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Background and aims: Alcohol consumption increased in the early phases of the COVID‐19 pandemic in the United States. Alcohol use disorder (AUD) and risky drinking are linked to harmful health effects. This paper aimed to project future health and cost impacts of shifts in alcohol consumption during the COVID‐19 pandemic. Design: An individual‐level simulation model of the long‐term drinking patterns for people with life‐time AUD was used to simulate 10 000 individuals and project model outcomes to the estimated 25.9 million current drinkers with life‐time AUD in the United States. The model considered three scenarios: (1) no change (counterfactual for comparison); (2) increased drinking levels persist for 1 year ('increase‐1') and (3) increased drinking levels persist for 5 years ('increase‐5'). Setting: United States. Participants: Current drinkers with life‐time AUD. Measurements: Life expectancy [life‐years (LYs)], quality‐adjusted life‐years (QALYs), alcohol‐related hospitalizations and associated hospitalization costs and alcohol‐related deaths, during a 5‐year period. Findings Short‐term increases in alcohol consumption (increase‐1 scenario) resulted in a loss of 79 000 [95% uncertainty interval (UI]) 26 000–201 000] LYs, a loss of 332 000 (104 000–604 000) QALYs and 295 000 (82 000–501 000) more alcohol‐related hospitalizations, costing an additional $5.4 billion ($1.5–9.3 billion) over 5 years. Hospitalizations for cirrhosis of the liver accounted for approximately $3.0 billion ($0.9–4.8 billion) in hospitalization costs, more than half the increase across all alcohol‐related conditions. Health and cost impacts were more pronounced for older age groups (51+), women and non‐Hispanic black individuals. Increasing the duration of pandemic‐driven increases in alcohol consumption in the increase‐5 scenario resulted in larger impacts. Conclusions: Simulations show that if the increase in alcohol consumption observed in the United States in the first year of the pandemic continues, alcohol‐related mortality, morbidity and associated costs will increase substantially over the next 5 years. [ABSTRACT FROM AUTHOR]

Substance use disorders (SUDs) have long been misinterpreted as character flaws rather than ailments. With the evolving body of medical research, a dichotomy has been formed between drunkenness and the disease we now know. Art has served a special role in the reflection of the human condition. It serves as both a third-party storyteller and an influencer of our perception of the world around us. For a modern analysis of SUD streaming technology was used to study film and the depiction of addiction through the last 70 years. This paper will explore the topic of film's ability to reliably report on this issue. Beautiful Boy is the most modern and the central film to the analysis. Research questions include: Can film accurately portray SUD? Specifically, the human suffering associated with addiction on the individual level and the family unit. Can it help people, who might not otherwise be exposed to its effects, understand the intricacies of addiction and reform? Now that we understand SUD to be a disease, art's role in portraying it to the public is crucial to recovery for all. [ABSTRACT FROM AUTHOR]

Alcoholism, more professionally termed alcohol use disorder (AUD), is a widespread and costly behavioral health condition. The aims of this paper are draw attention to systemic gaps in care for patients with AUD and advocate for patient safety leaders to partner with both the mainstream medical and substance abuse treatment communities to reduce harm in this patient population. The authors performed a narrative review of the literature on the current state of AUD treatment and patient safety, finding extensive evidence that patients with AUD usually go undiagnosed, unreferred and untreated. When they do receive AUD treatment, little evidence was found to indicate that a patient safety approach is incorporated into their care. Behavioral medicine is virgin territory for the patient safety movement. Medical care and behavioral medicine in the United States currently constitute two separate and unequal systems generally lacking in pathways of communication or care coordination for AUD patients. Significant barriers include institutional culture, individual and systemic bias against those with AUD, and health care infrastructure, especially the separation of medical and behavioral treatment. It is the authors' conclusion that care of patients with AUD is unsafe. We advocate for the patient safety approach common in American hospitals to be extended to AUD treatment. Experienced patient safety leaders are in the strongest position to initiate collaboration between the mainstream medical and substance abuse treatment communities to reduce harm for this patient population. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) is highly prevalent among adults in the US and is associated with substantial personal and societal costs. Yet only a small percentage of adults with AUD initiate treatment, including those with severe AUD symptoms who are most in need of treatment. In this paper we use latent profile analysis (LPA) to describe differences in symptoms of AUD severity and alcohol-related consequences among untreated adults with severe AUD symptoms who were recruited from the community. Identification of such differences will result in better understanding of this population and will improve methods of treatment outreach. The LPAs were conducted on the baseline data of 403 (50% male, 77% White, M age = 40.74 with severe AUD recruited from the community and enrolled in a trial of an intervention designed to encourage treatment initiation. Participants reported no prior AUD treatment history. The LPAs were based on indicators of AUD severity, alcohol-related negative consequences, and self-reported intention to initiate AUD treatment. The LPAs revealed 4 profiles. Profile membership was predicted by baseline participant sex and whether they were living with a partner and was associated with baseline past 30-days alcohol consumption. The findings characterize and describe the variability among adults in the community with untreated severe AUD on variables that tend to motivate such individuals to seek treatment, which could significantly advance treatment outreach efforts. [ABSTRACT FROM AUTHOR]

The present paper highlights how alcohol use disorder (AUD) conceptualizations and resulting diagnostic criteria have evolved over time in correspondence with interconnected sociopolitical influences in the United States. We highlight four illustrative examples of how DSM-defined alcoholism, abuse/dependence, and AUD have been influenced by sociopolitical factors. In doing so, we emphasize the importance of recognizing and understanding such sociopolitical factors in the application of AUD diagnoses. Last, we offer a roadmap to direct the process of future efforts toward the improved diagnosis of AUD, with an emphasis on pursuing falsifiability, acknowledging researchers' assumptions about human behavior, and collaborating across subfields. Such efforts that center the numerous mechanisms and functions of behavior, rather than signs or symptoms, have the potential to minimize sociopolitical influences in the development of diagnostic criteria and maximize the treatment utility of diagnoses. [ABSTRACT FROM AUTHOR]

This paper discusses methodological issues that emerged during the design and implementation of a large-scale survey of licensed social workers in the USA. Benefits and challenges of survey research are identified. The paper provides recommendations for future workforce studies and surveys that assess behavioral health problems. [ABSTRACT FROM AUTHOR]

Background Alcoholics Anonymous (AA) is a world-wide recovery mutual-help organization that continues to arouse controversy. In large part, concerns persist because of AA's ostensibly quasi-religious/spiritual orientation and emphasis. In 1990 the United States' Institute of Medicine called for more studies on AA's effectiveness and its mechanisms of behavior change (MOBC) stimulating a flurry of federally funded research. This paper reviews the religious/spiritual origins of AA and its program and contrasts its theory with findings from this latest research. Method Literature review, summary and synthesis of studies examining AA's MOBC. Results While AA's original main text ('the Big Book', 1939) purports that recovery is achieved through quasi-religious/spiritual means ('spiritual awakening'), findings from studies on MOBC suggest this may be true only for a minority of participants with high addiction severity. AA's beneficial effects seem to be carried predominantly by social, cognitive and affective mechanisms. These mechanisms are more aligned with the experiences reported by AA's own larger and more diverse membership as detailed in its later social, cognitive and behaviorally oriented publications (e.g. Living Sober, 1975) written when AA membership numbered more than a million men and women. Conclusions Alcoholics Anonymous appears to be an effective clinical and public health ally that aids addiction recovery through its ability to mobilize therapeutic mechanisms similar to those mobilized in formal treatment, but is able to do this for free over the long term in the communities in which people live. [ABSTRACT FROM AUTHOR]

Persons with alcohol use disorders (AUDs) and substance use disorders (SUDs) appear to be heavily affected by cigarette smoking. In order to address the consequences of smoking in this population, an understanding of the current state of knowledge is needed. Epidemiologic research provides the opportunity to obtain detailed information on smoking behaviors in large community samples. The aim of this paper was to synthesize the epidemiologic evidence on smoking among persons with AUDs/SUDs and suggest directions for future research. Literature searches of Medline and PubMed were used to identify articles and additional articles were elicited from publication reference lists. To be included in the review, papers had to be published in English, analyze epidemiologic data, and examine an aspect of smoking behavior in persons with AUDs/SUDs. Twenty-nine studies met inclusion criteria and were included in the review. In summary, epidemiologic evidence to date suggests greater lifetime and current smoking, nicotine dependence, and non-cigarette tobacco use; lower quitting; and differences in quit attempts and withdrawal symptoms for persons with AUDs/SUDs compared to other people. Most studies examined nationally representative data and were conducted on persons in the United States and Australia. Few publications examined outcomes by demographics (e.g., gender, age) but these studies suggested that specific patterns differ by demographic subgroups. More research is needed on persons with AUDs/SUDs in order to develop the most effective public health and clinical interventions to reduce smoking behaviors, improve cessation outcomes, and reduce the harmful consequences of smoking for those with AUDs/SUDs. [ABSTRACT FROM AUTHOR]

Background Alcohol-related blackouts are periods of amnesia that reflect the failure of the brain to record memories of what transpires while drinking. This paper examined the incidence, predictors, and behavioral correlates of blackouts among emerging adults and examined whether questions about blackouts could serve as better markers of risk for other alcohol related harms than questions about levels of consumption. Methods In 2012 to 2013, 1,463 (68%) of 2,140 respondents 1-year past high school reported having consumed alcohol. They were asked whether, in the past 6 months because of drinking, they forgot where they were or what they did. The survey also explored demographics, substance use behaviors, and other alcohol-related problems in the past 6 months. Chi-square and logistic regression analyses explored bivariate and multivariate predictors of blackouts and other alcohol-related problems. Results Twenty percent of respondents who ever drank alcohol reported a blackout in the past 6 months. Blackouts were more prevalent among females and those who, in the past 30 days, used multiple drugs, more frequently binged, were drunk, smoked, had lower body weight, and lived in college dorms. After controlling for drinking levels, having a blackout was the strongest independent predictor of most other alcohol problems examined, including in the past 6 months because of drinking, missing class or work, getting behind in work or school, doing something respondents later regretted, arguing with friends, experiencing an overdose, and total number of alcohol problems reported. It was also an independent predictor of hangovers, damaging property, getting hurt, and trouble with police. Conclusions Because blackouts indicate drinking at levels that result in significant cognitive and behavioral impairment, questions about blackouts could serve as important, simple screeners for the risk of experiencing other alcohol related harms. Additional work on this subject is warranted. [ABSTRACT FROM AUTHOR]

Purpose: The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.Method: NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.Result: The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.Conclusions: Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options. [ABSTRACT FROM AUTHOR]

PURPOSE: Patient-reported outcome measures (PROMs) that assess how patients feel and function have potential for evaluating quality of care. Stakeholder recommendations for PRO-based performance measures (PMs) were elicited, and feasibility testing was conducted at six cancer centers. METHODS: Interviews were conducted with 124 stakeholders to determine priority symptoms and risk adjustment variables for PRO-PMs and perceived acceptability. Stakeholders included patients and advocates, caregivers, clinicians, administrators, and thought leaders. Feasibility testing was conducted in six cancer centers. Patients completed PROMs at home 5-15 days into a chemotherapy cycle. Feasibility was operationalized as ≥ 75% completed PROMs and ≥ 75% patient acceptability. RESULTS: Stakeholder priority PRO-PMs for systemic therapy were GI symptoms (diarrhea, constipation, nausea, vomiting), depression/anxiety, pain, insomnia, fatigue, dyspnea, physical function, and neuropathy. Recommended risk adjusters included demographics, insurance type, cancer type, comorbidities, emetic risk, and difficulty paying bills. In feasibility testing, 653 patients enrolled (approximately 110 per site), and 607 (93%) completed PROMs, which indicated high feasibility for home collection. The majority of patients (470 of 607; 77%) completed PROMs without a reminder call, and 137 (23%) of 607 completed them after a reminder call. Most patients (72%) completed PROMs through web, 17% paper, or 2% interactive voice response (automated call that verbally asked patient questions). For acceptability, > 95% of patients found PROM items to be easy to understand and complete. CONCLUSION: Clinicians, patients, and other stakeholders agree that PMs that are based on how patients feel and function would be an important addition to quality measurement. This study also shows that PRO-PMs can be feasibly captured at home during systemic therapy and are acceptable to patients. PRO-PMs may add value to the portfolio of PMs as oncology transitions from fee-for-service payment models to performance-based care that emphasizes outcome measures. [ABSTRACT FROM AUTHOR]

Deaths of Despair (DoD), or mortality resulting from suicide, drug overdose, and alcohol-related liver disease, have been rising steadily in the United States over the last several decades. In 2020, a record 186,763 annual despair-related deaths were documented, contributing to the longest sustained decline in US life expectancy since 1915–1918. This forum feature considers how health humanities disciplines might fruitfully engage with this era-defining public health catastrophe and help society better understand and respond to the crisis. [ABSTRACT FROM AUTHOR]

This study aimed to examine differences in mental health and alcohol use outcomes across distinct patterns of work, home, and social life disruptions associated with the COVID-19 pandemic. Data from 2093 adult participants were collected from September 2020 to April 2021 as a part of a larger study examining the impacts of the COVID-19 pandemic on substance use. Participants provided data on COVID-19 pandemic experiences, mental health outcomes, media consumption, and alcohol use at baseline. Alcohol use difficulties, including problems related to the use, desire to use alcohol, failure to cut down on alcohol use, and family/friend concern with alcohol use, were measured at 60-day follow-up. Factor mixture modeling followed by group comparisons, multiple linear regressions, and multiple logistic regressions was conducted. A four-profile model was selected. Results indicated that profile membership predicted differences in mental health and alcohol use outcomes above and beyond demographics. Individuals experiencing the most disruption reported the strongest daily impact of COVID-19 and significantly high levels of depression, anxiety, loneliness, overwhelm, alcohol use at baseline, and alcohol use difficulties measured at 60-day follow-up. The findings highlight the need for integrated mental health and/or alcohol services and social services targeting work, home, and social life during public health emergencies in order to respond effectively and comprehensively to the needs of those requiring different types of support. [ABSTRACT FROM AUTHOR]

Policy PointsPublic health science regarding alcohol consumption and problems, alcohol's role in equity and social justice, and identification of effective policy interventions has grown steadily stronger in the past 30 years.Progress on effective alcohol policies has stalled or gone backward in the United States and much of the world.Because alcohol influences at least 14 of the 17 sustainable development goals, as well as more than 200 disease and injury conditions, reducing alcohol problems should offer a platform for collaboration across public health silos but will require that public health itself respect and follow its own science. [ABSTRACT FROM AUTHOR]

Introduction: Binge drinking, five or more drinks on an occasion for men and four or more for women, marks risky alcohol use. However, this dichotomous variable removes information about higher, more dangerous consumption. This paper examines predictors, consequences, and changes over a decade in drinking one to two times, two to three times, and three or more times standard gender-specific binge thresholds, labeled Levels I, II, and III.Methods: In 2001-2002 and 2012-2013, respectively, 42,748 and 36,083 U.S. respondents aged ≥18 years were interviewed in person in cross-sectional waves of the National Epidemiologic Survey on Alcohol and Related Conditions (response rates, 81% and 61%). Respondents were asked their past-year maximum drink consumption per day, categorized as Levels I, II, or III. Predictors and whether Levels II and III were associated with more negative consequences were analyzed in 2012-2013 data.Results: In 2001-2002, 23% of adults reported past-year binge drinking, with 15% peaking at Level I, 5% at Level II, and 3% at Level III. In 2012-2013, those percentages increased significantly to 33% binging, and 20%, 8%, and 5% binging at Levels I, II, and III, respectively. After adjusting for alcohol use disorder, the strongest predictor of Level I, II, and III binging, Level III versus I and non-binge drinkers had higher odds of past-year driving after drinking and, after drinking, experiencing physical fights, injuries, emergency department visits, arrests/detentions, and other legal problems.Conclusions: Level II and III-relative to Level I-binging is associated with more negative alcohol consequences and may be increasing nationally. Research needs to explore prevention and counseling interventions. [ABSTRACT FROM AUTHOR]

Excessive alcohol consumption is one of the most important lifestyle factors affecting the disease burden in the Western world. The results of treatment in daily practice are modest at best. The aim of the RESCueH programme is to develop and evaluate methods, which are as practice-near as possible, and therefore can be implemented quickly and easily in everyday clinical practice. It is the first clinical alcohol programme to be transatlantic in scope, with implementation in treatment centers located in Denmark, Germany and the US. The RESCueH programme comprises 5 randomized controlled trials, and the studies can be expected to result in (1) more patients starting treatment in specialized outpatient clinics, (2) a greater number of elderly patients being treated, (3) increased patient motivation for treatment and thus improved adherence, (4) more patients with stable positive outcomes after treatment and (5) fewer patients relapsing into harmful drinking. The aim of this paper is to discuss the rationale for the RESCueH programme, to present the studies and expected results. [ABSTRACT FROM AUTHOR]

Abstaining from substance use is a goal of many people with alcohol use disorder (AUD). Understanding patient perspectives of a period of abstinence may assist persons with AUD in achieving this goal. We accessed the electronic health records of adults with AUD entering an emergency department in Baltimore, Maryland, who received a brief peer support intervention for substance use. Data contained open-ended text entered by staff after a patient indicated ever having a sustained period of substance abstinence. Using qualitative template analysis methodology, we identified codes and themes from these open-ended responses from N = 153 adults with AUD. The sample was primarily male (n = 109, 71.2%) and White (n = 98, 64.1%) with an average age of 43.8 years (SD = 11.2). Themes identified included the abstinence length, abstinence reason, relapse, triggers, time of relapse, and treatment. The most common code for abstinence length was "between 1 and 5 years" (n = 55, 35.9%). Other abstinence length codes included "less than 1 year" and "more than 5 years." Relapse triggers included "family (non-death)," "death of a loved one," "social," "economic," and "treatment-related" reasons. Findings from this study could be used to inform strategies for peer support interventions to assist patients with substance abstinence. [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]

BackgroundGauging the feasibility of using Amazon Mechanical Turk ® (MTurk) for various types of substance use research is precluded by a lack of information pertaining to the recruitment process in published studies utilizing it and concurrent information on data quality. ObjectiveThe present report addressed this gap by documenting the prevalence of alcohol and nicotine use, self-reported major health conditions, and information on data quality and retention on MTurk. Individuals 21 to 90 years old (N = 1101, Mdn age = 30) with United States-based MTurk accounts completed a stand-alone screening survey. The screening consisted of basic demographic, substance use, and physical/mental health questions, as well as items to gauge language proficiency/attention (i.e., data quality). ResultsPoor quality data was infrequent (6.5% of participants) and associated with self-reported non-United States residence, affirmative responding (e.g., currently pregnant, using both alcohol and nicotine), and other response characteristics (e.g., not disclosing health conditions). Among those passing quality checks, alcohol and nicotine use were relatively common (71.5% and 24.8%). Major physical (6.3%) and mental health conditions (14.8%) were less common. Despite not sending direct invitations, most eligible participants returned to and completed the main study (81.7%). Conclusions/Importance: Alcohol and nicotine use were relatively common among MTurk workers and retention rates were high. Together with the low prevalence of poor quality data, MTurk appears to remain a fruitful platform for substance use research; although researchers must be diligent in using appropriate screening tools, as substance use was sometimes associated with poor data quality and MTurk account information may not be reliable. [ABSTRACT FROM AUTHOR]

Background: Despite its potential to produce serious adverse outcomes, DSM‐5 alcohol withdrawal syndrome (AWS) has not been widely studied in the general population. Methods: We used cross‐sectional data from 36,309 U.S. adults from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions‐III to examine the past‐year prevalence of AWS and its correlates. We focused on an important clinical population–past‐year drinkers with unhealthy alcohol use–i.e., those with a positive score on the Alcohol Use Disorders Identification Test–Consumption (AUDIT‐C) questionnaire. We also examined the association of AWS with sociodemographic measures, psychiatric disorders, alcohol‐related measures, and healthcare utilization. Results: Approximately one‐third (n = 12,634) of respondents reported unhealthy alcohol use (AUDIT‐C+). Of these, 14.3% met criteria for a DSM‐5 AWS diagnosis. The mean (SE) number of withdrawal symptoms among individuals with AWS was 2.83 (1.88), with the most common being nausea/vomiting and insomnia (19.8% and 11.6%, respectively). Among AUDIT‐C+ respondents, the odds of AWS were significantly higher among males (adjusted odds ratio [aOR] = 1.17 [95% CI, 1.02–1.33]), unmarried participants (aOR = 1.55 [95% CI, 1.25–1.92]), and those at the lowest (vs. highest) income levels (aOR = 1.62 [95% CI, 1.37–1.92]). Among AUDIT‐C+ respondents, AWS was also associated with psychiatric disorders (with aORs that ranged from 2.08 [95% CI, 1.79–2.41]) for major depressive disorder to 3.14 (95% CI, 1.79–2.41) for borderline personality disorder. AUDIT‐C+ respondents with AWS also had higher odds of past‐year alcohol use disorder (aOR = 11.2 [95% CI, 9.66–13.07]), other alcohol‐related features (e.g., binge drinking), and healthcare utilization. Conclusions: Among individuals with unhealthy alcohol use, AWS is prevalent, highly comorbid, and disabling. Given the risk of AWS among unhealthy drinkers, a comparatively large segment of the general population, clinicians should seek to identify individuals with AWS and intervene with them to prevent serious adverse outcomes. [ABSTRACT FROM AUTHOR]

Aim: To determine whether statistically distinct classes of smokers exist according to mental health (MH) diagnoses within primary care and to evaluate whether class membership is associated with healthcare utilization. Subject and methods: Data were obtained from the US Department of Veterans Affairs (VA) electronic medical record for encounters between January 1, 2014, and December 31, 2014, from the New York/New Jersey region. Data from a subset of 25,713 smokers from a larger sample of 111,333 primary care patients were used. An exploratory latent class analysis (LCA) was conducted to determine the presence of distinct groups of smokers based on observed MH diagnosis, while a confirmatory LCA assessed for reliability of those distinct groups. Using group as a predictor, we then utilized regression to determine whether group membership was associated with elevated numbers of primary care, integrated primary care, and specialty care encounters. Diagnosis was based on primary care encounter codes. Results: Three independent groups of current smokers were established: those with no MH diagnoses (77.8%), those with depressive diagnoses (16.7%), and those with alcohol/substance use diagnoses (5.5%). Most smokers were in the non-MH group, which utilized the least healthcare services (e.g., 2.7 primary care visits per year). The depressed group had 3.6 primary care visits per year and were most likely to use integrated primary care. The alcohol/substance-use group utilized primary and specialty services significantly more often than the other two groups, with an average of 5.5 primary care visits per year. Conclusion: Distinct classes of smokers can be identified in primary care settings. [ABSTRACT FROM AUTHOR]

Despite the centrality of dating relationships for teens, it is unclear whether the influence of romantic partners' alcohol use on adolescents' under-age drinking is distinct from the influence of peers and parents. To address this gap, this study used longitudinal data from a population-based sample of 825 adolescents (49% male, 51% female), ages 12 to 19. Adolescents completed a survey using laptops for privacy, and a parent completed a survey separately. Ordinary least squares and logistic regression models assessed alcohol use frequency and alcohol problems and included dating partners' drinking, adolescents' prior drinking, peers' drinking, parents' substance use, parental monitoring, and sociodemographic background characteristics. Alcohol use frequency and alcohol problems were influenced by dating partners' alcohol use and dating partners' influence was stronger on older adolescents and male adolescents. The study results are useful for public health messaging and prevention efforts by demonstrating the influence of parents, peers, and dating partners on teens' alcohol use. [ABSTRACT FROM AUTHOR]

This article is part of a Festschrift commemorating the 50th anniversary of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Established in 1970, first as part of the National Institute of Mental Health and later as an independent institute of the National Institutes of Health, NIAAA today is the world's largest funding agency for alcohol research. In addition to its own intramural research program, NIAAA supports the entire spectrum of innovative basic, translational, and clinical research to advance the diagnosis, prevention, and treatment of alcohol use disorder and alcohol-related problems. To celebrate the anniversary, NIAAA hosted a 2-day symposium, "Alcohol Across the Lifespan: 50 Years of Evidence-Based Diagnosis, Prevention, and Treatment Research," devoted to key topics within the field of alcohol research. This article is based on Dr. Schuckit's presentation at the event. NIAAA Director George F. Koob, Ph.D., serves as editor of the Festschrift. [ABSTRACT FROM AUTHOR]

Practitioners in federally-assisted substance use disorder (SUD) treatment programs are faced with increasingly complex decisions when addressing patient confidentiality issues. Recent policy changes, intended to make treatment more available and accessible, are having an impact on delivery of SUD treatment in the United States. The addition of electronic health records provides opportunity for more rapid and comprehensive communication between patients' primary and SUD care providers while promoting a collaborative care environment. This shift toward collaborative care is complicated by the special protections that SUD documentation receives in SUD treatment programs, which vary depending on what care is provided and the setting where the patient is treated. This article explores the special protections for substance abuse documentation, discrepancies in treatment documentation, ways to deal with these issues in clinical practice, and the need for more knowledge about how to harmonize treatment in the SUD and primary care systems. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Under the proposed DSM-5 revision to the criteria for alcohol use disorder (AUD), a substantial proportion of DSM-IV AUD cases will be lost or shifted in terms of severity, with some new cases added. Accordingly, the performance of the AUDIT-C in screening for DSM-IV AUD cannot be assumed to extend to DSM-5 AUD. The objective of this paper is to compare the AUDIT-C in screening for DSM-IV and DSM-5 AUD. Methods: Using a broad range of performance metrics, the AUDIT-C was tested and contrasted as a screener for DSM-IV AUD (any AUD, abuse and dependence) and DSM-5 AUD (any AUD, moderate AUD and severe AUD) in a representative sample of U.S. adults aged 21 and older and among past-year drinkers. Results: Optimal AUDIT-C cutpoints were identical for DSM-IV and DSM-5 AUD: ≥4 for any AUD, ≥3 or ≥4 for abuse/moderate AUD and ≥4 or ≥5 for dependence/severe AUD. Screening performance was slightly better for DSM-5 severe AUD than DSM-IV dependence but did not differ for other diagnoses. At optimal screening cutpoints, positive predictive values were slightly higher for DSM-5 overall AUD and moderate AUD than for their DSM-IV counterparts. Sensitivities were slightly higher for DSM-5 severe AUD than DSM-IV dependence. Optimal screening cutpoints shifted upwards for past-year drinkers but continued to be identical for DSM-IV and DSM-5 disorders. Conclusions: Clinicians should not face any major overhaul of their current screening procedures as a result of the DSM-5 revision and should benefit from fewer false positive screening results. [Copyright &y& Elsevier]

California's Mental Health Services Act (MHSA) substantially expanded funding of county mental health services through a state tax, and led to broad prevention efforts and intensive services for individuals experiencing serious mental disorders. We estimated the associations between MHSA and mortality due to suicide, homicide, and acute effects of alcohol. Using annual cause-specific mortality data for each US state and the District of Columbia from 1976–2015, we used a generalization of the quasi-experimental synthetic control method to predict California's mortality rate for each outcome in the absence of MHSA using a weighted combination of comparison states. We calculated the association between MHSA and each outcome as the absolute difference and percentage difference between California's observed and predicted average annual rates over the postintervention years (2007–2015). MHSA was associated with modest decreases in average annual rates of homicide (−0.81/100,000 persons, corresponding to a 13% reduction) and mortality from acute alcohol effects (−0.35/100,000 persons, corresponding to a 12% reduction). Placebo test inference suggested that the associations were unlikely to be due to chance. MHSA was not associated with suicide. Protective associations with mortality due to homicide and acute alcohol effects provide evidence for modest health benefits of MHSA at the population level. [ABSTRACT FROM AUTHOR]

Aims: To estimate US population health utilities for subgroups defined by alcohol use disorder (AUD) status and consumption level. Design Cross‐sectional survey. Setting: Community settings in the United States (i.e. excluding institutional settings). Participants: A total of 36,042 adults (age 18+) in non‐institutional settings in the United States. Measurements We used 12‐item Short Form Survey (SF‐12) data from the National Epidemiologic Survey on Alcohol and Related Conditions–III to calculate mean Short Form–6 dimension (SF‐6D) utility scores across World Health Organization alcohol consumption risk levels—very high risk, high risk, medium risk, low risk and an additional abstinent level—for three groups: (1) the general population (n = 36,042), (2) individuals with life‐time AUD (n = 9925) and (3) individuals with current AUD (n = 5083), and assessed minimally important differences (MIDs) between consumption levels. Each group is a subset of the previous group. Findings The general population's mean SF‐6D utility was higher than that of individuals with life‐time or current AUD across all consumption risk levels (0.79 versus 0.76 for both AUD groups). For all groups, SF‐6D utilities increased as consumption risk level decreased to non‐abstinent levels, and reducing consumption from very high risk to any lower level was associated with a statistically significant and meaningful improvement in utility. For individuals with life‐time or current AUD, becoming abstinent from high‐, medium‐ and low‐risk levels was associated with significantly and meaningfully worse utilities. Conclusions: Higher alcohol consumption risk levels appear to be associated with lower health index scores for the general population and individuals with a history of alcohol use disorder, meaning that higher alcohol consumption is associated with worse health‐related quality of life. [ABSTRACT FROM AUTHOR]

Background: The current study examined the extent to which within‐person variation in drinking motives differentiates moderate, binge, and high‐intensity drinking; and independent associations of motives and drinking intensity with alcohol use consequences in a sample of young adult drinkers from across the United States. Methods: Participants were past 30‐day drinkers in the U.S. nationally representative Monitoring the Future 12th grade sample in 2018, who also reported alcohol use during a 14‐day data collection burst 1 year later (N = 484 people, mean age 19.3 [SD 0.40], 43% female; N = 1042 drinking days) as part of the Young Adult Daily Life Study in 2019. Weighted multilevel modeling estimated within‐ and between‐person associations of drinking motives, drinking intensity (i.e., moderate [women 1–3, men 1–4 drinks], binge [women 4–7, men 5–9 drinks], and high‐intensity drinking [women 8+, men 10+ drinks]), and number of positive and negative alcohol consequences. Results: On days participants reported greater enhancement and social motives, they were more likely to engage in high‐intensity (vs. binge) drinking and binge (vs. moderate) drinking and experience more positive alcohol consequences. On days participants reported greater enhancement and coping motives, they experienced more negative alcohol consequences. Binge (vs. moderate) drinking on a given day was associated with more positive and negative alcohol consequences; high‐intensity (vs. binge) drinking on a given day was associated with more negative alcohol consequences that day. Moderation analyses indicated that social motives were associated with high‐intensity (vs. binge) drinking only among college students. Conclusions: Stronger drinking motives on a given day were associated with drinking intensity (enhancement and social motives) and negative consequences (enhancement and coping). High‐intensity (vs. binge or moderate) drinking was associated with more negative consequences but not more positive consequences. These results underscore that high‐intensity drinking and consequences vary across days and time‐varying, occasion‐specific risks such as current motivational context are appropriate targets for intervention. [ABSTRACT FROM AUTHOR]

Background: Past research identified that a desire for dissociative experiences, rather than dissociative tendencies, mediate the relationship between early sexual abuse and problem drinking in college students. Desire to dissociate was conceptualized as a mechanism facilitating substance-induced dissociation or the use of substances to achieve dissociative-like experiences and was measured using a modified version of the Dissociative Experiences Scale-II. The validity and cross-cultural generalizability of the modified scale are not yet known.Objectives: The current study examined the psychometric properties of the modified scale, exploring findings across U.S. and Filipino college samples, and explored how the desire to dissociate construct related to other variables linked to substance-induced dissociation. Methods: Participants were recruited across two U.S. samples and one Filipino sample (N = 2404; 72% female). Instead of asking "how often do you experience" dissociative items, 14-items from the original scale were selected and individuals were asked "how often would you like to experience" items.Results: Results supported the validity of the Desire to Dissociate Scale (DDS) with a bifactor model best fitting the data in U.S. and Filipino samples. The bifactor model identified that the DDS primarily measured a general 'desire to dissociate' factor and two specific factors comprised smaller portions of the variance. DDS scores were positively correlated with trauma-related and alcohol use variables including drinking to cope, variables conceptually consistent with theories of substance-induced dissociation.Conclusion: Clinical implications address avoidant coping patterns and differences in specific factor findings between U.S. and Filipino samples. [ABSTRACT FROM AUTHOR]

Background: Research that links parenting factors to adolescent drinking is fairly well developed, but few studies have examined the association between home alcohol availability and problematic drinking. The present study examines the net relationship between easy access to alcohol at home and several types of alcohol-related problems among US adolescents. Methods: A total of 3,964 US adolescents participating in the National Longitudinal Study of Adolescent Health (Add Health) reported on the accessibility of alcohol in their homes as well as whether they experienced various types of personal problems caused by alcohol use. Binary logistic regression analysis that included relevant controls was conducted to estimate the link between ease of access and alcohol-related problems. Results: Multivariate analysis revealed that easy home access to alcohol significantly predicted alcohol-related difficulties after adjusting for relevant control variables, and it did so across all problem areas. Discussion: Results suggest that the risk of problematic drinking is raised among adolescents if alcohol is readily accessible at home. Restricting access might be a simple strategy to reduce drinking-related problems among adolescents. [ABSTRACT FROM AUTHOR]

Over the past century, differences in alcohol use and related harms between males and females in the United States have diminished considerably. In general, males still consume more alcohol and experience and cause more alcohol-related injuries and deaths than females do, but the gaps are narrowing. Among adolescents and emerging adults, gaps in drinking have narrowed primarily because alcohol use among males has declined more than alcohol use among females. Among adults, alcohol use is increasing for women but not for men. Rates of alcohol-related emergency department visits, hospitalizations, and deaths all have increased among adults during the past two decades. Consistent with the changing patterns of alcohol use, increases in these outcomes have been larger for women. Recent studies also suggest that females are more susceptible than males to alcohol-induced liver inflammation, cardiovascular disease, memory blackouts, hangovers, and certain cancers. Prevention strategies that address the increases in alcohol consumption and unique health risks for women are needed. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption, alcohol‐related emergency department visits, and hospitalizations have all increased in the last 2 decades, particularly among women and people middle‐aged and older. The purpose of this study was to explore data from death certificates to assess whether parallel changes in alcohol‐related mortality occurred in the United States in recent years. Methods: U.S. mortality data from the National Center for Health Statistics were analyzed to estimate the annual number and rate of alcohol‐related deaths by age, sex, race, and ethnicity between 1999 and 2017 among people aged 16+. Mortality data contained details from all death certificates filed nationally. For each death, an underlying cause and up to 20 multiple or contributing causes were indicated. Deaths were identified as alcohol‐related if an alcohol‐induced cause was listed as either an underlying or multiple cause. Joinpoint analyses were performed to assess temporal trends. Results: The number of alcohol‐related deaths per year among people aged 16+ doubled from 35,914 to 72,558, and the rate increased 50.9% from 16.9 to 25.5 per 100,000. Nearly 1 million alcohol‐related deaths (944,880) were recorded between 1999 and 2017. In 2017, 2.6% of roughly 2.8 million deaths in the United States involved alcohol. Nearly half of alcohol‐related deaths resulted from liver disease (30.7%; 22,245) or overdoses on alcohol alone or with other drugs (17.9%; 12,954). Rates of alcohol‐related deaths were highest among males, people in age‐groups spanning 45 to 74 years, and among non‐Hispanic (NH) American Indians or Alaska Natives. Rates increased for all age‐groups except 16 to 20 and 75+ and for all racial and ethnic groups except for initial decreases among Hispanic males and NH Blacks followed by increases. The largest annual increase occurred among NH White females. Rates of acute alcohol‐related deaths increased more for people aged 55 to 64, but rates of chronic alcohol‐related deaths, which accounted for the majority of alcohol‐related deaths, increased more for younger adults aged 25 to 34. Conclusions: Death certificates suggest that alcohol‐related mortality increased in the United States between 1999 and 2017. Given previous reports that death certificates often fail to indicate the contribution of alcohol, the scope of alcohol‐related mortality in the United States is likely higher than suggested from death certificates alone. Findings confirm an increasing burden of alcohol on public health and support the need for improving surveillance of alcohol‐involved mortality. [ABSTRACT FROM AUTHOR]

Alcohol consumption is increasing in the United States, as is alcohol‐attributable mortality. Historically, men have had higher rates of alcohol consumption than women, though evidence for birth cohort effects on gender differences in alcohol consumption and alcohol‐related harm suggests that gender differences may be diminishing. We review studies using U.S. national data that examined time trends in alcohol consumption and alcohol‐related harm since 2008. Utilizing a historical–developmental perspective, here we synthesize and integrate the literature on birth cohort effects from varying developmental periods (i.e., adolescence, young adulthood, middle adulthood, and late adulthood), with a focus on gender differences in alcohol consumption. Findings suggest that recent trends in gender differences in alcohol outcomes are heterogeneous by developmental stage. Among adolescents and young adults, both males and females are rapidly decreasing alcohol consumption, binge and high‐intensity drinking, and alcohol‐related outcomes, with gender rates converging because males are decreasing consumption faster than females. This pattern does not hold among adults, however. In middle adulthood, consumption, binge drinking, and alcohol‐related harms are increasing, driven largely by increases among women in their 30s and 40s. The trend of increases in consumption that are faster for women than for men appears to continue into older adult years (60 and older) across several studies. We conclude by addressing remaining gaps in the literature and offering directions for future research. [ABSTRACT FROM AUTHOR]

Background: The USA ranks last in life expectancy among high-income countries. Since 2000, excess US mortality has been particularly concentrated in the working ages, which are also the ages hardest hit by the increase in drug deaths. This study measures the effect of drug-related mortality on the gap in life expectancy between the USA and other countries.Methods: Data from the Human Mortality Database and the World Health Organization were combined to construct age-standardized mortality rates for 2000-14 in 12 high-income countries and the USA for seven broad causes of death, including drug use. The contribution of each cause to the difference in life expectancy between the USA and the other 12 countries was estimated.Results: In 2014, the increase in drug-related deaths accounted for 10-15% of the US disadvantage in mortality, but with marked differences by age group. For working-age men, the increase in drug-related deaths accounted for up to 38% of the difference. Overall, American mortality is higher than the comparison countries across a wide range of causes.Conclusions: The severity of the drug epidemic appears to be specific to the USA, but it only partly contributes to the American shortfall in mortality. [ABSTRACT FROM AUTHOR]

Twenty-nine Americans die in alcohol-impaired driving crashes daily. The National Academies of Sciences, Engineering, and Medicine released a report that identified strategies to reduce alcohol-impaired driving deaths. One strategy suggests amending state laws to reduce the legal blood alcohol concentration (BAC) limit from 0.08 to 0.05. Although BAC 0.05 laws would likely reduce alcohol-related deaths, they are also controversial. Critics object to these laws because they restrict individual liberty and fail to consider that individuals value social drinking. We explored the ethical acceptability of BAC 0.05 laws. We made an ethical argument in support of BAC 0.05 laws, which include preventing harm to both drinking drivers and to others. We then considered and rejected liberty-based objections to BAC 0.05 laws. We concluded that BAC 0.05 laws are not only ethically defensible but desirable. States and Congress should work to promote them. [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.

Introduction: The objective of this research is to study transitions to and from at-risk alcohol use. Methods: Logistic regression analyses (done 2015-2016) assessed transitions to and from past-year at-risk drinking in a representative sample of U.S. adults surveyed twice (in 2001-2002 and 2004-2005). Results: Among 34,653 adults, 28% reported at-risk use at time 1. Of those, 73% had at-risk use at time 2. Of those without at-risk use at time 1, 15% reported at-risk use at time 2. Positive high-risk drinking transition predictors were, at time 1, being young, male, white, childless, in good to excellent health, ever smoking, using drugs, military membership (time 1 but not 2), and becoming divorced or separated by time 2. Positive low-risk drinking transition predictors were being elderly (age ≥ 65), female, non-white, never smoking or using drugs, no alcohol use disorder, alcohol treatment, and, after time 1, having children. Conclusions: Many adults transition to and from at-risk alcohol use; youth is the strongest positive predictor of transition to at-risk and not transitioning to low-risk drinking. Persons transitioning to legal drinking age are most likely to transition to high-risk and least likely to low-risk drinking. [ABSTRACT FROM AUTHOR]

The article presents alcohol and its role playing in decreasing in the life expectancy in the United States. Topics include article discussing on underestimating the effects of alcohol use causing death; quantifying alcohol mortality via epidemiological methods of estimating population-attributable fractions; and the potential interaction between alcohol use and socioeconomic status in causing premature mortality.

Background and Objectives: While alcohol use disorder is prevalent in U.S. veterans, little is known about the nature and determinants of predominant trajectories of alcohol consumption in this population. The objective of the current study was to identify predominant trajectories of alcohol consumption over a 4-year period, and baseline determinants of these trajectories in veterans.Methods: Data were analyzed from the National Health and Resilience in Veteran Study, which surveyed a nationally representative sample of 3,157 veterans (Wave 1). Assessments (Waves 2 and 3) were conducted every 2 years thereafter. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test-Consumption, a brief alcohol screen for identifying problematic drinking based on alcohol consumption. Wave 1 sociodemographic, military, health, and psychosocial variables were examined as possible determinants of trajectories of alcohol consumption.Results: Latent growth mixture modeling revealed that a four-class model best fit the data: rare drinkers (65.3%), moderate drinkers (30.2%), excessive drinkers (2.6%), and recovering drinkers (1.9%). Lifetime major depressive disorder (MDD) was linked to an excessive drinking trajectory, while fewer medical conditions and lower social support were linked to a moderate drinking trajectory. Having a secure attachment style and greater social support, and absence of lifetime MDD was linked to recovery from excessive drinking.Conclusions and Scientific Significance: Four predominant trajectories of alcohol consumption were identified. Targeting MDD and related interpersonal factors such as attachment style and social support in population-based prevention and treatment initiatives may help prevent, mitigate, and promote recovery from excessive alcohol consumption in veterans. (Am J Addict 2018;XX:1-8). [ABSTRACT FROM AUTHOR]

Rates of alcohol consumption continue to be a concern, particularly for individuals who are college age. Drinking patterns have changed over time, with the frequency of binge drinking (consuming four/five or more drinks for women/men) remaining high (30% to 40%). Young adults in the college age range are developmentally and socially at higher risk for drinking at binge levels. Changes in autonomy, parental control, norms, and attitudes affect binge drinking behaviors. This article reviews those changes, as well as the individual and environmental factors that increase or decrease the risk of participating in binge drinking behaviors. Risk factors include risky drinking events (e.g., 21st birthdays), other substance use, and drinking to cope, while protective factors include religious beliefs, low normative perceptions of drinking, and use of protective behavioral strategies. Additionally, this article discusses the physical, social, emotional, and cognitive consequences of consuming alcohol at binge levels. Alcohol policies and prevention and intervention techniques need to incorporate these factors to reduce experiences of alcohol-related problems. Targeting policy changes and prevention and intervention efforts toward young adults may increase effectiveness and prevent both short- and long-term consequences of binge drinking. [ABSTRACT FROM AUTHOR]

Binge drinking, commonly defined as consuming five or more standard drinks per occasion for men and four or more drinks for women, typically begins in adolescence. Adolescents, although they may drink less often, tend to consume higher quantities of alcohol per occasion compared with adults. This developmental difference in pattern of alcohol consumption may result, in part, from maturational changes that involve an adolescent-specific sensitivity to certain alcohol effects and greater propensity for risk-taking behaviors, such as binge drinking. Adolescent binge drinking is associated with a range of acute alcohol-related harms, some of which may persist into adulthood. The prevalence of binge drinking, including high-intensity drinking (i.e., 10 or more and 15 or more drinks per occasion), has declined among adolescents in recent years. Overall, however, the proportion of youth who engage in binge drinking remains high. This article reviews the definition and prevalence of binge drinking in adolescence, trajectories of binge drinking and their correlates, and implications for prevention. [ABSTRACT FROM AUTHOR]

Background: Alcohol use is a pervasive and costly public health problem in the United States. Relapse rates from alcohol use disorders are high. Although exercise has been proposed as a strategy to prevent relapse, lifestyle modification is the least studied aspect of relapse prevention programs, especially among racial/ethnic minority populations. Objective: The current study assessed whether being physically active was associated with remission from alcohol abuse or dependence among Black (African American and Afro Caribbean) adults in the U.S. Method: We utilized data on Black adult participants (n = 4,828) from the nationally representative National Survey of American Life (NSAL) conducted in 2001–2003. Logistic regression models were estimated to assess the odds of being in 12-month remission or currently meeting DSM-IV criteria for alcohol abuse or dependence based on level of physical activity, adjusting for socio-demographic and neighborhood characteristics. Results: People who endorsed being physically active had higher odds of being in 12-month remission from alcohol use problems (OR: 1.67, 95% CI: 1.28, 2.17) than people who were physically inactive, adjusting for individual- and neighborhood-level characteristics. People who were physically active did not differ significantly from those who were inactive with respect to odds of currently meeting DSM-IV criteria for alcohol abuse or dependence. Conclusions/Importance: Physical activity was positively associated with being in 12-month remission from alcohol use problems. Longitudinal studies are needed to establish temporal ordering and to explore exercise as a potential relapse prevention strategy for alcohol use problems. [ABSTRACT FROM AUTHOR]

Background and Aims To assess the burden of excessive alcohol use, researchers estimate alcohol-attributable fractions (AAFs) routinely. However, under-reporting in survey data can bias these estimates. We present an approach that adjusts for under-reporting in the estimation of AAFs, particularly within subgroups. This framework is a refinement of a previous method conducted by Rehm et al. Methods We use a measurement error model to derive the 'true' alcohol distribution from a 'reported' alcohol distribution. The 'true' distribution leverages per-capita sales data to identify the distribution average and then identifies the shape of the distribution with self-reported survey data. Data are from the National Alcohol Survey (NAS), the National Household Survey on Drug Abuse (NHSDA) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We compared our approach with previous approaches by estimating the AAF of female breast cancer cases. Results Compared with Rehm et al.'s approach, our refinement performs similarly under a gamma assumption. For example, among females aged 18-25 years, the two approaches produce estimates from NHSDA that are within a percentage point. However, relaxing the gamma assumption generally produces more conservative evidence. For example, among females aged 18-25 years, estimates from NHSDA based on the best-fitting distribution are only 19.33% of breast cancer cases, which is a much smaller proportion than the gamma-based estimates of approximately 28%. Conclusions A refinement of Rehm et al.'s approach to adjusting for underreporting in the estimation of alcohol-attributable fractions provides more flexibility. This flexibility can avoid biases associated with failing to account for the underlying differences in alcohol consumption patterns across different study populations. Comparisons of our refinement with Rehm et al.'s approach show that results are similar when a gamma distribution is assumed. However, results are appreciably lower when the best-fitting distribution is chosen versus gamma-based results. [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 Alcohol consumption patterns on the U.S.-Mexico border and their relationships with DSM-5 alcohol use disorders ( AUD) have been understudied. Yet, the effects of drinking by Mexican-origin individuals may differ between cities on versus off the border both in the United States and in Mexico. We characterize prior 12-month drinking patterns and examine their relationships with AUD, in border and off-border cities of Texas and adjacent Mexican states. Methods Data come from the U.S.-Mexico Study of Alcohol and Related Conditions involving 2,336 Mexican Americans in Texas and 2,460 Mexicans in bordering states of Nuevo Leon and Tamaulipas in Mexico. Drinking pattern was defined as an interaction between volume and maximum amount, or intensity (never vs. ever 5+/4+ [men/women], 8+, and 12+ drinks in a day). DSM-5 AUD was assessed using an adaptation of the Alcohol Section of the World Health Organization Composite International Diagnostic Interview core. Separately by gender, 5 logistic regressions models controlling for age were estimated predicting symptoms in 2 or more AUD criteria domains from volume, heavy pattern and, successively, effects of country, and (by country) residing on vs. off the border, or in each of 3 cities/country. Results A segmentation analysis for Texas males based on rate of experiencing AUD generated several distinct volume groups, each partitioned by an empirically selected maximum, and helped identify a drinking-pattern typology. In gender-stratified models of AUD rates using this typology, adjusting for age, significant volume and intensity effects were seen, more strongly in the United States. Border versus interior differences implied more AUD for given patterns at the border in the United States and the reverse in Mexico, with some city differences also evident. Conclusions Drinking-pattern analyses confirm that border proximity may affect drinking problems but in opposite directions in the United States and Mexico, possibly related to economic and psychological stresses specific to respective communities. [ABSTRACT FROM AUTHOR]

Background Posttraumatic stress disorder ( PTSD) and alcohol use disorder disproportionately impact certain populations including American Indians/Alaska Natives ( AIAN). While PTSD and alcohol use disorder have been studied both separately and in tandem, less is known about the association in AIAN. The objective was to examine the association between lifetime PTSD and past year alcohol use disorder among AIAN and non-Hispanic Whites ( NHW). Methods Data come from the 2012 to 2013 U.S. National Epidemiologic Survey on Alcohol and Related Conditions- III. We used logistic regression to estimate odds of AUD among adults with and without PTSD by race. Results A total of 19,705 participants, of whom 511 were AIAN and 19,194 were NHW, were included in this study. The percentage of PTSD among AIAN was 22.9% ( n = 117) compared to 11.7% ( n = 2,251) in NHW ( p-value <0.0001). The percentage of past year alcohol use disorder among AIAN was 20.2% ( n = 103) compared to 14.2% ( n = 2,725) in NHW ( p-value <0.0001). The percentage of comorbid past year alcohol use disorder with lifetime PTSD among AIAN was 6.5% ( n = 33) compared to 2.4% ( n = 457) in NHW ( p-value <0.0001). Regarding the joint distribution of PTSD and AUD, AIAN men have greater than 3 times the percentage compared to NHW men (9.5% vs. 3.1%). When stratifying by race (after adjusting for age, sex, depression, and education), among AIAN, the odds of past year alcohol use disorder with (vs. without) lifetime PTSD were 1.76 (95% CI 1.07, 2.90) and among NHW, the odds were 1.59 (95% CI 1.41, 1.80). Conclusions PTSD is significantly associated with alcohol use disorder in the study populations. Despite a lack of pre- PTSD measures of alcohol use disorder, these findings show a trend indicating that AIAN exposed to PTSD are more burdened with alcohol use disorder compared to NHW in the general U.S. population. [ABSTRACT FROM AUTHOR]

Background All stages of development of alcohol use disorder ( AUD) have not been equally studied. While initiation of drinking has been given considerable attention, other stages have not been as thoroughly investigated. It is not clear whether the same factors are associated consistently across early and late transitions in AUD involvement. High-risk family samples that are enriched for AUD vulnerability and transitions in AUD development offer an opportunity to examine influences across multiple stages of AUD development. Methods Data from adolescents and young adults from high-risk families were used to study 4 transitions in AUD development-time to first drink, first drink to first problem, first drink to first diagnosis, and first problem to first diagnosis. Cox modeling was used to compare associations of parental AUD, parental separation, peer substance use, offspring ever-use of cannabis, trauma exposures, and internalizing and externalizing psychopathology across transitions. Results Hazards of most transitions were elevated for those who had ever used cannabis, those who attributed substance use to their peers, those with externalizing disorders, and those with parents with AUD. Many risk factors were linked to early initiation of alcohol, particularly cannabis use. Internalizing disorders were associated with later stages. Nonassaultive trauma was associated only with early initiation; assaultive trauma was not associated with any transition. Conclusions In this large, ethnically diverse sample of high-risk youth, significant influences across transitions were fairly consistent, with externalizing disorders and cannabis ever-use elevating the likelihood of each stage, and peer and parental (and especially maternal AUD) influences linked to initiation and some later stages. Finally, in light of the increasingly permissive legal and social stances toward cannabis in the United States, the marked elevations of all alcohol outcomes observed for cannabis use underscore the importance of studying the underpinnings of this relationship. [ABSTRACT FROM AUTHOR]

Data from approximately 140 articles and reports published since 2000 on drinking, alcohol use disorder ( AUD), correlates of drinking and AUD, and treatment needs, access, and utilization were critically examined and summarized. Epidemiological evidence demonstrates alcohol-related disparities across U.S. racial/ethnic groups. American Indians/Alaska Natives generally drink more and are disproportionately affected by alcohol problems, having some of the highest rates for AUD. In contrast, Asian Americans are less affected. Differences across Whites, Blacks, and Hispanics are more nuanced. The diversity in drinking and problem rates that is observed across groups also exists within groups, particularly among Hispanics, Asian Americans, and American Indians/Alaska Natives. Research findings also suggest that acculturation to the United States and nativity affect drinking. Recent studies on ethnic drinking cultures uncover the possible influence that native countries' cultural norms around consumption still have on immigrants' alcohol use. The reasons for racial/ethnic disparities in drinking and AUD are complex and are associated with historically rooted patterns of racial discrimination and persistent socioeconomic disadvantage. This disadvantage is present at both individual and environmental levels. Finally, these data indicate that admission to alcohol treatment is also complex and is dependent on the presence and severity of alcohol problems but also on a variety of other factors. These include individuals' sociodemographic characteristics, the availability of appropriate services, factors that may trigger coercion into treatment by family, friends, employers, and the legal system, and the overall organization of the treatment system. More research is needed to understand facilitators and barriers to treatment to improve access to services and support. Additional directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Aims To evaluate the association between Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) alcohol screening scores, collected as part of routine clinical care, and three outcomes in the following year (Aim 1), and the association between changes in AUDIT-C risk group at 1-year follow-up and the same outcomes in the subsequent year (Aim 2). Design Cohort study. Setting Twenty-four US Veterans Affairs (VA) healthcare systems (2004-07), before systematic implementation of brief intervention. Participants A total of 486 115 out-patients with AUDIT-Cs documented in their electronic health records (EHRs) on two occasions ≥ 12 months apart ('baseline' and 'follow-up'). Measurements Independent measures were baseline AUDIT-C scores and change in standard AUDIT-C risk groups (no use, low-risk use and mild, moderate, severe misuse) from baseline to follow-up. Outcome measures were (1) high-density lipoprotein cholesterol (HDL), (2) alcohol-related gastrointestinal hospitalizations ('GI hospitalizations') and (3) physical trauma, each in the years after baseline and follow-up. Findings Baseline AUDIT-C scores had a positive association with outcomes in the following year. Across AUDIT-C scores 0-12, mean HDL ranged from 41.4 [95% confidence interval (CI) = 41.3-41.5] to 53.5 (95% CI = 51.4-55.6) mg/l, and probabilities of GI hospitalizations from 0.49% (95% CI = 0.48-0.51%) to 1.8% (95% CI = 1.3-2.3%) and trauma from 3.0% (95% CI = 2.95-3.06%) to 6.0% (95% CI = 5.2-6.8%). At follow-up, patients who increased to moderate or severe alcohol misuse had consistently higher mean HDL and probabilities of subsequent GI hospitalizations or trauma compared with those who did not ( P-values all < 0.05). For example, among those with baseline low-risk use, in those with persistent low-risk use versus severe misuse at follow-up, the probabilities of subsequent trauma were 2.65% (95% CI = 2.54-2.75%) versus 5.15% (95% CI = 3.86-6.45%), respectively. However, for patients who decreased to lower AUDIT-C risk groups at follow-up, findings were inconsistent across outcomes, with only mean HDL decreasing in most groups that decreased use ( P-values all < 0.05). Conclusions When AUDIT-C screening is conducted in clinical settings, baseline AUDIT-C scores and score increases to moderate-severe alcohol misuse at follow-up screening appear to have predictive validity for HDL cholesterol, alcohol-related gastrointestinal hospitalizations and physical trauma. Decreasing AUDIT-C scores collected in clinical settings appear to have predictive validity for only HDL. [ABSTRACT FROM AUTHOR]