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1.
OBJECTIVE: To compare self-administered versions of three questionnaires for detecting heavy and problem drinking: the CAGE, the Alcohol Use Disorders Identification Test (AUDIT), and an augmented version of the CAGE. DESIGN: Cross-sectional surveys. SETTING: Three Department of Veterans Affairs general medical clinics. PATIENTS: Random sample of consenting male outpatients who consumed at least 5 drinks over the past year (“drinkers”). Heavy drinkers were oversampled. MEASUREMENTS: An augmented version of the CAGE was included in a questionnaire mailed to all patients. The AUDIT was subsequently mailed to “drinkers.” Comparison standards, based on the tri-level World Health Organization alcohol consumption interview and the Diagnostic Interview Schedule, included heavy drinking (>14 drinks per week typically or ≥5 drinks per day at least monthly) and active DSM-IIIR alcohol abuse or dependence (positive diagnosis and at least one alcohol-related symptom in the past year). Areas under receiver operating characteristic curves (AUROCs) were used to compare screening questionnaires. MAIN RESULTS: Of 393 eligible patients, 261 (66%) returned the AUDIT and completed interviews. For detection of active alcohol abuse or dependence, the CAGE augmented with three more questions (AUROC 0.871) performed better than either the CAGE alone or AUDIT (AUROCs 0.820 and 0.777, respectively). For identification of heavy-drinking patients, however, the AUDIT performed best (AUROC 0.870). To identify both heavy drinking and active alcohol abuse or dependence, the augmented CAGE and AUDIT both performed well, but the AUDIT was superior (AUROC 0.861). CONCLUSIONS: For identification of patients with heavy drinking or active alcohol abuse or dependence, the self-administered AUDIT was superior to the CAGE in this population. This research was supported by Department of Veteran Affairs, Hines Center for Cooperative Studies in Health Services Research, grant 91-007, and Health Services Research and Development, grant SDR 96-002, Ambulatory Care Quality Improvement Project (ACQUIP); a grant from the University of Washington Alcohol and Drug Abuse Institute; and the Health Services Research and Development Field Program and Medical Service, Seattle Division, VA Pudget Sound Health Care System.  相似文献   

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OBJECTIVE: To compare self-administered versions of three questionnaires for detecting heavy and problem drinking: the CAGE, the Alcohol Use Disorders Identification Test (AUDIT), and an augmented version of the CAGE. DESIGN: Cross-sectional surveys. SETTING: Three Department of Veterans Affairs general medical clinics. PATIENTS: Random sample of consenting male outpatients who consumed at least 5 drinks over the past year ("drinkers"). Heavy drinkers were oversampled. MEASUREMENTS: An augmented version of the CAGE was included in a questionnaire mailed to all patients. The AUDIT was subsequently mailed to "drinkers." Comparison standards, based on the tri-level World Health Organization alcohol consumption interview and the Diagnostic Interview Schedule, included heavy drinking (>14 drinks per week typically or >/=5 drinks per day at least monthly) and active DSM-IIIR alcohol abuse or dependence (positive diagnosis and at least one alcohol-related symptom in the past year). Areas under receiver operating characteristic curves (AUROCs) were used to compare screening questionnaires. MAIN RESULTS: Of 393 eligible patients, 261 (66%) returned the AUDIT and completed interviews. For detection of active alcohol abuse or dependence, the CAGE augmented with three more questions (AUROC 0.871) performed better than either the CAGE alone or AUDIT (AUROCs 0.820 and 0.777, respectively). For identification of heavy-drinking patients, however, the AUDIT performed best (AUROC 0.870). To identify both heavy drinking and active alcohol abuse or dependence, the augmented CAGE and AUDIT both performed well, but the AUDIT was superior (AUROC 0.861). CONCLUSIONS: For identification of patients with heavy drinking or active alcohol abuse or dependence, the self-administered AUDIT was superior to the CAGE in this population.  相似文献   

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Objective:To assess the patient and physician characteristics that influence physicians’ detection of problem drinking in their medical patients. Setting:The outpatient medical clinic at an urban university teaching hospital staffed by interns and residents. Design:Cross-sectional study of a rendomly chosen subsample of consecutive patients. Measurement:Univariate and multivariate analysis with calculated adjusted odds ratios of factors associated with physician detection of drinking problems. A problem was diagnosed according to the patient’s results on the alcohol module of the Diagnostic Interview Schedule (DIS). Results:Physicians detected 22% of 189 presumably inactive problems and 49% of 92 current problems, i.e., those that have occurred within the preceding year. Multivariate correlates of detection of active problems included male patient gender, presence of gastrointestinal complications of excessive drinking, number of concurrent medical disorders, and previous medical record reference to alcohol (p<0.05). Physician gender and year of training were not associated with detection. Conclusion:Our physicians appear to rely on specific patient characteristics as well as the patient’s medical record to detect drinking problems in their ambulatory patients. Their reliance upon these factors may hinder their detection of drinking problems in women patients and less seriously impaired individuals. Supported in part by Commonwealth Center on Drug Abuse Faculty Grant Program and Bureau of Health Professions, HRSA Grant for Residency Training in General Internal Medicine.  相似文献   

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OBJECTIVE: This study describes primary care discussions with patients who screened positive for at-risk drinking. In addition, discussions about alcohol use from 2 clinic firms, one with a provider-prompting intervention, are compared. DESIGN: Cross-sectional analyses of audiotaped appointments collected over 6 months. PARTICIPANTS AND SETTING: Male patients in a VA general medicine clinic were eligible if they screened positive for at-risk drinking and had a general medicine appointment with a consenting provider during the study period. Participating patients (N=47) and providers (N=17) were enrolled in 1 of 2 firms in the clinic (Intervention or Control) and were blinded to the study focus. INTERVENTION: Intervention providers received patient-specific results of positive alcohol-screening tests at each visit. MEASURES AND MAIN RESULTS: Of 68 visits taped, 39 (57.4%) included any mention of alcohol. Patient and provider utterances during discussions about alcohol use were coded using Motivational Interviewing Skills Codes. Providers contributed 58% of utterances during alcohol-related discussions with most coded as questions (24%), information giving (23%), or facilitation (34%). Advice, reflective listening, and supportive or affirming statements occurred infrequently (5%, 3%, and 5%, of provider utterances respectively). Providers offered alcohol-related advice during 21% of visits. Sixteen percent of patient utterances reflected “resistance” to change and 12% reflected readiness to change. On average, Intervention providers were more likely to discuss alcohol use than Control providers (82.4% vs 39.6% of visits; P=.026). CONCLUSIONS: During discussions about alcohol, general medicine providers asked questions and offered information, but usually did not give explicit alcohol-related advice. Discussions about alcohol occurred more often when providers were prompted. This research was supported by grants from the University of Washington Royalty Research Fund, and the Department of Veterans Affairs, Health Services Research and Development Service (SDR 96-002). Dr. Bradley is an investigator at the VA Puget Sound Health Care System, and is currently supported by National Institute of Alcohol Abuse and Alcoholism grant no. K23AA00313) and is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar. Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, the National Institute of Alcohol Abuse and Alcoholism, or the Robert Wood Johnson Foundation.  相似文献   

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Psychiatric disorders, particularly depression and alcohol abuse, represent a large burden of illness to the society. Many individuals with these disorders receive all of their care from health care providers who are not mental health specialists. There is evidence that non-psychiatric physicians frequently do not recognize these disorders in their patients. Screening questionnaires have been introduced to improve detection of these patients. Several studies have found that these screening questionnaires can increase detection rates, but no important impact on patient outcomes has been demonstrated. This review article outlines several reasons why it has been difficult to discern improvement in patient outcomes: inadequate study design, insufficient physician education, interdependence of psychiatric and medical conditions, and vague treatment guidelines. Practical use of the current psychiatric screening questionnaires and key areas for further investigation are considered. Presented at the conference, Frontiers in Disease Prevention, The Johns Hopkins University, June 5–6, 1989.  相似文献   

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Aims To establish predictors of age 21 alcohol‐related harm from prior drinking patterns, current levels of alcohol consumption and use of controlled drinking strategies. Participants One thousand, five hundred and ninety‐six students recruited from an initial sample of 3300 during their final year of high school in 1993. Design Longitudinal follow‐up across five waves of data collection. Setting Post high school in Victoria, Australia. Measurements Self‐administered surveys examining a range of health behaviours, including alcohol consumption patterns and related behaviour. Findings Drinking behaviours at age 21 were found to be strongly predicted by drinking trajectories established through the transition from high school. Multivariate regression analysis revealed that alcohol‐related harms at age 21 were reduced where current levels of alcohol use fell within limits recommended in Australian national guidelines. After controlling for this effect it was found that the range of strategies employed by participants to control alcohol use maintained a small protective influence. Post‐high‐school drinking trajectories continued to demonstrate a significant effect after controlling for current behaviours. Findings revealed that over one quarter of males and females drank alcohol, but on a less‐than‐weekly basis. This pattern of alcohol use demonstrated considerable stability through the post‐school transition and was associated with a low level of subsequent harm at age 21. Conclusions Future research should investigate whether encouraging more Australian adolescents to drink alcohol on a less‐than‐weekly basis may be a practical intervention target for reducing alcohol‐related harms.  相似文献   

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Aims To determine the effect of an intervention to improve alcohol screening and brief counseling for hypertensive patients in primary care. Design Two‐year randomized, controlled trial. Setting/participants Twenty‐one primary care practices across the United States with a common electronic medical record. Intervention To promote alcohol screening and brief counseling. Intervention practices received site visits from study personnel and were invited to annual network meetings to review the progress of the project and share improvement strategies. Measurements Main outcome measures included rates of documented alcohol screening in hypertensive patients and brief counseling administered in those diagnosed with high‐risk drinking, alcohol abuse or alcohol dependence. Secondary outcomes included change in blood pressure among patients with these diagnoses. Findings Hypertensive patients in intervention practices were significantly more likely to have been screened after 2 years than hypertensive patients in control practices [64.5% versus 23.5%; adjusted odds ratio (OR) = 8.1; 95% confidence interval (CI) 1.7–38.2; P < 0.0087]. Patients in intervention practices diagnosed with high‐risk drinking, alcohol abuse or alcohol dependence were more likely than those in control practices to have had alcohol counseling documented (50.5% versus 29.6%; adjusted OR = 5.5, 95% CI 1.3–23.3). Systolic (adjusted mean decline = 4.2 mmHg, P = 0.036) and diastolic (adjusted mean decline = 3.3 mmHg, P = 0.006) blood pressure decreased significantly among hypertensive patients receiving alcohol counseling. Conclusions Primary care practices receiving an alcohol‐focused intervention over 2 years improved rates of alcohol screening for their hypertensive population. Implementation of alcohol counseling for high‐risk drinking, alcohol abuse or alcohol dependence also improved and led to changes in patient blood pressures.  相似文献   

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Objective: This cross-sectional study was conducted to investigate which components of acculturation relate to drinking games participation among Hispanic college students. We also sought to examine whether the relationships between acculturation and drinking games would differ from the associations between acculturation and other alcohol-related outcomes. Method: A sample of 1,397 Hispanic students aged 18–25 (75% women; 77% US-born) from 30 US colleges and universities completed a confidential online survey. Results: Associations among acculturative processes, drinking games participation, general alcohol consumption, and negative drinking consequences differed across gender. Most significant findings emerged in the domain of cultural practices. For women, US cultural practices were associated with greater general alcohol consumption, drinking games frequency, and amount of alcohol consumed while gaming, whereas for men, US cultural practices were associated with general alcohol consumption and negative drinking consequences. Conclusions: Hispanic and US cultural practices, values, and identifications were differentially associated with drinking games participation, and these associations differed by gender. It is therefore essential for college student alcohol research to examine US culture acquisition and Hispanic culture retention separately and within the domains of cultural practices, values, and identifications.  相似文献   

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AIMS: Brief alcohol interventions typically have been directed to heavy-drinking patients seeking primary health care and college students. This study examined the efficacy of mailing brief personalized assessment-feedback to interested drinkers recruited from the general public. We hypothesized that problem drinkers would benefit more from the intervention than individuals who were not problem drinkers. DESIGN: A two-arm, double-blinded, community-based randomized controlled trial with 6-month follow-up. SETTING AND PARTICIPANTS: A screening interview was administered to a stratified random sample of 10 014 Canadians 18 years of age and older (5621 women and 4393 men; M age = 43.3 years, SD = 15.99; response rate = 65.4%). INTERVENTION: Current drinkers interested in receiving alcohol self-help materials (n = 1727) were assigned randomly to receive brief personalized assessment-feedback on male and female population drinking norms by mail, or to a delayed-treatment control group, and were contacted 6 months later (76% retention rate). MEASUREMENTS: Problem drinking status at baseline [using sex-specific Alcohol Use Disorders Identification Test (AUDIT) cut scores], and frequency and quantity of alcohol use at follow-up. FINDINGS: Analysis of covariance identified the hypothesized interaction of baseline problem drinking status and treatment condition (P < 0.01). Among problem drinkers identified at baseline the intervention caused a 10.1% reduction in per-occasion binge drinking compared to controls, whereas there was no difference in binge drinking across conditions for non-problem drinkers. CONCLUSIONS: The continuum of care for alcohol problems can be broadened by providing brief interventions to interested drinkers in the general population.  相似文献   

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AIMS: The direct effects of screening on drinking behaviour have not previously been evaluated experimentally. We tested whether screening reduces self-reported hazardous drinking in comparison with a non-screened control group. DESIGN: Two-arm randomized controlled trial (RCT), with both groups blinded to the true nature of the study. SETTING AND PARTICIPANTS: A total of 421 university students aged 18-24 years, recruited in five London student unions. INTERVENTIONS: Both groups completed a brief pen-and-paper general health and socio-demographic questionnaire, which for the experimental group also included the 10-item Alcohol Use Disorders Identification Test (AUDIT) screening questionnaire. MEASUREMENTS: The primary outcome was the between-group difference in AUDIT score at 2-3-month follow-up. Eight secondary outcomes comprised other aspects of hazardous drinking, including dedicated measures of alcohol consumption, problems and dependence. FINDINGS: A statistically significant effect size of 0.23 (0.01-0.45) was detected on the designated primary outcome. The marginal nature of the statistical significance of this effect was apparent in additional analyses with covariates. Statistically significant differences were also obtained in three of eight secondary outcomes, and the observed effect sizes were not dissimilar to the known effects of brief interventions. CONCLUSIONS: It is unclear to what extent these findings represent the effects of screening alone, a Hawthorne effect in which drinking behaviour has changed in response to monitoring, or whether they indicate reporting bias. These possibilities have important implications both for the dissemination of screening as an intervention in its own right and for behavioural intervention trials methodology.  相似文献   

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This article updates a 2017 review on the effectiveness of digital interventions for reducing alcohol use in the general population. An updated systematic search of the MEDLINE database was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to identify randomized controlled trials (RCTs) published from January 2017 to June 2022 that evaluated the effectiveness of digital interventions compared with no interventions, minimal interventions, and face-to-face interventions aimed at reducing alcohol use in the general population and, that also reported changes in alcohol use (quantity, frequency, quantity per drinking day, heavy episodic drinking (HED), or alcohol use disorders identification test (AUDIT) scores). A secondary analysis was performed that analyzed data from RCTs conducted in students. The review was not preregistered. The search produced 2224 articles. A total of 80 studies were included in the review, 35 of which were published after the last systematic review. A total of 66, 20, 18, 26, and 9 studies assessed the impact of digital interventions on alcohol quantity, frequency, quantity per drinking day, HED, and AUDIT scores, respectively. Individuals randomized to the digital interventions drank 4.12 (95% confidence interval (CI): 2.88, 5.36) fewer grams of alcohol per day, had 0.17 (95% CI 0.06, 0.29) fewer drinking days per week, drank approximately 3.89 (95% CI: 0.40, 7.38) fewer grams of alcohol per drinking day, had 1.11 (95% CI: 0.32, 1.91) fewer HED occasions per month, and had an AUDIT score 3.04 points lower (95% CI: 2.23, 3.85) than individuals randomized to the control condition. Significant reductions in alcohol quantity, frequency, and HED, but not quantity per drinking day, were observed among students. Digital interventions show potential for reducing alcohol use in general populations and could be used widely at the population level to reduce alcohol-attributable harms.  相似文献   

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Aims  To estimate probabilities of alcohol high-risk drinking, alcohol abuse and alcohol dependence on grounds of smoking-behaviour related variables and single nicotine dependence criteria.
Design  Cross-sectional population-based study.
Setting  Adult population of a region in north Germany.
Participants  Cigarette smokers ( n  = 2437) among a random sample of 4075 females and males aged 18–64, drawn in 1996.
Measurement  Smoking, nicotine dependence according to the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV) and the Fagerström Test for Nicotine Dependence (FTND); increasing alcohol-related harm (ARH): high-risk drinking, DSM-IV alcohol abuse, remitted and current alcohol dependence diagnosed by the Composite International Diagnostic Interview (CIDI).
Findings  Having smoked 30 cigarettes or more per day, onset of smoking at the age of 17 or younger, nicotine dependence and single nicotine dependence criteria revealed odds ratios higher than 4.0 for alcohol dependence. For alcohol dependence, a logistic regression model showed an increased odds ratios for male gender, smoking for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems, craving for nicotine, withdrawal experience 1 day or longer, smoking first cigarette in the morning 5 minutes or less after waking. The probability of increasing ARH was more likely in males, smokers for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems and smoking first cigarette in the morning 5 minutes or less after waking.
Conclusions  Gender and single nicotine dependence criteria show particularly high probabilities of alcohol dependence and increasing ARH. Interventions need to take these connections into account.  相似文献   

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近年我国老龄化进程加快,老年人成为了慢性病人群的主体,生活方式与慢性病密切关联。饮酒是老年人生活中的普遍现象,饮用不同种类和不同量的酒会对身体产生不同的影响。同时,不良饮酒习惯对老年人某些慢性疾病的成因和发展也有影响,恰当的饮酒量可改善某些疾病的发生与发展。本文就两者之间的关系做一综述。  相似文献   

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