John D. Clapp

The relationship between drinking games and intentions to continue drinking, intentions to drive after drinking, and adverse consequences: Results of a field study

Abstract Background: Drinking games have become a nearly universal aspect of excessive drinking on university campuses with 50–62% of college students reporting playing drinking games in the past month. Participation in drinking games has been correlated with numerous negative consequences and increased consumption of alcohol. Objectives: The present study addresses the influence of drinking games on three drinking-related outcomes: problems experienced the night of the drinking event, the intent to keep drinking, and the intent to drive after drinking. Methods: The data collected for the present study were part of a study testing environmental influences of drinking behaviors of young adults. A total of 226 randomly selected parties (representing 1725 partygoers) were selected for study inclusion. Three multilevel logistic regression models tested the relationship between drinking games and the three drinking-related outcomes. Results: Participants who reported playing drinking games were 1.58 times more likely to report continued drinking intentions than participants who did not play drinking games. If drinking games were observed at a party, participants were 2.38 times more likely to plan to drive while intoxicated. Additionally, participants who reported playing drinking games were 1.59 times more likely to report experiencing a drinking-related problem than participants who did not play drinking games. Conclusion: Drinking games have consequences beyond increasing the level of intoxication; they contribute to problematic behavior at individual and environmental levels. Preventing drinking games is warranted.

Modeling and Analysis of Group Dynamics in Alcohol-Consumption Environments

High-risk drinking is considered a major concern in public health, being the third leading preventable cause of death in the United States. Several studies have been conducted to understand the etiology of high-risk drinking and to design prevention strategies to reduce unhealthy alcohol-consumption and related problems, but there are still major gaps in identifying and investigating the key components that affect the consumption patterns during the drinking event. There is a need to develop tools for the design of methodologies to not only identify such dangerous patterns but also to determine how their dynamics impact the event. In this paper, based on current empirical evidence and observations of drinking events, we model a human group that is in an alcohol-consumption scenario as a dynamical system whose behavior is driven by the interplay between the environment, the network of interactions between the individuals, and their personal motivations and characteristics. We show how this mathematical model complements empirical research in this area by allowing us to analyze, simulate, and predict the drinking group behaviors, to improve the methodologies for field data collection, and to design interventions. Through simulations and Lyapunov stability theory, we provide a computational and mathematical analysis of the impact of the model parameters on the predicted dynamics of the drinking group at the drinking event level. Also, we show how the dynamical model can be informed using data collected in situ and to generate information that can complement the analysis.

Dynamics of Metabolism and Decision Making During Alcohol Consumption: Modeling and Analysis

Heavy alcohol consumption is considered an important public health issue in the United States as over 88 000 people die every year from alcohol-related causes. Research is being conducted to understand the etiology of alcohol consumption and to develop strategies to decrease high-risk consumption and its consequences, but there are still important gaps in determining the main factors that influence the consumption behaviors throughout the drinking event. There is a need for methodologies that allow us not only to identify such factors but also to have a comprehensive understanding of how they are connected and how they affect the dynamical evolution of a drinking event. In this paper, we use previous empirical findings from laboratory and field studies to build a mathematical model of the blood alcohol concentration dynamics in individuals that are in drinking events. We characterize these dynamics as the result of the interaction between a decision-making system and the metabolic process for alcohol. We provide a model of the metabolic process for arbitrary alcohol intake patterns and a characterization of the mechanisms that drive the decision-making process of a drinker during the drinking event. We use computational simulations and Lyapunov stability theory to analyze the effects of the parameters of the model on the blood alcohol concentration dynamics that are characterized. Also, we propose a methodology to inform the model using data collected in situ and to make estimations that provide additional information to the analysis. We show how this model allows us to analyze and predict previously observed behaviors, to design new approaches for the collection of data that improves the construction of the model, and help with the design of interventions.

Feeling No Buzz or a Slight Buzz Is Common When Legally Drunk

The authors argue that many young adults in America are at high risk of driving drunk and disproportionately represent those who are fatally injured in alcohol-related accidents due to changing perceptions about what constitutes drunk driving and buzzed (impaired) driving under U.S. law. The transition of advertising campaigns from driving drunk prevention to buzzed driving prevention is examined, along with the psychological aspects of sober and intoxicated individuals in America.

Comparison of Clinical Outcomes Following Head and Neck Surgery Among Patients Who Contract to Abstain From Alcohol vs Patients Who Abuse Alcohol

Importance Alcohol abuse is highly prevalent in the population of patients with head and neck cancer, and active abuse at the time of surgery results in poor postoperative outcomes. Objective To determine the association of alcohol abstinence with postoperative outcome in alcohol misusers undergoing major surgical procedures of the head and neck. Design, Setting, and Participants As a case-control study, from July 2013 to August 2015, outcomes were collected in patients at an academic tertiary referral center requiring free flap reconstruction who had undergone an abstinence contract (n = 15) and compared with those who were abusers of alcohol prior to the inception of the protocol (n = 30). Interventions Our institution developed a clinical protocol in which patients who are misusers of alcohol are educated and voluntarily asked to sign an alcohol abstinence contract agreeing to be abstinent of alcohol a minimum of 7 days prior to surgery. Main Outcomes and Measures Rate of alcohol withdrawal, length of stay, return to operating room, and readmission within 30 days were determined from medical record review. Results In the contracted group (15 patients), the mean age was 62 years, and 12 were male; in the control group (30 patients), the mean age was 58 years, and 26 were male. In both cohorts, no statistically significant difference was found between initial staging, surgery performed, and preoperative morbid conditions. The alcohol abstinence contracted group had an average of 14.8 days of abstinence prior to surgery. Abstinence was achieved at home for 11 patients, in a detoxification facility for 2 patients, and with preoperative admission for 2 patients. In direct comparisons between the groups, the rates of alcohol withdrawal (63% vs 0%; difference, 0.63; 95% CI, 0.33-0.85), delirium (73% vs 0%; difference, 0.73; 95% CI, 0.45-0.92), cellulitis (43% vs 7%; difference, 0.37; 95% CI, 0.04-0.64), and wound dehiscence (67% vs 13%; difference, 0.53; 95% CI, 0.22-0.79) were higher in the noncontracted group vs the contracted group. Furthermore, hospital stay (median 13 days vs 9 days; difference, 5 days; 95% CI, 3-7 days) and time lapse to starting adjuvant radiation therapy (median, 60.0 days vs 42.5 days; difference, 15 days; 95% CI, 5.0-25 days) were statistically and clinically significantly longer in the noncontracted group vs the contracted group. Conclusions and Relevance An alcohol abstinence program for surgically treated patients is safe and seems to be effective in reducing morbidity and improve outcomes.

A Control-Theoretic Assessment of Interventions During Drinking Events

This paper employs control-theoretic tools to provide guidelines for in-situ interventions aimed at reducing high-risk alcohol consumption at drinking events. A dynamical directed network model of a drinking event with external intervention, suitable for mathematical analysis and parameter estimation using field data is proposed, with insights from pharmacokinetics and psychology. Later, a characterization of a bound on blood alcohol content (BAC) trajectories is obtained via Lyapunov stability analysis, and structural controllability guarantees are obtained via a graph-theoretic method. We use the degree of controllability, given to be the trace of the system’s controllability Gramian, as a metric to compare the viability of network nodes for intervention based on theoretic and heuristic centrality measures. Results of numerical examples of bars and parties, informed by field data, and the stability and controllability results, suggest that intervening in the environment in wet bars, while targeting influential individuals with high alcohol consumption motivations in private parties efficiently yield lower peak BAC levels in individuals at the drinking events.