Performance of Screening Instruments for Alcohol Use Disorders in Emergency Department Patients in Argentina

The performance of the Alcohol Use Disorders Identification Test (AUDIT), CAGE, Brief Michigan Alcohol Screening Test (Brief MAST), Rapid Alcohol Problems Screen (RAPS), Rapid Alcohol Problems Screen-Quantity and Frequency (RAPS4-QF), and TWEAK was evaluated against a diagnosis of alcohol dependence and harmful drinking or alcohol abuse from ICD-10 and DSM-IV criteria. Data were collected from a probability sample of 779 patients admitted to the emergency department of a public general hospital in Mar del Plata, Argentina, during the year 2001. The majority of the patients sampled were male. The age range was 18 to 89 years, with a mean value of 36 years and a median of 31 years. Almost half of the sample had an elementary school education or less. All instruments were more sensitive for alcohol dependence than for harmful drinking or abuse and more sensitive for men than for women. Findings suggest the RAPS4 and RAPS4-QF may be preferred when screening for alcohol use disorders in the emergency department in Argentina. The study's limitations are noted.     

Performance of the AUDIT in Detecting DSM-5 Alcohol Use Disorders in College Students

Background: It is critical that our alcohol screening instruments maintain their accuracy at detecting DSM-5 Alcohol Use Disorder (AUD) symptomatology. The Alcohol Use Disorders Identification Test (AUDIT) is one of the most widely used alcohol screening instruments, despite no studies evaluating its performance for detecting DSM-5 AUDs. Objectives: The present study evaluated the performance of the AUDIT in the screening of DSM-5 AUDs in non-treatment seeking college students. Methods: Participants (N = 251) were undergraduate students who had at least one binge drinking occasion in the past 90-days. Results: The AUROC value for DSM-5 AUD status in the overall sample was.779 (SE =.029; 95% CIs =.721 to.837). The AUROC values for the reference groups of any DSM-IV AUD and any binge drinker were.798 (SE =.028; 95% CIs =.742 to.853) and.827 (SE =.03; 95% CIs.768 –.886), respectively. A similar pattern of findings emerged between males and females. Gender differences emerged in the identification of AUDIT cut-off scores. A score of ≥ 8 and ≥ 9 had the best balance of sensitivity and specificity for females and males in college, respectively. Conclusion: Findings indicate that the AUDIT has a reasonable degree of diagnostic proficiency in screening for DSM-5 AUDs in college students.     

Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal

IntroductionPhenobarbital has been successfully used in the emergency department (ED) to manage symptoms of alcohol withdrawal, but few studies have reported outcomes for ED patients who receive phenobarbital and are discharged. We compared return encounter rates in discharged ED patients with alcohol withdrawal who were treated with benzodiazepines and phenobarbital.MethodsThis is a retrospective cohort study conducted at a single academic medical center utilizing chart review of discharged ED patients with alcohol withdrawal from July 1, 2016, to June 30, 2019. Patients were stratified according to ED management with benzodiazepines, phenobarbital, or a combination of both agents. The primary outcome was return ED encounter within three days of the index ED encounter. Multivariate logistic regression identified significant covariates of an ED return encounter.ResultsOf 470 patients who were discharged with the diagnosis of alcohol withdrawal, 235 were treated with benzodiazepines, 133 with phenobarbital, and 102 with a combination of both. Baseline characteristics were similar among the groups. However, patients who received phenobarbital were provided significantly more lorazepam equivalents compared to patients who received benzodiazepines alone. Treatment with phenobarbital, alone or in combination with benzodiazepines, was associated with significantly lower odds of a return ED visit within three days compared with benzodiazepines alone [AOR 0.45 (95% CI 0.23, 0.88) p = 0.02 and AOR 0.33 (95% CI 0.15, 0.74) p = 0.007].ConclusionsPatients who received phenobarbital for alcohol withdrawal were less likely to return to the ED within three days of the index encounter. Despite similar baseline characteristics, patients who received phenobarbital, with or without benzodiazepines, were provided greater lorazepam equivalents the ED.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13181-021-00863-2.     

酒精所致精神障碍的临床分析

目的探讨酒精所致精神障碍患者的临床特点。方法回顾分析精神专科医院2011年10月至2012年9月收治的196例酒精所致精神障碍患者,临床资料。结果长期饮酒对神经系统损害较大,精神障碍患者可出现不同程度的幻觉、幻视、妄想、抑郁、情绪高涨、兴奋躁动等不稳定症状,有些患者出现人格障碍及记忆障碍。患病率中文化水平低、体力劳动重的男性居多。对照组总有效率高于常规组（x2=4．6296,P〈0．05）。结论酒精可致精神和躯体损害,早期治疗能改善症状,少量抗精神药物及戒酒等综合性治疗可有效改善患者病情,值得在临床推广应用。     

An Assessment of the Compatibility of DSM-IV and Proposed DSM-5 Criteria in the Diagnosis of Cannabis Use Disorders

The current study used an automated version of the Substance Use Disorder Diagnostic Schedule-IV (SUDDS-IV) to assess DSM-IV (fourth edition of the Diagnostic and Statistical Manual of Mental Disorders) and two sets of proposed DSM-5 (fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) cannabis use disorder criteria among adult prison inmates in the Minnesota Department of Corrections state prison system from 2000 to 2003. Initially proposed DSM-5 criteria had only two diagnostic designations (moderate and severe). A subsequent revision added a mild designation and required a greater number of positive findings for the severe diagnosis. The sample was composed of 7,672 (89.6% male) inmates. Inmates with no DSM-IV diagnoses and most who currently received a cannabis dependence diagnosis according to the DSM-IV guidelines will fit into corresponding DSM-5 categories (i.e., no diagnosis and severe cannabis use disorder, respectively). Some diagnostic criteria, in addition to those proposed for the DSM-5, emerged as cardinal indicators of moderate cannabis use disorder. The study's limitations are noted.     

Gender Differences in Alcohol Beliefs and Usual Blood-Alcohol Concentration

ABSTRACT

The objectives of this study were (1) to evaluate how males and females express alcohol-related beliefs differently, and (2) to assess, by gender, whether particular beliefs are associated with levels of blood-alcohol concentration. Fifty-nine male and 65 female high school students from a rural Michigan county were interviewed in the winter of 1995 and oral accounts of their beliefs about moderate and heavy drinking and their usual blood-alcohol concentration (per typical drinking episode) were obtained. Results indicate that most heavy-drinking males believe that alcohol makes them lose physical and emotional control but a few believe they are in control of their behavior regardless of heavy drinking. Females who abstain or are light drinkers believe heavy alcohol use will lead to negative consequences. Since many of the alcohol beliefs that indicate negative consequences can be interpreted as stereotypically male “acting out” behaviors, males tend to see these negative effects as less consequential than females. Thus, believing that drinking has negative effects is a predictor of a female's drinking status, but not of male drinking status.     

Gender Differences in Psychotic Disorders With Concurrent Substance Use

Objective: We conducted a comparative analysis of gender differences in patients with primary psychotic disorders with concurrent substance use and in those with substance-induced psychoses. Methods: A total of 385 individuals admitted to psychiatric emergency departments with early-onset psychosis and recent substance use were interviewed at baseline and at six-month intervals for two years. Using a standardized research diagnostic assessment instrument, we classified patients at baseline into primary and substance-induced psychosis groups and analyzed the effects of gender on demographic, family, and clinical characteristics at baseline, the interaction of gender and diagnosis, and gender main effects on illness course, adjustment, and service use over the two-year follow-up period. Results: Women had better premorbid adjustment, less misattribution of symptoms, and a later age at onset of regular drug use compared to men. Women, however, showed greater depression and histories of abuse compared to men. Men had greater arrest histories. No interactions between gender and diagnosis were significant. Both genders in the primary and substance-induced psychosis groups showed clinical and functional improvement over the follow-up period despite the overall minimal use of mental health and substance abuse treatment services. Conclusions: Women and men with psychosis and substance use differ on several dimensions. Our findings suggest the need for gender-specific treatment programming across both diagnostic groups.     

The Role of Alcohol Use in Emergency Department Episodes

This study investigates the association between alcohol use and emergency-department (ED) utilization in the United States using nationally representative data from the 2001 National Health Interview Survey (N = 33,326). Estimates from our probit models indicate that among men, current drinkers are less likely to have visited the ED in the past year than former drinkers. Among women, lifetime abstainers are less likely than current drinkers to have had an ED episode. Finally, frequency of binge drinking significantly increases the likelihood of ED visits for men. The results suggest that focusing solely on problem drinking provides a limited perspective.     

Doing Gender in a Toxic World. Women and Freebase Cocaine in the City of Buenos Aires (Argentina)

Consumption of freebase cocaine in Argentina has been investigated among males but not females. This qualitative study focuses on the complexity of relationships between gender identity and the use of drugs, investigating freebase cocaine as an example in the Metropolitan Area of Buenos Aires, Argentina. In-depth interviews were conducted with female consumers in 2010. The results reveal the different ways in which female identity is constructed in the context of social vulnerability. We identify ways of doing gender and feeling like a woman in a man's world that are associated with a higher risk of violence and exclusion for being female.     

Alcohol Use Severity Among Adult Hispanic Immigrants: Examining the Roles of Family Cohesion,Social Support,and Gender

Background: This study examined (a) the direct association of family cohesion on alcohol use severity among adult Hispanic immigrants; (b) the indirect association of family cohesion on alcohol use severity via social support; and (c) if gender moderates the direct and indirect associations between family cohesion and alcohol use severity. Method: Mediation and moderation analyses were conducted on a cross-sectional sample of 411 (men = 222, women = 189) participants from Miami-Dade, Florida. Results: Findings indicate that higher family cohesion was directly associated with higher social support and lower alcohol use severity. Higher social support was also directly associated with lower alcohol use severity. Additionally, family cohesion had an indirect association with alcohol use severity via social support. Moderation analyses indicated that gender moderated the direct association between family cohesion and alcohol use severity, but did not moderate the indirect association. Conclusions: Some potential clinical implications may be that strengthening family cohesion may enhance levels of social support, and in turn, lower alcohol use severity among adult Hispanic immigrants. Furthermore, strengthening family cohesion may be especially beneficial to men in efforts to lower levels of alcohol use severity.     

Alcohol and Other Drug Use Disorders Among Homeless People in Australia

This paper describes alcohol and drug-use disorders among 210 homeless people in Australia, and compares the Australian findings with the international literature. While the prevalence of alcohol-use disorders among people who are homeless in Australia is comparable with other international studies, drug-use disorders appear to be more prevalent among Australian homeless than comparable international studies. Reasons for this difference are explored.     

Gender Differences in Cognitive Functioning in Older Alcohol-Dependent Patients

Background: Alcohol dependence is associated with impairments in cognition, especially in later life. Previous studies suggest that excessive drinking has more negative impact on cognition in women than in men. Objectives: In this study, differences in cognition between male and female older, alcohol-dependent patients were examined. Method: Older alcohol-dependent inpatients (N = 164, 62.2% men, mean age 62.6 ± 6.4) underwent neuropsychological tests of sensitivity to interference, mental flexibility, and visual processing. Results: No gender differences were found in age, educational level, estimated premorbid verbal intelligence, and sensitivity to interference. Duration of alcohol dependence was longer for men than for women. Men performed better than women on visual processing, and women better than men on mental flexibility. The superior mental flexibility of women remained significant after adjustment for duration of alcohol dependence. Conclusions/Importance: Older alcohol-dependent inpatients performed below average on cognitive tasks, which suggests that long-term excessive alcohol use negatively affects cognition. Our study does not demonstrate more severe cognitive impairment in women than in men.     

Gender Differences in the Use of Alcohol and Psychotropics in a Brazilian Population

This cross-sectional, interview-based survey aimed to assess the use of licit substances in terms of gender and sociodemographic factors in the city of Pelotas, southern Brazil. Subjects aged 15 years and over and living in urban areas were eligible and a total of 1277 subjects were interviewed. The prevalence of alcohol consumption was 54.2%; 11.9% (21.7% of men and 4.1% of women) reported potentially harmful levels of alcohol use (“at-risk alcohol intake”); 4.2% were classified as manifesting alcohol dependence by CAGE questionnaire. At-risk alcohol intake and subjects with a positive CAGE score were more common among males aged 35–54 yrs. Among the youngest age group, the prevalence of CAGE positive score was similar for males and females, while subjects with lower educational levels showed a higher prevalence. Women were more likely than men to report the use of psychotropic drugs (15% vs. 7%). These results highlight the importance of substance use in Brazil, and suggest that gender differences must to be taken into consideration when planning intervention programs in developing countries.     

Gender Differences in Alcohol Use and Alcohol Problems: Mediation by Social Roles and Gender-Role Attitudes

This study assesses the causal place of Traditional Gender Role Attitudes (TGRA) in models for men and women, which also include social roles by explanatory variables for alcohol use and alcohol problems. Mediation of gender differences by TGRA occurs mainly in abstinence. Interaction effect is weak for alcohol consumption and frequency of “heavy drinking.” The most important explanatory variables are the status factors age and education, which are mediated by TGRA in a small way. Specific aspects of alcohol-related problems are analyzed separately for the problem drinking category. Differences in results with other studies are discussed, and further study is proposed.     

Gender Differences in Risk and Protective Factors for Alcohol Use and Substance Use Problems among Hispanic Adolescents

This study investigates gender differences within the context of risk and protective factors for alcohol use and substance use problems in a sample of 8,992 Hispanic students in grades 6 through 12, who responded to a statewide survey of alcohol and other drug use. The effects of gender, grade, and risk and protective factors on past-month alcohol use, binge drinking, and risk for substance use problems are examined. Results show that outcomes were moderated by gender, such that females had greater predicted probabilities than males for alcohol use, binge drinking, and risk for substance use problems across levels of risk and protective factors. An ecological framework is applied to speculate why Hispanic female adolescents were more vulnerable than their males to problem alcohol use.     

Substance Use and Depressive Symptoms Among Adolescents Treated in a Pediatric Emergency Department

ABSTRACT

The current study examined associations between substance use and depressed mood by gender and type of substance used (no use, alcohol, marijuana, or both alcohol and marijuana) in a sample of 713 adolescents (M_age = 15.3) recruited from a Pediatric Emergency Department (PED). Adolescents who reported any marijuana use had higher overall depressed mood scores compared to all other adolescents. When examined by gender, females with both alcohol and marijuana use reported the highest overall depressed mood symptoms. These results suggest the usefulness of screening and identification of depressive symptoms among adolescents presenting to a PED for substance use-related problems.     

Adolescent Social Networks and Alcohol Use: Variability by Gender and Type

Background: Scientists have established that social networks influence adolescents' substance use behavior, an influence that varies by gender. However, the role of gender in this mechanism of influence remains poorly understood. Particularly, the role an adolescent's gender, alongside the gender composition of his/her network, plays in facilitating or constraining alcohol use is still unclear. Objectives: This study examined the associations among the gender composition of adolescents' networks, select network characteristics, intrapersonal and interpersonal factors, and alcohol use among a sample of adolescents in the United States. Methods: We assessed cross-sectional data from a 2010 study of 1,523 high school students from a school district in Los Angeles. Analyses of adolescents' network characteristics were conducted using UCINET 6; and logistic regression analyses testing the associations between gender composition of the network and alcohol use were conducted using SPSS 20. Results: Our results indicate that the gender composition of adolescents' networks in our sample is associated with alcohol use. Adolescents in predominantly female or predominantly male friendship networks were less likely to report alcohol use compared to adolescents in an equal/balanced network. In addition, depending upon the context/type of network, intrapersonal and interpersonal factors varied in their association with alcohol use. Conclusions/Importance: Based on these findings, we make several recommendations for the future research. We call for researchers to further examine gender as a risk factor for alcohol abuse, particularly within the complex interplay between gender and network contexts.     

Measurements,Instruments, Scales,and Tests: Use of AUDIT for Alcohol Screening among Emergency Room Patients in Thailand

This study evaluated the Alcohol Use Disorders Identification Test (AUDIT) against blood alcohol levels and medical diagnoses. The population under study included 695 current drinkers admitted to emergency rooms of four regional Thailand hospitals. The AUDIT positivity rate was 61% among 343 patients who drank prior to admission and 32% among 352 patients who did not drink alcohol before admission. Breath alcohol levels were positively associated with AUDIT scores. The sensitivity against a previous or current alcohol-related medical diagnosis was 89%. We concluded that the AUDIT is a satisfactory instrument for alcohol screening in this population.