THE MEDICAL PROFILE OF UNIDENTIFIED PROBLEM DRINKERS IN GENERAL PRACTICE: TEST OF AN HYPOTHESIS

In order to facilitate general practitioner (GP) detection ofproblem drinkers the Dutch College of General Practitionersdeveloped a standard specifying the differences in medical profilebetween problem drinker and non-problem drinkers. The standardmentions 35 Reasons for Encounter (RFEs) and OP Evaluations(Es) that are thought to be specific for problem drinkers. Thestudies referred to in the standard base their conclusions aboutdifferences in medical profile upon a comparison of problemdrinkers already identified by the GP with other patients. Thisstudy tests the hypothesis that the medical profile specifiedby the standard also applies to unidentified problem drinkers.All known problem drinkers in the practices of 16 GPs, as wellas a one in 10 random sample of patients considered to be non-drinkerswere admitted to the study at their first surgery visit duringa 1-year period. Hidden problem drinkers were detected by meansof a screening questionnaire, although the results were notconveyed to the GP until the study was completed. Over the 1-yearstudy period the GPs then registered all RFEs and Es of thestudy population. RFE and E sum scores were then constructedbased on the Alcohol Standard. The estimated population prevalenceof problem drinking, corrected for the one in 10 sample fractionwas 7%. We found 6% problem drinkers (n = 78) in the categoryregarded by the GPs as non-problem drinkers (n = 1254). Differencesin RFEs and Es between hidden problem drinkers and those regardedas non-problem drinkers were significant for irregular heartbeatand psychological problems. Sexual problems were significantat the RFE level, social problems at the E level. When identifiedproblem drinkers are compared with non-problem drinkers moredifferences in the medical profile are found (four times bothRFE and E; twice RFE and once E). We conclude that most of thepublished differences in the medical profile between problemdrinkers and other GP patients are not found for unidentifiedproblem drinkers. The observed differences between unidentifiedproblem drinkers and non-problem drinkers are too small to behelpful to the GP to detect problem drinkers.     

HEALTH LOCUS OF CONTROL IN PROBLEM DRINKERS WITH AND WITHOUT LIVER DISEASE

The purpose of this study was to investigate whether patientswho developed alcoholic liver disease have more awareness ofthe link between their behaviour and subsequent health thanpatients with non-alcoholic liver disease and people with drinkproblems with no liver disease. This study included three groupsof patients, alcoholic liver disease (ALD) (n = 57), non-alcoholicliver disease (n = 77), and problem drinkers with no liver diseaseattending a London community day treatment centre (ACCEPT) (ⁿ= 115). Health locus of control differentiates people into twogroups, health externals who are individuals who maintain thattheir health is largely determined by external factors, as opposedto health internals, who believe that their behaviour playsa major role in determining their subsequent health or illness.The results of the Health Locus of Control (HLC) scale administeredto the above subjects suggested that the ALD group had limitedinsight into the relationship between their drinking and subsequentliver disease, compared to the ACCEPT group. It is suggestedthat alcoholic liver disease patients receive counselling aspart of their total management.     

At which drinking level to advise a patient? General practitioners' views

This study examined the views of 64 general practitioners (GPs) on how much a patient has to drink to be advised by them and compared the results to the recommended Finnish threshold values of heavy drinking. The levels stated by GPs were not too high to prevent early-phase intervention in heavy drinking; rather, they were so low that numerous moderate drinkers were also included. The mean (SD) level was 15.5 (6.5) drinks for male and 11.0 (4.6) drinks for female patients per week. These are about two-thirds of the Finnish threshold values of heavy drinking. Attempting to advise such high proportions of patients, including both heavy and moderate drinkers, might mean a discouraging burden for GPs. However, there may be a discrepancy between GPs' statements about when to advise and when they actually do so.     

Associations of antidepressant use with alcohol use and problem drinking: Ontario population data from 1999 to 2017

ObjectiveThis study investigated the rates of and change in past-year antidepressant use from 1999 to 2017 among a representative sample of Ontario adults and past-year alcohol users and problem drinkers. It examined whether alcohol use and problem drinking are associated with antidepressant use over time, whether gender moderated the effect of problem drinking on antidepressant use, and the potential correlates of past-year antidepressant use.MethodThis study utilized data from the Centre for Addiction and Mental Health Monitor study, a repeat cross-sectional telephone survey of the Ontario general adult population. Data are from 15 annual cycles of the survey 1999–2017 (where relevant variables were included), resulting in a sample size of N = 35,210. Variables of interest included demographic variables, past-year antidepressant use, past-year alcohol use, and past-year problem drinking (e.g., 8+ on the Alcohol Use Disorders Identification Test).ResultsPast-year antidepressant use increased from 1999 to 2017 similarly among the full sample, past-year alcohol users, and past-year problem drinkers. Approximately 9% of Ontarians reported past-year antidepressant use in 2017. Overall, past-year problem drinkers were 1.5 times more likely to use antidepressants than non-problem drinkers. Past-year alcohol use was not associated with antidepressant use. Gender moderated the association between past-year problem drinking and antidepressant use.ConclusionThis study determined that past-year antidepressant use increased from 1999 to 2017, that past-year problem drinkers are more likely to use antidepressants than non-problem drinkers, and that past-year problem drinking is associated with past-year antidepressant use among women but not among men.     

THE RELIABILITY OF ALCOHOLISM HISTORY IN PATIENTS WITH ALCOHOL-RELATED CIRRHOSIS

Alcoholic liver disease is considered an indication for livertransplantation when a candidate is felt to have a high likelihoodof abstinence following transplantation. Historical variablessuch as duration of sobriety, duration and quantity of drinking,and treatment history are commonly used to estimate alcoholismprognosis, yet their reliability and validity in patients withalcoholic cirrhosis has received limited study. Fifty subjects(9 women and 41 men) with alcoholic cirrhosis underwent an alcoholismhistory interview. Each subject had a collateral source (usuallya spouse) who was interviewed by a second interviewer blindto the subject's alcoholism history. The two histories werecompared for duration of abstinence in months and estimatedalcoholism relapse risk was calculated using the High-risk AlcoholismRelapse scale (HRAR). Duration of sobriety correlated highlybetween subject and collateral source (Spearman r=0.96, P=0.0001)as did HRAR total score (Spearman r=0.72, P=0.0001). Categoricalassignments also showed high correlations with duration of sobriety(k=0.97) and HRAR category (k=0.63). When disagreements werepresent, collateral sources tended to underestimate severityof alcoholism. We conclude that patients with alcoholic liverdisease provide a reliable history for alcoholism variableswhen compared with a collateral source, and that, when disagreementsare present, subjects tend to report a more acute or severealcohol problem. The results support the clinical use of patienthistory information in making decisions about medical interventionsfor alcoholic liver disease.     

Alcohol consumption and heavy drinking: a survey in three Italian villages

Aims: We investigated drinking habits, and heavy and problemdrinking prevalence in a sample of individuals attending theconsulting rooms of local General Practitioners in three Italianvillages. Methods: The samples were selected to be representativeof the entire population of the three villages. Informationon alcohol-drinking patterns was collected using a questionnairethat included a masked form of the CAGE rating scale. Accordingto the frequency of alcohol intake, subjects were grouped inthree categories: abstainers, occasional drinkers, and dailydrinkers. In agreement with WHO guidelines, 40 g/day for malesand 20 g/day for females were taken as cut-off for ‘heavydrinking’ and consumptions of >80 g/day for males and40 g/day for females were used to define ‘problem drinking’.Results: A total of 2972 individuals were included in the survey(19% of the population). Of these, 44% were abstinent, 20% occasionaldrinkers, and 36% daily drinkers. Daily drinking was found tobe more common in males than in females but heavy drinking wassignificantly higher in females compared with males (P 0.0001).The problem drinkers were 12% of the entire population and theCAGE-positive subjects (2 positive answers) were 3.5%. Conclusions:Our data indicate that alcohol drinking is widely diffused inthe three communities. A large layer of the population drinksabove the WHO-established cut-off. The incidence of heavy andproblem drinking seems to have significant gender and regionaldifferences that are important to consider when planning effectiveprevention programmes.     

Cross-sectional survey: Risk-averse French general practitioners are more favorable toward influenza vaccination

ObjectivesWe tested the following hypotheses: (i) risk-averse general practitioners (GPs) are more likely to be vaccinated against influenza; (ii) and risk-averse GPs recommend influenza vaccination more often to their patients. In risk-averse GPs, the perceived benefits of the vaccine and/or the perceived risks of the infectious disease might indeed outweigh the perceived risks of the vaccine.Patients/MethodsIn 2010–2012, we conducted a cross-sectional survey of a nationwide French representative sample of 1136 GPs. Multivariate analyses adjusted for four stratification variables (age, gender, urban/suburban/rural practice location and annual patient consultations) and for GPs’ characteristics (group/solo practice, and occasional practice of alternative medicine, e.g., homeopathy) looked for associations between their risk attitudes and self-reported vaccination behavior. Individual risk attitudes were expressed as a continuous variable, from 0 (risk-tolerant) to 10 (risk-averse).ResultsOverall, 69% of GPs reported that they were very favorable toward vaccination in general. Self-reported vaccination coverage was 78% for 2009/2010 seasonal influenza and 62% for A/H1N1 pandemic influenza. Most GPs (72%) reported recommending the pandemic influenza vaccination to at-risk young adults in 2009, but few than half (42%) to young adults not at risk. In multivariate analyses, risk-averse GPs were more often vaccinated against seasonal (marginal effect = 1.3%, P = 0.02) and pandemic influenza (marginal effect = 1.5%, P = 0.02). Risk-averse GPs recommended the pandemic influenza vaccination more often than their more risk-tolerant colleagues to patients without risk factors (marginal effect = 1.7%, P = 0.01), but not to their at-risk patients and were more favorable toward vaccination in general (marginal effect = 1.5%, P = 0.04).ConclusionIndividual risk attitudes may influence GPs’ practices regarding influenza vaccination, both for themselves and their patients. Our results suggest that risk-averse GPs may perceive the risks of influenza to outweigh the potential risks related to the vaccine.     

The impact of an alcohol policy change on developmental trajectories of youth alcohol use: examination of a natural experiment in Canada

ObjectivesIn 2015, the Liquor Control Board of Ontario (LCBO) authorized sale of alcohol in some Ontario grocery stores. This research evaluates the impact of the new policy on alcohol use patterns of youth in a quasi-experimental setting with two control groups.MethodsThe sample consists of 2267 grade 9 students attending 60 secondary schools across Ontario (n = 56) and Alberta (n = 4), who provided 4-year linked longitudinal data (2013–2014 to 2016–2017) in the COMPASS study. The study used the frequency of drinking and the frequency of binge drinking to characterize alcohol use behaviours.ResultsLatent transition analysis found four statuses of alcohol use: abstainer, periodic drinker, low-risk drinker, and high-risk regular drinker. The new policy had no negative impact among periodic and low-risk drinkers, but the risk of transitioning from the abstainer (lowest risk status) to high-risk regular drinker (highest risk status) among the exposed cohort was 1.71 times greater post-policy than pre-policy change, compared with those of Ontario-unexposed (0.50) and Alberta-unexposed cohorts (1.00). The probability of sustaining high-risk drinking among the exposed cohort increased by a factor of 1.76, compared with 1.13-fold and 0.89-fold among the Ontario-unexposed and Alberta-unexposed cohorts, respectively.ConclusionYouth are more likely to transition from abstinence to high-risk regular drinking, and high-risk regular drinkers are more likely to maintain their behaviours in the jurisdictions exposed to the latest change in LCBO policy authorizing grocery stores to sell alcohol. When formulating policy interventions, youth access to alcohol should be considered in order to reduce their harmful alcohol consumption.Electronic supplementary materialThe online version of this article (10.17269/s41997-020-00366-7) contains supplementary material, which is available to authorized users.     

Take me away: The relationship between escape drinking and attentional bias for alcohol-related cues

Previous research has indicated that implicit attentional bias to alcohol-related cues may serve as a cognitive measure of susceptibility to alcohol dependence. The primary goal of the current study was to examine whether college students who drink to escape dysphoric emotions or moods (i.e., escape drinkers) have stronger attentional biases for alcohol-related cues than non-escape drinkers. Additionally, because previous research has shown that presentation time and content of smoking-related stimuli moderates differences between smokers' and nonsmokers' reaction times, this study sought to determine whether these effects generalized to alcohol-related stimuli. Participants who were identified as either escape (n = 74) or non-escape drinkers (n = 48) completed a dot-probe task in which alcohol-related pictures that contained humans interacting with the alcohol-related cues (active) or alcohol-related cues alone (inactive) were presented along with matched control pictures. These stimuli were presented for either 500 ms or 2000 ms to determine whether attentional biases occur as a function of initial or maintained attention to the alcohol-related cues. Escape drinkers displayed a significantly stronger attentional bias for alcohol-related inactive cues at longer presentation times (i.e., 2000 ms) compared to non-escape drinkers. This bias was independent of alcohol dependence and family history of alcoholism. These results suggest that in addition to dependence and family history, escape drinking is an important factor to consider when examining attentional biases to alcohol-related cues.     

Occupational Factors and Problem Drinking among a Japanese Working Population

Problem drinking is a serious public health problem in the workplace. However, few Japanese epidemiological studies have investigated the occupational characteristics of problem drinking. The purpose of this study is to clarify the occupational risk factors for problem drinking among a Japanese working population. We used data from a random-sampling survey about mental health and suicide, conducted among Hamamatsu City residents aged 15 to 79 yr old during May and June in 2008. The relation between occupational factors and problem drinking was analyzed with multiple logistic regression models stratified by gender. CAGE questionnaire was used to assess problem drinking. With regard to employment types, problem drinkers were more prevalent among self-employed women. With regard to occupational types, clerical and service professions had more problem drinkers of either sex, while administrative/managerial and sales professions had more women with such problem. With regard to company size, male problem drinkers were more prevalent in smaller companies than in larger ones. These results indicate that the prevalence of problem drinkers in the workplace depends on where one works. It is necessary to consider these characteristics to provide effective measures to address problem drinking in the workplace.     

Vitamin D and Calcium Status in South African Adolescents with Alcohol Use Disorders

Adequate vitamin D and calcium are essential for optimal adolescent skeletal development. Adolescent vitamin D insufficiency/deficiency and poor calcium intake have been reported worldwide. Heavy alcohol use impacts negatively on skeletal health, which is concerning since heavy adolescent drinking is a rising public health problem. This study aimed to examine biochemical vitamin D status and dietary intakes of calcium and vitamin D in 12–16 year-old adolescents with alcohol use disorders (AUD), but without co-morbid substance use disorders, compared to adolescents without AUD. Substance use, serum 25-hydroxyvitamin D (s-25(OH)D) concentrations, energy, calcium and vitamin D intakes were assessed in heavy drinkers (meeting DSM-IV criteria for AUD) (n = 81) and in light/non-drinkers without AUD (non-AUD) (n = 81), matched for age, gender, language, socio-economic status and education. Lifetime alcohol dose was orders of magnitude higher in AUD adolescents compared to non-AUD adolescents. AUD adolescents had a binge drinking pattern and “weekends-only” style of alcohol consumption. Significantly lower (p = 0.038) s-25(OH)D (adjusted for gender, smoking, vitamin D intake) were evident in AUD adolescents compared to non-AUD adolescents. High levels of vitamin D insufficiency/deficiency (s-25(OH)D < 29.9 ng/mL) were prevalent in both groups, but was significantly higher (p = 0.013) in the AUD group (90%) compared to the non-AUD group (70%). All participants were at risk of inadequate calcium and vitamin D intakes (Estimated Average Requirement cut-point method). Both groups were at risk of inadequate calcium intake and had poor biochemical vitamin D status, with binge drinking potentially increasing the risk of the latter. This may have negative implications for peak bone mass accrual and future osteoporosis risk, particularly with protracted binge drinking.     

BIPHASIC EFFECTS OF ALCOHOL DRINKING ON METHAMPHETAMINE METABOLISM IN MAN

In methamphetamine (MAP) addicts, long-term ethanol ingestion3–4 times per week induced an increased rate of p-hydroxylationof MAP and amphetamine (AMP). Simultaneous ingestion of ethanoland MAP inhibited both p-hydroxylation of MAP and AMP and N-demethylationof MAP in inebriated addicts. The p-hydroxylation of MAP andAMP was also significantly inhibited in daily drinkers despitethe almost total absence of urinary ethanol. This suggests thatthe intensity of MAP-induced behavioral and psychological effectsin MAP addicts may, in part, depend upon their drinking habits.     

NATURE AND HEALING OF TIBIAL SHAFT FRACTURES IN ALCOHOL ABUSERS

Alcohol abuse is associated with an increased risk of osteopeniaand fractures. Previous histomorphometric studies on iliac crestbone have found decreased bone formation and increased boneresorption in alcohol abusers but it has not been establishedwhether alcohol abuse has any effect on the anatomical locationor the healing time of tibial shaft fractures. We studied, retrospectively,199 adult male patients hospitalized for isolated tibial shaftfracture in the city of Malmö, Sweden, between 1980 and1990. Forty-nine of the patients had earlier been registeredat the Department of Alcohol Diseases and were judged to beproblem drinkers. Abusers sustained their tibial shaft fracturesmore often by falling at ground level (P<0.0001) or froma higher level (P=0.009) and the fractures were more often obliquethan transverse (P=0.002) as compared with non-abusers. Healingtime was impaired in abusers who had sustained a transversefracture (P=0.035), but no difference was observed in healingtime in those with an oblique fracture. We found no differencebetween the abusers and the non-abusers regarding duration ofhospital stay, fracture location, amount of displacement, occurrenceof open fractures or the rate of complications.     

PHYSICIAN KNOWLEDGE OF THE CAGE ALCOHOL SCREENING QUESTIONS AND ITS IMPACT ON PRACTICE

A cross-sectional survey of physicians (n=301) and patients(n=321) at a universitybased department of medicine was completedto determine physician's ability to list CAGE alcohol screeningquestions and how this knowledge is associated with practicepatterns. Forty-five percent of the physicians had heard ofthe CAGE, but only 14% could list all four of the questionscorrectly. Physicians who knew the CAGE were more likely toreport counseling and referral of their patients who abuse alcohol.However, as assessed by patient interview and chart review,patients with an alcohol abuse problem were no more likely tohave been recognized by or to have received more aggressivecare from residents who knew the CAGE than patients cared forby residents who did not know the CAGE. Knowledge of an alcoholscreening test is not sufficient to change physician practicerelated to care of patients with an alcohol abuse problem. Moreattention must be directed towards the development of effectivestrategies which integrate into clinical practice screeningand initial treatment of patients who abuse alcohol.     

Solitary and Social Drinking in South Korea: An Exploratory Study

ObjectivesThis study aimed to identify differences in drinking norms, heavy drinking, and motives between types of drinkers (abstainers, solitary, and social drinkers) in a representative sample of Korean adults.MethodsAn online survey of people registered on the electoral roll were randomly invited to be part of the “National Korean Drinking Culture Study” conducted in 2018 (n = 3,015). Participants included 1,532 men and 1,469 women aged 19–60 years. Questions included the number of times they drank in the last month, what they drank, and the volume drank. The amount of pure alcohol consumed was calculated. Drinking norms, motives, and types were determined in the survey questions.ResultsSolitary drinkers were more likely to be divorced or separated, less educated, and marginally employed. Solitary drinking peaked in those in their 30s (18.5%) and social drinkers in their 50s (68.1%). Solitary drinkers drank more frequently compared with social drinkers (6.1 vs. 3.6 times per month, p < 0.001), and consumed a significantly larger quantity of alcohol (69.5 g vs. 46.8 g per week). Solitary drinkers were more accepting of drinking-related behaviors in diverse situations compared with social drinkers. The regression analysis revealed that personal drinking motives were the most important factor influencing the frequency and quantity of alcohol consumption in both solitary and social drinking.ConclusionSolitary drinkers may be more vulnerable to alcohol abuse than social drinkers.     

Intervention for excessive alcohol consumption in primary health care: attitudes and practices of English general practitioners.

General practitioners' (GPs') recognition of, attitudes towards, and intervention for, excessive drinking and alcohol problems among their patients were assessed in a postal questionnaire survey. Levels of recognition of, and intervention for, excessive drinking by GPs were low. GPs did not routinely enquire about alcohol and had managed only small numbers of patients specifically for excessive drinking or alcohol problems in the previous year. Enquiry about alcohol issues was elicited mainly by physical symptoms or by new patient registrations. Although 83% of GPs felt prepared to counsel excessive drinkers, only 21% felt effective in helping patients reduce consumption. Over the past 10 years, there appears to have been an increase in numbers of GPs who feel that they should be working with alcohol issues, but fewer GPs perceive themselves as being effective in this work. The main barriers to brief alcohol intervention were given as insufficient time and training, and lack of help from government policy; the main incentives related to availability of appropriate support services and proven efficacy of brief interventions.