Concussion History,Hazardous Drinking,and BrAC Levels Among a Sample of Bar Patrons, 2015

Background: Alcohol consumption and experiencing a concussion are positively correlated. Concussion history has not been examined previously in any alcohol field study (i.e., conducted in a natural setting). Objective: To better understand the relationship between concussion history and alcohol consumption. Methods: We conducted two anonymous field studies among a 2015 sample of bar patrons (N = 544; 62.5% males) in a college town to assess concussion history and two alcohol consumption measures: (1) breath alcohol concentration (BrAC) levels and (2) hazardous drinking scores (based on the AUDIT-C). Next, we conducted a logistic regression analysis to predict concussion history using the two alcohol consumption measures and other potential covariates (i.e., age, gender, race, college student status). Results: Among participants in our sample, the average BrAC level was.070 (SD =.053) and the average hazardous drinking score was 4.7 (SD = 2.5). Less than half of participants indicated that they had experienced a concussion in their lifetime (235; 43.2%). The logistic regression model indicated that hazardous drinking scores were significantly, positively associated with having experienced a concussion, whereas other covariates (i.e., BrAC, age, gender, race, college student status) did not significantly predict concussion history. Conclusions/Importance: Hazardous drinkers were more likely to have experienced a concussion. Therefore, the relationship found in this sample, between hazardous drinking behavior and concussion history, points to hazardous drinking as a possible risk factor for having had a concussion in the past.     

Repeated Measures Analysis of Alcohol Patterns among Gay and Bisexual Men in the Momentum Health Study

Background: This study analyzed repeated study visits (n = 2,624) of 693 gay and bisexual men (GBM) in the Momentum Health Study from July, 2012 to June, 2015. Based on recent cross-sectional analyses, we hypothesized that over the study period: (1) hazardous drinking levels would remain high, (2) GBM classified as Hazardous Drinkers will be consistently associated with high risk sex, and (3) GBM classified as Always Hazardous Drinkers differ significantly from Sometimes Hazardous Drinkers. Methods: AUDIT classified participants as Non-Hazardous Drinkers or Hazardous Drinkers, the Cochran–Mantel–Haenszel Test assessed hazardous drinking trends, and Generalized Estimating Equations (GEE) analysis identified Hazardous Drinking covariates. Logistic regression analysis of participants with at least two study visits (575) compared those who were Sometimes Hazardous Drinkers (n = 171) with Always Hazardous Drinkers (n = 129). Results: At baseline 40% of participants were Hazardous Drinkers, but there was a significant decline in hazardous drinking by visit and Hazardous Drinkers were not significantly associated with high risk sex. Always Hazardous Drinkers had significantly more high risk sex and gay bar attendance, but less often sought Internet sex partners compared to Sometimes Hazardous Drinkers. Conclusions: Analyses did not support the first two hypotheses, but distinguishing between Always and Sometimes Hazardous drinkers identified a young GBM subgroup associated with significantly higher levels of high risk sex and social support measures. These results suggest interventions programs based on Social Norms Theory, which predicts peer norms among youth are important factors in regulating drinking patterns, may be effective for these men.     

Brief Intervention in Hazardous Drinking: An Important Adjunct to Medical School ATOD Curriculum

Most medical school alcohol, tobacco and other drug (ATOD) curricula emphasize the diagnosis and treatment of alcohol abuse and dependence, even though a significant amount of alcohol-related morbidity and mortality is associated with the hazardous use of alcohol. An increased emphasis on screening for hazardous drinking and the use of early intervention has been shown to be effective in reducing heavy drinking in the primary care setting. This paper describes a family medicine clerkship seminar on clinical preventive medicine that focuses on tobacco and alcohol use. Results indicate that students learn that brief intervention counseling can influence patient behavior and plan to continue to use it in future patient encounters. However, the low number of students electing to intervene in hazardous drinking suggests that more curricular time is needed to overcome student resistance to addressing the alcohol use patterns of their patients.     

Effectiveness of the CAGE questionnaire, gamma-glutamyltransferase and mean corpuscular volume of red blood cells as markers for alcohol-related problems in the workplace

OBJECTIVE: To evaluate the usefulness of gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV), as well as that of the CAGE questionnaire, in workplace screening for alcohol abuse/dependence. METHODS: A total of 183 male employees were submitted to structured interviews (Structured Clinical Interview for DSM-IV 2.0 and CAGE questionnaire). Blood samples were collected. Diagnostic accuracy and odds ratio were determined for the CAGE, GGT and MCV. RESULTS: The CAGE questionnaire presented the best sensitivity for alcohol dependence (91%; specificity, 87.8%) and for alcohol abuse (87.5%, specificity, 80.9%), which increased when the questionnaire was used in combination with GGT (sensitivity, 100% and 87.5%, respectively; specificity, 68% and 61.5, respectively). CAGE positive results and/or alterations in GGT were less likely to occur among employees not presenting alcohol abuse/dependence than among those presenting such abuse (OR for CAGE=13, p<0.05; OR for CAGE-GGT=11, p<0.05) or dependence (OR for CAGE=76, p<0.01; OR for GGT=5, p<0.01). Employees not presenting alcohol abuse/dependence were also several times more likely to present negative CAGE or GGT results. CONCLUSIONS: The use short, simple questionnaires, combined with that of low-cost biochemical markers, such as GGT, can serve as an initial screening for alcohol-related problems, especially for employees in hazardous occupations. The data provided can serve to corroborate clinical findings.     

Reward and Cognition: Integrating Reinforcement Sensitivity Theory and Social Cognitive Theory to Predict Drinking Behavior

Background: Both Reinforcement Sensitivity Theory and Social Cognitive Theory have been applied to understanding drinking behavior. We propose that theoretical relationships between these models support an integrated approach to understanding alcohol use and misuse. Objectives: We aimed to test an integrated model in which the relationships between reward sensitivity and drinking behavior (alcohol consumption, alcohol-related problems, and symptoms of dependence) were mediated by alcohol expectancies and drinking refusal self-efficacy. Methods: Online questionnaires assessing the constructs of interest were completed by 443 Australian adults (M age = 26.40, sd = 1.83) in 2013 and 2014. Results: Path analysis revealed both direct and indirect effects and implicated two pathways to drinking behavior with differential outcomes. Drinking refusal self-efficacy both in social situations and for emotional relief was related to alcohol consumption. Sensitivity to reward was associated with alcohol-related problems, but operated through expectations of increased confidence and personal belief in the ability to limit drinking in social situations. Conversely, sensitivity to punishment operated through negative expectancies and drinking refusal self-efficacy for emotional relief to predict symptoms of dependence. Conclusions: Two pathways relating reward sensitivity, alcohol expectancies, and drinking refusal self-efficacy may underlie social and dependent drinking, which has implications for development of intervention to limit harmful drinking.     

Acculturation,hazardous drinking and depressive symptomatology among Hispanics enrolled in a clinical trial

Background: Among Hispanics in USA, lower acculturation level has been found to be protective against alcohol abuse and depression. However, this relationship may not hold within at-risk samples. The prevalence and co-occurrence of hazardous drinking and depressive symptoms and their relationship to acculturation were examined among Hispanics enrolled in a study to reduce heavy drinking. At enrolment, all the participants reported past-month heavy drinking (one or more occasions of >4/5 drinks for females/males, and average weekly consumption >7/14 drinks per week). We explored whether gender moderated the effects of acculturation on hazardous drinking and depressive symptoms. Methods: Participants (N?=?100) completed measures at baseline. Results: Eighty-nine percent of participants met criteria for hazardous alcohol use as assessed by the AUDIT and of those, 55% (n?=?49) also reported elevated depressive symptoms. Of those who reported elevated depressive symptoms, nearly all (94%) met AUDIT criteria for hazardous drinking. Acculturation was not related to hazardous drinking or depressive symptoms in the full sample. Highly acculturated women reported more hazardous drinking than less acculturated women. Acculturation was not associated with hazardous drinking in men, but less acculturated men reported higher levels of depression than highly acculturated men. Discussion: Depression should be assessed in alcohol interventions for Hispanics. Alcohol interventions should be tailored for acculturation level and gender to improve relevance and efficacy. Clinical Trial Registration #NCT01996280.     

Substance abuse and relationship violence among men court‐referred to batterers’ intervention programs

There is extensive theoretical and empirical evidence linking substance abuse and marital violence. However in batterer populations, researchers have not compared hazardous and nonhazardous drinkers' substance use characteristics, marital aggression, extramarital violence (i.e., general violence), depressive symptomatology, marital satisfaction, and other relevant variables. In addition, much of the previous research on substance use and abuse in batterer populations employed a single, nonstandard‐ized measure of substance use, and no previous research has examined substance use in court‐mandated batterers' relationship partners. We recruited 150 men who were arrested for violence and court‐referred to batterer intervention programs. We administered multiple measures of substance use and abuse and assessed the batterers ' marital aggression, relationship satisfaction, depressive symptomatology, use of general violence, and their relationship partners' substance use. We also divided the sample into groups of Hazardous Drinkers (HD) and Nonhazardous Drinkers (NHD). Across the entire sample, half of the batterers had an alcohol‐related diagnosis and approximately one third reported symptoms consistent with a drug‐related diagnosis. Over one third of the total sample reported that their relationship partners were hazardous drinkers. Relative to the NHD group, the HD group scored significantly higher on measures of general violence, depressive symptomatology, alcohol use, alcohol problems, and drug problems. The HD group also reported significantly higher partner alcohol and drug use and abuse scores, relative to the NHD group. The results of the study suggest that substance use and abuse should routinely be assessed as part of batterer interventions and that batterer programs would be improved by offering adjunct or integrated alcohol treatment.     

Drinking patterns and psychosocial aspects at two age points of adolescence: A study on a panel of Italian students at 16 and 18

Aims: Juvenile alcohol consumption and abuse cohort studies are rare. A three-year-long project, provided a cohort of students followed up at 16 and 18 years of age. Alcohol behaviour is supposed to link drinking patterns with psychosocial influences. A panel of 258 Italian students was interviewed in 2009 and in 2011 using a questionnaire focussed on: drinking habits, alcohol use and abuse awareness and opinions, family cohesion, personality traits self-perception and coping. Methods: Drinking patterns were identified based on Alcohol use, Intoxication and Binge Drinking by means of a multivariate analysis. The results are consistent with findings from the ESPAD study. A set of psychosocial variables used as potential predictors of three drinking patterns has been investigated adopting a Discriminant Analysis. Findings: Results contribute to “fill the gap” of the drinking pattern’s profiles. Those who do not drink to excess show a higher coping disposition and family cohesion. Conclusions: Positive influences derive from awareness of the drinking consequences since the Drinking to Intoxication and Drinking to excess are associated with low awareness of alcohol risks.     

Treatment Seeking among College Students with Comorbid Hazardous Drinking and Elevated Mood/Anxiety Symptoms

Background: Hazardous drinking is prevalent among college students and often comorbid with mood and/or anxiety disorders; however, these disorders frequently go untreated. Prior studies have found that individuals with comorbid hazardous drinking are more likely to seek treatment than those with an hazardous drinking alone. Objectives: The current study tested possible psychological and structural explanations to understand these treatment seeking behaviors. Methods: A sample of 222 students identified as hazardous drinkers (AUDIT ≥ 8) participated from September 2010 to April 2011. Behavioral measures designed to mimic actual treatment seeking and self-report measures were used to assess treatment seeking behaviors, and the influence of psychopathology and individual predictors on treatment interest. Results: Students were more interested in treatment for emotional problems than for alcohol problems. Further, treatment seeking interest was significantly higher among individuals with comorbid hazardous drinking. When provided a telephone offer for a free on-campus clinic appointment, no students were interested in receiving treatment for alcohol use problems, but some were interested in an appointment for emotional problems (n = 13). Of those students expressing interest on the phone, seven attended the clinic appointment. Logistic regression analyses revealed that students with anxiety, anxiety sensitivity, and depression were more likely to attend the clinic appointment. Conclusions/Importance: In sum, targeting mood and anxiety disorders may be a viable way to increase treatment seeking rates in hazardous drinking college students.     

Perceived Addiction Treatment Needs Among Alcohol Using Injection Drug Users

ABSTRACT

Hazardous drinking is common among active injection drug users (IDUs). This report examines: (1) the perceived alcohol and drug treatment needs of a cohort of IDUs, and (2) whether perceived needs predict treatment entry. One hundred and eighty-seven AUDIT-positive ($ 8), active IDUs were recruited between 2/98–10/99 for the Brief Alcohol Intervention for Needle Exchangers (BRAINE) trial. At entry, about 18% of participants perceived no need for substance abuse treatment, 52% for drug treatment alone, 26% for drug and alcohol treatment, and only 3% a need for alcohol treatment only. Very high levels of drinking and adverse drinking consequences were observed among those perceiving no need for treatment of alcohol problems. Perceived need for alcohol treatment was positively associated with measures of adverse drinking consequences and DSM-IV diagnosis for alcohol dependence. Persons who at baseline perceived the need for alcohol treatment were more likely to enter alcohol treatment at 6-month follow-up than those withouta perceived need (20% vs. 5%;p = .006).We conclude that IDUs with co-occurring alcohol-use disorders perceive alcohol treatment needs as less immediate than drug treatment. Because perceived need predicts treatment entry, changing alcohol treatment perceptions in IDUs promises the potential of significant long-term public health benefits.     

Socioecological Factors Related to Hazardous Alcohol use among Female Sex Workers in Lilongwe,Malawi: A Mixed Methods Study

Background: Alcohol use is pervasive among female sex workers (FSW) placing them at increased risk of violence and sexual risk behaviors. FSW often live and work where alcohol is highly normative. Objective: To understand the socioecological influences on hazardous alcohol use among FSW in Malawi. Methods: In 2014, 200 FSW identified through venue-based sampling in Lilongwe, Malawi, completed a quantitative behavioral survey, with a sub-sample participating in qualitative interviews. Multivariable log-binomial regression was used to identify associations between hazardous alcohol use (AUDIT score ≥ 7) and time in sex work, clients per week, unprotected sex, alcohol use with clients, and living environment. Qualitative interviews enhanced findings from quantitative data and identify emergent themes around socioecological influences on alcohol use. Results: Over 50% reported hazardous alcohol use and lived in an alcohol-serving venue. Hazardous alcohol use was associated with sex work duration of ≥2 years (aPR: 1.30; 95%CI: 1.02,1.65) and alcohol use at last sex with a client (aPR: 1.29; 95%CI: 1.06,1.57). FSW perceived alcohol as a facilitator for sex work by reducing inhibitions and attracting clients, but acknowledged alcohol leads to violence and/or unprotected sex. Despite these risks and a motivation to reduce use, FSW feared that refusing to drink would be tantamount to turning away clients. Conclusions: Although FSW recognized alcohol-related risks, the norms and power dynamics of sex work perpetuated hazardous alcohol use. Multilevel interventions are needed to collectively change norms around drinking and sex work that will enable FSW to reduce alcohol consumption when engaging in their work.     

Are Commonly Ordered Lab Tests Useful Screens for Alcohol Disorders in Older Male Veterans Receiving Primary Care?

Abstract

Although mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferases (ALT), and the AST/ALT ratio are sometimes used as markers of alcohol disorders, their utility has not been established in older persons. We determined the tests' performance characteristics for (1) at-risk drinking, (2) CAGE positivity, (3) at-risk drinking and CAGE positivity, and (4) a clinician-recorded diagnosis of alcohol abuse/dependence in a study of older male veterans receiving primary care. Participants (n = 587) included patients who had MCV, AST, and/or ALT data collected as part of routine care no more than 12 weeks before or after enrollment. MCV, AST, and ALT test results were obtained from the VA's database. At enrollment, the Timeline Followback and Alcohol Use Disorders Identification Test (AUDIT) were used to identify at-risk drinkers (>15 drinks per week or AUDIT score > 8), and the CAGE questionnaire was administered to identify participants with a history abuse/dependent drinking (CAGE score > 2). Participants' medical records were reviewed to identify subjects with a clinician-recorded diagnosis of alcohol abuse/dependence. The prevalence of abnormal test results for MCV (threshold value = > 98), AST (> 41), ALT (> 41), and the AST/ALT ratio (> 2) was 11%, 4%, 4%, and 5%, respectively. The occurrence of at-risk drinking, CAGE positivity, at-risk drinking and CAGE positivity, and a clinician-recorded diagnosis of alcohol abuse/dependence was 11%, 25%, 5%, and 9%, respectively. Test sensitivity ranged from 3.9% to 25.4% and specificity from 88.5% to 97.1%, whereas positive likelihood ratios varied from 0.72 to 4.01 and negative likelihood ratios from 0.82 to 1.04. Areas under the receiver operating characteristic curve were similar (range = 0.50–0.58) across tests. In conclusion, MCV, AST, ALT, and the AST/ALT ratio are not useful markers of alcohol disorders in older male veterans.     

History of Physical Abuse and Periconceptional Drinking in Pregnant Women

This study examines the relationship between physical abuse and periconceptional drinking in women presenting to a mid-Atlantic, urban hospital-based OB/GYN clinic serving a largely indigent population between April 2003 and May 2004. During their first prenatal visit, 308 women completed a screening battery that included the Abuse Assessment Screen (AAS) and measures of alcohol use, including the CAGE, T-ACE, TWEAK, and the PRIME-MD Patient Health Questionnaire (PHQ). Bivariate analyses, including odds ratios (ORs) and 95% confidence intervals (CIs), revealed that women with a history of physical abuse were more likely to report drinking alcohol within the 3 months prior to their prenatal care visit and were significantly more likely to meet criteria for risk drinking on multiple measures. A history of physical abuse appears to be associated with higher self-reported rates of periconceptional drinking in pregnant women. Study findings support the need for assessment of abuse history as a potential risk factor for alcohol use in pregnant women.     

Neurotic Personality Traits and Risk for Adverse Alcohol Outcomes: Chained Mediation through Emotional Disorder Symptoms and Drinking to Cope

Background: Rates of alcohol abuse are high on Canadian postsecondary campuses. Individual trait differences have been linked to indices of alcohol use/misuse, including neurotic traits like anxiety sensitivity (AS) and hopelessness (HOP). We know little, though, about how these traits confer vulnerability. AS and HOP are related to anxiety and depression, respectively, and to drinking to cope with symptoms of those disorders. Neurotic personality may therefore increase risk of alcohol use/abuse via (1) emotional disorder symptoms and/or (2) coping drinking motives. Objectives: Allan and colleagues (2014) found chained mediation through AS-generalized anxiety-coping motives-alcohol problems and AS-depression-coping motives-alcohol problems. We sought to expand their research by investigating how emotional disorder symptoms (anxiety, depression) and specific coping motives (drinking to cope with anxiety, depression) may sequentially mediate the AS/HOP-to-hazardous alcohol use/drinking harms relationships among university students. Methods: This study used cross-sectional data collected in Fall 2014 as part of the Movember-funded Caring Campus Project (N = 1,883). The survey included the SURPS, adapted DMQ-R SF, and AUDIT-3. Results: AS and HOP were both related to hazardous alcohol and drinking harms via emotional disorder symptoms and, in turn, coping drinking motives. All indirect pathways incorporating both mediators were statistically significant, and additional evidence of partial specificity was found. Conclusions/Importance: The study's results have important implications for personality-matched interventions for addictive disorders.     

Childhood abuse and neglect and transitions in stages of alcohol involvement among women: A latent transition analysis approach

Background

Childhood abuse and neglect have been linked with alcohol disorders in adulthood yet less is known about the potential of early trauma to influence transitions in stages of alcohol involvement among women. Study aims were to (1) identify stages of women's alcohol involvement, (2) examine the probability of transitions between stages, and (3) investigate the influence of four domains of childhood abuse and neglect (sexual abuse, physical abuse, neglect, and witness to domestic violence), assessed individually and as poly-victimization, on transitions.

Methods

The sample consisted of 11,750 adult female current drinkers identified in Wave 1 (2001–2002) and re-interviewed in Wave 2 (2004–2005) of the National Epidemiological Survey on Alcohol and Related Conditions.

Results

Three stages of alcohol involvement emerged from latent class analysis of 11 DSM-IV abuse/dependence criteria: severe (1.5% at Wave 1, 1.9% at Wave 2), hazardous (13.6% at Wave 1, 16.0% at Wave 2), and non-problem drinking (82.1% at Wave 1, 84.5% at Wave 2). Adjusted latent transition analyses determined transition probabilities between stages across waves. Women reporting any childhood abuse and neglect were more likely to advance from the non-problem drinking class at Wave 1 to severe (AOR = 3.90, 95% CI = 1.78–8.53) and hazardous (AOR = 1.56, 95% CI = 1.22–2.01) drinking classes at Wave 2 relative to women without this history. Associations were also observed between individual domains and transition from no problems to severe alcohol stage.

Conclusions

Results suggest a long-term impact of childhood abuse and neglect as drivers of progression in women's alcohol involvement.     

The Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ-MSM): a measure of substance-related beliefs

Introduction and Aims. Alcohol expectancies are associated with drinking behaviour and post‐drinking use thoughts, feelings and behaviours. The expectancies held by specific cultural or sub‐cultural groups have rarely been investigated. This research maps expectancies specific to gay and other men who have sex with men (MSM) and their relationship with substance use. This study describes the specific development of a measure of such beliefs for alcohol, the Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ‐MSM). Design and Methods. Items selected through a focus group and interviews were piloted on 220 self‐identified gay or other MSM via an online questionnaire. Results. Factor analysis revealed three distinct substance reinforcement domains (‘Cognitive impairment’, ‘Sexual activity’ and ‘Social and emotional facilitation’). These factors were associated with consumption patterns of alcohol, and in a crucial test of discriminant validity were not associated with the consumption of cannabis or stimulants. Similarities and differences with existing measures will also be discussed. Discussion and Conclusions. The DEQ‐MSM represents a reliable and valid measure of outcome expectancies, related to alcohol use among MSM, and represents an important advance as no known existing alcohol expectancy measure, to date, has been developed and/or normed for use among this group. Future applications of the DEQ‐MSM in health promotion, clinical settings and research may contribute to reducing harm associated with alcohol use among MSM, including the development of alcohol use among young gay men.[Mullens AB, Young R McD, Dunne MP, Norton G. The Drinking Expectancy Questionnaire for Men who have Sex with Men (DEQ‐MSM): A measure of substance‐related beliefs. Drug Alcohol Rev 2011;30:372–380]     

Screening Instruments for Alcohol Problems: A Comparison of Cut Points between Mexican American and Mexican Patients in the Emergency Room

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.     

Pregaming: A Field-Based Investigation of Alcohol Quantities Consumed Prior to Visiting a Bar and Restaurant District

Background: Investigations examining the association between pregaming, or the consumption of alcohol prior to attending a social gathering or drinking establishment, and blood alcohol concentrations have primarily relied on estimations (i.e., Widmark equation), rather than objective biologic samples, such as breath alcohol concentration (BrAC). Objectives: The current study assessed: (1) pregaming, using quantity-based measures, among a sample of college and non-college affiliated bar patrons, (2) associations between pregaming intensity/status and participant intoxication (BrAC), and (3) whether participants who pregamed were more likely to identify as a hazardous drinker. Methods: 548?bar patrons provided data on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and a single pregaming item assessing quantity of alcohol consumed prior to visiting a bar/restaurant district in 2015. BrAC samples were collected post interview. We used hierarchical linear regression models, respectively, to assess whether pregaming significantly impacted BrAC and whether presence of hazardous drinking predicted pregaming behavior. Results: After controlling for sex, race/ethnicity, age, student status, and Greek affiliation, the linear regression model explained 32.3% (R²?=?.323) of the variance of BrAC levels (F(12)?=?21.162, p?<?.001), with 4.30% of the variance explained solely by pregaming (β?=?0.014; p?<?.001). The linear regression model to assess if harzardous drinking behavior (AUDIT-C) significantly predicted pregaming explained 31.2% (R²?=?.312) of the variance of pregaming behavior (F(18)?=?13.276, p?<?.001), with 4.2% of the variance explained solely by AUDIT-C scores (β?=?0.280; p?<?.001). Conclusion: Findings further highlight pregaming as a harmful risk behavior linked to elevated levels of hazardous drinking and intoxication.     

Alcohol misuse is rare among Hong Kong medical students

Introduction and Aims. High rates of hazardous alcohol consumption have been reported among medical students in several countries. This study aimed to determine the degree of self‐reported alcohol use among medical students in Hong Kong, and to compare this with published data from medical students elsewhere. Design and Methods. 111/137 (81%) final year medical students from the Chinese University of Hong Kong were recruited and anonymously completed the World Health Organization's Alcohol Use Disorders Identification Test, a screening tool which assesses alcohol consumption, dependence and alcohol‐related problems. Results are graded as low risk (score 1–7) or harmful and hazardous (8 or more). Results. The rate of ever drinking among this group of Hong Kong medical students is relatively high (74%) but few students reported at‐risk drinking patterns (1.8%). Most students who drank did so less than once per month and most reported typically drinking only one to two drinks when they did drink alcohol. Discussion and Conclusions. While rates of alcohol drinking among this group of Hong Kong medical students are comparable to those reported in Europe and North America, rates of problem drinking are much lower.[Rotheray KR, Cattermole GN, Liow ECH, Machin P, Graham CA, Rainer TH. Alcohol misuse is rare among Hong Kong medical students. Drug Alcohol Rev 2011;30:685–688]     

The Impact of Hazardous Alcohol Use on Behavioral Healthcare Utilization Among National Guard Service Members

Background: Prior research suggests that both posttraumatic stress disorder (PTSD) and alcohol abuse affect behavioral healthcare utilization among combat-exposed military populations. However, their interactive effect is not well documented, especially after experiencing psychological trauma. Objective: This study examined the role of hazardous alcohol use (i.e. repeated patterns of drinking which lead to harmful consequences) on behavioral healthcare utilization among service members stratified by past-year combat exposure. Method: This study utilized a sample of National Guard service members who participated in an in-depth survey 2–4 months after returning from Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn deployments (2011–2013) (n = 467). We examine the marginal effect (the change in the probability) of hazardous alcohol use on utilization while controlling for trauma exposure, PTSD and other potential covariates. Results: In the unadjusted logistic model, hazardous alcohol use reduced the probability of behavioral healthcare utilization by 77% among service members who had been exposed to combat within the past year. In the adjusted model, which controlled for socio-demographics (age, gender, and race), health status (PTSD symptoms, depression and physical health), and measures of stigma (perception of services as embarrassing or harmful to one's career or social networks), hazardous alcohol use further reduced the utilization probability by 302%. Conclusion/Importance: Although these findings require replication, they appear to demonstrate that when combat-exposed service members engaged in hazardous alcohol use at postdeployment, they were much less likely to utilize behavioral healthcare to manage their posttraumatic stress symptoms during this period.