Visits by the elderly to United States EDs for alcohol-related disorders

Standardized Models for Identification and Intervention for Emergency Department Patients at Risk for Alcohol Use Disorder

Alcohol use disorder (AUD) is chronic, lasting a person's lifetime. An increase in driving under the influence of alcohol, as well as emergency department (ED) visits, has been reported. The Alcohol Use Disorder Identification Test Consumption (AUDIT-C) is utilized to assess hazardous drinking. The Screening, Brief Intervention, Referral to Treatment (SBIRT) model assists in early intervention and referral for treatment. The Transtheoretical Model standardized instrument assesses individual readiness to change. These tools may be used by nurses and nonphysicians in the ED to help reduce alcohol use and the consequences of its use.

Psychometric Properties of the CAGE Questionnaire Amongst Middle-Aged and Older Adults in Khuzistan Province of Iran

The CAGE questionnaire is an instrument, proved useful in helping to make a diagnosis of alcoholism. The questions focus on Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. The questionnaire has been more pervasive simple tool than AUDIT and LAST scales to screen in busy medical settings where limited time is considered for adult patient interviews. The present study aimed to determine the reliability and validity of the CAGE questionnaire in Khuzistan province, Iran and evaluate its role in detecting alcohol-related problems. For this purpose, 382 men with mean age of 65 ± 5 were sampled by cluster-random sampling method in convenience model from the medical centers in eight counties of Khuzistan province during 2019 and they responded to the CAGE questionnaire. The coefficients of Cronbach's alpha (α = 0.82), convergent validity (0.73), divergent validity (-0.06), and criterion validity (0.87) were estimated (ρ < 0.01). The exploratory factor analysis demonstrated that the four -items related to the CAGE for the aged samples are organized into one factor, which clarifies 94% of the variance. Based on the results of the second-order confirmatory factor analysis, all factors were matched up well into a principal factor. Finally, the one -factor model was appropriate for the data by using the fit index techniques for adjusting the scale (AGFI = 0.81, TLI = 0.91, GFI = 0.93, RMSEA = 0.006, IFI = 0.94, NFI = 0.91, CFI = 0.97).The results could prove the well-adjusted reliability and validity of the CAGE and its usefulness for the relevant studies.

Opioid and Alcohol Misuse in Veterans with Chronic Pain: A Risk Screening Study

In United States military veterans, chronic pain represents a risk factor for opioid and alcohol misuse, yet few studies have examined interactions among chronic pain, opioid prescription, and opioid and alcohol misuse. Previous work found substantial risk of co-morbid alcohol and opioid misuse in a community sample of opioid-prescribed individuals with chronic pain, a finding expanded upon here. Specifically, 211 veterans assessed within a chronic pain treatment service for opioid-prescribed individuals completed self-report measures of opioid misuse, alcohol misuse, pain intensity, depression, pain catastrophizing, and post-traumatic stress symptoms (PTS). Based on the substance misuse measures, 32% (n = 68) were misusing neither opioids nor alcohol, 23% (n = 48) were misusing both opioids and alcohol, 40% (n = 84) were misusing opioids alone, and 5% (n = 11) were misusing alcohol alone. Group comparisons indicated that individuals not misusing either substance were less distressed in comparison to those who were misusing opioids alone or both substances. The latter groups differed in PTS. Overall, misuse frequencies mirrored previous work, with approximately 1 of 3 misusing opioids and approximately 1 of 5 misusing both substances. There is a need for increased focus on both polysubstance misuse and the development of integrated treatment.

Alcohol use by people in their seventies is not an exception: a preliminary prospective study

The ageing population is rapidly increasing worldwide, and the alcohol-related disease burden in most Western countries is on the rise. However, very few studies assess alcohol use in older people. Here, a self-reported questionnaire was administered to all individuals aged 70 years or more who visited a social centre for older people in western France. The average age of the 98 subjects included in the survey was 79 years (range, 70-97 years; SD=6), and 57.1% (n=56) reported weekly alcohol consumption. An average consumption of over two standard units each day during weekends was reported by 53% subjects (n=52), and the same on each weekday was reported by 34% (n=33). Thus, a significant proportion of subjects aged 70 years or over consumed more alcohol than is recommended in current guidelines. The participants also reported that they rarely discussed alcohol consumption with their general practitioners. Alcohol use should be assessed regularly. District nurses and members of the primary care team should recommend strategies to help older people reduce their alcohol consumption.

Alcohol and Opioid Use in Chronic Pain: A Cross-Sectional Examination of Differences in Functioning Based on Misuse Status

Opioid misuse is regularly associated with disrupted functioning in those with chronic pain. Less work has examined whether alcohol misuse may also interfere with functioning. This study examined frequency of opioid and alcohol misuse in 131 individuals (61.1% female) prescribed opioids for the treatment of chronic pain. Participants completed an anonymous survey online, consisting of measures of pain, functioning, and opioid and alcohol misuse. Cut scores were used to categorize individuals according to substance misuse status. Individuals were categorized as follows: 35.9% (n = 47) were not misusing either opioids or alcohol, 22.9% (n = 30) were misusing both opioids and alcohol, 38.2% (n = 50) were misusing opioids alone, and only 3.0% (n = 4) were misusing alcohol alone. A multivariate analysis of variance was performed to examine differences in pain and functioning between groups (after excluding individuals in the alcohol misuse group due to the small sample size). Group comparisons indicated that individuals who were not misusing either substance were less disabled and distressed in comparison to those who were misusing opioids alone or both opioids and alcohol. No differences were indicated between the latter 2 groups. Overall, the observed frequency of opioid misuse was somewhat higher in comparison to previous work (approximately 1 out of every 3 participants), and misuse of both alcohol and opioids was common (approximately 1 out of every 5 participants). While these data are preliminary, they do suggest that issues of substance misuse in those with chronic pain extends beyond opioids alone.

PERSPECTIVE

Opioid and alcohol misuse was examined in 131 individuals prescribed opioids for chronic pain. In total, 35.9% were not misusing either, 22.9% were misusing both, 38.2% were misusing opioids, and 3.1% were misusing alcohol. Individuals not misusing either were generally less disabled and distressed compared to those misusing opioids or both.