Progression through early drinking milestones in an adolescent treatment sample

Aims Research using nationally representative and community samples demonstrates a robust association between early onset of drinking and increased likelihood of numerous adverse outcomes. However, little is known about the subsequent drinking that occurs early in the drinking career. The present study dissects the transition from any alcohol use to treatment entry by taking a fine‐grained approach to examining the attainment and progression of drinking events in a sample of adolescents in substance use treatment. Design/Setting Data were taken from the Drug Abuse Treatment Outcome Study for Adolescents (DATOS‐A), a multi‐site, community‐based study of adolescents entering treatment. Participants Respondents included 3331 youth aged 12–18 years (mean = 15.75) admitted to treatment in 1993–95 (74% male, 52% white, 24% African American, 20% Hispanic). Measurements Age of attainment was obtained for five drinking‐related milestones, including first drink of alcohol, first time drunk, first monthly drinking, first drank five or more drinks/day on a weekly basis and first drank five or more drinks/day on a daily basis. Findings Most milestones were attained at a very early age, and average progression through adjacent drinking events was relatively swift, Movement through early drinking milestones was accelerated in girls and white youth. Youth who reported their first drink at an early age (age 10 or younger) showed slower progression, suggesting the existence of distinct processes underlying early use and drinking transitions within an individual. Conclusions This study provides data relevant to understanding drinking progression/natural history in a large clinical sample, especially for differences by gender and ethnicity. The findings have implications for the identification of intermediate stages that might benefit from selected intervention programs.     

Working hours and alcohol problems in early adulthood

Aims To examine the associations between working hours and alcohol‐related problems during early adulthood. Design and setting Longitudinal study of a birth cohort born in Christchurch, New Zealand in 1977 and studied to age 30. Participants A total of 1019 participants with data available for working hours and alcohol‐related problems at either age 25 or 30. Measurements Weekly working hours in paid employment; frequent alcohol use; diagnosis of alcohol abuse/dependence; number of symptoms of alcohol abuse/dependence. Associations between working hours and alcohol‐related problems were adjusted for covariates including measures of: parental and family background; personality and behaviour; IQ and educational achievement; recent negative life events; recent mental health problems; and current partner and family circumstances. Findings Longer work hours were associated significantly with more frequent alcohol use (P < 0.0001), higher rates of alcohol abuse/dependence (P = 0.0001) and a greater number of alcohol abuse/dependence symptoms (P = 0.01). These associations were adjusted for a wide range of confounding factors. After adjustment there remained significant (P < 0.05) associations between working hours and alcohol‐related problems, with those working 50 or more hours per week having rates of alcohol‐related problems 1.8–3.3 times higher than those who were not working. The associations between work hours and alcohol use were similar for males and females. Conclusions Longer work hours appear to be associated with higher rates of alcohol‐related problems, including more frequent alcohol use, higher rates of alcohol abuse/dependence and a greater number of alcohol abuse/dependence symptoms. These associations remain even after extensive adjustment for confounding.     

Drinking patterns in mid-adolescence and psychosocial outcomes in late adolescence and early adulthood

AIMS: To describe the pattern of drinking at age 16 and to relate this to outcomes at 16-21 years and 21-25 years across a number of psychosocial domains. DESIGN: A prospective birth cohort study with annual follow-up until age 16 then at 18, 21 and 25 years. SETTING: Christchurch, New Zealand. PARTICIPANTS: Of 1265 subjects, 953 were interviewed at age 16. MEASUREMENTS: Multiple measures of family background were collected from birth to 16 years. Alcohol consumption was measured in terms of frequency, usual or last quantity drunk and most drunk per occasion. Problems were also recorded. Questions about psychiatric symptoms enabled Diagnostic and Statistical Manual (DSM) criteria to be applied. Detailed reports on educational outcomes, employment, sexual behaviours and offending were collected. FINDINGS: Four latent classes were required to describe drinking at age 16, but these appeared to lie along a single dimension which strongly predicted outcomes at ages 16-21 and 21-25 across all domains (alcohol-related, substance dependence, mental health, education, sexual relationships and offending). After controlling for background and correlates only a small number of outcomes were still related consistently to drinking at age 16 over both periods: most alcohol-related outcomes, the number of sexual partners and the extent of violent offending. CONCLUSIONS: Drinking at age 16 is a clear indicator of future life-course over most domains in late adolescence and early adulthood. Many of these associations are due to other covariates. Outcomes specific to drinking at age 16 are alcohol outcomes, number of sexual partners and violence.     

Alcohol-related cirrhosis—early abstinence is a key factor in prognosis, even in the most severe cases

Aims   To determine the effect of pathological severity of cirrhosis on survival in patients with alcohol-related cirrhosis.
Design   Liver biopsies from 100 patients were scored for Laennec score of severity of cirrhosis, and medical notes were reviewed to determine various clinical factors, including drinking status. Up-to-date mortality data were obtained using the National Health Service Strategic Tracing Service.
Setting   Southampton General Hospital between 1 January 1995 and 31 December 2000.
Participants   A total of 100 consecutive patients with biopsy proven alcohol-induced liver cirrhosis.
Measurements   Laennec score of severity of cirrhosis and mortality.
Findings   Most surprisingly, the severity of cirrhosis on biopsy had little impact on survival; indeed, early death was more likely in patients with the least severe cirrhosis. Abstinence from alcohol at 1 month after diagnosis of cirrhosis was the more important factor determining survival with a 7-year survival of 72% for the abstinent patients versus 44% for the patients continuing to drink.
Conclusions   It is never too late to stop drinking, even with the most severe degrees of cirrhosis on biopsy. Early drinking status is the most important factor determining long-term survival in alcohol-related cirrhosis.     

Emotion differentiation in early recovery from alcohol use disorder: Associations with in-the-moment affect and 3-month drinking outcomes

Background

Early recovery from alcohol use disorder (AUD) is commonly associated with high levels of negative affect, stress, and emotional vulnerability, which confer significant relapse risk. Emotion differentiation—the ability to distinguish between discrete emotions—has been shown to predict relapse after treatment for a drug use disorder, but this relationship has not been explored in individuals recovering from AUD.

Methods

The current study used thrice daily random and up to thrice daily self-initiated ecological momentary assessment surveys (N = 42, observations = 915) to examine whether 1) moments of high affective arousal are characterized by momentary differences in emotion differentiation among individuals in the first year of a current AUD recovery attempt, and 2) individuals’ average emotion differentiation would predict subsequent alcohol use measured by the timeline follow-back over a 3-month follow-up period.

Results

Multilevel models showed that moments (Level 1) of higher-than-average negative affect (p < 0.001) and/or stress (p = 0.033) were characterized by less negative emotion differentiation, while moments of higher-than-average positive affect were characterized by greater positive emotion differentiation (p < 0.001). At the between-person level (Level 2), participants with higher stress overall had lower negative emotion differentiation (p = 0.009). Linear regression showed that average negative, but not positive, emotion differentiation was inversely associated with percent drinking days over the subsequent 3-month follow-up period (p = 0.042). Neither form of average emotion differentiation was associated with drinking quantity.

Conclusions

We found that for individuals in early AUD recovery, affective states are associated with acute shifts in the capacity for emotion differentiation. Further, we found that average negative emotion differentiation prospectively predicts subsequent alcohol use.

     

Gender differences in the impact of families on alcohol use: a lagged longitudinal study of early adolescents

Aims From the pre‐teen to the mid‐teen years, rates of alcohol use and misuse increase rapidly. Cross‐sectional research shows that positive family emotional climate (low conflict, high closeness) is protective, and there is emerging evidence that these protective mechanisms are different for girls versus boys. The aim of this study was to explore gender differences in the longitudinal impact of family emotional climate on adolescent alcohol use and exposure to peer drinking networks. Design Three‐wave two‐level (individual, within‐individual over time) ordinal logistic regression with alcohol use in the past year as the dependent measure and family variables lagged by 1 year. Setting Adolescents completed surveys during school hours. Participants A total of 855 Australian students (modal age 10–11 years at baseline) participating in the International Youth Development Study (Victoria, Australia). Measurements These included emotional closeness to mother/father, family conflict, parent disapproval of alcohol use and peer alcohol use. Findings For girls, the effect of emotional closeness to mothers on alcohol use was mediated by exposure to high‐risk peer networks. Parent disapproval of alcohol use was protective for both genders, but this effect was larger for boys versus girls, and there was no evidence that peer use mediated this effect. Peer drinking networks showed stronger direct risk effects than family variables. Conclusions Family factors unidirectionally impact on growth in adolescent alcohol use and effects vary with child gender.     

Alcohol expectancies and drinking in different age groups

Aims Because expectancies about the effects of alcohol change as drinking experience is accumulated, it is likely that the relationship of expectancy to drinking will differ with age. In this study, we examine the prediction of drinking behavior from positive and negative outcome expectancy at different ages. Design Data were collected as part of the National Alcohol Survey, using a multi‐stage area probability sample of the household population of the 48 contiguous United States. Participants US residents aged 12 and older (n = 2875). Measurements Survey questions included drinking habits (frequency, quantity, frequency of drunkenness, maximum quantity) and beliefs about the effects of alcohol (alcohol expectancies). Findings Structural equation models tested the relationship of positive and negative expectancy to drinking behavior in six age groups. Outcome expectancy accounted for a larger portion of the variance in drinking among younger respondents than among older respondents. However, suppression effects were common. When suppression effects were considered, positive expectancy predicted drinking better than negative expectancy only among respondents under 35, while negative expectancy was a better predictor of drinking status in most respondents over 35 years. Among drinkers, positive expectancy predominated over negative expectancy when suppression effects were considered. Conclusions These results suggest that negative expectancy predicts abstention, while positive expectancy predicts level of drinking among drinkers. In expectancy research, differences between drinkers and abstainers, age of participants and the presence of suppression effects should be taken into account.