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Background We examined differences in response to self-reported alcohol use items by survey mode, whether self-report differences were the result of modality effects or self-selection, and whether these differences varied across the treatment and control arms of a preventative intervention trial. Methods Data from an existing alcohol prevention trial were used to estimate the effect of survey modality on adolescent's self-reported alcohol use at ages 17 to 18. Estimates were derived from regression models controlling for self-reported alcohol use during 8th grade, measured using a single survey modality, as well as time invariant selection factors. Results No statistically significant survey modality effects were found. No differential effects of survey modality were observed by assigned intervention group. Conclusions We provide initial evidence that adolescent alcohol prevention trials may use multiple survey modalities when necessary to increase response rates without harming interpretation of intervention effects. [ABSTRACT FROM AUTHOR]

Background This paper examines the prevalence, the symptom profile, and the drinking and sociodemographic predictors of current (past 12 months) DSM- IV alcohol abuse and dependence among Mexican Americans living along the U. S.- Mexico border and those living in metropolitan areas away from the border. Methods Respondents in the non-border areas (primarily Houston and Los Angeles) constitute a multistage probability sample ( N = 1,288) of these areas, interviewed as part of the 2006 Hispanic Americans Baseline Alcohol Survey ( HABLAS). Respondents in the border area ( N = 1,307) constitute a household probability sample of Mexican Americans living on the border. In both surveys, data were collected during computer-assisted interviews conducted in respondents' homes. The HABLAS and the border sample response rates were 76 and 67%, respectively. Results Although bivariate analyses revealed no overall differences between border and non-border locations, (negative) age trends were more pronounced on the border for male abuse and for dependence among both genders. Among females aged 18 to 29, border residence was linked to significantly higher rates of dependence. In multivariable analyses, the prevalence of male abuse declined more rapidly with age on the border than off the border. Other unique predictors of male abuse were Jewish/other religion and weekly volume of alcohol consumption. Being married or out of the workforce, attaining a higher education, having no religious preference, and weekly volume uniquely predicted female dependence. Age and weekly volume uniquely predicted male dependence. Conclusions The prevalence of alcohol use disorders among Mexican Americans on and off the U. S.- Mexico border largely mirrors previously documented patterns of alcohol consumption in these areas. For young Mexican American women in particular, border residence is linked to heightened vulnerability to alcohol dependence. [ABSTRACT FROM AUTHOR]

Background: The objective of this paper is to examine 10-year trends (1992 to 2002) in the number and type of indicators of DSM-IV abuse and dependence among whites, blacks, and Hispanics in the United States. Methods: Data are from the 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES; n = 42,862) and the 2001 to 2002 National Epidemiologic Study on Alcohol and Related Conditions (NESARC; n = 43,093). Both surveys used multistage cluster sample procedures to select respondents 18 years of age and older from the U.S. household population. Results: Increases in the prevalence of alcohol abuse between 1992 and 2002 seem associated with a rise in the prevalence of the indicator for 'hazardous use.' which usually means reports of driving after drinking. The decrease in dependence was not associated with changes in a particular indicator. In addition, both in 1992 and 2002, 12.3 to 15.4% of the men and 5.2 to 7.9% of the women were diagnostic 'orphans.' These respondents reported 1 or 2 indicators of alcohol dependence as present. Conclusions: The observed trends in number and types of indicators of DSM-IV alcohol abuse and dependence were probably triggered by a complex interplay between individuals' volume and pattern of drinking and reactions from the drinkers' social environment. The close association between hazardous use of alcohol and the prevalence of abuse deserves further discussion. A medical diagnostic category should not be so dependent on a criterion that may be influenced by social situations. It is necessary to understand more about diagnostic 'orphans' to better design interventions to address their problems. [ABSTRACT FROM AUTHOR]

Previous research has documented a relationship between child sexual abuse and alcohol dependence. This paper extends that work by providing a comprehensive description of past year and lifetime alcohol consumption patterns, consequences, and dependence among women reporting either physical and sexual abuse in a national sample. This study used survey data from 3,680 women who participated in the 2005 U.S. National Alcohol Survey. Information on physical and sexual child abuse and its characteristics were assessed in relation to 8 past year and lifetime alcohol consumption measures. Child physical or sexual abuse was significantly associated with past year and lifetime alcohol consumption measures. In multivariate analyses, controlling for age, marital status, employment status, education, ethnicity, and parental alcoholism or problem drinking, women reporting child sexual abuse vs. no abuse were more likely to report past year heavy episodic drinking (OR = 1.7; 95% CI 1.0 to 2.9), alcohol dependence (OR = 7.2; 95% CI 3.2 to 16.5), and alcohol consequences (OR = 3.6; 95% CI 1.8 to 7.3). Sexual abuse (vs. no abuse) was associated with a greater number of past year drinks (124 vs. 74 drinks, respectively, p = 0.002). Sexual child abuse was also associated with lifetime alcohol-related consequences (OR = 3.5; 95% CI 2.6 to 4.8) and dependence (OR = 3.7; 95% CI 2.6 to 5.3). Physical child abuse was associated with 4 of 8 alcohol measures in multivariate models. Both physical and sexual child abuse were associated with getting into fights, health, legal, work, and family alcohol-related consequences. Alcohol-related consequences and dependence were more common for women reporting sexual abuse compared to physical abuse, 2 or more physical abuse perpetrators, nonparental and nonfamily physical abuse perpetrators, and women reporting injury related to the abuse. Both child physical and sexual abuse were associated with many alcohol outcomes in adult women, even when controlling for parental alcohol problems. The study results point to the need to screen for and treat underlying issues related to child abuse, particularly in an alcohol treatment setting. [ABSTRACT FROM AUTHOR]

Background Treatment for alcohol use disorders (AUDs) has traditionally been abstinence oriented, but new research and regulatory guidelines suggest that low-risk drinking may also be an acceptable treatment outcome. However, little is known about long-term outcomes for patients who become low-risk drinkers posttreatment. This study explores a posttreatment low-risk drinking outcome as a predictor of future drinking and psychosocial outcomes over 9 years. Methods Study participants were adults with AUDs at treatment entry who received follow-up interviews 6 months posttreatment intake ( N = 1,061) in 2 large randomized studies conducted at Kaiser Permanente Northern California, a large private, nonprofit, integrated health system. Six-month drinking status was defined as abstinent, low-risk (nonabstinent, no 5+ drinking days), or heavy drinking (1 or more days of 5+ drinks). Using logistic regression models, we explored the relationship between past 30-day drinking status at 6 months and odds of being abstinent or a low-risk drinker (compared to heavy drinking), and positive Addiction Severity Index psychosocial outcomes over 9 years (9-year follow-up rate of 73%). Results Abstainers and low-risk drinkers at 6 months had higher odds of recent abstinence/low-risk drinking over 9 years than heavy drinkers; abstainers had better drinking outcomes than low-risk drinkers. Additionally, among those with interview data, 95% of abstainers and 94% of low-risk drinkers at 6 months were abstinent/low-risk drinkers at 9 years; surprisingly, 89% of heavy drinkers at 6 months were also abstinent/low-risk drinkers although still significantly fewer than the other groups. Abstainers and low-risk drinkers at 6 months had better psychiatric outcomes, and abstainers had better family/social outcomes than heavy drinkers; medical outcomes did not differ. Low-risk drinkers and abstainers showed no reliable differences across psychosocial measures. Conclusions The findings suggest that a low-risk drinking outcome may be reasonable over the long-term for some alcohol-dependent individuals receiving addiction treatment. [ABSTRACT FROM AUTHOR]

Background Standardized alcohol craving scales are rarely used outside of research environments despite recognized clinical utility. Scale length is a key barrier to more widespread application. A brief measure of alcohol craving is needed to improve research and treatment of alcohol use disorders ( AUDs). Grounded in the Elaborated Intrusion Theory of Desire, the Alcohol Craving Experience ( ACE) Questionnaire comprises two 11-item self-report scales that assess past-week frequency and maximum strength of alcohol craving. This study aimed to create a brief version of the ACE while maintaining psychometric integrity and clinical utility. Methods Patients attending a university hospital alcohol and drug outpatient service for the treatment of AUD completed the ACE as part of a questionnaire battery. Three patient samples were utilized: 519 patients with pretreatment and outcome data, 228 patients with pretreatment data, and 66 patients who completed the ACE at treatment sessions 1 and 2. Results The Frequency scale of the ACE possessed greater clinical utility and predictive validity than the Strength scale. Revision of the Frequency measure produced a 5-item 'Mini Alcohol Craving Experience' ( MACE) Questionnaire. Satisfactory validity (construct, predictive, concurrent, convergent, and incremental) and reliability (internal and test-retest) were maintained. A 1 standard deviation increase in pretreatment MACE score was associated with a 54 percentage increase in the odds of patient lapse or dropout. Conclusions The MACE provides a brief, theoretically, and psychometrically robust measure of alcohol craving suitable for use with AUD populations in time-limited clinical and research settings. [ABSTRACT FROM AUTHOR]

Background This study reports findings from the International Alcohol Control ( IAC) study that assesses the impact of alcohol control policy on consumption and policy-related behaviors. Modeled on the International Tobacco Control study that uses longitudinal surveys with comparison between countries, the baseline survey was carried out in New Zealand. This study reports analysis of the purchasing behavior respondents report separately for on- and off-premise outlets, providing validation data for both alcohol consumption and reported prices. Methods New Zealand is a high-income country with an adult per capita alcohol consumption (as of 2011) of 9.5 l. The survey was carried out among a nationally representative sample of drinkers. Interview data on place and time of purchase, amounts purchased, price paid, and consumption (beverage and location specific) was collected. Relationships between policy relevant variables and consumption were modeled taking into account demographic variables. Validation was provided by government data on alcohol available for consumption, aggregate expenditure and prices from the Consumer Price Index. Results Drinkers paying low prices at on- or off-licensed premises had higher odds of consuming 6+ drinks on a typical occasion, as did drinkers purchasing alcohol at later times. Regarding frequency, drinkers purchasing at later times were more likely to be daily drinkers. Lower price in off licenses but not on licenses predicted daily drinking. The data collected accounted for approximately 96% of alcohol available for consumption and the prices accounted for 98% of aggregate expenditure. Conclusions Valid survey data were collected to give an accurate picture of alcohol consumption and prices paid by drinkers. Heavy drinkers were more likely to buy cheaper alcohol and purchase at later times; 2 policy issues under discussion in many settings. This analysis suggests the IAC study that has the potential to provide data to contribute to the debate on appropriate policy responses to reduce alcohol-related harm. [ABSTRACT FROM AUTHOR]

Background This article examines age at first drink and adult drinking, binge drinking and DSM-5 alcohol use disorder ( AUD) among U.S. Hispanic national groups. Methods Respondents come from 2 independent studies. The Hispanic Americans Baseline Alcohol Survey used a multistage cluster sample design to interview 5,224 individuals 18 years of age and older selected from the household population in Miami, New York, Philadelphia, Houston, and Los Angeles. Respondents in the border area ( N = 1,307) constituted a household probability sample of Mexican Americans living on U. S. counties that border Mexico. In both surveys, data were collected during computer-assisted interviews conducted in respondents' homes. The Hispanic American Baseline Alcohol Survey and the border sample response rates were 76 and 67%, respectively. Results U. S.-born Hispanics begin drinking at a younger age than those who are foreign-born, independent of national group. Among foreign-born Hispanics, age of arrival in the United States is not associated with age at first drink. Results support the hypothesis that a younger age at first drink is associated with a higher mean volume of drinking, a higher probability of bingeing, and a higher probability of DSM-5 AUD. But the results do not show a clear pattern by which a particular national group would consistently show no associations or stronger associations between age at first drink and the alcohol-related outcomes under consideration. Conclusions An earlier age at first drinking is positively associated with heavier drinking patterns among U. S. Hispanics. However, as in other areas of alcohol epidemiology, here too there is considerable variation in age at first drink and drinking across Hispanic national groups. [ABSTRACT FROM AUTHOR]

Background Suicide-related ideation and behaviors ( SRIB) are associated with both alcohol disorders and major depressive disorder ( MDD). The objective of this study was to evaluate the relationship of alcohol dependence ( AD) and major depression to the risk for lifetime SRIB. Methods Data from a community-based sample of 1,237 adult Israeli lifetime drinkers assessed with reliable diagnostic measures were analyzed using logistic regression. Results Lifetime SRIB was reported in 4.7% and was more prevalent among participants with AD (9.0%) than among those without AD (4.1%); p-value = 0.01. Although both AD and major depression were associated with SRIB ( AD: OR 2.2, 95% CI 1.1 to 4.4; MDD: OR 11.4, 95% CI = 6.4 to 20.4), joint analysis showed that AD without MDD increased risk for SRIB as compared to those without AD or MDD ( OR 3.1, 95% CI 1.1 to 9.1), but AD did not increase risk among those with MDD ( OR 1.1, 95% CI 0.4 to 2.7). Among those with AD, the severity of subclinical depressive symptoms was associated with increased SRIB. Conclusions These findings show that AD increases risk for SRIB among individuals without a history of major depression. Suicidal tendencies may be undetected and underdiagnosed in this group because of the absence of major depression and therefore left untreated. These findings should be considered when adopting suicide prevention or treatment strategies for this high-risk subpopulation. [ABSTRACT FROM AUTHOR]

Background Heavy prenatal alcohol exposure ( AE) results in a broad array of neurobehavioral deficits. Recent research has focused on identification of a neurobehavioral profile or profiles that will improve the identification of children affected by AE. This study aimed to build on our preliminary neurobehavioral profile to improve classification accuracy and test the specificity of the resulting profile in an alternate clinical group. Methods A standardized neuropsychological test battery was administered to 3 groups of children: subjects with AE ( n = 209), typically developing controls ( CON, n = 185), and subjects with attention-deficit/hyperactivity disorder ( ADHD, n = 74). We assessed a large sample from 6 sites in the United States and South Africa, using standardized methodology. Data were analyzed using 3 latent profile analyses including (i) subjects with fetal alcohol syndrome (FAS) and controls, (ii) subjects with AE without FAS and controls, and (iii) subjects with AE (with or without FAS) and subjects with ADHD. Results Classification accuracy was moderate but significant across the 3 analyses. In analysis 1, overall classification accuracy was 76.1% (77.2% FAS, 75.7% CON). In the second analysis, overall classification accuracy was 71.5% (70.1% AE/ non- FAS, 72.4% CON). In the third analysis, overall classification accuracy was 73.9% (59.8% AE, 75.7% ADHD). Subjects that were misclassified were examined for systematic differences from those that were correctly classified. Conclusions The results of this study indicate that the neuropsychological effects of AE are clinically meaningful and can be used to accurately distinguish alcohol-affected children from both typically developing children and children with ADHD. Further, in combination with other recent studies, these data suggest that approximately 70% of children with heavy prenatal alcohol exposure are neurobehaviorally affected, while the remaining 30% are spared these often-devastating consequences, at least those in the domains under study. Refining the neurobehavioral profile will allow improved identification and treatment development for children affected by prenatal alcohol exposure. [ABSTRACT FROM AUTHOR]

Background Emerging research suggests that genetic influences on adolescent drinking are moderated by environmental factors. The present study builds on molecular-genetic findings by conducting the first analysis of gene-environment interactions in the association between a functional single nucleotide polymorphism ( SNP) of the μ-opioid receptor ( OPRM1) gene ( A118 G) and risk of developing an alcohol use disorder ( AUD) during adolescence. Specifically, we tested whether variation in parenting practices or affiliation with deviant peers moderated the link between the OPRM1 gene and risk of an AUD. Methods Adolescents reporting European ancestry ( N = 104), ages 12 to 19 years ( M = 15.60, SD = 1.77), were interviewed to ascertain AUD diagnoses, provided a DNA sample for genetic analyses, and completed measures of parental monitoring and deviant peer affiliation. Logistic regression was used to test the effects of environmental variables and their interactions with OPRM1 genotype as predictors of AUD diagnosis while controlling for age and sex. Results Case-control comparisons showed that the proportion of youth with an AUD ( n = 18) significantly differed by genotype such that 33.3% of G allele carriers met criteria for an AUD compared to 10.8% of youth who were homozygous for the A allele ( p = 0.006). The OPRM1 × parental monitoring (odds ratio = 0.16) and OPRM1 × deviant peer affiliation (odds ratio = 7.64) interactions were significant predictors of AUD risk, such that G allele carriers with high levels of deviant peer affiliation or lower levels of parental monitoring had the greatest likelihood of developing an AUD ( p-values <0.01). Conclusions This study provides initial evidence that the association between the A118 G SNP of the OPRM1 gene and risk of AUDs is moderated by modifiable factors. These results are limited, however, by the small sample size and require replication. [ABSTRACT FROM AUTHOR]

Background Alcohol use disorders ( AUDs) are clinically heterogeneous and strongly influenced by familial/genetic factors. Can we identify specific clinical features of AUDs that index familial liability to illness? Methods In twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders meeting DSM- IV criteria for lifetime AUDs, we examined whether clinical features of AUDs, including individual DSM- IV criteria for alcohol dependence ( AD) and alcohol abuse ( AA), predicted risk for AUDs in cotwins and/or parents. Analyses of individual criterion were repeated controlling for the total number of endorsed criteria. Results Across these analyses, examining narrowly and broadly defined AUDs, risk of AUDs in relatives was more consistently predicted by abuse criteria than by dependence criteria, and by criteria reflecting negative psychosocial consequences rather than pharmacologic/biological criteria. Age at onset (AAO) poorly predicted risk in relatives. AUD associated legal problems, the one criterion slated for removal in DSM-5, was the most consistent single predictor of familial risk. Associations observed between individual criteria and risks of illness in relatives were generally stronger in monozygotic than dizygotic twin pairs, suggesting that these symptoms reflect a genetic risk for AUDs. Conclusions Individual DSM- IV criteria for AA and AD differ meaningfully in the degree to which they reflect the familial/genetic liability to AUDs. Contrary to expectation, the familial/genetic risk to AUDs was better reflected by symptoms of abuse and negative psychosocial consequences of AUD than by early AAO, or symptoms of tolerance and withdrawal. [ABSTRACT FROM AUTHOR]

Background Research on the association between alcohol use and unemployment has been conducted in various settings and subgroups. While most studies confirm that problem use is related to subsequent unemployment, results are inconclusive regarding the reverse association. Few studies have analyzed binge drinking as either a predictor or an outcome. Methods This study investigates 13,031 residents in Stockholm county, who participated in a 2002 survey with a follow-up in 2007, aged 20 to 59, and currently employed or on leave at T1. Associations between frequency of binge drinking and total unemployment duration in 2003 to 2006 were assessed using logistic regression, taking previous binge drinking and previous unemployment experience into account. Results After full adjustment, high frequency of binge drinking (1 per week or more) had a nonsignificant association with any subsequent unemployment for men and women and a significant association with long-term unemployment (>6 months) for women ( OR 1.87). For men, both short-term unemployment and long-term unemployment were unrelated to later binge drinking after adjustment for previous binge drinking. Associations were stronger for women, but not significant in the full model. Conclusions Frequent binge drinking among women was associated with long-term unemployment. There was little support for the social causation hypothesis. [ABSTRACT FROM AUTHOR]

Background Based on published data showing that daily smokers have high rates of hazardous drinking and higher rates of smoking relapse, we hypothesized that New York State Smokers' Quitline ( NYSSQL) callers would exhibit elevated rates of risky drinking and risky drinking callers would report lower rates of smoking cessation. Methods We assessed rates of hazardous drinking among 88,479 callers to the NYSSQL using modified NIAAA guidelines. Using 2 routine NYSSQL short-term follow-up interviews ( n = 14,123 and n = 24,579) and a 3-month follow-up interview ( n = 2,833), we also compared smoking cessation rates for callers who met criteria for hazardous drinking compared to moderate drinkers and nondrinkers. Results At baseline, 56% of callers reported drinking, and 23% reported hazardous drinking using modified NIAAA guidelines. Hazardous drinkers did not differ on measures of smoking cessation outcomes compared to nondrinkers but did have lower smoking cessation rates compared to persons who reported moderate alcohol consumption for the enhanced services program 1-week follow-up (adjusted OR [95% CI] = 1.09 [1.01, 1.17], p = 0.04) and the standard 2-week follow-up (adjusted OR [95% CI] = 1.17 [1.07, 1.29], p = 0.001). Conclusions Nearly a quarter of smokers calling the NYSSQL reported a hazardous drinking pattern, which was associated with lower cessation outcomes compared to those who reported a moderate drinking profile. Given the large number of high-risk drinkers who can be identified through a quitline, tobacco quitlines may provide a venue for providing brief alcohol interventions to these high-risk drinkers. Future studies should evaluate whether a brief alcohol intervention would result in improved smoking cessation rates for hazardous drinking smokers. [ABSTRACT FROM AUTHOR]

Background Prenatal alcohol use, a leading preventable cause of birth defects and developmental disabilities, remains a prevalent public health concern in the United States. This study aims to detect the proportion and correlates of prenatal alcohol use in the prenatal care settings in Alabama. Prenatal care settings were chosen because of their potential as stable locations to screen for and to reduce prenatal alcohol use within a community. Methods We conducted a cross-sectional study of 3,046 women in the 22 and 23 weeks of gestation who sought prenatal care in 8 community-based public clinics and participated in the Perinatal Emphasis Research Center project in Jefferson County, Alabama, from 1997 to 2001. Frequency and quantity of alcohol use in the past 3 months were assessed by research nurses during face-to-face interviews. We conducted logistic regression analyses to calculate adjusted odds ratios ( ORs) and 95% confidence intervals ( CIs) of correlates of prenatal alcohol use. Results Participants were predominantly young, African American, and unmarried, 86.5% on Medicaid. The proportion of alcohol use in the second trimester of pregnancy was 5.1%; 0.3% of women reported 4 or more drinks on a drinking day to research nurses. Older maternal age ( OR = 1.11; 95% CI = 1.08 to 1.15), use of welfare ( OR = 1.43; 95% CI = 1.02 to 2.02), and male partner-perpetrated violence ( OR = 2.96; 95% CI = 1.92 to 4.56) were positively associated with elevated risk of prenatal alcohol use. Protective factors included higher levels of self-esteem ( OR = 0.94; 95% CI = 0.89 to 0.98) and more years of education ( OR = 0.88; 95% CI = 0.78 to 0.98). Conclusions Prenatal alcohol use remains a public health issue among low-income pregnant women in Jefferson County, Alabama. Research nurses detected it in the second trimester. Future studies need to encourage screening for prenatal alcohol use in the prenatal care settings by obstetrician-gynecologists, family physicians, nurses, and midwives. Combined interventions to educate and empower women and strengthen families are needed. [ABSTRACT FROM AUTHOR]

Background: The vast majority of individuals with alcohol problems in the United States and elsewhere do not seek help. One policy response has been to encourage institutions such as criminal justice and social welfare systems to mandate treatment for individuals with alcohol problems (Addiction, 1997; 92:1133). However, informal pressures to drink less from family and friends are far more common than institutional pressures mandating treatment (Addiction, 1996; 91:643). The prevalence and correlates of these informal pressures have been minimally studied. Methods: This analysis used data from 5 Alcohol Research Group National Alcohol Surveys (NAS) collected at approximately 5-year intervals over a 21-year period (1984 to 2005, pooled N = 16,241) to describe the patterns of pressure that drinkers received during the past year from spouse, family, friends, physicians, police, and the workplace. Results: The overall trend of pressure combining all 6 sources across all 5 NAS data sets indicated a decline. Frequent heavy drinking and alcohol-related harms also declined, and both were strong predictors of receiving pressure. Trends among different sources varied. In multivariate regression models, pressure from friends showed an increase. Pressure from spouse and family showed a relatively flat trajectory, with the exception of a spike in pressure from family in 1990. Conclusions: The trajectory of decreasing of pressure over time is most likely the result of decreases in heavy drinking and alcohol-related harm. Pressure was generally targeted toward higher risk drinkers, such as heavy drinkers and those reporting alcohol-related harm. However, demographic findings suggest that the social context of drinking might also be a determinant of receiving pressure. Additional studies should identify when pressure is associated with decreased drinking and increased help seeking. [ABSTRACT FROM AUTHOR]

Background: Prior to the establishment of the uniform drinking age of 21 in the United States, many states permitted legal purchase of alcohol at younger ages. Lower drinking ages were associated with several adverse outcomes, including elevated rates of suicide and homicide among youth. The objective of this study is to examine whether individuals who were legally permitted to drink prior to age 21 remained at elevated risk in adulthood. Methods: Analysis of data from the U.S. Multiple Cause of Death files, 1990 to 2004, combined with data on the living population from the U.S. Census and American Community Survey. The assembled data contained records on over 200,000 suicides and 130,000 homicides for individuals born between 1949 and 1972, the years during which the drinking age was in flux. Logistic regression models were used to evaluate whether adults who were legally permitted to drink prior to age 21 were at elevated risk for death by these causes. A quasi-experimental analytical approach was employed, which incorporated state and birth-year fixed effects to account for unobserved covariates associated with policy exposure. Results: In the population as a whole, we found no association between minimum drinking age and homicide or suicide. However, significant policy-by-sex interactions were observed for both outcomes, such that women exposed to permissive drinking age laws were at higher risk for both suicide (OR = 1.12, 95% CI: 1.05, 1.18, p = 0.0003) and homicide (OR = 1.15, 95% CI: 1.04, 1.25, p = 0.0028). Effect sizes were stronger for the portion of the cohort born after 1960, whereas no significant effects were observed for women born prior to 1960. Conclusions: Lower drinking ages may result in persistent elevated risk for suicide and homicide among women born after 1960. The national drinking age of 21 may be preventing about 600 suicides and 600 homicides annually. [ABSTRACT FROM AUTHOR]

This study examined alcohol use patterns among men and women with depression seeking outpatient psychiatric treatment, including factors associated with recent heavy episodic drinking and motivation to reduce alcohol consumption. The sample consisted of 1,183 patients aged 18 and over who completed a self-administered, computerized intake questionnaire and who scored ≥10 on the Beck Depression Inventory-II (BDI-II). Additional measures included current and past alcohol questions based on the Addiction Severity Index, heavy episodic drinking (≥5 drinks on 1 or more occasions in the past year), alcohol-related problems on the Short Michigan Alcoholism Screening Test (SMAST), and motivation to reduce drinking using the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Among those who consumed any alcohol in the past year (73.9% of the sample), heavy episodic drinking in the past year was reported by 47.5% of men and 32.5% of women. In logistic regression, prior-year heavy episodic drinking was associated with younger age ( p = 0.011), male gender ( p = 0.001), and cigarette smoking ( p = 0.002). Among patients reporting heavy episodic drinking, motivation to reduce alcohol consumption was associated with older age ( p = 0.008), greater usual quantity of alcohol consumed ( p < 0.001), and higher SMAST score ( p < 0.001). In contrast to prior clinical studies, we examined subdiagnostic alcohol use and related problems among psychiatric outpatients with depression. Patients reporting greater drinking quantities and alcohol-related problems also express more motivation to reduce drinking, providing intervention opportunities for mental health providers that should not be overlooked. [ABSTRACT FROM AUTHOR]

Background: Previous research has suggested a positive risk-relationship between volume of consumption and adverse behavioral and social consequences of drinking. However, because the risk-relationship may be modified by factors such as pattern of drinking, attributes of social drinking contexts, and drunken comportment, the shape of the risk-function appear to be contingent upon the larger cultural context of drinking. Methods: In this article, I use graphical risk-curve analyses and model estimations to assess how the risk of experiencing alcohol-related problems is associated with self-reported volume of alcohol consumption in the 3 Baltic countries (Estonia, Latvia, and Lithuania) as well as Sweden and Italy. The analysis utilized data from 2 general population surveys (including Sweden plus Italy and the Baltic countries, respectively) with approximately 1,000 respondents from each country. Results: The risk-curves for the 3 Baltic countries and Sweden were fairly parallel and clearly steeper than that for Italy. In the logistic regression models, the country-specific Baltic estimates were not entirely homogenous; for Estonia and Latvia, the estimates were similar to that for Sweden and significantly larger than that for Italy, whereas the estimate for Lithuania did not differ significantly from that for Italy. However, the negative binominal regression models suggested that increasing volume of consumption is associated with the risk of experiencing a larger number of different problems in all 3 Baltic countries and Sweden than in Italy. Overall, the result thus suggests that there is a significant relationship between volume of consumption and risk of experiencing alcohol-related problems in all countries but that the relationship generally is stronger in the Baltic countries and Sweden than in Italy. Conclusions: The results were largely in line with the hypothesis of a European north to south gradient in the strength of the risk-relationship, but also add that most Baltic countries may be placed alongside the Nordic countries in this context. Because only volume of consumption is considered, the results cannot be used to specify which factors and mechanisms that actually modify the shape of the risk-function in each culture. [ABSTRACT FROM AUTHOR]