Risks of alcohol use disorders related to drinking patterns in the U.S. general population

Factors associated with very high-risk drinking in the Australian general population: How do men and women compare?

INTRODUCTION

Despite vulnerability to alcohol-related harms, women have historically been under-represented in alcohol research. This study examined the prevalence and characteristics of women who drink at very high-risk levels (11+ standard drinks monthly), factors associated with this consumption and comparisons with men.

METHODS

Secondary analyses of 2019 National Drug Strategy Household Survey data were undertaken. Significant differences by sex in the distribution of demographic and alcohol-related variables were explored using chi-squared and Mann-Whitney U tests. Binary logistic regression examined factors associated with very high-risk drinking.

RESULTS

Very high-risk drinking was reported by 10.4% of men and 3.1% of women. Compared to men, women were significantly younger with higher levels of psychological distress/mental health conditions, and were more likely to be unmarried. Both women and men engaged in a range of harm-minimisation strategies. Odds of very high-risk drinking were significantly higher for respondents who were male, younger, employed, lived in a regional/rural/remote area, psychologically distressed, smoked and used illicit drugs. Interactions with sex indicated that very high-risk drinking declined after the age of 24 for men compared to 44 for women. Being married reduced the likelihood of very high-risk drinking more greatly among women compared to men, while living in a major city reduced the likelihood among men (and not women).

DISCUSSION AND CONCLUSIONS

Very high-risk drinking is not limited to Australian men, and the women who drink at these levels have distinct profiles and factors associated with consumption.

Dynamic regulation of CeA gene expression during acute and protracted abstinence from chronic binge drinking of male and female C57BL/6J mice

Binge alcohol consumption is a major risk factor for developing Alcohol Use Disorder (AUD) and is associated with alcohol-related problems like accidental injury, acute alcohol poisoning, and black-outs. While there are numerous brain regions that have been shown to play a role in this AUD in humans and animal models, the central nucleus of the amygdala (CeA) has emerged as a critically important locus mediating binge alcohol consumption. In this study, we sought to understand how relative gene expression of key signaling molecules in the CeA changes during different periods of abstinence following bouts of binge drinking. To test this, we performed drinking in the dark (DID) on two separate cohorts of C57BL/6J mice and collected CeA brain tissue at one day (acute) and 7 days (protracted) abstinence after DID. We used qRTPCR to evaluate relative gene expression changes of 25 distinct genes of interest related to G protein-coupled receptors (GPCRs), neuropeptides, ion channel subunits, and enzymes that have been previously implicated in AUD. Our findings show that during acute abstinence CeA punches collected from female mice had upregulated relative mRNA expression of the gamma-aminobutyric acid receptor subunit alpha 2 (Gabra2), and the peptidase, angiotensinase c (Prcp). CeA punches from male mice at the same time point in abstinence had upregulated relative mRNA encoding for neuropeptide-related molecules, neuropeptide Y (Npy) and somatostatin (Sst), as well as the neuropeptide Y receptor Y2 (Npyr2) but downregulated, Glutamate ionotropic receptor NMDA type subunit 1 (Grin1). After protracted abstinence CeA punches collected from female mice had increased mRNA expression of corticotropin releasing hormone (Crh) and Npy. While CeA punches collected from male mice at the same timepoint had upregulated relative mRNA expression of Npy2r and downregulated mRNA expression of Gabra2, Grin1 and opioid receptor kappa 1 (Oprk1). Our findings support that there are differences in how the CeA of male and female respond to binge-alcohol exposure, highlighting the need to understand the implications of such differences in the context of AUD and binge drinking behavior.

Impact of COVID-19's Economic Burden on Alcohol-Related Problems: An Indirect Effect of Depression, Stress, and Anxiety

The COVID-19 pandemic resulted in global monumental upheaval. Many people were displaced from their jobs and sources of income. COVID-19 was also linked to increased mental health difficulties and increased alcohol consumption and problems. The current study aims to identify the indirect effect of depression, stress, and anxiety on the relations between the economic burden of COVID-19 and alcohol problems. Participants (N = 344) were recruited via Amazon's Mechanical Turk (MTurk). Participants completed a questionnaire about substance use, mood, and the economic burden of COVID-19. Eligible participants were 18 years or older, consumed alcohol or cannabis within the past week, and verified through Amazon. Results indicated significant indirect effects of depression, stress, and anxiety on the association between the economic burden of COVID-19 and alcohol problems regardless of use. Findings revealed large effect sizes, suggesting that mental health symptomatology may have a large impact on the association between COVID-19's economic burden and alcohol-related problems. Findings suggest mental health difficulties indirectly effect the association between COVID-19's economic burden and alcohol-related problems. Intervention efforts targeting mental health may be beneficial in reducing alcohol problems among individuals experiencing distress due to large-scale public health impact, such as the COVID-19 pandemic.

High Intensity Drinking (HID) Assessed by Maximum Quantity Consumed Is an Important Pattern Measure Adding Predictive Value in Higher and Lower Income Societies for Modeling Alcohol-Related Problems

Adjusting for demographics and standard drinking measures, High Intensity Drinking (HID), indexed by the maximum quantity consumed in a single day in the past 12 months, may be valuable in predicting alcohol dependence other harms across high and low income societies. The data consisted of 17 surveys of adult (15,460 current drinkers; 71% of total surveyed) in Europe (3), the Americas (8), Africa (2), and Asia/Australia (4). Gender-disaggregated country analyses used Poison regression to investigate whether HID (8-11, 12-23, 24+ drinks) was incrementally influential, beyond log drinking volume and HED (Heavy Episodic Drinking, or 5+ days), in predicting drinking problems, adjusting for age and marital status. In adjusted models predicting AUDIT-5 for men, adding HID improved the overall model fit for 11 of 15 countries. For women, 12 of 14 countries with available data showed an improved fit with HID included. The results for the five Life-Area Harms were similar for men. Considering the results by gender, each country showing improvements in model fit by adding HID had larger values of the average difference between high intensity and usual consumption, implying variations in amounts consumed on any given day. The amount consumed/day often greatly exceeded HED levels. In many societies of varying income levels, as hypothesized, HID provided important added information on drinking patterns for predicting harms, beyond the standard volume and binging indicators.

Designing Effective Alcohol Warnings: Consumer Reactions to Icons and Health Topics

Introduction

New warning labels for alcohol could reduce alcohol-related health harms. This study examined consumer responses to alcohol warnings with different designs.

Methods

A national sample of 3,051 U.S. adults completed an online survey in August 2021. Participants were randomized to 1 of 4 warning topics (addiction, liver damage, early death, or colon cancer). Participants viewed 3 labels, presented in random order: 2 types of warning labels (text-only and icon) showing a newly developed warning message about their assigned topic and a text-only control label showing a neutral message. Participants rated each label on effectiveness at discouraging alcohol consumption (primary outcome) and attention (secondary outcome) using 1 to 5 Likert-type scales. Participants also rated warnings with different causal language variants (e.g., "increases risk of," "contributes to") and marker words (e.g., "WARNING," "SURGEON GENERAL WARNING").

Results

Both the text-only and icon warnings were perceived as more effective (Average Differential Effects [ADEs]=0.79 and 0.86, respectively) and more attention-grabbing (ADEs=0.43 and 0.69, respectively) than control labels (all ps<0.001). The icon warnings were rated as more effective and attention-grabbing than the text-only warnings (ADEs=0.07 and 0.27, respectively, both ps<0.001). Although all warning topics outperformed the control messages, warnings about addiction were rated as less effective and attention-grabbing than the other topics. A majority (60%) of participants selected "increases risk of" as the most discouraging causal variant and a plurality (47%) selected "SURGEON GENERAL WARNING" as the most discouraging marker word.

Conclusions

New alcohol warnings could discourage alcohol consumption, especially if warnings include icons.

Does ethyl glucuronide in hair correlate with alcohol consumption? A comparative study with other traditional biomarkers among individuals with alcohol dependence syndrome

AIM

Ethyl glucuronide (EtG) in hair is a direct biomarker proven to be useful for the detection of chronic excessive alcohol use. This study investigated the association of self-reported alcohol consumption with traditional biomarkers: GGT, AST, ALT, CDT, and MCV in blood and a direct biomarker, hair EtG, in a total of 122 patients with alcohol dependence syndrome. The diagnostic accuracy of the biomarkers to differentiate heavy from non-heavy drinkers was also evaluated.

METHOD

GGT, AST, and ALT in serum were measured by Automated Chemistry Analyzer, MCV in blood was measured by Haematology Analyzer, serum CDT was analyzed by ELISA, and EtG in hair was evaluated by gas chromatography-mass spectrometry. The association between the biomarkers and the amount of alcohol consumed (self-reported) was determined using Spearman's rank correlation.

RESULTS

All participants showed EtG level above the cut-off (0.03 ng/mg). Hair EtG showed a statistically significant linear and positive correlation with the amounts (in grams) of alcohol consumed (r = 0.60; p < 0.001). No correlation was observed among the traditional biomarkers and the quantity of alcohol consumed. Also, EtG showed an excellent receiver operating characteristic (ROC) curve (98%) with good sensitivity (85%) and specificity (60%) to classify heavy drinkers among individuals with alcohol dependence syndrome.

CONCLUSION

Hair EtG can be helpful to estimate retrospective alcohol consumption in long-term chronic alcohol consumption cases. Hair EtG also provides a reliable diagnostic test to detect heavy drinkers among individuals with alcohol dependence syndrome.

Predicting severe alcohol use disorders in primary care using number of heavy drinking days

BACKGROUND AND AIMS

Although screening for unhealthy alcohol use is becoming more common, severe alcohol use disorders (AUDs) associated with the most severe medical and socio-economic sequelae still often go unidentified in primary care. To improve identification of severe AUDs and aid clinical decision-making, we aimed to identify a threshold of heavy drinking days (HDDs) associated with severe AUDs.

DESIGN, SETTING AND CASES

This cohort study analyzed electronic health record data of 138 765 adults who reported ≥ 1 HDD (4+ drinks/occasion for women and men aged ≥ 65 years, 5+ for men aged 18-64 years) during a 3-month period at a routine alcohol screening in primary care in a large Northern California, USA health-care system from 2014 to 2017. Our sample was 66.5% male, 59.7% white, 11.0% Asian/Pacific Islander, 5.0% black, 17.4% Latino/Hispanic and 7.0% other/unknown race/ethnicity; the mean age was 40.6 years (standard deviation = 15.2).

MEASUREMENTS

We compared sensitivity and specificity of different thresholds of the reported number of HDDs during a 3-month period for predicting severe AUD diagnoses in the following year, in the full sample and by sex and age.

FINDINGS

The prevalence of severe AUD diagnoses in the year after the screening was 0.6%. The optimal threshold predicting future severe AUD diagnoses in the full sample was ≥ 5 HDDs during a 3-month period [sensitivity = 68.9%, 95% confidence interval (CI) = 65.9, 72.0; specificity = 63.2%, 95% CI = 62.9, 63.4], but varied by sex and age. Women had a lower threshold than men (4 versus 6 HDDs), which decreased as women aged (from 5 HDDs among 18-24 years to 4 HDDs ≥ 25 years), but increased as men aged (from 5 HDDs among 18-24 years to 6 HDDs among 25-64 years, to 7 HDDs ≥ 65 years).

CONCLUSIONS

Five or more heavy drinking days in a 3-month period may indicate heightened risk of future severe alcohol use disorder in an adult primary care population. The optimal thresholds are lower for women than for men, and thresholds decrease as women age but increase as men age.

The role of anterior insular cortex inputs to dorsolateral striatum in binge alcohol drinking

How does binge drinking alcohol change synaptic function, and do these changes maintain binge consumption? The anterior insular cortex (AIC) and dorsolateral striatum (DLS) are brain regions implicated in alcohol use disorder. In male, but not female mice, we found that binge drinking alcohol produced glutamatergic synaptic adaptations selective to AIC inputs within the DLS. Photoexciting AIC→DLS circuitry in male mice during binge drinking decreased alcohol, but not water consumption and altered alcohol drinking mechanics. Further, drinking mechanics alone from drinking session data predicted alcohol-related circuit changes. AIC→DLS manipulation did not alter operant, valence, or anxiety-related behaviors. These findings suggest that alcohol-mediated changes at AIC inputs govern behavioral sequences that maintain binge drinking and may serve as a circuit-based biomarker for the development of alcohol use disorder.

Binge Drinking and Alcohol Problems Among Moderate Average-Level Drinkers

INTRODUCTION

A significant amount of binge drinking among adults escapes public health scrutiny because it occurs among individuals who drink at a moderate average level. This observational study examined the role of a binge pattern of drinking in predicting alcohol problems among moderate drinkers in a U.S. national sample of adults.

METHODS

Participants were 1,229 current drinkers aged ≥30 years from 2 waves of the study of Midlife Development in the United States, with a 9-year time lag (2004-2015) (analyzed in 2021‒2022). Negative binomial regression analyses were used to examine the number of alcohol problems, and binary logistic regression analyses were used to examine multiple (≥2) alcohol problems.

RESULTS

Independent of the average level of drinking, binge drinking was linked with an almost 3 times increase in the number of concurrent alcohol problems and a 40% increase in the number of alcohol problems prospectively 9 years later. Moderate average level drinkers accounted for most cases of binge drinking and multiple alcohol problems. Among moderate drinkers, binge drinking was linked with a close to 5 times increase in concurrent multiple alcohol problems and a >2 times increase in multiple alcohol problems prospectively 9 years later.

CONCLUSIONS

These results substantially broaden an increasing recognition that binge drinking is a public health concern among adults. Moderate average-level drinkers should be included in efforts to reduce alcohol problems in adults. These findings are applicable to primary and secondary prevention of alcohol problems with the potential to advance population health.

Increases in Risky Drinking During the COVID-19 Pandemic Assessed via Longitudinal Cohort Design: Associations With Racial Tensions, Financial Distress, Psychological Distress and Virus-Related Fears

BACKGROUND

The COVID-19 pandemic has created disruptions to daily life resulting in wide-spread unemployment and psychological distress. Recent studies have reported high rates of alcohol use during this time; however, longitudinal data remain scarce and factors associated with increases in high-risk drinking observed over time are unknown.

AIMS

The current study examined changes in high-risk drinking patterns across four 7-day observation periods, prior to and following a university wide campus closure. Additionally, factors associated with changes in alcohol use patterns were examined including financial distress, psychological distress, impact of racial tensions and virus-related fears.

METHOD

Students (N = 1001) in the Midwestern USA completed repeated assessments between March and June 2020. Each survey included a timeline follow-back measure of alcohol use. Pandemic-related distress spanning several factors was assessed at the final follow-up.

RESULTS

Risky drinking patterns increased significantly over time. Overall, psychological distress and impact of racial tensions were associated with higher rates of risky drinking, whereas COVID-19-related fears were associated with lower rates. However, only financial-related distress was associated with an increase in risky drinking patterns over time.

CONCLUSIONS

Increased risky drinking patterns observed in the current study may signal problems that are likely to persist even after the direct impact of the COVID-19 pandemic on daily life ends. Individuals experiencing financial distress may represent a particularly high-risk group. Interventions targeting the cross-section of job loss, financial stress and problematic alcohol use will be important to identify.

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys

OBJECTIVE

The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434).

METHOD

Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous).

RESULTS

In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks.

CONCLUSIONS

AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys

OBJECTIVE

The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434).

METHOD

Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous).

RESULTS

In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks.

CONCLUSIONS

AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.

Addictive behaviors across the menstrual cycle: a systematic review

Research examining relations between menstrual cycle phase and female addictive behaviors is accumulating. Theories suggest addictive behaviors may increase during specific phases of the menstrual cycle resulting from cyclical fluctuations in hormones and affect. In line with self-medication theory, we predicted that addictive behaviors would increase premenstrually and menstrually, phases marked by elevations in negative affect, relative to the follicular and luteal phases. We also hypothesized, coinciding with reward-sensitivity theory, that addictive behaviors may increase during ovulation, a phase characterized by increased positive affect, compared to the same phases. This systematic review summarizes extant literature examining the menstrual cycle phase-addictive behavior relationship and underlying motivations. Articles pertaining to menstrual cycle phase and addictive behaviors within the PsycINFO, CINAL, and PubMED databases were screened to determine eligibility following PRISMA guidelines (n = 1568). Thirty-four articles examining alcohol use, cannabis use, nicotine use, caffeine use, and gambling behavior across menstrual cycle phase met inclusion criteria. Consistent with self-medication theory, strong evidence indicated that nicotine use increased premenstrually and menstrually. Other factors increasing both nicotine and alcohol use premenstrually and menstrually include having a premenstrual dysphoric disorder diagnosis or having premenstrual syndrome. Motivations for using alcohol and nicotine may too vary by menstrual cycle phase. Results were less consistent or understudied for other addictive behaviors and thus conclusions cannot be drawn. Menstrual cycle phase appears to be a female-specific factor affecting some addictive behaviors, particularly nicotine use, and should be considered when conducting addictive behavior research or clinical interventions for reproductive-aged females with addictive disorders.

Differential Effects of State Policy Environments on Substance Use by Sexual Identity: Findings From the 2000-2015 National Alcohol Surveys

Introduction

This study explored whether structural stigma, defined by U.S. state policies related to sexual minority rights, moderated the relationship between sexual identity identity and heavy drinking, alcohol problems, and marijuana use among men and women.

Methods

Using combined data from the National Alcohol Survey (NAS) series (2000, 2005, 2010, and 2015), the sample included 11,115 men (421 sexual minority and 10,694 heterosexual) and 14,395 women (413 sexual minority and 13,982 heterosexual). State policy environment was assessed using a time-varying dichotomous indicator of comprehensive protections for sexual minorities (4-6 protections vs. limited or no protections). Gender-stratified logistic regression analyses examined the differential effect of the policy environment by sexual identity on three past-year substance use outcomes: high-intensity drinking (8+ drinks/day), any DSM-5 alcohol use disorder, and marijuana use.

Results

Among women, sexual minority status was associated with increased odds of all alcohol and marijuana use outcomes. Among men, sexual minority status was associated with decreased odds of high-intensity drinking but increased use of marijuana. Comprehensive policy protections were associated significantly decreased odds of high-intensity drinking among sexual minority men and marginally significant decreases among women.

Conclusions

Comprehensive policy protections appear to be protective for high-intensity drinking among sexual minority men and women. Findings underscore the importance of supportive policies in reducing risk of alcohol-related problems among sexual minorities.

Investigating differential protective effects of marriage on substance use by sexual identity status

BACKGROUND

Research suggests that marriage is protective against substance use. However, few studies have examined whether this protective effect differs for sexual minorities, a population at increased risk for substance use. Using data from four waves of the cross-sectional U.S. National Alcohol Survey (NAS; 2000, 2005, 2010, and 2015), we investigated whether the protective effects of marriage varied by sexual identity.

METHODS

Sex-stratified logistic regression models were used to examine independent and interactive effects of current marital status (being married vs. not) and sexual minority status (lesbian/gay/bisexual vs. heterosexual) on high-intensity drinking, alcohol use disorder, and marijuana use in the past year.

RESULTS

Among both women and men, sexual minority status was generally associated with higher odds of these outcomes and marriage was consistently associated with lower odds. Differential effects of marriage by sexual identity with respect to marijuana use were found only among men; marriage was significantly associated with decreased odds of marijuana use among heterosexual men but increased odds among sexual minority men.

CONCLUSIONS

Marriage may be less consistently protective against hazardous drinking and marijuana use among sexual minorities than heterosexuals. Findings underscore the importance of both quantitative and qualitative studies designed to better understand disparities in substance use across both sexual identity and relationship statuses.

Using ecological momentary assessment (EMA) to explore mechanisms of alcohol-involved HIV risk behavior among men who have sex with men (MSM)

BACKGROUND AND AIMS

Heavy drinking is associated with increased risk of incident HIV infection among men who have sex with men (MSM). Past studies suggest that this association may be due to the tendency for intoxication to interfere with condom use. However, research on potential causal mechanisms explaining this relationship has been limited primarily to laboratory studies. In this study, we tested several potential mediators of the relationship between alcohol use level and HIV risk behavior.

DESIGN

Ecological momentary assessment (EMA) methods conducted over a 30-day period.

SETTING AND PARTICIPANTS/CASES

MSM (n = 100) in the northeastern United States.

MEASUREMENTS

Participants completed daily diary surveys and up to six experience sampling surveys randomly prompted throughout the day.

FINDINGS

Very heavy levels of drinking (12+ drinks) increased the odds of engaging in any sex [odds ratio (OR) = 1.87, P < 0.001]. Coefficient products and 95% confidence intervals indicated that both subjective sexual arousal (OR = 1.52, P < 0.001) and sex intentions (OR = 1.74, P < 0.001) significantly mediated the association between very heavy drinking and the odds of sex. When participants reported sex, the odds of engaging in high-risk condomless anal sex (CAS) increased incrementally after drinking heavily (five to 11 drinks; OR = 3.27, P = 0.006) and very heavily (12+ drinks; OR = 4.42, P < 0.001). Only subjective sexual arousal significantly mediated the association between alcohol use level and high-risk CAS (OR = 1.16, P = 0.040).

CONCLUSIONS

Increases in subjective sexual arousal after drinking heavily appear to partly account for alcohol-related HIV risk behaviors in the daily lives of men who have sex with men. Alcohol's role in strengthening motivationally consistent emotional states may therefore play a more important role in facilitating alcohol-involved HIV risk than explicit sexual motivation.

Opioid and Dopamine Genes Interact to Predict Naltrexone Response in a Randomized Alcohol Use Disorder Clinical Trial

BACKGROUND

While the opiate antagonist, naltrexone, is approved for treating alcohol use disorder (AUD), not everyone who receives the medication benefits from it. This study evaluated whether the OPRM1 SNP rs1799971 interacts with the dopamine transporter gene DAT1/SLC6A3 VNTR rs28363170 or the catechol-O-methyltransferase (COMT) gene SNP rs4680 in predicting naltrexone response.

METHODS

Individuals who met DSM-IV alcohol dependence were randomly assigned to naltrexone (50 mg/d) or placebo based on their OPRM1 genotype (75 G-allele carriers and 77 A-allele homozygotes) and also genotyped for DAT1 VNTR (9 vs. 10 repeats) or COMT SNP (val/val vs. met carriers). Heavy drinking days (%HDD) were evaluated over 16 weeks and at the end of treatment. Effect sizes (d) for naltrexone response were calculated based on genotypes.

RESULTS

Naltrexone, relative to placebo, significantly reduced %HDD among OPRM1 G carriers who also had DAT1 10/10 (p = 0.021, d = 0.72) or COMT val/val genotypes (p = 0.05, d = 0.80), and to a lesser degree in those OPRM1 A homozygotes who were also DAT1 9-repeat carriers (p = 0.09, d = 0.70) or COMT met carriers (p = 0.03, d = 0.63). All other genotype combinations showed no differential response to naltrexone. Diarrhea/abdominal pain was more prominent in OPRM1 A homozygotes who were also DAT 9 or COMT met carriers.

CONCLUSIONS

These results suggest that individuals with AUD with a more opioid-responsive genotype (OPRM1 G carriers) respond better to naltrexone if they have genotypes indicating normal/less dopamine tone (DAT1 10,10 or COMT val,val), while those with a less responsive opioid-responsive genotype (OPRM1 A homozygotes) respond better to naltrexone if they have genotypes indicating greater dopamine tone (DAT1 9-repeat or COMT met carriers). These results could lead to more personalized AUD treatments.

Which adolescent factors predict alcohol misuse in young adulthood? A co-twin comparisons study

BACKGROUND AND AIMS

Research on adolescent predictors of later alcohol misuse is typically conducted on samples of singletons, and associations may be confounded by between-family differences. To address potential confounding, we applied a co-twin comparison design to evaluate whether differences between co-twins in a wide array of adolescent risk factors predicted differences in young adult alcohol misuse.

DESIGN

Longitudinal study in which associations between characteristics of the sample as adolescents were used to predict young adult alcohol misuse in individual-level analyses and co-twin comparisons.

SETTING

Finland.

PARTICIPANTS

A total of 3402 individuals (1435 complete twin pairs; 36% monozygotic; 57% female) from the FinnTwin12 study.

MEASUREMENTS

The young adult alcohol misuse outcome was a composite score of alcohol use and intoxication frequency. Adolescent predictors included factor scores representing academic performance, substance use, externalizing problems, internalizing problems, peer environment, physical health and relationship with parents; and single measures tapping alcohol expectancies, life events and pubertal development.

FINDINGS

In individual-level analyses, individuals with higher adolescent substance use, externalizing problems, time with friends, peer deviance, sports involvement, sleeping difficulties, parental discipline, positive alcohol expectancies and difficulty of life events reported higher alcohol misuse in young adulthood (Ps < 0.019, R²  = 0.0003-0.0310%). Conversely, those with higher adolescent internalizing problems, parent-child relationship quality and time with parents reported lower alcohol misuse (Ps < 0021, R²  = 0.0018-0.0093%). The associations with adolescent substance use and alcohol expectancies remained significant in co-twin comparisons (Ps < 0.049, R²  = 0.0019-0.0314%). Further, academic performance emerged as a significant predictor, such that individuals with higher grades compared with their co-twin reported higher young adult alcohol misuse (Ps < 0.029, R²  = 0.0449-0.0533%).

CONCLUSIONS

Adolescent substance use, positive alcohol expectancies and higher academic performance appear to be robust predictors of later alcohol misuse.

The pattern of alcohol use and its relationship with consequences among problem alcohol users: A community-based cross-sectional study from India

BACKGROUND

Pattern of drinking has a strong bearing on alcohol-related negative consequences. Very few studies from India have assessed this relationship using any standardized instrument.

AIM

The current study aims to assess the relationship between pattern of alcohol use and negative consequences among problem alcohol users using a standardized instrument.

MATERIALS AND METHODS

This cross-sectional, observational study using snowball sampling technique was conducted among 75 participants in an urban slum of a metropolitan city of India. Screening of the participants was done by the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST). Alcohol use details and alcohol-related adverse consequences were obtained by a semi-structured questionnaire and Drinker Inventory of Consequences (DrInC) inventory, respectively. Descriptive statistics, Chi-square test, and logistic regression test were used to analyze the data.

RESULTS

There was a significant association between high total DrInC score and ≥3 subscale scores with employment status, percentage of total family income spent on alcohol, source of income to procure alcohol, amount of alcohol, morning drinking, alcohol use for relaxation, and drinking throughout the day (Chi-square test). Age ≤35 years, current unemployment/part-time employment state, spending ≥25% of total family income on alcohol, family history, and drinking throughout the day were more likely to have high total DrInC score and ≥2 subscale scores (logistic regression analysis).

CONCLUSION

A large proportion of the participants were suffering significantly from alcohol-related consequences but still were not receiving any treatment. It emphasizes the need for more epidemiological studies in this area for its treatment and policy-level implication.

Harmful drinking, tobacco, and marijuana use in the 2000-2015 National Alcohol Surveys: Examining differential trends by sexual identity

BACKGROUND

Population-based surveys document disparities in substance use among sexual minorities compared to heterosexuals, but few studies examine changes over time. This study compared changes in harmful drinking (including alcohol use disorders and high-intensity drinking), tobacco use, marijuana use, and simultaneous marijuana and alcohol co-use between heterosexual and sexual minority adults over a 15-year period. Methods: Gender-stratified logistic regression analyses using 4 waves of cross-sectional data from the National Alcohol Survey (2000, 2005, 2010, and 2015) were conducted to test overall trends over time and differences by sexual identity, as well as the interaction between survey year and sexual identity. Results: Among women, significant effects for sexual identity were present in all models, reflecting greater odds of use among sexual minorities across waves. Among men, significant effects for sexual identity were found for high-intensity drinking (reflecting less use among sexual minorities) as well as marijuana use and marijuana and alcohol co-use (reflecting more use among sexual minorities). For women and men, tobacco use generally decreased and both marijuana use and simultaneous marijuana and alcohol co-use increased during the study period. Although trends were largely driven by heterosexual respondents, only one instance of an interactive effect was found; reports of harmful drinking were generally stable over time among heterosexual women, but higher and more variable over time among sexual minority women. Conclusions: Findings highlight that differences in patterns of substance use by sexual identity persist and underscore the need for screening, prevention, and intervention, particularly for sexual minority women.

Hazardous drinking, alcohol use disorders, and need for treatment among Pacific Islander young adults

Pacific Islander (PI) young adults are suspected to bear heavy risk for hazardous drinking, alcohol use disorders (AUD), and alcohol-related harms. Yet, PIs remain among the most understudied racial groups in the United States-creating a lack of empirical data documenting their alcohol use problems and treatment needs. The present study presents the first known data on PI young adults' hazardous drinking, possible AUDs, alcohol-related harms, and treatment needs. Survey data were collected from 156 community-dwelling PI young adults (40% women, age 18-30 years) in 2 large PI communities: Los Angeles County and Northwest Arkansas. We screened participants for alcohol, cigarette, and marijuana use, hazardous drinking, possible AUD, alcohol-related harms, and past-year need for mental health and substance use disorder (SUD) treatment. Logistic regressions examined whether experiencing possible AUD and alcohol-related harms were associated with past-year need for treatment. PI young adults reported 78% lifetime rate of alcohol use with 56% screening positive for hazardous drinking, 49% for any possible AUD, and 40% experiencing significant alcohol-related harm (e.g., health, finances). Yet, just 25% of participants reported past-year need for SUD treatment. Although having possible AUD was not associated with perceived SUD treatment need, experiencing any alcohol-related harm associated with 4.7-13.2 times greater adjusted odds for needing treatment. Therefore, despite having low self-perceived treatment need, PI young adults experience excessive burden of hazardous drinking and alcohol-related harms. Given the profound negative social and health effects of AUDs, culturally grounded interventions should be designed to reduce PI young adults' elevated rates of hazardous drinking and alcohol-related harms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Risk of harm from alcohol use and heavy alcohol consumption: Its association with other NCD risk factors in Thailand

While there is an abundance of literature examining the relation between quantity of alcohol consumption and risk factors for non-communicable diseases (NCD), there is less evidence on whether the risk of harm from alcohol use would have a similar relationship with NCD risk factors. The study aims to determine the association between level of harm from alcohol use and NCD risk factors. A cross-sectional survey was conducted among health care workers in Thailand in 2013. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to assessed risk of harm from alcohol use. The results suggest that higher risk of harm from alcohol use was associated with two of the eight NCD risk factors among women (higher blood pressure and higher triglyceride level) and five of the eight NCD risk factors among men (smoking, physical inactivity, higher blood pressure, higher blood glucose and higher triglyceride level). For men, assessing risk of harm could be incorporated as part of NCD programs as practitioners do not have to worry about the accuracy of the alcohol quantification and conversion to standard drinks. However, among women, quantifying volume may still be needed.

Addiction resistance to alcohol: What about heavy drinkers who avoid alcohol problems?

BACKGROUND

Some individuals are resistant to alcohol use disorders despite high levels of intake. Addiction Resistance (AR) measures the disparity between alcohol consumption and alcohol use disorder (AUD) symptoms, such that some persons exhibit few (AUD) symptoms despite higher intake. The validity of the concept and the factors contributing to AR are not well understood. The aim of this study was to predict AR based on variables related to risk for addiction that are measured in the Family Health Patterns Project.

METHOD

Participants were healthy young adults (n = 1122) with and without a family history of alcohol and other substance use disorders who were given measures of mood stability and risk-taking tendencies, and were interviewed to determine alcohol intake, AUD symptoms, and other substance use disorders (SUD). AR was calculated using maximal lifetime alcohol intake and number of AUD symptoms.

RESULTS

A principal components analysis was run with varimax rotation, which yielded three components: Component 1 indexed behavioral and mood regulation, Component 2 encompassed family and environmental factors, and Component 3 included cognitive factors. A multiple regression analysis revealed that Component 1 and Component 2 were predictive of AR whereas Component 3 was not.

DISCUSSION

Individuals who reported greater emotional stability, norm adherence, risk avoidance, and fewer family members with substance use disorders were more resistant to AUD despite higher alcohol intake. These findings suggest that AUD risk and resistance may represent different points of the same continuum.

Do Associations Between Alcohol Use and Alcohol Use Disorder Vary by Weight Status? Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III

BACKGROUND

Understanding whether the associations between alcohol use and alcohol use disorder (AUD) differ by weight status may be useful in screening for AUD in populations where obesity is common. We aimed to determine whether the associations between alcohol use and AUD differ by weight status.

METHODS

A total of 24,869 adult participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III with a body mass index ≥18.5 kg/m² who reported past-year alcohol use were included. The AUD and Associated Disabilities Interview Schedule-5 were administered to identify past-year AUD. Logistic regression was used to test the associations between weight status and levels and patterns of alcohol use with AUD; interactions between weight status and alcohol use variables in relation to AUD were examined. Analyses were stratified by gender.

RESULTS

For males and females, the odds of AUD were higher with greater frequency of any alcohol use and heavy drinking, higher average quantity of drinks per drinking day, and past-year high-risk drinking. Among males, at the same average quantity of drinks per drinking day, frequency of heavy drinking, or presence of high-risk drinking, those with class 3 obesity had higher odds of AUD versus lower classes or no obesity (p for all interactions <0.01). Among females, at the same frequency of any alcohol use, those with healthy weight had the highest odds of AUD, while females with class 3 obesity had the lowest odds of AUD (p for interaction <0.001); interactions between weight status and other alcohol use variables were not significant (p ≥ 0.05).

CONCLUSIONS

The associations between some measures of alcohol use and AUD differed by weight status, with inconsistent results between males and females. Alcohol use thresholds typically used in AUD screening may be too high in males with class 3 obesity.

Heterogeneous Dose-Response Analyses of Alcohol Abuse and Dependence

BACKGROUND

Survey-based estimates of the prevalence of alcohol abuse, dependence, and disorders in the United States rely upon self-reports of drinking patterns (e.g., binge drinking), social problems (e.g., trouble at work), physiological responses to use (e.g., tolerance), and desistance from use (e.g., withdrawal). Diagnostic criteria derived from these reports enable prevalence estimates of abuse and dependence, but moderating structural relationships among symptom groups may lead some light and moderate drinkers to appear to exhibit an alcohol use disorder (AUD).

METHODS

A dynamic model of drinking and problems predicts that symptoms of dependence will moderate relationships between drinking measures and symptoms of abuse. Wave 1 National Epidemiologic Survey on Alcohol and Related Conditions data on DSM-IV diagnoses of abuse and dependence were used to test predictions from this model and assess whether moderating effects were observed among lighter and heavier drinkers (those who drink 1 to 3 vs. 4 or more drinks on average). A dose-response model that accounts for other known sources of risk heterogeneity related to drinking and problems enabled us to test these predictions.

RESULTS

As expected from previous work, symptoms of abuse and dependence and dependence criteria were nonlinearly related to drinking patterns; more symptom reports appeared and criteria were met among less frequent drinkers who drank more on each occasion and this pattern of dose-response was substantially moderated among heavier drinkers. Controlling for these effects, relationships between drinking and symptoms of abuse were moderated among respondents who met more dependence criteria. These effects were observed among both lighter and heavier drinkers.

CONCLUSIONS

Moderating relationships observed between measures of drinking, abuse, and dependence criteria among lighter and heavier drinkers suggest that the same etiologic forces are at play among all drinking groups. Greater symptoms of dependence among lighter drinkers may lead to greater reports of symptoms of abuse and an AUD diagnosis.

Amygdala-orbitofrontal functional connectivity mediates the relationship between sensation seeking and alcohol use among binge-drinking adults

BACKGROUND

Decreased amygdala-orbitofrontal cortex (OFC) neural functional connectivity (FC) positively predicts alcohol use among adolescents. Low amygdala-OFC FC is also associated with poor emotion regulation, a trait robustly linked to alcohol use. Thus, decreased amygdala-OFC connectivity may represent a risk factor for the development of alcohol use disorder (AUD) via impaired emotion regulation or reward processing. In this study, we examined amygdala-OFC FC among young adult binge drinkers at high risk for AUD. We also tested if amygdala-OFC FC mediates the relationship between externalizing personality traits and alcohol use.

METHODS

Healthy male and female (n = 39) binge drinkers completed a resting state fMRI scan and the Eysenck Impulsive Personality questionnaire. We utilized seed-based connectivity of the left and right amygdala to prefrontal regions as well as mediation analysis.

RESULTS

Individuals with higher weekly alcohol use displayed decreased right amygdala-OFC FC. Furthermore, high trait venturesomeness, but not impulsivness, was associated with decreased right amygdala-OFC FC. Finally, right amygdala-OFC FC mediated the relationship between trait venturesomeness and weekly drinking; individuals with high trait venturesomeness displayed decreased right amygdala-OFC FC, which in turn predicted greater weekly drinking.

CONCLUSIONS

Our findings corroborate and extend the adolescent literature by showing that decreased amygdala-OFC FC is associated with higher alcohol consumption among adults at elevated risk for AUD. This study also demonstrates for the first time that this neural profile reflects a tendency to sensation seeking. In sum, our findings suggest that amygdala-OFC FC may be an objective neural target for alcohol use prevention and intervention.

Drinking Level Versus Drinking Pattern and Cigarette Smoking Among Older Adults

BACKGROUND

There is a lack of research on the role of alcohol consumption in cigarette smoking among older adults, and the few studies on alcohol use and smoking with older adults have failed to distinguish between average level and pattern of drinking as predictors of smoking. The main purpose of this study was to examine the independent contributions of average level versus pattern of drinking as predictors of cigarette smoking among older adults. A subsidiary purpose was to examine the link between continued smoking and mortality among older smokers.

METHODS

We investigated average level and pattern of drinking as predictors of current smoking among 1,151 older adults at baseline and of continued smoking and mortality among the subset of 276 baseline smokers tracked across 20 years. We used multiple linear and logistic regression analyses and, to test mediation, bias-corrected bootstrap confidence intervals.

RESULTS

A high level of average drinking and a pattern of episodic heavy drinking were concurrently associated with smoking at baseline. However, only episodic heavy drinking was prospectively linked to continued smoking among baseline smokers. Continued smoking among baseline smokers increased the odds of 20-year mortality and provided an indirect pathway through which heavy episodic drinking related to mortality.

CONCLUSIONS

Smokers who misuse alcohol are a challenging population for smoking cessation efforts. Older adults who concurrently misuse alcohol and smoke cigarettes provide a unique target for public health interventions.

Late-Life Drinking Problems: The Predictive Roles of Drinking Level vs. Drinking Pattern

OBJECTIVE

Research on late-middle-aged and older adults has focused primarily on average level of alcohol consumption, overlooking variability in underlying drinking patterns. The purpose of the present study was to examine the independent contributions of an episodic heavy pattern of drinking versus a high average level of drinking as prospective predictors of drinking problems.

METHOD

The sample comprised 1,107 adults ages 55-65 years at baseline. Alcohol consumption was assessed at baseline, and drinking problems were indexed across 20 years. We used prospective negative binomial regression analyses controlling for baseline drinking problems, as well as for demographic and health factors, to predict the number of drinking problems at each of four follow-up waves (1, 4, 10, and 20 years).

RESULTS

Across waves where the effects were significant, a high average level of drinking (coefficients of 1.56, 95% CI [1.24, 1.95]; 1.48, 95% CI [1.11, 1.98]; and 1.85, 95% CI [1.23, 2.79] at 1, 10, and 20 years) and an episodic heavy pattern of drinking (coefficients of 1.61, 95% CI [1.30, 1.99]; 1.61, 95% CI [1.28, 2.03]; and 1.43, 95% CI [1.08, 1.90] at 1, 4, and 10 years) each independently increased the number of drinking problems by more than 50%.

CONCLUSIONS

Information based only on average consumption underestimates the risk of drinking problems among older adults. Both a high average level of drinking and an episodic heavy pattern of drinking pose prospective risks of later drinking problems among older adults.

Concurrent polysubstance use in a longitudinal study of US youth: associations with sexual orientation

AIMS

To estimate longitudinal associations between self-reported sexual orientation and past-year polysubstance use among youth, and test how gender, age and early onset of tobacco and alcohol use contributed to variation in polysubstance use.

DESIGN

Longitudinal community-based cohort of US adolescents from the Growing Up Today Study (GUTS 1) (n = 16 873) followed from ages 12-29 years.

SETTING

United States of America.

PARTICIPANTS

A total of 13 519 individuals (7839 females; 5680 males) who responded to at least one of five self-administered questionnaires from 1999 to 2010. Ninety-three per cent reported their race/ethnicity as non-Hispanic white.

MEASUREMENTS

Multivariable repeated measures generalized estimating equations estimated relative risks (RRs) of concurrent polysubstance use (i.e. past 12-month use of three or more substances) comparing sexual orientation minority youth [i.e. mostly heterosexual (MH), bisexual (BI), gay/lesbian (GL)] to their same-gender, completely heterosexual (CH) counterparts. Mediation analyses tested whether early onset of tobacco and/or alcohol use explained relationships between sexual orientation and concurrent polysubstance use.

FINDINGS

Compared with their same-gender CH peers, sexual minorities evidenced higher risk for concurrent polysubstance use over all repeated measures [risk ratios (RRs) for sexual minority subgroups: from 1.63-2.91, P-values: <0.001] and for all age groups (RRs: from 1.50-4.04, P-values: < 0.05-< 0.001), except GL males aged 18-20 years. Differences between sexual minorities and CHs were larger among females than males (P-values for sexual orientation × gender interactions were < 0.05 for MHs and BIs), and among younger versus older ages (P-values for sexual orientation × age interactions were < 0.05, except for BI males). Sexual minorities' younger age of smoking and/or drinking initiation contributed to their elevated polysubstance use (% of effect explained was between 9.4-24.3, P-values: 0.04-< 0.001), except among GL males.

CONCLUSIONS

Sexual minority youth in the United States, and in particular younger females, appear to be at disproportionate risk for concurrent past-year polysubstance use. Early onset of smoking and drinking may contribute to elevated risk of polysubstance use among sexual minorities.

Alcohol Use Patterns and DSM-5 Alcohol Use Disorder on Both Sides of the U.S.-Mexico Border

BACKGROUND

Alcohol consumption patterns on the U.S.-Mexico border and their relationships with DSM-5 alcohol use disorders (AUD) have been understudied. Yet, the effects of drinking by Mexican-origin individuals may differ between cities on versus off the border both in the United States and in Mexico. We characterize prior 12-month drinking patterns and examine their relationships with AUD, in border and off-border cities of Texas and adjacent Mexican states.

METHODS

Data come from the U.S.-Mexico Study of Alcohol and Related Conditions involving 2,336 Mexican Americans in Texas and 2,460 Mexicans in bordering states of Nuevo Leon and Tamaulipas in Mexico. Drinking pattern was defined as an interaction between volume and maximum amount, or intensity (never vs. ever 5+/4+ [men/women], 8+, and 12+ drinks in a day). DSM-5 AUD was assessed using an adaptation of the Alcohol Section of the World Health Organization Composite International Diagnostic Interview core. Separately by gender, 5 logistic regressions models controlling for age were estimated predicting symptoms in 2 or more AUD criteria domains from volume, heavy pattern and, successively, effects of country, and (by country) residing on vs. off the border, or in each of 3 cities/country.

RESULTS

A segmentation analysis for Texas males based on rate of experiencing AUD generated several distinct volume groups, each partitioned by an empirically selected maximum, and helped identify a drinking-pattern typology. In gender-stratified models of AUD rates using this typology, adjusting for age, significant volume and intensity effects were seen, more strongly in the United States. Border versus interior differences implied more AUD for given patterns at the border in the United States and the reverse in Mexico, with some city differences also evident.

CONCLUSIONS

Drinking-pattern analyses confirm that border proximity may affect drinking problems but in opposite directions in the United States and Mexico, possibly related to economic and psychological stresses specific to respective communities.

Prevalence and predictors of drinking, binge drinking, and related health and social problems in Puerto Rico

BACKGROUND

This paper examines prevalence and predictors of drinking, binge drinking, and alcohol-related social and health problems in Puerto Rico.

METHODS

Respondents constitute a multi-stage household probability sample (N = 1,510) from San Juan, Puerto Rico. The response rate was 83%.

RESULTS

Men compared to women (Coeff: .34; 95 CI = .19-.50; p < .001), those with more liberal norms (Coeff: 1.05; 95 CI = .87-1.23; p < .001) and those with more positive attitudes about drinking (Coeff: 1.06; 95 CI= .63-1.49; p < .001) have a higher average number of weekly drinks. Those in the 40-49 age group have a lower mean number of weekly drinks than those in the 18-29 age group (Coeff.: -.23; 95 CI = -.42-.03; p < .02). Those with income between $30,001 and $40,000 a year compared to those with less than $10,000, (OR: .28; 95 CI = .08-1.93; p < .039) report fewer social/health problems. Protestants compared to Catholics (AOR: 1.94; 95 CI = 1.08-3.47; p < .026), those with more liberal drinking norms (AOR: 3.62; 95 CI = 1.87-6.99; p < .001) and more positive attitudes about drinking (AOR: 3.41; 95 CI = 1.04-11.09; p < .001), and those who consume a higher number of drink per week (AOR: 1.03; 95 CI = 1.01-1.05; p < .001) and binge (AOR: 3.52; 95 CI = 2.14-5.80; p < .001) are more likely to report social and health problems associated with alcohol use.

DISCUSSION AND CONCLUSIONS

The finding that male gender is not associated with binge drinking and social and health problems was not expected. Puerto Ricans appear to drink less than the general population and Hispanics and Puerto Ricans on the U.S. mainland.

SCIENTIFIC SIGNIFICANCE

Up to date epidemiological findings provide information about high risk groups and correlates of alcohol problems in the population. These are now available for Puerto Rico and can be used in the design of prevention interventions. (Am J Addict 2016;25:478-485).

Poor, persecuted, young, and alone: Toward explaining the elevated risk of alcohol problems among Black and Latino men who drink

BACKGROUND

Even given equivalent drinking patterns, Black and Latino men experience substantially more dependence symptoms and other consequences than White men, particularly at low/no heavy drinking. No known studies have identified factors driving these disparities. The current study examines this question.

METHODS

The 2005 and 2010 National Alcohol Surveys were pooled. Surveys are nationally representative, telephone interviews of the U.S. including Black and Latino oversamples; male drinkers were analyzed (N=4182). Preliminary analyses included negative binomial regressions of dependence symptom and consequence counts testing whether effects for race/ethnicity were diminished when entering potential explanatory factors individually. Additional analyses re-examined effects for race/ethnicity when using propensity score weighting to weight Blacks to Whites, and Latinos to Whites, first on heavy drinking alone, and then on heavy drinking and all explanatory factors supported by preliminary analyses.

RESULTS

Preliminary regressions suggested roles for lower individual SES, greater prejudice and unfair treatment, and younger age in the elevated risk of alcohol problems among Black and Latino (vs. White) men at low heavy drinking levels; additional support emerged for single (vs. married) status among Blacks and neighborhood disadvantage among Latinos. When Blacks and Latinos were weighted to Whites on the above variables, effects for race/ethnicity on dependence counts were reduced to nonsignificance, while racial/ethnic disparities in consequence counts were attenuated (by >43% overall).

CONCLUSIONS

Heavy drinking may be especially risky for those who are poor, exposed to prejudice and unfair treatment, young, and unmarried, and these factors may contribute to explaining racial/ethnic disparities in alcohol problems.

Risk of the Metabolic Syndrome in Sexual Minority Women: Results from the ESTHER Study

OBJECTIVE

Compared to heterosexuals, sexual minority women (SMW) have higher rates of the metabolic syndrome risk factors (e.g., obesity, smoking, heavy drinking, and depression). Yet, no published research has examined whether SMW have higher rates of the metabolic syndrome. The aim of this study is to describe the prevalence of the metabolic syndrome and its individual factors in a sample of heterosexuals and SMW, and identify whether SMW are at greater risk of having the metabolic syndrome.

MATERIALS AND METHODS

Data are from the Epidemiologic STudy of HEalth Risk in Women (ESTHER), a cross-sectional convenience sample of 479 SMW and 400 heterosexual women from Pittsburgh, Pennsylvania. Participants provided self-report questionnaire data, clinical data, and blood work.

RESULTS

Compared to heterosexuals, SMW had higher mean waist circumference, fasting glucose, and systolic and diastolic blood pressure. Nearly one-quarter (24.3%) of SMW had the metabolic syndrome compared to 15.6% of heterosexual women (p = 0.002). After controlling for demographic and risk factors, SMW had a 44% higher risk of having the metabolic syndrome than heterosexuals (p = 0.031).

CONCLUSIONS

To our knowledge, this is the first study to identify this health disparity in SMW. Future studies should explore differential risk of mortality and metabolic health between SMW and heterosexuals.

Effects of acute exercise on liver function and blood redox status in heavy drinkers

Excessive alcohol consumption can induce oxidative stress, resulting in the development of several diseases. Exercise has been reported to prevent and/or improve a number of health issues through several mechanisms, including an improvement in redox status. It has also been previously suggested that exercise can help individuals with alcohol use disorders reduce their alcohol intake; however, research in this field is limited. The aim of the present study was to investigage the effects of acute exercise of moderate intensity on the liver function and blood redox status in heavy drinkers. For this purpose, a total of 17 heavy drinkers [age, 31.6±3.2 years; body mass index (BMI), 27.4±0.8 kg/m2; experimental group (EG)] and 17 controls [age, 33.5±1.3 years; BMI, 26.1±1.4 kg/m2; control group (CG), who did not exceed moderate alcohol consumption], underwent one trial of acute exercise of moderate intensity (50-60% of the heart rate reserve) for 30 min on a cycle ergometer, following an overnight fast, and abstaining from smoking and alcohol consumption. Blood samples were obtained before and immediately after exercise for later determination of the indices of liver function and blood redox status. The subjects in the EG had significantly higher (p<0.05) baseline γ-glutamyl transferase (γ-GT) levels compared to the subjects in the CG. Exercise thus resulted in significantly higher γ-GT levels (p<0.005) only in the EG. No significant differences in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) baseline levels were observed between the 2 groups. Following exercise, the AST levels increased significantly (p<0.001) in both groups, whereas the ALT levels increased significantly (p<0.01) only in the EG. The baseline glutathione (GSH) levels were significantly lower (p<0.05) and remained low following exercise in the EG. In addition, we observed a trend for higher (p=0.07) baseline levels of thiobarbituric acid-reactive substances (TBARS), which remained elevated post-exercise in the EG compared to the CG. Significantly increased post-exercise total antioxidant capacity (TAC; p<0.01) and uric acid (UA; p<0.05) levels were noted in the CG, whereas the TAC (p=0.06) and UA (p=0.08) levels increased and approached significance post-exercise in the EG. No significant differences in the baseline levels of total bilirubin and protein carbonyl were observed between the 2 groups, even post-exercise. Thus, the findings of the present study indicate that even though heavy drinkers may be prone to oxidative stress, their exercise-induced antioxidant response is similar to that of individuals who do not drink heavily.

Daily co-occurrence of alcohol use and high-risk sexual behavior among heterosexual, heavy drinking emergency department patients

BACKGROUND

Global association and experimental studies suggest that alcohol use may increase sexual behavior that poses risk for exposure to sexually transmitted infections (STI) among heterosexual men and women. However, results from longitudinal and daily recall studies exploring the co-occurrence of alcohol use with various sexual risk outcomes in more naturalistic contexts have been mixed, and the bulk of this research has focused on college students.

METHODS

The current study enrolled heavy-drinking emergency department (ED) patients and used a cross-sectional, 30-day Timeline Followback (TLFB) method to examine the daily co-occurrence between alcohol use and three sexual behavior outcomes: Any sex, unprotected intercourse (UI), and UI with casual partners (versus protected intercourse [PI] with casual partners, or UI/PI with steady partners).

RESULTS

Results indicated that increasing levels of alcohol use on a given day increased the odds of engaging in any sexual activity and that heavy drinking (but not very heavy drinking) on a given day was associated with an increased odds of engaging in UI with either steady or casual partners. However, day-level alcohol use was not associated with an increased odds of UI with casual partners.

CONCLUSIONS

These findings suggest that alcohol may play an important role in increasing risk for HIV/STIs among heterosexuals, and support the continued need to target heavy drinking in sex risk reduction interventions. However, our results also suggest that alcohol may not universally result in unprotected sex with casual partners, a behavior posing perhaps the highest risk for HIV/STI transmission.

Does a Change Over All Equal a Change in All? Testing for Polarized Alcohol Use Within and Across Socio-Economic Groups in Germany

AIMS

This study aimed at testing whether drinking volume and episodic heavy drinking (EHD) frequency in Germany are polarizing between consumption levels over time. Polarization is defined as a reduction in alcohol use among the majority of the population, while a subpopulation with a high intake level maintains or increases its drinking or its EHD frequency. The polarization hypothesis was tested across and within socio-economic subgroups.

METHOD

Analyses were based on seven cross-sectional waves of the Epidemiological Survey of Substance Abuse (ESA) conducted between 1995 and 2012 (n = 7833-9084). Overall polarization was estimated based on regression models with time by consumption level interactions; the three-way interaction with socio-economic status (SES) was consecutively introduced to test the stability of effects over socio-economic strata. Interactions were interpreted by graphical inspection.

RESULTS

For both alcohol use indicators, declines over time were largest in the highest consumption level. This was found within all SES groups, but was most pronounced at low and least pronounced at medium SES.

CONCLUSION

The results indicate no polarization but convergence between consumption levels. Socio-economic status groups differ in the magnitude of convergence which was lowest in medium SES. The overall decline was strongest for the highest consumption level of low SES.

Drinking Patterns in US Counties From 2002 to 2012

OBJECTIVES

We estimated the prevalence of any drinking and binge drinking from 2002 to 2012 and heavy drinking from 2005 to 2012 in every US county.

METHODS

We applied small area models to Behavioral Risk Factor Surveillance System data. These models incorporated spatial and temporal smoothing and explicitly accounted for methodological changes to the Behavioral Risk Factor Surveillance System during this period.

RESULTS

We found large differences between counties in all measures of alcohol use: in 2012, any drinking prevalence ranged from 11.0% to 78.7%, heavy drinking prevalence ranged from 2.4% to 22.4%, and binge drinking prevalence ranged from 5.9% to 36.0%. Moreover, there was wide variation in the proportion of all drinkers who engaged in heavy or binge drinking. Heavy and binge drinking prevalence increased in most counties between 2005 and 2012, but the magnitude of change varied considerably.

CONCLUSIONS

There are large differences within the United States in levels and recent trends in alcohol use. These estimates should be used as an aid in designing and implementing targeted interventions and to monitor progress toward reducing the burden of excessive alcohol use.

Daily associations between alcohol use and unprotected anal sex among heavy drinking HIV-positive men who have sex with men

Men who have sex with men (MSM) account for the largest proportion of new HIV infections in the United States. Alcohol may facilitate HIV transmission by increasing unprotected anal sex, but few studies have focused on transmission behaviors in HIV-positive MSM. This study explored daily associations between alcohol use and sexual behavior among heavy drinking HIV-positive MSM using a 30-day Timeline Followback interview. Results of generalized estimating equations indicated that greater alcohol consumption on a given day was associated with a linear increase in the odds of having unprotected anal sex with partners of any HIV status. However, the odds of reporting unprotected anal sex with HIV-negative or HIV-status unknown partners increased in a curvilinear fashion, occurring primarily at very heavy levels of use (12+ drinks). Results suggest that very heavy drinking increases the risk of engaging in sexual behavior that has the potential for transmitting HIV to other men.

Adolescent drinking onset and its adult consequences among men: a population based study from India

BACKGROUND

Few population-based studies from low-income and middle-income countries have addressed adolescent drinking onset and its association with adult alcohol-related adverse outcomes. The aims of this study were to: (1) estimate the rate of adolescent drinking onset and its trend over time among men (2) describe demographic and socioeconomic factors associated with adolescent drinking onset; and (3) examine the association between adolescent drinking onset and adverse outcomes in later life, including hazardous or harmful alcohol use, heavy episodic drinking, alcohol dependence, injuries and psychological distress.

METHODS

Population-based survey of men (n=1899) from rural and urban communities in northern Goa, India. Analysis addressed age of drinking onset among those who reported ever drinking in their lifetime, and drinking patterns and consequences among current drinkers.

RESULTS

Adolescent drinking onset showed an increasing trend over time (p<0.001), from 19.5% for those born between 1956 and 1960 to 74.3% for those born between 1981 and 1985. Urban residence, Christian religion and low standard of living were associated with adolescent drinking onset. Adolescent drinking onset was associated with psychological distress (OR 2.82; 95% CI 1.41 to 5.63), alcohol dependence (OR 2.56; 95% CI 1.79 to 3.68), lifetime history of alcohol related injuries (OR 3.07; 95% CI 1.16 to 8.14), alcohol related injuries during the past year (OR 3.04; 95% CI 1.35 to 6.81), and a Alcohol Use Disorder Identification Test score ≥8 indicating hazardous or harmful alcohol use (OR 1.9; 95% CI 1.17 to 3.08) in adulthood.

CONCLUSIONS

This study among men in Goa, India suggests a substantial increase in adolescent drinking onset in more recent birth cohorts. Consistent with other countries, adolescent drinking onset increased the likelihood of lifetime alcohol dependence, hazardous or harmful alcohol use, alcohol related injuries and psychological distress. These findings highlight the need for policies and programmes to delay drinking onset in India.