Does the short form of the Alcohol Use Disorders Identification Test (AUDIT-C) work at a trauma emergency department?

The accuracy of the consumption items of AUDIT (AUDIT-C) was analyzed, using the full AUDIT score as gold standard, in 120 traffic casualties (78% men and 22% women), median age 27 years (IQR = [22-34]), entering an urban emergency room between 2001 and 2003, with (67%) and without (33%) a positive blood alcohol level (> or =0.2 g/L). Sensitivity, specificity, predictive value, overall accuracy, and receiver operating characteristics of AUDIT-C were measured. Diagnostic accuracy was 0.79, using cutoff indices of > or =5 for males and > or =4 for females. AUDIT-C may be useful in emergency departments for a stepwise screening. Further validation of this test with larger samples and different settings is warranted.     

Cue Exposure Therapy for Alcohol Use Disorders: What Can Be Learned from Exposure Therapy for Anxiety Disorders?

Background: Cue Exposure Therapy (CET) has shown efficacy for treating alcohol use disorders (AUDs). Exposure therapy is highly effective for treating anxiety. Both techniques involve repeated, controlled exposures to alcohol or fear-related stimuli. Objectives: We considered the mechanisms of CET for AUDs by comparing it to exposure therapy for anxiety. Method: We conducted a narrative review contrasting theoretical literature examining the mechanisms of CET versus exposure therapy for anxiety. We reviewed RCTs and acute laboratory paradigms examining CET for AUDs. We considered common areas of emerging research, including the use of d-Cycloserine (DCS) and virtual reality (VR). Results: We found evidence that exposure therapy and CET at least partially achieve their effects through extinction learning. We found evidence that CET for AUDs is effective, with comparable benefits to other effective psychosocial treatments. DCS and VR have shown some limited success for augmenting CET for AUDs, so further research is needed to determine their value. Conclusions: There are theoretical and practical similarities between exposure to fear cues and cues of addiction, especially regarding extinction learning. However, these processes are also unique, particularly regarding the differing motivational properties of fear versus reward-related stimuli. We propose that unlike exposure for anxiety, CET takes effect by increasing self-control with each unreinforced exposure. We consider reasons for CET’s limited use for AUDs, including its lower acceptability to clients and clinicians. We also note the limited evidence for CET for other substance use disorders, highlighting the need for continued investigation into its mechanisms and efficacy.     

Sub-Clinical Anxiety and the Onset of Alcohol Use Disorders: Longitudinal Associations from the Baltimore ECA Follow-Up, 1981–2004

ABSTRACT

The current study examines the longitudinal relationship between anxiety disorders in general, specific phobia in particular, and subsequent-onset alcohol use disorders in an adult population-based sample. In addition, the authors explore whether the hypothesized associations vary by gender. Approximately 23 years of data from the Baltimore Epidemiological Catchment Area Follow-up (N = 587) allow for the estimation of the development of incident alcohol use disorders in later life among those with anxiety disorders at the time of the baseline interview in 1981. Although baseline specific phobias were common, neither the number of fears nor any specific fear was statistically associated with the onset of alcohol use disorders. Rather, the findings suggested a modest association between adult sub-clinical specific phobia (without substantial distress or interference) and later-onset alcohol use disorders (odds ratio = 3.2). Moreover, the authors found that this association might be stronger for women than for men.     

Alcohol Use Disorder Identification Test (AUDIT): What Does It Screen? Performance of the AUDIT against Four Different Criteria in a Swedish Population Sample

The purpose of this article was to examine the kinds of alcohol use disorder the AUDIT most accurately screens for since the literature is inconsistent in the use of the AUDIT. Sometimes it is viewed as a measure of hazardous or harmful drinking and sometimes as a measure of dependence. The performance of its subsets (consumption items, AUDIT-C; and problem items, AUDIT-P) and of the full AUDIT (AUDIT-10) was tested against four criteria: high-volume drinking, alcohol-related social problems, alcohol-related health problems, and alcohol dependence. A general population sample of 600 Swedish subjects was interviewed during the winter 2000–01. The results document that, at the recommended cutoff score of 8+, the AUDIT-10 performed well against all four criteria, even if less well against the alcohol-related health problems. The AUDIT-C also performed well against all the problem criteria, showing high areas under the ROC curve, even though significantly lower than the full scale. When measuring high-volume drinking, the AUDIT-C outperformed the full instrument. Scoring at least 1 on the AUDIT-P improved sensitivity of the instrument when screening for social problems and dependence and made it a satisfactory measure of health problems. It is suggested that, when using the full AUDIT to screen for problems more severe than high-volume drinking, the criterion of scoring at least 1 on the AUDIT-P should be applied in combination with a cutoff score on the AUDIT-C.     

Alcohol Use Disorder Identification Test (AUDIT): what does it screen? Performance of the AUDIT against four different criteria in a Swedish population sample

The purpose of this article was to examine the kinds of alcohol use disorder the AUDIT most accurately screens for since the literature is inconsistent in the use of the AUDIT. Sometimes it is viewed as a measure of hazardous or harmful drinking and sometimes as a measure of dependence. The performance of its subsets (consumption items, AUDIT-C; and problem items, AUDIT-P) and of the full AUDIT (AUDIT-10) was tested against four criteria: high-volume drinking, alcohol-related social problems, alcohol-related health problems, and alcohol dependence. A general population sample of 600 Swedish subjects was interviewed during the winter 2000-01. The results document that, at the recommended cutoff score of 8+, the AUDIT-10 performed well against all four criteria, even if less well against the alcohol-related health problems. The AUDIT-C also performed well against all the problem criteria, showing high areas under the ROC curve, even though significantly lower than the full scale. When measuring high-volume drinking, the AUDIT-C outperformed the full instrument. Scoring at least 1 on the AUDIT-P improved sensitivity of the instrument when screening for social problems and dependence and made it a satisfactory measure of health problems. It is suggested that, when using the full AUDIT to screen for problems more severe than high-volume drinking, the criterion of scoring at least 1 on the AUDIT-P should be applied in combination with a cutoff score on the AUDIT-C.     

Can Assessment Reactivity Predict Treatment Outcome Among Adolescents with Alcohol and Other Substance Use Disorders?

Abstract

The objectives of this paper are two-fold: to examine first, if the change from positive to negative alcohol and any other substance use status from baseline assessment to the onset of the first session (i.e., pre-treatment phase) occurs in adolescents, that is, Assessment Reactivity (AR); second, whether AR predicts treatment outcome. Participants were 177 adolescents with alcohol and other substance use disorders (AOSUD) in a 9-weekly group sessions of cognitive behavioral therapy. Drug urinalysis results at baseline assessment, first and last session and self-report for alcohol use were used as outcome measures. Participants showed a highly significant shift to non-use of both alcohol and of other substances from intake assessment to first session and from first to last session. Alcohol and substance use at first session predicted use at last session. This is the first study in youth asserting Assessment Reactivity as a valid construct during the pretreat-ment phase. AR should be considered in any analysis targeting treatment outcomes.     

Alcohol Medical Scholars Program—A Mentorship Program for Improving Medical Education Regarding Substance Use Disorders

ABSTRACT

The Alcohol Medical Scholars Program (AMSP) is designed to improve medical education related to substance use disorders (SUDs) through mentorship of junior, full-time academic faculty from medical schools across the United States. Scholarship focuses on literature review and synthesis, lecture development and delivery, increasing SUD education in their medical schools, professional development, and networking. Results are reported from an anonymous survey of self-reported changes in educational involvement by 28 of 33 AMSP graduates. Participation was associated with a 4-fold increase in yearly SUD lecture time and topics, increased numbers of medical disciplines taught and trained in clinical rotations, design of new SUD-related electives and journal clubs, and membership on medical education committees. Sixty percent of scholars reported promotion since involvement in AMSP, with the majority endorsing the organization's contribution to professional development. AMSP is a useful mentorship model for junior faculty and is associated with increasing SUD-related medical education.     

What Aspects of Human Alcohol Use Disorders Can Be Modeled Using Selectively Bred Rat Lines?

The use of selective breeding to produce animal models for the study of alcohol abuse and alcoholism represents one of the major advances in the field of alcohol research. Rats selectively bred for alcohol preference and alcohol nonpreference have been useful to both preclinical and clinical investigators in the alcohol research community for studying the behavioral, neurobiological, and molecular basis of alcohol drinking, for identifying the genes that may contribute to the development of alcohol abuse and alcoholism, and for evaluating the utility of drugs aimed at reducing alcohol intake and preventing alcohol relapse. Rats selectively bred for alcohol preference (alcohol preferring or “P” line) have enhanced responsiveness to the low dose reinforcing effects of alcohol, less aversion to moderate/high doses of alcohol, and are able to develop tolerance to the aversive effects of alcohol more rapidly and to maintain tolerance longer than rats selectively bred for alcohol nonpreference (alcohol nonpreferring or “NP” line). The increased potency of low-dose alcohol as a reinforcer for P rats might be expected to foster and maintain alcohol drinking. Weaker aversion to the pharmacological effects of moderate/high doses of alcohol in the P line would allow P rats to drink more alcohol than NP rats before the postingestional effects become aversive. Rapid induction of tolerance to the aversive effects of alcohol with repeated bouts of voluntary alcohol drinking, as well as persistence of alcohol tolerance in rats of the P line might serve to maintain alcohol drinking. These are powerful mechanisms that may serve to promote and maintain a high alcohol drinking behavior. Although these rat lines have been used to address several characteristics of excessive alcohol consumption in humans, they have not yet been used to model several aspects of human alcohol use disorders. New applications of these selectively bred rat lines are discussed which may further our understanding of the factors contributing to alcohol abuse and alcoholism.     

Drug Users’ Test-Retest Reliability of Self-Reported Alcohol Use on the Risk Behavior Assessment

Using data collected from 218 street drug users in 11 cities in the United States, we examined the test-retest reliability of the alcohol-related items on the Risk Behavioral Assessment (RBA; National Institute on Drug Abuse, 1993), an instrument commonly used in drug abuse research. With a 48-hr retest interval, findings indicated excellent to good reliability for the following variables: age of first use, ever used alcohol, and days used alcohol in last 30 days. Items with fair to poor reliability were number of occasions used alcohol in last 30 days without injecting and number of times used alcohol immediately before or during sex. These findings suggest that self-report items on alcohol use from the RBA are generally reliable, particularly items that ask for more general, rather than specific, information.     

Alcohol Use and Alcohol Consumption–Related Problems in Rural Vietnam: An Epidemiological Survey Using AUDIT

This study aimed to assess alcohol use and alcohol consumption–related problems in different sociodemographic groups in a rural district in Vietnam. Interviews were completed between March 2004 and July 2004. The Alcohol Use Disorder Identification Test (AUDIT) was applied to interview 3423 people, who were randomly selected in a rural district (1695 men and 1728 women). People who had an AUDIT score greater than 7 (in men) or greater than 5 (in women) were identified as having alcohol consumption–related problems. Prevalences and adjusted odds ratios of alcohol use and alcohol consumption–related problems were estimated for different subgroups of the population. Weekly and daily “binge drinking” among men were 5.7 and 3.6%, while binge drinking in women was virtually nonexistent. The prevalence of alcohol consumption–related problems was 25.5% among men and 0.7% among women. The differences between sociodemographic groups were not strong, but women who were separated, divorced, or widowed as well as those with higher education had significantly higher rates of alcohol consumption–related problems than married women and those with lower education. This study indicates an urgent need for alcohol intervention programs focused on men. However, further monitoring of alcohol use and problems among women is important to follow-up changes in consumption pattern. The study's limitations are discussed.     

Does Drug Use Inhibit Crime Deceleration or Does Crime Inhibit Drug Use Deceleration? A Test of the Reciprocal Risk Postulate of the Worst of Both Worlds Hypothesis

Background: Prior research has shown that ongoing drug use inhibits the commonly reported maturing out of crime process and that ongoing crime inhibits the commonly reported maturing out of drug use process. Objectives: To test the predictive efficacy of drug use for crime deceleration and of crime for drug deceleration using a prospective analysis of data on a group of 524 male California Youth Authority parolees to see if both effects exist simultaneously. Method: A two-equation regression analysis of Year 3 arrests and illicit drug use was performed, controlling for age, race, marital status, employment status, and number of months free in the community. Results: It was determined that illicit drug use at Year 2 predicted an increase in arrests between the first and third years of the analysis and arrests at Year 2 predicted an increase in illicit drug use over this same time period. Alcohol use, on the other hand, failed to predict a change in arrests and arrests failed to predict a change in alcohol use. Conclusions: The results of this study suggest that illicit drug use may inhibit the natural maturing out of crime process observed in emerging adults whereas involvement in crime may inhibit the natural maturing out of illicit drug use process. These findings not only support the reciprocal risk postulate from the Worst of Both Worlds hypothesis but also have implications for risk prediction, risk management, and treatment.     

Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis,Tobacco, and Other Drug Use?

Background: The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. Objective: A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs. Methods: Participants included 12–17-year olds (n?=?4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer. Results: A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.     

Earlier Alcohol Use and Lower Neuropsychological Performance in Brazilian Adolescence: Is the School Environment Related to This?

Objectives: The aim of this study was to evaluate impulsivity, inhibitory control, and alcohol use in preadolescents and adolescents aged 10 to 16 from public and private schools. Methods: Participants were 190 adolescents selected from public and private schools in Brazil. Neuropsychological measures related to impulsivity (i.e., Barratt Impulsiveness Scale), inhibitory control (i.e., Go/No-go Task), and processing speed (i.e., Five Digits Test) were assessed. Results: 60% of the sample had started drinking alcohol. Early alcohol consumption is not influenced by type of school, indicating that adolescents consume alcohol early, regardless of the type of education or income. Although there were significant differences in neuropsychological performance between types of schools, better neuropsychological performance was found in students from private schools. Conclusions: When comparing consumption of alcohol among public and private school students, there were no significant differences, perhaps because the use of early alcohol can be a public health problem. Private school students may perform better in inhibitory control task because they have a good school environment, which serves as a protective factor.     

The Validity of Truant Youths’ Marijuana Use and Its Impact on Alcohol Use and Sexual Risk Taking

Few studies investigating the validity of marijuana use have used samples of truant youths. In the current study, self-reports of marijuana use are compared with urine test results for marijuana to identify marijuana underreporting among adolescents participating in a longitudinal brief intervention for drug-involved truant youths. It was hypothesized that marijuana underreporting would be associated with alcohol underreporting and engaging in sexual risk behaviors. The results indicated marijuana underreporting was significantly associated with self-denial of alcohol use, but not associated with sexual risk behavior. Also, there was an age effect in marijuana use underreporting such that younger truant youths were more likely to underreport marijuana use, compared to older truant youths. Implications for policy and future research are discussed.     

Does Emergency Department Use for Alcohol and Other Drug Use Cluster Geographically? A Population-Based Retrospective Cohort Study

Purpose: To identify geographic areas in Alberta, Canada with higher numbers of adolescents with an emergency department (ED) presentation for a mental or behavioral disorder secondary to alcohol and other drug use. Methods: A population-based cohort analysis of ED visits (n = 7787) by adolescents aged 15–17 years (n = 7238) during 2002–2011. We calculated sex-adjusted directly standardized rates (DSRs) and identified space-time clusters in health zones (North, Edmonton, Calgary, Central, and South). Results: The North zone had higher DSRs compared to other areas. Clusters were identified in: (1) North, Edmonton, and northwest Central zones [relative risk (RR: 1.54; from 2004 to 2008); (2) western South and southern Calgary zones (RR: 1.58; from 2007 to 2011); and (3) northern South zone (RR: 2.38; from 2006 to 2007). Conclusions: The spatial scan can identify geographic areas of high health care use for specific health conditions. These results, in turn, can be used to inform health resource planning.     

Does Documented Brief Intervention Predict Decreases in Alcohol Use in Primary Care?

Background: Brief intervention (BI) is recommended for patients with unhealthy alcohol use, but the effectiveness of BI in usual care settings remains unclear. Objective: We evaluated whether BI predicts decreases in drinking 6 months after a positive screen for unhealthy alcohol use. Method: We enrolled patients who recently screened positive for unhealthy alcohol use during a routine screen in Veterans Health Administration primary care. We conducted medical record review to assess whether providers documented advice to reduce or abstain, feedback about risks to health, feedback about how patient drinking compares to norms or recommended limits, and discussion of drinking-related goals. BI elements were coded from 7 days before the date of the positive screen to 60 days after. We conducted baseline and 6-month follow-up telephone interviews to assess change in past 30-day drinking. We fit regression models examining each BI element and another model for the total count of instances of any combination of elements. Results: Of the 327 patients included, 86% had at least one documented instance of receiving advice, 86% had risk feedback, 55% had normative feedback, 38% had goal discussion, and 75% had three or more instances of any combination of elements of BI. None of the individual BI elements, nor the total number of instances, were significantly associated with decreased drinking. Conclusions: Results suggest that provider documentation of elements of BI and increasing numbers of instances of BI elements were not associated with decreased heavy drinking at 6-month follow-up among patients identified with unhealthy alcohol use.     

Religiosity and Alcohol Use: Is Religiosity Important for Abstention and Consumption Levels in the Second Half of Life?

Objective: The aim of this study was to investigate the relative role of religiosity for alcohol abstention and consumption levels among individuals aged 40 years or above. Method: A two-wave prospective survey was conducted among Norwegians aged 40 to 80 years (Time 1 in 2002/2003, and Time 2 in 2007/2008). The analytical sample of this study constituted those who responded to the questionnaire survey at both time points (n = 2671). Results: The findings showed that religiousity was strongly associated with abstention and less consumption while adjusting for demographics and health variables. The results also reflected that females and those with higher age were more likely to abstain from alcohol than males and those with lower age, respectively. Individuals with high education were less likely to abstain than those with basic education. Females and those with high age also reflected less alcohol consumption than males and individuals of lower age, respectively. Further, people who were married or with a registered partner consumed less alcohol than people who were not married or with a registered partner. High education and good physical health was associated with higher consumption. The main results were consistent across prospective and cross-sectional models. Conclusion: Religiosity seems to be important both for abstention and alcohol consumption levels in the second half of life.     

Drinkers’ Use of Physical Availability of Alcohol: Buying Habits and Consumption Level

On the aggregate level, physical availability of alcohol is related to per capita consumption, prompting the question whether high availability can increase consumption net of social norms which enhance drinking. This issue is investigated using individual-level data in a high-availability urban environment. Effortless, efficient purchase of alcoholic beverages explains a small but significant amount of the variance in consumption when normative factors are statistically controlled. Qualitative factors of availability are discussed, with particular emphasis on food stores, which account for more than half this sample's purchases.     

Fatal Injuries Associated with Alcohol Use Among Youth and Adults: 1990–1998

ABSTRACT

The major objective of this study was to compare trends in three types of fatal injuries associated with alcohol use among youth under the legal drinking age and among adults of legal drinking age from 1990–1998. The fatal injuries investigated included homicide, suicide, and motor vehicle-traffic deaths.

Results were: (1) motor vehicle-traffic deaths and homicide were higher among youth under the legal drinking age than among adults of legal drinking age; whereas, suicide was more common among adults of legal drinking age than among youth under the legal drinking age; and, (2) African American, Hispanic, and American Indian male youth under the legal drinking age were at substantial risk of being victims of homicide and motor vehicle-traffic deaths.