Weekend effects on binge drinking and homicide: the social connection between alcohol and violence in Russia

AIMS AND DESIGN: This study employs unique newly available Russian mortality data to examine the social connection between binge drinking and homicide in the country. SETTING, PARTICIPANTS AND MEASUREMENTS: All death certificates of those aged 20-64 years in the Udmurt Republic, Russia, were analyzed according to day and cause of death for the years 1994-98. Deaths due to alcohol poisoning were used as a proxy for binge drinking. FINDINGS: There was a high bivariate correlation (r = 0.75) between the daily distribution of deaths due to alcohol and homicide. The number of alcohol deaths was significantly higher on Saturdays and Sundays (presumably as a result of drinking on Friday and Saturday nights) and the number of homicide deaths was significantly higher on Fridays and Saturdays. CONCLUSIONS: The levels of alcohol consumption and homicide in Russia are among the highest in the world, and there is mounting evidence that the two are related. Binge drinking, preference for distilled spirits and a high social tolerance for heavy drinking may act as social and cultural contextual factors that might increase the risk of violent outcomes. The high correspondence between the daily distribution of alcohol and homicide deaths provides indirect evidence for the social connection between them. While these findings do not represent a causal connection, when placed in the context of the growing literature on this topic they provide further support of an association between alcohol consumption and homicide rates in Russia and preliminary evidence for the intermediate role in this relationship played by social context.     

A time-series analysis of the impact of heavy drinking on homicide and suicide mortality in Russia, 1956-2002

AIM: Assess the impact of heavy drinking on homicide and suicide mortality in Russia between 1956 and 2002. MEASURES AND DESIGN: Alcohol-related mortality was used as a proxy for heavy drinking. We used autoregressive integrated moving average techniques to model total and sex-specific alcohol-homicide and alcohol-suicide relationships at the population level. FINDINGS: We found a positive and significant contemporaneous association between alcohol and homicide and between alcohol and suicide. We found no evidence of lagged relationships. These results held for overall and sex-specific associations. CONCLUSION: Our results lend convergent validity to the alcohol-suicide link in Russia found by Nemtsov and to the alcohol-homicide associations found in cross-sectional analyses of Russia. Levels of alcohol consumption, homicide and suicide in Russia are among the highest in the world, and the mounting evidence of the damaging effects of consumption on the social fabric of the country reveals the need for intervention at multiple levels.     

Ten-year patterns of alcohol consumption and drinking problems among older women and men

AIMS: This study focused on changes in 10-year patterns of alcohol consumption among older women and men, late-life and life history predictors of drinking problems, and gender differences in these predictors. DESIGN, SETTING, PARTICIPANTS: A sample of late-middle-aged community residents (N = 1291) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 1 year, 4 years and 10 years later. MEASUREMENTS: At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems and health-related and life context factors. Participants also provided information about their life history of drinking. RESULTS: Over the 10 years, the proportion of individuals who consumed alcohol declined. Among individuals who continued to drink, women and men showed comparable declines in alcohol consumption, minor concomitants of alcohol consumption and drinking problems. In addition to the amount of alcohol consumption, smoking, friends' approval of drinking and avoidance coping consistently predicted late-life drinking problems. With respect to life history factors, heavy drinking, drinking problems and increased drinking in response to life events were related to a higher likelihood of late-life drinking problems; obtaining help from family members and friends and, among men, participation in Alcoholics Anonymous, were related to a lower likelihood of problems. CONCLUSION: Older women and men show comparable declines in alcohol consumption and drinking problems. Specific late-life social context and coping variables, and life history indices, are risk factors for late-life drinking problems among both women and men.     

Volume of alcohol consumption, patterns of drinking and burden of disease in the European region 2002

AIMS: To describe the volume of alcohol consumption and patterns of drinking in the World Health Organization (WHO) European regions in 2002 and to estimate quantitatively the burden of disease attributable to alcohol in that year. METHODS: Secondary data analysis. Exposure data were taken from the WHO Comparative Risk Assessment, outcome data from the WHO Measurement and Health Information department, and used to derive three outcome measures: deaths, years of life lost (YLL) and disability adjusted life years (DALY) for 2002. All calculations were conducted according to age, sex and region. RESULTS: Alcohol consumption in the WHO regions for Europe was high, with 12.1 litres pure alcohol per capita, on average more than 100% above the global consumption. Alcohol consumption caused a considerable disease burden: 6.1% of all the deaths, 12.3% of all YLL and 10.7% of all DALY in all European regions in 2002 could be attributed to this exposure. Intentional and unintentional injuries accounted for almost 50% of all alcohol-attributable deaths and almost 44% of alcohol-attributable disease burden. Young people and men were affected the most. Geographically, the most eastern region around Russia had the highest alcohol-attributable disease burden. CONCLUSIONS: Interventions should be implemented to reduce the high burden of alcohol-attributable disease in the European regions. Given the epidemiological structure of the burden, injury prevention, including but not restricted to the prevention of traffic injuries, and specific prevention for young people should play the most important role in a comprehensive plan to reduce alcohol-attributable burden.     

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

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

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.     

The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview

Aims As part of a larger study to estimate the global burden of disease attributable to alcohol:

• ? to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and
• ? to combine exposure and risk estimates to determine regional and global alcohol‐attributable fractions (AAFs) for major disease and injury categories.

Design, methods, setting Systematic literature reviews were used to select diseases related to alcohol consumption. Meta‐analyses of the relationship between alcohol consumption and disease and multi‐level analyses of aggregate data to fill alcohol–disease relationships not currently covered by individual‐level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi‐level analyses with prevalence data. Findings Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed. Conclusions Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.     

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.     

The distribution of alcohol consumption and the prevention paradox in Brazil

Aims To examine the proportion of self‐reported alcohol consumed by different gender and age groups in Brazil over the past year, and to examine whether the ‘prevention paradox’ applies to Brazilian data on alcohol‐related problems. Design A multi‐stage cluster sample, representative of the Brazilian household population. Setting This study was conducted in Brazil between November 2005 and April 2006. Participants Respondents were aged ≥ 14 years (n = 3007). Measurements Measures included past year estimates of (i) number of standard drinks, (ii) frequency of binge drinking, and (iii) alcohol‐related problems. Findings The survey response rate was 66.4%. The top 2.5% of the drinkers by volume consume 14.9%, the top 5% consume 27.4% and the top 10% consume 44.2% of all alcohol consumed in Brazil. Men consume 77.8% of the total alcohol, and 18–29‐year‐olds consume 40.3%. Individuals below risky drinking guidelines for weekly volumetric intake account for 49–50% of all problem drinkers and 45–47% of all problem types reported. Individuals who do not binge or who binge infrequently (1–3 times/year) account for 50–51% of all problem drinkers and 45–46% of all reported problem types. Most binge drinkers are low‐volume drinkers. Conclusions Consistent with the prevention paradox literature, most drinking problems in Brazil are associated with low or moderate drinking. Binge drinking accounts more clearly for the distribution of alcohol problems than total volume consumed.     

Alcohol drinking as a predictor of intensive care and hospital mortality in general surgery: a prospective study

Aims To analyse whether alcohol drinking increases admission to intensive care and in‐hospital mortality in general surgery. Design and participants A prospective cohort study on a consecutive series of 1505 hospitalized patients in a Service of General Surgery of a tertiary hospital. Measurements Drinking pattern was defined by quantity, frequency and volume of drinking. Information on relevant confounders was obtained: smoking, body mass index, nutritional status (measured by serum albumin), cholesterol and its fractions, severity of the underlying disease and all therapeutic measures. Multivariate logistic regression was applied to assess the relationship between drinking and both admission to intensive care and in‐hospital death. Results Twenty‐nine (1.9%) patients died and 33 (2.1%) were admitted to the intensive care unit (ICU). Drinking was heavier in men, patients without antecedents of cancer, with lower preoperative risk assessment scores, number of co‐morbidities and age and higher serum albumin levels. After adjusting for age, severity of underlying disease, smoking and serum albumin, male drinkers of 72+ g/day had an increased risk of being admitted to ICU, the effect being stronger for week‐day drinking (odds ratio, OR = 8.48; 95% confidence interval, CI = 1.68–42.8). A significant association was also seen between week‐day drinking (72+ g/day) and death in men (OR = 7.19, 95% CI = 1.43–36.1). Numbers for women were too small to evaluate. Conclusion Heavy drinking increases admission to intensive care and in‐hospital mortality in hospitalized male patients undergoing general surgery procedures.     

Risky drinking and alcohol use patterns in a national sample of women of childbearing age

AIMS: We examined risky drinking and alcohol use patterns associated with prenatal effects of alcohol exposure in women of childbearing age, using various definitions of low-risk drinking. DESIGN: Computer-assisted telephone interview (CATI) methodology was used to gather information in a cross-sectional survey on alcohol use and problems, pregnancy and likelihood of future pregnancy. SETTING: Participants were respondents in the 2000 National Alcohol Survey (NAS, N10, response rate 58%) which includes men and women from all 50 states of the United States and the District of Columbia. PARTICIPANTS: A total of 1504 women aged 18-39 years were included; 72 were pregnant, 511 were currently not pregnant but reported being likely to be pregnant in the next 5 years, and 921 women were neither pregnant nor likely to be in the next 5 years. MEASUREMENTS: Various alcohol use patterns in the past 12 months including average volume, amount per session, drinking with food and time spent drinking were assessed. FINDINGS: Seven per cent of childbearing age women exceeded guidelines used to classify women as risky drinkers in the past month. Thirty per cent were classified as risky drinkers when these guidelines were extended to past-year drinking. Examination of specific alcohol use patterns revealed that while under 10% of risky drinkers reported past-month heavy episodic drinking, 30% or more reported heavy episodic drinking and exceeding daily limits for alcohol consumption in the past year. CONCLUSIONS: Public health professionals should note that past-year drinking in a significant proportion of women of childbearing age exceeds guidelines for alcohol use. When targeting such prevention efforts, they should thus include assessment of past-year alcohol use patterns.     

Anxiety,depression, and HIV symptoms among persons living with HIV/AIDS: the role of hazardous drinking

Hazardous drinking is common among persons living with HIV/AIDS (PLWHA) and associated with numerous negative health consequences. Despite the well-established negative effects of hazardous drinking among PLWHA, scholarly work has neglected to explore the role of such drinking in regard to anxiety/depressive symptoms and HIV symptom expression. The current study investigated associations between hazardous drinking and anxiety/depressive symptoms and HIV symptoms among PLWHA. Participants (n = 94; 88.3% male; M_age = 48.55; SD = 9.15) included PLWHA recruited from AIDS service organizations in the northeast. Hazardous drinking was significantly associated with anxiety/depressive symptoms and HIV symptom expression above and beyond the variance accounted for by sex, race, recruitment site, and CD4 T-Cell count, as well as other cognitive-affective variables (emotion dysregulation, distress intolerance, and anxiety sensitivity). The present results provide empirical support that hazardous drinking is indeed related to depressive and anxiety symptoms as well as HIV symptom distress and that this effect is not attributable to other factors commonly related to both alcohol use problems and emotional distress among PLWHA. Results highlight the importance of alcohol interventions for excessive drinking specifically tailored for PLWHA to facilitate better mental and physical health adjustment.     

P rats develop physical dependence on alcohol via voluntary drinking: changes in seizure thresholds, anxiety, and patterns of alcohol drinking

BACKGROUND: It has been proposed that the alcohol-preferring P rat meets many of the criteria for an animal model of alcoholism. However, the development of alcohol dependence has not been explored in rats that self-administer ethanol for less than 15-20 weeks. The present study investigated the development of physical dependence upon alcohol after 2-6 weeks of voluntary alcohol intake. Changes in bicuculline-induced seizure thresholds, microstructure of alcohol drinking, and anxiety-related behavior were used as indices of alcohol dependence. In addition, we evaluated the microstructure of alcohol drinking associated with the development of physical dependence upon alcohol. METHODS: Alcohol (10% ethanol solution) was measured in graduated drinking tubes with both alcohol and water available continuously. Microstructure of alcohol intake was monitored by a computerized drinkometer. Physical dependence upon alcohol was determined by measuring bicuculline-induced seizure thresholds after alcohol withdrawal. Anxiety-related behavior of P rats after alcohol withdrawal was determined by the social interaction and elevated plus maze tests. RESULTS: Initial alcohol intake in the alcohol-preferring P rat was relatively modest (3.9 +/- 0.4 g/kg/day). Four days of forced alcohol exposure (initiation) followed by 6 weeks of voluntary drinking resulted in an increase of alcohol intake to 5.5 +/- 0.2 g/kg/day. Ethanol self-administration for 6 weeks, but not for 2 or 4 weeks, produced a significant reduction (30%; p < 0.05) in bicuculline-induced seizure thresholds during alcohol withdrawal. Alterations in the microstructure of alcohol intake (i.e., 90% increase in the size of alcohol drinking bouts compared to the baseline [p < 0.001] with no change in bout frequency) were associated with the development of alcohol dependence. Termination of alcohol intake after 6 weeks of voluntary alcohol consumption resulted in increased anxiety according to both the social interaction and elevated plus maze tests. CONCLUSIONS: The results of this study indicate that 6 weeks of voluntary alcohol intake are sufficient for the development of physical dependence upon alcohol in the alcohol-preferring P rats as measured by susceptibility to bicuculline-induced seizures. This time is much shorter than the 15-20 weeks reported earlier. Development of physical dependence to alcohol was associated with an increase in daily alcohol intake (40% over the baseline), an increase in alcohol intake during each drinking bout (90% over the baseline), and elevated anxiety during alcohol withdrawal.