Patterns of use and their relationship to DSM-IV abuse and dependence of alcohol among adolescents and young adults

First use and initiation of regular alcohol use has been frequently found to start in adolescence. However, only few studies have also investigated how many adolescents proceed during ages 14-24 to harmful drinking or even develop alcohol use disorders. This paper - using the EDSP baseline sample of 3,021 community respondents from the Munich area - examines the prevalence of use, abuse and dependence and investigates the dose/disorder relationship. Alcohol abuse was reported by 9.7% of respondents and alcohol dependence by 6.2%. Men were more likely to report an alcohol disorder than women, prevalence also increased in the older age cohorts. However, even among 14- to 17-year-olds a substantial proportion of respondents report high and regular consumption rates, the occurrence of abuse and dependence criteria and even a full dependence syndrome. There is however only a moderate association between average number of standard drinks consumed with the risk of developing abuse and dependence. In light of the substantial rates among adolescents and young adults the validity of DSM-IV alcohol disorder criteria is discussed.     

Drinking to cope and alcohol use and abuse in unipolar depression: A 10-year model.

This study examined drinking to cope with distress and drinking behavior in a baseline sample of 412 unipolar depressed patients assessed 4 times over a 10-year period. Baseline drinking to cope operated prospectively as a risk factor for more alcohol consumption at 1-, 4, and 10-year follow-ups and for more drinking problems at 1- and 4-year follow-ups. Findings elucidate a key mechanism in this process by showing that drinking to cope strengthened the link between depressive symptoms and drinking behavior. Individuals who had a stronger propensity to drink to cope at baseline showed a stronger connection between depressive symptoms and both alcohol consumption and drinking problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol consumption and the 5-year incidence of age-related maculopathy: the Beaver Dam eye study

OBJECTIVE: This study evaluated alcohol consumption as a risk factor for incidence of age-related maculopathy (ARM). DESIGN: Persons aged 43 to 86 years in 1988 in Beaver Dam, Wisconsin, were examined from 1988 through 1990 and 1993 through 1995, n = 3684. The presence and severity of ARM at both examinations were determined from gradings of stereoscopic fundus photographs using the Wisconsin Age-related Maculopathy Classification System. Alcohol consumption was determined by self-report. RESULTS: Men drinking at least 78 g/week of alcohol from beer had a higher 5-year age-adjusted incidence of early ARM (10.6%) than did men who did not drink beer (6.9%), but the test for trend was only borderline significant (P = 0.08). However, incidence of soft indistinct drusen (P = 0.01), increased drusen area (P < 0.01), and confluent drusen (P = 0.02) are all associated with beer drinking in men. Increased retinal pigment and retinal pigment epithelial depigmentation are not associated with beer drinking in men or women nor are any lesions associated with total alcohol consumption or consumption from liquor or wine in either men or women. CONCLUSIONS: Except for an association of beer drinking with retinal drusen in men, consumption of alcoholic beverages is not likely to be an important risk factor for incidence of ARM.     

Social characteristics of urban café guests in Norway

Which factors may influence the number of hours spent per week in cafés, and the amount of alcohol consumed in licensed premises, by urban café guests in Norway? In 1991 a comprehensive questionnaire survey was undertaken among 1053 visitors to 41 licensed cafés in Oslo, Norway. The five most important predictors of time spent in cafés were: household situation (beta = 0.20), occupation (beta = 0.18), personal economic resources and sex (both beta = 0.15) and age (beta = 0.11). These factors were also significant predictors of the number of days during the past 4 weeks the respondents had drunk four glasses or more of alcohol in cafés. Men, people living with others, people with poor economic resources and people not engaged in paid employment or education were the ones who reported spending the most hours per week and the most episodes of "heavy" drinking in cafés during a 4-week period. Visiting and drinking in cafés may be a way of structuring everyday life.     

Changes in social roles as predictors of changes in drinking behaviour

AIM: To assess the possible effects of changes in marital status, employment status and having children at home on alcohol consumption and the frequency of heavy drinking. With role theory as a starting point it was expected that a shift into more social roles would decrease consumption and heavy drinking while the shift away from social roles would be associated with an increase in consumption and heavy drinking. DESIGN: Prospective cohort study. SETTING: The province of Limburg, The Netherlands (1980-89). PARTICIPANTS: 1327 men and women aged 16-69 years at first measurement. MEASUREMENTS: Weekly consumption of standard units (10 g ethanol) of alcoholic beverages; frequency of drinking six units or more; self-reported social role. FINDINGS: The acquisition of a spouse role and a parental role but not an employment role was associated with a decrease in consumption or heavy drinking. The loss of the spouse role among women was associated with an increase in heavy drinking. Otherwise, losing a role was not linked with a change in consumption and heavy drinking. CONCLUSIONS: Limited support was found for the expectation that role transitions influence drinking behaviour. Our study suggests that other theories must be sought to explain social differences in drinking behaviour.     

Prospective association of smoking and alcohol use with cognitive function in an elderly cohort

Cross-sectional studies of the associations of alcohol and tobacco use with cognitive function do not take into account behavior change after memory loss or differential survival. This prospective study examines the association of cigarette smoking and alcohol consumption at baseline with risk of poor cognitive function 13-18 years later. Between 1973 and 1975, 1469 relatively well-educated, noninstitutionalized men and women from Rancho Bernardo, California, answered standardized questions about smoking and alcohol consumption. Between 1988 and 1991, 511 of these men and women completed five standardized cognitive function tests. At baseline, 20.4% of the men and 23.0% of the women were cigarette smokers. Smoking was associated with increased mortality in men but not in women. In surviving male participants, cognitive function test scores did not significantly differ by baseline smoking status. Among female participants, smoking was associated with categorically defined poorer function on two of five tests. At baseline, 16% of the men and 29% of the women were nondrinkers. Drinking more than two drinks per day was associated with decreased mortality in both sexes. Among women, increasing consumption of alcohol predicted a significant decline in the long-term recall and savings scores of the visual reproduction test. Moderate drinking, approximately two drinks per day, predicted categorically defined poor performance on the Buschke long-term recall task in women. Alcohol consumption was not associated with cognitive function in men. Overall, the observed associations were weak, and no clear pattern was observed. Although there were some gender differences in observed associations and a survivor effect cannot be excluded, data from these healthy, educated, noninstitutionalized people offer no compelling evidence that social drinking or cigarette smoking causes or prevents impaired cognitive function in old age. The large number of comparisons and inconsistent results suggest that the few statistically significant findings may be spurious. Additional long-term prospective studies are needed to determine the generalizability of these findings to individuals in less healthy or less well-educated cohorts.     

Older adult controlled drinkers and abstainers

Little is known about the lifetime course of alcohol problems, especially during late adulthood. Many individuals with a history of alcohol problems achieve remission of their symptoms through abstinence or controlled drinking. This study examined 135 older adults with a prior history of alcohol diagnoses who were symptom free for at least the past year. Two groups were identified based on their alcohol consumption within the past year: abstinent individuals (n = 92) and controlled drinkers (n = 43). The groups did not differ in age, racial composition, education, income, or years since their last alcohol-related symptom, but they did differ in gender composition, indices of alcoholism severity, history of formal and informal treatment, as well as lifetime alcohol consumption patterns. Abstinent individuals had more severe alcohol problems, consumed higher amounts of alcohol on drinking days, had more years of heavy alcohol consumption, and were more likely to have attended alcohol treatment and Alcoholics Anonymous (AA). The controlled drinkers had a longer history of moderate social drinking, and their current consumption habits appeared to be similar to symptom-free older adult drinkers. The results suggest that gender, alcoholism severity, history of formal and informal treatment, and past consumption patterns are associated with whether older adults with histories of alcoholism attain successful outcomes through abstinence or controlled drinking.     

Chronicity of back problems during working life

STUDY DESIGN: A follow-up study of a cohort of 444 patients aged 16 to 59 years who consulted with their general practitioners (GPs) in 1987-1988 for an incident episode of back pain. OBJECTIVES: To determine the proportion of patients with back pain in whom chronic back problems develop after a follow-up of 7 years, to compare health outcomes and labor force participation of patients with and without chronic back problems and to identify determinants of chronicity. SUMMARY OF BACKGROUND DATA: The incidence and prevalence of back pain are very high. A large proportion of the costs related to medical consumption, absence from work, and disability are probably caused by chronic back problems. It is unknown what proportion of back problems become chronic, especially after a long follow-up period, and which factors can predict chronicity. METHODS: Data on the course of the symptoms and medical consumption from the period between 1987-1988 and 1991 were gathered retrospectively. Data on several health outcomes, including LFP, and data on some work characteristics were collected prospectively in 1991. A more extensive data set on health outcomes including psychologic status and working situation was collected in 1994. RESULTS: Chronic back problems developed in 28% of the patients. These patients reported more pain, higher levels of medical resource consumption, worse health outcomes, and lower labor force participation. Episodes of back pain before 1987-1988, severe pain in 1991, and disability score in 1991 were positively associated with chronicity in 1994, difficulties with job performance in 1991, and frequent stooping in the subgroup of patients who held a paying job in the follow-up period. CONCLUSIONS: Even after a follow-up of 7 years, the proportion of people with chronic back problems was high. The consequences for quality of life, labor force participation, and consumption of medical resources are clear. Further research is necessary to examine determinants and ways to prevent chronicity.     

Cohort differences in attitudes toward mental health services among older persons.

In order to investigate historical shifts in attitudes toward mental health and mental health services, two independent samples of older adults separated by a 14-year time interval were administered questionnaires. There were 91 in the 1977 sample (mean age 69.91 yrs) and 116 in the 1991 sample (mean age 71.94 yrs). Four newly created, internally consistent scales assessed multiple dimensions of their mental health attitudes (breadth of conceptions, bias, openness to help, range of problems). Analyses suggested that the younger cohorts of older adults held more positive attitudes toward mental health and mental health services than the older cohorts. These cohort differences remained when controlled for age, level of education, self-reported health, and income. These data indicate a positive cohort shift in attitudes toward mental health, a finding with numerous implications for the design and implementation of mental health services for future cohorts of older persons. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of drinking outcomes for male alcoholics after 10 to 14 years

This study reports on the long-term outcomes of 360 men who were hospitalized for alcoholism during 1980 to 1984 and followed at 12 months and again 10 to 14 years later. At the 10/14-year follow-up, 96 (26.7%) men were confirmed as deceased; 255 (70.8%) men participated in the assessment/interview battery completed during baseline hospitalization. The battery consisted of psychosocial, alcohol-related, and psychiatric measures. Two distinct but highly correlated outcome measures were selected: a clinical rating scale and a factor score. Overall, predictors from baseline and 12-month follow-up included age at intake hospitalization, alcoholism severity, social stability, drinking days, and antisocial personality disorder. Approximately 37% of the assessed survivors were either totally abstinent or drinking nonabusively throughout the 10/14-year follow-up, whereas another 37% continued to drink abusively. Men who abstained or reduced alcohol intake reported better physical health at follow-up than those who continued to drink. Although our findings did not directly link alcoholism to death, they strongly indicate that chronic alcohol abuse may lead to premature death.     

Reasons for abstaining or limiting drinking: A developmental perspective.

The cross-sectional and longitudinal relations between reasons for abstaining or limiting drinking (RALD) and abstention were examined in a 16-year longitudinal study (N = 489) of college students with and without a family history of alcohol problems. Results indicated that RALD based upon upbringing or religiosity were associated with increased rates of abstention, whereas RALD based upon perceived or experienced negative consequences of drinking were associated with lower rates of abstention and increased alcohol consumption among drinkers. In addition, changes in RALD over time coincided with alcohol consumption transitions. Abstainers who began drinking after turning 21 reported a decrease in the importance of RALD associated with loss of control and upbringing or religiosity compared to abstainers who continued to abstain after turning 21. Conversely, drinkers who began abstaining after leaving college reported an increase in the importance of RALD associated with loss of control and upbringing or religiosity compared to drinkers who continued to drink after leaving college. Examining the reciprocal influences of RALD on drinking outcomes extends previous research and may inform prevention and intervention programs among college drinkers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting the development of late-life late-onset drinking problems: a 7-year prospective study

There has been little empirical study of risk factors for the development of late-life late-onset drinking problems. In the current prospective study, we compare two groups of older adults who, at a baseline assessment, were nonproblem drinkers: individuals who developed drinking problems over the course of the next 7 years (n = 77) and those who did not (n = 197). Late-onset problem drinkers reported mild to moderate drinking problems and spontaneous remission rates were high. Compared with stable nonproblem drinkers, late-onset problem drinkers at baseline were more likely to report incipient problems, heavier alcohol consumption, greater friend approval of drinking, more reliance on avoidance coping strategies, were more likely to smoke, and were less likely to have acute medical conditions that could potentially be complicated by alcohol consumption. Contrary to expectation, life stressors did not predict drinking problem onset. However, compared with stable nonproblem drinkers, late-onset problem drinkers were more likely to have a history of responding to stressors and negative affect with increased alcohol consumption.     

Twenty-year dynamics of serum cholesterol levels in the middle-aged population of eastern Finland

BACKGROUND: In cross-sectional analyses, serum cholesterol levels differ among different age groups. However, secular time trends in cholesterol levels can be seen across age groups in a population. A birth cohort analysis provides useful information on the combined effect of age and time on changes in serum cholesterol levels. OBJECTIVE: To analyze the 20-year dynamics of serum total cholesterol levels in relation to age, sex, birth cohort, time period, mortality rate, and changes in the intake of saturated fats. DESIGN: Cross-sectional measurements of serum total cholesterol levels in five independent population surveys done in 1972, 1977, 1982, 1987, and 1992. SETTING: Kuopio and North Karelia provinces in eastern Finland. PATIENTS: Random sample of 16,711 men and 17,542 women 25 to 64 years of age. Persons in the oldest birth cohort were born in 1913; persons in the youngest birth cohort were born in 1967. MEASUREMENTS: Total serum cholesterol levels and daily intake of dietary fat. RESULTS: Between 1972 and 1992, mean cholesterol levels decreased with time in each age group and for both sexes. According to the cross-sectional data, cholesterol levels increased with age and increased more steeply in women than in men. Contrary to these data, cholesterol levels in birth cohorts did not increase with age. Cholesterol levels did not change at all within birth cohorts of women and started to decrease after 45 years of age in birth cohorts of men. Cholesterol levels in the youngest birth cohorts (persons 25 to 29 years of age) entering the study each study year were markedly lower than levels in the same age group in the previous survey of risk factors. Daily intake of saturated fat decreased markedly between 1972 and 1992. Most of this decrease could be explained by change in intake of liquid dairy products and spreadable fats. In both sexes, changes in saturated fat intake were correlated with the time period, whereas the association with age was weak. CONCLUSIONS: In this Finnish population, total serum cholesterol levels are more closely associated with birth cohort than with age. Changes in dietary intake of saturated fat over time may account for changes in cholesterol levels. This finding suggests that community-based strategies for preventing cardiovascular disease can affect most of the population.     

The effect of drink price and next-day responsibilities on college student drinking: A behavioral economic analysis.

More than [3/4] of U.S. college students report a heavy drinking episode (HDE; 5 (for men) and 4 (for women) drinks during an occasion) in the previous 90 days. This pattern of drinking is associated with various risks and social problems for both the heavy drinkers and the larger college community. According to behavioral economics, college student drinking is a contextually bound phenomenon that is impacted by contingencies such as price and competing alternative reinforcers, including next-day responsibilities such as college classes. This study systematically examines the role of these variables by using hypothetical alcohol purchase tasks to analyze alcohol consumption and expenditures among college students who reported recent heavy drinking (N = 207, 53.1% women). The impact of gender and the personality risk factor sensation seeking (SS) were also assessed. Students were asked how many drinks they would purchase and consume across 17 drink prices and 3 next-day responsibility scenarios. Mean levels of hypothetical consumption were highly sensitive to both drink price and next-day responsibility, with the lowest drinking levels associated with high drink prices and a next-day test. Men and participants with greater levels of SS reported more demand overall (greater consumption and expenditures) than women and students with low SS personality. Contrary to our hypotheses women appeared to be less sensitive to increases in price than men. The results suggest that increasing drink prices and morning academic requirements may be useful in preventing heavy drinking among college students. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The influence of alcohol expectancy priming and mood manipulation on subsequent alcohol consumption.

Studies showing that verbal priming can implicitly affect alcohol consumption have been used to support cognitive models of expectancies. However, because expectancy words reflect affective states as well as drinking outcomes, mediation through an affective pathway remains theoretically plausible (i.e., such words inadvertently may affect mood, which in turn influences drinking). The primary pathway was identified (and expectancy theory was tested) by comparing memory priming (using alcohol expectancy or neutral words) with mood induction (using positive or neutral music); an unrelated experiment paradigm allowed the priming manipulation to implicitly affect drinking. Men in the alcohol priming group drank significantly more than men in each of the other conditions, and, consistent with theory, men with histories of heavier drinking drank the most when primed with alcohol expectancies, indicating that expectancies can function as automatic memory processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subsensitivity to bronchoprotection against adenosine monophosphate challenge following regular once-daily formoterol

Questions about usual drinking play an important role in the construction of alcohol consumption measures. However, little is known about difficulties in answering these questions for respondents with variability in their drinking patterns. We investigated this in a community sample of 945 drinkers and in a clinical sample of 400 patients treated for alcohol and/or drug problems. Demographic variables were not consistently related to self-reported difficulty in answering, but a diagnosis of current DSM-IV alcohol dependence was significantly related in both samples. In modeling the relationship between alcohol consumption and DSM-IV alcohol dependence, the fit of the model to the data was significantly improved by the addition of a variable indicating respondents' difficulty answering the usual drinking questions. Using this information in the development of alcohol consumption questions may provide more precise estimates of the risk from alcohol consumption to outcomes such as alcohol dependence.     

Association between DNA cleavage during apoptosis and regions of chromatin replication

This randomized controlled trial evaluated the efficacy of a brief intervention designed to reduce the harmful consequences of heavy drinking among high-risk college students. Students screened for risk while in their senior year of high school (188 women and 160 men) were randomly assigned to receive an individualized motivational brief intervention in their freshman year of college or to a no-treatment control condition. A normative group selected from the entire screening pool provided a natural history comparison. Follow-up assessments over a 2-year period showed significant reductions in both drinking rates and harmful consequences, favoring students receiving the intervention. Although high-risk students continued to experience more alcohol problems than the natural history comparison group over the 2-year period, most showed a decline in problems over time, suggesting a developmental maturational effect.     

Effects of a brief motivational intervention with college student drinkers.

This study consisted of a randomized controlled trial of a 1-session motivational intervention for college student binge drinkers. Sixty students who reported binge drinking 2 or more times in the past 30 days were randomly assigned to either a no-treatment control or a brief intervention group. The intervention provided students with feedback regarding personal consumption, perceived drinking norms, alcohol-related problems, situations associated with heavy drinking, and alcohol expectancies. At 6-week follow-up, the brief intervention group exhibited significant reductions on number of drinks consumed per week, number of times drinking alcohol in the past month, and frequency of binge drinking in the past month. Estimates of typical student drinking mediated these reductions. This study replicates earlier research on the efficacy of brief interventions with college students and extends previous work regarding potential mechanisms of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family history and antisocial traits moderate naltrexone's effects on heavy drinking in alcoholics.

Naltrexone's (NAL) effects on alcohol consumption are generally modest, so identifying patients likely to benefit would improve treatment utility. Several studies indicate that potentially significant moderators of NAL's effects might include family history of alcohol problems (FH), age of onset of alcohol problems, degree of antisocial traits, and comorbid drug use. Data from 128 alcoholic patients enrolled in a 12-week NAL treatment study (50 mg/day) were reanalyzed to determine the role of FH, age of onset, antisocial traits, and comorbid drug use in NAL's treatment effects on heavy drinking days. Dichotomized FH, age of onset of alcohol problems, and comorbid cocaine or marijuana use had no interaction effect with medication. Percentage of relatives with problem drinking (family history percentage [FHP]) moderated the effects of NAL on drinking such that NAL resulted in lower drinking rates only for patients with higher FHP. Antisocial traits also moderated the effects of medication on drinking for patients compliant with =70% of medication. Patients with more antisocial traits had less heavy drinking on NAL than on placebo, whereas patients low on antisocial traits had no benefit from NAL. Covarying antisociality in regressions of drinking outcome on FHP showed that the effects of FHP were not attributable to antisociality. Thus, NAL may selectively benefit alcoholics with antisocial traits or 20% or more relatives with problem drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)