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BACKGROUND: The onset of alcohol use during adolescence is associated with concurrent and subsequent related problems. Research on drinking contexts that underly these key first-time experiences and how they differ by initiation type is needed. The current study examined the physical, social, and situational characteristics of three types of initiation: first drink, first heavy episodic drinking (HED), and first intoxication and considered variations between early and later initiating adolescents. METHODS: A mixed-methods approach was used to survey and interview adolescents who reported lifetime drinking. Survey responses from 471 participants were analyzed using multilevel multinomial and logistic regressions accounting for nesting of drinking events (i.e., type of initiation) within respondents. A subsample of 50 participants recruited at baseline took part in in-depth interviews that were thematically coded. RESULTS: After controlling for demographics, initiation of HED and intoxication, compared to initiation of a whole drink, were more likely to occur when more close friends are present and when those close friends are also drinking. The likelihood of early initiation of a whole drink and intoxication was also positively associated with being in an outdoor setting. Narratives identified distinct and shared patterns of context characteristics across the types of alcohol initiation. CONCLUSION: The quantitative and qualitative findings revealed several parallels as well as aspects that differ, enriching our understanding of early drinking contexts. Results highlight the importance of considering contextual characteristics by initiation type for prevention efforts.

International audience; Background: Recent data suggest that the COVID-19 pandemic and associated restrictions may have influenced alcohol use and promoted addictive behavior. We aimed to investigate the impact of the pandemic on acute alcohol intoxication (AAI) in France. Methods: We identified all hospital stays related to alcohol abuse in 2018–2020. Differences in number of hospitalizations between 2019 and 2020 were tested using Poisson regressions. Differences between observed and expected deliveries of drugs used in alcohol dependence in 2020 were also studied. Results: There was a decrease in the number of hospitalizations for AAI between 2019 and 2020 (−9677[−11·4%],RR:0·89[0·88–0·89]). This decrease was observed among men and women of all age groups, except women ≥ 85 years. We observed an increase in in-hospital mortality during 2020 and more hospitalizations for AAI with certain medical complications, especially during the first 2020 lockdown. There was a drop in observed deliveries of drugs used in alcohol dependence during the first 2020 lockdown. Conclusions: The decrease in the number of hospitalizations for AAI in 2020 could be explained by several factors: fewer available hospital beds due to COVID-19, individuals with AAI delaying or avoiding medical care due to COVID-19 fears, and decreases driven by younger age groups returning to live with parents and socializing less. While alcohol consumption patterns have changed with the implementation of social distancing measures and lockdowns, the increase in mortality and the share of hospitalizations with complications suggest that these measures had an impact on event severity in a context of strained access to healthcare.

Few studies have assessed how children are affected by parental alcohol consumption without clinically diagnosed alcohol problems, especially in relation to more long-term and severe consequences. The aim is to investigate how fathers' alcohol use is related to the risk for substance-related disorders in offspring.A prospective cohort study of 64 710 Swedish citizens whose fathers were conscripted for compulsory military training at ages 18-20 in 1969/70. Information on fathers' alcohol consumption, frequency of intoxication and apprehended for drunkenness, was collected during conscription. Offspring was followed for substance-related disorders from age 12 to end of follow up in 2009.All measures of fathers' alcohol use were significantly and positively associated with risk for substance-related disorders in offspring. The associations were to a large extent explained by other risk factors in childhood. In the fully adjusted model, those with fathers in the highest alcohol consumption quintile still had a 63% higher risk (HR=1.63 CI 1.26-2.12) of substance-related disorders compared to those whose fathers' reported abstinence. The highest risk was found among offspring to fathers with alcohol-related disorders or that had been apprehended for drunkenness, with a more than two-fold increased risk for substance-related disorders.Despite the lower risk found among offspring to fathers with sub-clinical drinking when compared to those with alcohol-related disorders, the former group accounts for a much larger proportion of all cases of substance-related disorders in the population, prompting universal prevention efforts targeting the level of total alcohol consumption in society.

Improved survival in trauma patients with acute alcohol intoxication has been previously reported. The effect of illegal and controlled substances on mortality is less clear. We hypothesized that alcohol, illegal and controlled substances are each independently associated with lower odds of mortality in adult trauma patients.The Trauma Quality Improvement Program (2010-2016) was queried for patients screening positive for alcohol, illegal or controlled substances on admission. A multivariate logistic regression analysis was used to determine odds of mortality. A similar analysis was used after stratification by injury severity scale (ISS).From 1,299,705 adult patients, 660,135 were screened for substance use. Of these patients, 497,872 were male, 227,995 (34.5 %) screened positive for alcohol, 155,437 (23.5 %) for illegal substances and 90,259 (13.7 %) for controlled substances. Mortality rate was 6.2 % with alcohol, 5.1 % with illegal substances, and 5.7 % with controlled substances compared to 8.0 % with no substance use (p0.001). After controlling for covariates, all groups had lower odds of mortality: alcohol (OR = 0.88, CI = 0.84-0.92, p0.001), illegal substances (OR = 0.83, CI = 0.77-0.90, p0.001), controlled substances (OR = 0.72, CI = 0.67-0.79, p0.001). When stratified by ISS, alcohol and illegal substances continued to be associated with decreased mortality until ISS 50. Controlled substances were associated with decreased mortality when ISS16.Patients positive for alcohol, illegal or controlled substances have 12 %, 17 %, and 28 % decreased odds of mortality, respectively. This paradoxical association should be confirmed with future clinical studies and merits basic science research to identify biochemical or physiological components conferring a protective effect on survival in trauma patients.

Objective The purpose of the present study was to identify drinking patterns and determine their intraindividual stability over the course of four weeks among a sample of adults from the general population. Methods The sample comprised 288 adults who reported drinking alcohol at least once per month (49% female; mean age = 33.1 years, SD = 12.8 years). Participants were recruited in the waiting area of a local registration office in northeastern Germany. Data were collected four times over four consecutive weeks by interview (once in the registration office and thrice by telephone). To assess alcohol consumption in the past seven days, timeline follow-back questions were administered each time. For data analysis, latent profile and latent transition analyses were applied. Indicators for latent classes were total number of drinks per seven days, number of drinking days, and number of days with heavy episodic drinking. Results Three classes of seven-day drinking patterns were identified at baseline: (a) light drinkers (77%), (b) moderate drinkers (18%), and (c) heavy drinkers (5%). Approximately one-fifth (21%) of baseline light drinkers and 94% of baseline moderate drinkers changed their drinking pattern at least once during the four weeks. The majority (81%) of baseline moderate drinkers also reported light drinking in at least one of the three subsequent weeks. Conclusions Our findings suggest intraindividual changes in drinking patterns even during a short period of time. Instability of drinking patterns may potentially impair the assessment of light to moderate alcohol consumption when a quantity-frequency approach is applied.

To examine the trends in incidence and socio-demographic, organizational, academic, and clinical risk markers of student alcohol intoxication associated with emergency department (ED) visits.Student admission data from 2009 to 2015 were linked to primary healthcare data and subsequent ED visits with alcohol intoxication identified using ICD-9 codes within one year following the first (index) enrollment each year. Incidence rate per 10,000 person-years was calculated. Cox proportional hazard regression provided adjusted hazard ratios (HR) (95 % CIs) for the association between student characteristics and subsequent ED visits with alcohol intoxication.Of 177,128 students aged 16-49 enrolled, 889 had at least one ED visit with alcohol intoxication, resulting in an incidence rate of 59/10,000 person-years. Incidence increased linearly from 45/10,000 person-years in 2009-10 to 71/10,000 person-years in the 2014-15 academic year (p 0.001). HRs (95%CIs) of student characteristics associated with this outcome were: males (versus females): 1.38 (1.21-1.58); below 20 years of age (versus 25-30 years): 3.36 (1.99-5.65); Hispanic (versus Asian) students: 1.61 (1.16-2.25); parental tax dependency: 1.49 (1.16-1.91); Greek life member: 1.96 (1.69-2.26); member of an athletic team: 0.51 (0.36-0.72); undergraduate (versus graduate) students: 2.65 (1.88-3.74). Past year alcohol use or having been diagnosed with depression or anxiety were also significant predictors. Adjustments for campus-related factors strongly attenuated the associations between student socio-demographic characteristics with this outcome.Linking student admission data with ED clinical data can help monitor student alcohol intoxication associated with ED visits and identify student groups at higher risk who subsequently can be targeted for intervention efforts.

Background This study examined blood alcohol content (BAC) among suicide decedents aged 50+ and its associations with suicide precipitating/risk factors, means, and other drug toxicology. Methods The National Violent Death Reporting System, 2005–2015, provided data (N = 56,118 for all suicide decedents and N = 29,115 with alcohol test results). We used logistic regression models, with BAC > 0.0 (BAC positive) and BAC > = 0.08 (intoxication) as the dependent variables. Results Almost a third of decedents who were tested for alcohol were BAC positive, and almost two-thirds of those who were positive had a BAC > = 0.08. Alcohol problems prior to suicide (AOR = 6.71, 95% CI = 6.24–7.21), relationship problems (AOR = 1.53, 95% CI = 1.44–1.63), and death/suicide of family/friends (AOR = 1.22, 95% CI = 1.11–1.35) were associated with greater odds of a positive BAC, but suicide means were not significantly associated with a positive BAC. Alcohol problems (AOR = 2.98, 95% CI = 2.68–3.31), relationship problems (AOR = 1.18, 95% CI = 1.06–1.30), firearm use (AOR = 1.85, 95% CI = 1.59–2.16), and hanging/suffocation (AOR = 1.38, 95% CI = 1.16–1.64) were associated with greater odds of a BAC > = 0.08. A toxicology positive for antidepressants, marijuana, cocaine, or amphetamines was associated with greater odds of a positive BAC; however, a toxicology positive for antidepressants, opiates, or amphetamines was associated with lower odds of a BAC > = 0.08. BAC > = 0.08 rates increased over the study period. Conclusions Alcohol intoxication may have contributed to using more violent suicide means. The significant association between relationship problems and intoxication before suicide calls for restricting access to alcohol and suicide means for individuals with these problems. Suicide prevention may require crisis counseling/support for acute life stressors and ongoing emotional support.

Background The purpose of this study is to examine the conditions under which daily stressful and positive events are associated with alcohol use among heavy drinking sexual minority men (SMM). Specifically, we examined the moderating effects of two indicators of alcohol addiction severity (i.e., alcohol dependence severity and negative drinking consequences) on the associations between daily stressful events and alcohol use and between daily positive events and alcohol use among heavy drinking SMM. Procedures Secondary data analyses were performed using data from a randomized controlled trial of heavy drinking and treatment seeking SMM who were assigned male at birth (N = 200). Participants responded to a daily survey delivered via interactive voice recording (IVR). The first seven days of the IVR were analyzed for this study. Results While accounting for treatment condition, weekday/weekend, and baseline drinking, stressful and positive events were both associated with increased daily drinking; however, indicators of alcohol addiction severity moderated these associations. For heavy drinkers with high alcohol addiction severity, daily stressful events were not associated with alcohol use, and daily positive events were associated with increased alcohol use. In contrast, for heavy drinkers with low alcohol addiction severity, daily stressful events were associated with less drinking, and daily positive events were not associated with alcohol use. Conclusions The findings of this study indicate that alcohol addiction severity plays a key role in explaining when daily stressful or positive events are associated with daily alcohol use among heavy drinking SMM.

Aim To investigate the association between socio-demographic characteristics and alcohol consumption in India. Methods Analytical data were derived from household surveys conducted by the study team that included 6088 adults in five states of India (male = 3803, female = 2285). The sample was a cross-sectional selected through stratified multistage sampling design. The survey collected data on socio-demographic characteristics of the respondents as well as the pattern of alcohol consumption. Multivariate logistic regression models were fitted to investigate the socio-demographic association with both alcohol consumption and types of alcoholic beverages consumed (distilled spirits, country liquor, home-brewed). Results More than one-third of the sample respondents (38.6%, 95%CI = 29.2–48.8%) reported to be current drinkers and approximately one-fifth (21.7%, 95%CI = 4.2–31.7%) were heavy drinkers and 7.4% (95%CI = 4.6–11.6%) were heavy episodic drinkers. In multivariate analyses, age greater than 50 years (OR = 0.70, 95%CI = 0.56–0.86), being female (OR = 0.08, 95%CI = 0.06–0.09), schooling greater than 12 years (OR = 0.61, 95% CI = 0.50–0.75), owning land (OR = 0.74, 95%CI = 0.65–0.86), and living in pucca house (OR = 0.85, 95% CI = 0.74–0.98) were negatively associated with current drinking status. Higher income (OR = 1.30, 95%CI = 1.08–0.57) and living in urban areas (OR = 1.54, 95%CI = 1.33–1.78) were positively associated with current drinking status. Conclusions Substantial differences in the socio-demographic correlates of alcohol consumption and types of alcoholic beverages exist in India. It is recommended that intervention and prevention strategies to curb alcohol consumption should include drinkers’ characteristic.

Background There is little knowledge about characteristics of the heaviest drinkers. This study aimed at exploring 1) socio-demographic characteristics and 2) drinking patterns and drinking contexts of heavy drinkers and other drinkers in Norway, applying various criteria for heavy drinking. Methods Data from cross-sectional population surveys among adults in Norway (aged 16 +) in 2015 through 2018 (current drinkers, n = 6 940) were analysed. Two measures were applied to categorize heavy drinkers: 1) AUDIT score (10 +), and 2) annual consumption volume (445 + units) (both above 90th percentile). Social contexts of drinking included location (private homes, licensed premises); social company (partner/family, work mates, friends, no one); and weekend versus weekdays. Results Heavy drinkers accounted for 10% of the sample and up to half of the total consumption. Heavy drinkers differed significantly from other drinkers with regard to age, education level and criterion; by AUDIT score, the prevalence of heavy drinkers decreased with increasing age and education level, whereas the opposite was the case for by volume. Compared to other drinkers, heavy drinkers drank relatively more often on weekdays and relatively more often alone, and more frequently at licenced premises. Conclusions In Norway, the distribution of alcohol consumption is heavily skewed, and the heaviest drinkers differ from the rest of the population in several aspects. This group of drinkers represent an important target for public policy, and there is a need for further knowledge of this group enabling more targeted interventions in addition to policies aimed at reducing the per-capita consumption.

Objective The present paper extends the scope of testing Skog’s theory on the ‘collectivity of drinking culture’ to adolescent alcohol use in 26 European countries. The aim was to 1) examine whether changes in adolescent alcohol use are consistent across different consumption levels, and 2) explore whether trends in heavy and light drinkers diverged or converged. Method Data came from six waves of the cross-sectional European School Survey Project on Alcohol and other Drugs (ESPAD) between 1999 and 2019. The sample consisted of n = 452,935 students aged 15–16 years. Trends in alcohol volume across consumption levels including abstainers were estimated by quantile regression models (50th, 80th, 90th and 95th percentile). Countries were classified according to trends showing (soft/hard) collectivity or (soft/hard) polarisation. Trends in heavy drinkers were compared with the population trend. Results Trends in alcohol consumption at different levels across 26 European countries in the period 1999–2019 were not homogeneous. Collective changes were found in 15 (14 soft/1 hard), and polarised trends in 11 countries (5 soft/6 hard). Collectivity was generally associated with a declining trend. In 18 countries, trends in heavy and light drinkers diverged. Conclusion Accepting some variation in the strength of changes across consumption levels, changes in many European countries occurred in the same direction. Yet, diverging trends at different consumption levels in most countries indicate a less beneficial change in heavy compared with light drinkers, implying that in addition to universal population-level strategies, intervention strategies targeting specific risk groups are needed to prevent alcohol-related harm.

Background Some former heavy drinkers identify themselves as being in recovery. Previous research has examined how common the recovery identity is by recruiting participants who identified as having a past drinking problem. However, there are many people who reduce their drinking without identifying (at least in retrospect) that they had a problem. What are the possible implications of this recruitment question on prevalence estimates of the recovery identity? Methods A convenience sample of participants were recruited through the Prolific website. Participants were asked about their current and past drinking. Those who were former heavy drinkers were asked if their drinking had ever been a problem and if they currently, or ever, regarded themselves as being in recovery. Results From a sample of 4450 participants, 240 people were identified as former heavy drinkers who now drink in a moderate fashion or were not drinking at all. Less than a third (29.2 %) of these former heavy drinkers endorsed that they used to have a problem but now no longer do. Only 13.8 % said that they had ever been in recovery (8.8 % currently identified as in recovery). Almost all participants who identified as being in recovery also agreed that they used to have a problem with their drinking. Conclusions Recruiting participants who identify as having had a problem, but now no longer do, will lead to an underestimation of the number of former heavy drinkers in the general population and an inflated estimate of the proportion of these former heavy drinkers who identify as being in recovery.

Background and aims Fatal traffic accidents affect thousands of people in the US alone every year. Alcohol consumption has been identified as a strong predictor of traffic fatalities. This result is hardly surprising as drivers who decide to consume alcohol and then drive are more likely to exhibit poor driving performance. In this paper, I argue that alcohol consumption can lead to traffic fatalities by increasing restraint omission. Methods I analyzed individual-level data about victims (n = 488,829) of fatal traffic accidents that occurred in the US between January 1, 1999 and December 31, 2015 from the Fatality Analysis Reporting System of the National Highway Traffic and Safety Administration. Results There is a strong relationship between alcohol consumption and restraint use. Both vehicle drivers and occupants are far less likely to be restrained when inebriated. Additional analyses show that part of the effect of alcohol consumption on traffic fatalities can be attributed to restraint omission. Conclusions There is a significant relationship between alcohol consumption and restraint omission for both drivers and occupants of vehicles that were involved in fatal traffic accidents in the US between January 1999 and December 2015. Past public health campaigns have focused on preventing traffic fatalities by persuading drivers to refrain from getting behind the wheel after consuming alcohol. My data suggest that public health campaigns should inform both drivers and occupants of vehicles about the relationship between alcohol and restraint omission in order to minimize future casualties.

Background Early-onset drunkenness is associated with an increased risk of developing an alcohol use disorder (AUD), which predicts excess mortality risk. Here, we estimated mortality risk for drinkers with and without early drunkenness. Methods For 14,848 adult participants interviewed about drinking, drunken episodes, and AUD in 1981–83 for the Epidemiologic Catchment Area in New Haven (Connecticut), Baltimore (Maryland), St. Louis (Missouri), and Durham (North Carolina), we linked National Death Index records through 2007. Results Cox regression modeling estimates showed excess mortality for drinkers with age of first drunkenness earlier than 15 years old (hazard ratio, HR: 1.47, 95% CI: 1.25, 1.72) and when first drunkenness occurred at or after age 15 (HR: 1.20, 95% CI: 1.11, 1.29), as compared with adults who had never been drunk. Consistent results were observed, irrespective of AUD history. That is, early drunkenness signaled excess mortality risk even in absence of AUD. Conclusions In a large community sample from four cities in the US, early age of onset of drunkenness predicts mortality risk. We discuss experiments to investigate the possible causal significance of this predictive association.

Background People arrested for driving under the influence of alcohol (DUI) are at high risk to reoffend. One reason for this high rate of recidivism among DUI offenders is that these individuals systematically underestimate the degree to which alcohol impairs their ability to drive. This study compared perceived and objective driving ability following alcohol and performance feedback in drivers with and without a history of DUI. Method Adult drivers with (n = 20) and without (n = 20) a history of DUI arrest attended two dose challenge sessions where they received 0.64 g/kg alcohol or placebo, completed a simulated driving task, and provided measures of subjective impairment. They attended a third retesting session where they received feedback that they were impaired by alcohol. They received 0.64 g/kg alcohol and their objective and perceived driving ability was retested. Results Both groups showed significant impairment of driving performance following 0.64 g/kg alcohol compared to placebo. DUI offenders rated themselves as less impaired than controls. After performance feedback, self-reported impairment during the alcohol retest increased for DUI offenders but not for controls. There was no effect of performance feedback on objective driving ability. Conclusions These results support the notion that under alcohol DUI offenders characteristically perceive themselves as better able to drive than non-offenders. These perceptions can be tempered by performance feedback. To the extent that perceived ability to drive safely after drinking contributes to DUI and its recidivism, feedback geared towards lowering this self-efficacy could reduce willingness to engage in this behavior.

Background This study aimed to evaluate the factors associated with drinking behavior of cancer survivors after cancer diagnosis. Methods The study subjects were 906 adult cancer survivors who had reportedly drunk alcohol before cancer diagnosis and participated in the Korean National Health and Nutrition Examination Surveys conducted from 2007 to 2013. Among them, 360 abstained from alcohol drinking after cancer diagnosis. We categorized remaining 546 persistent drinkers into high-risk drinker (consuming ≥ 7 glasses of alcohol for men and ≥ 5 glasses of alcohol for women at one sitting at the frequency of at least once a month) or moderate drinker. We used multiple logistic regression analysis to evaluate risk factors associated with drinking behavior. Results The high-risk drinkers occupied 27.1% (148 survivors) of the persistent alcohol drinking survivors. Age increase (OR = 0.96; 95% CI 0.93-0.99), female sex (OR = 0.15; 95% CI 0.08-0.28), and increase of time lapse (by 1-year) after cancer diagnosis (OR = 0.94; 95% CI 0.92-0.97) were associated with a lower risk of high-risk drinking as compared with moderate drinking. Meanwhile, ≤ 9 years of education (OR = 1.99; 95% CI 1.10-3.60), alcohol-related cancer (OR = 2.09; 95% CI 1.23-3.56), and current smoking (OR = 1.92; 95% CI 1.03-3.59) were associated with increased risk of high-risk drinking of cancer survivors. Conclusions These findings suggest that greater efforts for preventing high-risk drinking should be laid on the cancer survivors, with consideration of individual sociodemographic characteristics, especially when the survivors had been diagnosed with alcohol-related cancer.

Background Increases in inhibitory errors in heavy drinkers are established; less well-studied is whether heavy drinkers are aware of these errors in performance. Reductions in error detection and awareness limit the possibility for remedial action to be taken, and have implications for substance abusers seeking to control use: failure to monitor and/or adjust ongoing behaviour may be linked to using more or more often than intended, and failing to adjust behaviour after a slip. Here we report the first study of both inhibitory control and error awareness in young heavy drinkers, using behavioural and psychophysiological measures. Methods Heavy drinkers (n = 25) and light- or non-drinking controls (n = 35) completed a difficult inhibitory task which required signaling the awareness of inhibitory errors on the subsequent trial, while brain electrical activity was recorded. Results Heavy drinkers made more inhibitory errors than controls, but we observed no difference in error awareness, both via overt signaling and with equivalent amplitude of the error positivity (Pe), indexing conscious error detection. Similarly, controls and heavy drinkers showed no difference in amplitude or latency of the error-related negativity (ERN), indexing early pre-conscious error detection. Conclusions This research suggests no significant difference in detection of errors in heavy drinkers, even as they are more prone to make these errors, a result seen in dependent drinkers reported elsewhere. Future research with larger sample sizes, and a more difficult task producing sufficient errors, should determine whether heavy drinkers employ sufficient post-error remedial action.

Background Young adults with higher trait urgency (i.e., a tendency to act rashly in response to heightened affect) may be especially vulnerable to heavy drinking. The current study examined 1) the influence of urgency on daily relations between affect and drinking to intoxication, and 2) whether urgency influenced the effectiveness of naltrexone (vs. placebo) for reducing alcohol use. Methods This study is a secondary analysis of data from 126 (n = 40 female) heavy drinking young adults, ages 18–25, enrolled in a double-blind, 8-week clinical trial comparing brief motivational intervention and either naltrexone or placebo. Multilevel models examined whether trait urgency moderated daily relations between positive and negative affect and drinking to intoxication, measured by an estimated blood-alcohol concentration (eBAC) at or above the legal limit (≥0.08 g%). Person-level interactions examined whether naltrexone was more effective than placebo at reducing the odds of eBAC ≥ 0.08 g% for individuals with higher vs. lower trait urgency. Results On days of greater within-person positive or negative affect, young adults with higher urgency were more likely to drink to intoxication than those with lower urgency. Naltrexone reduced the odds of drinking to intoxication significantly more than placebo, independent of positive or negative urgency. Conclusions Although naltrexone treatment reduced drinking overall, young adults with higher trait urgency were still at increased risk for hazardous drinking following times of strong positive or negative mood. Targeted interventions are needed to reduce the risk of heavy drinking among young adults with high trait urgency.

Introduction Although much of the work on risky alcohol use behaviors, such as heavy drinking, focuses on adolescence and young adulthood, these behaviors are associated with negative health consequences across all ages. Existing studies on age trends have focused on a single alcohol use behavior across many ages, using methods such as time-varying effect modeling, or a single age period with many behaviors, using methods such as latent class analysis. This study integrates aspects of both modeling approaches to examine age trends in alcohol use behavior patterns across ages 18–65. Methods Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to identify past-year alcohol use behavior patterns among a nationally representative sample of U.S. adults (n = 30,997; 51.1% women; 63.5% White Non-Hispanic) and flexibly estimate nonlinear trends in the prevalences of those patterns across ages 18–65. Results Five patterns were identified: Non-Drinkers, Frequent Light Drinkers, Infrequent Heavy Episodic Drinkers, Frequent Heavy Episodic Drinkers, and Extreme Drinkers. Pattern prevalences were allowed to vary flexibly across the entire age range. Prevalences of the Infrequent Heavy Episodic and Extreme Drinkers peaked around ages 22–24, but peaked for Frequent Heavy Episodic Drinkers around age 49. Non-Drinkers were most prevalent across all ages except during the early 20 s when Extreme Drinkers were more prevalent. Around ages 24–30, the Non-, Frequent Light, and Extreme Drinkers were approximately equally prevalent. Conclusions The approach used here holds promise for understanding characteristics associated with behavior patterns at different ages and long-term age trends in complex behaviors.

Background Recent research has highlighted the growing trend of alcohol preloading before a night out. We wished to look at people’s motivations for preloading, their estimation for drinking during the night, and assess the impact that preloading has on how inebriated people become across the night as measured by Breath Approximated blood Alcohol Content (BrAC). Method We randomly surveyed and breath-tested patrons as they entered and exited Night Time Entertainment Districts (NEDs) in Brisbane, Queensland. We obtained 360 participants who were encouraged to contact us at the end of their night, compensating them for their time with a taxi voucher. Of these, 143 people returned and completed an exit questionnaire. Findings We found that people were motivated to preload in order to save money and socialise, were likely to drink more than they predicted over the course of the night, and were more surprised by their alcohol reading the higher their BrAC; this trajectory displayed little difference between men and women. It was further found that, for men, personality contributed 19% of the variance to exit BrAC, but entry BrAC accounted for nearly 38% of unique variance. For women, body mass index significantly predicted exit BrAC (9% unique variance), but entry BrAC accounted for nearly 30% unique variance. Interpretation To reduce general levels of intoxication in city NEDs, interventions should focus on having people come in earlier, less drunk, and be taught to have more realistic appraisals of their drinking.

Background Hnrnph1 is a validated quantitative trait gene for methamphetamine behavioral sensitivity that encodes for heterogeneous nuclear ribonucleoprotein H1 (hnRNP H1). This RNA-binding protein is involved in all stages of RNA metabolism that impacts mesocorticolimbic dopamine neurotransmission to influence addiction-related behavior. Methods We characterized the alcohol behavioral phenotypes of mice heterozygous for a deletion in the first coding exon of Hnrnph1 (Hnrnph1+/-). We examined alcohol intake under both continuous- and limited-access procedures, as well as alcohol-induced place-conditioning. Follow-up studies examined genotypic differences in the psychomotor-activating and sedative-hypnotic effects of acute and repeated alcohol, and a behavioral test battery was employed to determine the effects of Hnrnph1 deletion on the manifestation of negative affect during alcohol withdrawal. Results Relative to wild-type (WT) controls, Hnrnph1+/- males exhibited blunted intake of high alcohol concentrations under both drinking procedures. Hnrnph1 deletion did not impact the conditioned rewarding properties of low-dose alcohol, but reversed the conditioned place-aversion elicited by higher alcohol doses (2 and 4 g/kg), with more robust effects in male versus female mice. No genotypic differences were observed for alcohol-induced locomotor activity. Hnrnph1+/- mice exhibited a modest increase in sensitivity to alcohol’s sedative-hypnotic effects, but did not differ from WT mice with regard to tolerance to alcohol’s sedative-hypnotic effects or alcohol metabolism, Inconsistent effects of Hnrnph1 deletion were observed in models for withdrawal-induced negative affect. Conclusions These data identify Hnrnph1 as a novel, male-selective, driver of alcohol consumption and high-dose alcohol aversion that is potentially relevant to the neurobiology of alcohol abuse and alcoholism.

Background Chronic pain and alcohol use disorder (AUD) are often co-occurring conditions. Pain catastrophizing, an emotional component of pain, and pain intensity are related to alcohol use as a coping mechanism; however, how pain interacts with tonic alcohol craving is an understudied area. This study sought to determine the unique and independent effects of pain intensity and pain catastrophizing on alcohol craving in heavy drinkers. Method Non-treatment seeking heavy drinkers (n = 128) completed self-report measures of pain (both intensity and catastrophizing), depression, alcohol use and problems, and reasons for heavy drinking. A hierarchical regression examined the unique contribution of pain intensity to alcohol craving. Depression, pain catastrophizing, and alcohol use measures were added to the hierarchical model in sequential blocks. Results The final model of the hierarchical regression demonstrated that pain catastrophizing has an independent effect on alcohol craving over and above demographic, pain intensity, depression, and alcohol measures. Exploratory analyses suggest that individuals in the high intensity pain grade have higher levels of depression symptomology, pain catastrophizing, alcohol use and problems, as well as engaging in heavy drinking to “feel normal” compared to the no pain and low intensity pain grades. Conclusions These results demonstrate that pain catastrophizing predicts alcohol craving independent of self-reported chronic pain intensity. Individuals with high intensity chronic pain have more severe alcohol use and mood-related symptomology. Upon replication in clinical samples, these findings can inform clinical care for pain management.

Background Recent laboratory studies have shown that acute alcohol intoxication selectively and effectively dampens aversive responding to uncertain threat. An emerging hypothesis is that individuals who exhibit heightened reactivity to uncertain threat may be especially motivated to use alcohol to dampen their distress, setting the stage for negative reinforcement processes to drive excessive alcohol use. However, no study to date has directly examined whether current problematic drinkers exhibit heightened reactivity to uncertain threat as would be expected. Methods The present study was therefore designed to examine the association between current problematic alcohol use and reactivity to uncertain threat during sobriety in two, independent samples. In Study 1 (n = 221) and Study 2 (n = 74), adult participants completed the same well-validated threat-of-shock task which separately probes responses to temporally predictable and unpredictable threat. Startle potentiation was measured as an index of aversive responding. Problematic alcohol use was defined as number of binge episodes within the past 30 days in Study 1 and total scores on a self-report measure of hazardous drinking in Study 2. Results As hypothesized, across both studies greater levels of problematic drinking were associated with greater startle potentiation to unpredictable threat. In Study 2, hazardous drinking scores were also positively associated with startle potentiation to predictable threat. Conclusions The findings are notably consistent with the notion that heightened reactivity to uncertain threat is an important individual difference factor associated with the onset and/or maintenance of problematic drinking behaviors and may therefore be a novel prevention and intervention target.

Background Predictors of use of alcohol mixed with energy drinks (AmED) among youth have been understudied. The current analyses investigated the prevalence of and correlates for use of AmED among alcohol users from a national study of stimulant use among youth. Methods The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) assessed behaviors and risk factors for stimulant use from 11,048 youth, 10–18 years of age recruited from entertainment venues across 10 US cities. Of the four cross sections, two had questions on having alcohol mixed with energy drinks (AmED) in the past 30 days along with sociodemographic characteristics, current tobacco and marijuana use and current nonmedical use of prescription opioids, anxiolytics, and stimulants. Only 13 to18 year olds and those who reported alcohol use were included in the analyses. Results Overall, 28.4% (1392 out of 4905) of the 13 to18 year olds reported past 30-day alcohol use. Among alcohol users, 27% reported having alcohol mixed with energy drinks in the past 30 days. Multivariate logistic regression indicated that use of AmED was significantly associated with tobacco and marijuana use and nonmedical use of prescription stimulants. Conclusions Underage drinking is common among youth and more than a quarter of these drinkers use AmED. Use of AmED is significantly associated with tobacco and marijuana use and nonmedical use of prescription stimulants. Drug and alcohol intervention programs should educate on the risks of AmED, as the same population is at high-risk for use of AmED and alcohol/drug use.

BACKGROUND: Even given equivalent drinking patterns, Black and Latino men experience substantially more dependence symptoms and other consequences than White men, particularly at low/no heavy drinking. No known studies have identified factors driving these disparities. The current study examines this question. METHODS: The 2005 and 2010 National Alcohol Surveys were pooled. Surveys are nationally representative, telephone interviews of the U.S. including Black and Latino oversamples; male drinkers were analyzed (N=4182). Preliminary analyses included negative binomial regressions of dependence symptom and consequence counts testing whether effects for race/ethnicity were diminished when entering potential explanatory factors individually. Additional analyses re-examined effects for race/ethnicity when using propensity score weighting to weight Blacks to Whites, and Latinos to Whites, first on heavy drinking alone, and then on heavy drinking and all explanatory factors supported by preliminary analyses. RESULTS: Preliminary regressions suggested roles for lower individual SES, greater prejudice and unfair treatment, and younger age in the elevated risk of alcohol problems among Black and Latino (vs. White) men at low heavy drinking levels; additional support emerged for single (vs. married) status among Blacks and neighborhood disadvantage among Latinos. When Blacks and Latinos were weighted to Whites on the above variables, effects for race/ethnicity on dependence counts were reduced to nonsignificance, while racial/ethnic disparities in consequence counts were attenuated (by >43% overall). CONCLUSIONS: Heavy drinking may be especially risky for those who are poor, exposed to prejudice and unfair treatment, young, and unmarried, and these factors may contribute to explaining racial/ethnic disparities in alcohol problems.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. Language: en

Background Expanding access to treatment and recovery services is key to reducing substance use-related harms. Fundamental to expanding such services is better understanding the populations identifying themselves as in recovery. This study uses nationally representative data to estimate prevalence and correlates of recovery in the U.S. Methods Data are from the 43,026 adults (aged 18 or older) participating in the 2018 National Survey on Drug Use and Health. Based on self-reported data, we estimate prevalence of ever having a substance use problem, the percentage in recovery among those with a substance use problem, and a multivariable logistic regression model to explore associations of recovery status with demographic characteristics and lifetime mental health problems. Among adults reporting a substance use problem, we compare prevalence of substance use by recovery status, followed by a multivariable model examining associations between each substance used and being in recovery. Results More than 1 in 10 adults (27.5 million) in the U.S. reported ever having a substance use problem, and, among those with a problem, nearly 75 % (20.5 million) reported being in recovery. Reporting lower prevalence of using substances in the past year and having received treatment for their substance use problem were associated with being in recovery. Ever having a mental health problem was highly prevalent among those reporting a substance use problem. Conclusions The provision and expansion of substance use treatment services continues to be important to reduce harms related to substance use, especially for those with both substance use and mental health disorders.

Background Humans interact with multiple stimuli across several modalities each day. The “redundant signal effect” refers to the observation that individuals respond more quickly to stimuli when information is presented as multisensory, redundant stimuli (e.g., aurally and visually), rather than as a single stimulus presented to either modality alone. Studies of alcohol effects on human performance show that alcohol induced impairment is reduced when subjects respond to redundant multisensory stimuli. However, redundant signals do not need to involve multisensory stimuli to facilitate behavior as studies have shown facilitating effects by redundant unisensory signals that are delivered to the “same sensory” (e.g., two visual or two auditory signals). Methods The current study examined the degree to which redundant visual signals would reduce alcohol impairment and compared the magnitude of this effect with that produced by redundant multisensory signals. On repeated test sessions, participants (n = 20) received placebo or 0.65 g/kg alcohol and performed a two-choice reaction time task that measured how quickly participants responded to four different signal conditions. The four conditions differed by the modality of the target presentation: visual, auditory, multisensory, and unisensory. Results Alcohol slowed performance in all conditions and reaction times were generally faster in the redundant signal conditions. Both multisensory and unisensory redundant signals reduced the impairing effects of alcohol compared with single signals. Conclusions These findings indicate that the ability of redundant signals to counteract alcohol impairment does not require multisensory input. Duplicate signals to the same modality can also reduce alcohol impairment.

Background Alcohol may cause death directly by acute poisoning, as well as induce illnesses or accidents that lead to death. Our research question was whether the current decreasing trend in acute fatal alcohol poisonings in Finland is a real phenomenon or an artefact caused by possible changes in the process of determining the cause of death. Methods All cases in the national post-mortem toxicology database in which the underlying cause of death was acute alcohol poisoning in 1987–2018 were investigated in terms of blood alcohol concentration (BAC), age and gender. The number of acute alcohol poisonings was compared to the number of deaths from alcohol induced illness in the post-mortem toxicology database. Results A total of 12 126 acute alcohol poisoning cases were retrieved. Between 2004 and 2017 the number of acute alcohol poisonings decreased 60.1 %. At the same time the number of alcohol induced illnesses in the study material remained stable or decreased marginally. The median BAC in all acute alcohol poisonings was 3.2 g/kg. The annual median BAC values showed a small but significant decrease over the study period. The proportion of women in acute alcohol poisonings increased significantly over the study period, from 17.1%–22.3%. Women were on average 2.5 years older than men. Conclusions On grounds of the BAC statistics and supporting evidence, we conclude that the significant decrease in the number of fatal alcohol poisonings is true and likely reflects changes in the overall consumption of alcohol.

Background This study describes the frequency and characteristics of aggression and/or violence in ambulance attendances involving alcohol, illicit and/or pharmaceutical drug use in Victoria, Australia between January 2012 and January 2017. Methods Patient characteristics, context, and substance use involvement in ambulance attendances were examined to determine associations with attendances where aggression and/or violence was recorded. Results There were 205,178 ambulance attendances where use of alcohol, pharmaceutical drugs or illicit substances contributed to the reason for the attendance. Paramedics recorded acts of aggression and/or violence in 11,813 (5.76 %) of these attendances. Aggression/violence was more likely to be recorded in certain contexts. Compared with attendances where aggression/violence was not recorded, attendances where aggression/violence was recorded were significantly more likely to involve younger and male patients, and occur on Friday and Saturday nights. Alcohol intoxication was involved in more than half of attendances where aggression/violence was recorded, and was almost twice as prevalent as those involving illicit drug use where aggression/violence was recorded. This pattern was consistent across all hours, high-alcohol hours only, by metropolitan/regional location, and by police co-attendance. Conclusions Aggression and violence are frequently recorded in ambulance attendances involving alcohol, pharmaceutical drugs or illicit substances, and, most often involve alcohol. This violence poses a recurring threat to the health and safety of paramedics, bystanders, and patients. Greater priority should be given to reducing alcohol-related violence through evidence-based policy measures targeting high-risk groups (e.g. young adult males) and contexts (e.g. weekends, late at night) where harm is most likely to occur.

International public policy on age of first alcoholic drink (AFD) has emphasised the long-term benefits of delaying AFD. This study aimed to compare AFD to age of first intoxication (AFI) as predictors of substance use disorder and mental disorder outcomes in adulthood.Data were obtained from a longitudinal birth cohort in Christchurch, New Zealand. Participants were born in 1977. Analysis samples ranged from n = 1025 (age 18) to n = 962 (age 35). Measures of AFD and AFI were generated using parental- and self-report data collected from age 11. Outcomes at age 18-35 were alcohol quantity consumed, DSM-IV alcohol use disorder (AUD) and AUD symptoms, major depression, anxiety disorder, and nicotine, cannabis, and other illicit drug dependence. Covariate factors measured during childhood included family socioeconomic status, family functioning, parental alcohol-related attitudes/behaviours, and individual factors.There was a significant unadjusted association between AFD and symptoms of AUD (p .001) and nicotine dependence (p .05) but not other outcomes. AFI was significantly (p .05) associated with all outcomes. After adjustment for covariates, the association between AFD and outcomes was not statistically significant. Conversely, in adjusted models, statistically significant (p .05) associations remained between AFI and all AUD and substance use disorder outcomes but not alcohol consumption or mental disorder outcomes.AFI was a more robust predictor of adult substance use disorder outcomes than AFD. Public health and policy interventions aimed at prevention of long term harms from alcohol should therefore focus on AFI rather than AFD.

BACKGROUND: Substance use can reduce care engagement for individuals with HIV. However, little is known as to whether heavy drinkers differ from drug users. This study compares heavy drinkers, drug users, and those drinking heavily and using drugs on their HIV care engagement. METHODS: HIV-infected adult inpatients (n=801; 67% male; 78% Black) from 11 urban hospitals across the United States participated in a multisite clinical trial to improve patient engagement in HIV care and virologic outcomes. All participants drank heavily and/or used drugs, and had poorly controlled HIV. Participants reported care history at baseline. We compared heavy drinkers, drug users, and those both drinking heavily and using drugs (reference group) on their engagement in care. RESULTS: Heavy drinkers reported lowest rates of lifetime HIV care, AOR = 0.59 (95% CI = 0.36, 0.97). Groups did not differ in recent care, prescription of HIV medication, medical mistrust, or patient-provider relationship. Drug users evidenced the best medication adherence, AOR = 2.38 (95% CI = 1.33, 4.23). Exploratory analyses indicated that drinkers had lower initial care engagement, but that it increased more rapidly with duration of known HIV infection, with similar rates of recent care. Drinkers had the lowest CD4 counts (B=−0.28, p

Aim Despite significant reductions in Driving Under the Influence (DUI) in the United States during recent decades, DUI continues to be a major public health threat. The current study investigated the intersection of two domains known to influence DUI: criminal history and psychiatric comorbidity. Methods DUI recidivists (N = 743) attending a court-mandated two-week inpatient DUI program completed a computerized mental health assessment as part of their intake to that program. Participants’ criminal records were obtained 4–5 years after program attendance. Findings This study identified three primary repeat DUI offender subtypes with distinct patterns of criminal behavior and psychiatric comorbidity: (Type I) those whose DUI emerges from a pattern of drinking to cope with mood and anxiety problems, (Type II) those whose DUI emerges as part of a larger pattern of externalizing and criminal behavior, and (Type III) those whose DUI offenses reflect more acute triggers and isolated episodes of excessive drinking. Conclusion These findings suggest that current treatment models used in DUI programs are inadequate to address the heterogeneity in the population of DUI recidivists and that earlier and more comprehensive screening would allow for better targeting of resources to DUI offender subtypes.

Background Stressful or supportive social environments promote biological changes with regulatory implications for future relationships and substance abuse. Recent research suggests links between adverse social environments, prosocial relationships, methylation at the oxytocin receptor gene (OXTR), and substance abuse. The potential for OXTR methylation to act as the mechanism linking social environments to substance abuse has yet to be investigated. We hypothesized that, for young African American men, childhood adversity increases, and supportive, prosocial bonds with parents, peers, partners, and community mentors decrease OXTR methylation levels, which in turn predict increases in substance-related symptoms. Methods A sample of 358 rural African American men (age 19 at baseline) provided self-report data at three time points separated by 18 months and a genetic specimen at Time 2. Results Early adversity was associated with OXTR methylation indirectly via contemporary prosocial relationships. OXTR methylation was a proximal predictor of changes in substance-related symptoms. We found no evidence for a direct association of self-reported childhood trauma with OXTR methylation status. Conclusions Findings suggest that OXTR methylation is linked to substance use symptomatology, ostensibly resulting in increased expression of oxytocin (OT) in peripheral and central nervous systems. OXTR may act as a mechanism to explain how prosocial ties deter substance abuse and related problems. Despite conjectures in the literature that early adversity may become physiologically embedded via methylation in the OT system, direct effects were not evident. Rather, early adversity may affect OXTR methylation via influence on contemporary prosocial relationships.

Background Documenting changes in alcohol consumption is critical for assessing future health service and alcohol treatment needs, evaluating efforts to modify drinking behavior and understanding the impact of shifting demographics and social norms. For the period since 2000, published data on drinking trends have been scarce and inconsistent. Methods Using data from two large, nationally representative surveys of U.S. adults (2001–2002 and 2012–2013) that contained virtually identical questions on consumption, we assessed differences by period in the prevalence of drinking, volume of intake, frequency of drinking and prevalence of ≥monthly heavy episodic drinking (HED) and determined whether changes in consumption were consistent across beverage types and in population subgroups. Results Between 2001–2002 and 2012–2013, the prevalence of drinking increased, as did volume and frequency of drinking and prevalence of ≥monthly HED among drinkers. Increases were greater for women than men for all measures and smaller among the formerly married for consumption among drinkers. The increase in overall drinking prevalence was magnified among all race-ethnic minorities, whereas the increase in ≥monthly HED was magnified only among Blacks (all relative to Whites). Conclusions Our findings are suggestive of a “wetter” drinking climate in 2012–2013 than in 2001–2002, indicating the need for continued and expanded efforts to prevent chronic and episodic heavy alcohol consumption. Given the across-the-board increases in alcohol consumption in recent years, policy efforts that address drinking at the population level are supported, even if specific drinking behaviors and subgroups of drinkers are additionally targeted for individualized approaches.

Aims Deficits in behavioural inhibitory control are attracting increasing attention as a factor behind the development and maintenance of substance dependence. However, evidence for such a deficit is varied in the literature. Here, we synthesised published results to determine whether inhibitory ability is reliably impaired in substance users compared to controls. Methods The meta-analysis used fixed-effects models to integrate results from 97 studies that compared groups with heavy substance use or addiction-like behaviours with healthy control participants on two experimental paradigms commonly used to assess response inhibition: the Go/NoGo task, and the Stop-Signal Task (SST). The primary measures of interest were commission errors to NoGo stimuli and stop-signal reaction time in the SST. Additionally, we examined omission errors to Go stimuli, and reaction time in both tasks. Because inhibition is more difficult when inhibition is required infrequently, we considered papers with rare and equiprobable NoGo stimuli separately. Results Inhibitory deficits were apparent for heavy use/dependence on cocaine, MDMA, methamphetamine, tobacco, and alcohol (and, to a lesser extent, non-dependent heavy drinkers), and in pathological gamblers. On the other hand, no evidence for an inhibitory deficit was observed for opioids or cannabis, and contradictory evidence was observed for internet addiction. Conclusions The results are generally consistent with the view that substance use disorders and addiction-like behavioural disorders are associated with impairments in inhibitory control. Implications for treatment of substance use are discussed, along with suggestions for future research arising from the limitations of the extant literature.

Introduction Longitudinal reciprocal associations between substance use and delinquency are understudied in general adolescent populations, with previous research showing differing findings. This study aims to assess reciprocal associations between drunkenness, drug use and delinquency in a prospective, age-homogenous cohort study, using an analytical strategy that separates within- from between-person variance. Material and methods Data comes from the Longitudinal Research on Development in Adolescence (LoRDIA) study in Sweden. Adolescents were surveyed at baseline (age 13, grade 7, N = 1409) and followed-up at grades 8 and 9. Random-intercept cross-lagged panel analysis was undertaken. Results Between-person variance in the development of drunkenness, drug use, and delinquency were between 26% and 47%. At the within-person level, the links between these behaviors were only weak: delinquency was associated with later drug use across grades 7–9, and with drunkenness between grades 8–9 only; drunkenness was associated with later drug use between grades 7–8. Drug use was not associated with later delinquency or drunkenness at any time point. Discussion Stable individual factors play a larger than a hitherto known role in within- and over-time relationships between drunkenness, drug use, and delinquency. Longitudinal reciprocal associations between these behaviors are at best weak and such associations may not be of primary importance in practice with general adolescent populations. Moreover, the behaviors appear to follow three distinct developmental pathways, to which intervention design may need to pay attention. Conclusion Reciprocal associations between drunkenness, drug use, and delinquency were assessed, highlighting the differential developmental pathways of these behaviors in early-mid adolescence.

Few studies have explored the epidemiology of students presenting to the emergency department (ED) as a consequence of hazardous drinking. This study examined differentials and trends in ED visits following alcohol intoxication and co-occurring conditions among students presenting to a major U.S. university health system.The ED electronic medical records from academic years 2010-2015 were queried for student visits and their records were linked to the university's student admission datasets. Student alcohol-related visits were identified based on ICD-9 codes. Student characteristics and trends in the rate of alcohol intoxication per 100 ED student visits were analyzed. A random sample of 600 student clinical records were reviewed to validate diagnostic codes.There were 9616 student ED visits (48% males) to the ED of which 1001 (10.4%) visits involved alcohol intoxication. Two thirds of ED visits with alcohol intoxication had a co-occurring diagnosis, with injuries (24%) being the most common condition. The rate of alcohol intoxication varied greatly by student demographics and campus-related factors. There was a linear increase in the rate of alcohol intoxication from 7.9% in 2009-10 to 12.3% in 2014-15 (p0.01). The increase was greater among female students, students below 20 years of age, Asian students, and student athletes. In the sample reviewed, only two thirds of ED visits with alcohol intoxication were recorded by diagnostic codes.The rate of ED visits following alcohol intoxication varied by student demographic characteristics and campus-related factors with a rising trend over the study period.

Background We report a series of studies examining the effect of alcohol mixed with energy drinks (AmEDs) versus alcohol on objective intoxication (breath alcohol concentration; BrAC), intensity, and nature of intoxication. We also aimed to disentangle the role of energy drink (ED) ingredients in any effects. Method Three within-subject double-blind placebo-controlled studies measured BrAC, subjective intoxication and impairment (‘intensity of intoxication’), stimulation and sedation (‘nature of intoxication’) following administration of ED, Cola, Caffeine + Sugar, and Placebo with alcohol (Study 1, n = 18); ED, Caffeine-only, Sugar-only and Placebo with alcohol (Study 2, n = 20); and ED and Placebo with alcohol (Study 3, n = 27). Results Significant moderate-to-large magnitude BrAC decrements and delayed time to peak BrAC were observed after ED administration versus Placebo. However, no meaningful BrAC differences between ED and other active conditions were observed in Study 1 and 2. After BrAC adjustment, moderate-to-large magnitude reductions in intoxication and impairment ratings were observed after ED versus Placebo on the ascending limb in all studies and at peak in Study 2 and 3. No meaningful differences were observed in intoxication and impairment ratings between ED and Caffeine + Sugar and Cola conditions (Study 1); ratings were lower after ED versus Sugar-only (Study 2). Stimulation and sedation ratings did not differ between ED and Placebo. Conclusion Reductions in objective intoxication and perceived intensity of intoxication, but not nature of intoxication, were observed after AmED consumption. However, effects may be common to alcohol mixers containing sugars (objective intoxication) and caffeine (intensity of intoxication) and specific to a laboratory setting.

We investigated contexts of simultaneous use of alcohol and marijuana and the impact of simultaneous use on problems among adolescents. Ecological momentary assessment data were obtained over two weekends from 150 adolescents in California (47% female, M age = 16.36 years), using smartphone surveys administered early and late in the evening and again the following morning. We assessed whether, in what context, and with whom adolescents drank alcohol and used other substances over 3 evening hours. We assessed problems they experienced each evening on the following morning. Results showed that greater adult supervision in every context was associated with a 55% lower risk of simultaneous use (RRR=0.45, p≤ .05). Contexts with no other underage drinkers were associated with 99% lower risk of simultaneous use (RRR=0.01, p≤ .005). Each occasion of simultaneous use was related to 110% increase in the number of problems (IRR=2.10, p≤ .005), with 83%, 221% and 311% greater odds of violence (OR=1.83, p≤ .05), driving under the influence or riding with a drunk driver (OR=3.21, p≤ .05), or being drunk (OR=4.11, p≤ .005). Additional analyses showed that these problems may be attributed largely to the alcohol consumed in each context. Results demonstrate that it is essential to consider situational and social characteristics of substance use contexts to better understand adolescent simultaneous use of alcohol and drugs and problems.

Background Research examining alcohol use trajectories among Latina/os is scarce. Further, prior findings on alcohol use by ethnic group and gender is mixed. The purpose of this study was twofold: (a.) to examine developmental trajectories for two types of alcohol (drunkenness and heavy drinking) use across four Latina/o ethnic groups (Cubans, Puerto Ricans, Central/South American, and Mexican Americans) and, (b.) to examine the role of gender and ethnicity in developmental trajectories of drunkenness and heavy drinking among Latina/os. Methods Data were drawn from Waves I–IV of the National Longitudinal Study of Adolescent to Adult Health. The sample consisted of 1670 Latina/os that were followed from adolescence into adulthood. Multi-level logistic regression models were used to estimate drunkenness and heavy drinking trajectories and trajectories by gender. Results indicate that, for all four ethnic groups examined, the probability of drunkenness and heavy drinking gradually increased in adolescence, peaked in “emerging adulthood”, and decreased as they transitioned into adulthood. Findings also show divergent age trajectories by gender, but patterns varied across ethnicity and alcohol use outcome. Conclusions Key findings from this study demonstrate that among Latina/os, there are critical developmental periods for reported drunkenness and heavy drinking in the last 12 months, and that ethnicity and gender play substantial roles in the development of hazardous alcohol use over the life course.

Background Excessive alcohol use among the homeless may contribute to their high rates of emergency department use. Survey-based studies have provided some information on the relation between alcohol and emergency department use among the homeless. Methods This study used an intensive schedule of random breath collections and self-report assessments to examine the relation between emergency department utilization and alcohol use in homeless alcohol-dependent adults. Data were from homeless alcohol-dependent adults (N = 116) who were participating in a therapeutic workplace that provided job-skills training every weekday for 26 weeks. Breath-sample collections and assessments of self-reported alcohol use were scheduled each week, an average of twice per week per participant, at random times between 9:00 A.M. and 5:00 P.M. Participants received $35 for each breath sample collected. Self-reports of emergency department use were assessed throughout the study. Results Thirty-four percent of participants reported attending an emergency department and reported an average of 2.2 emergency department visits (range 1–10 visits). Alcohol intoxication was the most common reason for emergency department use. Participants who used the emergency department had significantly more alcohol-positive breath samples and more self-reported heavy alcohol use than participants who did not use the emergency department. Conclusions This study provided a rare intensive assessment of alcohol and emergency department use in homeless alcohol-dependent adults over an extended period. Emergency department use was high and was significantly related to indices of alcohol use.

Background The purpose of this study was to identify distinct classes of college students on the basis of recent and past drinking behaviors and evaluate how implicit and explicit measures of drinking identity predict membership in these classes. Methods US undergraduate students (N = 456) completed online implicit (Implicit Association Test) and explicit (self-report) measures of drinking identity and assessments of drinking behaviors, including past month drinking, at-risk drinking in the past year, and lifetime history of intoxication. Latent class analysis (LCA) was used to identify classes of college students based on their drinking behaviors. Results LCA identified five classes: (1) Lifetime Nondrinker, (2) Recent Nondrinker/Past Risk, (3) Light Drinker, (4) Moderate Drinker, and (5) Heavy Drinker. Overall, stronger implicit and explicit drinking identities were uniquely associated with greater odds of belonging to classes with greater alcohol consumption and related consequences relative to those classes characterized by lower alcohol consumption and consequences. Notably, explicit drinking identity was positively associated with odds of membership to the Recent Nondrinker/Past Risk class relative to the Lifetime Nondrinker and Light Drinker classes, and implicit and explicit drinking identities were positively associated with odds of membership to the Heavy Drinker class relative to all other classes. Conclusions Findings suggest that drinking identity is sensitive to risky drinking experiences in the past, is especially strong among the highest-risk group of college student drinkers, and may be an important cognitive factor to consider as a target for intervention.