Identification and management of acute alcohol intoxication

Acute alcohol intoxication (AAI) is a harmful clinical condition, potentially life-threatening, secondary to the intake of large amounts of alcohol. Clinical manifestations of AAI are characterized by behavioural and neurological symptoms, even if its effects involve several organs and apparatus. Moreover, severe alcohol intoxication can produce a global neurological impairment leading to autonomic dysfunction, respiratory depression, coma and cardiac arrest. The evaluation of blood alcohol concentrations (BAC) is useful to confirm the suspicion of intoxication, both for clinical and legal reasons. Most of patients with AAI are referred to Emergency Departments due to behavioural, social, traumatic or clinical complications. Patient's stabilization is the first step in the management of AAI, in order to support vital functions and to prevent complications. Metadoxine represents a useful drug to increase ethanol metabolism and elimination. Given that AAI could represent a sentinel event of chronic alcohol abuse, patients presenting with acute intoxication should be screened for the presence of an underlying alcohol use disorder and referred to and an alcohol addiction unit to start a multidisciplinary treatment to achieve long term alcohol abstinence. The present review will focus on clinical features, diagnostic criteria and treatment strategies of AAI.

Alcohol and Nicotine Use among Adolescents: An Observational Study in a Sicilian Cohort of High School Students

In recent years, the mode of alcoholic intake known as binge drinking (BD) has become a common practice, especially among adolescents who, due to socio-environmental motives, tend to reach a rapid state of drunkenness. This drunkeness leads to alterations in brain areas responsible for executive functions and cognitive processes, as well as to the genesis of factors that predispose to lasting addiction. Likewise, nicotine leads to a comparable degree of addiction. On this basis, the aim of this research was to evaluate, on a cohort of 349 high school students (15−17 years old) in the province of Palermo, the following: (I) the drinking model of alcoholic beverages; (II) the use of nicotine and the degree of dependence; (III) the correlation between the consumption of alcoholic beverages and the use of nicotine. We employed the AUDIT-C test and the Fagerström test, two valid and standard instruments, in order to assess alcohol and nicotine use, respectively. Statistical analysis of the data showed that male and female students consumed alcohol prominently in a BD mode (77.2%, audit score (AS) 3.497, confidence interval (CI) 3.206−3.788; 69.6%, AS 2.793, CI 2.412−3.274) and nicotine (41.5%, Fagerström score (FS) 3.882, CI 3.519−4.245; 28%, FS 3.286, CI 2.547−4.024). Furthermore, a positive correlation between alcohol consumption and nicotine use was found for male (r = 0.6798, p < 0.0001) and female (r = 0.6572, p < 0.0001) students. This study provided further insights into the use of legal substances of abuse in adolescents, evidencing the obvious need for the promotion of specific school educational programs aimed at the wellbeing of youth populations.

Selenium, a dietary-antioxidant with cardioprotective effects, prevents the impairments in heart rate and systolic blood pressure in adolescent rats exposed to binge drinking treatment

BACKGROUND

Binge drinking (BD) during adolescence is related to cardiovascular alterations. Selenium (Se) is an essential trace element with antioxidant, anti-inflammatory and antiapoptotic properties, essential for correct heart function.

OBJECTIVES

To study the protective cardiovascular effects of selenium in adolescent rats exposed to a BD-like procedure.

METHODS

32 adolescent male rats exposed to an intraperitoneally BD-like model or not, and supplemented with 0.4ppm of selenite or not, were divided into 4 groups: control, alcohol, control-selenium and alcohol-selenium. Blood pressure and heart rate (HR) were determined after experimentation. Se deposits, oxidative balance and the expression of glutathione peroxidases (GPxs), NF-kB and caspase-3 were measured in the heart. Also, DNA instability in rat lymphocytes and serum vascular markers were determined. Statistical analysis was performed with the ANOVA model.

RESULTS

The BD-like model depleted Se heart deposits (p < .01), decreased GPx activity (p < .01) and GPx1 (p < .001) and GPx4 (p < .05) expression, increased NF-kB (p < .01), caspase-3 (p < .001) expression, and generated oxidation in myocytes. Outside the heart, the BD-like model caused double-strand breaks in lymphocyte DNA and increased all the vascular markers measured. These cardiovascular alterations were related to higher systolic (p < .001) and diastolic (p < .05) blood pressure and HR (p < .05). In the heart, Se supplementation in BD-exposed rats significantly increased Se deposits (p < .001) and improved oxidative balance and vascular damage, including increased GPxs and decreased NF-kB and caspase-3 activation, consequently decreasing systolic (p < .05) blood pressure and HR (p < .01).

CONCLUSIONS

Se supplementation presents cardioprotective effects since it reversed HR and systolic blood pressure observed in BD-exposed adolescent rats.

Substance use among sexual minorities in the US - Linked to inequalities and unmet need for mental health treatment? Results from the National Survey on Drug Use and Health (NSDUH)

BACKGROUND

Sexual minorities (SM) have specific substance use patterns and show elevated rates of substance use and substance use disorders. We investigated the potential association between substance use - including chemsex drug use - among SM adults in the United States (US) and social inequality, with an additional focus on disparities in unmet need for mental health treatment.

METHODS

A secondary cross-sectional data analysis was performed using National Survey on Drug Use and Health (NSDUH) data from 2015 to 2017 and including 126,463 individuals with 8241 identifying as SM. Multivariable logistic regression models were implemented to quantify disparities in substance use, to calculate the effect of sociodemographic variables on substance use, and to examine associations with socioeconomic vulnerability.

FINDINGS

SM showed higher odds of past-year substance use and lifetime chemsex drug use. All SM except for bisexual men exhibited higher odds of past-month binge drinking relative to heterosexuals. Bisexual women had higher odds for use of all analysed substances relative to heterosexual women. Being older and being a woman were shown to be protective factors. Urbanity, being uninsured, and unmet need for mental health treatment were associated with significantly higher odds of substance use, chemsex drug use and binge drinking. A link was established between drug use and health indicators, with higher odds of drug use for lower health ratings. SM experienced significantly higher levels of socioeconomic vulnerability. Higher vulnerability indices were associated with increased odds for drug use.

INTERPRETATION

This study is among the first nationally representative samples that analysed the link between sociodemographic factors and unmet need for mental health treatment and substance use in SM. It emphasises the multifactorial aetiology of substance use exposure, highlights the underlying mechanisms for substance use among SM while underscoring disparities among them. Approaches tailored to SM subgroups may be needed to address comorbidities and negative health outcomes of substance use in the long-term. However, critical gaps in the literature remain and large-scale studies inclusive of SM individuals are needed to present causal links.

FUNDING

Gillings Fellowship SYOG054 to ARU.

Binge Eating and Binge Drinking: A Two-Way Road? An Integrative Review

Unhealthy diet and alcohol are serious health problems, especially in adolescents and young adults. "Binge" is defined as the excessive and uncontrolled consumption of food (binge eating) and alcohol (binge drinking). Both behaviors are frequent among young people and have a highly negative impact on health and quality of life. Several studies have explored the causes and risk factors of both behaviors, and the evidence concludes that there is a relationship between the two behaviors. In addition, some research postulates that binge eating is a precipitating factor in the onset and escalation of excessive alcohol consumption, while other studies suggest that alcohol consumption leads to excessive and uncontrollable food consumption. Given that no review has yet been published regarding the directionality between the two behaviors, we have set out to provide an upto- date overview of binge eating and binge drinking problems, analyzing their commonalities and differences, and their uni- and bidirectional associations. In addition, we explore the reasons why young people tend to engage in both behaviors and consider directions for future research and clinical implications.

Understanding the Influence of Eating Patterns on Binge Drinking: A Mediation Model

BACKGROUND

Binge drinking is an important health problem, and it has been related to binge eating and fat intake in animal models, but this relationship has not been tested in humans. The first objective of this study was to analyze whether binge eating and fat intake are related to binge drinking in a youth sample. The second objective was to analyze whether binge eating and fat intake mediate the relationship between individual factors associated with binge eating and fat intake (sex, body mass index (BMI), drive for thinness, body dissatisfaction, eating styles, impulsivity, and food addiction) and binge drinking.

METHODS

A sample of 428 undergraduate students filled out several questionnaires on binge drinking, binge eating, fat intake, drive for thinness, body dissatisfaction, eating styles, food addiction, and impulsivity.

RESULTS

Results showed an excellent model fit: χ2(25) = 30.342 (p = 0.212), comparative fit index (CFI) = 0.992, root mean squared error of approximation (RMSEA) = 0.022 [90% CI = 0.000, 0.047]. Binge eating and fat intake were positively related to binge drinking. Furthermore, emotional eating, external eating, and food addiction showed positive and statistically significant indirect relationships with binge drinking, whereas the relationship with restrained eating was negative.

CONCLUSIONS

These findings point to the need to use a broader approach in understanding and preventing binge drinking in the youth population by showing the influence of the eating pattern on this problem. This information could be helpful in preventing future behaviors and improving interventions that address health risk behaviors.

Predicting relapse after alcohol use disorder treatment in a high-risk cohort: The roles of anhedonia and smoking

On average, two-thirds of individuals treated for alcohol use disorder (AUD) relapse within six months. There is a critical need to identify modifiable risk factors associated with relapse that can be addressed during AUD treatment. Candidate factors include mood disorders and cigarette smoking, which frequently co-occur with AUD. We predicted that co-occurrence of mood disorders, cigarette smoking, and other modifiable conditions will predict relapse within six months of AUD treatment. Ninety-five Veterans, 23-91 years old, completed assessments of multiple characteristics including demographic information, co-occurring psychiatric disorders, and medical conditions during residential treatment for AUD. Participants' alcohol consumption was monitored over six months after participation. Logistic regression was used to determine if, mood disorders, cigarette smoking status, alcohol consumption, educational level, and comorbid general medical conditions are associated with relapse after AUD treatment. Sixty-nine percent of Veterans (n = 66) relapsed within six months of study while 31% remained abstinent (n = 29). While education, comorbid general medical conditions, and mood disorder diagnoses were not predictors of relapse, Veterans with greater symptoms of anhedonia, active smokers, and fewer days of abstinence prior to treatment showed significantly greater odds for relapse within six months. Anhedonia and cigarette smoking are modifiable risk factors, and effective treatment of underlying anhedonic symptoms and implementation of smoking cessation concurrent with AUD-focused interventions may decrease risk of relapse.

Psychometric Properties of the "Alcohol Consumption Consequences Evaluation" (ACCE) Scale for Young Spanish University Students

Instruments that evaluate alcohol use consequences among young people do not consider the intensive alcohol consumption pattern that is so characteristic during these ages. Some of these instruments are even ineffective in the Spanish population. Hence the interest in developing an instrument more adapted to the reality of our young people. A total of 601 university students (35.9% male and 64.1% female) from 18 to 20 years old were recruited. All of them answered a total of 77 items obtained from the review of both the scientific literature and the different scales used to measure consequences derived from alcohol consumption. In addition, they completed the AUDIT and the Timeline Followback for self-reported consumption. The data were analyzed using factor analysis and a two-parameter logistic model. ROC curve analysis was used to establish cut-off points for different risk levels of alcohol consumption distinguishing between genders. The final 43-item scale Alcohol Consumption Consequences Evaluation (ACCE) (Evaluación de Consecuencias derivadas del Consumo de Alcohol [ECCA]) shows adequate psychometric properties: α = 0.94; unidimensionality through exploratory factor analysis (EFA) (26.25% of explained variance) and confirmatory factor analysis (CFA) (RMSEA = 0.39; TLI and CFI > 0.90). In addition, ROC analyses, both at a global scale and distinguishing between genders, were able to characterize consumers with different levels of risk, obtaining areas under the curve between 0.82 and 0.88. A scale has been obtained that enables the establishment of cut-off points to distinguish between the consequences of low, moderate and high risk alcohol consumption. The clinical utility of the ACCE is highlighted by using one single instrument to perform the screening of a possible alcohol risk consumption as well as identifying the consequences that need to be worked on in the evaluated person’s or group’s intervention.

[Excessive alcohol intake and dissatisfaction with body image among adolescents and young adults in a municipality in Bahia State, Brazil]

The study aimed to analyze the association between excessive alcohol intake and dissatisfaction with one's body image in a population of adolescents and young adults. This was a cross-sectional study with a household survey design in a sample of 1,582 individuals 15 to 24 years of age living in Camaçari, Bahia State, Brazil. Excessive alcohol intake was identified by the Alcohol Use Disorder Identification Test (AUDIT), and dissatisfaction with body image was measure with the Silhouette Figure Scale. Confounding variables were: sex, age, race, schooling, work, religion, family composition, number of close friends, marital status, and children. The association between excessive alcohol intake and body dissatisfaction was estimated by logistic regression. Prevalence of excessive alcohol intake was 21.9% (higher in males), and prevalence of body image dissatisfaction was 79.5% (higher in females). No statistically significant association was found between excessive alcohol intake and dissatisfaction with body image. After adjustment of the final model, the variables that remained associated with excessive alcohol intake were religion (OR = 2.02), schooling (OR = 1.63), family composition (OR = 1.61), age (OR = 0.55), and work (OR = 0.61). Although the analyses did not show an association between excessive alcohol intake and dissatisfaction with body image, the study's results call attention to the high prevalence rates for the two phenomena. This shows the need to develop interventions focused on practices of care for this specific population.

How Does Alcohol Consumption Affect Perceptions of One's Own and a Drinking Partner's Ability to Consent to Sexual Activity?

In this naturalistic study, our aim was to examine the extent to which alcohol consumption affected perceptions of one's own and one's friend's ability to consent to sexual activity. We surveyed 160 adult bargoers in pairs about their own and their friends' alcohol consumption, intoxication symptoms, and ability to consent to sexual activity. On average, participants reported consuming 4.97 drinks, rated themselves at the legal limit for driving, reported one intoxication symptom, and had a blood alcohol concentration (BAC) just over .08. However, few thought they or their friend had diminished cognitive function. Accordingly, most indicated that they could consent to sex (93%) and their friend could consent to sex (87%). Number of drinks people reported consuming, self-reported intoxication levels and symptoms, and BACs were significantly correlated; however, none of these measures was significantly related to individuals' perceptions of their own or their friends' ability to consent to sexual activity. Finally, those in man-man pairs were significantly more likely than those in woman-woman pairs to indicate they would allow their friend to have sex if approached by an interested party. These findings have potential implications for prevention programming and for legal cases involving individuals who engage in sexual activity while intoxicated.

KNOWLEDGE OF THE CONSEQUENCES AND USE OF DRUGS FOR COSTA RICA UNIVERSITY STUDENTS

ABSTRACT Objective: to determine the relationship between knowledge of consequences and drug use in undergraduate students of a university in San José, Costa Rica. Method: the cross-sectional study examines the demographic profile of the sample and the relationship between knowledge of consequences, drug use and academic performance. The study focuses on three types of drugs: alcohol, marijuana and cocaine. Three variables will be analyzed: demographic data, knowledge of consequences and use of drugs. Results: the relationship between knowledge of consequences and use of drugs was made using of the T-test. The sample had 272 students, 28.2% (n=77) of them were men and 71.4% were women (n=195). They were selected from the areas of social sciences (n=137, 50.2%), and from the area of health sciences (n=136; 49.8%). Alcohol was the most used drug (n=217, 79.8%), followed by marijuana (n=72, 26.6%) and finally cocaine (n=3, 1.1%) in the last 12 months. Conclusion: the results shown indicate that there is no significant relationship between such variables. The findings are important at the level of drug policies to support the development of new preventive strategies for drug use.

Binge Drinking among adolescents is related to the development of Alcohol Use Disorders: results from a Cross-Sectional Study

Binge drinking (BD) is a common pattern of alcohol consumption among adolescents. At present few data are available on the possible relationship between BD and alcohol use disorders (AUD) in adolescents. The aim of this study was to assess the prevalence of BD and relationship between BD behavior and AUD among adolescents. A total of 2704 students attending 10 purposively selected high schools from three Italian provinces were surveyed. Questionnaires regarding socio-demographic data, pattern and amount of alcohol intake, smoking habits, use of illicit drugs, and physical activity were administered. AUD and affective disorders were also evaluated. Alcohol intake was reported by 2126 participants; 1278 reported at least one episode BD in the last year and 715 in the last month. A diagnosis of AUD was made in 165 adolescents. The prevalence of AUD was higher in adolescents that reported BD behavior than in those that did not report BD (11.6% vs 0.9%, respectively; p < 0.0001). Logistic regression showed a positive relationship between a diagnosis of AUD and BD behavior (OR 9.6; 95% CI 4.7–22·9; p < 0.0001). In conclusion alcohol consumption with the pattern of BD among adolescents is highly related to development of AUD.

Students Who Limit Their Drinking, as Recommended by National Guidelines, Are Stigmatized, Ostracized, or the Subject of Peer Pressure: Limiting Consumption Is All But Prohibited in a Culture of Intoxication

There is an unquestionable need to address drinking patterns in subcultures where excessive drinking is normative. Regulatory bodies advocate moderating alcohol consumption but it is unclear whether individuals have agency to do so, particularly when excessive consumption is the norm. This study aimed to address this gap by examining student’s perceptions of limiting consumption, as recommended by government guidelines, in one university in New Zealand. Using a qualitative social science approach, university students surveyed and interviewed their heavy-drinking peers (n = 201) to investigate perceptions of 3 drinking behaviors (Heavy, Moderation, and Abstinence). Thematic analysis revealed that students who drink heavily are labeled positively and viewed as sociable (Dr Froth, Liver of Steel, Trooper, Champion, Hero, Good Alcoholic, popular, a friend). Students who limit drinking, on the other hand, were viewed similar to those who abstain, labeled using explicit, emotive, and derogative terminology (eg, Fag, Vagina, Grandma, Weirdo, Coward, Killjoy) and excluded, ostracized, or the subject of peer pressure. They were also expected to provide a justification for moderating their drinking (eg, being an athlete, broke). Although individuals who moderated their consumption were perceived to have strong willpower and maturity (eg, self-aware, brave, sophisticated), these positive attributes were mentioned less frequently and involved less emotive language than were labels linking moderation to a negative social identity. The method employed in this study provided a frank insight into a student culture of intoxication and the barriers facing students who try to drink in moderation. Our findings reveal that limiting consumption, even occasionally, threatens students’ social identity and inclusion in the student drinking culture. These results suggest that individualistic harm minimization strategies are unlikely to be effective. Instead, the findings underscore the need to develop alternative cultures emphasizing extracurricular activities which may facilitate students’ agency to go against the norm and moderate their drinking.

Alcohol use disorder and cognitive impairment in old age patients: A 6 months follow-up study in an outpatient unit in Barcelona

There has been little research about deleterious effects, including cognitive impairment, related to hazardous long-term alcohol use in old adults. This study aims to assess cognitive decline in old patients with alcohol use disorder and changes in cognitive state at 6 months follow-up, achieving or not abstinence. A six-month follow-up study was conducted in an outpatient center in Barcelona on a sample of old adults (≥65 years old) who had hazardous alcohol use. The sample was compared with healthy volunteers adjusted for age, sex and years of education. A neuropsychological protocol was performed at baseline and after 6 months follow-up covering four cognitive domains: attention, visuospatial abilities, memory and executive functions. Several domains were significant impaired at baseline: visual immediate and delayed recall, working memory, immediate verbal learning, total words learned, set switching and sustained attention. At 6 months reassessment, alcohol abstinence was achieved in 93.5% of patients and it was detected a trend towards improvement in direct mean scores of all cognitive areas, although it was not significant. The current study points out a cognitive impairment in many areas secondary to alcohol long-term hazardous use in old adults. A trend towards cognitive improvement after recovery was detected in most patients.

The psychometric properties of a shortened Dutch version of the consequences scale used in the Core Alcohol and Drug Survey

BACKGROUND

Alcohol and drug misuse among college students has been studied extensively and has been clearly identified as a public health problem. Within more general populations alcohol misuse remains one of the leading causes of disease, disability and death worldwide. Conducting research on alcohol misuse requires valid and reliable instruments to measure its consequences. One scale that is often used is the consequences scale in the Core Alcohol and Drug Survey (CADS). However, psychometric studies on the CADS are rare and the ones that do exist report varying results. This article aims to address this imbalance by examining the psychometric properties of a Dutch version of the CADS in a large sample of Flemish university and college students.

METHODS

The analyses are based on data collected by the inter-university project 'Head in the clouds', measuring alcohol use among students. In total, 19,253 students participated (22.1% response rate). The CADS scale was measured using 19 consequences, and participants were asked how often they had experienced these on a 6-point scale. Firstly, the factor structure of the CADS was examined. Two models from literature were compared by performing confirmatory factor analyses (CFA) and were adapted if necessary. Secondly, we assessed the composite reliability as well as the convergent, discriminant and concurrent validity.

RESULTS

The two-factor model, identifying personal consequences (had a hangover; got nauseated or vomited; missed a class) and social consequences (got into an argument or fight; been criticized by someone I know; done something I later regretted; been hurt or injured) was indicated to be the best model, having both a good model fit and an acceptable composite reliability. In addition, construct validity was evaluated to be acceptable, with good discriminant validity, although the convergent validity of the factor measuring 'social consequences' could be improved. Concurrent validity was evaluated as good.

CONCLUSIONS

In deciding which model best represents the data, it is crucial that not only the model fit is evaluated, but the importance of factor reliability and validity issues is also taken into account. The two-factor model, identifying personal consequences and social consequences, was concluded to be the best model. This shortened Dutch version of the CADS (CADS_D) is a useful tool to screen alcohol-related consequences among college students.

Drunkorexia: an emerging trend in young adults

OBJECTIVE

Several studies demonstrated an association between alcohol consumption and unhealthy food habits. Particularly, in young adults it has been observed the tendency to use extreme forms of weight control as a way to compensate planned binge drinking.

METHOD

A questionnaire was administered to a sample of 4275 healthy subjects (43.9% males; 56.1% females), aged between 18 and 26 (mean age 22.04). The survey investigated socio-economic characteristics, drinking habits with a specific focus on binge consumption, abnormal eating behaviours and psychoactive substance use.

RESULTS

34.1% of the overall sample reported to limit their calorie intake before drinking, with no significant gender difference. A significant correlation was found between drunkorexic attitudes and, respectively, binge drinking behaviours (p < .01), use of cocaine (p < .01), and use of Novel Psychoactive Substances (p < .01).

DISCUSSION

Our data identified drunkorexia as a common behaviour among Italian young adults. Raising awareness on drunkorexia may help health care providers to timely address and approach its possible short- and long-term consequences.

LEVEL OF EVIDENCE

Level V (descriptive study).

Substance-related psychopathology and aggressiveness in a nightlife holiday resort: Results from a pilot study in a psychiatric inpatient unit in Ibiza

OBJECTIVES

We aimed to describe a sample of subjects admitted to a psychiatric unit after the intake of psychoactive substances for recreational purposes.

METHODS

Between June and September 2015, 49 subjects were included. Sociodemographic characteristics and psychopathological aspects were investigated, and urine samples for further analysis were collected. Three subgroups (cannabinoids, stimulants, and depressors users) were identified, according to the structured interview regarding substance use and urinalysis.

RESULTS

Level of aggressiveness was found to be significantly higher (p < .05) in the cannabinoids subgroup. Self-reported symptom severity was comparable among groups, but trends could be identified: SCL-90 results showed a prevalence of anxiety symptoms among depressors users, hostility or aggression in the tetrahydrocannabinol subgroup, and psychoticism in the stimulants subgroup.

CONCLUSIONS

The use of psychoactive substances was be characterised by poly-use of both traditional and novel substances. The presence of aggressiveness emerged as a main feature associated with the use of cannabis and other cannabinoids. Binge drinking and sleep deprivation also represented a relevant component in almost all the evaluated subjects.

Problematic Alcohol Use among University Students

BACKGROUND

Alcohol is attributable to many diseases and injury-related health conditions, and it is the fifth leading risk factor of premature death globally. Hence, the objective of this study was to assess the proportion and associated factors of problematic alcohol use among University students.

MATERIAL AND METHODS

Cross-sectional study was conducted among 725 randomly selected University students from November to December 2015. Data were collected by self-administered questionnaire, and problematic alcohol use was assessed by Alcohol Use Disorder Identification Test. Chi-square test was used to show association of problematic use and each variable and major predicators was identified using logistic regression with 95% confidence interval (CI); and variables with p-value less than 0.05 were considered statistically significant.

RESULTS

About 83 (11.4%) of the samples were problematic alcohol users of which 6.8% had medium level problems and 4.6% had high level problems. Significantly associated variables with problematic alcohol use among students were presence of social phobia (AOR = 1.7, 95% CI: 1.0, 2.8), lifetime use of any substance (AOR = 6.9, 95% CI: 3.8, 12.7), higher score in students cumulative grade point average (AOR = 0.6, 95% CI: 0.4, 0.9), and having intimate friend who use alcohol (AOR = 2.2, 95% CI: 1.3, 3.8).

CONCLUSION

Problematic alcohol use among university students was common and associated with social phobia, poor academic achievement, lifetime use of any substance, and peer pressure. Strong legislative control of alcohol in universities is important to reduce the burden of alcohol.