Dimensions of alcohol-related social and health consequences in survey research

Levels and outcomes of 12-step participation among sexual and gender minority subgroups

INTRODUCTION

Sexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes.

METHODS

We used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately.

RESULTS

Participants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model.

CONCLUSIONS

This study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.

Hazardous drinking and violence-related hospitalizations in the Danish general population: A historical cohort study

BACKGROUND

It is well documented by case-control and case-crossover studies that hazardous drinking and the risk of experiencing violence-related injuries are related. The present study investigated this relationship in a cohort of general population survey respondents in Denmark using subsequent hospital admissions for violence.

METHODS

The cohort consisted of participants in the 2011 Danish national survey on alcohol and drugs (N = 5126). Survey responses were used to identify those with hazardous alcohol use. Register data on the cohort's hospital admissions for violence from 2010 through 2018 served as the outcome. The relationship between respondents' hazardous drinking and counts of subsequent hospital admissions was investigated using a Poisson regression model.

RESULTS

After controlling for confounding, respondents with hazardous consumption (Alcohol Use Disorders Identification Test Consumption [AUDIT-C] cut off: 5 points) had an increased rate of hospital admissions for violence, with an incidence rate ratio (IRR) of 2.28 (95% CI: 1.16-4.50) compared to respondents without hazardous alcohol use. Each additional AUDIT-C point was associated with a 20% increase in the incidence rate for violence-related admission (IRR=1.20, 95% CI: 1.06-1.37). Furthermore, interaction analyses showed a significant interaction between gender and AUDIT-C score on hospital admissions for violence (IRR=0.69, 95% CI: 0.53-0.90).

CONCLUSIONS

Results provide evidence that hazardous alcohol use is associated with subsequent hospital admissions for violence in the Danish general population and that gender moderates this relationship.

Rates and predictors of Alcoholics Anonymous attendance across sexual orientations

Sexual minority (e.g., gay, lesbian, bisexual) individuals experience alcohol dependence at 2-6 times the rates of heterosexual individuals. Among the general population, Alcoholics Anonymous (AA) serves as the most common source of support for alcohol-related problems in the United States. Yet, relatively little is known about sexual minority involvement in AA, including rates and predictors of AA attendance among sexual minorities. This paper aims to: 1) Compare rates of AA attendance across sexual orientations; 2) Compare relationships between AA attendance and common predictors of AA attendance across sexual orientations. Using five waves of the National Alcohol Survey (N = 7862 respondents with at least one lifetime AUD symptom), this study found lesbian and bisexual women, but not gay and bisexual men, had greater odds of attending AA, even while controlling for lifetime AUD severity, gender, race/ethnicity, age, religiosity, and current income. Interaction models for women showed there was a stronger association between older age and AA attendance, a stronger association between greater religiosity and AA attendance, and a weaker association between lifetime AUD severity and AA attendance for sexual minority women relative to heterosexual women. This study did not find significant interactions between sexual orientation and these covariates for men. These results suggest AA may serve as a promising resource for sexual minority individuals experiencing alcohol-related problems, particularly for sexual minority women who are older, more religious, and have less severe AUD.

Gender differences in social harms from drinking among young Australians: findings from the Mater University Study of Pregnancy and its Outcomes

Background: Despite the growing interest in investigating social harms from drinking, little is known about drinkers' reports of these harms and their gender differences among Australian young adults at age 30. We aimed to examine gender differences of social harms from drinking as reported by drinkers.Methods: 2,200 young adults at age 30 with complete data on social harms from drinking were drawn from the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy. Measures included percentages of 11 past-year drinkers' self-reported social harms stratified by gender. Logistic regression was used to examine associations between gender and each social harm, accounting for relevant confounding.Results: More than one in five young adults (22%) reported at least one social harm in the past year. Among binge drinkers, 44% reported at least one social harm. After adjustments for social roles and binge drinking, we found no gender differences on several self-reported social harms: friendship problems, people criticizing drinking, non-marital family problems, employment problems, and alcohol-fuelled fights. However, men were more likely to report spousal threats to leave, drink-driving legal problems and financial problems.Conclusions: Our findings demonstrate that young adults are still vulnerable to risky drinking at age 30 and the social harm resulting from drinking. Thus, alcohol prevention campaigns should target this age group and include women in their focus. Strategies aiming to reduce alcohol-related harms, such as screening in clinical settings for risky drinking and alcohol-related harms, followed by motivational behavior interventions, could be beneficial among these vulnerable groups.

Alcohol use and its consequences in the Czech Republic

OBJECTIVE

Alcohol consumption is associated with substantial public health burden. This article summarises available information on the patterns and prevalence of alcohol use in the Czech Republic with a focus on the heavy alcohol use and its health and social consequences.

METHODS

A non-systematic literature review was conducted. The data sources included primarily 3 series of surveys in the adult population, 2 series of surveys in the school population, routine monitoring system of per capita alcohol consumption, routine statistics on alcohol-related morbidity and mortality, and alcohol-related crime.

RESULTS

In recent years the registered alcohol consumption in the Czech Republic has been very high; 9.8 litres of pure alcohol were consumed per capita in 2017. Recently, the prevalence of hazardous alcohol consumption in the adult population has reached 16.8-17.6% and harmful alcohol consumption 9.0-9.3%. From 12% to 17% of adult population and 12% of adolescent population were heavy episodic drinkers. Alcohol-related disorders are disproportionately higher (2-3 times) among men. Mortality for alcohol-related causes fully attributable to alcohol (AAF = 100%) and their proportion in overall mortality is on increase.

CONCLUSIONS

Alcohol consumption as well as the prevalence of heavy episodic drinking in the Czech Republic belongs among the highest globally. On the other hand, declines in alcohol use have been recently observed among children and adolescents. Available data on alcohol-related morbidity indicate stable situation, though alcohol-related mortality is increasing. Alcohol-related burden is rather underestimated and evidence-based alcohol policy should be increasingly implemented.

Predicting Alcohol-Related Harm by Sociodemographic Background: High Prevalence versus High Risk

The main purpose of this study is to examine the relationship between sociodemographic background (gender, age, household situation, socioeconomic status, and region of residence) and the level of alcohol-related harm, when controlling for actual drinking habits in terms of average volume and binge drinking frequency. The dependent variables, modelled in logistic regressions, were summary measures of four areas of harm from alcohol–-impaired self-control, chronic health problems, public disorder, and interpersonal problems. The data was drawn from a 2002 Swedish national survey, consisting of 5,469 completed telephone interviews with adults 17 years old and above. Across all the problem areas, sociodemographic background variables seem to be rather weak overall predictors of experienced harm from drinking. The strongest effects found, besides drinking itself, were for being young–-especially for public disorder and impaired self-control. Socioeconomic indicators (income and education) and marital status also showed some significant effects, but these pointed in different directions for men and women, as well as for the different problem areas. Almost no regional differences could be observed. The results are, at least in part, in line with the so-called two-step model–-particularly for people above 30. According to this model, sociodemographic variables are good predictors of variation in drinking habits, while other factors may have a higher explanatory value for the harm from a given level of drinking. Based on the findings, interventions aimed to affect everybody's drinking might be preferred rather than harm reduction strategies targeted at particular risk groups.

Conceptual and Methodological Issues in Studying Alcohol's Harm to Others1

While there is a longer history of concern about alcohol's harm to others, researchers' interest has intensified in the last few years. The background of variation in concern over time in different societies is outlined. Three main traditions of research have emerged: population survey studies of such harm from the perspective of the ‘other’; analysis of register or case-record data which includes information on the involvement of another's drinking in the case; and qualitative studies of interactions and experiences involved in particular harms from others' drinking. In the course of the new spate of studies, many conceptual and methodological issues have arisen, some of which are considered in the paper. The diverse types of harms which have been studied are discussed. The social and personal nature of many of the harms means they do not ft easily into a disability or costing model, raising questions about how they might best be counted and aggregated. Harm from others' drinking is inherently interactional, and subject to varying definitions of what counts as harm. The attribution to drinking, in the usual situation of conditional causation, is also subject to variation, with moral politics potentially coming into play. For measurement and comparison, account needs to be taken of cultural and individual variations in perceptions and thresholds of what counts as a harm, and attribution to alcohol. The view from the windows of a population survey and of a response agency case register are often starkly different, and research is needed, as an input and spur to policy initiatives, on what influences this difference and whether and how the views might be reconciled.

Positioning Alcohol's Harm to others (AHTO) within Alcohol Research: A Reinvented Perspective with Mixed Policy Implications

Aims & Design

This overview analyses the recent emergence of the concept of alcohols harm to others (AHTO) and the potential policy implications embedded in this research perspective. The overview is an account of ways in which recent alcohol research has grasped the kind of harm that goes beyond the drinker. It positions the dimensions of alcohol's harm to others as a research perspective in relation to other established research approaches to alcohol-related problems.

Findings

Several concepts presented within different disciplines have focused on how adverse consequences of drinking go beyond the individual drinker. However, the scientific discussion is still characterised by an obvious conceptual instability. Alongside the growing research interest in alcohol's harm to others there is a political discourse stressing the urgency of alcohol policy measures protecting innocent victims against damage from others' alcohol use.

Conclusions

In drawing attention to the interactional nature of alcohol-related harm, the AHTO perspective brings a novel syntagmatic and cross-cutting aspect to established traditions in alcohol research and forms a unique scientific approach. The AHTO perspective has the potential for creating a political will to move the alcohol policy agenda forward, but the question of a suitable and credible term is unresolved. Conceptually, the AHTO perspective is still in a state of flux, while politically it is loaded with considerable ambitions and interests related to causal attributions and ethical conclusions embedded in the research perspective.

Involvement in alcohol-related verbal or physical aggression. Does social status matter?

Introduction

–The analyses (1) assessed the association between social status variables and aggression when controlling for volume of alcohol consumption and episodic heavy drinking (EHD), (2) tested whether social status moderates the association between volume or EHD and verbal as well as physical aggression, and (3) investigated whether EHD moderates the effect of volume on aggression.

Methods

Swedish Alcohol Monitoring Survey (2003 to 2011); N=104,316 current drinkers; response rate: 51 to 38%. Alcohol-related aggression was defined as involvement in a quarrel or physical fight while drinking. Social status was defined as the highest education, monthly income and marital status.

Results

The associations between social status variables and aggression showed mixed results. Verbal aggression was associated with education in males and with marital status in both genders. Physical aggression was associated with education in both genders. No associations with aggression were found for income. With few exceptions, these associations remained significant when controlling for drinking patterns; social status did not moderate the association between drinking and aggression; EHD moderated the effect of volume on physical aggression in males.

Conclusions

Groups of lower educated and non-married individuals experience verbal or physical aggression over and above different levels of consumption. Individual differences in aggression vulnerability rather than differences in aggression predisposition account for higher risks of aggression in these groups.

Evidence-Based Prevention for Adolescent Substance Use

Due to the significant consequences of adolescent substance use behaviors, researchers have increasingly focused on prevention approaches. The field of prevention science is based on the identification of predictors of problem behaviors, and the development and testing of prevention programs that seek to change these predictors. As the field of prevention science moves forward, there are many opportunities for growth, including the integration of prevention programs into service systems and primary care, an expansion of program adaptations to fit the needs of local populations, and a greater emphasis on the development of programs targeted at young adult populations.

To Cause Harm and to be Harmed by Others: New Perspectives on Alcohol's Harms to Others

OBJECTIVE

To examine how sociodemographic factors and alcohol consumption are related to a four-way typology of causing harm to others and/or being harmed by others’ and one’s own drinking.

DATA AND METHODS

Data from the 2011 Danish national survey (n = 2,569) were analyzed with multi nomial logistic regression.

RESULTS

Younger age and heavy drinking were significant correlates of both causing harm and being harmed. Women and better educated respondents were more likely to report negative effects on relationship and family from another’s drinking. Better educated respondents had higher risks for work, financial, or injury harms from another’s drinking. Mean alcohol consumption and risky single occasion drinking were related to both causing harm and being harmed from one’s own drinking.

CONCLUSIONS

Drinking variables were the strongest correlates of causing harm and being harmed. Efforts to reduce risky drinking may also help reduce exposures to collateral harm.

Alcohol and burden of disease in Australia: the challenge in assessing consumption

OBJECTIVE

Alcohol consumption is one of the major avoidable risk factors for disease, illness and injury in the Australian community. Population health scientists and economists use estimates of alcohol consumption in burden of disease frameworks to estimate the impact of alcohol on disease, illness and injury. This article highlights challenges associated with estimating alcohol consumption in these models and provides a series of recommendations to improve estimates.

METHODS

Key challenges in measuring alcohol consumption at the population level are identified and discussed with respect to how they apply to burden of disease frameworks.

RESULTS

Methodological advances and limitations in the estimation of alcohol consumption are presented with respect to use of survey data, population distributions of alcohol consumption, consideration of 'patterns' of alcohol use including 'bingeing', and capping exposure. Key recommendations for overcoming these limitations are provided. Implications and conclusion: Alcohol-related burden has a significant impact on the health of the Australian population. Improving estimates of alcohol related consumption will enable more accurate estimates of this burden to be determined to inform future alcohol policy by legislators.

Alcohol drinking patterns and differences in alcohol-related harm: a population-based study of the United States

Alcohol use and associated alcohol-related harm (ARH) are a prevalent and important public health problem, with alcohol representing about 4% of the global burden of disease. A discussion of ARH secondary to alcohol consumption necessitates a consideration of the amount of alcohol consumed and the drinking pattern. This study examined the association between alcohol drinking patterns and self-reported ARH. Pearson chi-square test (χ²) and logistic regression analyses were used on data from the National Comorbidity Survey Replication (NCS-R). The NCS-R is a cross-sectional nationally representative sample. Data was obtained by face-to-face interviews from 9282 adults aged ≥18 years in the full sample, and 5,692 respondents in a subsample of the full sample. Results presented as odds ratio (OR) and 95% confidence intervals (95% CI). Alcohol drinking patterns (frequency of drinking, and drinks per occasion) were associated with increased risks of self-reported ARH; binge or “risky” drinking was strongly predictive of ARH than other categories of drinks per occasion or frequency of drinking; and men had significantly higher likelihood of ARH in relation to frequency of drinking and drinks per occasion. Findings provide evidence for public health practitioners to target alcohol prevention strategies at the entire population of drinkers.

Heavy drinking occasions in Australia: do context and beverage choice differ from low-risk drinking occasions?

INTRODUCTION AND AIMS

The aim of the current study is to look for differences in drink choice and drinking location between a recent heavy drinking occasion (RHDO) and usual low-risk occasions among those that recently had both types of drinking occasion.

DESIGN AND METHODS

Seven hundred and seventy-four respondents to a population-based survey reported having a RHDO [8 + Australian standard drinks (ASD) for females, 11 + ASD for males] in the past six months also reported that their usual drinking occasion in at least one location involved less than five ASD. Drink choice and drinking locations for the RHDO and usual low-risk occasions were compared using confidence intervals.

RESULTS

The RHDO was more likely than usual low-risk occasions to occur away from licensed premises (59%), despite a higher percentage of respondents reporting drinking at a pub, bar or nightclub on a RHDO (28%) than on a usual low-risk night (12%). A higher percentage of respondents nominated bottled spirits (33%) as their main drink for their RHDO, with 11% primarily drinking bottled spirits on a usual low-risk occasion; the converse was true for bottled wine (20% and 33%, respectively).

DISCUSSION AND CONCLUSIONS

While the high proportion of RHDOs that occurred at least in part at pubs or nightclubs was not surprising, a high proportion also occur in private homes. Previously found links between heavy drinking and beer may be a reflection of the usual drink choice of heavier drinkers, rather a choice specific to a particularly heavy occasion.

Gender differences in associations of neighbourhood disadvantage with alcohol's harms to others: a cross-sectional study from the USA

INTRODUCTION AND AIMS

To examine whether alcohol's harms to others are more prevalent in socioeconomically disadvantaged neighbourhoods and whether men or women are at differential risk in these neighbourhoods.

DESIGN AND METHODS

Cross-sectional survey data from 2000 and 2005 National Alcohol Surveys were linked to geo-referenced indicators of neighbourhood disadvantage from the US 2000 Decennial Census. The pooled sample included 10,121 adults (54% female; average age 44.4 years; 69% White; 13% African-American; 13% Hispanic). A dichotomous indicator denoted neighbourhoods based on the top quartile on a five-item measure of disadvantage (alpha = 0.90). We examined past-year family problems due to someone else's drinking (marriage difficulties and/or financial trouble) and victimisation by someone who had been drinking (having property vandalised and/or being pushed, hit or assaulted).

RESULTS

During the prior 12 months, 6% of women and 3% of men experienced family problems from someone else's drinking, and 4% of women and 7% of men reported being victimised by drinkers. Multivariate logistic regression models adjusting for individual-level socioeconomic status and other demographic characteristics showed the relationship between neighbourhood disadvantage and harms from someone else's drinking was moderated by gender, with significantly higher odds of family problems in disadvantaged neighbourhoods for men but not for women, as well as significantly higher odds of crime victimisation in disadvantaged neighbourhoods for women but not men.

DISCUSSION AND CONCLUSIONS

Experiences of harms from someone else's drinking in disadvantaged neighbourhoods vary for men and women. Targeted intervention strategies are needed to reduce alcohol's harm to others.

Lifetime victimization and past year alcohol use in a U.S. population sample of men and women drinkers

BACKGROUND

Research on alcohol use among victims of physical and sexual violence has focused mostly on women and alcohol use disorders. It is also limited by the relative lack of consideration of victimization over the lifetime and of population data on both men and women. We critically examined associations between lifetime victimization and diverse past year alcohol use patterns and problems and whether these associations differ for men and women.

METHODS

Population data from the 2005 U.S. National Alcohol Survey (NAS11, n=6919) are reported for 4256 adult men and women drinkers. Logistic regressions assessed associations between physical only or any sexual victimization experienced over the lifetime and past year heavy episodic drinking, drinking to intoxication, alcohol-related consequences and any alcohol use disorder. Models controlled for demographics and parental history of alcohol abuse and examined interactions of gender with victimization.

RESULTS

Associations between victimization experienced over the lifetime and all past year alcohol measures were significant for both men and women. These associations did not differ by type of lifetime victimization (physical only vs any sexual). The association of physical only victimization with drinking to intoxication was stronger for victimized vs non-victimized women compared to victimized vs non-victimized men. This gender difference ceased to be significant when specific victimization characteristics were controlled for.

CONCLUSIONS

Lifetime victimization is associated with increased risk for diverse alcohol use problems for both men and women. All prevention and treatment programs should screen men and women for lifetime victimization and diverse alcohol use problems.

Age differences in diagnostic criteria of DSM-IV alcohol dependence among adults with similar drinking behaviour

AIMS

To test age differences in the prevalence of DSM-IV alcohol dependence (AD) diagnostic criteria in the adult general population while controlling for drinking behaviour.

DESIGN AND SETTING

Cross-sectional data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used, applying a two-stage probability sampling design. The survey used self-administered questionnaires and telephone interviews (mixed-mode design; 45% response rate).

PARTICIPANTS

The analytical sample consisted of n = 6984 individuals aged 18-64 years reporting alcohol consumption within the previous year.

MEASUREMENTS

Age effects on individual AD criteria were estimated using logistic regression models, adjusting for eight mutually exclusive drinking groups (defined in terms of average daily alcohol intake and episodic heavy drinking) and socio-economic variables.

FINDINGS

When controlling for drinking behaviour, 18-24-year-olds were more likely to meet the criteria 'tolerance', 'larger/longer' and 'time spent' relative to older age groups. In contrast, the likelihood of experiencing 'withdrawal' symptoms increased with age. There was no significant age effect on the diagnosis of AD.

CONCLUSIONS

Age differences in the prevalence of specific alcohol dependence diagnostic criteria such as 'tolerance', 'drinking larger amount or for longer than intended' and 'time spent recovering' cannot be fully explained by differences in drinking behaviour.

Alcohol-related negative consequences among drinkers around the world

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.

Child physical and sexual abuse: a comprehensive look at alcohol consumption patterns, consequences, and dependence from the National Alcohol Survey

BACKGROUND

Previous research has documented a relationship between child sexual abuse and alcohol dependence. This paper extends that work by providing a comprehensive description of past year and lifetime alcohol consumption patterns, consequences, and dependence among women reporting either physical and sexual abuse in a national sample.

METHODS

This study used survey data from 3,680 women who participated in the 2005 U.S. National Alcohol Survey. Information on physical and sexual child abuse and its characteristics were assessed in relation to 8 past year and lifetime alcohol consumption measures.

RESULTS

Child physical or sexual abuse was significantly associated with past year and lifetime alcohol consumption measures. In multivariate analyses, controlling for age, marital status, employment status, education, ethnicity, and parental alcoholism or problem drinking, women reporting child sexual abuse vs. no abuse were more likely to report past year heavy episodic drinking (OR(adj) = 1.7; 95% CI 1.0 to 2.9), alcohol dependence (OR(adj) = 7.2; 95% CI 3.2 to 16.5), and alcohol consequences (OR(adj) = 3.6; 95% CI 1.8 to 7.3). Sexual abuse (vs. no abuse) was associated with a greater number of past year drinks (124 vs. 74 drinks, respectively, p = 0.002). Sexual child abuse was also associated with lifetime alcohol-related consequences (OR(adj) = 3.5; 95% CI 2.6 to 4.8) and dependence (OR(adj) = 3.7; 95% CI 2.6 to 5.3). Physical child abuse was associated with 4 of 8 alcohol measures in multivariate models. Both physical and sexual child abuse were associated with getting into fights, health, legal, work, and family alcohol-related consequences. Alcohol-related consequences and dependence were more common for women reporting sexual abuse compared to physical abuse, 2 or more physical abuse perpetrators, nonparental and nonfamily physical abuse perpetrators, and women reporting injury related to the abuse.

CONCLUSION

Both child physical and sexual abuse were associated with many alcohol outcomes in adult women, even when controlling for parental alcohol problems. The study results point to the need to screen for and treat underlying issues related to child abuse, particularly in an alcohol treatment setting.

Substanzkonsum und substanzbezogene Störungen

Ziel: Untersucht wurden Prävalenzen des Konsums sowie substanzbezogener Störungen von illegalen Drogen, Alkohol, Tabakwaren und Medikamenten. Methodik: Die Stichprobe des Epidemiologischen Suchtsurveys (ESA) 2009 umfasst 8.030 Personen im Alter zwischen 18 und 64 Jahren und wurde in einem zweistufigen Verfahren auf Grundlage der Einwohnermelderegister zufällig gezogen. Die Befragung erfolgte schriftlich, telefonisch bzw. über das Internet und erzielte eine Antwortrate von 50.1 %. Ergebnisse: In den letzten 12 Monaten haben 4.8 % der Befragten Cannabis, 0.8 % Kokain und 0.7 % Amphetamine konsumiert. Bezogen auf die letzten 30 Tage gaben 59.9 % einen risikoarmen und 16.5 % einen riskanten Alkoholkonsum an. Als aktuelle Raucher (30-Tage-Prävalenz) konnten 29.2 % der Befragten klassifiziert werden. Mit einer 12-Monats-Prävalenz von 61.6 % waren Schmerzmittel die am häufigsten eingenommenen Medikamente. Schätzungen zu substanzbezogenen Störungen ergaben für Cannabisabhängigkeit 1.2 % und für Nikotinabhängigkeit 6.3 %. Für problematischen Alkoholkonsum wurden 19.0 % und für problematischen Medikamentengebrauch 4.0 % ermittelt. Schlussfolgerungen: Die Ergebnisse belegen eine hohe gesundheitspolitische Bedeutung des Substanzkonsums in Deutschland. Um negative Konsequenzen des Konsumverhaltens zu vermeiden, sind eine effektive Versorgung behandlungsbedürftiger Personen sowie frühzeitige Präventionsbemühungen erforderlich.

Changes in alcohol availability, price and alcohol-related problems and the collectivity of drinking cultures: what happened in southern and northern Sweden?

Aims: The aims of this study were to study whether alcohol-related self-reported problems follow the same pattern of changes in alcohol consumption in southern Sweden, assumed to be affected by a decrease in Danish spirits tax and by an increase in Swedish travellers’ import quotas, and to study whether the results obtained for southern and northern Sweden follow the predictions of Skog's theory of collectivity of drinking cultures. Methods: Analysis was carried out on a sample from the  Swedish general population from southern and northern Sweden separately. Two indices such as impaired self-control/dependent behaviour and extrinsic problems for alcohol-related problems were computed and analysed in terms of sex, age, income and alcohol consumption level. Results: Although there were no huge changes in the number of persons reporting alcohol-related problems, the general trend in data for various subpopulations was a decrease in the southern site and an increase in the northern site. In the northern site, the increase in alcohol consumption among men also showed an increase in alcohol-related problems. However, various population subgroups changed in different directions and did not move in concert over the population distribution. Conclusions: Analysis confirmed that alcohol-related problems, according to the two indices used, followed a similar pattern to alcohol consumption, but less divergent. A version of Skog's theory applied on alcohol-related problems could not confirm that alcohol-related problems did not change collectively within the population.

Social desirability biases in self-reported alcohol consumption and harms

AIMS

Self-reports remain the most common means of assessing alcohol consumption despite concern for their validity. The objective of this research is to assess the extent to which social desirability biases relate to self-reported consumption, hazardous use, and harms.

METHODS

In each of two studies presented, undergraduate students (N=391 and N=177) who reported that they had consumed alcohol in the past year completed online confidential surveys.

RESULTS

Both studies show consistent associations between impression management bias and self-reported consumption such that high impression managers report 20 to 33% less consumption and are about 50% less likely to report risky drinking. No significant correlations involving consumption were found for self-deception bias. Study 2 also indicated that high impression managers report 30-50% fewer acute harms following a drinking episode, and that these effects are maintained after controlling statistically for trait impulsivity/constraint.

CONCLUSIONS

Impression management bias represents a significant threat to the validity of self-reported alcohol use and harms. Such bias may lead to misspecification of models and under-estimates of harmful or hazardous use.

Measuring alcohol-related consequences in school surveys: alcohol-attributable consequences or consequences with students' alcohol attribution

In alcohol epidemiology surveys, there is a tradition of measuring alcohol-related consequences using respondents' attribution of alcohol as the cause. The authors aimed to compare the prevalence and frequency of self-attributed consequences to consequences without self-attribution using alcohol-attributable fractions (AAF). In 2007, a total of 7,174 Swiss school students aged 13-16 years reported the numbers of 6 alcohol-related adverse consequences (e.g., fights, injuries) they had incurred in the past 12 months. Consequences were measured with and without attribution of alcohol as the cause. The alcohol-use measures were frequency and volume of drinking in the past 12 months and number of risky single-occasion (> or =5 drinks) drinking episodes in the past 30 days. Attributable fractions were derived from logistic (> or =1 incident) and Poisson (number of incidents) regression analyses. Although relative risk estimates were higher when alcohol-attributed consequences were compared with nonattributed consequences, the use of AAFs resulted in more alcohol-related consequences (10,422 self-attributed consequences vs. 24,520 nonattributed consequences determined by means of AAFs). The likelihood of underreporting was higher among drinkers with intermediate frequencies than among either rare drinkers or frequent drinkers. Therefore, the extent of alcohol-related adverse consequences among adolescents may be underestimated when using self-attributed consequences, because of differential attribution processes, especially among infrequent drinkers.

Alcohol measurement methodology in epidemiology: recent advances and opportunities

AIM

To review and discuss measurement issues in survey assessment of alcohol consumption for epidemiological studies.

METHODS

The following areas are considered: implications of cognitive studies of question answering such as self-referenced schemata of drinking, reference period and retrospective recall, as well as the assets and liabilities of types of current (e.g. food frequency, quantity-frequency, graduated frequencies and heavy drinking indicators) and life-time drinking measures. Finally we consider units of measurement and improving measurement by detailing the ethanol content of drinks in natural settings.

RESULTS AND CONCLUSIONS

Cognitive studies suggest inherent limitations in the measurement enterprise, yet diary studies show promise of broadly validating methods that assess a range of drinking amounts per occasion; improvements in survey measures of drinking in the life course are indicated; attending in detail to on- and off-premise drink pour sizes and ethanol concentrations of various beverages shows promise of narrowing the coverage gap plaguing survey alcohol measurement.

Spreading or concentrating drinking occasions--who is most at risk?

AIMS

(a) To compare acute negative consequences for people who drink a given amount of alcohol on few occasions (concentrators) per week in comparison with the consequences for people who drink the same amount on more days in a week (spreaders). (b) To investigate whether these associations are cross-culturally stable.

METHODS

Analysis is based on general population surveys of adults conducted in 7 European countries.

RESULTS

It appeared that more drinking occasions in many countries lead to more consequences independent of the volume consumed. Risky single-occasion drinking was to be associated with higher risks for immediate health consequences and legal problems, accidents and fights. Among older respondents the same frequency pattern appeared, with the exception of immediate health consequences among women. Hence, more regular drinking seemed to have more beneficial effects on older individuals compared to younger ones, which may be related to the different drinking situation: younger people mostly drinking outside the home. Amongst the younger people, frequent drinking seemed to be associated with more acute consequences. Cultural and methodological variations must be taken into account.

CONCLUSION

Even so, it is concluded that the credibility of these findings is strengthened by differences in the methods of the surveys.

Addiction sciences and its psychometrics: the measurement of alcohol-related problems

AIMS

The focus of this paper is on psychometric issues related to the measurement of alcohol problems.

METHODS

Taking a broad perspective, this paper first examines several issues around the use of instruments to provide diagnostic categories in surveys, including dimensionality, severity and alcohol consumption. Secondly, a discussion of some of the political issues surrounding measurement of alcohol problems is presented, including some of the conflicts that arise when the psychometric properties of commonly used instruments are questioned. Finally, newer statistical techniques that can be applied to scale development in the alcohol field are examined, including non-linear multivariate analyses and confirmatory/hypothesis-based methods.

RESULTS AND CONCLUSIONS

Continued scholarly discussion needs to be encouraged around these psychometric issues so that instrument development and maintenance in the addiction sciences becomes an ongoing academic pursuit as we strive to measure alcohol problems in the best way possible.

Health effects from drinking: type, severity, and associated drinking patterns based on qualitative and quantitative questions in a methodological survey

The specific content of reported health harms are explored in relation to heavy episodic drinking and alcohol dependence symptoms. A national telephone computer-assisted interview of U.S. adults (N = 635), was conducted in 1994. A modified National Alcohol Survey instrument assessed self-reported health harms and related economic costs and work missed. Among the 579 lifetime drinkers, 26% reported health harms from drinking. In multivariate logistic regression harms relating to intoxication, injuries or internal organs were associated with monthly heavy drinking (5+ drinks) and past dependence symptoms. Study limitations are noted. Dependence symptoms should be assessed in screening for those most at risk for alcohol-related health harms.

Alcohol-Related Social Consequences in Castille and Leon, Spain

BACKGROUND

The purpose of this study was to examine the prevalence of alcohol-related social problems, as well as to assess the relationship between alcohol-related social problems and patterns of alcohol consumption in the general population during the year 2004.

METHODS

A total of 2,500 individuals, age range from 14 to 70 years, in Castille and Leon, Spain, were surveyed in 2004 for their patterns of alcohol consumption and alcohol-related social consequences during the previous year.

RESULTS

Participants who admitted to having had some kind of social problem related to the consumption of alcohol in the previous year were 6.5%, with a mean of 2.4 alcohol-related social problems. The most frequent problems cited were "argument, discussion, or serious conflict without physical aggression" (3%).

CONCLUSIONS

The present study shows that the reporting of alcohol-related social problems was quite frequent and that having alcohol-related social problems was related to drunkenness episodes in the previous year, having 5 or more drinks on a single occasion in the previous year, and alcohol intake.

Measuring confrontation during recovery from addiction

The effect of confrontation on recovery from addiction continues to be a topic of considerable debate. Although many residential treatment programs view some form of confrontation as an integral part of recovery, a number of studies have found confrontation from professional treatment staff to be counterproductive. One of the problems inherent in the current debates about confrontation is the lack of a comprehensive measure of confrontation that assesses different dimensions. This study describes the development of the "Alcohol and Drug Confrontation Subscale" (ADCS), a 72-item instrument designed to measure the quantity and frequency of confrontation that individuals receive about drug or alcohol use-related problems. Confrontation is defined as an individual being told "bad things" might happen to them if they do not make changes to address a drug or alcohol use-related problem or make changes to maintain sobriety. The instrument also measures the respondents' perceptions about their relationships with confronters (three-item alpha = .79) and perceptions about the confrontational statements (three-item alpha = .63). The sample included 108 individuals entering three sober living housing organizations in Northern California between 2003 and 2005. They indicated that receiving confrontational statements about alcohol or drug use-related problems was common, especially from spouses/significant others (56% of those with significant others) and family members (60%). Participants who reported receiving more confrontation reported having more positive views about their relationships with confronters and about confrontational statements than those who received less confrontation. Additional studies are necessary to establish validity, generalize results to more diverse populations, and assess confrontation at different time points during recovery.

The 5-year course of intimate partner violence among White, Black, and Hispanic couples in the United States

This article examines the 5-year incidence, prevalence, and recurrence of intimate partner violence (IPV) among White, Black, and Hispanic intact couples in the United States. A national multistage household probability sample of couples, age 18 years or older, was interviewed in 1995 with a response rate of 85%, and reinterviewed in 2000 with a response rate of 72%. Results indicate that the incidence and recurrence of IPV are higher for Blacks and Hispanics than for Whites. Compared to Whites, Hispanics are 2.5 times more likely to initiate IPV between baseline and follow-up and Blacks are 3.7 times more likely to report IPV at baseline and follow-up. Couples reporting severe IPV in 1995 are more likely than others to report severe IPV at follow-up. The rate of recurrence for severe IPV among Black and Hispanic couples is 6 and 4 times higher, respectively, than the rate among Whites. The results suggest that Blacks and Hispanics may be more affected by IPV.

Drinking, alcohol problems and the five-year recurrence and incidence of male to female and female to male partner violence

BACKGROUND

This study examined the 5-year incidence and recurrence of male to female (MFPV) and female to male partner violence (FMPV) as well as their relationship with drinking and alcohol problems among intact couples in the United States.

METHODS

A national sample of couples 18 years of age or older were interviewed in 1995 and again in 2000.

RESULTS

Recurrence is slightly higher for FMPV (44%) than MFPV (39%), whereas incidence rates are similar for these two types of violence (MFPV, 5.7%; FMPV, 6%). Cross-tabulations show that a higher frequency of drinking five or more drinks on occasion is positively associated with the overall occurrence of MFPV and with both the recurrence and the overall occurrence of FMPV. Male alcohol problems are associated with a higher recurrence of MFPV and higher overall MFPV. Female alcohol problems are associated with incidence of FMPV. In multivariate analysis, black ethnicity, male unemployment, and severe physical abuse during childhood are associated with recurrence of MFPV. Black ethnicity, male unemployment, male employment status as "retired/other," female age, and couples in which the female drinks more are associated with recurrence of FMPV. Incidence of MFPV is associated with cohabitation, Hispanic ethnicity, and man's observation of violence between parents. Male unemployment, male observation of violence between parents, and man's drinking volume predict incidence of FMPV.

CONCLUSIONS

Volume of drinking is the only alcohol indicator associated with intimate partner violence once the effects of other factors are controlled in multivariate analysis. Both MFPV and FMPV are areas of health disparity across whites, blacks, and Hispanics. Factors of risk that predict recurrence and incidence can be identified and used in prevention efforts.

Drinking patterns and traffic casualties in Switzerland: matching survey data and police records to design preventive action

OBJECTIVE

To examine the association between drinking patterns and alcohol-related traffic casualties.

STUDY DESIGN

Data linkage of cross-sectional survey data on alcohol consumption with official traffic casualty records.

METHODS

Alcohol consumption measures for usual heavy drinking and risky single occasion drinking were derived for different time segments of the day from a 7-day drinking diary study of 747 current drinkers. Measures were correlated with official records of alcohol-related traffic casualties.

RESULTS

There was a high correlation between alcohol-related traffic casualties and the number of risky single occasion drinkers that consumed alcohol outside their homes (r=0.92). On average, about 50% of these drinking occasions were attributed to usual moderate drinkers. The proportion of usual heavy drinkers was lowest in the time segments with the most alcohol-related casualties.

CONCLUSION

Preventive countermeasures should be targeted at the general population, enforced particularly during specific periods of the week.

Psychopathology associated with drinking and alcohol use disorders in the college and general adult populations

This paper examines the associations between past-year drinking status and the prevalence of 15 different past-year anxiety, mood and personality disorders, using a large (n = 43,093) nationally representative sample of the U.S. population. The prevalence of these disorders and their associations with drinking are compared for college students 18-29 years of age, other youth 18-29 years of age, and adults 30 years of age and older. After adjusting for sociodemographic characteristics and past-year tobacco and illicit drug use, only drinkers with alcohol dependence experienced an excess risk of a mood or anxiety disorder among college students 18-29 years of age, OR = 2.4. In contrast, the excess risk of any mood or anxiety disorder associated with drinking status among non-college youth varied from an OR of 1.8 for non-binge drinkers to 4.7 for drinkers with alcohol dependence. Among persons 30 years of age and older, the degree of excess risk was slightly lower but still higher than those for college students, OR = 1.5-3.8. Similarly, the excess odds of any personality disorder associated with drinking varied from 1.6 to 5.0 for the younger, non-college group and from 1.5 to 3.8 for the older adults, with no significant effect observed among college students. Factors that may help explain the weaker association of psychopathology and drinking in the college population include selectivity and greater availability of social and treatment resources that serve as alternatives to self-medicating the symptoms of psychological distress with alcohol.

Alcohol consumption and total mortality/morbidity-definitions and methodological implications

Two main types of studies of alcohol consumption and total mortality/morbidity are distinguished, namely: individual level studies and aggregate level studies. Alcohol consumption is usually characterized in terms of volume or average volume of consumption. More recently, patterns of drinking, especially heavy drinking occasions, have been introduced. On the individual level, the definition of mortality is trivial (death) and morbidity is either defined by hospitalization or by subjective definitions. On the aggregate level, mortality is defined either in death rates or in years of life lost, and morbidity as hospitalization rates or years of life lost to disability. Disability Adjusted Life Years (DALYs) combine mortality and morbidity into a summary measure of health. Individual level studies clearly should be given preference in assessing the relationship between alcohol and outcomes, as long as the assessment of alcohol consumption is state-of-the-art and the sample includes all relevant drinking patterns, plus if there is adequate control for confounding and adequate statistical analysis.

Towards agreement on ways to measure and report drinking patterns and alcohol-related problems in adult general population surveys: the Skarpö conference overview

A thematic conference of the Kettil Bruun Society (KBS) for Social and Epidemiological Research on Alcohol was held in Skarpö, near Stockholm, on April 3-7, 2000. The goals of the meeting were to develop consensus sets of questionnaire items for measuring alcohol consumption and social harm, to delineate statistical and practical concerns related to the aggregation of consumption and harm data and to identify summary measures to be used for descriptive purposes and in analyses of the association between alcohol intake and alcohol-related outcomes. The results of the conference discussions are summarized below, with emphasis on both areas where the conference yielded recommendations for measures and methods of aggregation for analysis, and on areas where consensus could not be obtained and/or where additional research is needed.

Ways of measuring drinking patterns and the difference they make: experience with graduated frequencies

This paper reviews methodological issues in assessing volume and pattern of alcohol consumption. It focuses on three measures developed at the Alcohol Research Group (ARG) to assess frequencies of drinking in a graduated series of quantity intervals, called the graduated quantity-frequency (QF) approach. The three measures include two reference periods, 30 days and 12 months, and use three distinct ways of assembling the graduated QF data. The Cahalan-Treiman 30-day measure, developed for self-administered mail surveys, targets daily amounts of beverage alcohol, with thresholds asked in ascending order. The other two measures use descending quantity ranges. The Knupfer Series (KS) asks for three beverage-specific quantity levels. The Graduated Frequencies (GF) measure assesses intake of combined alcohol with five levels. Both are available in face-to-face and telephone formats. All three measures inquire about consumption in the metric of "drinks," defined within the form or interview; each is useful for estimating volume and pattern of consumption. Methodological studies with the GF include comparisons with other measures, between- and within-subject interview comparisons, and qualitative protocol analyses designed to examine cognitive response processes. Uses for each measure are considered, and recommendations are made for improvement and more thorough specification of drinking patterns.