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Two studies examining environmental predictors of heavy drinking by college students.

Two sequential studies are presented that examine the validity of a set of environmental variables to predict heavy drinking at college students' most recent drinking occasions. Random telephone interviews (n=1609, n=400) of graduate and undergraduate students attending two large public universities in the southwestern United States were conducted during three separate surveys in 2000 and 2001. An original interview schedule was used and it included measures that examined environmental characteristics of students' most recent drinking events, motivations for drinking, demographics, and alcohol consumption. Using nonparametric exploratory and confirmatory discriminant analyses to distinguish between heavy episodic and non-heavy episodic drinking events, a discriminant function was identified that included the following environmental variables: (1) having many people intoxicated at an event, (2) having illicit drugs available at an event, (3) BYOB events and, (4) the playing of drinking games at the event. The validity of these environmental variables to predict heavy drinking among students was supported in a subsequent study examining a separate sample from the same student population. Environmental factors can be useful to predict heavy drinking events experienced by students. Prevention programs would benefit from targeting such factors in combination with more traditional individual-level approaches.

Adolescent↗

Evaluation of the Yale-Brown Obsessive Compulsive Scale (YBOCS-hd) for heavy drinking with mild to moderately dependent alcohol abusers.

BACKGROUND: Many similarities have been noted between urges and desires to drink heavily and obsessive-compulsive disorders (OCD). Based on such similarities, Modell et al. (1992) developed the Yale-Brown Obsessive Compulsive Scale for heavy drinking (YBOCS-hd), a modified version of YBOCS, to assess obsessions and compulsions related to heavy drinking. Evaluation of the YBOCS-hd has been limited to more severely dependent alcohol abusers. METHODS: The present study used a self-administered version of the YBOCS-hd to evaluate (1) the severity of drinking-related obsessive compulsive symptoms with mild to moderately dependent alcohol abusers (problem drinkers), and (2) whether end-of-treatment changes in YBOCS-hd scores would be related to within-treatment functioning. RESULTS: Results indicated that problem drinkers have lower alcohol-related Obsessive and Compulsive subscale scores than did more severely dependent drinkers, but higher scores than did non-problem drinkers, supporting the construct validity of the YBOCS-hd. In addition, at the end of treatment, the YBOCS-hd scores of alcohol abusers who drank at low-risk levels during treatment were significantly lower than the scores of those who drank at high-risk levels. Lastly, exploratory factor analysis did not provide support for the two purported YBOCS-hd subscales (Obsessive, Compulsive). Instead, the analysis yielded a single general factor and a second factor that contained two questions measuring heavy drinking. CONCLUSIONS: Despite the fact that total YBOCS-hd scores covaried with drinking, neither the total YBOCS-hd pretreatment score nor the two subscale scores predicted functioning at the end of treatment. The present results call into question the utility of the YBOCS-hd, because a single item measuring the heaviness of drinking was as useful as the total YBOCS-hd and its two subscales in relating changes during treatment to end-of-treatment functioning for problem drinkers. However, although the YBOCS-hd does not predict changes in drinking, it may have value as an indirect measure of drinking in situations where direct measurement of alcohol consumption is undesirable (i.e., direct measurement might be reactive). Because the present findings are derived from problem drinkers, further research is needed to confirm the factor structure of the YBOCS-hd with clients who represent a broader range of alcohol problem severity.

Adult↗

Episodic heavy drinking in four Nordic countries: a comparative survey.

AIMS: The purpose of this study was to compare the phenomenon of episodic heavy drinking (binge drinking) and its different indicators in the Nordic countries. DESIGN: A comparative survey of four Nordic countries. SETTING: Telephone interviews in Denmark, 1997; Finland, 1996; Norway, 1996; and Sweden 1996-97. PARTICIPANTS: Random samples of men and women aged 19-71 years. MEASUREMENTS: Episodic heavy drinking was measured by the frequency of subjective intoxication, of drinking six or more drinks at a time (6+), and of negative consequences (mainly hangover symptoms). Additionally, annual consumption and measures of intake per occasion were used. FINDINGS: Annual consumption, overall frequency of drinking and frequency of drinking 6+ were highest in Denmark and lowest in Norway. Frequency of subjectively defined intoxication was highest in Finland. There it was clearly higher than the frequency of drinking 6+, whereas in Denmark the contrary was observed. Finnish and Norwegian men and Danish women reported the largest quantities drunk per occasion. Results on 6+ frequency and the prevalence of negative consequences, with annual consumption held constant, suggest that Danes have the least concentrated drinking pattern. With annual consumption held constant, Norwegians report as high a frequency of intoxication, as do Finns. CONCLUSIONS: The relations between subjective and more objective measures of episodic heavy drinking vary considerably between the Nordic countries. The results suggest that the definition, acceptability and experience of intoxication vary even when a set of relatively homogeneous countries are compared.

Adult↗

Chronic active heavy drinking and family history of problem drinking modulate regional brain tissue volumes.

The goals of this study were to measure if chronic active heavy drinking is associated with brain volume loss in non-treatment seeking men and women, and to assess the effect of positive family history of problem drinking on brain structure in heavy drinkers. Automated image processing was used to analyze high-resolution T1-weighted magnetic resonance images from 49 active heavy drinkers and 49 age- and sex-matched light drinkers, yielding gray matter, white matter and cerebrospinal fluid (CSF) volumes within the frontal, temporal, parietal and occipital lobes. Regional brain volume measures were compared as a function of group, sex and their interaction. Within heavy drinkers, volumes were correlated with measures of alcohol consumption and compared as a function of family history of problem drinking. Deformation morphometry explored localized patterns of atrophy associated with heavy drinking or severity of drinking. We found significant gray matter volume losses, but no white matter losses, in active heavy drinkers compared with light drinkers. Women had greater gray matter and smaller white matter and CSF volumes as a percentage of intracranial vault than men. Within heavy drinkers, smaller gray matter volumes were associated with higher current levels of drinking and older age, while a positive family history of problem drinking was associated with smaller CSF volumes. Community-dwelling heavy drinkers who are not in alcoholism treatment have dose-related gray matter volume losses, and family history of problem drinking ameliorates some structural consequences of heavy drinking.

Adult↗

Correlates of heavy drinking and alcohol related problems among men and women in drug treatment programs.

A series of analyses were conducted to explore if there were significant differences in heavy drinking and alcohol-related problems in clients admitted to different types of drug treatment programs and whether such differences, if found, could be attributed to variation in social characteristics, drug use behavior, drinking norms, drinking contexts, or in reasons for combining alcohol and drug use. Men and women (N = 246) in four types of publicly funded treatment programs were interviewed at intake regarding drinking and drug use patterns and related problems. The results of the study showed significant differences in drinking behavior and alcohol-related problems of clients in different treatment modalities. Men in a county jail substance abuse program exhibited the highest frequency of heavy drinking and highest rates of alcohol problems; clients of methadone programs reported the lowest rates and those in therapeutic communities described intermediate rates. A series of regression analyses showed that the only significant predictors of the frequency of heavier drinking and drunkenness were drinking context and reasons for combining alcohol and drug use. In addition, age (youthfulness) was associated with the frequency of getting drunk. The most powerful predictors of alcohol-related problems were the frequency of getting drunk and drinking to enhance the effects of other drugs. Heavy drinking and drinking to prevent getting sick from drugs were also significantly associated with drinking problems. The frequency of drug use (by specific type) and most social characteristics showed no direct association with drinking patterns or problems.

Adult↗

Heavy Drinking and Suicide in Russia.

Russian levels of alcohol consumption and suicide are among the highest in the world. While observers have long suspected an association between the two, they were unable to investigate this hypothesis until recently due to past Soviet secrecy and thus a lack of data. This study took advantage of the newly available data during the post-Soviet era to examine the cross-sectional association between heavy drinking and suicide mortality in Russia. Aggregate mortality data for the Russian regions (n = 78) for the year 2000 were used to measure heavy drinking and suicide rates. Government data were used to control for the regional economic situation and strength of social institutions. Ordinary Least Squares regression was employed to estimate the effect of a proxy for heavy drinking on overall and sex-specific age-adjusted suicide rates. The results showed a positive and significant association between the two, and the association held for overall, male and female rates. These results not only confirmed an association between heavy drinking and suicide in Russia, but when compared to findings from previous studies of other countries they led to the hypothesis that a nation's beverage preference may be as important as its wet/dry drinking culture in its sensitivity of suicide rates to alcohol consumption.

Journal Article↗

Psychosocial and behavioral factors in early adolescence as predictors of heavy drinking among high school seniors.

OBJECTIVE: Most adolescents experiment with alcohol, and the use of alcohol typically escalates during the teenage years. The present study examined how several risk and protective factors measured during early adolescence were associated with heavy drinking in a sample of high school seniors. METHOD: As part of a school-based survey, seventh-grade students (N = 1,132) reported degrees of experimentation with alcohol and cigarettes. Several psychosocial factors deemed to be important in the etiology of drinking were also assessed. Students were followed-up in the twelfth grade, when 16% were categorized as heavy drinkers based on drinking and drunkenness frequency and quantity typically consumed. RESULTS: Logistic regression analyses revealed that heavy drinking was predicted by having had experimented with alcohol or cigarettes, having had a majority of one's friends drink and having had poor behavioral self-control in early adolescence. In addition, several effects were limited to either boys or girls. For example, positive alcohol expectancies predicted greater later heavy drinking in boys, while friends' smoking predicted later heavy drinking in girls. CONCLUSIONS: The findings suggest that early intervention programs aimed at preventing alcohol use by addressing the social and psychological determinants of alcohol use may have important preventive effects in terms of later heavy drinking.

Adolescent↗

Longitudinal associations between fathers' heavy drinking patterns and children's psychosocial adjustment.

Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique patterns of heavy drinking in alcoholic fathers were identified through cluster analysis. The results demonstrated significant and meaningful associations between these drinking patterns in fathers and adjustment problems in children over time. Overall, children whose fathers remained mostly abstinent following their treatment showed lowest and decreasing adjustment problems, while children whose fathers continued and increased heavy drinking following their treatment showed greatest and increasing adjustment problems over time.

Adaptation, Psychological↗

The combined use of the early detection of alcohol consumption (EDAC) test and carbohydrate-deficient transferrin to identify heavy drinking behaviour in males.

The aim of this study was to determine the efficacy of the combined use of carbohydrate-deficient transferrin (CDT) and the Early Detection of Alcohol Consumption (EDAC) test to assess heavy drinking in a population of males (n = 187) drinking an average of 20 drinks per day. Heavy drinkers (n = 138) and light drinkers (n = 49) were analysed in three ways: using the EDAC test alone, using the CDT test alone and using the EDAC and CDT tests combined. The EDAC method uses linear discriminant function to analyse a battery of routine laboratory tests that generate a score for each subject and its associated probability value. This translates into the likelihood of each individual being a heavy or a light drinker. CDT uses ion-exchange chromatography to extract CDT in the serum and quantifies it by radioimmunoassay. The EDAC alone showed 88% (122/138) sensitivity rate when identifying heavy drinking males and 98% (48/49) specificity rate when assessing light drinkers. The CDT test alone showed a sensitivity rate of 58% (80/138) and a corresponding specificity rate of 96% (47/49). When analysed in parallel, 92% (127/138) of heavy drinkers showed abnormal EDAC and/or CDT tests and 94% (46/49) of light drinkers were negative for both tests. When analysed sequentially, the CDT test confirmed 61% (75/122) of the heavy drinkers identified by the EDAC test. Specificity rate for this testing strategy was 100%, because the only false positives for EDAC tested negative for CDT. This preliminary study shows that EDAC and CDT may react independently to alcohol intake and can be combined for maximum diagnostic accuracy.

Adult↗

Social anxiety, alcohol expectancies, and self-efficacy as predictors of heavy drinking in college students.

Burke and Stephens (1999) [Burke, R.S., Stephens, R.S. Social anxiety and drinking in college students: A social cognitive theory analysis. Clinical Psychology Review, 19, (1999) 513-530.] proposed a social cognitive theory of heavy drinking in college students. According to this theory, alcohol expectancies for social facilitation and self-efficacy for refusing heavy drinking in anxiety-producing social situations moderate the relationship between social anxiety and drinking. In the current study, a significant three-way interaction was observed among social anxiety, expectancies, and self-efficacy when amount and frequency of drinking was the dependent variable. As predicted by the model, socially anxious college students with low self-efficacy for avoiding heavy drinking in social situations and high positive expectancies for social facilitation reported more alcohol consumption than other socially anxious individuals.

Adolescent↗

Heavy drinking in hospital patients.

The study examines the prevalence of high consumption of alcohol among the patients of a large university hospital, and the ability of physicians to detect heavy drinking. According to self-report, the results of CAGE questionnaire or the physicians' opinion, 25% of the male and 11% of the female patients were heavy drinkers. The physicians identified 43% and 26% of the men and women who screened positively either according to CAGE or self-report. On the other hand, 17% of the men and 14% of the women who were identified by the physicians as heavy drinkers had a negative screening result. Heavy drinking was most often connected with psychiatric disorders, but it was present in all specialties. A wide range of diagnoses were found among abusers. It is concluded that all patients in all clinics should be asked about their drinking habits instead of relying solely on the physician's instinct or on the patient's self-report or CAGE. More individual interviews should be done to make possible early intervention in heavy drinking.

Adolescent↗

Use of biomarkers of heavy drinking in health care practice.

Several biochemical tests are available to screen for heavy drinking in patients. Most of these (e.g., liver function tests and macrocytic volume) rise due to adverse effects of alcohol on organs or the organ's functions. Carbohydrate-deficient transferrin, however, seems to elevate because of the direct action of alcohol or one of its metabolites. A second valuable contribution of biomarkers is identification of relapse events in recovering alcoholics that either would not be voluntarily reported or reported only much later. Finally, providing feedback to patients in treatment based on their biomarker values and changes in them during the course of treatment can enhance motivation, a key component in recovery from alcohol problems. The current article offers a clinical rationale for routine use of biomarkers of heavy drinking in health care practice and proposes recommendations on how they might be best used.

Alanine Transaminase↗

A time-series analysis of the impact of heavy drinking on homicide and suicide mortality in Russia, 1956-2002.

AIM: Assess the impact of heavy drinking on homicide and suicide mortality in Russia between 1956 and 2002. MEASURES AND DESIGN: Alcohol-related mortality was used as a proxy for heavy drinking. We used autoregressive integrated moving average techniques to model total and sex-specific alcohol-homicide and alcohol-suicide relationships at the population level. FINDINGS: We found a positive and significant contemporaneous association between alcohol and homicide and between alcohol and suicide. We found no evidence of lagged relationships. These results held for overall and sex-specific associations. CONCLUSION: Our results lend convergent validity to the alcohol-suicide link in Russia found by Nemtsov and to the alcohol-homicide associations found in cross-sectional analyses of Russia. Levels of alcohol consumption, homicide and suicide in Russia are among the highest in the world, and the mounting evidence of the damaging effects of consumption on the social fabric of the country reveals the need for intervention at multiple levels.

Alcohol Drinking↗

Serum beta-hexosaminidase as a marker of heavy drinking.

Beta-hexosaminidase, also called N-acetyl-beta-D-glucosaminidase, is a lysosomal glycosidase, which has been found to be increased in the sera of alcoholics admitted to acute detoxification treatment. To study serum beta-hexosaminidase (beta-HEX) as a marker of heavy drinking, it was compared with GGT, ASAT, and ALAT in three study groups: twenty-five drunken arrestees, 16 social drinkers, and 27 teetotallers. Mean serum beta-HEX levels were two times higher among drunken arrestees than among social drinkers or teetotallers. Average daily alcohol intake during the preceding 30 days in the pooled group of drunken arrestees and social drinkers correlated positively (r = 0.69; p less than 0.0001) with serum beta-HEX. The sensitivity of beta-HEX in the detection of heavy drinking, defined as over 60 g ethanol daily, was 85.7% compared to 47.6% for GGT. The specificity of beta-HEX was 97.6%. The positive correlations between beta-HEX and ASAT (r = 0.74; p less than 0.0001) and ALAT (r = 0.41; p less than 0.05) indicate that increased serum beta-HEX level may reflect early liver injury. Serum beta-HEX seems to be a sensitive biological marker of heavy drinking reflecting better the ingested amounts of alcohol than GGT.

Adult↗

Screening for heavy drinking and alcohol-related problems in young university students: the CAGE, the Mm-MAST and the trauma score questionnaires.

The efficacy of the CAGE questions, the Malmö modification of the MAST questionnaire (Mm-MAST) and Skinner's five-item trauma score were used as a part of a larger health questionnaire in a sample of 1,663 female and 707 male first-year university students in Finland. The Mm-MAST correlated well (0.51-0.66) to reported alcohol intake and drinking for intoxication, the correlation (0.30-0.39) to CAGE was not as high but significant (p < .001). The trauma score did not correlate significantly to reported alcohol intake. Sensitivity and specificity for Mm-MAST > or = 3 in detecting heavy drinking, defined as a reported consumption of pure ethanol per year of at least 10 kg for women and at least 15 kg for men, was 63.8% and 87.1%, respectively, for female students and 86.3% and 87.4% for male students. Mm-MAST can be recommended as a useful screening tool for heavy drinking and alcohol-related problems in young university students. It is more specific and more sensitive than the CAGE questionnaire in this population. Skinner's trauma score was not useful for the screening of heavy drinking among young university students.

Adolescent↗

Alternative definitions of high risk for impaired driving: the overlap of high volume, frequent heavy drinking and alcohol dependence.

This paper examines the distributions of past-year volume of ethanol intake, frequency of drinking 5+ drinks and alcohol dependence in a representative sample of 18,352 U.S. current drinkers aged 18 years or over. Within categories defined by these three partially overlapping domains, it presents rates of self-perceived impaired driving, i.e. driving after having had too much to drink, in the year preceding interview. High volume drinkers, those with an average daily ethanol intake of 1 ounce or more, composed 19.7% of current drinkers and accounted for 66.5% of all reported ethanol consumption, 72.6% of all heavy drinking days, 49.2% of all alcohol dependence and 62.8% of all impaired driving incidents. Frequent heavy drinkers, those who drank 5+ drinks at least once a week, composed 12.3% of current drinkers and accounted for 42.9% of all reported ethanol consumption, 81.9% of all heavy drinking days, 40% of all alcohol dependence and 57% of all impaired driving incidents. Drinkers with DSM-IV alcohol dependence composed 9.9% of current drinkers and accounted for 28.9% of all reported ethanol consumption, 37% of all heavy drinking days and 56.9% of all impaired driving incidents. The overlap of these three high risk groups, each of which had a probability of at least one impaired driving incident per year, was far from complete. Of individuals who met any of these criteria for high risk drinking (i.e. high volume, frequent heavy drinking or dependence), more than half met only one criterion and only one in seven met all three. The group that did meet all three criteria had such a high rate of impaired driving incidents, an average of 5.14/year, that it accounted for 36.4% of all such incidents despite making up only 3.8% of all current drinkers. The results are discussed in terms of their implications for targeting prevention and intervention efforts, e.g. whether targeting one problematic aspect of drinking behavior will reach drinkers with other types of problem behaviors as well.

Accidents, Traffic↗

Effectiveness of structured questionnaires for screening heavy drinking in middle-aged women.

BACKGROUND: There is a need for an effective and feasible alcohol screening instrument. The aim of the study was to evaluate how the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire perform in comparison with the original AUDIT and what the optimal cutoffs are when screening for heavy drinking among women. METHODS: All the 40-year-old women in the city of Tampere, Finland, are invited yearly for a health screening. From 1 year, data from 894 women (response rate 68.2%) invited for a health screening were utilized in the study. The original 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, AUDIT-3, AUDIT-QF, and CAGE were evaluated against the Timeline Followback. Consumption of at least 140 g of absolute ethanol per week on average during the past month was considered heavy drinking. RESULTS: In the Timeline Followback, the mean+/-SD weekly reported alcohol consumption was 45+/-67 g (range 0-936 g) of absolute ethanol. Of the women, 6.2% (55/894) were heavy drinkers. The optimal combination of sensitivity and specificity was reached for the AUDIT with cutoff > or =6, for the AUDIT-C with cutoff > or =5, for the Five Shot with cutoff > or =2.0, for the AUDIT-PC with cutoff > or =4, and for the AUDIT-QF with cutoff > or =4. When choosing the optimal cutoffs, the AUDIT-C, the Five Shot, the AUDIT-PC, and the AUDIT-QF performed as well as the 10-item AUDIT. With these cutoffs, sensitivities were 0.84 to 0.93 and specificities were 0.83 to 0.90. The AUDIT-3 and the CAGE did not perform as well as the other questionnaires. CONCLUSIONS: The 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, and AUDIT-QF seem to be equally effective tools in screening for heavy drinking among middle-aged women. However, their applicability is achieved only if the cutoffs are tailored according to gender.

Alcoholism↗