Hannu Alho

AUDIT and its abbreviated versions in detecting heavy and binge drinking in a general population survey

BACKGROUNDnThe aim of this study was to define optimal cut points for the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated versions (AUDIT-C, AUDIT-QF, and AUDIT-3), and to evaluate how effectively these questionnaires detect heavy drinking in the general population.nnnMETHODSnThe study population consisted of a sub-sample of the National FINRISK Study. A stratified random sample of 3216 Finns, aged 25-64, was invited to a health check. Of these, 1851 (57.6%) completed the AUDIT and participated in person in the Timeline Followback (TLFB) interview regarding their alcohol consumption. The TLFB-based definition of heavy drinking was used as a primary gold standard (for males > or =16 standard drinks average in a week or > or =7 drinks at least once a month; for females, respectively, > or =10 and > or =5 drinks). Areas under receiving operating characteristics curves (AUROCs), sensitivities and specificities were used to compare the performance of the tests.nnnRESULTS AND CONCLUSIONSnThe AUDIT and its abbreviated versions are valid for detecting heavy drinking also in a general population sample. However, performance seems to vary between the different versions and accuracy of each test is achieved only by using tailored cut points according to gender. The AUDIT and AUDIT-C are effective for both males and females. The optimal cut points for males were found to be >/=7 or 8 for AUDIT and > or =6 for AUDIT-C. Among females the optimal cut points were found to be > or =5 for AUDIT and > or =4 for AUDIT-C. The study also indicates that AUDIT-QF among females and AUDIT-3 among males are relatively effective. The cut points for detecting all heavy drinkers (including binge drinkers without exceeding weekly thresholds) were lower than for detecting heavy drinkers excluding those who are only binge drinkers.

The alcohol use disorders identification test (AUDIT) and its derivatives in screening for heavy drinking among the elderly

The performance of the Alcohol Use Disorders Identification Test (AUDIT) in screening for heavy drinking among the elderly has been unsatisfactory. The aim of the present study was to determine whether tailoring the cut point improves the performance of the AUDIT and its derivatives in this age group.

Treatment of alcohol dependence in patients with co-morbid major depressive disorder - predictors for the outcomes with memantine and escitalopram medication

BackgroundAlcohol dependence comorbid with major depressive disorder poses a major challenge in the clinical setting. The results in the treatment with selective serotonin re-uptake inhibitors have been conflicting. Thus, we compared in alcohol-dependent patients with co-morbid major depressive disorder the selective serotonin re-uptake inhibitor escitalopram to a compound that acts on different transporter system and may reduce craving, the glutamate receptor antagonist memantine.MethodsEighty alcohol-dependent patients comorbid with major depressive disorder in municipal alcohol clinics were randomized 1:1 to receive memantine 20 mg or escitalopram 20 mg in a double-blind manner. During the 26-week study period patients continued their routine treatment at the clinics. Abstinence was not required but encouraged. The patients attended visits weekly during the first month, and then at 3 and at 6 months. Outcome measures were Alcohol Use Disorders Identification Test (AUDIT), Obsessive Compulsive Drinking Scale (OCDS) and Drinking Diary.ResultsThe completion rate was high in both groups, especially among the patients who had been abstinent at the beginning of the study. However, among those patients who were not abstinent at baseline, 47% in both groups discontinued the study. Numbers of abstinent days were high in both groups throughout the study. Alcohol consumption measured by the AUDIT QF (quantity-frequency) score was significantly reduced in both groups, as was the craving for alcohol measured by the OCDS. Early age at first alcohol intoxication predicted poor treatment outcomes in patients treated with escitalopram, and the same was seen with the early onset of the first depressive episode. The same predictive effects were not found in patients treated with memantine.ConclusionOur results indicate that both memantine and escitalopram are useful adjunct medications for the treatment of alcohol dependence co-morbid with major depression. Memantine was at least as effective with regard to drinking as escitalopram. We believe that a direct comparison of memantine, with the commonly used escitalopram, can provide useful information for clinicians on the treatment of alcohol dependency co-morbid with MDD.Trial registrationClinicalTrials.gov Identifier # NCT00368862

µ-Opioid Receptor Gene (OPRM1) Polymorphism A118G: Lack of Association in Finnish Populations with Alcohol Dependence or Alcohol Consumption

Aims: The molecular epidemiological studies on the association of the opioid receptor µ-1 (OPRM1) polymorphism A118G (Asn40Asp, rs1799971) and alcohol use disorders have given conflicting results. The aim of this study was to test the possible association of A118G polymorphism and alcohol use disorders and alcohol consumption in three large cohort-based study samples. Methods: The association between the OPRM1 A118G (Asn40Asp, rs1799971) polymorphism and alcohol use disorders and alcohol consumption was analyzed using three different population-based samples: (a) a Finnish cohort study, Health 2000, with 503 participants having a DSM-IV diagnosis for alcohol dependence and/or alcohol abuse and 506 age- and sex-matched controls; (b) a Finnish cohort study, FINRISK (n = 2360) and (c) the Helsinki Birth Cohort Study (n = 1384). The latter two populations lacked diagnosis-based phenotypes, but included detailed information on alcohol consumption. Results: We found no statistically significant differences in genotypic or allelic distribution between controls and subjects with alcohol dependence or abuse diagnoses. Likewise no significant effects were observed between the A118G genotype and alcohol consumption. Conclusion: These results suggest that A118G (Asn40Asp) polymorphism may not have a major effect on the development of alcohol use disorders at least in the Finnish population.

Serotonin transporter polymorphism as a predictor for escitalopram treatment of major depressive disorder comorbid with alcohol dependence

The aim of this study was to determine whether the serotonin transporter gene polymorphism (5-HTTLPR) is associated with the treatment outcomes of escitalopram for patients with comorbid major depression and alcohol dependence. Eighty treatment-seeking patients were randomly assigned to either receive 20mg of escitalopram or a control of 20mg of the non-serotonergically acting memantine. Depression was measured by the Montgomery-Asberg Depression Rating Scale (MADRS) and alcoholism by the Alcohol Use Disorders Identification Test (AUDIT). Twenty-nine participants in each treatment group completed the study, and from those DNA was given by 27 in the escitalopram group and 21 in the memantine group. In the escitalopram group linear regression showed that LL genotype predicted greater decrease in MADRS scores compared with the SS/SL genotypes (p=0.04) after a 3month treatment period. Moreover, each L allele associated with MADRS score decrease by 15% (p=0.04) in the escitalopram group. In the memantine group, however, no association between LL genotype and MADRS decrease was detected. AUDIT decrease was not associated with the 5-HTTLPR genotype for either medication. This is the first study in the treatment of depression in dual diagnosis patients to report a significant association between outcomes with escitalopram and the 5-HTTLPR gene polymorphism.

Attitudes towards gambling, gambling participation, and gambling-related harm

BackgroundInformation about public gambling attitudes and gambling participation is crucial for the effective prevention of gambling-related harm. This study investigates female and male attitudes towards gambling, gambling participation, and gambling-related harm in the Finnish population aged 15–74.MethodsCross-sectional random sample data were collected in 2011 (nu2009=u20094484) and 2015 (nu2009=u20094515). The data were weighted based on gender, age and region of residence. Attitudes were measured using the Attitudes Towards Gambling Scale (ATGS-8). Gambling-related harms were studied using the Problem Gambling Severity Index and the South Oaks Gambling Screen.ResultsAttitudes towards gambling became more positive from 2011 to 2015. Female attitudes were generally negative, but nonetheless moved in a positive direction except in age groups under 25. Occasional gambling increased among women aged 18–24. Women aged 18–24 and 45–54 experienced more harms in 2015 than in 2011. Both land and online gambling increased among women aged 65–74. Male attitudes towards gambling were generally positive, and became more positive from 2011 to 2015 in all age groups except 15–17. Weekly gambling decreased among males aged 15–17. Gambling overall increased among males aged 18–24. Gambling several times a week decreased among men aged 35–44 and 45–54, and gambling 1–3 times a month increased in the latter age group. Online gambling increased only among men aged 55–64.ConclusionsAttitudes towards gambling became more positive in all except the youngest age groups. Under-age male gambling continued to decrease. We need to make decision-makers better aware of the continuing growth of online gambling among older people and women’s increasing experiences of gambling-related harm. This is vital to ensure more effective prevention.

At-risk and problem gambling among adolescents

BackgroundAdolescent gambling and substance use are viewed as a public health concern internationally. The early onset age of gambling is a known risk factor for developing gambling problems later in life. The aims of this study are: to evaluate the internal consistency reliability, factorial validity and classification accuracy of the Finnish version of DSM-IV-Multiple Response-Juvenile (DSM-IV-MR-J) criteria measuring at-risk/problem gambling (ARPG); to examine gender differences in gambling participation, ARPG and substance use among first-year junior high school students; and to investigate the association of gambling and gaming (video game playing) participation, substance use and social variables with ARPG.MethodsThis study examined 988 adolescents (mean age 13.4xa0years) at 11 public schools in Finland between October-December 2013. The response rate was 91.6%. Chi-squared test and binary logistic regression analysis were used.Results‘Illegal acts’ was the most endorsed and sensitive, but the least specific criteria identifying ARPG. During the past year, 51.6% of the respondents had gambled, 7.9% were identified as at-risk/problem gamblers (DSM-IV-MR-J scoreu2009≥u20092), 8.0% had smoked and 8.9% had been drinking for intoxication, and the first three were significantly more common among boys than girls. The odds ratio of being a male past-year at-risk/problem gambler was 2.27, 5.78 for gambling often or sometimes, 2.42 for video game playing weekly or more often and 6.23 for having peer gamblers.ConclusionsOverall, the Finnish version of the DSM-IV-MR-J had acceptable internal consistency reliability and factorial validity. None of the DSM-IV-MR-J criteria were accurate enough to screen ARPG per se. ARPG past-year prevalence was relatively high with males gambling more than females. ARPG was as common as drinking alcohol for intoxication and smoking. Peer gambling was strongly associated with ARPG. Efficient strategies to minimise the risks of gambling problems, tools for prevention and identification of ARPG among the underage are needed.

Concerned significant others of people with gambling problems in Finland: a cross-sectional population study

BackgroundProblem gambling not only impacts those directly involved, but also the concerned significant others (CSOs) of problem gamblers. The aims of this study were to investigate the proportion of male and female CSOs at the population level; to investigate who the CSOs were concerned about; and to investigate sociodemographic factors, gender differences, gambling behaviour, and health and well-being among CSOs and non-CSOs.MethodsThe data (nu2009=u20094484) were based on a cross-sectional population study. Structured telephone interviews were conducted in 2011–2012. The data were weighted based on age, gender and residency. The respondents were defined as CSOs if they reported that at least one of their significant others (father, mother, sister/brother, grandparent, spouse, own child/children, close friend) had had gambling problems. Statistical significance was determined by chi-squared and Fisher’s exact tests, and logistic regression analysis.ResultsAltogether, 19.3% of the respondents were identified as CSOs. Most commonly, the problem gambler was a close friend (12.4%) of the CSO. The percentage of close friends having a gambling problem was larger among male CSOs (14.4%) compared with female CSOs (10.3%; pu2009≤u20090.001), while the percentage of partners with gambling problem was larger among females (2.6%) than among males (0.8%; pu2009≤u20090.001). In the best fitting model, the odds ratio (95% CI) of being a male CSO was 2.03 (1.24–3.31) for past-year gambling problems, 1.46 (1.08–1.97) for loneliness and 1.78 (1.38–2.29) for risky alcohol consumption. The odds ratio (95% CI) of being a female CSO was 1.51 (1.09–2.08) for past-year gambling involvement, 3.05 (1.18-7.90) for past-year gambling problems, 2.21 (1.24–3.93) for mental health problems, 1.39 (1.03–1.89) for loneliness and 1.97 (1.43–2.71) for daily smoking.ConclusionsCSOs of problem gamblers often experience cumulating problems such as their own risky gambling behaviour, health problems and other addictive disorders. The clearest gender difference was seen in smoking by CSO. In order to develop efficient and targeted support and services for CSOs, it is necessary to understand the correlates related to different subgroups of CSOs.

Attitudes towards gambling in Finland: a cross-sectional population study

BackgroundAttitudes towards gambling influence gambling behaviour but also reflect the existing gambling policy in a society. However, studies examining general attitudes towards gambling at the population level are scarce. The first aim of this study was to investigate general attitudes of the Finnish population towards gambling. The second aim was to explore the association of socio-demographics, gambling behaviours, being a concerned significant other (CSO) of a problem gambler and perceived health and lifestyle with attitudes towards gambling among the Finnish population.MethodsA cross-sectional study was performed by structured telephone interview on a random sample of 15-74-year-old Finns between October 2011 and January 2012. The data (nu2009=u20094484) was weighted based on age, gender and region of residence. Attitudes towards gambling were measured with the eight-item version of the Attitude Towards Gambling Scale (ATGS-8). A factor analysis was performed to test the structure of the Finnish version of the ATGS-8. The data were analysed using one-way ANOVA test, t-test and multiple regression analysis.ResultsOn average, attitudes of Finns towards gambling were negative. The most significant factors associated with positive attitudes towards gambling were male gender, young age, 12 years or more education and net income more than 2000€, low score on gambling severity, being a non-CSO of a problem gambler and high alcohol consumptionConclusionsThe association between young age, male gender, high net income and risky alcohol consumption, and favourable gambling attitudes was strong, and also reflects risky gambling behaviour. Experiencing gambling-related harms caused by one’s own or significant other’s excessive gambling seems to indicate unfavourable attitudes towards gambling.

Concerned significant others of people with gambling problems in Finland

BackgroundProblem gambling not only impacts those directly involved, but also the concerned significant others (CSOs) of problem gamblers. The aims of this study were to investigate the proportion of male and female CSOs at the population level; to investigate who the CSOs were concerned about; and to investigate sociodemographic factors, gender differences, gambling behaviour, and health and well-being among CSOs and non-CSOs.MethodsThe data (nu2009=u20094484) were based on a cross-sectional population study. Structured telephone interviews were conducted in 2011–2012. The data were weighted based on age, gender and residency. The respondents were defined as CSOs if they reported that at least one of their significant others (father, mother, sister/brother, grandparent, spouse, own child/children, close friend) had had gambling problems. Statistical significance was determined by chi-squared and Fisher’s exact tests, and logistic regression analysis.ResultsAltogether, 19.3% of the respondents were identified as CSOs. Most commonly, the problem gambler was a close friend (12.4%) of the CSO. The percentage of close friends having a gambling problem was larger among male CSOs (14.4%) compared with female CSOs (10.3%; pu2009≤u20090.001), while the percentage of partners with gambling problem was larger among females (2.6%) than among males (0.8%; pu2009≤u20090.001). In the best fitting model, the odds ratio (95% CI) of being a male CSO was 2.03 (1.24–3.31) for past-year gambling problems, 1.46 (1.08–1.97) for loneliness and 1.78 (1.38–2.29) for risky alcohol consumption. The odds ratio (95% CI) of being a female CSO was 1.51 (1.09–2.08) for past-year gambling involvement, 3.05 (1.18-7.90) for past-year gambling problems, 2.21 (1.24–3.93) for mental health problems, 1.39 (1.03–1.89) for loneliness and 1.97 (1.43–2.71) for daily smoking.ConclusionsCSOs of problem gamblers often experience cumulating problems such as their own risky gambling behaviour, health problems and other addictive disorders. The clearest gender difference was seen in smoking by CSO. In order to develop efficient and targeted support and services for CSOs, it is necessary to understand the correlates related to different subgroups of CSOs.