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Importance: Recent information on the trends in past-year alcohol abstinence and marijuana abstinence, co-use of alcohol and marijuana, alcohol use disorder, and marijuana use disorder among US young adults is limited., Objectives: To assess national changes over time in past-year alcohol and marijuana abstinence, co-use, alcohol use disorder, and marijuana use disorder among US young adults as a function of college status (2002-2018) and identify the covariates associated with abstinence, co-use, and marijuana use disorder in more recent cohorts (2015-2018)., Design, Setting, and Participants: This study examined cross-sectional survey data collected in US households annually between 2002 and 2018 as part of the National Survey on Drug Use and Health. The survey used an independent, multistage area probability sample for all states to produce nationally representative estimates. The sample included 182 722 US young adults aged 18 to 22 years. The weighted screening and weighted full interview response rates were consistently above 80% and 70%, respectively., Main Outcomes and Measures: Measures included past-year abstinence, alcohol use, marijuana use, co-use, alcohol use disorder, marijuana use disorder, prescription drug use, prescription drug misuse, prescription drug use disorder, and other drug use disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria., Results: The weighted sample comprised 51.1% males. Between 2002 and 2018, there was an annual increase in past-year alcohol abstinence among young adults (college students: 0.54%; 95% CI, 0.44%-0.64%; non-college students: 0.33%; 95% CI, 0.24%-0.43%). There was an annual increase in marijuana use from 2002 to 2018 (college: 0.46%; 95% CI, 0.37%-0.55%; non-college: 0.49%; 95% CI, 0.40%-0.59%) without an increase in marijuana use disorder for all young adults. Past-year alcohol use disorder decreased annually (college: 0.66%; 95% CI, 0.60%-0.74%; non-college: 0.61%; 95% CI, 0.55%-0.69%), while co-use of alcohol and marijuana increased annually between 2002 and 2018 among all young adults (college: 0.60%; 95% CI, 0.51%-0.68%; non-college: 0.56%; 95% CI, 0.48%-0.63%). Young adults who reported co-use of alcohol and marijuana or met criteria for alcohol use disorder and/or marijuana use disorder accounted for 82.9% of young adults with prescription drug use disorder and 85.1% of those with illicit drug use disorder. More than three-fourths of those with both alcohol use disorder and marijuana use disorder reported past-year prescription drug use (78.2%) and illicit drug use (77.7%); 62.2% reported prescription drug misuse., Conclusions and Relevance: The findings of this study suggest that US colleges and communities should create and maintain supportive resources for young adults as the substance use landscape changes, specifically as alcohol abstinence, marijuana use, and co-use increase. Interventions for polysubstance use, alcohol use disorder, and marijuana use disorder may provide valuable opportunities for clinicians to screen for prescription drug misuse.

Background: Residential opioid rehabilitation aims to improve the mental health and quality of life of opioid users through abstinence and residential program participation. This study aimed to determine the depression, anxiety, stress and quality of life amongst maintenance to abstinence (MTA) program residents. Secondary study aims were to assess the personal characteristics of MTA clients, addiction and risk taking behaviours, factors associated with program completion, as well as to assess the reliable change in participants' mental health and quality of life on exit., Methods: Retrospective analysis of routinely collected data (2013-2017) from surveys completed by 100 clients. Outcome measures were: Depression, Anxiety, Stress Score (DASS-42), World Health Organisation Quality of Life 8 questions (WHOQOL-8) and Kessler Psychological Distress Scale (K10). Other variables included demographics, drug use, other addictions, aggression, self-harm, suicidal ideation/attempts, and risk taking behaviours. Statistical methods included Chi-square, Fisher's exact, t-tests, repeated measures analysis of variance and the Reliable Change Index., Results: All mean DASS-42, WHOQOL-8 and K10 scores improved significantly in all participants from entry to exit (p < 0.001). The majority of participants demonstrated reliable improvement across all psychometric measures. Completion rates for the MTA program were 51%. Depression (p = 0.023), anxiety (p = 0.010) and stress (p = 0.015) DASS-42 scores decreased significantly more in completers compared to non-completers. The rate of improvement in mean WHOQOL-8 scores and psychological distress scores (K10) was not statistically significantly different between completers and non-completers over time. There was no significant difference between completers and non-completers on socio-demographics, self-reported drug addiction or risk taking behaviour on program entry, except for suicidal thoughts while intoxicated (p = 0.033). Completers were more satisfied with their relationships (p = 0.044) and living place (p = 0.040) on program entry., Conclusion: Overall, completers and non-completers demonstrated improved mental health and quality of life from entry to exit, regardless of program completion. Depression, anxiety and stress reduced more markedly in program completers. Policy makers and programmers could use these findings to further validate their own programs to improve mental health and quality of life of opioid users.

Background: Many smokers give up smoking on their own, but materials that provide a structured programme for smokers to follow may increase the number who quit successfully., Objectives: The aims of this review were to determine the effectiveness of different forms of print-based self-help materials that provide a structured programme for smokers to follow, compared with no treatment and with other minimal contact strategies, and to determine the comparative effectiveness of different components and characteristics of print-based self-help, such as computer-generated feedback, additional materials, tailoring of materials to individuals, and targeting of materials at specific groups., Search Methods: We searched the Cochrane Tobacco Addiction Group Trials Register, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The date of the most recent search was March 2018., Selection Criteria: We included randomised trials of smoking cessation with follow-up of at least six months, where at least one arm tested print-based materials providing self-help compared with minimal print-based self-help (such as a short leaflet) or a lower-intensity control. We defined 'self-help' as structured programming for smokers trying to quit without intensive contact with a therapist., Data Collection and Analysis: We extracted data in accordance with standard methodological procedures set out by Cochrane. The main outcome measure was abstinence from smoking after at least six months' follow-up in people smoking at baseline. We used the most rigorous definition of abstinence in each study and biochemically validated rates when available. Where appropriate, we performed meta-analysis using a random-effects model., Main Results: We identified 75 studies that met our inclusion criteria. Many study reports did not include sufficient detail to allow judgement of risk of bias for some domains. We judged 30 studies (40%) to be at high risk of bias for one or more domains.Thirty-five studies evaluated the effects of standard, non-tailored self-help materials. Eleven studies compared self-help materials alone with no intervention and found a small effect in favour of the intervention (n = 13,241; risk ratio (RR) 1.19, 95% confidence interval (CI) 1.03 to 1.37; I² = 0%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for indirect relevance to populations in low- and middle-income countries because evidence for this comparison came from studies conducted solely in high-income countries and there is reason to believe the intervention might work differently in low- and middle-income countries. This analysis excluded two studies by the same author team with strongly positive outcomes that were clear outliers and introduced significant heterogeneity. Six further studies of structured self-help compared with brief leaflets did not show evidence of an effect of self-help materials on smoking cessation (n = 7023; RR 0.87, 95% CI 0.71 to 1.07; I² = 21%). We found evidence of benefit from standard self-help materials when there was brief contact that did not include smoking cessation advice (4 studies; n = 2822; RR 1.39, 95% CI 1.03 to 1.88; I² = 0%), but not when self-help was provided as an adjunct to face-to-face smoking cessation advice for all participants (11 studies; n = 5365; RR 0.99, 95% CI 0.76 to 1.28; I² = 32%).Thirty-two studies tested materials tailored for the characteristics of individual smokers, with controls receiving no materials, or stage-matched or non-tailored materials. Most of these studies used more than one mailing. Pooling studies that compared tailored self-help with no self-help, either on its own or compared with advice, or as an adjunct to advice, showed a benefit of providing tailored self-help interventions (12 studies; n = 19,190; RR 1.34, 95% CI 1.20 to 1.49; I² = 0%) with little evidence of difference between subgroups (10 studies compared tailored with no materials, n = 14,359; RR 1.34, 95% CI 1.19 to 1.51; I² = 0%; two studies compared tailored materials with brief advice, n = 2992; RR 1.13, 95% CI 0.86 to 1.49; I² = 0%; and two studies evaluated tailored materials as an adjunct to brief advice, n = 1839; RR 1.72, 95% CI 1.17 to 2.53; I² = 10%). When studies compared tailored self-help with non-tailored self-help, results favoured tailored interventions when the tailored interventions involved more mailings than the non-tailored interventions (9 studies; n = 14,166; RR 1.42, 95% CI 1.20 to 1.68; I² = 0%), but not when the two conditions were contact-matched (10 studies; n = 11,024; RR 1.07, 95% CI 0.89 to 1.30; I² = 50%). We judged the evidence to be of moderate certainty in accordance with GRADE, downgraded for risk of bias.Five studies evaluated self-help materials as an adjunct to nicotine replacement therapy; pooling three of these provided no evidence of additional benefit (n = 1769; RR 1.05, 95% CI 0.86 to 1.30; I² = 0%). Four studies evaluating additional written materials favoured the intervention, but the lower confidence interval crossed the line of no effect (RR 1.20, 95% CI 0.91 to 1.58; I² = 73%). A small number of other studies did not detect benefit from using targeted materials, or find differences between different self-help programmes., Authors' Conclusions: Moderate-certainty evidence shows that when no other support is available, written self-help materials help more people to stop smoking than no intervention. When people receive advice from a health professional or are using nicotine replacement therapy, there is no evidence that self-help materials add to their effect. However, small benefits cannot be excluded. Moderate-certainty evidence shows that self-help materials that use data from participants to tailor the nature of the advice or support given are more effective than no intervention. However, when tailored self-help materials, which typically involve repeated assessment and mailing, were compared with untailored materials delivered similarly, there was no evidence of benefit.Available evidence tested self-help interventions in high-income countries, where more intensive support is often available. Further research is needed to investigate effects of these interventions in low- and middle-income countries, where more intensive support may not be available.

Background: Problem alcohol use is common among people who use illicit drugs (PWID) and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opioid overdose in PWID., Objectives: To assess the effectiveness of psychosocial interventions to reduce alcohol consumption in PWID (users of opioids and stimulants)., Search Methods: We searched the Cochrane Drugs and Alcohol Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO, from inception up to August 2017, and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; and 2) online registers of clinical trials: Current Controlled Trials, ClinicalTrials.gov, Center Watch and the World Health Organization International Clinical Trials Registry Platform., Selection Criteria: We included randomised controlled trials comparing psychosocial interventions with other psychosocial treatment, or treatment as usual, in adult PWIDs (aged at least 18 years) with concurrent problem alcohol use., Data Collection and Analysis: We used the standard methodological procedures expected by Cochrane., Main Results: We included seven trials (825 participants). We judged the majority of the trials to have a high or unclear risk of bias.The psychosocial interventions considered in the studies were: cognitive-behavioural coping skills training (one study), twelve-step programme (one study), brief intervention (three studies), motivational interviewing (two studies), and brief motivational interviewing (one study). Two studies were considered in two comparisons. There were no data for the secondary outcome, alcohol-related harm. The results were as follows.Comparison 1: cognitive-behavioural coping skills training versus twelve-step programme (one study, 41 participants)There was no significant difference between groups for either of the primary outcomes (alcohol abstinence assessed with Substance Abuse Calendar and breathalyser at one year: risk ratio (RR) 2.38 (95% confidence interval [CI] 0.10 to 55.06); and retention in treatment, measured at end of treatment: RR 0.89 (95% CI 0.62 to 1.29), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was very low.Comparison 2: brief intervention versus treatment as usual (three studies, 197 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the Alcohol Use Disorders Identification Test (AUDIT) or Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) at three months: standardised mean difference (SMD) 0.07 (95% CI -0.24 to 0.37); and retention in treatment, measured at three months: RR 0.94 (95% CI 0.78 to 1.13), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 3: motivational interviewing versus treatment as usual or educational intervention only (three studies, 462 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured as scores on the AUDIT or ASSIST at three months: SMD 0.04 (95% CI -0.29 to 0.37); and retention in treatment, measured at three months: RR 0.93 (95% CI 0.60 to 1.43), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low.Comparison 4: brief motivational intervention (BMI) versus assessment only (one study, 187 participants)More people reduced alcohol use (by seven or more days in the past month, measured at six months) in the BMI group than in the control group (RR 1.67; 95% CI 1.08 to 2.60). There was no difference between groups for the other primary outcome, retention in treatment, measured at end of treatment: RR 0.98 (95% CI 0.94 to 1.02), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was moderate.Comparison 5: motivational interviewing (intensive) versus motivational interviewing (one study, 163 participants)There was no significant difference between groups for either of the primary outcomes (alcohol use, measured using the Addiction Severity Index-alcohol score (ASI) at two months: MD 0.03 (95% CI 0.02 to 0.08); and retention in treatment, measured at end of treatment: RR 17.63 (95% CI 1.03 to 300.48), or for any of the secondary outcomes reported. The quality of evidence for the primary outcomes was low., Authors' Conclusions: We found low to very low-quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.

Falls are a major health problem in older adults, but their relationship with alcohol consumption in this population remains unclear. In a cohort with 2170 older adults followed up for 3.3 years, both moderate drinking and the Mediterranean drinking pattern were associated with a lower risk of falls and injurious falls., Introduction: This study aims to examine the association between certain patterns of alcohol consumption, including the Mediterranean drinking pattern (MDP), and the risk of falls in older adults., Methods: A prospective cohort with 2170 community-dwelling individuals aged ≥60 years was recruited in Spain in 2008-2010 and followed up through 2012. At baseline, participants reported alcohol consumption and, at the end of follow-up, their falls during the previous year. The MDP was defined as moderate alcohol consumption (threshold between moderate and heavy intake was 40 g/day for men and 24 g/day for women) with preference for wine and drinking only with meals. Analyses were conducted with negative binomial or logistic regression, as appropriate, and adjusted for the main confounders., Results: Compared with never drinkers, the number of falls was lower in moderate drinkers (incidence rate ratio (95% confidence interval), 0.79 (0.63-0.99)) and drinkers with MDP (0.73 (0.56-0.96)). Also, moderate drinkers and those with MDP showed a lower risk of ≥2 falls (odds ratio (95% confidence interval), 0.58 (0.38-0.88) and 0.56 (0.34-0.93), respectively) and of falls requiring medical care (0.67 (0.46-0.96) and 0.61 (0.39-0.96), respectively)., Conclusion: Both moderate drinking and the MDP were associated with a lower risk of falls and injurious falls in older adults. However, sound advice on alcohol consumption should balance risks and benefits.

Objective: If abstinence from substance in adolescents may nowadays be regarded statistically as a deviant behavior, what is its significance from a developmental point of view? The aim of this article is to examine the mental health characteristics and the social integration of adolescent abstainers., Methods: A comprehensive literature review of epidemiological studies including data on adolescent abstainers was conducted., Results: Compared to the abundant literature devoted to adolescent substance abusers, few studies report data on adolescent abstainers. In addition, many methodological problems limit their interpretability and their comparison. However that may be, this body of work suggests that if abstinence may be due to something intrinsic about the individual (such as psychosocial adjustment difficulties, personality traits or gender), many other environmental factors (such as family background of temperance, cultural practices, upbringing or religion) may determine abstaining behavior. By this way, from a psychopathological angle, adolescent abstainers certainly constitute a more heterogeneous group than the adolescent substance abusers. Some of them are quite psychologically healthy, whereas others are more socially withdrawn and may suffer from emotional disorders., Conclusion: In terms of prevention, these data highlight the need for longitudinal prospective studies examining the psychosocial status of adolescent abstainers, their antecedents, their outcome and their motivations., (Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: No regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries., Objectives: This study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT)., Material and Methods: From May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis., Results: Out of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT., Conclusion: The differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.

Background: The association between alcohol consumption and somatic symptoms is unclear., Purpose: The aim of this study was to examine the cross-sectional association between the whole continuum of alcohol consumption, ranging from abstention to high-level consumption, and the overall level of common somatic symptoms in a large population-based sample., Methods: Data are from the Hordaland Health Study, conducted in 1997-1999 with participants aged 40-46 years (N = 15,018). The main exposure was a categorical variable based on self-reported abstention and alcohol consumption, while self-reported overall level of somatic symptoms was the outcome. The outcome was defined by the mean overall frequency of 17 commonly experienced somatic symptoms. Potential confounders included sociodemographic information, somatic diagnoses, and health-related behaviors. Linear regression models were computed in the statistical analyses., Results: We found no association between different levels of alcohol consumption and overall level of somatic symptoms. Abstainers reported, however, a higher overall level of somatic symptoms compared to those who consumed alcohol at any level, even after adjusting for potential confounders. Investigating the individual somatic symptoms, we found that the abstainers had a higher frequency of 10 of the 17 symptoms compared to the remainder, while higher frequency was found for only 2 somatic symptoms among the 5% with the highest alcohol consumption., Conclusions: We found no support for an association between alcohol consumption and overall level of somatic symptoms. There was, however, a small association between being abstinent and increased level of somatic symptoms. These findings may have several different explanations, and further investigation is called for.

Fifty-five former opioid addicts who have been methadone maintained patients for 10 or more years and whose urine has tested negative for drugs for 2 or more years were compared to 99 former opioid addicts who have been medication-free for 10 or more years. Groups were comparable in age and education, but the medication-free subjects were younger when having started opioids with more severe addiction scores. Methadone maintained patients presented with a higher proportion of psychiatric comorbidity and chronic pain. Their scores of perceived sleep quality and cognitive state were poorer than the medication-free individuals. Possible explanations of the differences are discussed in this article.

The aim of this study was to examine whether - in terms of personality characteristics and beliefs--former-drinkers and people who have never consumed alcohol exist on a continuum that includes low-risk drinkers and hazardous drinkers, or are distinct groups. An online questionnaire hosted on a secure server was completed by 1418 young people (642 men and 776 women) aged 16-21 living in South-East England. Participants' scores on the Alcohol Use Disorders Identification Test (AUDIT) were used to classify them as non-drinkers, former-drinkers, low-risk drinkers or hazardous drinkers. Multinomial logistic regression identified eight significant multivariate correlates that explained 39% of the variance in men's AUDIT category membership (χ(2)(24) = 263.32, p < .01), and seven significant multivariate correlates that explained 41% of the variance in women's AUDIT category membership (χ(2)(21) = 332.91, p < .01). The results suggest that non-drinkers and former-drinkers are more similar to each other than they are to both low risk and hazardous drinkers. We should not, therefore, treat these groups of young people as representing a drinking continuum. In particular, interventions for high risk young drinkers may be more effective if distinguished from general campaigns intended for all young people., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Heavy drinking jeopardizes the health of patients in HIV primary care. In alcohol dependent patients in HIV primary care, a technological enhancement of brief intervention, HealthCall administered via interactive voice response (HealthCall-IVR) was effective at reducing heavy drinking. The smartphone offered a technology platform to improve HealthCall., Methods: Working with input from patients, technology experts, and HIV clinic personnel, we further developed HealthCall, harnessing smartphone technological capacities (HealthCall-S). In a pilot study, we compared rates of HealthCall-S daily use and drinking outcomes in 41 alcohol dependent HIV-infected patients with the 43 alcohol dependent HIV-infected patients who used HealthCall-IVR in our previous efficacy study. Procedures, clinic, personnel, and measures were largely the same in the two studies, and the two groups of patients were demographically similar (~90% minority)., Results: Pilot patients used HealthCall-S a median of 85.0% of the 60 days of treatment, significantly greater than the corresponding rate (63.8%) among comparison patients using HealthCall-IVR (p < .001). Mean end-of-treatment drinks per drinking day was similar in the two groups. Patients were highly satisfied with HealthCall-S (i.e., 92% reported that they liked using HealthCall-S)., Conclusions: Among alcohol dependent patients in HIV primary care, HealthCall delivered via smartphone is feasible, obtains better patient engagement than HealthCall-IVR, and is associated with decreased drinking. In HIV primary care settings, HealthCall-S may offer a way to improve drinking outcomes after brief intervention by extending patient engagement with little additional demands on staff time.

Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors., (© 2013 Elsevier Ltd. All rights reserved.)

Background: In observational studies, moderate drinking is associated with a reduced risk of more than twenty different diseases and health problems. However, it would be premature to conclude that there is a causal relationship., Method: This paper critically reviews the evidence for such associations., Findings: It was found that reasons for questioning the causal association of moderate drinking and a reduced health risk are: the lack of dose-response relationships; the characteristics and lifestyles of today's abstainers and moderate drinkers; the lack of plausible biological mechanisms; the problems in the classification of drinking groups, and; the general limitations of observational studies., Conclusions: The evidence for the harmful effects of alcohol is undoubtedly stronger than the evidence for beneficial effects., (© 2013 The Author, Addiction © 2013 Society for the Study of Addiction.)

Objective: The present work aims to provide 10-year estimates of the probability of cancer occurrence in the Japanese population based on age, sex, and the pattern of adherence to five healthy lifestyle habits., Methods: The study population consisted of 74,935 participants in the Japan Public Health Center-Based Prospective Study (aged 45 to 74 years) who answered a 5-year follow-up questionnaire about various lifestyle habits between 1995 and 1999. The relationship between five previously identified healthy lifestyle habits (never smoking, moderate or no alcohol consumption, adequate physical activity, moderate salt intake, and appropriate body mass index) and cancer occurrence was assessed using a sex-specific parametric survival model., Results: Compared to individuals not adhering to any of the five habits, never-smoking men had a nearly 30% reduction in the 10-year probability of cancer occurrence (e.g., 20.5% vs. 28.7% at age 70), and never-smoking women had a 16% reduction (e.g., 10.5% vs. 12.5% at age 70). Adherence to all five habits was estimated to reduce the 10-year probability of cancer occurrence by 1/2 in men and 1/3 in women., Conclusion: By quantifying the impact of lifestyle habits on the probability of cancer occurrence, this study emphasizes the importance of lifestyle improvement., (© 2013.)

Background: Understanding alcohol consumption patterns of older adults with chronic illness is important given the aging baby boomer generation, the increase in prevalence of chronic conditions and associated medication use, and the potential consequences of excessive drinking in this population., Objectives: To estimate the prevalence of alcohol consumption patterns, including at-risk drinking, in older adults with at least one of seven common chronic conditions., Design/methods: This descriptive study used the nationally representative 2005 Medicare Current Beneficiary Survey linked with Medicare claims. The sample included community-dwelling, fee-for-service beneficiaries 65 years and older with one or more of seven chronic conditions (Alzheimer's disease and other senile dementia, chronic obstructive pulmonary disease, depression, diabetes, heart failure, hypertension, and stroke; n = 7,422). Based on self-reported alcohol consumption, individuals were categorized as nondrinkers, within-guidelines drinkers, or at-risk drinkers (exceeds guidelines)., Results: Overall, 30.9 % (CI 28.0-34.1 %) of older adults with at least one of seven chronic conditions reported alcohol consumption in a typical month in the past year, and 6.9 % (CI 6.0-7.8 %) reported at-risk drinking. Older adults with higher chronic disease burdens were less likely to report alcohol consumption and at-risk drinking., Conclusions: Nearly one-third of older adults with selected chronic illnesses report drinking alcohol and almost 7 % drink in excess of National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines. It is important for physicians and patients to discuss alcohol consumption as a component of chronic illness management. In cases of at-risk drinking, providers have an opportunity to provide brief intervention or to offer referrals if needed.

Purpose: This study examined concurrent and longitudinal associations between two dimensions of affiliation in Alcoholics Anonymous (AA)-attendance and spiritual awakening-and drinking outcomes among adult patients who were in treatment for alcohol dependence in Warsaw, Poland. In a study conducted at four addiction treatment centers, male and female patients (n = 118) with a DSM-IV diagnosis of alcohol dependence were assessed at baseline (Time 1 or T1), 1 month (T2), and 6-12 months postbaseline (T3) for AA meeting attendance, various aspects of AA affiliation, and alcohol use. Alcoholics Anonymous meeting attendance and alcohol consumption were measured using the Timeline Followback interview. Self-report of having had a spiritual awakening was measured using a modified version of the Alcoholics Anonymous Involvement Scale., Results: There were no cross-sectional or longitudinal associations between AA meeting attendance and improved drinking outcomes. In contrast, self-report of a spiritual awakening between T2 and T3 was significantly associated with abstinence (OR = 2.4, p < .05) and the absence of any heavy drinking (OR = 3.0, p < .05) at T3, even when demographic and clinical characteristics were statistically controlled., Conclusions: Self-reports of spiritual awakening predicted improved drinking outcomes in a Polish treatment sample.

In Europe, between 1880 and 1914, the alcoolism, one of the three social ills, represents more than ever a concern among the society's leaders against the ravages it causes in their working class. In this context, two schools of "anti-alcoholism" clash to policy matters: to prevent to only spirits or any form of alcohol beverage. Belgium, land of beer, forms an integral part of the debate...

Objectives: To determine whether alcohol use changes over time in older adults and whether alcohol intake is associated with common chronic diseases., Design: Twenty-four-year longitudinal study., Setting: Southern California community., Participants: One thousand seventy-six members of the Rancho Bernardo cohort aged 50 to 89 at baseline., Measurements: Participants completed two to six research visits at approximately 4-year intervals between 1984 and 2009. At each visit, participants completed standard questionnaires on alcohol use, chronic diseases, and behaviors. Mixed-effects linear models were used to examine changes in average weekly alcohol intake over time and in relationship to health status., Results: Prevalence and frequency of alcohol use was high throughout the study, with more than 60% of participants reporting weekly alcohol intake. The average amount consumed declined with advancing age, regardless of the presence of any of the eight most common chronic diseases. Prevalence of drinking in excess of age- and sex-specific low-risk guidelines was high across all visits and did not vary according to disease burden. At the final visit, 29% of participants drank in excess of low-risk drinking guidelines, including 28% of those with hypertension and 31% with diabetes mellitus., Conclusion: Prevalence and frequency of alcohol intake remained stable over a 24 year follow-up in this cohort of educated, white, middle-class, older adults, although average amount consumed decreased with advancing age. Despite this decrease, a high proportion of older adults, including those with common chronic health conditions, drank in excess of current guidelines. Clinicians should provide more education on the importance of older adults moderating alcohol intake., (© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.)

Objective: Alcohol and (or) illicit drug use (AIDU) problems are associated with mental health difficulties, but low-to-moderate alcohol consumption may have mental health benefits, compared with abstinence. Our study aimed to explore the hypothesis of a nonlinear, or J-curve, relation between AIDU profiles and psychological distress, psychiatric disorders, and mental health service use in the general Canadian population., Methods: Data were collected from a representative sample of the Canadian population (n = 36 984). Multiple correspondence analyses and cluster analyses were used to extract AIDU profiles. Sociodemographics, psychological distress, psychiatric disorders, and mental health service use were assessed and compared between profiles., Results: Seven AIDU profiles emerged, including 3 involving risky or problematic AIDU that correlate with major affective disorders, anxiety disorders, suicidal behaviours, and higher levels of psychological distress. No J-curve relation was found for psychiatric disorders and mental health service use. The lifetime-abstainer profile correlates with the lowest rates of psychiatric disorders and mental health service use. Lifetime abstainers are also more often female, immigrant, and unemployed. Compared with other profiles, spirituality is more important in their life., Conclusions: The hypothesis of a nonlinear relation between psychiatric disorders and AIDU was not supported. Lifetime AIDU abstainers have specific sociodemographic and cultural background characteristics in Canada.

Objective: The objective of the study is to determine whether Alcoholics Anonymous (AA) participation leads to reduced drinking and problems related to drinking within Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), an existing national alcoholism treatment data set., Method: The method used is structural equation modeling of panel data with cross-lagged partial regression coefficients. The main advantage of this technique for the analysis of AA outcomes is that potential reciprocal causation between AA participation and drinking behavior can be explicitly modeled through the specification of finite causal lags., Results: For the outpatient subsample (n = 952), the results strongly support the hypothesis that AA attendance leads to increases in alcohol abstinence and reduces drinking/ problems, whereas a causal effect in the reverse direction is unsupported. For the aftercare subsample (n = 774), the results are not as clear but also suggest that AA attendance leads to better outcomes., Conclusions: Although randomized controlled trials are the surest means of establishing causal relations between interventions and outcomes, such trials are rare in AA research for practical reasons. The current study successfully exploited the multiple data waves in Project MATCH to examine evidence of causality between AA participation and drinking outcomes. The study obtained unique statistical results supporting the effectiveness of AA primarily in the context of primary outpatient treatment for alcoholism.

Background: Previous studies have demonstrated that high alcohol consumption is a predictor of divorce. However, there is a lack of studies with prospective data from both spouses. The effects of drinking among husbands versus wives and of concordant versus discordant drinking in couples are therefore unknown. Concordant drinking may lead to increased divorce rates because the malignant effects of heavy drinking are experienced in double doses; alternatively it may lead to marital stability due to partner compatibility., Methods: All inhabitants in a Norwegian county were invited to participate in a health study. We identified 19,977 married couples where both spouses participated. Respondents provided information on alcohol use and mental distress. Survival analysis was applied to study the risk of divorce over the next 15 years. Demographics and mental distress were used as covariates., Results: Heavy drinking among men (hazard ratio [HR] = 1.39) and women (HR = 1.41) increased the risk of future marital dissolution, even after adjusting for demography (reference group "light drinkers"). The HR for divorce was 1.51 when only the husband was a heavy drinker, while it was 3.07 when only the wife was a heavy drinker. Moreover, there were strong interaction effects: concordant abstainers (HR = 0.40) and concordant heavy drinkers (HR = 0.35) had lower risks of divorce compared to the risk expected from combining the main effects. Nevertheless, couples with 2 heavy drinkers (HR = 1.63) had higher risk of divorce than couples with 2 light drinkers., Conclusions: This study demonstrated that both the level of alcohol use and compatibility in alcohol use are important predictors of marital dissolution., (Copyright © 2013 by the Research Society on Alcoholism.)

Background: Randomized controlled trials (RCTs) of mutual aid, including Alcoholics Anonymous (AA), are notoriously difficult to conduct and correlational studies are problematic to interpret due to potential confounds., Methods: A secondary analysis was conducted of Project MATCH, a RCT of alcoholism treatments. Although MATCH did not randomly assign subjects to AA vs. no AA, the 12 step facilitation (TSF) condition did result in a higher proportion of subjects attending community AA meetings than in the other two treatment conditions. The key inference is that there exists a latent subgroup in MATCH who attended AA only because its constituents received TSF, not because of the "normal" factors leading to self-selection of AA. A novel application of propensity score matching (PSM) allowed four latent AA-related subgroups to be identified to estimate an unconfounded effect of AA on drinking outcomes., Results: The study hypothesis was supported: subjects who consistently attended AA solely due to their exposure to TSF (the "Added AA" subgroup) had better drinking outcomes than equivalent subjects who did not consistently attend AA, but would have so attended, had they been exposed to TSF (the "Potential AA" subgroup); this indicates an AA effect on drinking., Conclusions: The analysis presents evidence that consistent AA attendance improves drinking outcomes, independent of "normal" confounding factors that make correlations between AA attendance and outcomes difficult to interpret., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The cognitive repercussions of alcohol dependence are well documented. However, the literature remains somewhat ambiguous with respect to which distinct cognitive functions are more susceptible to impairment in alcoholism and to how duration of abstinence affects cognitive recovery. Some theories claim alcohol negatively affects specific cognitive functions, while others assert that deficits are more diffuse in nature. This is the first meta-analysis to examine cognition in alcohol abuse/dependence and the duration of abstinence necessary to achieve cognitive recovery. A literature search yielded 62 studies that assessed cognitive dysfunction among alcoholics. Effect size estimates were calculated using the Comprehensive Meta-Analysis V2, for the following 12 cognitive domains: intelligence quotient, verbal fluency/language, speed of processing, working memory, attention, problem solving/executive functions, inhibition/impulsivity, verbal learning, verbal memory, visual learning, visual memory and visuospatial abilities. Within these 12 domains, three effect size estimates were calculated based on abstinence duration. The three groups were partitioned into short- (< 1 month), intermediate- (2 to 12 months) and long- (> 1 year) term abstinence. Findings revealed moderate impairment across 11 cognitive domains during short-term abstinence, with moderate impairment across 10 domains during intermediate term abstinence. Small effect size estimates were found for long-term abstinence. These results suggest significant impairment across multiple cognitive functions remains stable during the first year of abstinence from alcohol. Generally, dysfunction abates by 1 year of sobriety. These findings support the diffuse brain hypothesis and suggest that cognitive dysfunction may linger for up to an average of 1 year post-detoxification from alcohol., (© 2012 The Authors, Addiction Biology © 2012 Society for the Study of Addiction.)

Although Korean American women show high levels of involvement in religious practices and high prevalence of alcohol consumption, no studies have assessed the association between religious denomination and alcohol intake among this group of women. This cross-sectional study examined the associations of religious denomination and religious commitment to alcohol consumption among Korean American women in California. Polychotomous regression models were used to provide estimates of the associations between religious denomination and religious commitment to alcohol consumption. Catholic Korean American women (OR 5.61 P < 0.01) and Independent Christian women (OR 4.87 P < 0.01) showed stronger associations to heavy alcohol consumption when compared to Conservative Christian Korean American women. Path analysis suggested that specific denominations had both direct and indirect effects on the outcome of interest, and that religious commitment and drinking models served as moderators for this phenomenon.

Background: Abstinence from alcohol has been associated with higher mortality than a moderate consumption of alcohol. However, there is evidence to indicate that the abstainers constitute a select group which is exposed to various psychosocial risk factors., Material and Method: A population-based sample (N=1978) from the study Young in Norway - longitudinal was followed with repeated surveys from their teens until approaching the age of 30. This data set was linked to various registries. The collection of data included their use of alcohol, social integration and symptoms of anxiety and depression, as well as sexual behaviour. Data on receipt of social benefits were collected from registries., Results: At age 21, altogether 211 individuals (10.7%) had remained abstinent from alcohol throughout their entire lives. At age 28, their number had fallen to 93 individuals (4.7%). At age 21, abstinence was associated with weak networks of friends, loneliness and a higher likelihood of not yet having had a sexual debut. At age 28, the abstainers also reported a higher prevalence of symptoms of anxiety and depression. They were also more frequent recipients of social benefits., Interpretation: Abstinence from alcohol in adulthood is associated with psychosocial problems and weak integration. These may introduce confounding factors in studies of the health effects of alcohol consumption.

Aims: To investigate the direction and degree of potential bias introducedto analyses of drinking and health status which exclude former drinkers from exposure groups., Design: Pooled analysis of 14 waves (1997-2010) of the U.S. National Health Interview Survey (NHIS)., Setting: General population-based study., Participants: 404,462 participants, from 14 waves of the NHIS, who had knownself-reported health status and alcohol consumption status., Measurements: Self-reported health status was used as the indicatorof health. Two approaches were used to classify alcohol consumption: (i) separation of former drinkers and current drinkers, and (ii) combined former and current drinkers. The prevalence of fair/poor health by alcohol use, gender and age with 95% confidence intervals was estimated. The difference in prevalence of fair/poor health status for lifetime abstainers, former drinkers, current drinkers and drinkers (former drinkers and current drinkers combined) were compared using Poisson regression with robust estimations of variance., Findings: Excluding former drinkers from drinker groups exaggerates the difference in health status between abstainers and drinkers, especially for males., Conclusions: In cohort study analyses, former drinkers should be assigned to a drinking category based on their previous alcohol consumption patterns and not treated as a discrete exposure group.

Up to two thirds of adolescents consume alcohol and about a quarter engage in abusive behavior at some point. Many users begin alcohol use at young ages, and binge drinking is a dominant pattern for a proportion of youth. Because neurogenesis is inhibited by ethanol, consequences of adolescent alcohol abuse include changes in brain development and impairment of neurocognitive performance. A variety of mental and psychosocial problems are also often witnessed in alcohol abusing youth. Apart from the influence exerted by genetic and psychosocial factors, the chance of developing problematic alcohol consumption is increased by consumption in a binge drinking manner and by first contact with alcohol at a young age. Discrimination of alcohol consumption within the frames of normal adolescent behavior from problematic use is still a challenging issue. Different prevention programs provide treatment either directly to the adolescent, in the context of the school, or within the frame of the adolescent's family. Although some of these efforts have been shown to be effective in reducing alcohol misuse in youth, hardly any intervention reveals satisfactory outcomes in a long-term prospect. Successful prevention strategies would need to comprise treatment of current neuropsychological impairment as well as of comorbid mental health problems and concurrent other substance misuse.

Introduction and Aims: In the past 40 years, per capita consumption has increased dramatically in Finland. We study the core changes in drinking culture over this period by age and sex., Design and Methods: We used data from the Finnish Drinking Habit Surveys carried out every 8 years in 1968-2008 (n = 16385, response rates 74-97%). Central measures included share of abstainers, frequency of drinking, amounts drunk per occasion and contexts of drinking (location, company, timing)., Results: Weekly drinking and the frequency of moderate drinking increased among both women and men but proportionately more among women and among respondents aged over 30 years. Amounts drunk per occasion and intoxication increased proportionately more among women and younger respondents. Drinking in home surroundings increased more than drinking in licensed premises, and home drinking increasingly occurred in the company of partners only. Drinking was in all periods heavily concentrated on the weekends and evenings., Discussion and Conclusions: Finland has become a wet and permissive drinking culture, and there has been a fundamental cultural shift in women's drinking in particular. Increases in women's drinking have meant that men's drinking has also increasingly been brought to homes, as a part of spouses' shared activities, and pubs have lost their property as masculine strongholds. Intoxication has maintained its important position in the drinking culture, and drinking still takes place primarily in the evenings and weekends. If drinking cultures in present-day low and middle income countries develop similarly, strong increases in alcohol-related harm will follow., (© 2012 Australasian Professional Society on Alcohol and other Drugs.)

Aims: This paper describes changes in alcohol consumption among Swedish youth over the past decade with the aim of exploring the polarization hypothesis, which asserts that while a majority of young drinkers have reduced their alcohol consumption, a subgroup have increased their drinking substantially, resulting in greater harm., Methods: We analysed repeated cross-sectional self-report data from 45,841 15-16-year olds and 40,889 18-19-year-old high-school students living in the Stockholm municipality between 2000 and 2010. The questionnaire assessed alcohol and drug use, and risk factors for alcohol misuse. Changes over time at different levels of consumption are presented by age and gender., Results: We find evidence of a polarization effect in youth drinking, with consumption reducing significantly over the past 10 years among all young people, except the heaviest drinkers, where consumption and binge drinking tended to increase. The dispersion in per capita consumption also increased over time, indicating more heavy drinkers. The total number of risk factors for alcohol misuse decreased among most survey participants from 2000 to 2010, but with variability between years., Conclusion: Polarized drinking habits are a likely explanation for the recent divergence between per capita alcohol consumption, which has decreased, and alcohol-related hospitalizations, which have increased sharply among Swedish youth in recent years. We suggest that ongoing social changes could be affecting young people in the form of greater disparities, which are associated with a higher incidence of social problems generally, including heavy drinking.

Background: The inability of individuals with Alcohol Use Disorders (AUD) to recognize and describe their feelings and cravings may be due to alexithymia. Previous researches have shown evidence for a negative influence of alexithymia on treatment outcomes in patients with AUD. Therefore, it was hypothesized that high alexithymic patients with AUD would benefit less from cognitive behavioral therapy (CBT) compared with low alexithymic patients., Methods: One hundred alcohol-dependent inpatients (DSM IV) were assessed with the Mini International Neuropsychiatric Interview for psychiatric disorders, the Toronto Alexithymia Scale (TAS-20), and the European Addiction Severity Index (EuropASI). Baseline alexithymia, as a categorical and continuous variable, was used to compare or relate baseline demographic and addiction characteristics, time in treatment, abstinence, and differences in addiction severity at 1-year follow-up. Analyses were performed using χ(2) test, analysis of variance or Kruskal-Wallis, paired t-tests or Wilcoxon's signed rank tests, multivariate logistic, and linear regression models, as appropriate., Results: The prevalence of high alexithymia (TAS-20 > 61) was 45%. The total TAS-20 score correlated negatively with years of education (r = -.21; p = .04) and positively with the psychiatry domain of the EuropASI (r = .23; p = .04). Alexithymia showed no relation to abstinence, time in treatment, or change in severity of alcohol-related problems on the EuropASI., Conclusion: High alexithymic patients with AUD do benefit equally from inpatient CBT-like treatment as low alexithymic patients with AUD., Scientific Significance: Multimethod alexithymia assessments with an observer scale have been advised to judge the relationship with resulting outcome in CBT.

Aims: The aim of the study was to assess the proportions of 'high-risk' drinkers' abstinent or with 'low-risk' consumption levels 1 year after the initiation of high-dose baclofen., Methods: This is a retrospective 'open' study; the outcome of this study was to assess the level of alcohol consumption in the 12th month of treatment., Results: Of the 181 patients included, a follow-up evaluation was possible in 132 patients. The initial alcohol consumption of the 132 patients analysed averaged 182 ± 92 g/day. After 1 year, 80% of the 132 (i.e. 58% of 181) were either abstinent (n = 78) or drinking at low-risk levels (n = 28) in their 12th month of treatment. The mean baclofen dose at 1 year was 129 ± 71 mg/day., Conclusion: High-dose baclofen should be tested in randomized placebo-controlled trials among high-risk drinkers.

This study grouped treatment-seeking individuals (n = 1825) by common patterns of 12-step attendance using 5 waves of data (75% interviewed Year 9) to isolate unique characteristics and use-related outcomes distinguishing each class profile. The "high" class reported the highest attendance and abstention. The "descending" class reported high baseline alcohol severity, long treatment episodes, and high initial attendance and abstinence, but by Year 5, their attendance and abstinence dropped. The "early-drop" class, which started with high attendance and abstinence but with low problem severity, reported no attendance after Year 1. The "rising" class, with fairly high alcohol and psychiatric severity throughout, reported initially low attendance, followed by increasing attendance paralleling their abstention. Last, the "low" and "no" classes, which reported low problem severity and very low/no attendance, had the lowest abstention. Female gender and high alcohol severity predicted attendance all years. Consistent with a sustained benefit for 12-step exposure, abstinence patterns aligned much like attendance profiles., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Aims: This study examines 12-Step attendance trajectories over 7 years, factors associated with the trajectories, and relationships between the trajectories and long-term substance use outcomes among adolescents entering out-patient substance use treatment in a private, non-profit integrated managed-care health plan., Design: Longitudinal observational study., Setting: Four Kaiser Permanente Northern California substance use treatment programs., Participants: A total of 391 adolescents entering treatment between 2000 and 2002 who completed at least one follow-up interview in year 1, and at least one during years 3-7, after treatment entry., Measurements: Alcohol and drug use, 12-Step meeting attendance and activity involvement and post-treatment medical service utilization., Findings: Semiparametric group-based modeling identified three distinct 12-Step attendance trajectory groups over 7 years: low/no attendance (60%), early but not continued (26%) and continued (14%). There were lower proportions of males and of adolescents with prior substance use treatment experience in the low/no attendance group (P = 0.019 and P = 0.003, respectively). In addition, those in the low/no attendance group had lower perception on circumstances, motivation and readiness for treatment at baseline (P = 0.023). Multivariate logistic generalized estimating equation analyses found that those in the continued group were more likely to be abstinent from both alcohol and drugs during follow-ups than those in the low/no attendance group [odds ratio (OR) = 2.40, P = 0.003 and OR = 1.96, P = 0.026, respectively]. However, no differences in long-term outcomes were found between those in the other two groups., Conclusion: Robust connection with 12-Step groups appears to be associated with better long-term outcomes among adolescents with substance use disorders., (© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

Background: Discrepant results regarding the association between alcohol consumption and metabolic syndrome may be partly attributable to the different selection of the reference group., Methods: Data from a representative sample of 6,432 Korean adults in 2008 were analyzed., Results: Using lifetime abstainers as the reference group, the prevalence of metabolic syndrome among men was increased in ex-drinkers [3.15 (1.69-5.89)], responsible drinking [0.1-39.9 g/day; 1.77 (1.0-3.13)], and hazardous drinking [≥40 g/day; 2.06 (1.05-4.07)]., Conclusions: Alcohol consumption in men, but not in women, is associated with a higher prevalence of metabolic syndrome.

Aims: To construct Alcoholics Anonymous (AA) attendance, sponsorship and abstinence latent class trajectories to test the added benefit of having a sponsor above the benefits of attendance in predicting abstinence over time., Design: Prospective with 1-, 3-, 5- and 7-year follow-ups., Setting and Participants: Alcoholic-dependent individuals from two probability samples, one from representative public and private treatment programs and another from the general population (n = 495)., Findings: Individuals in the low attendance class (four classes identified) were less likely than those in the high, descending and medium attendance classes to be in high (versus low) abstinence class (three classes identified). No differences were found between the other attendance classes as related to abstinence class membership. Overall, being in the high sponsor class (three classes identified) predicted better abstinence outcomes than being in either of two other classes (descending and low), independent of attendance class effects. Although declining sponsor involvement was associated with greater likelihood of high abstinence than low sponsor involvement, being in the descending sponsor class also increased the odds of being in the descending abstinence class., Conclusions: Any pattern of Alcoholics Anonymous attendance, even if it declines or is never high for a particular 12-month period, is better than little or no attendance in terms of abstinence. Greater initial attendance carries added value. There is a benefit for maintaining a sponsor over time above that found for attendance., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

Background: Previous research has associated abnormalities in frontal lobe functioning with alcohol relapse. In this study, we used diffusion tensor imaging to investigate whether frontal white matter integrity measured at the start of treatment differs between persons with alcohol use disorders (AUD) who sustain treatment gains and those who return to heavy use after treatment., Methods: Forty-five treatment-seeking AUD inpatients and 30 healthy control subjects were included in the study. Six months after completing treatment, 16 of the AUD participants had resumed heavy use (RHU) and 29 others remained abstinent or drank minimally (treatment sustainers [TS]). Voxel-wise group comparisons (TS vs. RHU) were performed on fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity maps generated from each subject's diffusion tensor imaging scan at the start of treatment., Results: We found significantly lower FA and significantly higher RD in the frontal lobes of the RHU group, relative to the TS group. The RHU group data are consistent with previous reports of abnormal frontal white matter tract abnormalities in persons with AUD., Conclusions: It is possible that the lower FA and higher RD in the RHU group reflect microstructural injury to frontal circuitries, and these may underlie the reduced cognitive control amid heightened reward sensitivity associated with resumption of heavy drinking., (Copyright © 2012 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Alcohol problems are widespread throughout the United States. While treatment can be successful, many individuals continue to drink. One method to assess treatment results over time is by investigating abstinence as a measure of success., Objectives: The main aim of this study is to investigate factors that may be associated with past-year (PY) abstinence among individuals who received prior-to-past-year (PPY) treatment for alcohol problems, while also assessing abstinence by treatment subtype., Method: This study uses data from 1742 individuals who received PPY treatment for alcohol problems in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Logistic regression models were used to assess the strength of association between alcohol abstinence and key demographic and clinical factors., Results: The level of PY abstinence was 36.5% among those who previously sought treatment for alcohol problems. Younger age groups and those who were nicotine dependent or had a cannabis use disorder were less likely to be abstinent. There were no differences based on sex or PY major depression or generalized anxiety disorder., Conclusion: While causal inferences cannot be made, these results suggest that the majority of people continue to drink, even after being treated for alcohol problems. Nonetheless, variation may exist depending on the form of treatment a person receives. More research is needed regarding long-term levels of abstinence after individuals receive treatment.

Aims: To examine associations of abstention, alcohol consumption and problem drinking with subsequent disability pensioning (DP), and whether previous excessive consumption ('sick-quitting') could explain some of the increased risk for DP among abstainers., Design: Prospective population-based study., Setting and Participants: Data were from two waves of the Nord-Trøndelag Health Study (HUNT) linked with the national insurance database. The two main analyses included 37,729 (alcohol consumption) and 34,666 (problem drinking) participants., Measurements: Alcohol consumption was measured by self-reported consumption, while problem drinking was assessed by the Cut down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire. Information on subsequent DP, including diagnosis for which the DP was awarded, was gathered from the national insurance database. Covariates included somatic illness and symptoms, mental health, health-related behaviour, socio-economic status and social activity., Findings: Those reporting the highest level of alcohol consumption were not at increased risk for DP [hazard ratio (HR) 1.12, 95% confidence interval (CI): 0.92-1.38], whereas problem drinking was a strong predictor (HR 2.79, 95% CI: 2.08-3.75) compared to their corresponding reference groups. Alcohol abstainers were also at increased risk for DP, but among them, the previous consumers (HR 1.95, 95% CI: 1.48-2.57) and previous excessive consumers (HR 1.67, 95% CI: 1.01-2.74) were at higher risk for DP than constant abstainers., Conclusions: Problem drinking is linked to subsequent requirement for a disability pension but mere alcohol consumption is not. This is partly explained by 'sick-quitting'., (© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

Background: The relationship between alcohol consumption and ischaemic heart disease (IHD) risk is complex and several issues remain unresolved because many studies used rather crude exposure measures often based on one or two questions. The objective of this study was to investigate the association between heavy drinking occasions and IHD mortality while controlling for average daily alcohol intake and separating former drinkers from lifetime abstainers., Methods: Cox regression analyses were used with IHD mortality as the outcome in a sample of 9934 participants of the US National Alcohol Surveys conducted in 1984 and 1995., Results: To the end of 2006, 326 deaths from IHD were recorded in the 11- to 22-year follow-up period. Any past heavy drinking occasions in former drinkers [hazard ratio (HR) = 2.06; 95% confidence interval (95% CI): 1.10-3.85] compared with former drinkers without such drinking occasions, and any heavy drinking occasion in current drinkers at baseline (HR = 2.05; 95% CI: 1.03-3.98) compared with current drinkers with average daily intake of one to two drinks, were associated with higher IHD mortality in men and any heavy drinking occasions among drinkers of up to 1 drink average consumption in women with similar effect size. Confounding effects from age, race, education, employment, income, marital status, geographical region, depression score, survey period or other drug use were small., Conclusions: Among former and current drinkers, heavy drinking occasions should be taken into account when examining the complex association of alcohol consumption on IHD mortality risk.

Background: The influence of alcohol consumption on outcome in patients with peripheral artery disease (PAD) has not been thoroughly studied., Methods: Factores de Riesgo y ENfermedad Arterial (FRENA) is an ongoing, multicenter, observational registry of consecutive stable outpatients with arterial disease. We compared the mortality rate and the incidence of subsequent ischemic events in patients with PAD, according to their alcohol habits., Results: As of August 2010, 1073 patients with PAD were recruited, of whom 863 (80%) had intermittent claudication (Fontaine stage II), 102 (9.5%) had rest pain (Fontaine stage III), and 108 (10%) had ischemic skin lesions (Fontaine stage IV). In all, 422 patients (39%) consumed alcohol during the study period. Over a mean follow-up of 13 months, 150 patients (14%) developed subsequent ischemic events (myocardial infarction 28, stroke 30, disabling claudication/critical limb ischemia 100), and 70 patients (6.5%) died. The incidence of subsequent events was the same in both subgroups: 11.8 events per 100 patient-years (rate ratio: 1.00; 95% confidence interval [CI], 0.72-1.41), but the mortality rate was significantly lower in alcohol consumers than in non-consumers: 2.78 vs 6.58 deaths per 100 patient-years (rate ratio: 0.42; 95% CI, 0.23-0.74; P = .002). This better outcome was consistently found in patients with Fontaine stages II and III or IV, and persisted after multivariate adjustment (relative risk: 0.49; 95% CI, 0.28-0.88)., Conclusions: In patients with PAD, moderate alcohol consumption was associated with lower cardiovascular mortality and overall mortality than abstention. These patients should be informed that low to moderate alcohol consumption may not be harmful to their health., (Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Objectives: To study if an association between total weekly intake of alcohol, type-specific weekly alcohol intake, alcoholic beverage preference, and the number of teeth among older people exists., Methods: A cross-sectional study including a total of 783 community-dwelling men and women aged 65-95 years who were interviewed about alcohol drinking habits and underwent a clinical oral and dental examination. Multiple regression analyses were applied for studying the association between total weekly alcohol consumption, beverage-specific alcohol consumption, beverage preference (defined as the highest intake of one beverage type compared with two other types), and the number of remaining teeth (≤ 20 versus >20 remaining teeth)., Results: The odds ratio (OR) of having a low number of teeth decreased with the total intake of alcohol in women, with ORs for a low number of teeth of 0.40 [95 percent confidence interval (CI) 0.22-0.76] in women drinking 1-14 drinks per week and 0.34 (95 percent CI 0.16-0.74) in women with an intake of more than 14 drinks per week compared with abstainers. Similar relations could also be obtained for type-specific alcohol intake of wine and for wine and spirits preference among women. Men who preferred beer showed a decreased risk for a low number of teeth compared with men with other alcohol preferences., Conclusion: In this study, alcohol consumption, wine drinking, and wine and spirits preference among women were associated with a higher number of teeth compared with abstainers. Among men, those who preferred beer also had a higher number of teeth., (© 2011 American Association of Public Health Dentistry.)

Background: This study examined associations between two types of AA participation (i.e., meeting attendance, having a sponsor) and two types of post-treatment abstinence (i.e., abstinence from alcohol, abstinence from drugs)., Method: Respondents completed measures that assessed their demographic characteristics, the severity of their substance use, and their motivation to change when they enrolled in treatment (T1). They completed measures of AA participation at T1 and a 3-month follow-up assessment (T2), and measures of recent abstinence at T1 and a 6-month follow-up assessment (T3)., Results: T2 sponsor was associated prospectively with T3 abstinence from alcohol., Conclusions: Having a sponsor served as a marker for subsequent abstinence. Future research can examine factors that may mediate or moderate the associations between having a sponsor and subsequent abstinence., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aims: This paper examines (i) gender and country differences in negative consequences related to drinking; (ii) relative rates of different consequences; and (iii) country-level predictors of consequences., Design Setting and Participants: Multi-level analyses used survey data from the Gender, Alcohol, and Culture: An International Study (GENACIS) collaboration., Measurements: Measures included 17 negative consequences grouped into (i) high endorsement acute, (ii) personal and (iii) social. Country-level measures included average frequency and quantity of drinking, percentage who were current drinkers, gross domestic product (GDP) and Human Development Index (HDI)., Findings: Overall, the three groupings of consequences were reported by 44%, 12% and 7% of men and by 31%, 6% and 3% of women, respectively. More men than women endorsed all consequences, but gender differences were greatest for consequences associated with chronic drinking and social consequences related to male roles. The highest prevalence of consequences was in Uganda and lowest in Uruguay. Personal and social consequences were more likely in countries with higher usual quantity, fewer current drinkers and lower scores on GDP and HDI. However, significant interactions with individual-level quantity indicated a stronger relationship between consequences and usual quantity among drinkers in countries with lower quantity, more current drinkers and higher scores on GDP and HDI., Conclusions: Both gender and country need to be taken into consideration when assessing adverse drinking consequences. Individual measures of alcohol consumption and country-level variables are associated with experiencing such consequences. Additionally, country-level variables affect the strength of the relationship between usual quantity consumed by individuals and adverse consequences., (© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.)

Aims: To estimate the overall impact of alcohol on ischemic heart disease (IHD) mortality in the United States using aggregate-level models and to consider beverage-specific effects that may represent more effectively the changes in drinking patterns over time that are related to both harmful and protective impacts of alcohol consumption on IHD., Design: Several model specifications are estimated, including state-specific autoregressive integrated moving average (ARIMA) models and generalized least squares (GLS) panel models on first-differenced data., Setting: US states from 1950 to 2002., Participants: US general population., Measurements: Per capita alcohol sales and cigarette sales, age-standardized IHD and cirrhosis mortality rates., Findings: Apparent consumption of total alcohol was associated with a significant overall increase of IHD of about 1% mortality per litre of ethanol. Beverage-specific models found that spirits consumption was significantly positively related to IHD mortality overall, for both genders and in three regions defined by drinking culture (or 'wetness'), while beer was found to have a significant protective relationship overall and in the wet region. The results for wine also suggest a protective relationship, but only marginally significant effects were found. Cirrhosis mortality rates were consistently positively related to IHD mortality. Combined results from state-specific ARIMA models including both cigarette sales and cirrhosis rates were generally consistent with the GLS results., Conclusions: Population-level models confirm individual-level findings of both harmful and protective relationships between alcohol use patterns and ischemic heart disease mortality. However, an overall harmful impact of per capita alcohol consumption on IHD mortality was found., (© 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.)

Background: Disulfiram is used to a great extent in Denmark to treat alcoholism but the evidence is limited., Aim: To study the effect of supervised disulfiram treatment in alcohol dependence. Subjects were recruited from a psychiatric emergency ward following alcohol withdrawal treatment., Methods: A total of n=39 patients were openly randomized to either disulfiram 800 mg twice a week for 26 weeks (n=19) or no disulfiram (n=20). All patients were also treated with cognitive behavioural therapy (CBT) in groups., Results: The rate of abstinence was 20% and 26% in the control and disulfiram group, respectively. This difference was not statistically significant (NS). A trend towards increased mean time to first drink was found in the disulfiram group (96 vs. 76 days in the control group, NS), while fewer patients in this group completed CBT group therapy (41% vs. 67% in the control group, NS). Alcohol-free days were 100 days in both groups (NS)., Conclusion: Supervised disulfiram administration did not have any major impact on the treatment outcome.

Aims: The current study was designed to re-examine the motivation matching hypothesis from Project MATCH using growth mixture modeling, an analytical technique that models variation in individual drinking patterns., Design, Setting and Participants: Secondary data analyses of data from Project MATCH (n = 1726), a large multi-site alcoholism treatment-matching study., Measurements: Percentage of drinking days was the primary outcome measure, assessed from 1 month to 12 months following treatment. Treatment assignment, alcohol dependence symptoms and baseline percentage of drinking days were included as covariates., Findings: The results provided support for the motivation matching hypothesis in the out-patient sample and among females in the aftercare sample: the majority of individuals with lower baseline motivation had better outcomes if assigned to motivation enhancement treatment (MET) compared to those assigned to cognitive behavioral treatment (CBT). In the aftercare sample there was a moderating effect of gender and alcohol dependence severity, whereby males with lower baseline motivation and greater alcohol dependence drank more frequently if assigned to MET compared to those assigned to CBT., Conclusions: Results from the current study lend partial support to the motivation-matching hypothesis and also demonstrated the importance of moderating influences on treatment matching effectiveness. Based upon these findings, individuals with low baseline motivation in out-patient settings and males with low levels of alcohol dependence or females in aftercare settings may benefit more from motivational enhancement techniques than from cognitive-behavioral techniques.

National alcohol prohibition in the United States between 1920 and 1933 is believed widely to have been a misguided and failed social experiment that made alcohol problems worse by encouraging drinkers to switch to spirits and created a large black market for alcohol supplied by organized crime. The standard view of alcohol prohibition provides policy lessons that are invoked routinely in policy debates about alcohol and other drugs. The alcohol industry invokes it routinely when resisting proposals to reduce the availability of alcohol, increase its price or regulate alcohol advertising and promotion. Advocates of cannabis law reform invoke it frequently in support of their cause. This paper aims: (i) to provide an account of alcohol prohibition that is more accurate than the standard account because it is informed by historical and econometric analyses; (ii) to describe the policy debates in the 1920s and 1930s about the effectiveness of national prohibition; and (iii) to reflect on any relevance that the US experience with alcohol prohibition has for contemporary policies towards alcohol. It is incorrect to claim that the US experience of National Prohibition indicates that prohibition as a means of regulating alcohol is always doomed to failure. Subsequent experience shows that partial prohibitions can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement.