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This program calls attention to the upcoming timetable for the revision of the Diagnostic and Statistical Manual (DSM)-IV and the publication of DSM-V. It is vitally important for Research Society of Alcoholism members to be aware of the current discussions of the important scientific questions related to the next DSM revision and to use the opportunity for input. The title of the symposium highlights 1 key question, i.e., whether the DSM definitions should remain strictly categorical as in the past or whether a dimensional component should be included in this revision. Two substantive and 1 conceptual paper are included in this portion of the symposium. The fourth and final presentation detailing the revision timetable and the opportunities for input is by Dr. Darrel Regier. Dr. Regier is the director of American Psychiatric Institute for Research and Education the research and education branch of the American Psychiatric Association and the organization within the APA that will oversee the DSM revision. The discussion is by Marc Schuckit, who was chair of the Substance Use disorders (SUD) Committee for DSM-IV and cochair of the international group of experts reviewing the SUD definitions for DSM-V. [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: This paper examines differences in drinking and binge drinking between Mexican Americans living along the U.S.-Mexico border and those living in 2 metropolitan areas away from the border (Houston, Texas and Los Angeles, California). Methods: Respondents in the non-border area (Houston and Los Angeles) constitute a multistage probability sample ( N = 1,288), who were 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 U.S.-Mexico 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: There were no differences between border and non-border Mexican American men in the proportion of drinkers, the proportion who binge drink at least once a year, and volume of alcohol consumption. However, within each location, there were significant differences in drinking by age, indicating that younger men drank more than men who were older. Border women showed significant differences across age-groups in the proportion of drinkers, in binge drinking, and volume of alcohol consumption, which were not seen among non-border women. Conclusions: Women's drinking seems to be more affected than men's by their residence on or off the U.S.-Mexico border. This is seen most clearly among young women 18 to 29 years old, and it is associated with an increased proportion of drinkers, a higher volume of drinking, and an increased proportion of women who report binge drinking. Increased drinking in this group of younger women seems to be associated with drinking in Mexico. [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]

The 'prevention paradox,' a notion that most alcohol-related problems are generated by nonheavy drinkers, has significant relevance to public health policy and prevention efforts. The extent of the paradox has driven debate over the type of balance that should be struck between alcohol policies targeting a select group of high-risk drinkers versus more global approaches that target the population at-large. This paper examines the notion that most alcohol problems among 4 Hispanic national groups in the United States are attributable to moderate drinkers. A general population survey employing a multistage cluster sample design, with face-to-face interviews in respondents' homes was conducted in 5 metropolitan areas of the United States. Study participants included a total of 2,773 current drinkers 18 years and older. Alcohol consumed in the past year (bottom 90% vs. top 10%), binge drinking (binge vs. no binge), and a 4-way grouping defined by volume and binge criteria were used. Alcohol-related harms included 14 social and dependence problems. Drinkers at the bottom 90% of the distribution are responsible for 56 to 73% of all social problems, and for 55 to 73% of all dependence-related problems reported, depending on Hispanic national group. Binge drinkers are responsible for the majority of the social problems (53 to 75%) and dependence-related problems (59 to 73%), also depending on Hispanic national group. Binge drinkers at the bottom 90% of the distribution are responsible for a larger proportion of all social and dependence-related problems reported than those at the top 10% of the volume distribution. Cuban Americans are an exception. The prevention paradox holds when using volume-based risk groupings and disappears when using a binge-drinking risk grouping. Binge drinkers who drink moderately on an average account for more harms than those who drink heavily across all groups, with exception of Cuban Americans. [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: In light of the inconsistent evidence associating acculturation with drinking outcomes among Latinos in the United States, the current paper comprehensively reviews the literature on this topic. Methods: Studies were eligible for review if they (1) were published in a refereed journal, (2) were published in English, (3) sampled Latino/Hispanic adults aged 18+, (4) examined self-reported drinking behavior, alcohol-related problems, and/or alcohol abuse/dependence, and (5) reported original results or unique analyses from a larger dataset. The review includes only studies using composite scales of acculturation. Studies were identified via electronic databases (i.e., PSYCHINFO, ETOH, and PUBMED) using search terms, and combinations thereof, including “acculturat*,”“alcohol*,”“Latino,” and “Hispanic.” This search was supplemented by recursive checking and author searches. Thirty-two articles were identified and coded on methodological characteristics; results from 24 disaggregating genders and using appropriate outcomes were summarized. Results: Higher acculturation was very consistently associated with higher odds of drinking among women, even controlling for demographic covariates. The evidence for women also suggested associations between higher acculturation and heavier drinking on other outcomes, including total volume, drinking frequency, typical quantity, heavy/problem drinking, drinking problems, and abuse/dependence, despite some null results. Relationships were weaker and ambiguous among men. Some evidence suggested that highly acculturated men are (compared with peers low on acculturation) more prone to drink, and perhaps as a result, can show higher consumption and problems. However, results also implied that, among male drinkers, higher acculturation may be associated with a lighter drinking pattern. Important study limitations were identified, including low power, aggregation of nondrinkers with drinkers, restrictive sampling, measurement issues, and analytical issues. Conclusions: The pattern of results suggests important associations between acculturation and drinking outcomes—particularly for women—but conclusions are tempered by serious methodological limitations. The review urges further research, particularly large-scale, longitudinal studies, addressing these limitations. [ABSTRACT FROM AUTHOR]

Background: In a previous study, ondansetron, a serotonin 5‐HT3 receptor antagonist, reduced drinking intensity (drinks/drinking day [DPDD]) among European‐ancestry (EA) participants with moderate‐to‐severe alcohol use disorder (AUD) and variants in genes encoding the serotonin transporter (SLC6A4) and 5‐HT3A (HTR3A), and 5‐HT3B (HTR3B) receptors. We tested whether (1) ondansetron reduces DPDD among individuals of either European or African ancestry (AA), and (2) that reductions in DPDD are greatest among ondansetron‐treated individuals with population‐specific combinations of genotypes at SLC6A4, HTR3A, and HTR3B. Methods: In this 16‐week, double‐blind, placebo‐controlled, parallel‐group clinical trial, adults with AUD were randomized to receive low‐dose oral ondansetron (0.33 mg twice daily) or placebo stratified by "responsive" versus "nonresponsive" genotype defined using population‐specific genotypes at the three genetic loci. Generalized estimating equation regression models and a modified intent‐to‐treat analysis were used to compare the treatment groups on the primary outcome—DPDD—and two secondary outcomes—heavy drinking days per week [HDD] and drinks per day [DPD] across the 16 weeks of treatment. Results: Of 296 prospective participants screened, 95 (58 EA and 37 AA) were randomized and received at least one dose of study medication. In the modified intent‐to‐treat analysis, the ondansetron group averaged 0.40 more DPDD (p = 0.51), 1.35 times as many HDD (p = 0.16), and 1.06 times as many DPD (p = 0.59) as the placebo group. There were no significant interactions with genotype. There were no study‐related serious adverse events (AEs) and similar proportions of participants in the two treatment groups experienced AEs across organ systems. Conclusions: We found no evidence that low‐dose oral ondansetron is beneficial in the treatment of AUD, irrespective of genotype, thus failing to confirm prior study findings. However, the study was underpowered to identify medication by genotype interactions. [ABSTRACT FROM AUTHOR]

Background: Surveys of changes in drinking during the COVID‐19 pandemic have primarily relied on retrospective self‐report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage‐specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use. Methods: Data from 1819 completed interviews from the N14C follow‐up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage‐specific quantity and frequency, and DSM‐5 AUD items were asked in both surveys and used to estimate changes from pre‐pandemic drinking to drinking during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age. Results: Key findings include particularly large increases in drinking and AUD for African Americans and women, reduced drinking and heavy drinking prevalence among men and White respondents, and a concentration of increased drinking and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in drinking frequency and the consumption of spirits. Conclusions: Results confirm prior findings of overall increases and subgroup‐specific changes, and importantly, provide detailed information on the patterns of change across major socio‐demographic subgroups. Substantial increases in the prevalence of DSM‐5 moderate to severe AUDs are a novel finding that is of particular concern. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorder (AUD) is underdiagnosed and undertreated in medical settings, in part due to a lack of AUD assessment instruments that are reliable and practical for use in routine care. This study evaluates the test‐retest reliability of a patient‐report Alcohol Symptom Checklist questionnaire when it is used in routine care, including primary care and mental health specialty settings. Methods: We performed a pragmatic test‐retest reliability study using electronic health record (EHR) data from Kaiser Permanente Washington, an integrated health system in Washington state. The sample included 454 patients who reported high‐risk drinking on a behavioral health screen and completed two Alcohol Symptom Checklists 1 to 21 days apart. Subgroups of these patients who completed both checklists in primary care (n = 271) or mental health settings (n = 79) were also examined. The primary measure was an Alcohol Symptom Checklist on which patients self‐reported whether they experienced each of the 11 AUD criteria within the past year, as defined by the Diagnostic and Statistical Manual of Mental Disorders‐5th edition (DSM‐5). Results: Alcohol Symptom Checklists completed in routine care and documented in EHRs had excellent test‐retest reliability for measuring AUD criterion counts (ICC = 0.79, 95% CI: 0.76 to 0.82). Test‐retest reliability estimates were also high and not significantly different for the subsamples of patients who completed both checklists in primary care (ICC = 0.82, 95% CI: 0.77 to 0.85) or mental health settings (ICC = 0.74, 95% CI: 0.62 to 0.83). Test‐retest reliability was not moderated by having a past two‐year AUD diagnosis, nor by the age or sex of the patient completing it. Conclusions: Alcohol Symptom Checklists can reliably and pragmatically assess AUD criteria in routine care among patients who screen positive for high‐risk drinking. The Alcohol Symptom Checklist may be a valuable tool in supporting AUD‐related care and monitoring AUD criteria longitudinally in routine primary care and mental health settings. [ABSTRACT FROM AUTHOR]

Background: Binge drinking is a dichotomous variable that allows researchers to sort students into categories based upon a specific threshold of consumption, commonly 4 (females) or 5 (males) drinks. Crossing the binge threshold increases the risk of negative alcohol-related consequences. The use of such thresholds has played a vital role in the study of college drinking. While extremely valuable, the dichotomous nature of binge drinking variables removes information about how heavily students actually drink, leaving the characterization of college drinking incomplete. The present study examined patterns of alcohol use beyond the binge threshold. Methods: The data set consisted of self-reported 2-week drinking histories from 10,424 first-semester freshmen at 14 schools across the United States during the fall of 2003. The number of students who reached the 4+/5+ binge-drinking threshold was calculated, as was the number who reached 2 times (8+/10+ drinks) or 3 times (12+/15+ drinks) the binge threshold. Logistic regression analyses were used to explore gender differences and to assess whether frequent binge drinkers (3+ binges per 2 weeks) were more likely than infrequent binge drinkers (1–2 binges per 2 weeks) to reach high peak levels of consumption. Results: Roughly 1 of 5 males consumed 10+ drinks and 1 of 10 females consumed 8+ drinks, twice the binge threshold, at least once in the previous 2 weeks. Gender differences were observed at every drinking level and were particularly large at higher peak levels. Frequent binge drinkers were more likely than infrequent binge drinkers to consume 2 or 3 times the binge threshold. Discussion: A surprisingly large percentage of students, particularly males, drink at peak levels well beyond the binge threshold. Such findings suggest that schools might make additional progress in the battle against alcohol misuse by focusing on extreme drinking practices in addition to binge drinking per se. [ABSTRACT FROM AUTHOR]

Background: Although effective treatments exist, alcohol use disorder (AUD) is undertreated. We used a cascade of care framework to understand gaps in care for persons with AUD. Methods: Using 2015–2019 National Survey on Drug Use and Health data, we evaluated the following steps in the cascade of care: (1) adult prevalence of AUD; (2) proportion of adults with AUD who utilized health care in the past 12 months; (3) proportion with AUD screened about their alcohol use; (4) proportion with AUD who received a brief intervention about their alcohol misuse; (5) proportion with AUD who received information about treatment for alcohol misuse; and (6) proportion with AUD who received treatment. Analyses were stratified by AUD severity. Results: Of the 214,505 persons included in the sample, the weighted prevalence of AUD was 7.8% (95% CI 7.6–8.0%). Cascades of care showed the majority of individuals with AUD utilized health care in the past 12 months [81.4% (95% CI 80.7–82.1%)] and were screened about alcohol use [69.9% (95% CI 68.9–70.8%)]. However, only a minority of individuals received subsequent steps of care, including 11.6% (95% CI 11.0–12.2%) who reported receiving a brief intervention, 5.1% (95% CI 4.6–5.6%) who were referred to treatment, and 5.8% (95% CI 5.4–6.3%) who received treatment. Similar patterns were observed when cascades of care were stratified by AUD severity. Conclusions: Persons with AUD commonly utilize health care and are often screened about alcohol use, but few receive treatment. Healthcare settings—particularly primary care settings—represent a prime opportunity to implement AUD treatment to improve outcomes in this high‐risk population. [ABSTRACT FROM AUTHOR]

Background: Little is known about remission, recovery, and other outcomes of alcohol use disorder (AUD) as defined by the DSM‐5. Methods: Data from a large representative sample of the United States was used to examine correlates of past‐year AUD status among individuals with prior‐to‐past‐year AUD: persistent AUD, symptomatic high‐risk drinking, asymptomatic high‐risk drinking, symptomatic low‐risk drinking, asymptomatic low‐risk drinking (nonabstinent recovery, NAR), and abstainer (abstinent recovery, AR). Multiple logistic regression analyses were conducted to compare: (i) AR and NAR with persistent AUD, (ii) AR with NAR, and (iii) asymptomatic and symptomatic high‐risk drinking with AR and NAR. Results: Among individuals with AUD prior to past year (n = 7,785), 34.2% were classified with persistent AUD, 8.8 and 1.6% were symptomatic high‐risk and symptomatic low‐risk drinkers, respectively, 21.5% were asymptomatic high‐risk drinkers, 17.9% were asymptomatic low‐risk drinkers, and 16.0% were abstainers. One‐quarter of individuals with AUD prior to past year achieved AR or NAR without the benefit of treatment, while a much greater percentage of individuals achieving AR (43.2%) reported receiving treatment relative to those with NAR (12.3%). The number of lifetime AUD symptoms was greater among those achieving AR (among the treated) and lower among those achieving NAR relative to persistent AUD. The number of AUD symptoms was also greater among those achieving AR than NAR and lower among asymptomatic and symptomatic risk drinkers relative to those achieving AR and NAR. Consumption was greater among those achieving AR relative to those achieving NAR and greater among asymptomatic and symptomatic risk drinkers relative to AR and NAR. Odds of achieving AR or NAR relative to persistent AUD were generally lower among non‐Hispanic Blacks and those with higher education, greater among women and married individuals, and lower among illicit drug users and individuals with histories of a personality disorder or mood/anxiety disorder. Conclusions: There appears to be a substantial level of recovery from AUD. Information on specific factors associated with AUD outcomes can be useful in targeting appropriate treatment efforts. [ABSTRACT FROM AUTHOR]

Background: Although the risks of using central nervous system depressant (CNS‐D) medications with alcohol are well documented, little is known about trends in prescribed use of these medications among individuals who regularly consume alcohol (i.e., trends in "concurrent use"). We examined changes in the prevalence of prescribed CNS‐D medications among individuals who drank alcohol on 52 or more occasions in the past year ("regular drinking"). CNS‐D medications included sedative‐hypnotics (subclassified as anxiolytics or sleep medications) and opioids. Methods: We used 8 cross‐sectional cycles of the National Health and Nutrition Examination Survey (1999–2000 to 2013–2014) from participants aged 20 and older (n = 37,709). We used log‐binomial regression to examine (i) prevalence trends of prescribed CNS‐D medication use, (ii) trend differences by drinking status, and (iii) correlates of CNS‐D medication use. Results: Among those who drink regularly, the relative annual increase in prevalence of sedative‐hypnotic use was 5.3% (95% CI: 2.7 to 7.9): Anxiolytic and sleep medication use increased annually by 3.7% (95% CI: 0.8 to 6.7) and 11.2% (95% CI: 6.5 to 16.0), respectively. Opioid use trends among those who drink regularly were not statistically significant but were nonlinear. Differences in CNS‐D medication trends between those who drink regularly and those who drink infrequently/abstain were not statistically significant. Those who drink regularly were less likely than those who drink infrequently/abstain to use opioids (adjusted relative risk [ARR]: 0.69, 95% CI: 0.60 to 0.78) and anxiolytics (ARR: 0.71, 95% CI: 0.61 to 0.81), but not sleep medications (ARR: 1.04, 95% CI: 0.80 to 1.35). Those aged 40 and older were 2 to 5 times as likely as those aged 20 to 29 to use sedative‐hypnotics. Conclusions: Among those who drink regularly, the prevalence of prescribed sedative‐hypnotic use increased and prescribed opioid use remained common. These trends indicate that a substantial portion of the population is at risk of alcohol‐related adverse drug reactions—particularly those aged 40 and older. [ABSTRACT FROM AUTHOR]

The article offers information about the alcohol-associated liver disease (ALD) and alcohol use disorders (AUDs) as one of the major health problems in the U.S. Topic mention including the increasing mortality rate due to cirrhosis, alcohol withdrawal and impact of continued drinking to the gut liver in ALD.

Background: Acute alcohol consumption and chronic alcohol consumption increase the burden placed on emergency departments (EDs) by contributing to injury and disease. Whether the prevalence of alcohol‐related ED visits in the United States has changed in recent years is unknown. The purpose of this study was to examine trends in ED visits involving acute and chronic alcohol consumption in the United States by age and sex between 2006 and 2014. Methods: Data from the Nationwide Emergency Department Sample (NEDS), the largest all‐payer ED database in the United States involving 945 hospitals in 33 states and Washington, DC, were analyzed to assess changes in prevalence and rates of ED visits involving acute and chronic alcohol consumption by age and sex over time among persons aged ≥12 between 2006 and 2014. Results: Between 2006 and 2014, the number of ED visits involving alcohol consumption increased 61.6%, from 3,080,214 to 4,976,136. The rate increased 47% from 1,223 to 1,802 per 100,000 population and the total cost of such visits increased 272% from $4.1 billion to $15.3 billion. The number of acute alcohol‐related ED visits increased 51.5% from 1,801,006 to 2,728,313 and the rate increased 40% from 720.9 to 1,009.6 per 100,000 population. The number chronic alcohol‐related visits increased 75.7% from 1,279,208 to 2,247,823 and the rate increased 57.9% from 502.2 to 792.9 per 100,000. The annual percentage change in rates of all alcohol‐related ED visits was larger for females than for males (5.3% vs. 4.0%). Other drug involvement increased the likelihood of admission for inpatient treatment. Conclusions: Alcohol consumption contributed to an increasing number of ED visits in the United States between 2006 and 2014, especially among females. Increased utilization of evidence‐based interventions is needed. [ABSTRACT FROM AUTHOR]

Background Heavy episodic drinking ( HED) or consuming 4+/5+ drinks in 1 occasion for women/men is linked consistently with alcohol-related harms. Recent research suggests that many individuals drink at levels more than twice this cutoff (8+/10+ drinks), commonly referred to as 'high-intensity drinking.' Prevalence rates of high-intensity drinking and its dynamic association with alcohol use disorder (AUD) across all ages, however, remain unknown. The current study used data from a nationally representative sample to document age-varying prevalence rates of HED-only drinking and high-intensity drinking, prevalence rates of AUD for HED-only drinkers and high-intensity drinkers, and relative odds of experiencing an AUD for high-intensity drinkers as compared to HED-only drinkers. Methods Data were from the National Epidemiologic Survey on Alcohol and Related Conditions- III. The final analytic sample consisted of past-year drinkers aged 18 to 64 years ( n = 22,776). Results Time-varying effect modeling revealed that high-intensity drinking and HED-only drinking were equally prevalent during young adulthood and prevalence rates of both types of drinking generally became less common with increasing age. At all ages, high-intensity drinkers were at 3 or more times greater odds of meeting criteria for an AUD than HED-only drinkers. The association between high-intensity relative to HED-only drinking was strongest earlier in adulthood with approximately 83% of 18-year-old high-intensity drinkers having AUD relative to 42% of HED-only drinkers. Conclusions Future research aiming to identify drinkers most at risk of harms and in need of treatment may benefit from assessing the extent to which an individual exceeds the 8+/10+ threshold of drinking. [ABSTRACT FROM AUTHOR]

Background There is a well-known link between attending college and engaging in excessive alcohol use. This study examines in a national sample how the association between student status and excessive alcohol use changes from late adolescence through young adulthood and whether the association of student status with excessive alcohol use is different for students residing with versus away from parents during the school year. Methods This study used cross-sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of noninstitutionalized civilian adults residing in the United States. Our analyses included nonhigh school young adults who were ages 18 to 30 years ( n = 8,645). Excessive alcohol use included past-year (i) high-intensity drinking (men: ≥10 standard drinks; women: ≥8) and (ii) exceeding weekly drinking guidelines (men: >14 drinks per week; women: >7). Students who resided away from their parents and students who lived with their parents during the school year were compared to nonstudents. Results Analyses using time-varying effect modeling showed that the relationship of student status with excessive alcohol use varied as a function of age. Overall student status lost its association with excessive alcohol use in the early 20s, after controlling for demographics and other adult social roles. The association between student status and excessive alcohol use also varied considerably across age and depending on whether the student was residing with or away from parents. Conclusions The association of student status with excessive alcohol use is heterogeneous in terms of both age and living arrangements, suggesting opportunities for interventions targeting problematic alcohol use. Future research should examine additional sources of heterogeneity of students in their risk for excessive alcohol use. [ABSTRACT FROM AUTHOR]

The article discusses the purpose of substance use epidemiology, which according to the author, is to determine how great a problem is and focus on establishing public health, research priorities, and anticipating treatment needs. An overview how researchers characterize the magnitude of substance abuse in the U.S. is presented, which includes a table with statistics related to substance type and its prevalence of use among individuals 18 years and older.

Background This was a proof-of-concept study to evaluate the efficacy of LY2940094, a nociceptin/orphanin FQ peptide receptor antagonist, in reducing alcohol consumption in actively alcohol-drinking patients with alcohol dependence. Methods Eighty-eight patients, 21 to 66 years of age, diagnosed with alcohol dependence, reporting 3 to 6 heavy drinking days per week, were randomized (1:1) to 8 weeks of treatment with once-daily oral placebo ( N = 44) or 40 mg/d of LY2940094 ( N = 44). The primary efficacy analysis was the change from baseline in number of drinks per day ( NDD) utilizing mixed-model repeated measures comparing LY2940094 and placebo in Month 2 of the 8-week double-blind treatment period. The probability that the difference relative to placebo in NDD was ≤0 at endpoint was calculated, and a probability ≥80% was considered to be evidence that LY2940094 was associated with the reduction in NDD. Results After 8 weeks of treatment, reduction in mean NDD did not differ between LY2940094 versus placebo (−1.4 vs. −1.5, respectively, 44% probability of greater reduction relative to placebo), but there was a greater reduction in the mean percentage of heavy drinking days in a month with LY2940094 versus placebo (−24.5 vs. −15.7%, respectively, 93% probability of a greater reduction relative to placebo), and an increase in the mean percentage of abstinent days in a month compared to placebo (9.1 vs. 1.9%, respectively, 91% probability of a greater increase relative to placebo). Patients who were treated with LY2940094 showed decreased plasma levels of gamma-glutamyl transferase with probabilities ≥98% for greater reduction compared with placebo at Weeks 1, 4, 6, and 8. Treatment-emergent adverse events in ≥5% of patients treated with LY2940094 included insomnia, vomiting, and anxiety. There were no serious adverse events or significant changes in laboratory assessments or vital signs with LY2940094. Conclusions Although not reducing the NDD, LY2940094, compared to placebo, did reduce heavy drinking days and increased abstinence days in patients with alcohol dependence. [ABSTRACT FROM AUTHOR]

Background This research extends prior epidemiological estimates for the United States and re-examines a previously described male excess in alcohol drinking. Its aim was to estimate fine-grained age-specific incidence of becoming a drinker among 12- to 24-year-old U.S. males and females, and to compare incidence estimates with prevalence proportions. Methods The study population is 12- to 24-year-old noninstitutionalized U.S. civilian residents. Estimates are from 12 successive U.S. National Surveys on Drug Use and Health ( NSDUH), with nationally representative samples drawn each year from 2002 to 2013 and assessed via computer-assisted self-interviews ( n ~ 390,000). Analysis-weighted incidence and prevalence estimates are generated using the NSDUH Restricted Data Analysis System for 6 year-pairs. Meta-analysis-derived summary estimates are provided, treating each year-pair as a replication. Results In this 21st century evidence, there no longer is male excess of incidence with respect to underage drinking. Indeed, in mid-adolescence, there is a clear female excess for the risk of becoming an underage drinker. Meta-analytic summaries disclosed no other male-female differences in incidence. Nevertheless, a male excess in the prevalence of recently active drinking can be seen after the age of 19 years. Conclusions This new evidence from the United States shows that the so-called 'gender gap' in risk of becoming a drinker has narrowed to the point of there being no gap at all. Indeed, in mid-adolescence, risk of starting to drink is greater for females than for males. [ABSTRACT FROM AUTHOR]

Background Reducing the nicotine content in cigarettes could improve public health by reducing smoking and toxicant exposure, but may also have unintended consequences on alcohol use. The primary objective of this study was to examine the effect of reducing the nicotine content in cigarettes on alcohol outcomes. The secondary aim was to examine whether the effects of these cigarettes on alcohol outcomes were mediated by changes in nicotine exposure, smoking behavior, or withdrawal. Methods Between June 2013 and July 2014, we conducted a 7-arm, double-blind, randomized clinical trial at 10 U. S.-based sites. Daily smokers not currently interested in quitting ( n = 839) were assigned to equally sized groups to smoke for 6 weeks cigarettes containing either normal nicotine content ( NNC; 15.8 mg/g, 9 mg tar), moderate nicotine content (5.2 mg/g nicotine, 9 mg tar), or very low nicotine content ( VLNC; 0.4 to 2.4 mg/g, 9 to 13 mg tar). This investigation focused on a subsample of current drinkers ( n = 403). Each reduced nicotine content cigarette condition was compared to the NNC control condition with respect to trajectories over the 6-week period of average daily alcohol use and occurrence of binge drinking. Moderating variables were considered. Mediation analyses tested potential explanatory processes including changes in nicotine exposure, cigarettes per day, and withdrawal. Results Over time, reduced nicotine exposure and smoking rate mediated effects of VLNC cigarette use on reduced alcohol use. There was no evidence of compensatory drinking in response to nicotine reduction or nicotine withdrawal, even among subgroups expected to be at greater risk (e.g., relatively heavier drinkers, highly nicotine-dependent individuals). Conclusions The findings suggest that compensatory drinking is unlikely to occur in response to switching to VLNC cigarettes. In contrast, reducing the nicotine content of cigarettes may reduce alcohol use (clinicalTrials.gov number, NCT01681875). [ABSTRACT FROM AUTHOR]

Background Females in the United States consume less alcohol and cause and experience fewer alcohol-related harms than males. However, recent research suggests such gaps might be narrowing. The purpose of this study was to explore changes in alcohol use and associated outcomes among females and males in the United States between 2002 and 2012. Methods Data from the National Survey on Drug Use and Health were used to assess the prevalence and trends for females and males aged 12+ in lifetime abstinence, age of onset, current drinking, binge drinking, drinking and driving, reaching DSM-IV criteria for an alcohol use disorder, combining alcohol with other drugs such as marijuana, and other variables. Of particular interest was whether differences between females and males narrowed during the decade under study. Results Differences in the drinking patterns of females and males aged 12+ narrowed between 2002 and 2012 for current drinking, number of drinking days per month, past year DSM-IV alcohol abuse, and past-year driving under the influence of alcohol. In addition, convergence was noted in 1 or more age subgroups for the prevalence of binge drinking and DSM-IV alcohol dependence and mean age at drinking onset. Divergence in drinking habits did not occur for any measure in any age subgroups with the exception of a greater increase in the prevalence of combining alcohol with marijuana among young adult male drinkers than female drinkers aged 18 to 25. Conclusions Between 2002 and 2012, differences in alcohol consumption and related outcomes narrowed for females and males. Reasons for converging patterns of alcohol use are unclear and do not appear to be easily explainable by recent trends in employment status, pregnancy status, or marital status. More research is needed to identify the psychosocial and environmental contributors to these changes and to assess implications for prevention and treatment efforts. [ABSTRACT FROM AUTHOR]

Background Much is unknown about the relationship between socioeconomic status ( SES) and alcohol use, including the means by which SES may influence risk for alcohol use. Methods Using a sample of 672 twin pairs (aged 25 to 74) derived from the MacArthur Foundation Survey of Midlife Development in the United States, this study examined whether SES, measured by household income and educational attainment, moderates genetic and environmental influences on 3 indices of alcohol use: amount used, frequency of use, and problem use. Results We found significant moderation for amount of alcohol used. Specifically, genetic effects were greater in low- SES conditions, shared environmental effects (i.e., environmental effects that enhance the similarity of twins from the same families) tended to increase in high- SES conditions, and nonshared environmental effects (i.e., environmental effects that distinguish twins) tended to decrease with SES. This pattern of results was found for both income and education, and it largely replicated at a second wave of assessment spaced 9 years after the first. There was virtually no evidence of moderation for either frequency of alcohol use or alcohol problems. Conclusions Our findings indicate that genetic and environmental influences on drinking amount vary as a function of the broader SES context, whereas the etiologies of other drinking phenomena are less affected by this context. Efforts to find the causes underlying the amount of alcohol used are likely to be more successful if such contextual information is taken into account. [ABSTRACT FROM AUTHOR]

Background While emergency room (ER) studies have documented a strong association of alcohol with injury, these studies are not necessarily representative of the general population. To evaluate comparative risk of injury from drinking for those treated in the ER with non-ER-treated injuries (those treated elsewhere or those not treated), data on alcohol and injury are analyzed in the U.S. general population by type of injury treatment. Methods Relative risk (RR) of injury from drinking within 6 hours prior to the event was analyzed using case-crossover analysis based on respondents' usual frequency of drinking in 4 (1995 to 2010) National Alcohol Surveys ( n = 4,819). Results RR was 1.01 for the total injured and significantly elevated for ER-treated injured (1.46), but not for those treated elsewhere (0.75) and those not treated (1.02). RR was significantly elevated for those aged 18 to 30 years (1.45; 1.14, 1.85), Blacks (1.54; 1.11, 2.14) and Hispanics (1.98; 1.51, 2.59), those positive on the Rapid Alcohol Problems Screen (RAPS4) as a measure of alcohol dependence (2.41; 1.86, 3.11), and for motor vehicle injuries (2.61; 1.49, 4.58) or cutting/piercing injuries (2.04, 1.10, 3.81). For those reporting ER-treated injuries, significant effect modification was found for those aged 18 to 30 years (RR = 2.29), Blacks (RR = 2.59) and Hispanics (RR = 2.68), high risk-taking (RR = 1.71), positive RAPS4 (RR = 3.69), and for motor vehicle (RR = 3.79) and cutting/piercing injuries (RR = 2.60). Conclusions Data suggest alcohol plays a larger role in injuries for which ER treatment is sought than for other injuries, and estimates for injury from drinking derived from ER studies may be elevated. Future general population studies should take into account intensity of exposure to alcohol prior to injury, potential recall bias (by eliciting data on the proximity of injury to time of the respondent interview) and severity of injury, for improving estimates of the attributable burden of alcohol to injury in society. [ABSTRACT FROM AUTHOR]

Background Alcohol use disorders ( AUD) have long been considered to be some of the most disabling mental disorders; however, empirical data on the burden of disease associated with AUD have been sparse. The objective of this article is to quantify the burden of disease (in disability-adjusted life years [ DALYs] lost), deaths, years of life lost due to premature mortality ( YLL), and years of life lost due to disability ( YLD) associated with AUD for the United States in 2005. Methods Statistical modeling was based on epidemiological indicators derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Formal consistency analyses were applied. Risk relations were taken from recent meta-analyses and the disability weights from the burden of disease study of the National Institutes of Health. Monte Carlo simulations were used to derive confidence intervals. All analyses were performed by sex and age. Sensitivity analyses were undertaken on key indicators. Results In the United States in 2005, 65,000 deaths, 1,152,000 YLL, 2,443,000 YLD, and 3,595,000 DALYs were associated with AUD. For individuals 18 years of age and older, AUD were associated with 3% of all deaths (5% for men and 1% for women), and 5% of all YLL (7% for men and 2% for women). The majority of the burden of disease associated with AUD stemmed from YLD, which accounted for 68% of DALYs associated with AUD (66% for men and 74% for women). The youngest age group had the largest proportion of DALYs associated with AUD stemming from YLD. Conclusions Using data from a large representative survey (checked for consistency) and by combining these data with the best available evidence, we found that AUD were associated with a larger burden of disease than previously estimated. To reduce this disease burden, implementation of prevention interventions and expansion of treatment are necessary. [ABSTRACT FROM AUTHOR]

Background There are no existing data on alcoholic beverage prices and ethanol ( EtOH) content at the level of alcohol brand. A comprehensive understanding of alcohol prices and EtOH content at the brand level is essential for the development of effective public policy to reduce alcohol use among underage youth. The purpose of this study was to comprehensively assess alcoholic beverage prices and EtOH content at the brand level. Methods Using online alcohol price data from 15 control states and 164 online alcohol stores, we estimated the average alcohol price and percent alcohol by volume for 900 brands of alcohol, across 17 different alcoholic beverage types, in the United States in 2011. Results There is considerable variation in both brand-specific alcohol prices and EtOH content within most alcoholic beverage types. For many types of alcohol, the within-category variation between brands exceeds the variation in average price and EtOH content among the several alcoholic beverage types. Despite differences in average prices between alcoholic beverage types, in 12 of the 16 alcoholic beverage types, customers can purchase at least 1 brand of alcohol that is under $1 per ounce of EtOH. Conclusions Relying on data or assumptions about alcohol prices and EtOH content at the level of alcoholic beverage type is insufficient for understanding and influencing youth drinking behavior. Surveillance of alcohol prices and EtOH content at the brand level should become a standard part of alcohol research. [ABSTRACT FROM AUTHOR]

Background: We sought to determine the impact of naltrexone on hepatic enzymes and HIV biomarkers in HIV-infected patients. Methods: We used data from the Veterans Aging Cohort Study-Virtual Cohort, an electronic database of administrative, pharmacy, and laboratory data. We restricted our sample to HIV-infected patients who received an initial oral naltrexone prescription of at least 7 days duration. We examined aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and HIV biomarker (CD4 and HIV RNA) values for the 365 days prior to, during, and for the 365 days post-naltrexone prescription. We also examined cases of liver enzyme elevation (LEE; defined as >5 times baseline ALT or AST or >3.5 times baseline if baseline ALT or AST was >40 IU/l). Results: Of 114 HIV-infected individuals, 97% were men, 45% white, 57% Hepatitis C co-infected; median age was 49 years; 89% of the sample had a history of alcohol dependence and 32% had opioid dependence. Median duration of naltrexone prescription was 49 (interquartile range 30 to 83) days, representing 9,525 person-days of naltrexone use. Mean ALT and AST levels remained below the upper limit of normal. Two cases of LEE occurred. Mean CD4 count remained stable and mean HIV RNA decreased after naltrexone prescription. Conclusions: In HIV-infected patients, oral naltrexone is rarely associated with clinically significant ALT or AST changes and does not have a negative impact on biologic parameters. Therefore, HIV-infected patients with alcohol or opioid dependence can be treated with naltrexone. [ABSTRACT FROM AUTHOR]

Background: During the early 1990s in the United States, changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10-year period from 1991-1992 to 2001-2002 among U.S. whites, blacks, and Hispanics. Methods: Data come from 2 household surveys of the U.S. adult population. The 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey and the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions conducted face-to-face interviews with a multistage cluster sample of individuals 18 years of age and older in the continental United States. Treatment utilization represented both total utilization and the use of alcohol services. Data analyses were prevalence rates and multivariate logistic regressions for lifetime utilization with drinkers and individuals with alcohol use disorders (AUDs). Results: From 1991-1992 to 2001-2002, drinking-related emergency room and human services use increased for drinkers, while total utilization and the use of private health professional services and mutual aid decreased for individuals with AUDs. In drinkers and individuals with AUDs, blacks and Hispanics were less likely than whites to use private health professional care. Hispanics with AUDs were less likely than whites with AUDs to use alcohol or drug programs. Ethnicity interacted with alcohol severity to predict alcohol services utilization. At higher levels of alcohol severity, blacks and Hispanics were less likely than whites to ever use treatment and to use alcohol services (i.e., human services for Hispanic drinkers, mental health services for blacks with AUDs, and mutual aid for Hispanics with AUDs). Conclusions: Our findings showed increases from 1991-1992 to 2001-2002 in alcohol services utilization for drinkers, but reductions in utilization for individuals with AUDs. Blacks and Hispanics, particularly those at higher levels of alcohol severity, underutilized treatment services compared to whites. These utilization trends for blacks and Hispanics may reflect underlying disparities in healthcare access for minority groups, and language and logistical barriers to utilizing services. [ABSTRACT FROM AUTHOR]

The ultimate goal of alcohol treatment research is to develop interventions that help individuals reduce their alcohol use. To determine whether a treatment is effective, researchers must then evaluate whether a particular treatment affects changes in drinking behavior after treatment. Importantly, drinking following treatment tends to be highly variable between individuals and within individuals across time. Using data from the COMBINE study (), the current study compared 3 commonly used and novel methods for analyzing changes in drinking over time: latent growth curve (LGC) analysis, growth mixture models, and latent Markov models. Specifically, using self-reported drinking data from all participants ( n = 1,383, 69% male), we were interested in examining how well the 3 estimated models were able to explain observed changes in percent heavy drinking days during the 52 weeks following treatment. The results from all 3 models indicated that the majority of individuals were either abstinent or reported few heavy drinking days during the 52-week follow-up and only a minority of individuals (10% or fewer) reported consistently frequent heavy drinking following treatment. All 3 models provided a reasonably good fit to the observed data with the latent Markov models providing the closest fit. The observed drinking trajectories evinced discontinuity, whereby individuals seem to transition between drinking and nondrinking across adjacent follow-up assessment points. The LGC and growth mixture models both assumed continuous change and could not explain this discontinuity in the observed drinking trajectories, whereas the latent Markov approach explicitly modeled transitions between drinking states. The 3 models tested in the current study provided a unique look at the observed drinking among individuals who received treatment for alcohol dependence. Latent Markov modeling may be a highly desirable methodology for gaining a better sense of transitions between positive and negative drinking outcomes. [ABSTRACT FROM AUTHOR]

Percent subjects with no heavy drinking days (PSNHDDs), an efficacy end point recommended by the Food and Drug Administration, considers abstinent individuals or those engaging in low-risk drinking behavior as successful responders to treatment. As PSNHDD has been used infrequently in previous alcohol clinical trials, we evaluated the utility and validity of the PSNHDD outcome measure in 2 large alcohol clinical trials. Data sets from 2 alcohol trials, COMBINE and a multisite topiramate trial, were used to analyze PSNHDDs and other traditional end points for the topiramate, naltrexone, acamprosate, and placebo groups. Effect sizes of PSNHDDs were determined for each month of active treatment and by varying grace periods-early periods in the trial where outcome is not considered in the analysis-and were compared with that of other traditional outcome measures. Long-term outcomes were compared for groups that had no heavy drinking days versus those that had heavy drinking days during active treatment. PSNHDD effect sizes were significant for both topiramate (0.34 and 0.25 at months 2 and 3, respectively) and naltrexone (0.24 and 0.26 at months 3 and 4, respectively). Given a 2-month grace period for naltrexone, the effect size of PSNHDDs was comparable to the effect sizes using traditional outcome measures. With a 1-month grace period for topiramate, it was greater than the majority of traditional outcome measures. Little is gained by allowing up to 1, 2, or 3 heavy drinking days as an end point. Subjects with no HDDs during treatment fared better than those with some HDDs on drinking outcomes and alcohol-related consequences during a 1-year follow-up. PSNHDD appears to be a clinically informative end point measure, especially when used with a grace period, and is as sensitive as most traditional outcome measures in detecting differences between the medication and placebo groups. Nonetheless, these findings should be replicated in other clinical data sets, particularly with medications that work via different mechanisms. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine whether the number of alcohol outlets in local and adjacent areas, in particular bars, was related over time to completed suicide and suicide attempts. There is evidence both from studies of individuals and time series aggregate studies, mostly at the national level, of substantial alcohol involvement in suicide, but no small-area, longitudinal studies have been carried out. The present study is the first that is both longitudinal and based on a large number of small spatial units, California zip codes, a level of resolution permitting analysis of the relationship between local alcohol access and suicide rates over time. Method: Longitudinal data were obtained from 581 consistently defined zip code areas over 6 years (1995–2000) using data from the California Index Locations Database, a geographic information system that contains both population and place information with spatial attributes for the entire state. Measures obtained from each zip code included population characteristics (e.g., median age) and place characteristics (e.g., numbers of retail and alcohol outlets) which were related in separate analyses to (i) suicide mortality and (ii) the number of hospitalizations for injuries caused by suicide attempts. The effect of place characteristics in zip code areas adjacent to each of the 581 local zip codes (spatial lags) was also assessed. Analysis methods were random effects models corrected for spatial autocorrelation. Results: Completed suicide rates were higher in zip code areas with greater local and lagged bar densities; and higher in areas with greater local but not lagged off-premise outlet densities. Whereas completed suicide rates were lower among blacks and Hispanics, completed suicide rates were higher among low income, older whites living in less densely populated areas, that is, rural areas. Rates of suicide attempts were higher in zip code areas with greater local but not lagged bar densities, and higher among low income younger whites living in smaller households and in rural areas. Rates of attempted suicide were also higher among blacks. Completed suicide and suicide attempt rates were lower in zip code areas with greater local restaurant densities; there were no lagged effects for restaurants. Conclusions: Bar densities in particular appear related to suicide, meaning, because this is an aggregate-level spatial analysis, that suicides, both attempted and completed, occur at greater rates in rural community areas with greater bar densities. Because the suicide rate is highest in rural areas, this study suggests that although the number of completed and attempted suicides is no doubt greater in absolute numbers in urban areas, the suicide rate, both completed and attempted, is greater in rural areas, which draws attention, perhaps much needed, to the problems of rural America. [ABSTRACT FROM AUTHOR]

Background: U.S. epidemiologic surveys have consistently found higher lifetime prevalence of alcohol dependence among younger subjects than among older groups. Because lifetime prevalence is cumulative, such patterns are suggestive of strong secular trends; i.e., more-recently born subjects have developed more disease in a shorter period of time than their elders. However, it remains unclear whether such patterns truly reflect secular trends or are confounded by age-dependent factors such as differential recall, differential mortality, and other effects. Methods: Using data from 2 large, national epidemiological surveys, a repeated cross-sectional analysis was conducted to compare lifetime prevalence of alcohol dependence across temporally adjacent birth cohorts surveyed at the same age, thus enabling estimates of cross-cohort differences while controlling for age-related factors. Results: In contrast with results from single cross-sectional analyses, there were few significant cross-cohort differences among groups of men compared at similar ages. On the other hand, women born between 1954 and 1963 were at 1.2-fold higher odds for lifetime drinking, and those who drank were at 1.5-fold higher odds for lifetime alcohol dependence, compared with the immediately preceding birth cohort (1944 to 1953). The 1944 to 1953 cohort was also at elevated odds for lifetime drinking compared with their predecessors (1934 to 1943). These results were largely due to changes among White and Hispanic women. Conclusions: These results suggest that there have been substantial secular increases in drinking and alcohol dependence among women, but not men. Analyses of single cross-sectional studies may tend to over-estimate secular trends by failing to account for age-dependent effects. Nonetheless, secular increases in drinking and alcohol dependence among women are evident after taking age-related factors into account. [ABSTRACT FROM AUTHOR]

Background: There is little information on the stability of abstinent and nonabstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM-IV alcohol dependence, including rates and correlates of relapse, over a 3-year period. Methods: This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and reinterviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM-IV criteria for full remission from alcohol dependence. Of these, 1,772 were reinterviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM-IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low-risk drinkers relative to abstainers, adjusted for a wide range of potential confounders. Results: By Wave 2, 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with 27.2% of low-risk drinkers and 7.3% of abstainers. Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were 14.6 times as great for asymptomatic risk drinkers and 5.8 times as great for low-risk drinkers. The proportions of individuals who had experienced the recurrence of dependence were 10.2, 4.0, and 2.9%, respectively, and the adjusted odds ratios relative to abstainers were 7.0 for asymptomatic risk drinkers and 3.0 for low-risk drinkers. Age significantly modified the association between type of remission and relapse. Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse. Conclusions: Abstinence represents the most stable form of remission for most recovering alcoholics. Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse. [ABSTRACT FROM AUTHOR]

Background: Individual-level studies indicate the possibility of both protective and harmful effects of alcohol consumption on Ischemic Heart Disease (IHD) mortality depending on the pattern of consumption. Population-level relationships could be in either direction and previous studies have found mixed results. Methods: Population-level relationships between IHD mortality rates and per capita consumption of alcoholic beverages, cirrhosis mortality rates, cigarettes, and sugar sweetened soda for the period from 1950 to 2002 are modeled using autoregressive integrated moving average (ARIMA) and vector error correction methods. Results: In multivariate ARIMA models controlling for accumulated heavy drinking as represented by cirrhosis mortality, a protective effect of 4%/l was found for total alcohol consumption while cirrhosis mortality rates had significant positive effects on IHD rates. Beverage-specific models found no effect for wine, positive risks for spirits, and significant protective effects for beer. The protective effects for both total alcohol and beer were also found in vector error correction models. Significant positive effects of cigarette sales on IHD rates were also found in both types of models. Conclusions: The complexity of alcohol’s relationship with IHD is highlighted. Aspects of pattern represented by beverage-specific consumption and cirrhosis mortality indicate potential protective effects from moderate drinking and harmful effects from heavy drinking in accord with individual-level findings. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of drinking, binge drinking (4 or more drinks), and alcohol abuse and dependence and to identify predictors of heavier drinking among women of child-bearing age (18–44 years). Methods: Subjects are part of a national multistage random sample from the 2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Results: Binge drinking, abuse, and dependence are higher in younger (<30 years) pregnant and nonpregnant women. Among pregnant women, binge drinking is highest among Whites; alcohol abuse and dependence rates are relatively low and similar in all racial/ethnic groups. Among nonpregnant women, Whites and mixed race women have the highest rates of binge drinking. Alcohol abuse and dependence are highest among Native Hawaiian/Pacific Islanders, followed by Native American/Alaska Native women. Women who are White, younger (21–29 years), single, or cohabiting and with a higher income (>$40,000) are at a higher risk for heavier drinking. Conclusions: Drinking and heavier drinking remain at high levels among women of child-bearing age. Prevention efforts must be comprehensive and should target pregnant women who are drinking and those who could become pregnant and are drinking at high-risk levels. [ABSTRACT FROM AUTHOR]

In this article the author discusses the article "Percentage of Subjects With No Heavy Drinking Days: Evaluation as an Efficacy Endpoint for Alcohol Clinical Trials," by D. Falk, Xq Wang, L. Liu, J. Fertig, M. Matson, M. Ryan, B. Johnson, R. Stout and R. Z. Litten. He is supportive of the research which is contained in the article. Also discussed is the development of medications which can be used for the treatment of alcoholism and drug addiction.

The author comments on the 2006 article "Many College Freshmen Drink at Levels Far Beyond the Binge Threshold," by White, Kraus and Swartzwelder, within the context of culture and its change. He explains how the article highlighted the importance and complexity of the issue of alcohol abuse and alcoholism at U.S. colleges. The author supports the proposal for increased attention to more extreme college drinking practices. He also cites the need to find ways of collecting and reporting data that are as scientifically informative as possible, but that also resonate with the people to whom the information applies.

A review of the article "Clinical validation of reduced alcohol consumption after treatment for alcohol dependence using the World Health Organization risk drinking levels" by Witkiewitz K, et al, which appeared in the periodical "Alcoholism: Clinical & Experimental Research" in 2017, is presented.