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Purpose The association of bulimic symptoms with sensation seeking is uncertain; however, both behaviors have been linked to alcohol problems. We assessed in a longitudinal, community-based setting whether sensation seeking in adolescence is associated with bulimic symptoms in early adulthood, also accounting for alcohol problems. Methods Finnish men (N = 2000) and women (N = 2467) born between 1974–1979 completed Zuckerman’s sensation seeking scale (SSS) at age 18. Alcohol problems (Malmö-modified Michigan alcoholism screening test (Mm-MAST) and bulimic symptoms [eating disorder inventory-2, bulimia subscale (EDI-Bulimia), population and clinical scoring systems] were defined at age 22–27. We examined relationships between SSS, Mm-MAST, and EDI-Bulimia using Pearson’s correlation coefficient (r) and linear regression. Results Alcohol problems were moderately correlated with sensation seeking and bulimic symptoms (population scoring) among women and men (r = 0.21–0.31). The correlation between sensation seeking and bulimic symptoms (population scoring) was weak among men (r = 0.06, p = 0.006) and even weaker and non-significant among women (r = 0.03, p = 0.214). Adjustment for alcohol problems removed the association between sensation seeking and bulimic symptoms among men. Furthermore, there were no significant correlations between sensation seeking and bulimic symptoms when assessing EDI-Bulimia clinical scoring. Conclusion Sensation seeking and bulimic symptoms were not associated among women. The association between sensation seeking and bulimic symptoms among men was entirely attributable to increased alcohol problems among those with higher sensation seeking. While this association may be important on the population level, its clinical significance may be minor. Level of evidence Level III, well-designed cohort study.

Alcohol dependence (AD) is characterized by compulsive alcohol consumption, which involves behavioral impairments such as aggression. Members of fibroblast growth factor (FGF) 19 superfamily, including FGF19, FGF21, and FGF23, are major endocrine mediators that play an important role in alcohol metabolism and alcohol related disorders. The objective of the present study is to explore the possible associations among the interaction of single nucleotide polymorphisms (SNPs) of the FGF 19 superfamily, AD occurrence, and aggression in patients with AD. A total of 956 subjects were enrolled in this study, including 482 AD patients and 474 healthy controls (HCs). Michigan alcoholism screening test (MAST) was used to measure the level of AD, a Chinese version of the Buss–Perry Aggression Questionnaire was used to evaluate the aggressive behavior of subjects, and MassARRAY@ system was used to genotype rs948992 of FGF19, rs11665841 and rs11665896 of FGF21, rs7955866 and rs11063118 of FGF23. The results showed that AD patients presented a significantly higher level of aggression compared to HCs, and MAST scores were significantly positively associated Buss–Perry aggression scores (r = 0.402, p < 0.001) in AD patients. The interaction of FGF19 rs948992 TC × FGF21 rs11665896 GG presented the high-risk genotype combination predicting the high level of AD. In addition, the interaction of FGF19 rs948992 TC × FGF21 rs11665896 TG × FGF23 rs11063118 TT presented the high-risk genotype combination predicting the high level of aggression in AD patients. Our results added evidence linking the combination of rs948992 TC × rs11665896 TG × rs11063118 TT to aggressive behavior in AD patients and pointed out the potential usefulness of the SNPs of FGF19 superfamily as a predictor for the aggression in AD patients.

The goal of this study was to determine whether the plasma leptin, nesfatin-1, cortisol, brain-derived neurotrophic factor (BDNF), and inflammatory cytokines could be used as potential biomarkers for the degree of craving in the alcohol-dependent patients after 1 month of abstinence. A total of 83 patients with alcohol use disorder (AUD) and 61 healthy subjects were assessed. Patients with AUD were selected from Department of Material Dependence, Anhui Mental Health Center, and subjects in the control group were selected from healthy volunteers. The Alcohol Urge questionnaire Scale (AUQ) was used to evaluate the extent of craving for alcohol, and the Michigan Alcoholism Screening Test (MAST), the Fagerstrom Test for Nicotine Dependence (FTND), the Self-Rating Anxiety Scale (SAS), and the Self-Rating Depression Scale (SDS) were also assessed in patients with AUD. Enzyme-Linked Immunosorbent Assay (ELISA) was used for the measurement of plasma leptin, nesfatin-1, cortisol, BDNF, Interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) levels. Compare with healthy controls, the average leptin, leptin/BMI, IL-6, CRP, and TNF-α levels in patients with AUD were significantly increased, while the BDNF levels were significantly decreased. Moreover, the partial correlational analysis showed that the AUQ scores of the alcohol-dependent patients were positively correlated with the plasma leptin levels (r = 0.613, P < 0.001), rather than nesfatin-1 (r = 0.066, P = 0.569) after controlling for age as covariate. Furthermore, plasma nesfatin-1 levels were found to be correlated with the SDS scores (r = 0.366, P = 0.001) in the AUD group. In addition, plasma leptin levels were positively associated with the plasma IL-6 (r = 0.257, P = 0.033), CRP (r = 0.305, P = 0.011), and TNF-α (r = 0.311, P = 0.009) levels, and negatively associated with the BDNF levels (r = −0.245, P = 0.042) in patients with AUD. These results suggest that plasma leptin, but not nesfatin-1, might be a potential biomarker for the degree of craving in alcohol-dependent patients after 1 month of abstinence, the mechanism of which might be related to the dysfunction of the inflammatory cytokines and BDNF levels.

Alcohol-related behaviors are moderately heritable and have ethnic-specific characteristics. At present, genetic studies for alcohol dependence (AD) in Chinese populations are underrepresented. We are the first to conduct a genome-wide association study (GWAS) for AD using 533 male alcoholics and 2848 controls of Han Chinese ethnicity and replicate our findings in 146 male alcoholics and 200 male controls. We then assessed genetic effects on AD characteristics (drinking volume/age onset/Michigan Alcoholism Screening Test (MAST)/Barratt Impulsiveness Scale (BIS-11)), and compared the polygenic risk of AD in Han Chinese with other populations (Thai, European American and African American). We found and validated two significant loci, one located in 4q23, with lead SNP rs2075633*ADH1B (Pdiscovery = 6.64 × 10−16) and functional SNP rs1229984*ADH1B (Pdiscovery = 3.93 × 10−13); and the other located in 12q24.12-12q24.13, with lead SNP rs11066001*BRAP (Pdiscovery = 1.63 × 10−9) and functional SNP rs671*ALDH2 (Pdiscovery = 3.44 × 10−9). ADH1B rs1229984 was associated with MAST, BIS_total score and average drinking volume. Polygenic risk scores from the Thai AD and European American AD GWAS were significantly associated with AD in Han Chinese, which were entirely due to the top two loci, however there was no significant prediction from African Americans. This is the first case-control AD GWAS in Han Chinese. Our findings demonstrate that these variants, which were highly linked with ALDH2 rs671 and ADH1B rs1229984, were significant modulators for AD in our Han Chinese cohort. A larger replication cohort is still needed to validate our findings.

Background: DOVE (Determining Effects of Platelet Inhibition on Vaso-Occlusive Events) was a Phase 3, randomized, double-blind, placebo-controlled study conducted in children with sickle cell anemia at 51 sites in 13 countries across four continents. Procedure: Data from DOVE were assessed for regional differences in subject phenotype and treatment. Demographics, baseline clinical and laboratory data, hydroxyurea (HU) use, vaso-occlusive crisis (VOCs, composite endpoint of painful crisis or acute chest syndrome (ACS, Beijing, China)), serious adverse events (SAEs, Florence, Italy), hospitalization, and treatments were compared across the Americas, Europe, North Africa/Middle East, and Sub-Saharan Africa (SSA). Results: Race, body mass index, and blood pressures differed by region. Pre-enrollment VOCs were highest in the Americas. For subjects not on HU, baseline hemoglobin was lowest in SSA, reticulocyte count was lowest in the Americas. Within SSA, Kenya subjects presented higher baseline hemolysis. Painful crisis was the most common SAE, followed by ACS in the Americas and infections in other regions. VOC rate and percentage of VOC hospitalizations were highest in Europe. Regardless of region, most VOCs were treated with analgesics, approximately half were treated with intravenous fluids. The proportion of VOC-related transfusions was greatest in Europe. Lengths of hospital stay were similar across regions. Conclusions: Overall differences in SAEs and hospitalization for VOCs may be due to cultural diversities, resource utilization, disease severity, or a combination of factors. These data are of importance for the planning of future trials in SCA in a multinational setting.

Objective: verify the prevalence of abuse and probable alcohol dependence in the elderly; describe sociodemographic and clinical characteristics of the elderly; and verify the factors associated with alcohol abuse and probable dependence in the elderly. Method: cross-sectional study, observational, domiciliary survey type, conducted with 614 elderly people living in the urban area of the city of Uberaba, Brazil. The Mini Mental State Examination, sociodemographic instrument, Older Americans Resources and Services Questionnaire, Geriatric Depression Scale and Michigan Alcoholism Screening Test - Geriatric Version were used. Statistical analysis was performed in the Statiscal Package for Social Sciences. Results: the prevalence of abuse and probable alcohol dependence was 26.5%. Among the elderly with abuse and probable dependence on alcohol, there was predominance of males, 60 |- 70 years old, who lived with a spouse or partner, had 1 |- 5 years of schooling, individual monthly income from 1 -| 3 minimum wages, five or more morbidities and no indication of depressive symptoms. Abuse and probable alcohol dependence were associated with males and the presence of depressive symptoms. Conclusion: the study reinforces the need to identify early abuse and probable alcohol dependence in the elderly and to invest in health action strategies for the purpose of health promotion, disease prevention and rehabilitation of the elderly. RESUMEN Objetivo: comprobar la prevalencia del exceso y probable dependencia de alcohol en ancianos; describir las características sociodemográficas y clínicas de los ancianos, y verificar los factores asociados al exceso y probable dependencia de alcohol en ancianos. Método: estudio transversal, observacional, tipo encuesta domiciliaria, realizado con 614 ancianos residentes en la zona urbana del municipio de Uberaba, Brasil. Se utilizaron el Mini Examen de Estado Mental, el instrumento sociodemográfico, la encuesta Older Americans Resources and Services, la Escala Abreviada de Depresión Geriátrica y el Michigan Alcoholism Screening Test - Geriatric Version. El análisis estadístico se llevó a cabo en el Statiscal Package for Social Sciences. Resultados: la prevalencia del exceso y probable dependencia del alcohol fue de 26,5%. Entre los ancianos con exceso y probable dependencia de alcohol se pudo comprobar un predominio del sexo masculino, entre 60 |- 70 años, vivían con su esposo(a) o compañero(a), tenían de 1 |- 5 años de estudios, ingreso mensual individual de 1 -| 3 salarios mínimos, cinco o más morbilidades y ausencia de síntomas indicadores depresivos. El exceso y probable dependencia de alcohol se asoció al sexo masculino y a la presencia de síntomas indicadores de depresión. Conclusión: el estudio refuerza la necesidad de identificar precozmente el exceso y probable dependencia de alcohol en ancianos, e invertir en estrategias de acciones de salud con la finalidad de promover salud, prevenir enfermedades y rehabilitar al anciano. RESUMO Objetivo: verificar a prevalência do abuso e provável dependência do álcool em idosos; descrever as características sociodemográficas e clínicas e dos idosos; e verificar os fatores associados ao abuso e provável dependência do álcool em idosos. Método: estudo transversal, observacional, tipo inquérito domiciliar, realizado com 614 idosos residentes na zona urbana do município de Uberaba, Brasil. Foram utilizados o Mini Exame de Estado Mental, instrumento sociodemográfico, Questionário Older Americans Resources and Services, Escala de Depressão Geriátrica Abreviada e Michigan Alcoholism Screening Test - Geriatric Version. Realizou-se análise estatística no Statiscal Package for Social Sciences. Resultados: a prevalência do abuso e provável dependência do álcool foi de 26,5%. Entre os idosos com abuso e provável dependência do álcool, verificou-se predomínio do sexo masculino, 60 |- 70 anos, moravam com esposo(a) ou companheiro(a), tinham 1 |- 5 anos de escolaridade, renda mensal individual de 1 -| 3 salários mínimos, cinco ou mais morbidades e ausência de indicativo de sintomas depressivos. O abuso e provável dependência do álcool foram associados ao sexo masculino e a presença de indicativo de sintomas depressivos. Conclusão: o estudo reforça a necessidade de identificar precocemente o abuso e provável dependência do álcool em idosos e investir em estratégias de ações de saúde com a finalidade de promoção a saúde, a prevenção de doença e reabilitação do idoso.

Residential schools were the institutions, in operation from the 19th century to the late 20th century, which Indigenous children in Canada were forced to attend. The literature shows that many young people who attended these institutions were victims of neglect and abuse. Negative psychological effects resulting from child abuse have been amply documented. However, very few studies on this subject have been carried out among Canada's Indigenous Peoples. The objective of this study is to evaluate, for an Indigenous population in Quebec (Canada), the impact of residential schooling as well as self-reported experiences of sexual and physical abuse during childhood on the development of alcohol and drug use problems in adulthood. A total of 358 Indigenous participants were interviewed (164 men [45.8%] and 194 women [54.2%]). Alcoholism was evaluated using the Michigan Alcoholism Screening Test (MAST). Drug abuse was assessed with the Drug Abuse Screening Test-20 (DAST). Child abuse and residential schooling were assessed with dichotomous questions (yes/no). Among the participants, 28.5% (n=102) had attended residential schools, 35.2% (n=121) reported having experienced sexual abuse, and 34.1% (n=117) reported having experienced physical abuse before adulthood. Results of the exact logistic regression analyses indicated that residential school attendance was linked to alcohol problems, while child abuse was related to drug use problems. The results of this study highlight the importance of considering the consequences of historical traumas related to residential schools to better understand the current situation of Indigenous Peoples in Canada.

BACKGROUND Chronic non-communicable diseases (CNCDs) are the leading cause of mortality in the world. Identification of risk factors and the implementation of preventive measures can effectively reduce the chance of disease and death due to CNCDs. OBJECTIVES The aim of this study was to analyze selected risk factors of CNCDs in women and men hospitalized in surgical wards. MATERIAL AND METHODS The study group included 420 patients aged 18-84 years who were hospitalized in surgical wards. All participants were interviewed prior to anthropometric measurements, blood pressure, and fasting blood tests. A statistical analysis of the material was performed with the use of Student's t-test, χ2 test, Fisher's exact test, Mann-Whitney U test, and analysis of variance (ANOVA). RESULTS The analysis of the study material showed abdominal obesity in 63% of patients, more likely in women (p < 0.001); increased total cholesterol values in 30% of patients, more frequently in women (p = 0.025); blood pressure values ≥140/90 mm Hg in 28% of patients, more frequently in men (p < 0.001); alcohol abuse (≥5 points in the Michigan Alcoholism Screening Test, MAST) in 12.6% of patients, more frequently in men (p < 0.001). CONCLUSIONS Both women and men are at risk of developing CNCDs; however, women should pay more attention to psychological counseling and the prevention of obesity and hypercholesterolemia, while men should be educated on how to prevent hypertension and alcohol abuse.

Background To describe the prevalence of alcohol dependence and to explore the relationship between alcohol dependence and newly detected hypertension in China. Methods A multistage stratified cluster sampling method was used to obtain samples from February to June 2013. The Michigan Alcoholism Screening Test was used to estimate alcohol dependence level. A standard questionnaire measured other independent variables. Enumeration data were analyzed using chi-square; quantitative data were analyzed using t-tests. Spearman correlation analysis and multivariate logistic regression analysis were performed to identify the relationship between alcohol dependence and hypertension. Results The alcohol dependence rate was 11.56%; 22.02% of males (3854/17501) and 1.74% of females (324/18656) were classified as alcohol dependent. The newly detected hypertension rate was 9.46% (3422/36157). Significant associations were found between alcohol dependence levels and blood pressure (P

Comorbidity of alcohol use disorder and major depressive disorder has been reported in samples. The aim of this study was to examine the relationship between alcoholism and depression in undiagnosed patients by simultaneously applying screening tests for both disorders. A total of 421 subjects were included in the study, of which 246 were female. Two screening tests, the Michigan Alcoholism Screening Test and the Beck Depression Inventory, were used. In the total sample, 28.03% of the respondents engaged in some type of harmful alcohol use and 55.82% experienced some level of depression; 24.70% of the respondents had both at the same time, some type of harmful alcohol use and some level of depression. Results of statistical analysis showed that a more problematic alcohol use type was associated with a more severe level of depression, with a greater positive association between problematic alcohol use and severity of depressive symptoms among females and more harmful alcohol consumption among males. This study points to the importance of screening for alcoholism and depression, because their timely detection and treatment improves the quality of life in newly diagnosed individuals and reduces the economic burden on society for health services due to greater use if a greater severity of dual disorder is reached.

Objectives: To investigate the abusive consumption of alcohol in the elderly in the municipality of Santa Cruz - PB. METHODS: This is a cross-sectional, descriptive study, with quantitative approach with a sample of 170 elderly. To perform the study, three instruments were used: the Mini Mental State Examination (MMSE), a sociodemographic questionnaire and the Michigan Alcoholism Screening Test - Geriatric Version (MAST-G). The data were analyzed in the program Statistical Package for Social Sciences (SPSS - version 21). Results: 14.7% of the elderly were classified by the MAST-G score as elderly individuals presenting problems related to alcohol abuse, the majority of whom were male, single, with education above 05 years, who reside alone, and present some pathology and make use of medications. Conclusion: the research points out the need for multiprofessional work in health in Primary Care, in order to develop health actions that include the prevention of alcohol consumption and minimize the deleterious effects of consumption, in order to reduce the number of undesirable events arising from the use of that substance. Keywords: Primary health care; Alcohol; Old man.

Objective: To evaluate the internal consistency of the version of the Michigan Alcoholism Screening Test – Geriatric Version (MAST-G) instrument, translated and adapted for Brazil. Method: This was a descriptive, cross-sectional study. Data were collected through a demographic questionnaire, the ICD-10 and the MAST-G, following the steps of translation and cultural adaptation. One hundred eleven elderly in the city of São Carlos, SP, Brazil were interviewed. Results: The mean age of those interviewed was 70 years, with 45% men and 55% women, with the mean education of three years; 92% resided with family; 48% of the subjects consumed alcoholic beverages. The MAST-G presented a good level of reliability, with Cronbach’s α = 0.7873, and good levels of sensitivity and specificity with a cutoff score of five positive responses. Conclusion: The Brazilian version of the MAST-G presented internal consistency values similar to the original English version,showing it to be adequate for use in the national context. Objetivo: Evaluar la consistencia interna de la versión traducida y adaptada para Brasil del instrumento Michigan Alcoholism Screening Test – Geriatric Version (MAST-G) ─ Prueba de detección del alcoholismo de Michigan – Versión Geriátrica. Método: Estudio descriptivo de corte transversal. Los datos fueron recogidos mediante un cuestionario con informaciones sociodemográficas, CIE-10 y MAST-G, siguiendo las etapas de traducción y adaptación transcultural. Fueron entrevistados a 111 ancianos de la ciudad de São Carlos, SP, Brasil. Resultados: El promedio de edad de los entrevistados fue de 70 años, siendo el 45% varones y el 55% mujeres, con escolaridad media de tres años; el 92% vivían con la familia; el 48% de los sujetos consumían bebidas alcohólicas. El MAST-G presentó buen índice de fiabilidad, con Alfa de Cronbach α = 0,7873 y buenos índices de especificidad y sensibilidad, con nota de corte de cinco respuestas positivas. Conclusión: La versión brasileña del MAST-G ha presentado valores de consistencia interna similares a los de la versión original en inglés, mostrándose adecuada para su empleo en el marco nacional. Objetivo:Avaliar a consistência interna da versão traduzida e adaptada para o Brasil do instrumento Michigan Alcoholism Screening Test – Geriatric Version (MAST-G). Método: Estudo descritivo de corte transversal. Os dados foram coletados por meio de um questionário com informações sociodemográficas, o CID-10 e o MAST-G, seguindo as etapas de tradução e adaptação transcultural. Foram entrevistados 111 idosos do município de São Carlos, SP, Brasil. Resultados: A média de idade dos entrevistados foi de 70 anos, sendo 45% homens e 55% mulheres, com escolaridade média de três anos; 92% residiam com a família; 48% dos sujeitos consumiam bebida alcoólica. O MAST-G apresentou bom índice de confiabilidade, com Alfa de Cronbach α = 0,7873, e bons índices de especificidade e sensibilidade, com nota de corte de cinco respostas positivas. Conclusão: A versão brasileira do MAST-G apresentou valores de consistência interna semelhantes aos da versão original em inglês, mostrando-se adequada para uso no contexto nacional.

Objective: Certain skin diseases have been associated with increased alcohol consumption. Our aim was to investigate whether alcohol use and addiction have any effect on dermatologic diseases and relationship between alcohol consumption and cutaneous disease. Method: A total of 100 patients with psychiatric comorbidity and diagnosed with psychodermatologic disease (psoriasis, acne, chronic uticaria, psychogenic pruritus, alopecia areata), 60 patients with chronic dermatosis and 74 healthy subjects were enrolled to this study. They were given a questionnaire including sociodemographic characteristics, the history of the disease, the questions aimed to examine relationship between alcohol use and cutaneous disease, and Michigan Alcoholism Screening Test (MAST). All data were assessed statistically. Results: The ratio of alcohol consumption in our study population was 14,9%. The prevalence percentages of alcohol usage in the group of psychodermatologic diseases, in the group of chronic diseases and normal population were 18%, 8,3% and 16,2% respectively. This difference between the groups was not significant statistically (p=0.236). In terms of MAST score, the difference between the groups was not significant statistically (p=0.075). However, the relationship between alcohol and skin disease could not been evaluated because of the rate of alcohol use was low. Conclusion: Patients with dermatologic diseases associated with psychosocial morbidity did not consume more alcohol than patients with other chronic diseases and normal population. However, because of different sociocultural effects, there is a need of broad-scale and multicenter studies for more determinative results.

Detecting patterns of maternal drinking that place fetuses at risk for fetal alcohol spectrum disorders (FASDs) is critical to diagnosis, treatment, and prevention but is challenging because information on antenatal drinking collected during pregnancy is often insufficient or lacking. Although retrospective assessments have been considered less favored by many researchers due to presumed poor reliability, this perception may be inaccurate because of reduced maternal denial and/or distortion. The present study hypothesized that fetal alcohol exposure, as assessed retrospectively during child adolescence, would be related significantly to prior measures of maternal drinking and would predict alcohol-related behavioral problems in teens better than antenatal measures of maternal alcohol consumption. Drinking was assessed during pregnancy, and retrospectively about the same pregnancy, at a 14-year follow-up in 288 African-American women using well-validated semistructured interviews. Regression analysis examined the predictive validity of both drinking assessments on pregnancy outcomes and on teacher-reported teen behavior outcomes. Retrospective maternal self-reported drinking assessed 14 years postpartum was significantly higher than antenatal reports of consumption. Retrospective report identified 10.8 times more women as risk drinkers (≥ one drink per day) than the antenatal report. Antenatal and retrospective reports were moderately correlated and both were correlated with the Michigan Alcoholism Screening Test. Self-reported alcohol consumption during pregnancy based on retrospective report identified significantly more teens exposed prenatally to at-risk alcohol levels than antenatal, in-pregnancy reports. Retrospective report predicted more teen behavior problems (e.g., attention problems and externalizing behaviors) than the antenatal report. Antenatal report predicted younger gestational age at birth and retrospective report predicted smaller birth size; neither predicted teen IQ. These results suggest that if only antenatal, in-pregnancy maternal report is used, then a substantial proportion of children exposed prenatally to risk levels of alcohol might be misclassified. The validity of retrospective assessment of prior drinking during pregnancy as a more effective indicator of prenatal exposure was established by predicting more behavioral problems in teens than antenatal report. Retrospective report can provide valid information about drinking during a prior pregnancy and may facilitate diagnosis and subsequent interventions by educators, social service personnel, and health-care providers, thereby reducing the life-long impact of FASDs.

Factors related with relapse in male alcohol dependents: 12 months follow-up study Objective: Aim of this study was to evaluate clinical variables related with relapse to alcohol abuse during 12 months follow-up after inpatient treatment in male alcohol dependents. Method: Participants were 156 consecutively admitted male alcohol dependents. Among these patients, 102 were available at the evaluation that took place one year after the inpatient treatment. Patients were investigated with the Symptom Check List (SCL-90) and Michigan Alcoholism Screening Test (MAST) at baseline and with the PENN Alcohol Craving Scale (PACS) one year later, at follow-up. Results: Among 102 alcohol dependent inpatients, 61.8% (n=63) were considered as relapsed to alcohol abuse. Sociodemographic variables did not differ between groups. Mean scores of MAST and global severity index of SCL-90 did not differ significantly between groups, whereas craving score was higher in the relapsed group. Also the relapsed group had less polyclinic control, less attendance to the Outpatient Treatment Program (OTP), less changes in social environment for self protection and less use of anticraving medications during one year follow-up. Severity of craving and not attending OTP during follow-up period predicted relapse in alcohol dependents. Conclusions: Severity of craving and not attending OTP seems to be the main factors related with relapse. Together with using anti-craving medications, regular attendance to OTP may help patients to recognize and manage with alcohol craving.

Objective: Studies have shown a relationship between the development of alcohol use disorder (AUD) and the existence of childhood traumas (CT). In this study, in order to gain a better understanding of the association between CT and AUD, the relationship between CT and AUD was analyzed. Further, it was investigated whether Early Maladaptive Schemas (EMS) play a mediating role in the relationship between emotional abuse (EA) and AUD. Methods: The participants were consecutively admitted male alcohol-dependent inpatients (n=220) and healthy controls (n=108). The participants were investigated with the Childhood Trauma Questionnaire (CTQ-28), Young Schema Questionnaire-Short Form (YSQ-SF) and Michigan Alcoholism Screening Test (MAST). Mediation ana-lyses were conducted in order to evaluate the mediating effect of EMS between the relationship of AUD and CT. Results: The difference between CT total score and the EA score between the control group and the AUD group were statistically significant. An analysis of different types of traumas in the correlation with AUD revealed EA as the main predictor of AUD both directly and through its mediating effect with the EMS. In addition, it was determined that in the relationship between EA and AUD, EMS such as Enmeshment, Emotional Inhibition, Dependence and Insufficient Self-Control had mediating effect. Discussion: CT, especially EA are quite common in male inpatients with AUD and the negative effects of EA may play an important role in the development of AUD by causing EMS. Our findings imply that those with EA history in childhood may be particularly vulnerable to the development of AUD in adulthood. Therefore, in the prevention of the development and in the treatment of AUD, it may be useful to take into consideration EA experiences, to screen EMS that may mediate such relationship through scales and to conduct interventions in this regard.

The complete form of fetal alcohol syndrome (FAS) reportedly occurs in only 4% to 10% of children whose mothers drink heavily during pregnancy. Fetal alcohol spectrum disorder includes cases with some alcohol-related problems but not the full syndrome and is thus more common. Vulnerability to alcohol-related neurodevelopmental disorders is influenced by genetic polymorphisms of the class I alcohol dehydrogenase ADH1B, which affects the rate of alcohol metabolism. Expression of one of the 3 possible alleles, ADH1B*3, is associated with relatively rapid alcohol metabolism. This study sought to learn the degree to which the maternal ADH1B*3 allele may moderate the effects of in utero alcohol exposure on fetal growth and a range of cognitive and behavioral outcomes. The study population included 263 black mother-child pairs in whom moderate and heavy drinking were overrepresented. Most study participants were socioeconomically disadvantaged. The Michigan Alcoholism Screening Test (MAST) was administered to all mothers during the first prenatal visit, and blood was obtained for ADH genotyping; the children were genotyped at the 7.5- or 14-year visits. Fetal exposure to alcohol was assessed by interviewing the mothers about preconception drinking at the first prenatal visit and then at each subsequent visit asking about the amount of alcohol ingested daily since the previous visit. The children were evaluated at 6 and 12 months and 7.5 and 14 years of age. Infants were assessed using the Mental Development Index from the Bayley Scales of Infant Development. They also were tested for processing speed, visual reaction time, and complexity of play. At age 7.5 years, the children were tested for working memory by the Digit Span and Arithmetic subtests from the Wechsler Intelligence Scale for Children. The Verbal Fluency subtest of the McCarthy Scales of Children's Abilities served to measure executive function and working memory. The Continuous Performance Test quantified sustained attention. In addition, teachers were asked to assess social competence and behavior problems. Women who continued to drink during pregnancy decreased the frequency from 1.9 to 0.9 days a week, but the number of drinks consumed per occasion decreased only 20%, from 4.5 to 3.6 drinks. One third of the women also used cocaine, one third used marijuana, and almost two thirds smoked cigarettes. The most prominent genotype was homozygosity for the ADH1B*1 allele (64.5%), and the rest were either heterozygous (31.4%) or homozygous (4.6%) for the ADH1B*3 allele. At the time of conception, women who carried at least one copy of the ADH1B*3 allele drank half as much absolute alcohol per day (0.57 vs 0.96 ounces) and drank on fewer days per week (1.82 vs 2.45 days) than those who did not carry the allele. During pregnancy, both women who did and did not carry the ADH1B*3 allele reduced their drinking such that there was no difference between the groups in the amount of alcohol ingested per occasion (0.18 and 0.26 ounces, respectively) or the number of drinking days per week (0.67 and 0.85 days). Children whose mothers lacked the ADH1B*3 allele exhibited adverse effects of alcohol during infancy, scoring poorly on all tests, whereas the adverse effects on children whose mothers carried the ADH1B*3 allele were limited to reduced birth weight and processing speed on the FTII. At age 7.5 years, when focused attention, working memory, and efficiency of information processing were assessed, prenatal drinking was associated with poorer Category Fluency (the ability to monitor information retrieved from long-term memory) only in children whose mothers lacked the ADH1B*3 allele. These children also had poorer teacher ratings for attention, aggressive behavior, and social problems. In contrast, no consistent pattern of increased vulnerability during infancy was evident in children who themselves lacked the ADH1B*3 allele. When assessed at 7.5 years, children who carried at least one ADH1B*3 allele had fewer cognitive problems.

A case-control study on the relationship between alcohol dehydrogenase-2 (ADH2), aldehyde dehydrogenase-2 (ALDH2) and male probable alcohol use disorders (AUD) was performed in Khon Kaen, north-east Thailand. One hundred and fifty-three paired cases (probable AUD) and controls (non-probable AUD) were sampled from villagers aged 18-65 years using the modified Michigan Alcoholism Screening Test - Thai version, controls being matched for gender, age (+/- 4 years) and village. All of the cases and 86.9% of the controls were current drinkers. The percentage of ADH2*1/1 among cases was 47.1%, being significantly larger than the 29.4% among controls, and yielding a univariate odds ratio (OR) of 2.421* (95% confidence interval (CI) = 1.419-4.132) for developing probable AUD. The ALDH2*1/1 proportion among cases, 92.8%, was comparable to the 92.2% among controls, yielding a univariate OR of 1.100 (95%CI = 0.757-1.599). Multivariate analysis based on a conditional logistic regression model and a hierarchically well-formulated model strategy revealed that: (i) the OR of developing probable AUD due to 1 g increment of daily ethanol drinking was 1.110* among farmers (95%CI = 1.054-1.170); (ii) OR due to 1 g increment of daily ethanol drinking was 1.329* among non-farmers (95%CI = 1.109-1.593); (iii) OR due to either ADH2*1/1 or ALDH2*1/1 was insignificant; and (iv) the daily amount of smoking is independently associated with probable AUD. The present findings suggest that one of the genetic factors that may be related to probable AUD among Thai males living in the north-east is the ADH2 gene.

Although there are a wealth of clinically useful, brief, and low-cost assessment instruments available for use with drug-dependent populations, relatively few are broadly used in clinical practice. With an emphasis on: (1). the multidimensional nature of drug users' problems; and (2). assessments that can be integrated into empirically validated treatments, clinically useful assessments in four general categories (evaluation and diagnosis of drug dependence, identifying concurrent disorders and problems, treatment planning, and evaluation of treatment outcome) are briefly summarized. Progress in the field of drug abuse treatment has been significantly hampered by the failure to adopt, across research and clinical settings, a common set of assessments.

OBJECTIVES: To determine (1) the extent of agreement between the CAGE (acronym for cut down, annoyed by criticism, guilty about drinking, eye-opener drinks) and the Short Michigan Alcoholism Screening Test—Geriatric Version (SMAST-G) in identifying older persons who may have possible alcohol use disorders (AUDs) and (2) whether persons identified as having possible AUDs by each of these screening measures differ in their drinking, demographic, or health-related characteristics. DESIGN: Secondary analysis of a cross-sectional study using data from a self-administered mailed survey sample. SETTING: Three organizations were surveyed: (1) members of the American Association of Retired Persons and, in southern California, (2) managed care enrollees in a large medical group and (3) attendees of a community-based senior health center. PARTICIPANTS: One thousand eight hundred eighty-nine persons aged 55 and older completing a health risk appraisal for older persons (Health Risk Appraisal for the Elderly (HRA-E)). MEASUREMENTS: The HRA-E included items on drinking behaviors (including amount of alcohol use, the CAGE, and the SMAST-G) and health and demographic characteristics. RESULTS: Twenty-six percent of all persons screened positive on the CAGE or the SMAST-G. Fewer than half of all persons screening positive on either the CAGE or the SMAST-G, screened positive on both measures. Among current drinkers, persons screening positive on the SMAST-G alone drank less than persons screening positive on the CAGE alone, and these persons drank less than those screening positive on both the SMAST-G and the CAGE. More men screened positive on the CAGE alone than on the SMAST-G alone. CONCLUSION: Fewer than half of persons screening positive on either the CAGE or the SMAST-G screened positive on both measures, suggesting that these instruments may be capturing different aspects of unsafe drinking. A screening strategy employing both brief measures may identify more AUDs among older persons having differing demographic and health characteristics.

The study included 70 consecutive patients with fracture of the lower and upper limbs each and an equal number of age and sex matched normal control subjects. All the subjects were screened using the General Health Questionnaire (GHQ), the Michigan Alcoholism Screening Test (MAST), Carroll Rating Scale for Depression (CRSD), State-Trait Anxiety Inventory (STAI), Impact of Events Scale (IES), Fatigue Scale (FS) and the Perceived Stress Questionnaire (PSQ). Probable “Psychiatric cases” identified by the questionnaires underwent diagnostic psychiatric evaluation. As compared to normal controls, the limb fracture patients obtained significantly higher scores on the GHQ, MAST, CRSD, IES & FS but not on the STAI & PSQ. Psychiatric evaluation revealed significantly higher prevalence of psychiatric disorders in lower limb fracture patients (n=31) as compared to upper limb fracture patients (n=18) and control subjects (n=6). Limb fracture patients had a high prevalence of alcohol dependence/abuse (243%) and depressive disorders (6.4%). The results indicate that psychological intervention would greatly facilitate the management of these patients.

Despite a high prevalence of alcohol-related disabilities and the availability of cost-effective interventions, alcohol abuse and dependence commonly go undetected in hospital inpatients. In a university teaching hospital we compared three well validated screening methods for sensitivity and specificity—the Alcohol Use Disorders Identification Test (AUDIT, with various cut-off scores), CAGE (a four-question screening tool), and a 10-question version of the Michigan Alcoholism Screening Test (BMAST). A subset of patients also completed the DSM IV structured clinical interview for diagnosis. 1133 adult patients were randomly selected from all hospital admissions, with exclusion of day cases and patients too ill to be interviewed. Two-thirds of the patients were interviewed, most of the remainder being unavailable at the time. 30% of the men and 8% of the women met the DSM IV criteria for alcohol abuse or dependence. Sensitivities and specificities of the screening tools were as follows: AUDIT (with cut-off score > 8) 89% and 91%; CAGE 77% and 99%; BMAST 37% and 100%. 255 case records of patients scoring above the cut-off on one or more questionnaires were subsequently reviewed. The admitting team recognized an alcohol problem in only 46, of whom 17 were referred for appropriate follow up. As in previous hospital surveys, alcohol abuse and dependence was not receiving proper attention. The most efficient screening tool was the CAGE questionnaire.

The purpose of this paper is to review empirical data on currently used alcoholism screening instruments. It is the contention of this article that current established instruments have incorporated items significantly more characteristic of males' alcoholism or late stage problem drinking of women. They omit areas more germane to women's life course experiences, such as reproductive health issues and exposure to physical and sexual abuse. Indicators more appropriate for detecting problem drinking in women are proposed.

Objective: We aimed to examine the heavy metal bar patrons in Istanbul by means of self-reported questionnaires for psychiatric disorder symptoms. Material and Methods: Seventy-one volunteers from 4 popular heavy metal bars were included to the study. The Beck Depression Inventory, the Liebowitz Social Anxiety Scale (LSAS), the Adult Attention Deficit Disorder/Attention Deficit and Hyperactivity Disorder (ADD/ADHD) Scale and the Michigan Alcoholism Screening Test (MAST) were administered to the participants. Results: One fourth of the participants (25.4%) were under high risk for a depressive episode (BDI>17), 22 (32.3%) reported significant social anxiety (LSAS>30), and 41 (57.7%) showed moderate ADHD symptoms (Adult ADD/ADHD scale: 20-59). According to BDI score participants who were under the risk for depression showed higher scores in Adult ADD/ADHD scale scores than that of participants who were not under a risk for depression (p=0.001 for attention deficit; p=0.003 for hyperactivity; p=0.002 for impulsivity; p=0.001 for total score). In the study group, ADD/ADHD scale attention deficit score was positively correlated with the total fear, total avoidence and the total scores of LSAS (r=.359 p

Asian-Americans are a heterogeneous and rapidly growing population. The availability of and research on culturally specific assessment measures is an important consideration when working with Asian-American individuals. This chapter reviews substance use assessment instruments available for use in Asian populations and their psychometric properties. Both substance- and alcohol-specific abuse and dependence assessment measures have been translated and researched in different Asian populations. Specifically, the Addiction Severity Index, Drug Abuse Screening Test, Severity of Dependence Scale, CRAFFT, Alcohol Use Disorders Identification Test, Michigan Alcoholism Screening Test, and CAGE questionnaire have been evaluated. Notably, much of the research on psychometric properties of alcohol and substance assessment measures in Asian populations has been conducted in their respective countries and on limited samples. Further research into additional Asian subgroups, languages, females, and adolescents is necessary.

Alcoholism is a frequent and underdiagnosed mental health problem of later life. Its detection often relies on the use of screening instruments such as the Michigan Alcoholism Screening Test (MAST). The authors investigated the properties of the scale in a sample of 122 older adults recruited from a geriatric outpatient service in Sao Paulo, Brazil. Thirty-five subjects met criteria for the diagnosis of alcohol abuse or dependence according to DSM-III-R. The cutoff point 4/5 was associated with a sensitivity of 91.4%, specificity of 83.9%, and positive and negative predictive values of 69.6% and 96.0%, respectively. These results indicate that the MAST is a good screening test for the detection of alcohol abuse and dependence in an elderly male population and that the MAST should be used in combination with a questionnaire assessing the frequency/quantity of alcohol consumption to optimize the detection of cases and characterize their current drinking patterns.

Objective To measure a 1-day point prevalence of alcohol dependence among hospitalized patients and to assess practices of detection, evaluation, and diagnosis of alcohol problems. Patients and Methods On April 27, 1994, a total of 795 adult inpatients at 2 midwestern teaching hospitals were asked to complete a survey that included the Self-administered Alcoholism Screening Test (SAAST). The records of SAAST-positive patients were reviewed to determine the numbers of patients receiving laboratory screening for alcoholism, addiction consultative services, and a discharge diagnosis of alcoholism. Results The survey response rate was 84% (667/795). Of the 569 patients who provided SAAST information, 42 (7.4%) had a positive SAAST score and thus were identified as alcohol dependent. Thirteen (31%) of the 42 alcoholic patients received addiction or psychiatric consultative services during their hospitalization. Serum γ-glutamyltransferase was measured in 4 (11%) of the 38 actively drinking alcoholic patients. Three (7%) of 42 alcoholic patients received a discharge diagnosis of alcohol abuse or dependence. Conclusions The alcoholism prevalence rate was lower than those observed in several other US hospitals. Laboratory testing may be underutilized in identifying hospitalized patients who may be addicted to alcohol. Physician use of consultative services and diagnosis of alcohol dependence had not improved from similar observations more than 20 years earlier. These findings may indicate persistent problems in physician detection, assessment, and diagnosis of alcoholism.

Introduction: Beginning early in childhood, patients with sickle cell disease (SCD) are at risk of life-threatening and debilitating health events. Despite the high morbidity and mortality of this disease, hematopoietic cell transplantation (HCT), the only curative therapy for SCD, remains underutilized. Between 2008 and 2012, an average of 76 HCTs per year were performed on patients with SCD in the United States (US), a remarkably low rate considering that nearly 100,000 people in the US are living with this disease and approximately 1,000 infants are born with SCD in the US each year. Multiple factors may contribute to the low rates of HCT in this population. However, there is a paucity of data concerning the level of awareness of HCT among parents and guardians of children with SCD, an important factor to consider in the assessment of HCT utilization rates. Objectives: To identify the proportion of parents and guardians of children with SCD who are aware of HCT as a treatment option, and to evaluate the relationship between patient demographics and parental/guardian awareness of this treatment option. Methods: A 25-item paper-based survey was developed to assess parent/guardian awareness of HCT, based upon feedback from leaders in SCD community health organizations and pediatric hematologists. The survey was administered to parents/guardians of pediatric patients with SCD during routine outpatient appointments with their child's hematologist and at SCD community events sponsored by participating clinical sites. The survey was anonymous, and a $5.00 gift card was provided to all participants who completed the survey. Participants were recruited from four clinical centers across three cities in the Midwestern United States. All parents/legal guardians of children ( Results: 229 respondents (95% biological parent, 1% adoptive parent, 4% legal guardian) have participated in the study to date. 95% of all eligible parents/guardians agreed to participate. 82% of study respondents indicated that they have heard of HCT as a treatment option for SCD (N=187). 53% indicated that their child's physician has talked to them about HCT at some point in the past (N=120). On average, patients were 2.84 years old when the parent/guardian first heard about HCT (N=178, 95% CI: 2.31-3.37); patients were 3.08 years old on average when the child's physician first mentioned HCT (N=113, 95% CI: 2.42-3.75). 76% of respondents indicated that they are aware that HCT can potentially cure SCD (N=172). Higher parent/guardian education level and SS genotype were associated with having heard about HCT as a treatment option. SS genotype was associated with having been informed about HCT by their child's physician. Having been informed about HCT by their child's physician was associated with parent/guardian awareness that HCT is a potentially curative treatment. Conclusions: The majority of parents/guardians of children with SCD enrolled in this study have heard of HCT and are aware that HCT is a potentially curative treatment. In this population, non-physician sources of information and parent/guardian education level play an important role in awareness of this treatment modality. Physician-family discussion about HCT plays an important role specifically in parent/guardian awareness of the curative potential of this treatment. These data underscore the importance of physicians discussing HCT with families, particularly those who have limited resources to research treatment options on their own. Disclosures Quinn: Amgen: Research Funding; Eli Lilly: Research Funding; Silver Lake Research Corporation: Consultancy. Hsu:Centers for Medicare and Medicaid Innovation: Research Funding; Mast Therapeutics: Research Funding; Pfizer: Consultancy, Research Funding; Purdue Pharma: Research Funding; Sancilio: Research Funding; Gerson Lehman Group: Consultancy; Eli Lilly: Research Funding; EMMI Solutions: Consultancy; Astra Zeneca: Consultancy, Research Funding; Hilton Publishing: Consultancy, Research Funding. Piccone:Novartis: Other: Speaker.

Introduction: Patients with hemophilia A are at risk for acute bleeding which may affect muscles and other soft tissues but characteristically involves joints. Prophylaxis with factor VIII (FVIII) is the optimal treatment to prevent bleeding into joints and, when begun at a young age, may prevent arthropathy. BAX 8551, a polyethylene glycol (peg)ylated, full-length, recombinant FVIII built on ADVATE2, demonstrated extended half-life, efficacy, and safety for prophylaxis and treatment of bleeding in patients with severe hemophilia A. Methods: A phase 3, prospective, uncontrolled, multicenter study was performed in pediatric patients with severe hemophilia A without history of inhibitors. To be eligible, patients aged Results:Sixty-six patients were treated with a mean (SD) BAX 855 dose of 51.1 (5.5) IU/kg at a mean (SD) frequency of 1.8 (0.2) infusions/week. Fourteen of 66 patients (21.2%), 3/32 (9.4%) in the younger and 11/34 (32.4%) in the older cohort, had a total of 23 target joints at screening. The number of target joint bleeds decreased during a mean (SD) of 48.5 (7.7; median: 49.0) prophylactic EDs/patient. Five of 66 (7.6%) patients had at least 1 target joint bleed, 1/32 (3.1%) in the younger and 4/34 (11.8%) in the older cohort. The point estimate for the mean (95% CI) annualized rate of target joint bleeds was 0 (0 - infinity; median: 0) compared to an annualized rate of all joint bleeds of 1.1 (0.6 - 1.9; median: 0) and an annualized rate of all bleeds of 3.0 (2.2 - 4.2; median: 2.0) (Table 1). The point estimate for the mean (95% CI) annualized bleeding rate (ABR) in 52 patients without target joints was 2.9 (2.0 - 4.2; median: 2.0) and was similar in 14 patients with target joints at screening at 3.5 (1.9 - 6.6; median: 2.1). In the younger cohort, the ABR was lower in patients with than those without target joints. However, the number of patients During BAX 855 prophylaxis, no new target joints developed in any patient. Ten of 14 patients had at least 1 target joint revert to a non-target joint. In 8 of these 10 patients, 4 with 1 and 4 with 2 target joints, all target joints resolved. Conclusions:These results suggest that twice weekly infusion of BAX 855 is effective in the prevention of bleeding into target joints and may revert target to non-target joints in pediatric patients with severe hemophilia A. 1BAX 855 (Baxalta US Inc., now part of Shire) is licensed in the US and Japan under the trade name ADYNOVATE. 2ADVATE is a trade mark of Baxalta US Inc., now part of Shire. Disclosures Dunn: NovoNordisk: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Kedrion: Research Funding; Pfizer: Research Funding; CSL Behring: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Biogen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Baxalta (now part of Shire): Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Bayer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Octapharma: Research Funding. Thompson:Eli Lily: Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Research Funding; bluebird bio: Consultancy, Research Funding; ApoPharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Mast: Research Funding; Amgen: Research Funding; Baxalta (now part of Shire): Research Funding. Engl:Shire: Employment, Equity Ownership. Sharkhawy:Baxalta (now part of Shire): Employment. Abbuehl:Baxalta (now part of Shire): Employment.

Introduction: Cognitive impairment is a serious complication of sickle cell disease (SCD) that affects both children and adults. While it is known to adversely affect school performance and overall development in children, its functional impact in adults is not known. Importantly, poor disease self-management and adherence to hydroxyurea are major problems in SCD and are likely to be impacted by cognitive impairment. In the study presented herein, we hypothesized that lower cognitive function in areas of memory and executive function would be associated with worse adherence to hydroxyurea therapy in adults with SCD. Methods: We designed a cross-sectional study of patients with SCD from the University of Pittsburgh Medical Center Adult Sickle Cell Clinic. Patients who underwent neurocognitive testing between 2011 and 2016 as part of an ongoing neurocognitive study and whose adherence to hydroxyurea therapy has been monitored by a dedicated clinical nurse were included. Performance on four neurocognitive tests of verbal learning, memory and executive function - the Hopkins Verbal Learning Test-Revised (HVLT-R) retention, HVLT-R total recall, Delis-Kaplan Executive Function System Trail Making Condition 4 vs. 5, and Color Word Condition 3 - were selected a priori as explanatory variables. We explored the association between the four test scores and the most recent adherence data at the time of the study. Adherence measures included the laboratory biomarkers red blood cell corpuscular volume (MCV) and percentage of fetal hemoglobin (HbF) - whose values are expected to rise with hydroxyurea therapy - and the patient's self-report of adherence categorized as "good" (≥ 80% adherence) or "less-than-good" (< 80% adherence). Differences between groups were compared by 2-sided t-test or chi-square tests where indicated. Results: Study participants (n=48) had a mean age of 35.2 years (range 22-60) and were predominantly female (58.3%). Fifty-two percent had higher than high-school level education, and 72.9% had a HbSS or HbS/β0 thalassemia phenotype. There were no statistically significant differences between the "good" adherence and "less-than-good" adherence groups with regard to these baseline characteristics. As expected, the mean MCV, an objective marker of hydroxyurea adherence, was significantly higher in the "good" adherence group (102.3 ± 15.0 vs. 89.1 ± 11.5 fL, p=0.005), corroborating the patients' self-report. We observed a statistically significant positive correlation between the HVLT-R retention score and MCV that remained significant after adjustment for demographic characteristics (Pearson r=0.309, p=0.033) and a similar correlation with HVLT-R total recall (Pearson r=0.269, p=0.065). A similar trend between HVLT-R retention and HbF percentage was observed (Pearson r=0.260, p=0.081). The mean HVLT-R retention and HVLT-R total recall scores were higher in the "good" adherence group (80.1% ± 27% vs. 64.9% ± 33%, and 41.9% ± 14% vs.34.1% ± 13%, respectively), although the difference between the two groups did not reach statistical significance. There was no significant difference in performance on the Trail Making Condition 4 vs. 5 or the Color Word Condition 3 tests. Discussion: Our study suggests that adherence to hydroxyurea therapy in adult patients with SCD might be affected by impairment in episodic memory, as measured in our study through HVLT-R retention, with qualitatively similar patterns by HVLT-R total recall. Although more extensive investigation is warranted, these results suggest that a brief, targeted neurocognitive assessment should be considered as a component of any strategy aimed at improving adherence to hydroxyurea and other therapeutic interventions in patients with SCD. Disclosures Jonassaint: Sicklesoft: Other: officer of Sicklesoft. Kato:Mast Therapeutics: Consultancy; Bayer: Research Funding.

Background: Pain is the leading cause of hospitalization and pediatric emergency department (PED) visits for children with sickle cell disease (SCD). The National Heart, Lung and Blood Institute (NHLBI) recommends rapid evaluation and treatment of moderate-severe vaso-occlusive pain episodes (VOEs) in the acute care setting, with timely pain assessments and repeat analgesia delivery to control pain. Quality-of-care indicators for children with SCD include the receipt of parenteral analgesia within 30 minutes of triage or 60 minutes of registration, with frequent pain reassessments and re-dosing of opioids within 30 minutes. Objective: To assess adherence to the 2014 NHLBI guideline for VOE management with respect to time to 1st and 2ndparenteral opioid delivery and time to pain assessment and its reassessment frequency in PEDs across the United States and Canada. Methods: A retrospective chart review evaluated 20 consecutive charts per site from 20 high-volume PEDs (n=400 charts total) including 14 Pediatric Emergency Care Applied Research Network (PECARN) sites, assessing children age 3-21 years with SCD/VOE receiving parenteral opioids. Time from arrival and triage/room placement (whichever came first) to 1st and 2ndparenteral opioid administration, and time to pain assessment and reassessment were assessed. Adoption of bedside registration after triage/room placement at many sites decreased the relevance of a 60-minute window from registration; we therefore focused on triage time/room placement and arrival time to determine our quality outcome measures. Results: Annual SCD/VOE volume based on ICD-9 code discharge diagnosis for the 20 PED sites combined was 6082 visits, with an admission rate of 66%. Overall admission rate for the 400 patient chart review was 67%. Mean age of the chart review cohort was 14±5 years, 54% were female, and the majority (92%) had HbSS. Median (IQR) time from arrival to room placement was 4 (0, 10) minutes, while median time from triage/rooming to intravenous (IV) catheter placement was 46 (28, 76) minutes. Median time from triage/room placement to 1st parenteral opioid was 56 (32, 94) minutes; 24% within 30 min, 28% 31-60 min, and 48% >60 min. A total of 46% of patients received parenteral opioids within 60 minutes of ED arrival time. Analysis of children who received two or more opioid doses revealed that only 17% received a 2nd parenteral opioid dose within 30 minutes of their 1st dose. Only 17% of the cohort received both their 1st dose within 30 minutes of triage and 2nd parenteral opioid within 30 minutes of the first. Mean total number of parenteral opioid doses given while in the PED (min-max) was 2.4 (1-13), over a median (IQR) of 5 hours (4, 7) spent in the PED prior to disposition home or to the inpatient ward. Of admitted patients (n=268), 18% received only a single dose of parenteral opioids while in the PED, 30% received 2 doses and 52% received 3 or more doses. Pain assessment scores were documented in 99% of charts, within a median of 3 minutes (0, 12) of triage/rooming, and 89% had documentation of pain reassessment, occurring within a median of 27 minutes (10.0, 52.0) of 1stparenteral opioid delivery. The mean number of pain assessments documented during the PED stay was 5±2. Conclusions:Delays in pain management for children with SCD commonly occur across PEDs, despite NHLBI recommendations for rapid evaluation and treatment of VOEs in the acute care setting. Only a minority of children received rapid parenteral opioid administration defined by the 2014 NIH guidelines, although pain assessment is often performed immediately and with frequent reassessments. Although the majority of patients are rapidly triaged and placed in rooms, children commonly wait 45 minutes or longer for IV placement, which could contribute to delays in delivery of parenteral opioids. This data help identify areas for quality improvement that can be targeted to improve patient care in the future. Disclosures Morris: Nourish Life: Patents & Royalties: I am inventor of IP owned by UCSF Benioff Children's Hospital, Licenced to Nourish Life; Nestle: Honoraria; Calithera: Consultancy; Endeavor: Consultancy; Pfizer: Consultancy; MAST: Research Funding. Dampier:Eli Lilly and Company: Consultancy, Research Funding. Hsu:Pfizer: Consultancy, Research Funding; Hilton Publishing: Consultancy, Research Funding; EMMI Solutions: Consultancy; Purdue Pharma: Research Funding; Gerson Lehman Group: Consultancy; Mast Therapeutics: Research Funding; Centers for Medicare and Medicaid Innovation: Research Funding; Astra Zeneca: Consultancy, Research Funding; Sancilio: Research Funding; Eli Lilly: Research Funding.

Alcoholism is one of the most common psychosocial disorders, affecting approximately 10% of the general population. The impact of alcoholism on the care of patients with other medical illnesses has not been addressed in many of these populations, including patients with end-stage renal disease (ESRD) undergoing hemodialysis. We set out to determine the prevalence of alcoholism in an urban hemodialysis population and ascertain whether alcoholism had an effect on compliance in this population. One hundred sixty-three urban hemodialysis patients were screened using the Michigan Alcoholism Screening Test (MAST), a 25-item questionnaire that has been validated in multiple trials. Forty-five patients (27.6%) scored 5 or greater on the MAST. The MAST-positive subjects were younger (age, 55 +/- 15 years versus 64 +/- 13 years) and tended to be men (58% versus 43%). There was no significant difference in the incidence of diabetic kidney disease; however, there were significantly more human immunodeficiency virus (HIV)-positive patients in the MAST-positive group. The dietary compliance measures of predialysis potassium or phosphorus levels did not differ between the two groups. A trend toward lower serum albumin level was evident in the men in the MAST-positive group (3.75 +/- 0.57 versus 3.91 +/- 0.30 g/dL; P = 0.0212). In conclusion, there is a high prevalence of alcoholism in the urban dialysis population. Alcoholic patients with ESRD are younger and tend to be men. HIV-positive patients with ESRD have a high prevalence of concomitant alcoholism. Compliance indicators of predialysis potassium and phosphorus levels are not affected. However, nutritional status, measured by serum albumin level, tends to be poorer in the alcoholic group.

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.

Assessment of alcohol-related problems is essential in psychiatric settings. The Michigan Alcoholism Screening Test (MAST) has been the most commonly evaluated self-report alcohol assessment tool in psychiatric settings. However, due to a large variation in reports of findings and conclusions, a clear understanding of the utility of the MAST in psychiatric settings continues to be elusive. Therefore, the major goals of this investigation were (1) to integrate the available information pertaining to the validity of the MAST when used in psychiatric settings, and (2) to investigate factors that may moderate the performance of the MAST.Using clinically determined alcohol-related diagnosis as a criterion, a meta-analytic integration of nine published studies investigating the criterion validity of the MAST in psychiatric settings is presented.Findings revealed that the MAST is significantly valid when used in psychiatric settings. However, sensitivity estimates were found to be of greater magnitude than specificity estimates. Further, validity estimates of the MAST were found to be higher in psychiatric samples that had a greater proportion of women and in samples that exhibited higher base rates of alcohol-use disorder.Results of this integration support the continued use of the MAST in psychiatric settings as a screening instrument and suggest that those who administer the MAST must be attentive to particular characteristics of respondents.

A comparative multisite evaluation was conducted in four geographically distributed cities to examine the relative effectiveness of different approaches. The intervention systems represented a range of court-referral procedures (pretrial or postconviction), program duration (3 months to 9 months), and additional services (occasional referral or in-house alcohol treatment). 210 men at each site were recruited and tested (background, Millon Clinical Multiaxial Inventory, Michigan Alcoholism Screening Test). The batterers' partners were interviewed by phone every 3 months over a 15-month follow-up after intake, with a response rate of 77% overall. There was no significant difference in the reassault rate, portion of men making threats, and victim quality of life across the four sites. The longest, most comprehensive program did, however, have a significantly lower rate of severe reassault substantiated in a logistic regression controlling for background variables. The findings suggest that differing intervention systems that conform to fundamental standards can achieve similar outcomes.

This longitudinal study aimed at comparing aggregate measures of heavy or problem drinking and their variations across time among the same subjects. We examined middle-aged men participating in a health survey over a 5-year interval. Of the 133 consecutive men in the whole age group interviewed as 40-year-olds in 1989, 114 were reached and re-interviewed in 1994. Alcohol consumption was measured by self-report, Malmo-modified Michigan Alcoholism Screening Test (Mm-MAST), and serum carbohydrate-deficient transferrin (CDT). Self-reported alcohol consumption decreased with years (142 vs 105 g/week, P = 0.01), as did CDT (16.9 vs 14.4 U/l, P = 0.02), but there was no change in the Mm-MAST results. There was no significant difference in the number of heavy drinkers (either Mm-MAST score > or = 3, or by self-reported alcohol consumption > or = 280 g/week, or by CDT > or = 20 U/l) at 40 and 45 years of age (37 and 47% respectively). At the individual level, alcohol consumption both increased and decreased with age. At 45 years of age 5/114 (4%) of the men reported that they had increased their alcohol consumption by more than 80 g/week and 25/114 (22%) said that they had reduced their drinking by the same amount. The remaining 84 (74%) reported drinking the same amount as 5 years earlier (+/- 80 g/week). This indicates that alcohol drinking habits are not stable in middle age. Most heavy drinkers in both age groups were detected by Mm-MAST and this proportion increased with age while the proportion of positive self-reports and CDTs decreased. Thus, the social consequences, measured here by the Mm-MAST, may be more readily experienced with years even at smaller consumption levels.

The aim of this study was to compare the validity of two direct screening questionnaires, the CAGE and MAST, in the detection of hazardous alcohol consumption with a disguised assessment by using the Trauma Scale in a poststratified general hospital sample.Surgical and medical inpatients (N = 1,379) completed the three questionnaires. Hazardous alcohol consumption was defined by criteria derived from a World Health Organization study and assessed using self-reported quantity and frequency.The sensitivity of the Trauma Scale was not significantly different compared to the CAGE and MAST, whereas the direct questionnaires were higher in specificity and overall accuracy (p.0001). In male surgical patients the detection rate of the Trauma Scale was higher compared to the CAGE (p.05). Thirteen percent of subjects with hazardous levels of alcohol consumption were detected by the Trauma Scale only. In female surgical patients, the Trauma Scale, when used as an additional tool, does not improve the detection of hazardous drinkers.Because of the low specificity, indirect assessment using a history of trauma cannot be recommended as a screening instrument in a general hospital setting. Despite a high number of false positives, the Trauma Scale may serve as an additional tool in conjunction with direct questionnaires when high sensitivity is desired.

The sexual behaviors of bisexually active men, defined as men having sex with a man and a woman in previous 6 months, were compared with men who had sex with men only. Differential sexual practices associated with HIV risk between the two groups of men, as well as in the bisexual men with their male and female partners, were evaluated. Cross-sectional analyses were performed on baseline data from a prospective cohort of 508 young gay men recruited from bars, college campuses, and a health center in Boston from 1993 to 1994. Odds ratios (OR) and 95% confidence intervals (CI) were calculated on categorical variables, and McNemar's chi2 was used to compare the behaviors of bisexual men with their male versus female sex partners. Six months before the interview, 47 (10%) men had male and female sex partners, and 383 men had only male sex partners during the past year or ever. Fifty-eight percent of the men in the study had a female sexual partner in their lifetime, and 18% during the past year. Bisexual men were more likely to have drinking problems as identified by the Michigan Alcoholism Screening Test (MAST; OR = 3.96, 95% CI = 1.54-10.20), and fewer male partners over their lifetime (mean +/- standard deviation [SD], 24+/-42; median, 7; versus mean +/- SD, 69+/-516; median, 12), although this difference was not statistically significant. The two groups had similar levels of unprotected anal intercourse (25.5% versus 29.5%); however, bisexual men were half as likely to have anal sex as homosexual men (OR = 0.50; 95% CI = 0.27-0.93). Bisexual men were three times as likely to have unprotected sex with their female partner as their male partner (OR = 3.0; 95% CI = 1.02-8.8). Stratified analysis revealed similar discordant behavior while sober (OR = 4.0), drinking (OR = 7.0), and while drinking with concurrent drug use (OR = 8.0). Among this cohort of men who have sex with men (MSM), a sizable proportion also had vaginal sex with female partners in the previous 6 months. Bisexually active men were more likely to have unprotected sex with their female partners compared with their male partners, potentially increasing the risk for HIV and other sexually transmitted diseases. Behavioral interventions directed toward MSM need to address bisexual behaviors.Data were collected from 508 gay men recruited from bars, 17 Boston area college campuses, and a health center in Boston during 1993-94 for use in a study comparing the sex behaviors of men who had sex with a man and a woman during the previous 6 months against men who had sex with only men. Study participants were aged 18 to over 27 years, although 85.1% were aged 18-26. 6 months before the interview, 10% of the men had both male and female sex partners, while 383 men had only male sex partners during the past year or ever. 58% of the men in the study had ever had a female sex partner, and 18% during the past year. Bisexual men were more likely to have drinking problems as identified by the Michigan Alcoholism Screening Test and fewer male partners over their lifetime. 25.5% of the bisexual men and 29.5% of the homosexuals reported having unprotected anal intercourse, but bisexual men were less likely than homosexual men to have anal sex. Bisexual men were 3 times more likely to have unprotected sex with a female partner as with their male partner. Stratified analysis revealed this same discordant behavior while sober, drinking, and drinking together with other drug use.

Objectives. To evaluate whether the CAGE, MAST-G or an abnormally high MCV are effective screening instruments for alcohol misuse and if not to devise a new instrument. Design. Questionnaire survey of randomly selected patients. Setting. Acute admission wards of two district general hospitals. Period. 9 months. Subjects. Randomly selected patients, aged 65 and over, admitted as emergencies. Main outcome measures. Excessive alcohol intake, alcohol dependence. Results. The sensitivities of the CAGE, MAST-G and an abnormally high MCV for excess alcohol intake and alcohol abuse are low, ranging from 0.13 to 0.54. Conclusion. The results confirm previous UK studies which indicate that the CAGE and an abnormally high MCV are poor screening instruments for alcohol misuse in older patients and also indicate that the MAST-G is an insensitive screening instrument. A new two-step instrument with five questions in total was generated. This requires further validation. © 1997 John Wiley & Sons, Ltd.

The purpose of this study was to develop a sensitive as well as brief screening questionnaire by combining the well-known instruments CAGE and the Michigan Alcoholism Screening Test (MAST) in detecting patients with alcohol dependence or abuse in general hospitals and general practices. The number of items was reduced by means of logistic regression and item analysis based on data of 1, 167 consecutive admissions of a general hospital who completed both questionnaires. Further data were derived from a sample of 774 patients from 10 randomly selected general practices. A solution with nine items was validated in a second sample of 436 hospital inpatients. In all three samples, cases screening positive were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry to provide ICD-10 and DSM-Ill-R or DSM-IV diagnosis. In addition, 103 subjects with negative screening results were interviewed in the second general hospital sample. On grounds of the data of all three samples, a solution of seven items was chosen. This instrument comprises two CAGE and five MAST questions (Luebeck Alcohol Dependence and Abuse Screening Test; LAST) and was significantly higher in sensitivity than CAGE and SMAST. Data were robust in all three samples. It is concluded that the LAST is an optimized instrument for use in general hospital and general practice.

We evaluated the psychometric properties of the alcohol use disorders identification test (AUDIT), a ten-item screening test for identification of hazardous drinkers, in a sample of 82 patients with DSM-III-R drug dependence. AUDIT showed good internal consistency ( α = 0.94) and a unitary factor structure. Receiver operating characteristics analysis showed the AUDIT to be comparable to the Michigan alcoholism screening test (MAST) in identifying individuals with a current alcohol use disorder and superior to the MAST for those who are hazardous drinkers. In this patient sample, AUDIT performed well at the recommended cut-off score of ≥ 8. We recommend use of the AUDIT for identification of hazardous and harmful drinking among individuals with a drug use disorder.

We studied the relationship of D2 and D1 receptor gene polymorphisms and alcoholism in male Finnish alcoholics and assessed male controls. Seventy alcoholics entering a detoxification programme and 50 control individuals were recruited. Forty-three per cent of the alcoholic patients, but only 22% of controls, had the D2 receptor gene TaqI A restriction fragment length polymorphism A1 allele. The frequency of the A1 allele was significantly higher in alcoholics (p = 0.039). In comparison, no association between alcoholism and the D1 receptor gene EcoRI restriction fragment length polymorphism alleles was found. A logistic regression analysis of the alcoholic population failed to support the idea that the presence of the A1 allele would be linked to estimates of alcohol dependence severity rated with the Severity of Alcohol Dependence Questionnaire or the Michigan Alcoholism Screening Test. In conclusion, allelic association between the D2 but not D1 receptor gene and alcoholism in a genetically relatively homogenous population of male Finns was found. The results are in agreement with the view that the D2 receptor locus is involved in genetic susceptibility to alcoholism but does not give support to a special association of severe alcohol dependence and the A1 allele of the D2 receptor gene.

A sample of 315 nursing students in yearly cohorts (1988-1992) completed the Michigan Alcoholism Screening Test (MAST). A simple and quick instrument with established reliability and validity, the MAST had a reliability coefficient of .78 with this sample. The MAST scores of the nursing students indicated that 21.5% had probable alcoholism or were alcoholic. Drinking problems among these nursing students were similar to those of other nursing students and college students in general. Implications for nurse educators include recognition that nursing students need continuing self-assessment and monitoring to avoid drinking problems as a student and future practitioner. Alcoholism self-screening is an excellent introduction to client assessment for drinking problems. Implications for future research include identifying correlates and determinants of problem drinking behaviors and ultimately developing and testing educational interventions to eliminate the problem.

Background : Despite recognition of the high prevalence of alcoholism among patients with head and neck cancer, the prognostic importance of alcoholism has not been evaluated adequately. Previous investigators have speculated that alcoholic patients may have a poorer prognosis than nonalcoholic patients because of more advanced stage of cancer, the immunosuppressive effects of alcohol, and an increased rate of death due to other alcohol-related diseases. Purpose : The goal of this population-based study was to identify the features of alcoholism that are associated with survival for patients with head and neck cancer and to develop an alcoholic severity staging system from a composite of the independent features of alcoholism. Methods : This prospective study included 649 patients who were diagnosed with cancer of the oral cavity, oropharynx, hypopharynx, or larynx during the period from September 1, 1983, through February 28, 1987, in a three-county area of western Washington state that participates in the Surveillance, Epidemiology, and End Results Program of the U.S. National Cancer Institute. Details on lifetime alcohol consumption, treatment for alcoholism, abstinence from alcohol prior to the diagnosis of cancer, and alcohol-related health problems were ascertained through in-person interviews near the time of diagnosis. Patients were classified as either nonalcoholics or alcoholics according to their responses to questions from the Michigan Alcoholism Screening Test. The measures of alcohol consumption and abuse that were found to be independently associated with 5-year survival by logistic regression analysis were combined using conjunctive consolidation to create a final composite variable, called an alcoholic severity stage. Cox proportional hazards regression analysis was done to estimate the relative risk (RR) of death within 5 years due to specific causes of death for each of the alcoholic severity stages. Results : Alcoholism (RR = 2.06 ; 95% confidence interval [CI] = 1.43-2.98) and a history of alcohol-related systemic health problems (i.e., liver disease, pancreatitis, delirium tremens, or seizures) (RR = 2.76 ; 95% CI = 1.69-4.49) were associated with an increased risk of death, whereas abstinence (i.e., the consumption of fewer than one drink per week at 1 year prior to the diagnosis of cancer) (RR = 0.62 ; 95% CI = 0.39-0.97) was associated with a decreased risk of death. These associations were independent of age, site of cancer, anatomical stage, histopathologic grade, smoking, and type of antineoplastic treatment. Patients in the two worst alcoholic severity stages had an increased risk of dying not only of head and neck cancer but also of cardiovascular disease, pulmonary disease, and other alcohol-related causes. Conclusions : Alcohol abuse, measured by alcohol consumption, functional impairment, a history of alcohol-related health problems, or abstinence, can provide important prognostic information for patients with head and neck cancer. Our results suggest that sobriety among alcoholic patients can lead to prolonged survival.

Current trends in conceptions of alcohol problems and provision of health care put increased emphasis on identifying individuals whose alcohol use and problems cover a range of severity. The purpose of this study is to begin to provide information on the relative utility of self-report measures designed to identify (screen for) individuals with alcohol problems. To achieve this goal, the empirical literature on contrasts of self-report screening measures was reviewed, and 13 relevant studies across diverse settings and subject populations were identified. The review showed that the CAGE, the Michigan Alcoholism Screening Test (MAST), and the short MAST (sMAST) have been the most widely studied self-report instruments to screen for alcohol problems. Direct comparisons show the MAST to be more sensitive than the CAGE, but with elderly patients the CAGE may perform better than the MAST. Furthermore, available data suggest that the CAGE and the sMAST perform comparably. Finally, the CAGE, MAST, and sMAST all perform best when predicting criteria most similar to those the instruments were designed to reflect. The study concludes with a discussion of priorities for research on screening instruments.

The transition to parenthood has been occurring within the context of the increasing labor force participation of women and potential stress-related costs of "nontraditional" as well as "traditional" gender role choices of new parents. This study addressed the extent to which gender role-related stressors lead to increased problem drinking across the transition to parenthood.Fifty-five married couples expecting their first child were obtained from seven Chicago area hospitals and surveyed with a mailed questionnaire at two points in time: (1) during the second trimester of pregnancy and (2) at 6 months following childbirth. The study examined both wives' and husbands' changes in problem-related drinking by comparing problem drinking during the 6 months prior to pregnancy (retrospectively assessed at Time 1) with drinking during the 6 months following childbirth using a modified form of the Michigan Alcoholism Screening Test. In addition, the study contrasted problem drinkers with nonproblem drinkers following parenthood with regard to role overload (overwhelming demands from work and family roles), role deprivation (loss of work role following parenthood) and role deterioration (decreased support from role relationships).The data show increased problem drinking for both mothers and fathers but fail to support either role overload or role deprivation hypotheses. However, the data are congruent with the role deterioration perspective.If these findings are replicated, future studies of gender roles and alcohol abuse should focus greater attention on the perceived quality of social roles beyond noting their presence or absence.

This study assessed the extent of alcohol use among six classes of freshman medical students over an 8-year period to provide actuarial feedback about drinking patterns to these students. A total of 278 freshman medical students was anonymously surveyed in class using the Michigan Alcoholism Screening Test (MAST). Students were given subsequent group feedback about these data with ample time for discussion. Signs of clinical detection and community resources were highlighted. Of all students 11.7% were nondrinkers, 51% were nonproblematic drinkers, 7% were borderline, 23% were 80% likely to be alcoholic, and 7% were 100% likely to be alcoholic based on the MAST score. No time trends were evident in substance use patterns. The 13-item Short MAST (SMAST) compared to the MAST had a sensitivity of 52% and a specificity of 98%. The need for better education, detection, and intervention regarding alcohol abuse among medical students was evident. Fortunately, no time trends are evident in this school's freshmen classes in contrast to national trends in college students. Teaching about problem drinking based on the administration of the MAST and from drinking norms of the class appears to increase awareness, relevance, and concern about alcohol abuse among freshmen medical students.

Prior reports have indicated that the prevalence of alcohol-related problems in VA patients is significantly higher than that found in the general population. Prevalence rates, however, are likely to be affected by the screening instrument employed. A sample of 722 VA outpatients awaiting general medical and urgent care treatment was asked to complete two screening questionnaires: the World Health Organization's AUDIT and the brief MAST. Of 508 completed AUDITs, 55 (11%) scored above the cut-offs of 11 for harmful consumption, and 85 (17%) above the more liberal cut-off score of 8; whereas of 501 completed MASTs, 104 (21%) scored above the cut-off. Differences in identification rates are discussed.