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PubMed1996

The role of heavy drinking in the risk of traffic fatalities.

Recent studies have identified a "hard core" of drinking drivers who do not fit a "social" drinker profile and may require medical intervention. This article builds on these studies by quantifying the role of heavy drinking in motor vehicle fatalities. Data on male alcohol-involved fatally injured drivers (AIFIDs) were obtained from the U.S. Fatal Accident Reporting System (FARS) for the years 1989-1990 (n = 8876). The AIFIDs were grouped into either a "heavy" or "light" drinking category based on drinking behaviors inferred from prior driving records and blood alcohol concentrations (BAC). The majority of male AIFIDs were between the ages of 20-39 (70%). Sixty-five percent had a BAC of 150 mg/dl or greater, and 41% had a BAC in excess of 200 mg/dl. AIFIDs with high BACs were more likely to have histories of DUI convictions and license suspensions than AIFIDs with low BACs. According to the study's criteria, 73% percent of the AIFIDs could be classified as "heavy" drinkers. There were no driving variables that differentiated the heavy and light drinker groups, indicating that heavy drinking per se is the primary factor that distinguishes the groups. Male alcohol-involved fatally injured drivers are comprised mostly of heavy drinkers who may suffer from serious drinking problems or alcoholism. Successful interventions may require medical treatment as well as punitive criminal justice policies.

Accidents, Traffic↗

PubMed1998

Joint influence of alcohol, tobacco, and coffee on biological markers of heavy drinking in alcoholics.

BACKGROUND: Recent reports suggest that gamma-glutamyl transferase (GGT) decreases with coffee intake. The aim of this study was to examine the joint influence of alcohol, tobacco, cotinine, coffee, and caffeine on biological markers of heavy drinking in an alcoholic population. METHODS: Subjects were 160 alcohol-dependent inpatients. Biological assessments, performed at admission, were plasma levels of GGT, apolipoprotein AI, aspartate aminotransferase, and mean corpuscular volume (MCV), and urine cotinine and caffeine indexes. Years of alcohol abuse and of smoking, alcohol and coffee intake, and smoking rate were estimated in a semistructured interview, and Fagerström Tolerance Questionnaire was completed by inpatients. RESULTS: Coffee intake, but not caffeine, correlated negatively with biological markers of heavy drinking, after controlling for alcohol and tobacco intake. Years of smoking correlated positively to MCV, after controlling for alcohol and coffee intake. CONCLUSIONS: Concerning the effect of coffee, the most likely hypothesis is that noncaffeine coffee fractions have a protective effect on liver cells. Concerning the effect of smoking, one can propose that the increase of MCV with smoking could be a consequence of carbon monoxide inhalation, leading to hypoxemia, or of folate deficiency.

Adult↗

PubMed2006

Using routine laboratory tests to detect heavy drinking in the general population.

This article describes a new biomarker known as the Early Detection of Alcohol Consumption (EDAC) test, which has been steadily penetrating the U.S. market. The EDAC uses routine laboratory tests to make a prediction of heavy drinking in any given person. When tested in mainstream insurance populations, the EDAC has shown twice the specificity of the traditional liver enzyme tests and is significantly more sensitive than the CDT test, which is expected because the EDAC uses a combination of laboratory tests. Maximum diagnostic accuracy is achieved when the CDT test is used to confirm a positive EDAC test. Since brief interventions have proven successful, the early identification of alcohol problems becomes a vital role for physicians. Improved awareness of alcohol misuse can certainly be accomplished through an increased use of biomarkers, with and without concomitant self-report. The ultimate goal is to facilitate early intervention and the successful management of patients diagnosed with heavy drinking.

Adolescent↗

PubMed2002

A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood.

OBJECTIVE: This article offers a developmental perspective on college drinking by focusing on broad developmental themes during adolescence and the transition to young adulthood. METHOD: A literature review was conducted. RESULTS: The transition to college involves major individual and contextual change in every domain of life; at the same time, heavy drinking and associated problems increase during this transition. A developmental contextual perspective encourages the examination of alcohol use and heavy drinking in relation to normative developmental tasks and transitions and in the context of students' changing lives, focusing on interindividual variation in the course and consequences of drinking and on a wide range of proximal and distal influences. Links between developmental transitions and alcohol use and other health risks are discussed in light of five conceptual models: Overload, Developmental Mismatch, Increased Heterogeneity, Transition Catalyst and Heightened Vulnerability to Chance Events. We review normative developmental transitions of adolescence and young adulthood, focusing on the domains of physical and cognitive development, identity, affiliation and achievement. CONCLUSIONS: As shown in a selective review of empirical studies, these transitions offer important vantage points for examining increasing (and decreasing) alcohol and other drug use during adolescence and young adulthood. We conclude with a consideration of research and intervention implications.

Adolescent↗

PubMed1988

Organic mental disorders associated with heavy drinking and alcohol dependence.

Wernicke and Korsakoff first described their respective syndromes in the late nineteenth century, and they were linked to each other and to thiamine deficiency by the 1940s. Korsakoff's syndrome (alcohol amnestic disorder) became almost synonymous with alcohol-related organic mental disorder because of the apparent simplicity of its manifestations and pathology, while other, more diffuse cerebral dysfunction was relegated to the poorly defined term alcoholic dementia. Work in neuropsychology, pathology, and imaging studies during the last 15 years has resulted in a new understanding of the interactions of heavy drinking, nutritional deficiency states, premorbid factors, and associated medical pathology, such as head trauma. Heavy drinking appears to result in cortical deficits and mild to moderate amnesia (intermediate brain syndrome) through an interaction of direct neurotoxicity and premorbid and associated factors. Alcohol amnestic disorder seems to result from the synergistic combination of drinking, malnutrition, and genetic vulnerability to thiamine deficiency. Dementia associated with alcoholism is most likely a combination of intermediate brain syndrome and alcohol amnestic disorder.

Aged↗

PubMed2004

Prevention of heavy drinking and associated negative consequences among mandated and voluntary college students.

The Lifestyle Management Class (LMC) was evaluated as a universal and targeted alcohol prevention program among voluntary and mandated college students. The relative efficacy of peer- and professional-led group interventions was also tested in this randomized, controlled design. LMC participants showed decreases in driving after drinking relative to control participants. Changes in heavy drinking varied as a function of treatment condition, readiness to change, and gender, with a trend toward larger decreases among voluntary LMC participants high in readiness to change and a comparable though nonsignificant advantage for male LMC participants in the mandated sample. The LMC was comparably effective for mandated and voluntary students, with no clear advantage for peer- or professional-led groups.

Achievement↗

PubMed2006

HFE genotypes in decompensated alcoholic liver disease: phenotypic expression and comparison with heavy drinking and with normal controls.

OBJECTIVES: Predisposition to alcoholic liver disease (ALD) may be partly genetic. Heterozygosity for the HFE mutations C282Y and/or H63D has been associated with more severe disease in several liver conditions. Studies in ALD have not used controls matched for alcohol consumption and results have been conflicting. METHODS: HFE genotyping was performed in two Caucasian heavy-drinking cohorts (>60 units/wk (M) or 40 units/wk (F) for >5 yr): (a) 254 patients with decompensated ALD (Child's grade B or C), (b) 130 controls with similar alcohol consumption but without liver disease. Results in males were also compared with those from another study of healthy male blood donors. RESULTS: (1) Genotype distributions for the C282Y and H63D mutations were similar in ALD patients, heavy-drinking controls, and healthy blood donors. (2) ALD patients with and without HFE mutations had similar disease severity, age at presentation, and alcohol consumption. (3) Increased serum ferritin and % transferrin saturation were seen in 63% and 29% of ALD patients, regardless of HFE genotype; the increased % transferrin saturation was due to reduced unsaturated iron binding capacity, rather than increased serum iron. (4) Stainable liver iron was present in 52% of patients; grade was greater in patients with two HFE mutations than in those with one or with none. (5) Only the two C282Y homozygote patients had substantial iron overload. CONCLUSIONS: Although serum iron abnormalities are common, C282Y and H63D mutation frequencies were not increased in heavy drinkers with decompensated liver disease. HFE mutations, although modestly influencing liver iron, do not predispose to clinically significant ALD.

Alcohol Drinking↗

PubMed1994

Detection by the CAGE of alcoholism or heavy drinking in primary care outpatients and the general population.

There is a need to improve the diagnosis of alcoholism in clinical settings because alcoholism, particularly in its early stages, is often unrecognized in general medical practice and in hospitals. In this study the CAGE questionnaire was used to detect alcoholism or heavy drinking in three populations, namely, alcoholics in treatment (ALC), primary-care outpatients (PC), and the general population (GP). Nearly all the ALC tested positive on the CAGE (97.8%), both for current (past year) and for lifetime alcohol-related problems. Among the PC subjects, 44.8% tested positive for lifetime alcohol problems, but the prevalence decreased to 17.2% when only past-year problems were considered. Likewise, 38.3% of the GP sample tested positive for lifetime, but half of these did not meet the 1-year recency criterion. Compared to DSM-III-R criteria during the same time intervals, the sensitivity/specificity of the lifetime CAGE was 91.2%/84.0% and 76.9%/85.1% in the PC and GP, respectively. The corresponding sensitivity/specificity of the past-year CAGE was 94.4%/97.0% and 74.6%/91.6%, respectively. Thus, the CAGE is an appropriate screening test for alcohol problems in these two populations, but other confirmatory tests or interviews are necessary to eliminate false positives. There were neither gender nor racial differences in the ALC sample responses to individual CAGE questions. However, there were gender differences in the PC and GP samples, with more males responding yes to each of the questions. The gender differences probably reflected the higher prevalence of heavy drinking and alcoholism among males.

Adolescent↗

PubMed1995

Effects of normative feedback on consumption among heavy drinking college students.

College students, particularly those who drink heavily, tend to overestimate the prevalence of heavy drinking among their peers. A self-regulation model predicts that feedback of undesirable deviation from normative standards would result in correction of behavior toward perceived norms. From a screening of 568 college students, sixty-four heavy drinkers were identified and offered the opportunity to participate in a survey study of drinking. Of these, twenty-six accepted and returned questionnaires with detailed information regarding their drinking practices. These were randomized to receive or not receive, by return mail, personal feedback of their drinking relative to population norms. At an independent follow-up interview, feedback subjects showed greater reduction in weekly consumption and typical intoxication levels, relative to controls. This simple feedback intervention, requiring no personal contact, may be a cost-effective strategy for reducing risky drinking.

Adult↗

PubMed1991

beta-Hexosaminidase in the detection of alcoholism and heavy drinking.

The activities of beta-hexosaminidase (HEX), a lysosomal glycosidase, were studied in serum (sHEX) and urine (uHEX) among men with various drinking habits. Among 32 alcoholics, on the admission to the inpatient detoxification treatment, and among 25 drunkenness arrestees the average sHEX levels were twofold as compared with social drinkers (n = 16) or teetotallers (n = 27). The average urinary excretion of HEX was three times higher among alcoholics than teetotallers. In the detection of heavy drinking (over 60 g of 100% ethanol daily) sHEX and uHEX were more sensitive than serum gamma-glutamyltransferase (sGGT) both in alcoholics (sHEX = 69%, uHEX = 81%, sGGT = 48%) and in drunkenness arrestees (sHEX = 86%, sGGT = 66%). SHEX correlated positively with sASAT (r = 0.46 and 0.74; p < 0.01) and sALAT (r = 0.41 and 0.47; p < 0.01), but not with sGGT. The specificity of sHEX was 98% and that of uHEX 96%. The abstinence of 7-9 days had a significant decreasing effect on sHEX, but not on uHEX. Controlled moderate drinking (60 g of alcohol daily for ten days) was rapidly reflected on sHEX levels but not on uHEX levels. It is concluded that both sHEX and uHEX are sensitive laboratory markers of alcoholism and heavy drinking. As compared to each others sHEX may better reflect recent alcohol intake, whereas uHEX stays longer elevated after the cessation of drinking. HEX can be determined with a simple and inexpensive spectrophotometric method.

Alcohol Drinking↗

PubMed2005

Neighborhood disorder, psychological distress, and heavy drinking.

Studies show that residents of disadvantaged neighborhoods drink more heavily than residents of more affluent neighborhoods. However, explanations for this association are not well developed. Using data collected from a sample of low-income women with children from Boston, Chicago, and San Antonio, we explore the possibility that perceptions of neighborhood disorder encourage heavy drinking. Drawing on Conger's (Q. J. Stud. Alcohol 17 (1956) 296) tension reduction hypothesis, we propose that the stress of living in a neighborhood characterized by problems with drugs, crime, teen pregnancy, unemployment, idle youth, abandoned houses, and unresponsive police can be psychologically distressing and lead some people to consume alcohol as a means of palliative escape, to regulate feelings of anxiety and depression. In support of the tension reduction hypothesis, we find that the positive association between neighborhood disorder and heavy drinking is largely mediated by anxiety and depression.

Adult↗

PubMed2000

Heavy drinking, alcohol dependence, and injuries at work among young workers in the United States labor force.

BACKGROUND: To determine whether heavily drinking and alcohol-dependent workers are at higher risk of occupational injury, we analyzed the nationally representative cohort of people enrolled in the National Longitudinal Survey of Youth since 1979. METHODS: This analysis was restricted to the 8569 respondents in the 1989 annual interview (age 24-32) who were employed during the 6 months before the interview. We studied occupational injuries (excluding sprains or strains) reported within 6 months of the interview in 1989 (cross-sectional analysis) and 1990 (prospective analysis). RESULTS: Among current drinkers, significant two-fold increases in the odds of injury for one or more episodes of heavy drinking were reduced to an odds ratio (OR) of 1.2 (95% confidence interval [CI] = 0.7, 2.1) in the cross-sectional analysis and an OR of 1.6 (CI 1.0, 2.8) in the prospective analysis after adjustment for confounding. No dose-response relationship with the frequency of heavy drinking was found. Alcohol-dependent respondents were not at higher risk of injury in the cross-sectional (OR = 1.1, CI 0.7, 1.8) or prospective (OR = 1.3,CI 0.8, 2.2) analyses after adjustment for confounding. CONCLUSIONS: For young U.S. workers, common occupational injuries (excluding sprains and strains) may not be strongly associated with alcohol dependence. Confounding by other risk factors may explain much of the association between being a heavy drinker and occupational injuries in this population.

Accidents, Occupational↗

PubMed2006

Novelty seeking involved in mediating the association between the dopamine D4 receptor gene exon III polymorphism and heavy drinking in male adolescents: results from a high-risk community sample.

BACKGROUND: Previous research suggests that personality traits, particularly novelty seeking (NS), increase the risk of substance abuse. One possible explanation to account for this association relates to common genetic factors. The aim of this study was to examine whether allelic variants of the dopamine D4 receptor gene (DRD4) are associated with alcohol use in adolescents and to determine the extent to which these links are mediated by NS. METHODS: Three hundred three adolescents (144 male participants, 159 female participants, approximately 15 years old) from a high-risk community sample completed self-report questionnaires measuring alcohol intake and temperament (Junior Temperament and Character Inventory [JTCI]). DNA was genotyped for the DRD4 exon III polymorphism. RESULTS: Male participants carrying the 7-repeat allele of DRD4 drank higher maximum amounts of alcohol per occasion and had greater lifetime rates of heavy drinking than male participants without this allele. Higher levels of NS were associated with higher alcohol intake in both genders. Multiple regression analyses support the role of NS in mediating the relationship between DRD4 and heavy drinking in male adolescents but not in female adolescents. CONCLUSIONS: These findings extend previous work highlighting the significance of personality traits as a mediating factor between genetic susceptibility and substance use during the period of early experimental use.

Adolescent↗

PubMed1999

Recent heavy drinking of alcohol and embolic stroke.

BACKGROUND AND PURPOSE: Epidemiological evidence suggests that heavy alcohol consumption increases the risk for ischemic stroke, whereas light-to-moderate alcohol intake decreases the risk, but the role of different drinking patterns has remained unclear. We investigated recent light, moderate, and heavy alcohol drinking and former heavy drinking as risk factors for acute ischemic brain infarction by etiological subtype of stroke. METHODS: We compared 212 consecutive patients aged between 16 and 60 years, who were completely evaluated for the etiology of their ischemic stroke, with 274 control subjects admitted to the emergency unit of the same hospital. ORs, as estimates of multivariate relative risks (RRs), and 95% CIs after adjustment for possible confounding variables were calculated by logistic regression. The ORs were adjusted for age, sex, body mass index, hypertension, diabetes, hyperlipemia, current smoking, and history of migraine. RESULTS: Recent heavy drinking but not former heavy drinking was an independent risk factor for stroke (RR 1.82, 95% CI 1.08 to 3.05). Consumption of 151 to 300 g and >300 g alcohol within the week preceding the onset of stroke significantly increased the risk for cardioembolic and cryptogenic stroke. Consumption of >40 g alcohol within the preceding 24 hours increased the risk for cardiogenic embolism to the brain among those who had a high-risk source (RR 4.75, 95% CI 1.23 to 18.4), the risk for tandem embolism among those who had prominent large-artery atherosclerosis (RR 7.68, 95% CI 1.82 to 32.3), and the risk for cryptogenic stroke (RR 3.84, 95% CI 1.69 to 8.71). Light drinking did not increase the risk for stroke. CONCLUSIONS: We conclude that acute drinking of intoxicating amounts of alcohol may trigger the onset of embolic stroke among subjects who have a source of thrombus in the heart or the large arteries.

Adolescent↗

PubMed2000

Progression of consequences among heavy-drinking college students.

Among a sample of 180 male and 226 female undergraduates, 84.2% reported a heavy drinking episode (5+ drinks for men, 4+ for women) within the previous 90 days. Principal-components analysis revealed 3 alcohol-related problem factors among the heavy drinkers (Careless Behavior, Risky/Reckless Behavior, and Authority Problems). Nearly all heavy drinkers experienced a careless behavior that was due to drinking (92.7%), and many reported a risky/reckless behavior (60.2%), yet only one third (33.9%) experienced an authority problem. Guttman scaling procedures revealed a progression from Careless Behavior to Reckless/Risky Behavior to an Authority Problem. Heavy drinkers with an authority problem drank more frequently, consumed more when drinking, endorsed more alcohol expectancies, and reported earlier ages of initial and regular drinking than other groups.

Adult↗

PubMed1986

Haematological findings in chronic alcoholics after heavy drinking with special reference to haemolysis.

Haematological abnormalities are frequently found in heavy-drinking chronic alcoholics, but anaemia is generally a rare complication. When present, haemolysis is considered to be one of the most common causes. However, little is known about mild haemolysis without anaemia. The present report on eighteen male chronic alcoholics with a recent heavy debauche but without signs of severe liver disease gave support for the occurrence of a reversible low-degree haemolysis without concomitant gross changes of the erythrocytes. Thus the bone marrow showed an increased erythropoiesis in the absence of iron deficiency and known blood losses. Further, increased reticulocyte counts and low levels of haemopexin were noted in the early abstinence. Finally, during the withdrawal phase haptoglobin and haemopexin increased concomitantly with diminishing values of unconjugated bilirubin. The most likely cause of the proposed diminished red cell survival before the withdrawal is supposed to be a reduced membrane stability.

Adult↗

PubMed2003

Does heavy drinking affect academic performance in college? Findings from a prospective study of high achievers.

OBJECTIVE: This study examined the effects of heavy drinking, alcohol-related problems and drinking opportunities on academic performance (grade point average [GPA]) in a prospective cohort of college students attending the University of California at Berkeley. METHOD: Several waves of survey data were collected from 465 students beginning in the summer prior to their freshman year. Cross-sectional and regression analyses were conducted to determine whether heavy alcohol use, alcohol-related problems and drinking opportunities were associated with college GPA before and after controlling for demographics and high school GPA. RESULTS: Cross-sectional analyses generally revealed modest and nonsignificant associations between college GPA and measures of heavy alcohol use, alcohol-related problems and drinking opportunities in the first year of college. High school GPA was modestly associated with both heavy alcohol use and college GPA. Only a summative measure of alcohol-related academic problems was significantly associated with college GPA, but this relationship did not persist in a regression model that included high school GPA and student demographic characteristics as control variables. CONCLUSIONS: Heavy alcohol use, alcohol-related problems and drinking opportunities do not appear to have an important effect on students' academic performance, but additional research with longitudinal data from representative student samples is needed to confirm these findings.

Adolescent↗

PubMed2003

Alcohol culture, family structure and adolescent alcohol use: multilevel modeling of frequency of heavy drinking among 15-16 year old students in 11 European countries.

OBJECTIVE: Frequency of heavy alcohol use among adolescents is examined by family structure and propensity toward heavy alcohol use on the individual level, and by alcohol availability and drinking patterns among adolescents on the societal level. The analysis includes direct effects and moderating effects of societal-level indicators on individual-level associations between family structure and frequency of heavy alcohol use. METHOD: The study drew upon self-reports from 34,001 students in Cyprus, France, Hungary, Iceland, Ireland, Lithuania, Malta, the Slovak Republic, Slovenia, Sweden and the United Kingdom participating in the 1999 European School Survey Project on Alcohol and Other Drugs study. Distinctions were drawn between adolescents living with both parents, a single mother, a single father, a mother and stepfather, a father and stepmother, and neither biological parent. The multilevel analysis estimated the effects of societal-level factors on the intercepts and slopes of individual-level regression models. RESULTS: Adolescents living with both biological parents engaged less frequently in heavy alcohol use than those living in any other arrangements. Living with a single mother was associated with less heavy drinking than living with a single father or with neither biological parent. National beer sales figures and societal patterns of heavy adolescent alcohol use predicted more frequent heavy drinking and greater effects of living in nonintact families. CONCLUSIONS: Adolescent heavy drinking is more common in all types of nonintact families. The adverse effect of living in nonintact families is greater in societies where alcohol availability is greater and where adolescents drink more heavily.

Adolescent↗