Beate Coder

Alcohol problem drinking among general hospital inpatients in northeastern Germany.

OBJECTIVE To estimate proportions of alcohol problem drinking: alcohol use disorders (AUDs) and drinking above recommended levels among general hospital inpatients in northeastern Germany. METHOD The sample includes consecutively admitted inpatients (n=14,332) between 18 and 64 years old. This study adopted a two-stage-sampling approach including screening and ascertainment of diagnosis based on DSM-IV criteria and a quantity-frequency index. RESULTS In total, 20.4% of all inpatients screened positive. Nine percent of the total sample were identified with current problem drinking in the following descending order: 5.3% AUD and 3.6% drinking above recommended levels. In addition, 3.1% of persons were diagnosed with alcohol dependence in remission. Proportions differed significantly among men and women (P<.001). Higher proportions of problem drinking were found at rural sites compared to urban sites (13.7% vs. 7.5%, P<.001). CONCLUSIONS In addition to AUDs, drinking above recommended levels is a common problem among general hospital inpatients. Thus, the implementation of systematic alcohol screening and brief interventions should be considered.

Severity of unhealthy alcohol consumption in medical inpatients and the general population: is the general hospital a suitable place for brief interventions?

ObjectivesEvidence for brief interventions in general hospital (GH) settings is scarce, probably due to higher rates of dependent drinkers. The present study aims to compare unhealthy drinking patterns in GH patients with the general population (GP).MethodsSample 1 consisted of 4,075 individuals randomly drawn from registration office files, representing the non-institutionalised GP of a northern mixed rural–urban German area. Sample 2 consisted of 2,949 consecutively admitted patients from a GH covering the same area.ResultsCompared to individuals from the GP, GH patients revealed higher prevalence rates of alcohol dependence (1.3 vs. 5.5%) and alcohol abuse (1.2 vs. 2.8%), but did not differ significantly concerning at-risk drinking (5.1 vs. 6.2%). Multinomial logistic regression analysis controlling for age, sex and smoking using unrisky alcohol consumption as reference category belonging to the GH group was predictive for alcohol use disorders but not for at-risk drinking.ConclusionData show that a substantial number of individuals with unhealthy drinking patterns without alcohol use disorders can easily be accessed in GH settings if appropriate screening measures are conducted.ZusammenfassungHintergrundDie Evidenz für die Wirksamkeit von Kurzinterventionen im Setting des Allgemeinkrankenhauses ist eingeschränkt, möglicherweise aufgrund des hohen Anteils Alkoholabhängiger. Die vorliegende Studie vergleicht riskante Trinkmuster bei Patienten eines Allgemeinkrankenhauses mit der Allgemeinbevölkerung.MethodenStichprobe 1 bestand aus 4075 anhand von Einwohnermeldeamtsdaten randomisiert ausgewählten Personen, welche die nicht-institutionalisierte Bevölkerung einer gemischten ländlich-städtischen Bevölkerung Norddeutschlands repräsentieren (GP). Stichprobe 2 bestand aus 2949 konsekutiv aufgenommenen Patienten eines Allgemeinkrankenhauses der selben Region (GH).ErgebnisseGegenüber Personen der GP, wiesen Personen der GH höhere Prävalenzen an Alkoholabhängigkeit (1,3% vs. 5,5%) und Alkoholmissbrauch (1,2% vs. 2,8%) auf, ohne dass sich die Stichproben in der Häufigkeit riskanten Alkoholkonsums unterschieden (5,1% vs. 6,1%). In einer multinomialen logistischen Regression war die Zugehörigkeit zur GH-Gruppe nach Kontrolle auf Alter, Geschlecht und Rauchstatus prädiktiv für das Vorliegen einer alkoholbezogenen Störung, jedoch nicht für riskanten Alkoholkonsum.SchlussfolgerungDie Daten zeigen dass eine substanzielle Gruppe von Personen mit riskantem Alkoholkonsum im Setting des Allgemeinkrankenhauses bei Verwendung geeigneter Screening-Instrumente erreicht werden kann.

Predicting utilization of formal and informal help among general hospital inpatients with alcohol use disorders

Aim: The aim of this prospective study was to identify predictors of utilizing formal and informal help among currently non‐help‐seeking individuals with alcohol use disorders. Methods: Data was based on 197 general hospital inpatients with alcohol dependence or abuse. Using multivariable logistic regression analyses, intention to utilize formal help was tested in addition to evidence based predictors of utilization of help. Results: Intention to seek help and prior help‐seeking were identified as central predictors for formal and informal help‐seeking. Conclusions: The lack of utilization of formal help among persons with alcohol use disorders may be reduced by focusing professional interventions on enhancing help‐seeking motivation. Copyright

The performance of two motivation measures and outcome after alcohol detoxification.

AIMS The aims of this study were to investigate the performance of the treatment version of the Readiness to Change Questionnaire (RCQ[TV]) among individuals currently receiving alcohol detoxification and to develop a treatment version of the Treatment Readiness Tool (TReaT[TV]). METHODS A total of 549 patients (86% men) recruited from two detoxification units were interviewed close to treatment intake and followed up 12 months later. Confirmatory factor analyses and logistic regression analyses were conducted. RESULTS A modified nine-item version of the RCQ[TV] showed a good fit of the model (CFI = 0.95) and internal consistencies ranging between 0.49 and 0.91. Twelve months later, RCQ-Actors had an odds ratio of 1.95 (95% CI: 1.12-3.37) for being abstinent compared to Precontemplators/Contemplators. The development of the TReaT[TV] resulted in 15 items and 5 scales with a CFI of 0.97 and Cronbachs alphas ranging between 0.59 and 0.94. TReaT[TV] Precontemplators/Contemplators were less likely to utilize help than Maintainers (OR = 0.17, 95% CI: 0.06-0.45). CONCLUSIONS The psychometric properties were modest for the modified RCQ[TV] and good for the TReaT[TV]. Readiness to change and readiness to seek help should be assessed separately among treatment seekers.

Reported Beverage Consumed and Alcohol-Related Diseases among Male Hospital Inpatients with Problem Drinking

AIMS The aim of this study was to examine if problem drinkers have varying risks of having alcohol-related diseases according to their reported beverage consumed. METHODS In a cross-sectional study all consecutive inpatients aged 18- 64 years from four general hospitals of one catchment area were systematically screened for alcohol use. A total of 1011 men with problem drinking were used for this study. Routine treatment diagnoses for all participants were provided by hospital physicians and were classified into three categories according to their alcohol-attributable fractions (AAF; AAF = 0; AAF < 1; AAF = 1). RESULTS According to their reported beverage consumed, 53.0% of the participants were identified as exclusively beer drinkers, 14.1% exclusively spirits drinkers, 26.0% mixed beer and spirits drinkers and 6.9% individuals drinking wine exclusively or in combination with one or two other beverages (mixed wine drinkers). Compared to spirits drinkers and controlling for possible confounders (i.e. alcohol-associated characteristics, demographic variables), multinomial regressions revealed that beer drinkers, mixed beer and spirits drinkers, and mixed wine drinkers had lower odds of having diseases with AAF = 1 than spirits drinkers (e.g. for AAF = 1: beer versus spirits drinkers: OR = 0.42, CI: 0.25-0.72). Beer drinkers and mixed wine drinkers also had lower odds of having diseases with AAF < 1 than spirits drinkers (e.g. mixed wine versus spirits drinkers: OR = 0.36, CI: 0.18-0.72). CONCLUSIONS These data suggest an association between the reported beverage consumed and alcohol-related diseases. Among hospitalized problem drinkers, spirits drinkers had the greatest risk of having diseases with AAF < 1 and with AAF = 1.

Erfassung problematischen Alkoholkonsums

An overview with respect to the identification of patients with risky drinking, alcohol abuse or alcohol dependence is given. As a first step, a simple screening questionnaire should be used. Self-statements in standardized questionnaires are more valid than standard laboratory markers. A useful instrument is for example BASIC. In screening positive patients, an in-depth diagnosis is necessary and helps to distinguish between different forms of problematic alcohol use. Depending on the severity of the alcohol problem, brochures, internet-programs, counselling or referral to treatment services is helpful.

Assessment of problematic alcohol use

An overview with respect to the identification of patients with risky drinking, alcohol abuse or alcohol dependence is given. As a first step, a simple screening questionnaire should be used. Self-statements in standardized questionnaires are more valid than standard laboratory markers. A useful instrument is for example BASIC. In screening positive patients, an in-depth diagnosis is necessary and helps to distinguish between different forms of problematic alcohol use. Depending on the severity of the alcohol problem, brochures, internet-programs, counselling or referral to treatment services is helpful.

Reporting of problematic alcohol consumption.

An overview with respect to the identification of patients with risky drinking, alcohol abuse or alcohol dependence is given. As a first step, a simple screening questionnaire should be used. Self-statements in standardized questionnaires are more valid than standard laboratory markers. A useful instrument is for example BASIC. In screening positive patients, an in-depth diagnosis is necessary and helps to distinguish between different forms of problematic alcohol use. Depending on the severity of the alcohol problem, brochures, internet-programs, counselling or referral to treatment services is helpful.