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Background: While research suggests that both negative affect and alcohol use are impacted by exposure to harassment (i.e., sexual harassment, generalized harassment or bullying), less is known about the effect of harassment on negative affect subsequently leading to alcohol consumption, particularly in young adults. We examined the mediating role of negative affect on the relationships between sexual and generalized harassment at school and alcohol misuse. Methods: Participants were 2899 incoming freshmen in fall of 2011 who completed a Web-based survey assessing demographics (T0), sexual and generalized harassment at school (T0-T2), negative affect (T3), and problems associated with drinking, binge drinking, and drinking to intoxication (T0, T4, T5). Separate hybrid path models were fitted in Mplus v.8.8 for generalized harassment and sexual harassment and each outcome. Results: Mediation analyses showed a small but significant indirect effect for the sexual harassment model (beta = 0.05, S.E. = 0.01, p < 0.001) and generalized harassment (beta = 0.03, S.E. = 0.01, p < 0.01), indicating that negative affect partially mediated the associations between harassment early in students' college experience and later problems associated with drinking. No significant indirect effects were found for the binge drinking or intoxication models. Conclusions: High levels of negative affect associated with harassment may contribute to longer term impact on problematic use of alcohol in young adults, providing evidence that the effects of harassment on drinking may partly stem from harassment's lingering effects on negative affective pathways. [ABSTRACT FROM AUTHOR]

Background: Concurrent alcohol intoxication can complicate emergency department (ED) presentations for opioid-related adverse events. We sought to determine if there was a difference in resource utilization among patients who presented to the ED with concurrent opioid and alcohol intoxication compared to opioid intoxication alone. Methods: Using linked state-wide databases from the Maryland Healthcare Cost and Utilization Project (HCUP), we identified patients with a diagnosis of opioid intoxication treated in the ED from 2016 to 2018. We measured healthcare utilization for each patient in the ED settings for one year after the initial ED visit and estimated direct costs. We performed logistic regression comparing patients presented with co-intoxication to those without. Results: Of 12,295 patients who presented to the ED for opioid intoxication during the study period, 703 (5.7%) had concurrent alcohol intoxication. Patients with co-intoxication had more recurrent ED visits (340 vs 247.4 per 1000 patients, p < 0.05), higher index ED visit admission rates (26.9% vs 19.4%, p < 0.001), but similar overall costs ($3736 vs $2861, p < 0.05) at one year. Co-intoxication was associated with suicidal ideation (OR = 1.58, 95% CI 1.51–1.65), high zip code income (OR = 1.16, 95% CI 1.12–1.21), and higher rates of intoxication with all classes of drugs analyzed (p < 0.001). Conclusion: Our study demonstrated that mental health disorders, socioeconomic status, and increased ED utilization are associated with co-intoxication of opioids and alcohol presenting to the ED. Further research is needed to elucidate factors responsible for the increased resource use in this population. [ABSTRACT FROM AUTHOR]

Bystander intervention—when someone intervenes to help in situations that pose a risk for harm—is a promising strategy for sexual violence prevention. In the current study, a sample of U.S. Army male soldiers (N = 10; ages 18–24) who engaged in at-risk drinking completed a 90-min individual semi-structured interview to understand the ways in which soldiers intervene to address risk for sexual violence. Two independent raters coded soldier responses using thematic analysis and identified eight main themes: (a) recognizing risk for sexual violence; (b) labeling situations as problematic and taking responsibility; (c) facilitators of intervention; (d) barriers to intervention; (e) intervention strategies; (f) reactions and consequences to intervention; (g) alcohol's influence on intervention; and (h) using bystander intervention to shift cultural norms. As soldiers reported noticing more extreme risks for violence, prevention interventions may help service members identify situations earlier in the continuum of harm. Soldiers anticipated intervening in a way that was physical and aggressive, which could facilitate physical altercation and result in collateral misconduct. Results from the present study reveal ways that bystander intervention programs for civilians can be tailored to address the unique individual, situational, and contextual factors relevant to the military. These findings also highlight the importance of teaching soldiers indirect and nonaggressive strategies for intervention. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) afflicts over 29 million individuals and causes more than 140,000 deaths annually in the United States. A heuristic framework for AUD includes a three-stage cycle—binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation—that provides a starting point for exploring the heterogeneity of AUD with regard to treatment. Effective behavioral health treatments and US Food and Drug Administration–approved medications are available but greatly underutilized, creating a major treatment gap. This review outlines challenges that face the alcohol field in closing this treatment gap and offers solutions, including broadening end points for the approval of medications for the treatment of AUD; increasing the uptake of screening, brief intervention, and referral to treatment; addressing stigma; implementing a heuristic definition of recovery; engaging early treatment; and educating health-care professionals and the public about challenges that are associated with alcohol misuse. Additionally, this review focuses on broadening potential targets for the development of medications for AUD by utilizing the three-stage heuristic model of addiction that outlines domains of dysfunction in AUD and the mediating neurobiology of AUD. [ABSTRACT FROM AUTHOR]

Nonconsensual condom removal (NCCR) is a form of sexual violence that a significant minority of men use to obtain unprotected sex. Experiencing NCCR is associated with serious physical and mental health consequences, such as sexually transmitted infections, unplanned pregnancies, anxiety, and depression. Alcohol use is known to be associated with sexual violence in general; however, limited research has been done on the association between alcohol-related factors and NCCR specifically. Thus, the present study examined the associations between event-level drinking, daily drinking, drinking motives, alcohol expectancies, and NCCR. Young, single, heterosexually active men (N = 96) completed cross-sectional measures of their NCCR behavior, event-level drinking, drinking motives, and alcohol expectancies. A total of 19 (19.8%) participants reported successfully engaging in NCCR at least once since age 14. Results showed that consuming more alcohol during the event, having more highly intoxicated partners, drinking to enhance sex, and holding more negative alcohol expectancies were associated with increased likelihood of NCCR. To effectively decrease the rates of NCCR, prevention efforts could aim to decrease event-level alcohol consumption for both men and their partners and to challenge men's beliefs regarding alcohol's role in sexual behavior. Given the current study's limitations, future studies should consider employing an ecological momentary assessment design to avoid recall bias and include more diverse samples to increase the generalizability of findings. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol use disorder is comorbid with numerous other forms of psychopathology, including externalizing disorders (e.g. conduct disorder) and, to a lesser extent, internalizing conditions (e.g. depression, anxiety). Much of the time, overlap among alcohol use disorder and other conditions is explored at the disorder level, assuming that criteria are co‐equal indicators of other psychopathology, even though alcohol use disorder criteria span numerous varied domains. Emerging evidence suggests that there are symptom clusters within the construct of alcohol use disorder that relate differentially with important external criteria, including psychopathology and allied personality traits (e.g. impulsivity, novelty‐seeking). The present study mapped individual alcohol use disorder criteria onto internalizing and externalizing dimensions. Design and participants: We used multivariate and factor analytical modeling and data from two large nationally representative samples of past year drinkers (n = 25 604; 19 454). Setting: United States. Measurements: Psychopathology was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, yielding alcohol use disorder criteria, internalizing diagnoses (i.e. major depressive disorder, dysthymia, social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia and panic disorder) and externalizing diagnoses and symptoms (i.e. antisocial personality disorder, conduct disorder and three impulsivity items drawn from borderline personality disorder criteria). Alcohol consumption was assessed in terms of past‐year drinking frequency, usual amount of alcohol consumed on drinking days, binge drinking frequency, intoxication frequency, and maximum number of drinks in a 24‐hour period. Findings Four different patterns emerged. First, several alcohol use disorder criteria were relatively weakly associated with externalizing and internalizing. Secondly, withdrawal was associated with internalizing, but this association was not specific to distress. Thirdly, there was a general lack of specificity between alcohol use disorder criteria and narrower forms of internalizing, despite what might be predicted by modern models of addiction. Fourthly, recurrent use in hazardous situations reflected higher degrees of externalizing and lower internalizing liability. Conclusions: Different symptom combinations appear to yield differential expressions of alcohol use disorder that are disorder‐specific, or reflect broader tendencies toward externalizing, internalizing or both. [ABSTRACT FROM AUTHOR]

College women are at an elevated risk for sexual victimization (SV) and secondary physical and psychological consequences. While some women experience negative outcomes such as posttraumatic stress disorder (PTSD), others experience reduced or complete absence of distress following SV. The variation in outcomes may be associated with the victim's level of intoxication, which may in turn affect their processing of and coping with the event. We examined the effects of SV severity on PTSD via coping and intoxication using a moderated mediation analysis among female college students (N = 375). Results demonstrate that coping mediates the association between SV severity and PTSD symptomology; however, intoxication did not moderate these associations. Results suggest that regardless of intoxication, SV severity influences various coping styles and plays an important role in a victim's adjustment post-victimization. [ABSTRACT FROM AUTHOR]

There is a scarcity of national United States (U.S.) data on emergency department (ED) utilization among patients with psychiatric disorders (PD). This study aims to determine the most common reasons for ED visits among patients with PD, and baseline characteristics of patients who present to the ED due to PD. We obtained data from the Nationwide Emergency department Sample (NEDS), the largest all-payer ED database in U.S. Each ED visit in NEDS 2018, can have only 1 "principal" diagnosis, which is the main reason for the visit and up to 34 "secondary" diagnoses. We abstracted data for all ED visits with "any" diagnosis of a PD, using the ICD-10 code "F". We highlighted the 10 most common "principal" diagnoses based on organ-system involved, and most specific "principal" diagnoses for all ED visits by patients with "any" diagnosis of PD. We then highlighted baseline characteristics of ED visits with a "principal" diagnosis of PD. A total of 38.4 million ED visits for patients with PD, among these, 5,911,984 had PD as the principal diagnosis. Patients who presented principally due to PD were more likely to come from lower income household. Mental disorders and injuries and poisoning were the most common principal diagnosis by organ system categories for patients with PD. Possibility of coding errors and absence of date on race. Anxiety disorder, alcohol intoxication and major depressive disorder (MDD) were the most common specific psychiatric "principal" diagnosis for ED presentation among patients with PD. • Mental disorders, injuries/poisoning were the most common principal diagnosis category for ED visits among patients with PD. • Anxiety, alcohol intoxication & MDD were the most common specific psychiatric reasons for ED visits among patients with PD. • Patients who present to the ED principally for PD are more likely to come from low-income households in the south. • Screening, timely referral, & interdisciplinary outpatient management are invaluable in reducing ED utilization [ABSTRACT FROM AUTHOR]

Background: The role of alcohol expectancies and evaluations (i.e., perceived outcomes of drinking and whether these outcomes are desirable) in alcohol-related intimate partner aggression (IPA) has been debated, with some researchers arguing that expectancies fully account for the alcohol-IPA relationship and others suggesting they play a minimal if any role in alcohol-related IPA. In the current study, we examine the impact of expectancies and evaluations on alcohol-related IPA observed in the lab, in order to clarify what impact, if any, alcohol expectancies have on alcohol-related IPA. Consistent with findings from laboratory studies examining general aggression, we expected that individuals who were intoxicated would display greater IPA than individuals who were sober, but that alcohol expectancies and evaluations would be unrelated to in vivo IPA. Method: Participants were 69 dating couples (total N = 138), randomly assigned to consume either an alcohol or placebo beverage. IPA was measured with an in vivo aggression task based on the Taylor Aggression Paradigm. Results: As expected, alcohol intoxication predicted in vivo IPA following provocation (p <.03), whereas alcohol expectancies and evaluations were not related to IPA. Conclusions: These findings provide further support that alcohol expectancies and evaluations play little if any role in alcohol-related IPA. Rather, intoxication likely increases risk for IPA through its physiological effects on perception and thought. Further, treatments targeting alcohol use, rather than beliefs about outcomes of drinking, may have a greater impact on alcohol-related IPA. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the extent that alcohol consumption affected participants' perceptions of their own and their friend's ability to consent to sex in a non-bar drinking environment. We interviewed 176 people at tailgates in dyads about their own and their friends' alcohol consumption, intoxication symptoms, and ability to consent. Participants reported consuming a mean of 4.6 drinks and had a breath alcohol concentration (BrAC) of.075 on average, but few thought they or their friend had diminished cognitive function. Accordingly, 92.6% indicated they could consent to sex and 81.8% indicated their friend could consent to sex. Number of drinks people reported consuming, self-reported intoxication levels and symptoms, and BrACs were not significantly related to participants' perceptions of their own or their friends' ability to consent to sex. However, gender pairing of the dyad was significant; those in man–man pairs were more likely than those in woman–woman pairs to indicate their friend could consent and they would allow their friend to have sex if approached by an interested party. Participants also indicated that they did not perceive themselves or their friends to be "too intoxicated" as common reasons why they believed they and their friend could consent. Because alcohol-facilitated sexual assault is common among college students, we recommend sexual assault prevention educators focus on raising awareness regarding alcohol's negative cognitive effects, particularly related to consent communication. [ABSTRACT FROM AUTHOR]

Alcohol use is known to correlate with intimate partner violence (IPV) perpetration, yet little research examines how alcohol influences how the violence unfolds. The current study used sequential analysis to examine descriptions of past violent incidents and explore the behaviors that preceded men's perpetration of IPV. In accordance with the alcohol myopia model of alcohol use, it was hypothesized that intoxicated men would respond violently to a wide range of partner cues, whereas men who were sober would only react violently in response to the most threatening partner cues. Moreover, intoxicated men were expected to demonstrate less inhibition of violence to suppressor cues of the partners' distress as compared to sober men. Participants were 80 couples reporting male-to-female IPV within the past year. Female partners' descriptions of two past violent events were coded and entered into sequential analysis. Antecedents to the men's first violent action were examined. While sober men were likely to react violently to their partner's physical threat and perceived threat, intoxicate men did not. Sober men were less likely to become violent after their partners displayed distress cues, whereas there was no suppressor effect of women's distress for intoxicated men. The precursors of the violence of intoxicated men appears to be indiscriminate and unpredictable. Clinical interventions that rely on behavioral strategies or communication skills training are unlikely to be effective for those who have an unmanaged alcohol use disorder. [ABSTRACT FROM AUTHOR]

Aims: This study compares the incidence and risk-markers of student alcohol intoxication-related emergency department (ED) visits and alcohol-related incidents reported to student affairs. Methods: Enrollment data were linked to ED visits with alcohol intoxication and to alcohol-related incidents reported to campus authorities within one year following the first (index) annual enrollment. Incidence, annual trends and associated risk markers were analyzed. Results: The cohort consisted of 204,423 students aged 16–49. Incidence rates of first ED visit with alcohol intoxication and alcohol-related incidents were 59/10,000 and 311/10,000 person-years, respectively. Both outcomes shared common risk-markers including age, gender, race/ethnicity, fraternity and sorority (FSL) membership, an existing diagnosis of depression, etc. Being an athlete was associated with a lower risk of alcohol-related ED visits, and transfer students were at lower risk for alcohol-related incidents. Conclusion: Linking enrollment data with hazardous drinking events can help in better monitoring of student hazardous drinking and targeting interventions. First longitudinal study documenting the incidence of extreme student alcohol misuse. There were rising trends in student risky drinking based on two independent datasets. Analysis identified a range of risk markers predictive of risky drinking behaviors. Linking multiple student datasets can timely identify high risk students. [ABSTRACT FROM AUTHOR]

Objective Most studies on agreeing to unwanted sex have assessed sexual encounters between people who have had sex before. Thus, we examined instances of sexual compliance with a novel sexual partner. Participants: A probability sample of college students at a university in the Midwest United States (N = 7,112). Methods: Participants completed an online survey based on measures from the National Survey of Sexual Health and Behavior. Results: Only 2.5% (n = 179) agreed to unwanted sexual activity at their most recent sexual encounter. People who were sexually compliant with a novel sexual partner frequently did so due to their own alcohol intoxication. Further, sexual compliance with novel sexual partners was less frequently associated with affectionate sexual behaviors or orgasm. Conclusions: Our initial findings regarding the effect of sexual precedent on sexual compliance warrant further research on instances when people agree to sex they don't want with novel partners. [ABSTRACT FROM AUTHOR]

Research Questions: Rape prevention practice and policy have roots in data from 1985. This study uses 2015 national data to project recent prevalence, assesses whether rates now differ from those of 30 years ago, and disaggregates 2015 prevalence into rape of alcohol incapacitated victims, rapes combining both alcohol and physical tactics, and violent rape. Methods: Cross-sectional analyses were conducted comparing two national samples. The first was collected in 1984-85 (Koss, Gidycz, & Wisniewski, 1987); the second was collected 30 years later in 2014-2015. Both surveys used in-person administration and measurement by the most current version at the time of the Sexual Experiences Survey (SES). Prevalence rates were compared using Bayesian binomial tests. Results: In 2015, 33.4% (1 in 3) of women reported experiencing rape or attempted rape and 12.7% of men reported perpetration (1 in 8). Using Jeffreys' label for effect size of the Bayes binomial (1961), both results are "decisively" greater than expected given the 1985 benchmarks of 27.9% for victimization and 7.7% for perpetration. Victimization when incapacitated characterized approximately 75% of incidents in 2015 up from 50% in 1985. Cautions apply as cross-sectional data does not establish causality and the recent data set involved the revised SES. Conclusions: Across 30 years, neither containment nor reduction of rape was demonstrated and the increasingly prominent association with alcohol was apparent. Among the men who disclosed raping, 9 of 10 incidents were alcohol-involved. Prevention focus might profitably be directed to constraining alcohol environments and policies that facilitate rape of incapacitated persons and on misconduct responses that are proportional to the harm caused to rape victims, thereby raising the perceived risks of perpetration. [ABSTRACT FROM AUTHOR]

Bystander interventions for sexual assault promote third-party interference. People who endorse rape myths blame victims more and perpetrators less; consequently, rape myth acceptance (RMA) can impede helping behaviors toward sexual assault victims. Acute alcohol intoxication may exacerbate the effects of RMA on bystander intervention. In this study, we examined the influence of RMA—and potential moderating effect of acute alcohol intoxication—on predictors of bystander intervention. Young adults (N = 128) completed a survey in a lab setting, then consumed either an alcoholic or control beverage, read and listened to a fictional sexual assault scenario, and finally completed a semi-structured interview and postexperiment survey assessing their perceptions of the scenario. Using multivariate analysis of covariance (MANCOVA), we found people with higher RMA blamed the victim more and perpetrator less; they were also less likely to perceive responsibility to intervene for a sexual assault victim. Alcohol intoxication did not exacerbate these effects. That is, alcohol intoxication was not a context in which RMA was expressed more strongly. We recommend bystander programs continue to address RMA, specifically as a barrier to intervening. [ABSTRACT FROM AUTHOR]

Patients with alcohol-related diagnoses at initial hospitalization are at high risk of 30-day readmission. Understanding risk factors for 30-day readmission among these patients may help to identify those who would benefit from efforts to reduce risk of readmission. The Nationwide Readmissions Database was used to estimate 30-day all-cause readmissions among United States patients with an alcohol-related index hospitalization and to evaluate risk factors and costs associated with these readmissions. Included patients were 18 years of age or older at initial hospitalization, had an alcohol-related primary diagnosis (based on ICD-9-CM codes), and were discharged between 2010 and 2015. They were followed for 30 days after initial hospitalization within the calendar year to identify all-cause readmissions. A logistic regression analysis assessed the association between risk factors and 30-day readmission. Average costs of initial admissions and readmissions were estimated. Among 113,931,723 adult index hospitalizations, 1,124,228 had alcohol-related diagnoses. Patients had a mean age of 49 years, 73% were male, and 45% had public insurance coverage. The annual rate of 30-day readmissions among patients with index alcohol-related hospitalizations increased from 119 readmissions per 1000 admissions in 2010 to 140 per 1000 in 2015, while the rate of readmissions among patients with all-cause hospitalizations declined from 103 to 98 per 1000. The regression analysis suggested that age, male sex, comorbid conditions, discharge against medical advice, admission to large and teaching hospitals, and Medicaid vs. non-Medicaid payment were all risk factors for 30-day readmission. Mean costs of initial alcohol-related hospitalizations were greater among those with a 30-day readmission than without a 30-day readmission, and the mean cost of 30-day readmission was even greater. Mitigating the upward trend in rates of readmission following alcohol-related initial hospitalizations may be addressed through better identification of high-risk patients who are admitted with an alcohol-related diagnosis and greater use of existing evidence-based psychosocial and pharmacotherapy treatment methods. [ABSTRACT FROM AUTHOR]

Prior research has examined how posttraumatic stress disorder (PTSD) symptoms are influenced by the experience of different types of rape, defined according to the method of coercion used. This work, which classifies rape experiences as either forcible or substance-involved, has yielded mixed findings regarding differences in PTSD symptoms as a function of rape type. Based on recent evidence indicating significant heterogeneity within substance-involved rapes, the present study utilized a novel four-group conceptualization of rape type to examine differences in PTSD symptom severity and associated factors across rape type. Using a sample of 161 community women with experiences of adult rape, we examined four rape types based on method of coercion: forcible-only rape (i.e., involving only force/threat of force; n = 48), impaired rape (i.e., substance-related impairment was present, but the participant remained conscious; n = 56), combined rape (i.e., both force/threat of force and substance-related impairment were present; n = 29), and incapacitated rape (i.e., the participant was intoxicated to the point of unconsciousness; n = 28). We compared these groups on PTSD symptom severity within each symptom cluster, as well as on assault characteristics and consequences, including peritraumatic fear and injury, acknowledgment, and self-blame. Combined type rapes were associated with significantly more severe PTSD symptoms than forcible-only and impaired type rapes. Differences among the groups were also found for peritraumatic fear and injury, and rape acknowledgment. Utilizing a dichotomous approach to rape type overlooks the complexity of women's experiences. Differences in PTSD symptom severity as a function of the proposed four-group conceptualization of rape type highlight the importance of assessing method of coercion when treating rape-related PTSD. Likewise, differences across rape types in peritraumatic fear and rape acknowledgment highlight the potential utility of type-specific targets of intervention. [ABSTRACT FROM AUTHOR]

Drugs and alcohol are the third leading cause of death in U.S. jails. We analyzed 2000 to 2013 national jail mortality data by coding text data. We identified 1,442 deaths associated with drugs and alcohol. Drug-associated deaths were more than double alcohol-associated deaths during 2009 to 2013 when drug type was available for drug-associated mortality. Only 18% of deaths within 7 days of arrest for alcohol intoxication were officially coded as involving drugs/alcohol intoxication. Among the 103 deaths associated with substance withdrawal, 66 involved alcohol, 21 involved drugs (primarily opioids), and 16 could not be determined. Drugs and alcohol likely contribute to more deaths in jails than has been recognized due to how deaths are coded. Alcohol and opioid withdrawal represent a small but underappreciated contributor to jail deaths. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to assess whether different types of communities (ie, urban, suburban, small town, and rural) vary in the alcohol enforcement activities they conduct. Methods: We conducted a cross‐sectional study using data from a national survey of local law enforcement agencies. Data: The survey assessed enforcement of a range of alcohol policies at 1,082 law enforcement agencies. U.S. Census data were used to categorize agencies based on community type. Results: Agencies in urban areas conducted more enforcement activities than agencies in other community types. Urban agencies were more likely than rural agencies to conduct underage compliance checks (prevalence ratio [PR]: 0.42; CI: 0.34‐0.53), saturation patrols (PR: 0.80; CI: 0.67‐0.95), sobriety checkpoints (PR: 0.68; CI: 0.53‐0.86), and enforcement aimed at illegal sales to intoxicated patrons (PR: 0.59; CI: 0.42‐0.81). Urban agencies were also more likely than small town agencies to do compliance checks (PR: 0.66; CI: 0.56‐0.79) and sobriety checkpoints (PR: 0.75; CI: 0.61‐0.91), and they were more likely than suburban agencies to do compliance checks (PR: 0.67; CI: 0.57‐0.78) and enforcement actions around the sale of alcohol to intoxicated patrons (PR: 0.64; CI: 0.45‐0.90), provision of alcohol to minors (PR: 0.77; CI: 0.65‐0.92), and consumption by minors (PR: 0.90; CI: 0.82‐0.99). Conclusions: Enforcement of alcohol laws differs by community type. Future research is needed to identify mechanisms to increase enforcement by agencies in different types of communities. [ABSTRACT FROM AUTHOR]

Among ethnic minority groups, Latina/o emerging adults are most likely to engage in pregaming, a risky drinking practice. This study examined how U.S. acculturation and enculturation are associated with pregaming and the extent to which gender moderates this relation in a sample of 312 Latina/o emerging adults (18 – 25 years of age). Results indicated that men consumed more alcohol when pregaming than women, but there were no gender differences in pregaming frequency. Results also showed that lower levels of U.S. acculturation were associated with greater alcohol consumption while pregaming for men, but not women. Gender did not moderate the association between acculturation and pregaming frequency. This study highlights the need to account for gender when examining sociocultural determinants of high risk drinking behaviors such as pregaming among Latina/o emerging adults. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the association between alcohol use patterns and the prevalence of hypertension., Study Design: Data on alcohol use patterns and hypertension among 5918 adults from the 2015-2016 National Health and Nutrition Examination Survey was used for this study., Methods: The association of alcohol use patterns; "ever-used alcohol", "binge drinking", "heavy drinking", and "everyday alcohol use" with hypertension were assessed using multivariable-adjusted logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) at a two-sided P < 0.05., Results: Overall, the mean age of respondents was 48.3 ± 18.5 years, 50.9% (n = 3034) were women, and 44.6% (n = 2132) were hypertensive. Also, 85.9% (n = 4177) had used alcohol in their lifetime, 51.9% (n = 1764) were heavy drinkers, 25.1% (n = 370) engaged in binge drinking, and 17.7% (n = 721) reported everyday alcohol use. Compared to those that have never used alcohol, the aOR (95%CI) of stage II hypertension was 1.570 (1.565, 1.575) for overall alcohol use, 1.370 (1.367, 1.373) for everyday alcohol use, 1.127 (1.125, 1.129) for heavy drinking, and 1.092 (1.087, 1.098) for binge drinking. Among current active smokers, the aOR (95%CI) of stage II hypertension was aggravated for everyday alcohol use; 2.583 (2.576, 2.590)., Conclusion: Alcohol use patterns were associated with a higher prevalence of hypertension, particularly among smokers. A population-based longitudinal study should clarify whether these alcohol use phenotypes are predictive of hypertension at the population level in the United States., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

This study identifies subtypes of citizen behavioral characteristics within police use of force events and assesses ecological influences on these subtypes. Data comprised police use of force reports, recorded crime data, and census data. Latent class analysis was applied to 19,900 police use of force events to identify latent classes of citizen behavioral characteristics. A five class-solution demonstrated best fit and comprised the following classes: violent, unstable, and drug or alcohol affected; apparent mental disorder and possessing a weapon; alcohol-related violence; suspicious and fleeing; and violent behavior and threatening a weapon. Chi-square analysis and multilevel logistic regression showed each citizen presentation class was associated with distinct patterns of offence types and contexts for police use of force. Ecological influences were notable for three classes of citizen presentations. The clustering of citizen behaviors within incidents provides insights into the nature and distribution of types of police–citizen encounters where force is used. [ABSTRACT FROM AUTHOR]

Flame injuries are the primary cause of burns in young adults. Although drug and alcohol intoxication has been associated with other types of trauma, its role in burn injury has not been well described in this population. The purpose of this study was to investigate the association of intoxication and flame burn injuries in young adults in the United States. The 2014 Nationwide Emergency Department Sample was queried for burn injury visits of young adult patients, 13-25 years old. This data is weighted to allow for national estimates. Burn mechanism and intoxication status were determined by International Classification of Diseases, Ninth Revision codes. Multivariable logistic regression analysis was used to assess the association of intoxication and emergency department (ED) visits due to flame burns, adjusting for patient age, gender, zip code median income, zip code rural-urban designation, timing of visit, and hospital region. Further analyses assessed the odds of admission or transfer, as a possible proxy of injury severity, in patients with flame or other burns, with and without intoxication adjusting for patient age, gender, primary insurance, and hospital trauma designation. There were 20,787 visits for patients 13-25 years old with burn injuries and 12.9% (n = 2678) had a codiagnosis of intoxication. There was an increasing proportion of intoxication by age (5.8% 13-17 years old, 25% 18-20 years old, 69% 21-25 years old, P < .001). ED visits for burns with a codiagnosis of intoxication had 1.34 times ([95% confidence interval (CI): 1.18, 1.52], P < .01) higher odds of having flame burns compared to other burn mechanisms. Those with flame burns and intoxication were most likely to be admitted or transferred when compared to nonflame, nonintoxication visits in the adjusted model (odds ratio [OR] 5.49, [95% CI: 4.29, 7.02], P < .01). Furthermore, the odds of admission or transfer in visits with the combined exposure of intoxication and flame mechanism were significantly higher than visits due to nonflame burns and intoxication (OR 2.75, [2.25, 3.36], P < .01) or flame burns without intoxication (OR 3.00, [95% CI: 2.61, 3.42], P < .01). This study identified a significant association between flame-burn-related ED visits and intoxication in the young adult population in the United States. In addition, the combination of flame mechanism and intoxication appears to result in more substantial injury compared with either exposure alone. The relationship seen between intoxication and flame burn injury underscores a major target for burn prevention efforts in the young adult population. [ABSTRACT FROM AUTHOR]

Background: Although restrictive state alcohol policy environments are protective for individuals' binge drinking, research is sparse on the effect of alcohol policies on alcohol's harms to others (AHTO). We examined the lagged associations between efficacy of U.S. state alcohol policies and number of harms from others' drinking 1 year later. Methods: Individuals with AHTO data in a nationally representative sample of U.S. adults (analytic sample n = 26,744) that pooled the 2000, 2005, 2010, and 2015 National Alcohol Surveys and a 2015 National Alcohol's Harm to Others Survey were linked with prior‐year state policy measures. We used 2 measures from the Alcohol Policy Scale (APS)—effectiveness in reducing (i) binge drinking and (ii) impaired driving, based on experts' efficacy judgments regarding 29 state alcohol policies. Three 12‐month AHTO measures (due to another drinker) were experiencing: (i) either family/marriage difficulties or financial troubles; (ii) being assaulted or vandalized; and (iii) passenger with drunk driver or traffic accident. Multilevel models accounting for clustering within states and stratified by age‐groups (<40 vs. ≥40) examined associations between the APS and AHTO measures, controlling for individual covariates (gender, race, education, employment and marital status, family problem‐drinking history) of the victim. Results: Only for those aged <40, the lagged APS‐Binge drinking and APS‐Impaired driving scores were each inversely associated with aggression‐related harms and, separately, with drunk driving‐related harm from someone else's drinking (ps < 0.05 to < 0.01). Family/financial harms were not associated with APS scores for either age‐group. Composite AHTO measures (any of 3 harm‐types) also were inversely associated with stronger state alcohol policy environments (ps < 0.05 to <0.01). Conclusions: State alcohol policies may be effective in reducing, to a meaningful degree, aggression‐related harms and vehicular hazards due to other drinkers, but mainly in those under 40. [ABSTRACT FROM AUTHOR]

Objectives: An estimated 1.2 million annual emergency department (ED) visits for syncope/near syncope occur in the United States. Cardiac biomarkers are frequently obtained during the ED evaluation, but the prognostic value of index high‐sensitivity troponin (hscTnT) and natriuretic peptide (NT‐proBNP) are unclear. The objective of this study was to determine if hscTnT and NT‐proBNP drawn in the ED are independently associated with 30‐day death/serious cardiac outcomes in adult patients presenting with syncope. Methods: A prespecified secondary analysis of a prospective, observational trial enrolling participants ≥ age 60 presenting with syncope, at 11 United States hospitals, was conducted between April 2013 and September 2016. Exclusions included seizure, stroke, transient ischemic attack, trauma, intoxication, hypoglycemia, persistent confusion, mechanical/electrical invention, prior enrollment, or predicted poor follow‐up. Within 3 hours of consent, hscTnT and NT‐proBNP were collected and later analyzed centrally using Roche Elecsys Gen 5 STAT and 2010 Cobas, respectively. Primary outcome was combined 30‐day all‐cause mortality and serious cardiac events. Adjusting for illness severity, using multivariate logistic regression analysis, variations between primary outcome and biomarkers were estimated, adjusting absolute risk associated with ranges of biomarkers using Bayesian Markov Chain Monte Carlo methods. Results: The cohort included 3,392 patients; 367 (10.8%) experienced the primary outcome. Adjusted absolute risk for the primary outcome increased with hscTnT and NT‐proBNP levels. HscTnT levels ≤ 5 ng/L were associated with a 4% (95% confidence interval [CI] = 3%–5%) outcome risk, and hscTnT > 50 ng/L, a 29% (95% CI = 26%–33%) risk. NT‐proBNP levels ≤ 125 ng/L were associated with a 4% (95% CI = 4%–5%) risk, and NT‐proBNP > 2,000 ng/L a 29% (95% CI = 25%–32%) risk. Likelihood ratios and predictive values demonstrated similar results. Sensitivity analyses excluding ED index serious outcomes demonstrated similar findings. Conclusions: hscTnT and NT‐proBNP are independent predictors of 30‐day death and serious outcomes in older ED patients presenting with syncope. [ABSTRACT FROM AUTHOR]

Background: Alcohol consumption and related consequences is a problem on many college campuses. Tailgating parties before college sporting events may be contributing, however, little recent research has investigated alcohol consumption at these events. Objective: The purpose of this study is to evaluate the drinking behaviors of college game day tailgate attendees and subsequent alcohol-related consequences. Methods: Participants (N = 89; 44.9% female) were recruited from tailgates at a university in the Midwest United States on college football game days during fall 2014. Participants provided a breath sample, completed a questionnaire, and were given the opportunity to participate in a follow-up survey (n = 62) to assess resulting alcohol-related consequences. Results: Over half of participants had BrACs greater than 0.000. However, one in three participants reported intentions to abstain from alcohol or to drink but not enough to get buzzed. Intoxication intentions were a significant and unique predictor of alcohol consumption and experience with alcohol-related consequences at follow-up. Conclusions/Importance: This study updates and extends the literature on alcohol-related consequences in the context of college football tailgates. The results suggest that consequences may be prevented through changes in intentions to become intoxicated. [ABSTRACT FROM AUTHOR]

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

This essay provides an overview of the legal issues relating to intoxication, including the effect of voluntary intoxication in imputing to an offender a required culpable state of mind that he may not actually have had at the time of the offence; the effect of involuntary intoxication in providing a defence by negating a required offence culpability element or by satisfying the conditions of a general excuse; the legal effect of alcoholism or addiction in rendering intoxication involuntary; and the limitation on using alcoholism or addiction in this way if the offender can be judged to be reasonably responsible for creating his own addiction. It notes some of the differences between the US and UK approaches on some issues. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Irresponsible and illegal serving practices at bars and restaurants, such as sales to obviously intoxicated patrons, can lead to various public health harms. Training managers of bars and restaurants in the development and promotion of responsible alcohol policies may help prevent risky and illegal alcohol serving practices.Design and Methods: We implemented a training program for managers of bars/restaurants designed to establish and promote responsible beverage service policies/practices. The program included online and in-person components. Bars/restaurants were randomised to intervention (n = 171) and control (n = 163) groups. To assess changes in policies/practices, we surveyed managers prior to and at 1 and 6 months post-training. Logistic regression models assessed changes in policies/practices across time points.Results: The proportion in the intervention group that had written alcohol policies increased from 62% to 95% by 6 months post-training while the control group increased from 65% to 79% (P < 0.05). Similarly, by 6 months post-training 70% of managers in the intervention group reported they had communicated to their staff how to cut off intoxicated patrons, a significant increase from baseline (37%) and from the change observed in the control group (43%-56%). Prevalence of other policies/practices also increased post-training but differences between intervention and control groups were not statistically significant.Discussion and Conclusions: Our training program appears to have led to implementation of some policies/practices. Additional studies are needed to determine how training can be combined with other strategies to further improve establishment policies and ultimately reduce alcohol-related harms. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of alcohol intoxication, sexual attitudes, and sexual victimization history on the cognitive processes underlying undergraduate women’s risk judgments. Participants were 116 unmarried, undergraduate women between the ages of 21 and 29. The sample was diverse ethnically and composed primarily of heterosexual women. Stimuli were written vignettes describing social situations that varied on dimensions of sexual victimization risk and potential impact on women’s popularity. Participants were assigned randomly to an alcohol or a no-alcohol condition, and completed an explicit classification task in which they rated how risky each situation was in terms of their having an unwanted sexual experience. They then completed the Sexual Experiences Survey (SES) and the Sociosexuality Scale (SS); SES responses were used to quantify the severity of victimization experiences, and SS responses were used to measure endorsement of positive attitudes toward casual, impersonal sex. Although there was no main effect for condition, higher sociosexuality predicted use of higher thresholds for judging situations as risky. Importantly, sociosexuality interacted with condition such that higher sociosexuality predicted lower sensitivity to risk information in the alcohol condition but not in the no-alcohol condition. More severe victimization history predicted increased use of popularity impactwhen judging risk. This study emphasizes the importance of identifying specific cognitive processes affected by alcohol that may explain why women have difficulty processing contextual cues signaling risk in social situations. It demonstrates also the relevance of examining individual difference factors that may exacerbate the relationship between intoxication and cognitive processing of risk-relevant information. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed whether college student (1) protective behavioral strategy (PBS) use differed between those who reached legal intoxication during their most recent drinking episode compared to those who did not reach the legal blood alcohol concentration (BAC) threshold, and (2) frequency of PBS use could explain the variance associated with BAC during the most recent drinking episode, above and beyond one's sex, age, and involvement in the Greek system.Design: Secondary data analysis of the American College of Health Association's National College Health Assessment.Setting: Forty-four distinct campuses were included.Participants: A total of 21479 college students were included.Measures: BAC and PBS were measured.Analysis: The data were analyzed by conducting both independent samples t-tests and a multiple regression model. Effect sizes are reported.Results: Participants who reached legal intoxication used PBS less frequently ( P < .001; d = 0.80). Frequency of PBS use had the strongest unique contribution to the regression model (β = -.315, P < .001), such that participants with higher BAC reported less frequent use of PBS.Conclusion: Interventions should seek to develop strategies that encourage college student use of PBS prior to, and during, drinking episodes. More frequent use of PBS can reduce intoxication as well as occurrence of alcohol-associated consequences. [ABSTRACT FROM AUTHOR]

Purpose: This study sought to better understand the past change in the legal blood alcohol concentration (BAC) standard from 0.10% to 0.08% in the United States, as well as explore stakeholder perceptions about potential health and other impacts of further lowering the standard below 0.08%.Methods: In-depth interviews were conducted with representatives of 20 organizations considered to have an interest and investment in the potential impacts of strategies to decrease alcohol-impaired related crashes and injuries. Interviews were conducted by a trained moderator, using a structured guide.Results: Themes from the interviews are presented for several discussion topics explored for both the earlier change in the legal BAC limit from 0.10% to 0.08% and a potential lowering of the limit below 0.08%. Topics included arguments for and against change; organizational position on the change; stakeholders on both sides of the issue; strategies to support or oppose the change; health and economic impacts; and enforcement and adjudication challenges.Conclusions: Collectively, results suggest that moving the BAC standard below the current level will require considerable effort and time. There was strong, but not complete, agreement that it will be difficult, and maybe infeasible in the short-term, for states to implement a BAC standard lower than 0.08%. [ABSTRACT FROM AUTHOR]

This study profiles college students who died an alcohol-related death. Estimates of the scope of these mortality rates have received publicity but we know little about the nature of who, when, where, and how they perished. Using data derived from a website and accompanying news stories and obituaries, we constructed details about roughly 500 of these deaths. Being male, Greek, and enrolled in a four year, public institution increased the mortality odds for students. A large majority of these deaths occurred while students were alone following a drinking bout. Most students‘ perished while falling, drowning, being hit by a vehicle, or experiencing alcohol poisoning. Criminal charges were levied in one-third of these cases and families filed lawsuits in fourteen percent of these cases. Details surrounding these deaths suggest that intervention strategies center on ways in which schools and communities can partner to develop a system so that college drinkers are buddied up and can receive help when they need it. [ABSTRACT FROM PUBLISHER]

Background This study tested a moderated-mediation model whereby dimensions of impulsivity (i.e., negative urgency, positive urgency, sensation seeking, lack of premeditation, and lack of perseverance) differentially predict perpetration of physical intimate partner aggression (IPA) through problematic drinking in intoxicated and nonintoxicated heavy drinkers. Methods Participants were 249 heavy drinkers (148 men and 101 women) with a recent history of psychological and/or physical IPA perpetration toward their current partner recruited from 2 metropolitan U.S. cities. Participants completed questionnaires that assessed impulsivity and problematic drinking, consumed an Alcohol or No-Alcohol Control beverage, and completed a shock-based aggression task in which they were ostensibly provoked by their intimate partner. Results Results indicated an indirect effect of urgency on IPA through problematic drinking that was significantly more positive in intoxicated individuals. Conclusions These findings implicate a tendency to act rashly in response to emotions as the specific dimension of impulsivity associated with problematic drinking, which in turn exacerbates risk for IPA perpetration. Results also suggest acute effects of alcohol are key in facilitating this mechanism. [ABSTRACT FROM AUTHOR]

Background: Improving mechanisms for knowledge translation (KT) and connecting decision-makers to each other and the information and evidence they consider relevant to their work remains a priority for public health. Virtual communities of practices (CoPs) potentially offer an affordable and flexible means of encouraging connection and sharing of evidence, information and learning among the public health community in ways that transgress traditional geographical, professional, institutional and time boundaries. The suitability of online CoPs in public health, however, has rarely been tested. This paper explores the reasons why particular online CoP for alcohol harm reduction hosted by the UK Health Forum failed to generate sufficient interest from the group of public health professionals at which it was aimed.Methods: The study utilises online web-metrics demonstrating a lack of online activity on the CoP. One hundred and twenty seven responses to an online questionnaire were used to explore whether the lack of activity could be explained by the target audience's existing information and evidence practices and needs. Qualitative interviews with 10 members describe in more detail the factors that shape and inhibit use of the virtual CoP by those at which it was targeted.Results: Quantitative and qualitative data confirm that the target audience had an interest in the kind of information and evidence the CoP was set up to share and generate discussion about, but also that participants considered themselves to already have relatively good access to the information and evidence they needed to inform their work. Qualitative data revealed that the main barriers to using the CoP were a proliferation of information sources meaning that participants preferred to utilise trusted sources that were already established within their daily routines and a lack of time to engage with new online tools that required any significant commitment.Conclusions: Specialist online CoPs are competing for space in an already crowded market. A target audience that regards itself as busy and over-supplied is unlikely to commit to a new service without the assurance that the service will provide unique and valuable well-summarised information, which would reduce the need to spend time accessing competing resources. [ABSTRACT FROM AUTHOR]

Objectives: In 2014, 726 bicyclists were killed and an additional 50,000 were injured in crashes with motor vehicles. The number of cyclists in the United States is increasing, and as a result there has been a call for more bike lanes. We examined the difference in the severity of injury of bicyclists involved in motor vehicle crashes when riding in the traffic lane compared with riding in a bike lane or on a paved shoulder. We also controlled for other safety factors, including alcohol use, travel speed, posted speed, helmet usage, and lighting conditions to determine their impact on bicyclist safety.Methods: Single-year National Automotive Sampling System-General Estimates System files were used to analyze data regarding the bike lanes, and multiyear data were used to analyze the additional factors. Univariate and multiple regression analyses controlling for confounders were performed on the data.Results: When adjusting for speed limit, alcohol use by driver, weather conditions, time of day, and helmet use, the cyclist's position had no significant effect on the severity of injury (P = 0.57). The severity of injury was significantly greater when the driver or bicyclist had been drinking alcohol (P < 0.0001 and P < 0.003, respectively). Bicyclists were more severely injured when vehicles moved at greater speeds and the posted speed limit was higher (P < 0.0001 for both). Also, injury severity was found to be significantly higher when lighting conditions were "dark" (P < 0.0001).Conclusions: Our findings suggest that simply having a dedicated space for bicyclists, such as a bike lane or a paved shoulder, does not reduce the severity of injuries sustained when a crash with a motor vehicle takes place. Cyclist safety could be improved by implementing changes that affect vehicle speed, alcohol use by drivers, and lighting conditions. Moreover, emergency physicians should be aware that when they receive a report of a cyclist being struck by a car in a bike lane, they should prepare to treat injuries of severity similar to those received by a bicyclist hit by a vehicle in traffic. [ABSTRACT FROM AUTHOR]

Widespread concern regarding the detrimental effects of excessive alcohol consumption (especially by minors) and associated social problems (particularly drunk driving) continues to exist among policymakers, law enforcement officers, and the general public. Alcohol consumption is a leading contributor to death from injuries, which itself is one of the main causes of death for people under 21years of age in the United States. This study examines the relationship between the volume and timing of alcohol-control public service announcements (PSAs) and rates of drunk-driving fatal accidents in the U.S. We estimate ordinary least squares (OLS) regression models to predict rates of drunk-driving fatal accidents by state and month as a function of the volume of alcohol-control PSAs aired during the previous 8months. Models include controls for state anti-drunk-driving laws and regulations, state demographic characteristics, state taxes on alcohol, calendar year, and seasonality. Results indicate that higher volumes of anti-drunk driving PSAs airing in the preceding 2 to 3months are associated, albeit modest in magnitude, with reduced rates of drunk-driving fatal accidents. The regression coefficients are largest for adults (relative to underage drunk drivers) and when the PSAs air during prime time (relative to daytime or nighttime). We conclude that PSAs could play an important contributing role in reducing drunk-driving fatal accidents, although levels of exposure and potential effects likely remain modest due to reliance on donated air time. Well-funded anti-drunk driving campaigns could achieve higher levels of exposure and have a larger impact. [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]

The U.S. appears to be on a path toward legalizing cannabis on the alcohol model, which is to say allowing for-profit corporations to produce, sell, and promote its use. Even after national legalization, it will take decades to observe the full effects on industry structure and behavior, or on use and misuse. However, we should not be surprised if after markets have matured and consumption patterns stabilized, legalization increases acute cannabis intoxication in the U.S. by 40 billion hours per year. This increase in use will be the most important cannabis-specific effect of legalization. The bulk of it will be consumption by daily and near-daily users, and it is possible that roughly half will be by people who meet the medical criteria for substance use disorder. Much resulting harms will be borne by the users, and their families, and the harms are not primarily "medical", at least not in the narrow sense. Hence, legalization replaces the current problems of crime and black markets not so much with a medical or public health problem, but rather with a problem of potentially excessive consumption of a "temptation good" whose acute effects are performance degrading, not performance-enhancing. As legalization removes formal social controls, it might be prudent for society to develop stronger informal social norms - akin to "friends don't let friends drive drunk" - to protect the public and more importantly the users themselves from the performance degradation of bouts of nearly perpetual intoxication. [ABSTRACT FROM AUTHOR]

Aims To compare the acute effects of alcohol on set-shifting task performance (relative to sober baseline performance) during ascending and descending limb breath alcohol concentration (BrAC), as well as possible moderation of these effects by baseline individual differences. Design Shifting performance was tested during an initial baseline and a subsequent drinking session, during which participants were assigned randomly to one of three beverage conditions (alcohol, placebo or control) and one of two BrAC limb conditions [ascending and descending (A/D) or descending-only (D-only)]. Setting A human experimental laboratory on the University of Missouri campus in Columbia, MO, USA. Participants A total of 222 moderate-drinking adults (ages 21-30 years) recruited from Columbia, MO and tested between 2010 and 2013. Measurements The outcome measure was performance on set-shifting tasks under the different beverage and limb conditions. Shifting performance assessed at baseline was a key moderator. Findings Although performance improved across sessions, this improvement was reduced in the alcohol compared with no-alcohol groups (post-drink latent mean comparison across groups, all Ps ≤ 0.05), and this effect was more pronounced in individuals with lower pre-drink performance (comparison of pre- to post-drink path coefficients across groups, all Ps ≤ 0.05). In the alcohol group, performance was better on descending compared with ascending limb ( P ≤ 0.001), but descending limb performance did not differ across the A/D and D-only groups. Conclusions Practising tasks before drinking moderates the acute effects of alcohol on the ability to switch between tasks. Greater impairment in shifting ability on descending compared with ascending breath alcohol concentration is not related to task practice. [ABSTRACT FROM AUTHOR]

The article focuses on the vulnerability stemming from intoxication by directly prohibiting and engaging in nonconsensual sexual intercourse whose ability to communicate nonconsent is impaired due to intoxication. Topics discussed include sociological and psychological issues concerning interplay between sex and alcohol; laws governing the prosecution of sexual assault of intoxicated victims in the U.S.; and Kansas Supreme Court case State v. Chaney on same.

Aims To assess the relative impact of brief treatment (BT) compared with brief intervention (BI) on changes in substance use behavior in primary care screening programs for substance use disorders, overall and by patient severity. Design and participants A total of 9029 patients with both baseline and follow-up interviews were identified in the US Government Performance and Results Act (GPRA) data from October 2004 and February 2008. Using a propensity score framework, multiple generalized linear mixed models and a local linear matching method with a difference in difference estimator, patients from the BI group that resemble BT patients were used to determine the relative treatment effect of BT. A total of 3218 of these US patients with baseline and follow-up interviews were used in the final analysis sample after the propensity score-matching procedure (1448 patients assigned to a BI service category and 1770 assigned to a BT service category). Setting United States. Measurements Dependent variables were the number of days of use in the past 30 days of any alcohol, alcohol to intoxication, illicit drugs and marijuana. Findings The relative impact of BT was not significant for alcohol (0.269; P > 0.1) or alcohol to intoxication (0.462; P > 0.1). BT was found to reduce the frequency of use of illicit drugs at follow-up by 0.634 days more than BI ( P < 0.05). Marijuana days were not affected significantly by assignment to BT (−0.128; P > 0.1). Higher severity patients assigned to BT had a decrease in days of illicit drug use of 1.765 ( P < 0.05). Conclusions In the United States, brief treatment appears to have a stronger impact on reducing illicit drug use than brief intervention but is similar to brief intervention for reducing alcohol use, alcohol to intoxication and marijuana use alone. [ABSTRACT FROM AUTHOR]

Aims To estimate (1) the prevalence of underage binge drinking, high-intensity drinking and intoxication among young adults aged 19/20 years; (2) change in these behaviors across the transition out of high school and across historical time; and (3) associations between these behaviors and key covariates, including college status. Design, Setting, Participants Longitudinal data from the US nationally representative Monitoring the Future study included 1657 respondents first surveyed as 12th graders (modal age 18 years) in 2005-13 and again at modal age 19/20 years in 2006-14. Measurements Self-reported measures of alcohol use, demographics, college attendance and living situation. Findings Binge drinking (5+ drinks on one occasion) was reported by 24.2% [95% confidence interval (CI) = 22.0, 26.5] of young adults aged 19/20; 10.3% (CI = 8.7, 11.9) reported high-intensity drinking of 10+ drinks; 4.2% (CI = 3.1, 5.2) reported 15+ drinks. Usual moderate/high intoxication when drinking was reported by 33.1% (CI = 30.6, 35.6); 29.6% (CI = 27.2, 32.0) reported usual sustained intoxication of 3+ hours. Significant variability ( P < 0.001) in these behaviors from ages 18 to 19/20 was observed. Significant decreases ( P < 0.05) across historical time in 5+ and 10+ drinking were found. Four-year college students not residing with parents had significantly higher odds of moderate/high intoxication, binge drinking and high-intensity drinking compared with other groups ( P < 0.001). Conclusions Young adult underage binge drinking (5+ drinks on one occasion), high-intensity drinking (10+ and 15+ drinks) and intoxication are relatively common in the United States, and show meaningful variability across the transition out of high school. Four-year college students and those who do not live with their parents are more likely to engage in high-intensity drinking than their peers. [ABSTRACT FROM AUTHOR]

Aims: Alcohol intoxication is a source of significant illness and injury commonly resulting in emergency department (ED) visits. We characterize recent trends in alcohol-related visits to US EDs using nationally representative data. Methods: We conducted a retrospective review of data on national ED visits among patients aged 18 years or older with alcohol intoxication between 2001 and 2011 using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Demographic and resource utilization trends in alcohol-related visits were examined. We also assessed ED length of stay (LOS) across the study period, as well as the total hours spent on ED care for alcohol-related complaints. Results: Between 2001-2002 and 2010-2011, alcohol-related visits increased from 2,459,748 to 3,856,346 (P = 0.049). Utilization of resources such as laboratory tests, medications and radiography increased, with the use of advanced imaging (i.e. computed tomography and magnetic resonance imaging) increasing 232.2% (P < 0.001) from 2001-2002 to 2010-2011. Overall LOS increased 16.1% (P = 0.028), while LOS among patients admitted to the hospital increased 24.9% (P = 0.076). Total alcohol-related hours spent in EDs nationwide increased from 5.6 million in 2001 to 11.6 million in 2011, an increase of 108.5% (P < 0.001) compared with an increase in overall ED hours of 54.0% (P< 0.001). Conclusion: Alcohol-related ED visits are increasing at a greater rate than overall ED visits and represent a growing burden on hospital resources. [ABSTRACT FROM AUTHOR]

Background: While high blood alcohol concentrations (BACs) are required for alcohol-related blackouts (ARBs), additional characteristics also contribute to the risk, including a person's ethnicity, sex, and phenotypes relating to heavier drinking. Few prospective studies of ARBs have evaluated how these additional characteristics interact.Method: Data regarding 398 European American (EA), Asian and Hispanic students were extracted from a 55-week prospective study of different approaches to decrease heavy drinking among college freshmen. Information on past month ARB frequency was determined at 8 assessments. While controlling for the prior month maximum BAC and active education vs. control group assignment, the patterns and intensities of ARBs over time across ethnic groups were evaluated with ANOVA at each follow-up for the full sample, and then separately by sex and then by low vs. high levels of response to alcohol status (LR). The overall pattern of ARBs over time was evaluated with a 3 ethnic groups by 2 sexes by 2 LR status by 8 time points mixed-design ANOVA.Results: Higher rates of ARBs over time were associated with EA ethnicity, female sex and a low LR to alcohol, with the ethnic differences in ARBs most robust in females and drinkers with high LRs. Participation in education programs aimed at heavy drinking was associated with decreases in ARBs.Conclusions: The data indicate that in addition to BACs achieved, propensities toward ARBs relate to complex interactions between additional risk factors, including ethnicity, sex, and LR status. [ABSTRACT FROM AUTHOR]