Jason Bond

Are Lifetime Abstainers the Best Control Group in Alcohol Epidemiology? On the Stability and Validity of Reported Lifetime Abstention

Lifetime abstainers have often been recommended as the comparison group in alcohol epidemiology. The objective of this study was to provide insight into the validity and stability of lifetime abstention by using data derived from the National Alcohol Survey, a national probability survey of US households conducted in 1984, and its 2 follow-up surveys conducted in 1990 and 1992. Results indicated that more than half (52.9%; all proportions were weighted to represent the US population) of those who reported never having a drink of any alcoholic beverage in the 1992 survey reported drinking in previous surveys. Depending on assumptions, this difference may result in an underestimation of alcohol-attributable mortality of 2%−15% in men and 2%−22% in women. Sociodemographic factors differentiated those who consistently reported lifetime abstention across surveys from the rest of the study population. Results suggest that using reported lifetime abstainers as a sole comparison group is problematic, especially if reporting is based on 1 measurement only. Establishing multiple measurement points and including irregular lifetime light drinkers with lifetime abstainers as the comparison group are recommended for future epidemiologic studies.

Age-period-cohort modelling of alcohol volume and heavy drinking days in the US National Alcohol Surveys: divergence in younger and older adult trends.

AIMS The decomposition of trends in alcohol volume and heavy drinking days into age, period, cohort and demographic effects offers an important perspective on the dynamics of change in alcohol use patterns in the United States. DESIGN The present study utilizes data from six National Alcohol Surveys conducted over the 26-year period between 1979 and 2005. Setting United States. MEASUREMENTS Alcohol volume and the number of days when five or more and eight or more drinks were consumed were derived from overall and beverage-specific graduated frequency questions. RESULTS Trend analyses show that while mean values of drinking measures have continued to decline for those aged 26 and older, there has been a substantial increase in both alcohol volume and 5+ days among those aged 18-25 years. Age-period-cohort models indicate a potential positive cohort effect among those born after 1975. However, an alternative interpretation of an age-cohort interaction where drinking falls off more steeply in the late 20s than was the case in the oldest surveys cannot be ruled out. For women only, the 1956-60 birth cohort appears to drink more heavily than those born just before or after. Models also indicate the importance of income, ethnicity, education and marital status in determining these alcohol measures. CONCLUSIONS Increased heavy drinking among young adults in recent surveys presents a significant challenge for alcohol policy and may indicate a sustained increase in future US alcohol consumption.

Multicentre study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries

OBJECTIVES To study the risk of non-fatal injury at low levels and moderate levels of alcohol consumption as well as the differences in risk across modes of injury and differences among alcoholics. METHODS Data are from patients aged 18 years and older collected in 2001-02 by the WHO collaborative study on alcohol and injuries from 10 emergency departments around the world (n = 4320). We used a case-crossover method to compare the use of alcohol during the 6 hours prior to the injury with the use of alcohol during same day of the week in the previous week. FINDINGS The risk of injury increased with consumption of a single drink (odds ratio (OR) = 3.3; 95% confidence interval = 1.9-5.7), and there was a 10-fold increase for participants who had consumed six or more drinks during the previous 6 hours. Participants who had sustained intentional injuries were at a higher risk than participants who had sustained unintentional injuries. Patients who had no symptoms of alcohol dependence had a higher OR. CONCLUSION Since low levels of drinking were associated with an increased risk of sustaining a non-fatal injury, and patients who are not dependent on alcohol may be at higher risk of becoming injured, comprehensive strategies for reducing harm should be implemented for all drinkers seen in emergency departments.

The Role of Religion, Spirituality and Alcoholics Anonymous in Sustained Sobriety

Abstract Spirituality or belief in a higher being is an integral part of Alcoholics Anonymous (AA). This study examines the role of religiosity in AA involvement and long-term sobriety in a representative sample of 587 men and women interviewed upon entering treatment and re-interviewed 1 and 3 years later. Religiosity is defined as spiritual, religious, secular (atheist or agnostic) and unsure, using the Religious Beliefs and Practices Scale employed in Project MATCH. Similar proportions within each religiosity group reported prior 12-month AA exposure at baseline; and over 40% of the unsure, spiritual and religious respondents and 25% of the secular respondents reported having gone to at least one AA meeting in the 12 months before the year 3 interview. Those who reported a spiritual awakening at year 3 were at the highest odds of continuous so briety for the last year; notably, religious self-definition was not associated with a significantly higher odds of sobriety at year 3 after controlling for other considered influences. An increase in AA activities, other than AA meetings, between baseline and the year 1 follow-up was also associated with a higher odds of sobriety, highlighting the importance of increased AA involvement in the period immediately following treatment episodes.

The dimensionality of alcohol use disorders and alcohol consumption in a cross-national perspective

AIMS To replicate the finding that there is a single dimension trait in alcohol use disorders and to test whether the usual 5+ drinks for men and 4+ drinks for women and other measures of alcohol consumption help to improve alcohol use disorder criteria in a series of diverse patients from emergency departments (EDs) in four countries. DESIGN Cross-sectional surveys of patients aged 18 years and older that reflected consecutive arrival at the ED. The Composite International Diagnostic Interview Core was used to obtain a diagnosis of DSM-IV alcohol dependence and alcohol abuse; quantity and frequency of drinking and drunkenness as well as usual number of drinks consumed during the last year. SETTING Participants were 5195 injured and non-injured patients attending seven EDs in four countries: Argentina, Mexico, Poland and the United States (between 1995-2001). FINDINGS Using exploratory factor analyses alcohol use disorders can be described as a single, unidimensional continuum without any clear-cut distinction between the criteria for dependence and abuse in all sites. RESULTS from item response theory analyses showed that the current DSM-IV criteria tap people in the middle-upper end of the alcohol use disorder continuum. Alcohol consumption (amount and frequency of use) can be used in all EDs with the current DSM-IV diagnostic criteria to help tap the middle-lower part of this continuum. Even though some specific diagnostic criteria and some alcohol consumption variables showed differential item function across sites, test response curves were invariant for ED sites and their inclusion would not impact the final (total) performance of the diagnostic system. CONCLUSIONS DSM-IV abuse and dependence form a unidimensional continuum in ED patients regardless of country of survey. Alcohol consumption variables, if added, would help to tap patients with more moderate severity. The DSM diagnostic system for alcohol use disorders showed invariance and performed extremely well in these samples.

Attributable Risk of Injury Associated With Alcohol Use: Cross-National Data From the Emergency Room Collaborative Alcohol Analysis Project

OBJECTIVES We sought to determine gender- and age-specific attributable risks of all-cause and violence-related injuries associated with alcohol use. METHODS We used meta-analytic techniques to estimate attributable risks observed in emergency room studies conducted in 7 countries (n=17708). RESULTS In the case of both alcohol consumption before the injury event and individual drinking patterns, pooled attributable risk effect sizes for all-cause injuries were significant but minimal (2% to 6%). Effect sizes for violence-related injuries were 43% for drinking before an injury event and 27% for individual drinking pattern. Risks were greater for men, but no age-specific differences were found. CONCLUSIONS This meta-analysis showed that attributable risk of injury is greater for drinking before the injury event than for drinking pattern; in addition, risks were more pronounced for violence-related injuries. Differences in risk were explained by variables related to sociocultural contexts.

Clinical assessment compared with breathalyser readings in the emergency room: concordance of ICD-10 Y90 and Y91 codes

Objectives: The purpose of this study was to analyse the validity of clinical assessment of alcohol intoxication (ICD-10 Y91) compared with estimated blood alcohol concentration (BAC) using a breath analyser (ICD-10 Y90) among patients in the emergency room (ER). Methods: Representative samples of ER patients reporting within six hours of injury (n = 4798) from 12 countries comprising the WHO Collaborative Study on Alcohol and Injuries were breath analysed and assessed blindly for alcohol intoxication at the time of ER admission. Data were analysed using Kendall’s Tau-B to measure concordance of clinical assessment and BAC, and meta analysis to determine heterogeneity of effect size. Results: Raw agreement between the two measures was 86% (Tau-B 0.68), but was lower among those reporting drinking in the six hours prior to injury (raw agreement 39%; Tau-B 0.32). No difference was found by gender or for timing of clinical assessment in relation to breath analysis. Patients positive for tolerance or dependence were more likely to be assessed as intoxicated at low levels of BAC. Estimates were homogeneous across countries only for females and for those negative for alcohol dependence. Conclusions: Clinical assessment is moderately concordant with level of BAC, but in those patients who have actually been drinking within the last six hours the concordance was much less, possibly because, in part, of a tendency on the part of clinicians to assign some level of intoxication to anyone who appeared to have been drinking.

Externalities from Alcohol Consumption in the 2005 US National Alcohol Survey: Implications for Policy

A subsample (n = 2,550) of the 2005 US National Alcohol Survey of adults was used to estimate prevalence and correlates of six externalities from alcohol abuse––family problems, assaults, accompanying intoxicated driver, vehicular accident, financial problems and vandalized property––all from another’s drinking. On a lifetime basis, 60% reported externalities, with a lower 12-month rate (9%). Women reported more family/marital and financial impacts and men more assaults, accompanying drunk drivers, and accidents. Being unmarried, older, white and ever having monthly heavy drinking or alcohol problems was associated with more alcohol externalities. Publicizing external costs of drinking could elevate political will for effective alcohol controls.

Sober living houses for alcohol and drug dependence: 18-month outcomes.

OBJECTIVE A major challenge facing many individuals attempting to abstain from substances is finding a stable living environment that supports sustained recovery. Sober living houses (SLHs) are alcohol- and drug-free living environments that support abstinence by emphasizing involvement in 12-step groups and social support for recovery. Among a number of advantages, they are financially self-sustaining and residents can stay as long as they wish. Although SLHs can be used as housing referrals after inpatient treatment, while clients attend outpatient treatment, after incarceration, or as an alternative to treatment, they have been understudied and underutilized. METHOD To describe outcomes of SLH residents, we interviewed 245 individuals within 1week of entering SLHs and at 6-, 12-, and 18-month follow-up. Eighty-nine percent completed at least one follow-up interview. Outcomes included the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and measures of alcohol and drug use. Covariates included demographic characteristics, 12-step involvement, and substance use in the social network. RESULTS Regardless of referral source, improvements were noted on ASI scales (alcohol, drug, and employment), psychiatric severity on the BSI, arrests, and alcohol and drug use. Substance use in the social network predicted nearly all outcome measures. Involvement in 12-step groups predicted fewer arrests and lower alcohol and drug use. CONCLUSION Residents of SLHs made improvements in a variety of areas. Additional studies should use randomized designs to establish causal effects of SLHs. Results support the importance of key components of the recovery model used by SLHs: (a) involvement in 12-step groups and (b) developing social support systems with fewer alcohol and drug users.

Partner alcohol use, violence and women’s mental health: population-based survey in India

BACKGROUND The relationship between partner alcohol use and violence as risk factors for poor mental health in women is unclear. AIMS To describe partner-related and other psychosocial risk factors for common mental disorders in women and examine interrelationships between these factors. METHOD Data are reported on 821 women aged 18-49 years from a larger population study in north Goa, India. Logistic regression models evaluated the risks for womens common mental disorders and tested for mediation effects in the relationship between partner alcohol use and these disorders. RESULTS Excessive partner alcohol use increased the risk for common mental disorders two- to threefold. Partner violence and alcohol-related problems each partially mediated the association between partner excessive alcohol use and these mental disorders. Womens own violence-related attitudes were also independently associated with them. CONCLUSIONS Partner alcohol use, partner violence and womens violence-related attitudes must be addressed to prevent and treat common mental disorders in women.