Jukka T. Halme

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

BACKGROUND The 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. METHODS The 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. RESULTS AND CONCLUSIONS The 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.

Hazardous Drinking: Prevalence and Associations in the Finnish General Population

BACKGROUND Hazardous drinking, defined as consuming alcohol on a risky level and not meeting the diagnostic criteria of alcohol use disorders (AUDs), has been suggested for a new complementary nondependence diagnosis. This study aimed to investigate the prevalence and associations of hazardous drinking in comparison to AUDs, moderate drinking, and abstinence. METHODS A national representative sample of Finns was examined in the Health 2000 Survey. For 4477 subjects aged 30 to 64 years (76%, 2341 females), both the quantity frequency data about alcohol consumption and Composite International Diagnostic Interview (CIDI) data concerning AUD diagnoses were available. The nationally recommended limits for hazardous dinking were used (males: 24 drinks, females: 16 drinks/wk). Logistic regression models were used to analyze associations. RESULTS The prevalence of hazardous drinking was 5.8%. Hazardous drinking was more prevalent among males than females (8.5% vs. 3.1%). It was most prevalent among the subjects aged 40 to 49 years (7.3%), divorced or separated (8.3%), unemployed (8.2%) and subjects living in the southern (Helsinki) region (7.5%). AUDs versus hazardous drinking were more likely to be in males versus females and in the unemployed versus employed. Subjects aged 40 and over had higher odds for hazardous drinking versus AUDs. The odds for hazardous versus moderate drinking were higher for males versus females (adjusted odds ratio = 3.24), for subjects aged over 40 years, unemployed versus employed and cohabiting, divorced/separated or unmarried subjects versus married subjects. CONCLUSION The high prevalence of hazardous drinking makes it an important public health concern. Hazardous drinkers have different sociodemographic characteristics as compared to people in other alcohol use categories.

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.

Alcohol consumption and all-cause mortality among elderly in Finland

AIMS To estimate the gender-specific prevalences of alcohol consumption levels and to investigate the association between heavy drinking and all-cause mortality among elderly males. DESIGN A cohort derived from a nationally representative sample of Finns aged >65 years was followed for six years. Number of subjects was 1569 (72.7% of the original sample, 65.3% females, weighted n=1357). MEASUREMENTS Alcohol consumption was retrospectively measured by beverage-specific quantity and frequency over a 12-month period. Mortality data were obtained from the official Cause-of-Death Register. Cox proportional hazards models were used to analyse the relative risks (RRs) of death. FINDINGS The prevalence of heavy drinking (>8 standard drinks per week) was 20.3% in males and 1.2% in females. Over one-tenth (11.4%) of males reported drinking > or =15 standard drinks per week. Relative death risks suggested a J-curved relationship between alcohol consumption levels and mortality. However, significant curvilinear relationship was not found, when using alcohol consumption as continuous variable. The multivariate adjusted RR of death among moderate drinkers (1-7 drinks per week) vs. abstinent subjects was 0.41 (95% CI=.23-.72). Males drinking > or =15 standard drinks per week had a two-fold multivariate adjusted risk of death (RR=2.11, 95% CI=1.19-3.75) compared with abstinent males. The level of alcohol consumption by females was too low for analysis. CONCLUSIONS Heavy drinking is common among Finnish elderly males but not among females. The present study shows an increased all-cause mortality risk for males drinking, on average, more than two standard drinks per day.

Buprenorphine Misuse in Finland

In recent years in Finland, many clinicians have observed that treatment-seeking opioid dependents misuse mainly buprenorphine and hardly use any heroin at all. We carried out a study to evaluate how commonly those opioid dependents entering a maintenance treatment program have misused buprenorphine. The subjects were 30 consecutive patients entering the program between September 2004 and May 2005 in Kotka, which is a town on the south coast of Finland. Under Finnish legislation, the requirements for entry to a maintenance program are opioid dependence under the International Classification of Diseases-10 (ICD-10) and participation at least once in detoxification treatment. A research nurse interviewed all the subjects using the European Addiction Severity Index. Written informed consent was obtained from the subjects and the ethical committee of the Hospital District of Helsinki and Uusimaa approved the study protocol. The subjects were mainly male (n = 24; 80%). The mean age (S.D.; range) was 26.7 (4.9; 18–36) years. The subjects’ mean total years (S.D.) of education was 11.5 (1.8). Four (13%) were homeless. Fifteen (50%) lived with a partner, and of the partners, 12 had alcohol or drug problems. Four subjects lived in the same household as their own or their partner’s child. Thirteen of the males (54%) and three of the females (50%) had been mainly unemployed during the last three years. The main opioid used before the treatment by 29 (97%) subjects was buprenorphine. One mainly used oxycodone. Two subjects had taken buprenorphine only orally (8 and 16 mg per day). Others were intravenous users. The mean intravenous dose of buprenorphine per day before entering the treatment was 8.1 mg (S.D. = 4.5 mg; range = 2–16 mg). The mean time elapsing from first drug use to first opioid use was 8.5 years (S.D. = 4.8) and mean opioid misuse history was 3.6 years (S.D. = 1.7). Twenty-nine (97%) had used heroin during their lifetime. Eighteen of them had used heroin for less than one year. Only six (20%) subjects had been using heroin during the last 30 days before the treatment. Nine (30%) subjects reported starting opioid use with an opioid other than heroin. The mean age

Effectiveness of buprenorphine maintenance treatment as compared to a syringe exchange program among buprenorphine misusing opioid-dependent patients

Aims: To investigate the effectiveness of buprenorphine maintenance treatment (BMT) among opioid dependents who are mainly misusing buprenorphine intravenously. Methods: The study was a prospective naturalistic follow-up with a non-randomized control group. In Finland, 30 opioid dependents reporting previous misuse of buprenorphine and participating in the outpatient BMT and 30 matched controls participating in a syringe exchange program (SEP) were followed. Based on the evidence for the superiority of maintenance treatment, randomization was not done. The effectiveness was evaluated by retention rate, European Addiction Severity Index (EuropASI) interviews, Beck Depression Inventory (BDI), visual analogue scale for quality of life (VAS) during the 2-year follow-up and mortality rates during the 3-year follow-up. Because of drop-outs in the SEP group, only the BMT group was interviewed at 24 months. Results: At 3 months, the retention rate of the BMT group was 100% and of the SEP group 47%. At 12 months, the corresponding percentages were 83% and 37%. The total EuropASI composite score improved significantly only in the BMT group. In the BMT group, the BDI total score and VAS scales for quality of life improved significantly more than they did in the SEP group. During 3-year follow-up, four patients in the SEP died and none in the BMT. Conclusions: BMT appears to be an effective treatment for opioid dependents using mainly buprenorphine intravenously. On the other hand, bare SEP appears to result in high drop-out, not significant improvements and deaths.