Population screening of risky alcohol and drug use via Internet and Interactive Voice Response (IVR): a feasibility and psychometric study in a random sample

Background

The wide accessibility of computer-based technologies like the Internet and Interactive Voice Response (IVR) systems raises the question of whether population survey data could be collected more easily and cheaply compared to using paper questionnaires. In the area of possibly stigmatized behaviors such as problematic alcohol and drug use, the question extends to whether the prevalence of such behaviors in the general population could be surveyed without compromising the quality of the data.

Aims

This study compares Internet and IVR versions of the AUDIT and DUDIT with respect to: (1) response rate, (2) problematic alcohol and drug use and (3) reliability.

Method

5000 individuals, randomly selected from the Swedish general population, were contacted via postal mail and invited to complete the AUDIT and DUDIT questionnaires via Internet or IVR. In total, 1861 (37.8%) participated in the study, 1089 via Internet and 772 via IVR.

Results

The Internet administration mode yielded a higher response rate (38.1%) compared to the IVR mode (33.9%). When respondents were given a choice between Internet and IVR, a higher response rate resulted (43.2-46.6%). Problematic alcohol and drug use occurred among 21.1% and 2.8% of the sample, respectively, with no significant differences by administration mode. Both the AUDIT and DUDIT exhibited satisfactory reliability across administration modes, Cronbach's α 0.76/0.86.

Conclusions

Data quality does not deteriorate with computerized administration methods for the AUDIT and DUDIT in population studies but paper questionnaires should also be made available to respondents in order to maximize response rates.     

Violence among men and women in substance use disorder treatment: A multi-level event-based analysis

Background

This study examined associations between acute alcohol and drug use and violence towards others in conflict incidents (overall, partner, and non-partner conflict incidents) by men and women recruited from substance use disorder (SUD) treatment.

Methods

Semi-structured interviews were used to obtain details about interpersonal conflict incidents (substance use, whether specific conflicts were with intimate partners or non-partners) in the 180 days pre-treatment. Participants for this study were selected for screening positive for past-year violence (N = 160; 77% men, 23% women).

Results

Multi-level multinomial regression models showed that after adjusting for clustering within individual participants, the most consistent predictors of violence across models were acute cocaine use (significant for overall, intimate partner and non-partner models), acute heavy alcohol use (significant for overall and non-partner models), and male gender (significant in all models).

Conclusions

This study was the first to explicitly examine the role of acute alcohol and drug use across overall, partner and non-partner conflict incidents. Consistent with prior studies using a variety of methodologies, alcohol, cocaine use and male gender was most consistently and positively related to violence severity (e.g., resulting in injury). The results provide important and novel event-level information regarding the relationship between acute alcohol and specific drug use and the severity of violence in interpersonal conflict incidents.     

The effects of priming restrained versus disinhibited behaviour on alcohol-seeking in social drinkers

Background

Deficient response inhibition (disinhibition) may play a causal role in alcohol abuse, with impaired inhibition occurring prior to, and acting as a risk factor for, subsequent alcohol problems. We experimentally primed either disinhibited or restrained behaviour while participants completed a Stop-Signal task, before examining the effects on alcohol-seeking behaviour.

Methods

Fifty three social drinkers completed a Stop-Signal task following instructions that either emphasised rapid responding at the expense of successful inhibition (Disinhibition group) or vice versa (Restrained group). Subsequent ad lib alcohol-seeking was measured with a bogus taste test.

Results

As predicted, participants in the Disinhibition group consumed more beer during the taste test compared to participants in the Restrained group. Furthermore, within the Restrained group only, correlations indicated that those participants who responded more cautiously during the Stop-Signal task subsequently consumed less beer.

Conclusions

An experimental manipulation of response set during a response inhibition task, emphasising either restrained or disinhibited responding, has a causal influence on alcohol-seeking behaviour in social drinkers.     

Serotonergic and dopaminergic distinctions in the behavioral pharmacology of (±)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) and lysergic acid diethylamide (LSD)

Rationale

After decades of social stigma, hallucinogens have reappeared in the clinical literature demonstrating unique benefits in medicine. The precise behavioral pharmacology of these compounds remains unclear, however.

Objectives

Two commonly studied hallucinogens, (±)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI) and lysergic acid diethylamide (LSD), were investigated both in vivo and in vitro to determine the pharmacology of their behavioral effects in an animal model.

Method

Rabbits were administered DOI or LSD and observed for head bob behavior after chronic drug treatment or after pretreatment with antagonist ligands. The receptor binding characteristics of DOI and LSD were studied in vitro in frontocortical homogenates from naïve rabbits or ex vivo in animals receiving an acute drug injection.

Results

Both DOI- and LSD-elicited head bobs required serotonin_2A (5-HT_2A) and dopamine₁ (D₁) receptor activation. Serotonin_2B/2C receptors were not implicated in these behaviors. In vitro studies demonstrated that LSD and the 5-HT_2A/2C receptor antagonist, ritanserin, bound frontocortical 5-HT_2A receptors in a pseudo-irreversible manner. In contrast, DOI and the 5-HT_2A/2C receptor antagonist, ketanserin, bound reversibly. These binding properties were reflected in ex vivo binding studies. The two hallucinogens also differed in that LSD showed modest D₁ receptor binding affinity whereas DOI had negligible binding affinity at this receptor.

Conclusion

Although DOI and LSD differed in their receptor binding properties, activation of 5-HT_2A and D₁ receptors was a common mechanism for eliciting head bob behavior. These findings implicate these two receptors in the mechanism of action of hallucinogens.     

Public sentiment towards alcohol and local government alcohol policies in New Zealand

Background

In many countries, including New Zealand, alcohol availability and promotion have increased markedly in the last three decades as a result of liberalised central and/or state government alcohol policies. Accordingly, communities are increasingly relying on local government to manage alcohol-related problems. New Zealand's Local Government Act (2002) states the purpose of local government as facilitating public decision-making and promoting community well-being. We sought to describe public sentiment towards alcohol and local government alcohol policies.

Methods

A cross-sectional survey was conducted in 2007 with a sample of 2337 residents aged 18 years and over in a diverse set of New Zealand communities. Data were collected via a self-administered pen-and-paper questionnaire.

Results

There were responses from 1372 individuals (response: 59%). Problem drinking amongst youth (<25 years of age) was considered the leading problem by the majority of respondents in six of seven areas. Alcohol was considered to play a major role in incidents of violence, vandalism, dangerous driving and traffic crashes. Fifty-eight percent of respondents agreed that “it is up to local government to make sure alcohol does not become a problem in the community”. There was strong support for local governments to restrict the hours of operation of on-licenced premises, to use liquor bans to control drinking in public places, and for local governments and police to be stricter in their enforcement of drinking laws.

Conclusion

There is strong support for local government alcohol policies that restrict the availability and promotion of alcohol. The study findings are important in light of the stated purpose of local government in New Zealand and the recently completed “once in a generation” review of alcohol laws and policies.     

Associations among types of impulsivity, substance use problems and neurexin-3 polymorphisms

Background

Some of the genetic vulnerability for addiction may be mediated by impulsivity. This study investigated relationships among impulsivity, substance use problems and six neurexin-3 (NRXN3) polymorphisms. Neurexins (NRXNs) are presynaptic transmembrane proteins that play a role in the development and function of synapses.

Methods

Impulsivity was assessed with the Barratt Impulsiveness Scale Version 11 (BIS-11), the Boredom Proneness Scale (BPS) and the TIME paradigm; alcohol problems with the Michigan Alcoholism Screening Test (MAST); drug problems with the Drug Abuse Screening Test (DAST-20); and regular tobacco use with a single question. Participants (n = 439 Caucasians, 64.7% female) donated buccal cells for genotyping. Six NRXN3 polymorphisms were genotyped: rs983795, rs11624704, rs917906, rs1004212, rs10146997 and rs8019381. A dual luciferase assay was conducted to determine whether allelic variation at rs917906 regulated gene expression.

Results

In general, impulsivity was significantly higher in those who regularly used tobacco and/or had alcohol or drug problems. In men, there were modest associations between rs11624704 and attentional impulsivity (p = 0.005) and between rs1004212 and alcohol problems (p = 0.009). In women, there were weak associations between rs10146997 and TIME estimation (p = 0.03); and between rs1004212 and drug problems (p = 0.03). The dual luciferase assay indicated that C and T alleles of rs917906 did not differentially regulate gene expression in vitro.

Conclusions

Associations between impulsivity, substance use problems and polymorphisms in NRXN3 may be gender specific. Impulsivity is associated with substance use problems and may provide a useful intermediate phenotype for addiction.     

Stress and consumption of alcohol in humans with a Type 1 family history of alcoholism in an experimental laboratory setting

Background

This paper investigates how stress interacts with alcohol consumption in subjects with a family history of alcoholism. One mechanism for increases in alcohol intake may be that stress alters the subjective effects produced by the drug.

Methods

58 healthy volunteers, divided into two groups of family history positive (FHP) and two groups of family history negative (FHN) participated in two laboratory sessions, in which they performed in one out of two sessions a stress task. Then subjects were allowed to choose up to six additional drinks of ethanol or placebo depending on which session they were randomly assigned to start with.

Results

It was found that FHP subjects increased their consumption of alcohol after stress.

Conclusions

It is possible that both stress and alcohol specifically exaggerate the feelings of the reward in the FHP individuals in such way that it may increase the likelihood of consuming more alcohol.     

Behavioural measures of frontal lobe function in a population of young social drinkers with binge drinking pattern

Background

Binge drinking may lead to brain damage. The aim of the present study was to compare the cognitive abilities of binge and non-binge drinkers in tasks which test functions linked to discrete areas of the prefrontal cortex.

Methods

Non-binge and binge drinkers were identified according to their binge score derived from the Alcohol Use Questionnaire. Cognitive performance was tested with the Spatial Working Memory task (SWM) linked to the dorsolateral prefrontal cortex, Intra/Extradimensional Shift and reversal task (IED) linked to dorsolateral prefrontal cortex (shift) and to orbitofrontal cortex (reversal), Paired Associates Learning task (PAL) linked to temporal cortex, and Reaction Time Task (RTI) a task measuring motor impulsivity (Inferior frontal gyrus). Personality traits, alcohol outcome expectancies and mood were also evaluated.

Results

Binge drinkers recorded a significantly shorter movement time to target in the RTI, and completed fewer stages on first trial in the PAL, compared with non-bingers. In the IED as well as in the SWM, only female binge drinkers were more impaired than non-binge drinkers.

Conclusions

Functions linked to dorsolateral prefrontal cortex may be more impaired in female, whereas functions linked with the temporal lobe may be impaired in both male and female binge drinkers compared to non-binge drinkers. Functions linked to orbitofrontal cortex were not impaired. The increased speed of response in the RTI in binge drinkers may indicate an increased motor impulsivity in binge drinkers.     

Neural activation during inhibition predicts initiation of substance use in adolescence

Background

Problems inhibiting non-adaptive behaviors have been linked to an increased risk for substance use and other risk taking behaviors in adolescence. This study examines the hypothesis that abnormalities in neural activation during inhibition in early adolescence may predict subsequent substance involvement.

Methods

Thirty eight adolescents from local area middle schools, ages 12-14, with very limited histories of substance use, underwent functional magnetic resonance imaging (fMRI) as they performed a go/no-go task of response inhibition and response selection. Adolescents and their parents were then followed annually with interviews covering substance use and other behaviors. Based on follow-up data, youth were classified as transitioning to heavy use of alcohol (TU; n = 21), or as healthy controls (CON; n = 17).

Results

At baseline, prior to the onset of use, youth who later transitioned into heavy use of alcohol showed significantly less activation than those who went on to remain non to minimal users throughout adolescence. Activation reductions in TU at baseline were seen on no-go trials in 12 brain regions, including right inferior frontal gyrus, left dorsal and medial frontal areas, bilateral motor cortex, cingulate gyrus, left putamen, bilateral middle temporal gyri, and bilateral inferior parietal lobules (corrected p < .01, each cluster ≥32 contiguous voxels).

Conclusions

These results support the hypothesis that less neural activity during response inhibition demands predicts future involvement with problem behaviors such as alcohol and other substance use.     

A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization

Background

Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals.

Objectives

To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA).

Data sources

Six electronic databases and Google Scholar were queried for articles published in English, French and Spanish from 1988 to 2010. Selected references from primary articles were also examined.

Review methods

Selection criteria included: (1) AUD and adherence (N = 20); (2) AUD and health services utilization (N = 11); or (3) AUD with CD4 count or HIV-1 RNA treatment outcomes (N = 10). Reviews, animal studies, non-peer reviewed documents and ongoing studies with unpublished data were excluded. Studies that did not differentiate HIV+ from HIV− status and those that did not distinguish between drug and alcohol use were also excluded. Data were extracted, appraised and summarized.

Data synthesis and conclusions

Our findings consistently support an association between AUDs and decreased adherence to antiretroviral therapy and poor HIV treatment outcomes among HIV-infected individuals. Their effect on health care utilization, however, was variable.     

The effects of dopaminergic drugs in the dorsal hippocampus of mice in the nicotine-induced anxiogenic-like response

Rationale

Nicotine, an active alkaloid of tobacco has an acetylcholine property that alters anxiety-like behaviors in rodents. Moreover, several investigations suggest that the mesolimbic/cortical dopamine systems to be involved in the drugs affecting anxiety. The dopaminergic modulation of acetylcholine synaptic transmission has also been also suggested by different studies. Furthermore, modulation of such behaviors in rodents may be mediated through the dorsal hippocampus.

Objectives

In the present study, a possible role of the dorsal hippocampal acetylcholine receptor mechanism in nicotine's influence on anxiogenic-like responses has been investigated.

Methods

During test sessions, the hole-board was used to investigate the effects of SCH23390, sulpiride, SKF38393 and quipirole on nicotine response in mice.

Results

Intraperitoneal (i.p.) administration of nicotine (0.5 mg/kg) decreased the number of head dips but had no effect on other behaviors. Intra-dorsal hippocampal injections of ineffective doses of SCH23390 (SCH; 0.125 and 0.25 μg/mouse) or sulpiride (SUL; 0.5 and 0.75 μg/mouse) reversed head dips induced by nicotine but did not impact other exploratory behaviors. Furthermore, co-administration of ineffective doses of SKF38393 (SKF; 4 μg/mouse, dorsal hippocampus) or quipirole (QUI; 0.5 μg/mouse) in conjunction with an ineffective dose of nicotine (0.25 mg/kg, i.p.) decreased head dips induced by nicotine, but were otherwise ineffective.

Conclusion

These results may indicate a modulatory effect for the dorsal hippocampus dopamine receptors (D₁ and D₂) on an anxiogenic-like response induced by nicotine.     

Hospitalisation for an alcohol-related cause among injecting drug users in Scotland: Increased risk following diagnosis with hepatitis C infection

Background

The rate of hepatitis C (HCV) related liver disease progression is known to be strongly associated with alcohol consumption, yet there are very few data on alcohol use in injecting drug users (IDUs), who represent 90% of Scotland's HCV-diagnosed population. To investigate the extent of alcohol use in IDUs, we used hospitalisation with an alcohol-related diagnosis as an indicator for problematic consumption levels, and compared admission rates pre- and post-HCV diagnosis.

Methods

Data for 41,062 current/former IDUs attending drug treatment/support services in Scotland from April 1995 to March 2006 were linked to the national hospital discharge database to retrieve alcohol-related episodes, and to the national HCV Diagnosis database to determine HCV-diagnosed status. Relative risks were estimated using Cox proportional hazards regression for recurrent events.

Results

The proportion of IDUs with ≥1 alcohol-related admission following first attendance at drug services was greater among those diagnosed with HCV by the end of follow-up (16%) compared with those who were not (6%). For the 9145 IDUs who had been diagnosed with HCV by 31 March 2006, there was a 1.5-fold increased relative risk of an alcohol-related admission >30 days post-HCV diagnosis (95% CI: 1.2-1.7) compared with >30 days pre-HCV diagnosis, adjusted for sex, age, and deprivation.

Conclusions

IDUs diagnosed with HCV infection have an increased risk of subsequent hospital admission for an alcohol-related cause. Because of the synergistic effect of HCV infection and excessive alcohol intake on the development of cirrhosis, it is imperative that alcohol intake is addressed in the management of chronic HCV infection in this population.     

Genetic moderators and psychiatric mediators of the link between sexual abuse and alcohol dependence

Background/objective

This study used a case-control female sample to test psychiatric mediators and genetic moderators of the effect of sexual abuse on later alcohol dependence. The study also tested differences between alcohol dependent women with or without a history of sexual abuse on variables that might affect treatment planning.

Methods

A case-control design compared 192 treatment-seeking alcohol dependent women with 177 healthy population controls. All participants were assessed for alcohol-related behaviors, sexual abuse history, psychiatric problems, and personality functioning. Markers were genotyped in the CRHR1, MAO-A and OPRM1 genes.

Results

The association of sexual abuse with alcohol dependence was limited to the most severe category of sexual abuse involving anal or vaginal penetration. Of the five psychiatric disorders tested, anxiety, anorexia nervosa, and bulimia met criteria as potential mediators of the abuse-alcohol dependence association. Severe sexual abuse continued to have an independent effect on alcohol dependence status even after accounting for these potential mediators. None of the candidate genetic markers moderated the association between sexual abuse and alcohol dependence. Of alcohol dependent participants, those with a history of severe abuse rated higher on alcoholism severity, and psychiatric comorbidities.

Conclusion

Sexual abuse is associated with later alcohol problems directly as well as through its effect on psychiatric problems. Treatment-seeking alcohol dependent women with a history of abuse have distinct features as compared to other alcohol dependent women.     

Initiation and persistence of alcohol use in United States Black, Hispanic, and White male and female youth

Background

The relation between early and frequent alcohol use and later difficulties is quite strong. However, the degree that alcohol use persists, which is often a necessary cause for developing alcohol-related problems or an alcohol use disorder, is not well studied, particularly with attention to race and gender. A novel statistical approach, the Multi-facet Longitudinal Model, enables the concurrent study of age of initiation and persistence.

Methods

The models were applied to longitudinal data on youth alcohol use from ages 12 through 19, collected in the (U.S.) National Longitudinal Survey of Youth 1997 cohort (N = 8984).

Results

Results confirmed that Black adolescents initiate alcohol use at later ages than do White youth. Further, after initiation, White adolescents were substantially more likely than Black adolescents to continue reporting alcohol use in subsequent years. Hispanic teens showed an intermediate pattern. Gender differences were more ambiguous, with a tendency for boys to be less likely to continue drinking after initiation than were girls.

Conclusions

Novel findings from the new analytic models suggest differential implications of early alcohol use by race and gender. Early use of alcohol might be less consequential for males who initiate alcohol use early, Black, and Hispanic youth than for their female and White counterparts.     

Flunitrazepam in combination with alcohol engenders high levels of aggression in mice and rats

Rationale

Higher doses of benzodiazepines and alcohol induce sedation and sleep; however, in low to moderate doses these drugs can increase aggressive behavior.

Objectives

To assess firstly the effects of ethanol, secondly the effects of flunitrazepam, a so-called club drug, and thirdly the effects of flunitrazepam plus alcohol on aggression in mice and rats.

Methods

Exhaustive behavioral records of confrontations between a male resident and a male intruder were obtained twice a week, using CF-1 mice and Wistar rats. The salient aggressive and non-aggressive elements in the resident's repertoire were analyzed. Initially, the effects of ethanol (1.0 g/kg), and secondly flunitrazepam (0; 0.01; 0.1; and 0.3 mg/kg) were determined in all mice and rats; subsequently, flunitrazepam or vehicle, given intraperitoneally (0; 0.01; 0.1; and 0.3 mg/kg) was administered plus ethanol 1.0 g/kg or vehicle via gavage.

Results

The most significant finding is the escalation of aggression after a moderate dose of ethanol, and a low dose of flunitrazepam. The largest increase in aggressive behavior occurred after combined flunitrazepam plus ethanol treatment in mice and rats.

Conclusions

Ethanol can heighten aggressive behavior and flunitrazepam further increases this effect in male mice and rats.     

The psychological impact of heavy drinking among the elderly on their co-residents: the 10/66 group population based survey in the Dominican Republic

Background

There is very limited literature on alcohol use among the elderly and little is known about the impact it has on family and caregivers, especially in low and middle income countries.

Aim

To estimate the independent effect of heavy alcohol use among the elderly on the psychological health of their co-residents.

Methods

This is a secondary analysis using data from the comprehensive cross-sectional survey of the 10/66 dementia research group population-based research programme in the Dominican Republic. The characteristics of the elderly participants as well as the co-residents were described. The independent association of heavy drinking among the participants with psychological morbidity in their co-residents was estimated. Different models were generated to rule out potential mediating effects of disability and behavioural symptoms.

Results

Prevalence of heavy alcohol use in the elderly in Dominican Republic was 10.6%. There was a statistically significant independent effect of heavy alcohol use by the elderly on their co-residents mental health (PR = 1.47; 95% CI 1.07-2.01) which was not accounted by disability (Sobel-Goodman test, p = 0.15). Severity of psychological and behavioural symptoms partially (29.1% of the total effect) explained this association (Sobel-Goodman mediation test, p = 0.006).

Conclusions

Health services for the elderly in low and middle income countries will have to be configured around detection of alcohol problems among the elderly as well as offering appropriate support to their co-residents.     

"It's not rocket science, what I do": Self-directed harm reduction strategies among drug using ethno-racially diverse gay and bisexual men

Background

Research on harm reduction has typically focused on broad-based or organisational strategies such as needle exchange and opiate substitute programmes. Less attention has been paid to the self-directed harm reduction practices of substance users themselves. Few studies have focused on sexual minority populations such as gay and bisexual men and fewer still on the marginalised groups that constitute these populations. This paper identifies self-directed harm reduction strategies among substance using ethno-racially diverse gay and bisexual men.

Methods

This article presents findings from the Party Drugs Study in Toronto's gay dance club scene, a community-based qualitative study in Toronto, Canada. We present a thematic analysis of interviews with 43 gay and bisexual men from diverse ethno-racial backgrounds about their substance use in the gay dance club scene.

Findings

We identify five self-directed harm reduction strategies: rationing, controlling or avoiding mixing, controlling quality, maintaining a healthy lifestyle, and following guidelines during substance use.

Conclusions

We discuss our findings in relation to prior research and to critical theory. We suggest that drug users’ awareness of possible harm, and their personal investment in harm reduction, constitute a viable platform from which community-based and public health organisations may promote and strengthen harm reduction among gay and bisexual men from ethno-racially diverse backgrounds.     

Predictors of response and remission in the acute treatment of first-episode schizophrenia patients — Is it all about early response?

Background

To evaluate the predictive validity of early response compared to other well-known predictor variables in acutely ill first-episode patients.

Methods

112 patients were treated with a mean dosage of 4.14 mg (± 1.70) haloperidol and 112 patients with a mean dosage of 4.17 mg (± 1.55) risperidone for a mean inpatient treatment duration of 42.92 days (± 16.85) within a double-blind, randomized controlled trial. Early response was defined as a ≥ 30% improvement in the PANSS total score by week 2, response as a ≥ 50% reduction in the PANSS total score from admission to discharge and remission according to the consensus criteria. Univariate tests and logistic regression models were applied to identify significant predictors of response and remission.

Results

52% of the patients were responders and 59% remitters at discharge. Non-remitters at discharge were hindered from becoming remitters mainly by the presence of negative symptoms. Univariate tests revealed several significant differences between responders/non-responders and remitters/non-remitters such as age, severity of baseline psychopathology as well as the frequency of early response. Both early response (p < 0.0001) and a higher PANSS positive subscore at admission (p = 0.0002) were identified as significant predictors of response at discharge, whereas a shorter duration of untreated psychosis (p = 0.0167), a lower PANSS general psychopathology subscore (p < 0.0001), and early treatment response (p = 0.0002) were identified as significant predictors of remission.

Conclusion

Together with the finding that early response is a significant predictor of response and remission, the relevance and predictive validity of negative and depressive symptoms for outcome is also highlighted.     

A venue analysis of predictors of alcohol use prior to sexual intercourse among female sex workers in Senggigi, Indonesia

Background

Female sex workers’ (FSWs’) use of alcohol, a known disinhibitor to risk behaviour, has been largely understudied. Knowledge of how various sex work venues influence FSW's alcohol consumption before engaging in commercial sex is even rarer. Our analysis identifies those factors across three types of sex-work venues that predict alcohol use among FSWs prior to paid sexual intercourse with clients. Our data were collected through structured interviews with FSWs engaging in commercial sex in Senggigi Beach, Lombok Island in the eastern Indonesian province of West Nusa Tenggara.

Methods

Employing a cross-sectional and multilevel design, three categories of venues where FSWs meet clients in Senggigi were sampled: (1) discotheques and bars (freelance), (2) brothels, and (3) recreational enterprises such as karaoke establishments and massage parlors. The sample consisted of 115 women “nested” within 16 sex work venues. The FSWs reported on 326 clients interactions.

Results

Results show that FSWs consumed alcohol before commercial sex with 157 (48%) of the 326 clients interactions. Alcohol use varied by differences in HIV policies and services offered at the sex work venue, the FSW's educational level and age, and client characteristics.

Conclusion

Alcohol use is common prior to sexual intercourse among FSWs and their clients in Senggigi, and the venue where FSWs meet their clients influences the women's alcohol use. Freelancers were likelier to use alcohol than those who work at brothels and recreational enterprises. Given the recognized links between alcohol use prior to sex and high risk behaviour, HIV prevention programmes that discourage alcohol use should be introduced to both women who engage in commercial sex and also sex-work venue managers, owners, and clients.