Typical sources and locations where recent youth drinkers obtain and consume alcohol based on intensity of use

Background: The purpose of the present study was to examine whether typical sources and locations where youth recent drinkers, defined as youth who drank alcohol in the past month, obtain and consume alcohol differed significantly based on intensity of use. Intensity of use was based on binge drinking, which was defined as drinking five or more alcoholic beverages in a row on the same occasion. Methods: Youth recent drinkers from 12 to 17 years of age (N?=?2321) who participated in the National Survey on Drug Use and Health were included. After running a series of logistic regression models, all statistically significant variables were retained and included in final multiple logistic regression analyses. Results: Predictors for sources of last alcoholic beverage drank based on intensity were race/ethnicity, age, number of days drank in the past 30 days and usual number of drinks per day in past 30 days. Predictors for locations where alcohol users drank their last alcoholic beverage based on intensity of use were race/ethnicity, number of days binge drank in the past 30 days, usual number of drinks per day in past 30 days and age first drank alcohol. Conclusion: Recommendations for future studies are included.     

飞行员饮酒情况调查与分析

目的研究我军飞行员饮酒现状。方法采用整群抽样的方法,使用AUDIT问卷调查我军96名飞行员的饮酒情况,并按年龄进行分组,对各组间的问卷分数、饮酒频率等进行检验,计量资料采用One-wayANOVA检验,计数资料采用卡方检验。结果 96名飞行员中饮酒率为95.83%,其中92名饮酒者中正常饮酒28人（30.43%）,危险及有害饮酒64人（69.57%）。饮酒种类主要以白酒和啤酒为主,分别是38人（41.30%）和42人（45.65%）;饮酒原因主要是聚会76人（82.61%）;并且〈30岁和30～40岁的饮酒飞行员AUDIT问卷平均分数与40岁以上饮酒飞行员AUDIT问卷平均分数之间差异有统计学意义（P〈0.01,P〈0.05）,〈30岁和30～40岁的饮酒飞行员AUDIT问卷平均分数之间差异无统计学意义（P〉0.05）。结论飞行员饮酒情况比较普遍,且随年龄增长,饮酒程度也逐渐加重,应尽早给予教育和干预。     

Helping methadone patients who drink excessively to drink less: short-term outcomes of a pilot motivational intervention

Opiate addicts receiving methadone treatment who drink alcohol excessively tend not to reduce their drinking, which may imperil continued treatment as well as increasing health risks. The first study asked 136 methadone patients in a community treatment service about their alcohol consumption and requested the 116 who reported drinking during the previous year to complete the AUDIT. Thirty-two (24% of all) reported drinking above 'safe limits' (< 21 units per week for men, < 14 for women) during the previous week: 49 (36% of all) had AUDIT scores of 8 or more. A significant minority are potentially at risk. The second study explored the possibility of helping such patients to drink less by offering nine sessions of focussed help (involving the Drinkers' Check-up) using motivational interviewing techniques. Of the 39 patients referred, 22 attended for assessment, were identified as having a drinking problem, and were offered the structured intervention. Fourteen took up the offer, of whom 11 had good short-term outcomes (10 stopped drinking, and one reduced weekly consumption from 90 units to 30); three did not reduce their consumption. These short-term results encourage the development of ways of helping this group: the experience of providing the service suggests ways of doing this.     

Prevalence of problem drinking and characteristics of a single-question screen

Hazardous drinking and alcohol use disorders (i.e, abuse and dependence) are common in Emergency Departments (EDs). This study examined 1) the prevalence of these conditions among ED patients and 2) characteristics of a single screening question (having consumed at least five drinks for males or four for females during a single day). Data from the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Logistic regression for clustered data was used to estimate the relative risk for past-year ED use associated with hazardous drinking, abuse, and dependence. Contingency tables were analyzed to estimate the sensitivity and specificity of the single-question screen for detecting these conditions. Hazardous drinking was not associated with ED utilization. Alcohol abuse was associated with a relative risk of 1.3 (95% confidence interval [CI] 1.1-1.5) and alcohol dependence with a relative risk of 1.9 (95% CI 1.6-2.2). For current drinkers, the single question screen was 0.96, 0.85, and 0.90 sensitive for hazardous drinking, alcohol abuse, and alcohol dependence, respectively. Individuals with a positive screen in the past year were considered at least hazardous drinkers, and specificity was 0.80, 0.64, and 0.65 for hazardous drinking, abuse, and dependence, respectively. Specificity was modestly increased in women. Most problem drinkers were hazardous drinkers, but only severe alcohol use disorders were particularly prevalent in the ED. The single heavy-drinking-day item appears sensitive for problem drinking. Positive tests must be followed by additional assessment to differentiate hazardous drinking from alcohol use disorders.     

Chronic alcohol effects on anterior pituitary and ovarian hormones in healthy women

The effects of chronic alcohol intake on menstrual cycle status and hormonal function were studied in 26 healthy, adult women under controlled research ward conditions. Women were classified as heavy, social or occasional alcohol users on the basis of the actual number of drinks consumed during 3 consecutive weeks of alcohol availability. Heavy, social and occasional users drank an average of 7.81 ( +/- 0.69), 3.84 ( +/- 0.19) and 1.22 ( +/- 0.21) drinks/day, respectively. This drinking pattern was highly consistent with subjects' self-reports of alcohol use before the study. No evidence of menstrual cycle dysfunction or abnormality in reproductive hormone levels was found in the occasional drinkers or in two of the social drinkers who consumed less than an average of three drinks/day. In contrast, 50% of the social drinkers who consumed more than three drinks/day and 60% of the heavy drinkers had significant derangements of menstrual cycle and reproductive hormone function. The major abnormality found in social drinkers was anovulatory cycles, and three of the five women who were heavy drinkers had persistent hyperprolactinemia. These findings suggest that alcohol-related menstrual cycle and reproductive hormone dysfunction may be more prevalent among women who are social and heavy drinkers than has been assumed previously.     

The alcohol use disorders identification test (AUDIT): validation of an instrument for enhancing nursing practice in Hong Kong

This paper describes the psychometric analysis of the alcohol use disorders identification test (AUDIT) after it was modified for use in Hong Kong and administered to examine the patterns of hazardous and harmful drinking. The modified version of AUDIT was an 18-item instrument in which 10 items were completely adopted from the original version and 8 items were added to improve its cultural sensitivity. It was translated into Chinese and back translation was undertaken to confirm the equivalence of the Chinese and English versions. Following a pilot study the instrument was administered to 450 subjects who were recruited from two acute general hospitals, a University Health Clinic and three community health centres. The content validity was judged as adequate by a panel of five international and local experts and the instrument achieved a high reliability coefficient of 0.99 during a test-retest procedure conducted with 20 subjects. Factor analysis was performed on the responses obtained from 450 subjects which supported the construct validity of the 18-item instrument. The modified instrument had a consistently high internal consistency reliability (Cronbach's alpha=0.96-0.97) when tested in the different settings. It was found that a higher percentage of respondents from the hospitals (14.5%) drank at a hazardous or harmful levels compared to those from the community (6.2%) or the University (5.3%). The AUDIT proved a reliable and valid measure with potential applications in Chinese cultures. Early intervention and identification of 'at risk' drinking by the AUDIT is supported as a strategy to be implemented by nurses in primary and secondary health care settings in Hong Kong, where there are indications of increasing alcohol overuse.     

Hazardous and harmful drinking: a comparison of the AUDIT and CAGE screening questionnaires

BACKGROUND: Hazardous and harmful use of alcohol remains a public health concern, and many general hospital admissions are alcohol-related. AIM: To compare the CAGE and Alcohol Use Disorders Identification Test (AUDIT) questionnaires in screening general medical admissions for harmful or hazardous drinking. DESIGN: Prospective questionnaire-based study. METHODS: Both questionnaires were administered, and demographic data collected. RESULTS: One hundred and three patients were included. Of these, 36% were identified by the AUDIT to be drinking hazardously or harmfully, and 22% were identified as CAGE cases. All CAGE cases were also AUDIT cases. DISCUSSION: As the CAGE and the AUDIT are designed to identify different populations, it is not surprising that significantly fewer cases were identified using the CAGE. The AUDIT identifies not just the harmful drinkers detected by the CAGE, but also hazardous drinkers, who have not yet reached that level of harm. As drinkers at an earlier stage may respond better to interventions aimed at reducing their consumption, the AUDIT is preferable in clinical practice.     

Optimizing the US-AUDIT for alcohol screening in U.S. college students

This study examined cutoff scores on the new (2014) US-AUDIT (Alcohol Use Disorders Identification Test), adapted for U.S. standard drinks. No studies have examined optimal cutoff scores on the US-AUDIT for college students. 250 undergraduates (65% men) completed the US-AUDIT. At-risk drinkers reported at least four binge drinking episodes per week. Likely alcohol use disorder was assessed with a self-report diagnostic measure. Using the Youden method, the ideal cutoff to identify at-risk drinkers for the US-AUDIT was 5 for men (sensitivity = .93, specificity = .96) and 6 for women (sensitivity = .77, specificity = .86); and to identify likely alcohol use disorder was 13 for men (sensitivity = .69, specificity = .81) and 8 for women (sensitivity = .83, specificity = .80). Cutoffs were lower than the original AUDIT. Different US-AUDIT cutoffs for men and women should be used for likely alcohol use disorder, which may reflect differences in drinking quantity and frequency. Empirical guidelines for alcohol screening with the new US-AUDIT may be used to enhance research or identification of at-risk drinkers in college settings, or for college students in primary care or other health care settings.     

Feasibility of screening and intervention for alcohol problems among young adults in the ED

This study evaluates the feasibility of screening and brief intervention (SBI) for alcohol problems among young adults (18-39 years) in a rural, university ED. Research staff screened a convenience sample of patients waiting for medical treatment with the Alcohol Use Disorders Identification Test (AUDIT), used motivational interviewing techniques to counsel screen-positive patients (AUDIT >/= 6) during the ED visit, and referred patients to off-site alcohol treatment as appropriate. Patients were interviewed again at 3 months. Eighty-seven percent of age-eligible drinkers (2,067 of 2,371) consented to participate. Forty-three percent (894 of 2,067) screened positive, of which 94% were counseled. Forty percent of those counseled set a goal to decrease or stop drinking and 4% were referred for further treatment. Median times for obtaining consent, screening, and intervention were 4, 4, and 14 minutes, respectively. Project staff reported that 3% of patients screened or counseled were uncooperative. Seventy percent of 519 patients who participated in follow-up interviews agreed the ED is a good place to help patients with alcohol problems. High rates of informed consent and acceptance of counseling confirmed this protocol's acceptability to patients and indicated patients were comfortable divulging alcohol-related risk behavior. The modest times required for the process enhanced acceptability to patients as well as ED staff. The high prevalence of alcohol problems and the broad acceptance of SBI in this sample provide evidence of the ED's promise as a venue for this clinical preventive service.     

Linkages between young adult dating partners’ daily alcoholic drinks: risk for alcohol problems as a moderator

Dating relationships during young adulthood provide an important interpersonal context for individuals’ health behaviors, including alcohol use. To better understand dating partners’ alcohol-use associations and implications, this study examined within-couple daily linkages between daily alcoholic drinks reported by males and females and further investigated the potential role of hazardous drinking as a moderator of the daily links. Dyadic data from 57 young adult, heterosexual couples were obtained across global self-report questionnaires and daily-diary methods. Multilevel modeling results indicated positive within-couple associations between dating partners’ reports of daily drinks, such that on days when males and females reported drinking more than their average number of daily drinks, their partner also drank more. In addition, both males’ and females’ elevated risks for hazardous drinking moderated these associations by weakening the positive within-couple links between partners’ daily drinks. The study extends our understanding of young adults’ alcohol use in the context of intimate relationships, shedding particular light on the implications of within-couple daily fluctuations in number of drinks and partners’ risks for hazardous drinking.     

Swimming upstream: how and why an alcohol misuse screening and intervention service using the AUDIT can have limited impact in primary care

An alcohol-screening project using the AUDIT questionnaire (World Health Organisation 1992a) was undertaken in several primary healthcare centres in the eastern sector of Cardiff in 1997/1998. The aim of the project was three-fold: &#148 to raise awareness of problematic drinking in primary healthcare attenders &#148 to encourage GPs to perform brief alcohol education with their patients in addition to laboratory screening &#148 to offer primary care attenders identified as 'alcohol problem very likely' (AUDIT score greater than eight) a brief motivational interviewing counselling session with the nurse co-ordinating the project. This paper describes the process of implementing the screening and counselling service. Methods of AUDIT questionnaire distribution, reasons given for screening and cooperation of primary healthcare staff each have an impact on results. When administered anonymously in a pilot project, the AUDIT questionnaire identified very high rates of problematic drinking. Fifty-eight per cent of all those screening positive had some recorded intervention by their GP, but the majority were highly resistant to further counselling. The views of the primary healthcare staff involved in the project and those patients who attended for counselling are discussed.     

Alcohol consumption,dependence and foraging

Background: Smartphone technology enables treatment providers to deliver targeted outpatient support “on site” in “real time,” but this will require a better understanding of peer networks and substance users’ acquisition of drugs. Objectives: This study sought to understand contextual factors associated with risky levels of alcohol consumption. Methods: A total of 280 participants answered an online survey, completed the AUDIT and indicated their numbers of regular drinking partners, and the number of times and places alcohol was normally consumed. Results: Hazardous drinkers had a greater number of drinking partners and drank alcohol at a greater number of times and locations. Alcohol dependence was associated with alcohol use in more times and places, but was not linked to the numbers of drinking partners. Models drawn from foraging literature were used to describe the data. Conclusions/Importance: Patterns of alcohol foraging could be described by power laws, and such power laws could be used to compare foraging for a range of substances. A consideration of foraging behavior may inform location-aware services targeting risky substance use.     

Marijuana Use and Prior Injury among Injured Problem Drinkers

OBJECTIVES: The purpose of this paper is to better understand marijuana use among injured problem drinkers in the emergency department (ED). The specific objectives are: 1) to assess the prevalence of marijuana use; 2) to identify factors associated with marijuana use; 3) to determine whether prior injury is associated with marijuana use; and 4) to determine whether marijuana-using problem drinkers want to change behaviors. METHODS: The authors conducted a post-hoc analysis on data obtained prospectively. Subjects had injury and problem drinking: either measurable alcohol level (blood alcohol concentration, BAC), report of drinking, or an Alcohol Use Disorders Identification Test (AUDIT) score of > or =8. The study was conducted on weekend nights; 3,776 injured ED patients were screened, 383 refused, 578 were enrolled, and 433 had complete data. RESULTS: Of the 433 subjects, 48.3% reported using marijuana in the three months prior. Marijuana-using problem drinkers had more hazardous drinking, higher AUDIT scores (14.0 vs. 11.4, p < 0.001), and higher risk-taking scores (12.4 vs. 10.1, p < 0.001). More used other drugs (69.7% vs. 30.3%, p < 0.001). In regression analyses, marijuana use remained an independent predictor of prior injury (OR = 2.16, 95% CI = 1.25 to 3.75), particularly prior alcohol-related (OR = 2.26, 95% CI = 1.45 to 3.53) and motor-vehicle-related (OR = 1.69, 95% CI = 1.03 to 2.79) injury. Readiness-to-change scores were similar (4.14 vs. 4.22, p = 0.21) between users and nonusers. CONCLUSIONS: Marijuana use among injured problem drinkers is prevalent. Their risk of prior injury is increased. Counseling for alcohol and injury should address marijuana use.     

Operant acquisition of alcohol by women

Alcohol acquisition and use patterns were studied in 26 women on a clinical research ward. Women could earn alcohol (beer, wine or distilled spirits) or 50 for 30 min of performance on a second-order fixed ratio 300 (fixed interval 1 sec: S) schedule of reinforcement. Points earned for money and for alcohol were not interchangeable. A 7-day drug-free base line was followed by 21 days of alcohol availability and a postalcohol drug-free period of 7 days. Heavy, moderate and occasional drinkers differed significantly in the average number of alcohol drinks purchased (P less than .001). Five heavy drinkers purchased an average of 164 (+/- 14) drinks during the study; 12 moderate drinkers purchased an average of 80 (+/- 4) drinks; 9 occasional drinkers purchased an average of 26 (+/- 4) drinks. Individual drinking patterns fluctuated markedly from day-to-day. Daily peak blood alcohol levels (milligrams per deciliter) were significantly correlated with variations in daily drinking patterns in 22 of the 26 subjects (P less than .02-.0001). Computer analysis of daily alcohol consumption patterns (alcohol peak frequency and peak amplitude) showed that moderate drinkers had significantly more peaks in alcohol consumption than occasional drinkers (P less than .05). The average number of drinks constituting each peak was significantly greater for the heavy and moderate drinkers than for the occasional drinkers (P less than .05). The interval between successive peaks in alcohol consumption averaged 4.6 (+/- 0.8) days for the occasional drinkers, 3.2 (+/- 0.2) days for the moderate drinkers and 3.6 (+/- 0.17) days for the heavy drinkers but these differences were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)     

Identification of Hazardous/Harmful Drinking among Subcritically Injured Patients

Objectives: To examine the relationship between a saliva alcohol test (SAT) and hazardous/harmful drinking, as measured by the Alcohol Use Disorders Identification Test (AUDIT), among a sample of subcritically injured patients.
Methods: Patients ( n = 78) seeking treatment for a subcritical injury were saliva-tested for alcohol and interviewed regarding their drinking behaviors and related difficulties. Associations of SAT values with AUDIT results were determined.
Results: SAT results and hazardous/harmful drinking were not independent events (p < 0. 001). Estimates of sensitivity and specificity (using a dichotomous SAT result [≥ 4 mmol/L] to identify positive AUDIT patients) were 65. 2% and 83. 6%, respectively. SAT-positive people had significantly higher AUDIT scores than did SAT-negative individuals (p < 0. 0001). Patients experiencing assault-type injuries were much more likely to be SAT-positive than were patients incurring other types of injury. Discriminant function analysis suggests that AUDIT scores can successfully identify SAT-positive and SAT-negative patients; the analysis accounted for 42. 5% of the variance and correctly classified 84. 6% of the sample.
Conclusions: The use of an easy-to-administer, noninvasive, routine SAT, among patients presenting for a subcritical injury in a hospital ED, provides a mechanism for the identification of individuals with a history of hazardous/harmful drinking. However, since discrimination of hazardous/harmful drinking is imperfect, some caution is warranted when conducting such screening activities.     

Alcohol use among young adults presenting to the emergency department

Objectives: To determine the prevalence of young ED patients at risk from hazardous alcohol consumption, to identify high‐risk patient subgroups and evaluate the feasibility of use of the Alcohol Use Disorders Identification Test (AUDIT) in this setting. Methods: We undertook a cross‐sectional survey of 336 ED patients aged 18–30 years, inclusive. All were breathalysed prior to self‐administering the AUDIT. A ‘positive’ AUDIT score (≥8) defined hazardous alcohol consumption. AUDIT scores were correlated with sex and trauma diagnosis. Results: One hundred and thirty‐one (39.0%, 95% confidence interval [CI] 33.8–44.5) patients were classified as AUDIT‐positive. Men were significantly more likely to be AUDIT‐positive (49%vs 23%, P < 0.001) and had significantly higher total AUDIT scores (P < 0.001) than women. Trauma patients were significantly more likely to be AUDIT‐positive (P < 0.001) and had significantly higher AUDIT scores than non‐trauma patients (P < 0.001). Of the six patients who recorded a positive breath alcohol reading, all were AUDIT‐positive. One hundred (76.3%, 95% CI 68.0–83.1) AUDIT‐positive patients did not report others being concerned about their drinking or had not been given advice to cut down. Conclusion: It is feasible to use the AUDIT screening tool in the ED to identify those at risk from hazardous drinking. In our ED there is a high prevalence of hazardous alcohol consumption in young adult patients, many of whom have not previously received advice to cut down on their drinking.     

Substance Use Restraint: An Extension of the Construct to a Clinical Population

Restraint is a construct of potential use forunderstanding addictive behaviors. In terms of alcoholand other drug use, restrained individuals arecognitively and behaviorally preoccupied withcontrolling their substance use. Previous work in thecontext of alcohol consumption suggests that whenregulation fails, alcohol and other drug users are morelikely to engage in excessive substance use. Thisproposition was evaluated in a clinical population ofalcohol and other substance users admitted to aninpatient treatment program. A confirmatory factoranalysis of alcoholics' responses to the Temptation andRestraint Inventory, a measure of drinking restraint,replicated the two second-order factors previouslyreported for social drinkers: Cognitive and EmotionalPreoccupation (CEP) and Cognitive and Behavioral Control (CBC). CEP scores were a negative predictor ofpretreatment percentage of days abstinent and a positivepredictor of percentage of drinking days engaged inheavy drinking, drinks per drinking day, and drinking consequences. CBC scores were a negativepredictor onlyof drinks per drinking day. An analysis ofdrug users' responses to a drug version of theTemptation and Restraint Inventory also replicated thepreviously found CEP and CBC factors. Scores on the CEPfactor were a positive predictor and scores on the CBCfactor a negative predictor of drug use frequency. CEPscores also were a positive predictor of drug use consequences. The data taken together representa potentially useful extension of the restraintconstruct to alcoholics and other drug users and supporta multifactorial characterization of substance use restraint as reflecting a reciprocalrelationship between restricted and excessive substanceuse.     

长期危险饮酒者3项红细胞指标的研究

目的 探讨长期危险饮酒者血液中平均红细胞体积(MCV)、平均红细胞血红蛋白(MCH)、平均红细胞血红蛋白浓度(MCHC)的变化, 从而对长期危险饮酒提供一个监测参考指标.方法 按世界卫生组织的饮酒分类标准[1]:危险饮酒,男性＞14杯/周或1次饮酒＞4杯;女性＞7杯/周或1次饮酒＞3杯(1杯=12 g乙醇,相当于360 ml啤酒,或180 ml葡萄酒,或45 ml 90标准度乙醇饮品).按平均饮白酒＞100 ml/d,或饮啤酒＞750 ml/d,或葡萄酒＞360 ml/d,从本院体检中心选出符合以上条件者116例(A组),非饮酒者126例(B组),然后用全自动血液分析仪对以上两组受试者的MCV、MCH、MCHC 3个指标进行检测,并对两组数据进行了分析和比较.结果 A组与B组的结果比较,两组的MCHC无明显变化,而长期危险饮酒者的MCV、MCH显著升高(P＜0.01).结论 红细胞的MCV、MCH的检测可以作为长期危险饮酒的一个监测参考指标.     

Increased brain uptake and oxidation of acetate in heavy drinkers

When a person consumes ethanol, the body quickly begins to convert it to acetic acid, which circulates in the blood and can serve as a source of energy for the brain and other organs. This study used ¹³C magnetic resonance spectroscopy to test whether chronic heavy drinking is associated with greater brain uptake and oxidation of acetic acid, providing a potential metabolic reward or adenosinergic effect as a consequence of drinking. Seven heavy drinkers, who regularly consumed at least 8 drinks per week and at least 4 drinks per day at least once per week, and 7 light drinkers, who consumed fewer than 2 drinks per week were recruited. The subjects were administered [2-¹³C]acetate for 2 hours and scanned throughout that time with magnetic resonance spectroscopy of the brain to observe natural ¹³C abundance of N-acetylaspartate (NAA) and the appearance of ¹³C-labeled glutamate, glutamine, and acetate. Heavy drinkers had approximately 2-fold more brain acetate relative to blood and twice as much labeled glutamate and glutamine. The results show that acetate transport and oxidation are faster in heavy drinkers compared with that in light drinkers. Our finding suggests that a new therapeutic approach to supply acetate during alcohol detoxification may be beneficial.     

Predictors of hazardous drinking among home drinkers

Introduction and Aims: The United Kingdom has witnessed a shift from drinking in bars to drinking at home; to date, this phenomenon has received little international attention. The aim of this study was to examine the predictors of hazardous drinking (HD) levels when drinking at home. Design: An internet survey of university staff (n = 488) was given. Methods: Following an elimination process (p ≤ 0.05), a regression analysis was conducted using AUDIT scores as cutoffs of ≥6 females, and ≥8 males; these are consistent with most international research. Results: There were 286 hazardous drinkers (HD) (181, females 63.3%) and (105, males 36.7%). The variables that predicted HD were female (OR = 5.42 95% CI 1.87–15.66), younger age, greater frequency of consuming alcohol at home, preloading (drinking before going out), purchasing alcohol in an off license, and drinking alcohol at home because it is cheaper than drinking out. Discussion and Conclusions: These findings point to an interaction of gender, age purchasing patterns, and motivations contributing to hazardous drinking at home and indicate further profitable areas of national and international research.