relationship between life-events and alcohol use in the general population (i.e. non-problem drinking population) was investigated. Samples with a limited age range (e.g. college students) were excluded. Twelve studies with a cross-sectional design, and four articles with a longitudinal design were included in this review. RESULTS: Four cross-sectional studies found evidence that experiencing life-events is related to higher alcohol use, three other studies, however, found no such association. The relationship between specific life-events and alcohol use in the five remaining cross-sectional studies is less clear-cut. Being a victim of crime was associated with higher alcohol use, but divorce and financial problems were related to both higher and lower alcohol use. Health-related life-events were found to be associated with lower alcohol use. In studies with a longitudinal design, it was found that health-related life-events and financial problems caused a decrease in alcohol use, and life-events related to spouse, friends and relatives, and retiring led to an increase in alcohol use. CONCLUSIONS: Evidence points towards a relationship between the occurrence of life-events and alcohol use in the general population. The direction of the effect is, however, not unequivocal. When life-events are operationalized or categorized separately they are not only related to an increased alcohol use but also to a decreased alcohol use. Specification of the model to be tested, including buffering factors such as gender, social support, coping resources, as well as baseline consumption, is important for a correct estimation of the effect of negative life-events.     

CUGE: a screening instrument for alcohol abuse and dependence in students

OBJECTIVES: The prevalence of alcohol abuse on college campuses ranges from 7 to 17%. Frequent heavy drinkers place themselves and others at risk for a variety of adverse consequences and frequently remain undetected. Brief individual interventions result in a significant reduction on the number of drinks. Therefore, detection of students at risk is useful and desirable. The CUGE has been elsewhere described as a promising screening device for problem drinking in students. In order to determine the diagnostic value of this new questionnaire, we set up a validation study in a new and independent population of freshmen. METHODS: A cross-sectional diagnostic study. Participants were college freshmen of the Katholieke Universiteit Leuven. All students received a questionnaire, containing the CUGE, being the test of interest, and the CIDI as the reference test. RESULTS: The CUGE combines a very high sensitivity of 91% with a reasonable specificity of 76.3% in this validation group. CONCLUSIONS: The CUGE is an excellent screening device in this population of students. In addition, it is a short questionnaire with only yes or no questions. This makes the CUGE easily applicable as a part of broad routine questionnaires.     

Timevarying predictors of smoking cessation among individuals in treatment for alcohol abuse and dependence: findings from Project MATCH

AIMS: Individuals in treatment for alcohol use disorders are more likely to die from cigarette use than from alcohol consumption. Advanced statistical methodologies that increase study power and clinical relevance have been advocated to examine the timevarying nature of substance use relapse and abstinence, including drinking and smoking. The purpose of this investigation was to examine timevarying factors that are associated with smoking cessation among smokers in the general population, including alcohol use, self-efficacy, and depression, to determine if they were also related to smoking cessation during and after treatment for alcohol use disorders. METHODS: Data were garnered from Project MATCH, a longitudinal prospective study of the efficacy of three behavioural treatments for alcohol use disorders. Timevarying covariate analyses were conducted to examine future smoking cessation. RESULTS: Results showed that greater self-efficacy regarding resisting temptations to drink and lower levels of depression were independently associated with increased likelihood of stopping smoking. In contrast, drinks per drinking day and confidence regarding not drinking did not demonstrate such associations. CONCLUSIONS: Clinical implications of these findings suggest that interventions to help alcoholics in recovery avoid temptations to drink, as well as decrease depression, may be warranted. By using advanced statistical techniques, these results can help clinicians and organizations working with smokers in treatment for alcohol use disorders to make informed decisions regarding how best to use limited resources.     

Evaluation and management of chronic alcohol abuse

Alcohol abuse can be treated with diverse modalities that include drugs, behavioral modification, supportive therapy, and inpatient detoxification. Drugs and motivational programs have been especially important. The primary care physician may be the most effective mediator of change; brief advice or support can produce significant results.     

Paternal and maternal alcohol abuse and offspring mental distress in the general population: The Nord-Trondelag Health Study

ABSTRACT: BACKGROUND: The degree to which parental alcohol abuse is a risk factor for offspring mental distress is unclear, due to conflicting results of previous research. The inconsistencies in previous findings may be related to sample characteristics and lack of control of confounding or moderating factors. One such factor may be the gender of the abusing parent. Also, other factors, such as parental mental health, divorce, adolescent social network, school functioning or self-esteem, may impact the outcome. This study examines the impact of maternal and paternal alcohol abuse on adolescent mental distress, including potentially confounding, mediating or moderating effects of various variables. METHOD: Data from the Nord-Trondelag Health Study (HUNT), a Norwegian population based health survey, from 4012 offspring and their parents were analyzed. Parental alcohol abuse was measured by numerical consumption indicators and CAGE, whereas offspring mental distress was measured by SCL-5, an abbreviated instrument tapping symptoms of anxiety and depression. Statistical method was analysis of variance. RESULTS: Maternal alcohol abuse was related to offspring mental distress, whereas no effect could be shown of paternal alcohol abuse. Effects of maternal alcohol abuse was partly mediated by parental mental distress, offspring social network and school functioning. However, all effects were relatively small. CONCLUSION: The results indicate graver consequences for offspring of alcohol abusing mothers compared to offspring of alcohol abusing fathers. However, small effect sizes suggest that adolescent offspring of alcohol abusing parents in general manage quite well.     

The neurobiological and neurocognitive consequences of chronic cigarette smoking in alcohol use disorders

A vast body of research attests to the adverse effects of chronic smoking on cardiac, pulmonary, and vascular function as well as the increased risk for various forms of cancer. However, comparatively little is known about the effects of chronic smoking on human brain function. Although smoking rates have decreased in the developed world, they remain high in individuals with alcohol use disorders. Despite the high prevalence of comorbid chronic smoking in alcohol use disorders, very few studies have addressed the potential neurobiological or neurocognitive effects of chronic smoking in alcohol use disorders. Here, we briefly review the existing literature on the neurobiological and neurocognitive consequences of chronic cigarette smoking and summarize our neuroimaging and neurocognitive studies on the effects of comorbid chronic excessive alcohol consumption and cigarette smoking in treatment-seeking and treatment-na?ve populations. Our research suggests comorbid chronic cigarette smoking modulates magnetic resonance-detectable brain injury and neurocognition in alcohol use disorders and that neurobiological recovery in our abstinent alcoholics is adversely affected by chronic smoking. Consideration of the potential separate effects and interactions of chronic smoking and alcohol consumption may foster a better understanding of specific mechanisms and neurocognitive consequences of brain injury in alcoholism and of brain recovery during sustained abstinence from alcohol. The material presented also contributes to ongoing discussions about treatment strategies for comorbid alcoholism and cigarette smoking and will hopefully stimulate further research into the neurobiological and neurocognitive consequences of chronic smoking in alcoholism and other substance use disorders.