Update on Alcohol and Health

www.alcoholandhealth.orgwww.alcoholandhealth.org 11

Update on Update on Alcohol and HealthAlcohol and Health

Alcohol and Health: Current EvidenceAlcohol and Health: Current Evidence

JulyJuly–August–August 2004 2004


Studies on Studies on Alcohol and Alcohol and

Health ConditionsHealth Conditions


Alcohol, Hypertension, Alcohol, Hypertension, and Cardiovascular and Cardiovascular Disease MortalityDisease Mortality

Malinski MK, et al. Arch Intern Med. 2004;164(6):623–628.


Objectives/MethodsObjectives/Methods

To assess the relationship between drinking and To assess the relationship between drinking and mortality among patients with hypertensionmortality among patients with hypertension

Self-reported data from the Physicians’ Health Self-reported data from the Physicians’ Health StudyStudy 14,125 males with a history of current or past 14,125 males with a history of current or past

treatment for hypertension and without myocardial treatment for hypertension and without myocardial infarction, stroke, cancer, or liver disease at baselineinfarction, stroke, cancer, or liver disease at baseline

analyses adjusted for potential confounders (e.g., analyses adjusted for potential confounders (e.g., age, smoking, diabetes)age, smoking, diabetes)


ResultsResults

Amount Consumed Relative Risk (RR)* of Cardiovascular

Disease Death

RR of Total Death

11––6 drinks per 6 drinks per weekweek

0.60.6 0.70.7

≥≥1 drinks per day1 drinks per day 0.60.6 0.70.7

*Compared with Those who Rarely or Never Drank


Conclusions/CommentsConclusions/Comments In this cohort of physicians with hypertension who In this cohort of physicians with hypertension who

consumed low amounts, moderate alcohol consumed low amounts, moderate alcohol consumption reduced risk of CVD mortality and total consumption reduced risk of CVD mortality and total mortality.mortality.

There are limits to applying these results to broader There are limits to applying these results to broader primary care populations.primary care populations.

Clinicians should individualize recommendations about Clinicians should individualize recommendations about alcohol use and help patients determine whether the alcohol use and help patients determine whether the cardiovascular benefits from moderate drinking cardiovascular benefits from moderate drinking outweigh any potential risks.outweigh any potential risks.


Changes in Changes in Alcohol Consumption Alcohol Consumption and Their Effects on and Their Effects on

Mortality, Cancer, andMortality, Cancer, and Coronary Heart DiseaseCoronary Heart Disease

Grønbaek M, et al. Epidemiology. 2004;15(2):222–228.


Objectives/MethodsObjectives/Methods To examine how changes in intake To examine how changes in intake

affect risk of mortality, coronary affect risk of mortality, coronary heart disease (CHD), and cancerheart disease (CHD), and cancer

Data from a longitudinal study Data from a longitudinal study 6644 men and 8010 women 6644 men and 8010 women completed 2 health exams at 5-year completed 2 health exams at 5-year

intervalsintervals analyses adjusted for possible analyses adjusted for possible

confounders (e.g., age, sex, smoking)confounders (e.g., age, sex, smoking)


ResultsResultsRisk of All-Cause Risk of All-Cause MortalityMortality

Risk of CHD Risk of CHD MortalityMortality

Risk of Risk of Cancer Cancer MortalityMortality

Stable Stable drinking drinking

U-shaped, with non-U-shaped, with non-drinkers and heavy drinkers and heavy drinkers having the drinkers having the highest mortalityhighest mortality

No significant association No significant association with amount consumedwith amount consumed

Borderline significant risk Borderline significant risk in non-drinkers in non-drinkers

Significantly Significantly higher in higher in heavy heavy drinkersdrinkers

Increases Increases or or decreases decreases in intakein intake

Significantly higher when Significantly higher when intake decreased to <1 intake decreased to <1 drink per weekdrink per week

No significant association No significant association with increaseswith increases

Borderline significant risk Borderline significant risk for light drinkers who for light drinkers who decreased intake to <1 decreased intake to <1 drink per weekdrink per week

No No significant significant associationassociation

Non-drinkers consumed <1 drink per week.

Light drinkers consumed 1-6 drinks per week.

Heavy drinkers consumed >13 drinks per week.


Conclusions/CommentsConclusions/Comments

This study found that moderate drinkers This study found that moderate drinkers who decreased their consumption to little who decreased their consumption to little or no alcohol increased their risk of death or no alcohol increased their risk of death from all causes. from all causes.

According to these findings, adult According to these findings, adult

moderate drinkers—to lower their risk of moderate drinkers—to lower their risk of death—should not be advised to reduce death—should not be advised to reduce their intake or to abstain. their intake or to abstain.


Drinking PatternsDrinking Patterns——Not Just Total Amount—Not Just Total Amount—

Affect Risk Affect Risk

Trevisan M, et al. Trevisan M, et al. AddictionAddiction. 2004;99(3):313. 2004;99(3):313–322.–322.

Tolstrup JS, et al. Tolstrup JS, et al. AddictionAddiction. 2004;99(3):323–330.. 2004;99(3):323–330.


Objectives/MethodsObjectives/MethodsTrevisan study:Trevisan study:

To determine the effect of drinking patterns To determine the effect of drinking patterns on the risk of myocardial infarction (MI)on the risk of myocardial infarction (MI)

Case-control study Case-control study

427 white males with incident MI 427 white males with incident MI 905 healthy white male controls selected 905 healthy white male controls selected

randomly from 2 Western New York countiesrandomly from 2 Western New York counties analyses adjusted for multiple risk factors (e.g., analyses adjusted for multiple risk factors (e.g.,

age, smoking, diet, physical activity)age, smoking, diet, physical activity)


Results Results Risk of MI among Risk of MI among Current Drinkers* Current Drinkers*

compared with Lifetime compared with Lifetime AbstainersAbstainers

Drank Drank <1 time<1 time during the during the weekweek

OR 0.5OR 0.5

Drank dailyDrank daily 0.40.4

Drank on weekdays and Drank on weekdays and weekends (compared with weekends (compared with only on weekends)only on weekends)

0.50.5

Drank mainly with foodDrank mainly with food 0.50.5

*past 1-2 years



Tolstrup study:Tolstrup study:

To learn how drinking patterns affect risk To learn how drinking patterns affect risk of all-cause mortalityof all-cause mortality

Questionnaire data from a population-Questionnaire data from a population-based Danish cohort based Danish cohort 26,909 men and 29,626 women26,909 men and 29,626 women analyses adjusted for multiple risk factors (e.g., analyses adjusted for multiple risk factors (e.g.,

age, smoking, diet, physical activity)age, smoking, diet, physical activity)


ResultsResults Frequent drinkers (≥2 times per week) had a Frequent drinkers (≥2 times per week) had a

lower hazard of death than non-frequent drinkers.lower hazard of death than non-frequent drinkers. Compared with males drinking <1 drink per week, Compared with males drinking <1 drink per week,

male frequent drinkers who consumed 1–20 male frequent drinkers who consumed 1–20 drinks per week had significantly lower mortality. drinks per week had significantly lower mortality.

Compared with females drinking <1 drink per Compared with females drinking <1 drink per week, female frequent drinkers who consumed week, female frequent drinkers who consumed larger amounts did not have significantly lower larger amounts did not have significantly lower mortality.mortality.


Conclusions/CommentsConclusions/Comments These studies add to the accumulating evidence These studies add to the accumulating evidence

that drinking patterns do matter. that drinking patterns do matter.

Result of these and similar studies should be Result of these and similar studies should be viewed with caution because small numbers of viewed with caution because small numbers of infrequent drinkers in the high consumption infrequent drinkers in the high consumption categories make it difficult to adjust adequately for categories make it difficult to adjust adequately for total alcohol intake. total alcohol intake.

While they wait for better data, clinicians should While they wait for better data, clinicians should steer moderate drinkers towards more frequent steer moderate drinkers towards more frequent drinking of small amounts rather than less frequent drinking of small amounts rather than less frequent drinking of larger amounts. drinking of larger amounts.


Risky Sex:Risky Sex:It’s the AlcoholIt’s the Alcohol

Ehrenstein V, et al. Ehrenstein V, et al. Drug Alcohol Depend.Drug Alcohol Depend. 2004;73(2)1592004;73(2)159–166.–166.



To better understand alcohol’s effect To better understand alcohol’s effect on inconsistent condom useon inconsistent condom use

Data from a prospective cohort of Data from a prospective cohort of adults with HIV and current or past adults with HIV and current or past alcohol problemsalcohol problems 345 subjects345 subjects analyses adjusted for possible confounders analyses adjusted for possible confounders

(e.g., race, education, other drug use)(e.g., race, education, other drug use)


ResultsResults

Alcohol consumption was significantly Alcohol consumption was significantly associated with inconsistent condom use associated with inconsistent condom use (<100% over the last 6 months).(<100% over the last 6 months).

% Reporting % Reporting Inconsistent Condom Inconsistent Condom

UseUse

Heavier drinkers Heavier drinkers (>14 drinks (>14 drinks per week for men, >7 for per week for men, >7 for women) women)

51%51%

Moderate drinkersModerate drinkers 41%41%

AbstainersAbstainers 32%32%


Results (cont.)Results (cont.)

heavier drinking in heavier drinking in users of injection users of injection drugsdrugs

being femalebeing female identifying as gay or identifying as gay or

lesbianlesbian

living with a partnerliving with a partner having 2 or more having 2 or more

sexual partnerssexual partners agreeing that agreeing that

condoms are a hassle condoms are a hassle to useto use

Factors associated with significant increases in risk of Factors associated with significant increases in risk of inconsistent condom use (odds ratios between 2 and 4):inconsistent condom use (odds ratios between 2 and 4):

Factors associated with borderline significant increases in risk: recently testing HIV-positive, selling sex for drugs or money, having a higher CD4 cell count


Conclusions/CommentsConclusions/Comments Whether the findings in this cohort (30% Whether the findings in this cohort (30%

employed, 67% non-white, 29% homeless) employed, 67% non-white, 29% homeless) will hold true for others with HIV is unknown. will hold true for others with HIV is unknown.

Drinking Drinking >>1–2 drinks per day appears to 1–2 drinks per day appears to increase risk of inconsistent condom use, increase risk of inconsistent condom use, particularly among users of injection drugs. particularly among users of injection drugs.

When addressing this risk, clinicians, public When addressing this risk, clinicians, public health practitioners, and others must consider health practitioners, and others must consider factors that contribute to inconsistent use—factors that contribute to inconsistent use—many of which are modifiable.many of which are modifiable.


Lasting Effects of Lasting Effects of Alcohol on Cognitive Alcohol on Cognitive

Function in HIV Function in HIV InfectionInfection

Green JE, et al. Green JE, et al. Am J PsychiatryAm J Psychiatry. 2004;161(2):249. 2004;161(2):249––254.254.


Objectives/MethodsObjectives/Methods To better understand the effects of heavy To better understand the effects of heavy

alcohol use on cognitive function in people alcohol use on cognitive function in people infected with HIVinfected with HIV

Assessment of various neuropsychological Assessment of various neuropsychological functions and symptoms of anxiety and functions and symptoms of anxiety and depression in 80 gay or bisexual mendepression in 80 gay or bisexual men

50 with HIV (21 who also had past alcohol abuse or 50 with HIV (21 who also had past alcohol abuse or dependence)dependence)

30 without HIV (12 who had past alcohol abuse or 30 without HIV (12 who had past alcohol abuse or dependence)dependence)


ResultsResults Overall cognitive impairment did not differ Overall cognitive impairment did not differ

significantly between those with and without HIV. significantly between those with and without HIV.

Men with past alcohol abuse or dependence, Men with past alcohol abuse or dependence, compared with those without, showed cognitive compared with those without, showed cognitive impairment on a significantly greater number of impairment on a significantly greater number of measures. measures.

Mean # of Mean # of Measures Measures indicating indicating Cognitive Cognitive

ImpairmentImpairment

Those with past abuse/dependence and HIVThose with past abuse/dependence and HIV 55

Those with past abuse/dependence without Those with past abuse/dependence without HIVHIV

3.83.8

Those without past abuse/dependence but with Those without past abuse/dependence but with HIVHIV

3.53.5

Those with neither past abuse/dependence nor Those with neither past abuse/dependence nor HIVHIV

2.92.9


Conclusions/CommentsConclusions/Comments This study’s strength is its detailed This study’s strength is its detailed

assessments of participants.assessments of participants. Given the study’s small sample size, Given the study’s small sample size,

researchers could not adjust for factors that researchers could not adjust for factors that could have explained the association could have explained the association between past alcohol use disorders and between past alcohol use disorders and cognitive impairment. cognitive impairment.

Nonetheless, the findings suggest that the Nonetheless, the findings suggest that the association between alcohol abuse or association between alcohol abuse or dependence and cognitive dysfunction in dependence and cognitive dysfunction in HIV-infected men is particularly pronounced.HIV-infected men is particularly pronounced.


Another Complication Another Complication of Drinking during of Drinking during

PregnancyPregnancy

Avaria MD, et al. Avaria MD, et al. J PediatrJ Pediatr. 2004;144(3)338. 2004;144(3)338––343.343.



To examine the effects of alcohol To examine the effects of alcohol exposure in utero on the peripheral exposure in utero on the peripheral nervous systemnervous system

Study of 30 neonates born to women Study of 30 neonates born to women identified during prenatal careidentified during prenatal care 17 exposed neonates; 13 unexposed17 exposed neonates; 13 unexposed


ResultsResults No neonates had classic signs of fetal alcohol No neonates had classic signs of fetal alcohol

syndrome; 1 had possible fetal alcohol effects. syndrome; 1 had possible fetal alcohol effects.

Alcohol-exposed neonates had significantly Alcohol-exposed neonates had significantly

slower nerve conduction velocities and slower nerve conduction velocities and response amplitudes in some nerves. response amplitudes in some nerves.

Differences wereDifferences were significant in the ulnar motor significant in the ulnar motor nerve and borderline significant in the tibial motor nerve and borderline significant in the tibial motor nerve.nerve.

No significant differences were found in peroneal, No significant differences were found in peroneal, median, or sensory nerve conduction.median, or sensory nerve conduction.



This small study could not determine the This small study could not determine the length and intensity at which alcohol length and intensity at which alcohol exposure causes harm, nor could it inform exposure causes harm, nor could it inform us of the clinical implications of its us of the clinical implications of its findings. findings.

Despite its sample size, the study did Despite its sample size, the study did demonstrate yet another complication of demonstrate yet another complication of alcohol consumption during pregnancy. alcohol consumption during pregnancy.

The best advice to pregnant women or to The best advice to pregnant women or to those planning pregnancy is abstinence.those planning pregnancy is abstinence.


Alcohol Consumption Alcohol Consumption and Diabetes Mellitusand Diabetes Mellitus

Howard AA, et al. Howard AA, et al. Ann Intern MedAnn Intern Med. 2004;140(3):211. 2004;140(3):211––219.219.



To summarize the findings of studies To summarize the findings of studies on alcohol consumption and the risk on alcohol consumption and the risk and control of diabetesand control of diabetes

Systematic reviewSystematic review 32 studies, 27 involving type 2 diabetes 32 studies, 27 involving type 2 diabetes

onlyonly


ResultsResults Moderate drinking (defined variably in each Moderate drinking (defined variably in each

study), compared with not drinking, reduced study), compared with not drinking, reduced diabetes risk in 11 of 18 studies.diabetes risk in 11 of 18 studies.

Drinking (defined variably, but as little as 1.4 Drinking (defined variably, but as little as 1.4

drinks per day) significantly increased diabetes drinks per day) significantly increased diabetes risk in 4 of 18 studies. risk in 4 of 18 studies.

Consumption (about 1–6 drinks on an occasion Consumption (about 1–6 drinks on an occasion under experimental conditions) did not impair, under experimental conditions) did not impair, and sometimes improved, glycemic control.and sometimes improved, glycemic control.



In patients with diabetes, moderate drinking, In patients with diabetes, moderate drinking, compared with not drinking, significantly compared with not drinking, significantly decreased risk of decreased risk of death from coronary heart disease (CHD) (by death from coronary heart disease (CHD) (by

up to 79% in 3 of 4 studies);up to 79% in 3 of 4 studies); CHD-related events (by up to 55% in 2 of 3 CHD-related events (by up to 55% in 2 of 3

studies).studies).

Consuming about 3 drinks on an occasion with Consuming about 3 drinks on an occasion with troglitazone or a sulfonylurea did not affect troglitazone or a sulfonylurea did not affect glycemic control.glycemic control.

Heavy use (defined variably) significantly Heavy use (defined variably) significantly increased diabetic retinopathy in 1 study and had increased diabetic retinopathy in 1 study and had no effect in another.no effect in another.


Conclusions/CommentsConclusions/Comments Moderate alcohol use may decrease risk of type 2 Moderate alcohol use may decrease risk of type 2

diabetes and diabetes-related cardiovascular events. diabetes and diabetes-related cardiovascular events.

However, results from this review are inconsistent, However, results from this review are inconsistent, and some included studies suggest increased risk at and some included studies suggest increased risk at drinking levels often considered to be moderate. drinking levels often considered to be moderate.

Given current evidence, it is likely safe for people with Given current evidence, it is likely safe for people with type 2 diabetes to follow usual drinking type 2 diabetes to follow usual drinking recommendations (≤1 drink per day for women and recommendations (≤1 drink per day for women and people over 65 years; ≤ people over 65 years; ≤ 22 drinks per day for men aged drinks per day for men aged 65 and under).65 and under).


Studies on Studies on InterventionsInterventions


Efficacy of Efficacy of

Brief Interventions inBrief Interventions in

Primary Care Primary Care

to Reduce Risky andto Reduce Risky and

Harmful Alcohol Use Harmful Alcohol Use

Whitlock EP, et al. Ann Intern Med. 2004;140(7):557–568.



To inform clinical guidelines of the U.S. To inform clinical guidelines of the U.S. Preventive Services Task Force (USPSTF) Preventive Services Task Force (USPSTF) about brief behavioral counseling about brief behavioral counseling interventionsinterventions

Systematic review of studies on the Systematic review of studies on the efficacy of these interventionsefficacy of these interventions 12 controlled trials included12 controlled trials included


ResultsResults Those receiving brief multi-contact interventions Those receiving brief multi-contact interventions

(initial session up to 15 minutes and at least 1 (initial session up to 15 minutes and at least 1 follow-up) reduced their average weekly alcohol follow-up) reduced their average weekly alcohol intake by 13%intake by 13%–34% more than controls in 4 of 7 –34% more than controls in 4 of 7 trials.trials.

10%–19% more intervention participants than controls 10%–19% more intervention participants than controls drank safe amounts.drank safe amounts.

Very brief (up to 5 minutes) or brief single-Very brief (up to 5 minutes) or brief single-contact interventions were ineffective or less contact interventions were ineffective or less effective in reducing risky or harmful alcohol use.effective in reducing risky or harmful alcohol use.



All effective interventions included at All effective interventions included at least 2 of 3 key elements:least 2 of 3 key elements: feedback, advice, and goal setting.feedback, advice, and goal setting.

No significant differences were found No significant differences were found among men and women receiving among men and women receiving brief interventions.brief interventions.



USPSTF gave a USPSTF gave a grade B recommendationgrade B recommendation (at (at least fair evidence of improved health least fair evidence of improved health outcomes and benefits outweighing potential outcomes and benefits outweighing potential harms) to screening and brief counseling in harms) to screening and brief counseling in primary care to reduce risky or harmful alcohol primary care to reduce risky or harmful alcohol use among adults. use among adults.

Better strategies to implement screening and Better strategies to implement screening and more effective brief interventions in actual more effective brief interventions in actual clinical practice must be developed.clinical practice must be developed.


Alcohol Screening and Alcohol Screening and Referral on Referral on

College CampusesCollege Campuses

Foote J, et al. Foote J, et al. J Am Coll HealthJ Am Coll Health. 2004;52(4):149. 2004;52(4):149–157.–157.



To assess alcohol screening and referral To assess alcohol screening and referral on college campuseson college campuses

Survey of a state-stratified random Survey of a state-stratified random sample of 4-year colleges/universities sample of 4-year colleges/universities with health centerswith health centers 76% response rate; 234 schools analyzed76% response rate; 234 schools analyzed


ResultsResults 33% of the schools conducted routine alcohol 33% of the schools conducted routine alcohol

screening of most or all (96%) students visiting screening of most or all (96%) students visiting their health centers. their health centers.

Urban, large, and especially public schools were Urban, large, and especially public schools were significantly more likely to routinely screen.significantly more likely to routinely screen.

Screening was typically part of a standard Screening was typically part of a standard

medical history and physical. medical history and physical. 12% of schools used a standardized instrument 12% of schools used a standardized instrument

(most often the CAGE) to screen.(most often the CAGE) to screen.



On average, health centers offered 3 On average, health centers offered 3 referral options. The most common referral options. The most common included included the campus counseling center; the campus counseling center; substance abuse treatment in the substance abuse treatment in the

community; community; 12-step programs;12-step programs; individual therapy.individual therapy.



These findings highlight both the lack of These findings highlight both the lack of alcohol screening in college health centers alcohol screening in college health centers as well as potential inadequacies in as well as potential inadequacies in practices used by those who do screen.practices used by those who do screen.

Given the harm caused by—and few Given the harm caused by—and few

successful strategies to curb—heavy successful strategies to curb—heavy drinking, college health centers should drinking, college health centers should receive the necessary support to implement receive the necessary support to implement effective screening and referral. effective screening and referral.


Does Experience Influence Does Experience Influence Hospitals’ Resource Use in Hospitals’ Resource Use in

Treating Alcohol and Treating Alcohol and Other Drug DiagnosesOther Drug Diagnoses

Bramble JD, et al. Bramble JD, et al. J Gen Intern MedJ Gen Intern Med. . 2004;19(1):362004;19(1):36–42.–42.


Objectives/MethodsObjectives/Methods To investigate whether a hospital’s experience To investigate whether a hospital’s experience

with alcohol and other drug diagnoses or its with alcohol and other drug diagnoses or its teaching status impacts resource useteaching status impacts resource use

National data from 1996 Healthcare Costs and National data from 1996 Healthcare Costs and Utilization Project and other large Utilization Project and other large administrative databasesadministrative databases

Analyses adjusted for multiple hospital and Analyses adjusted for multiple hospital and patient characteristicspatient characteristics


ResultsResults

Relative experience was significantly Relative experience was significantly associated with associated with lower chargeslower charges but but also associated (borderline also associated (borderline significance) with significance) with greater length of greater length of staystay..

Teaching hospital status was not Teaching hospital status was not significantly associated with either significantly associated with either charges or length of stay.charges or length of stay.


Conclusions/CommentsConclusions/Comments The authors speculated that the lower The authors speculated that the lower

charges and longer lengths of stay in high charges and longer lengths of stay in high volume hospitals might have resulted from volume hospitals might have resulted from managing patients with substance-related managing patients with substance-related disorders in less expensive settings. disorders in less expensive settings.

They did not address the quality of care, They did not address the quality of care,

readmissions, or other outcomes. readmissions, or other outcomes.

Thus, whether this less expensive care Thus, whether this less expensive care leads to better or worse clinical outcomes leads to better or worse clinical outcomes remains unknown.remains unknown.


Studies on Studies on Special Special

PopulationsPopulations


Drinking Patterns and Drinking Patterns and Rates of Alcohol-Rates of Alcohol-

Related Problems in Related Problems in Three Three

Urban PopulationsUrban Populations

Bobak M, et al. Bobak M, et al. J Epidemiol Community HealthJ Epidemiol Community Health. . 2004;58(3):2382004;58(3):238–242.–242.



To examine whether drinking patterns, in To examine whether drinking patterns, in addition to overall consumption, addition to overall consumption, contributed to differences in alcohol-contributed to differences in alcohol-related problemsrelated problems

Interview data from 1118 men and 1125 Interview data from 1118 men and 1125 women randomly selected from Russian, women randomly selected from Russian, Czech Republic, and Polish population Czech Republic, and Polish population registriesregistries


Results Results

Russian Russian MenMen

Czech MenCzech Men Polish Polish MenMen

Reported Reported ≥≥2 positive 2 positive responses to the CAGE responses to the CAGE

35% 19% 14%

Reported ≥Reported ≥2 negative 2 negative consequences related to consequences related to consumptionconsumption

18% 10% 8%

Mean annual intakeMean annual intake 5 liters 9 liters 4 liters

Drinking sessions per Drinking sessions per yearyear

67 179 79

Average consumption Average consumption per drinking sessionper drinking session

mean 71 g 45 g 46 g

Russian men were also significantly more likely to drink ≥80, ≥120, or ≥160 g of alcohol on an occasion.



In this study, consuming large amounts per In this study, consuming large amounts per drinking session explained a substantial drinking session explained a substantial part of the differences in negative part of the differences in negative consequences among the 3 populations. consequences among the 3 populations.

These findings suggest that average These findings suggest that average consumption alone does not determine consumption alone does not determine alcohol-related problems at the population alcohol-related problems at the population level.level.


Alcohol and Other Alcohol and Other Drug Use Initiation in Drug Use Initiation in

American Indian American Indian AdolescentsAdolescents

Novins DK, et al. Novins DK, et al. J Am Acad Child Adolesc PsychiatryJ Am Acad Child Adolesc Psychiatry. . 2004;43(3):3162004;43(3):316–324.–324.



To examine the risk of initiation and To examine the risk of initiation and progression of substance use in progression of substance use in American Indian adolescentsAmerican Indian adolescents

Semiannual survey data collected Semiannual survey data collected over 3 years from 14over 3 years from 14 to 20 year olds to 20 year olds at 7 predominantly American Indian at 7 predominantly American Indian high schoolshigh schools


ResultsResults

Of 568 adolescents who were abstinent at baseline,

42% initiated use with alcohol, marijuana, and/or inhalants;

7% initiated use with other illicit drugs (e.g., cocaine).

Initiation of use peaked at approximately age 18. Alcohol was the most common first substance

used.


Results (cont.)Results (cont.) Of 1244 adolescents who used alcohol,

marijuana, and/or inhalants at baseline, 24% progressed to other illicit drug use.

Adolescents who had initiated substance use with marijuana or inhalants (versus alcohol) were significantly more likely to progress to other illicit drug use.

Risk of initiation and progression significantly differed by tribal group and season.



All American Indian adolescents will not All American Indian adolescents will not necessarily follow the specified patterns of necessarily follow the specified patterns of substance use initiation and progression.substance use initiation and progression.

The findings of this study, however, do suggest The findings of this study, however, do suggest that almost half of American Indian adolescents that almost half of American Indian adolescents initiate substance use with alcohol, marijuana, initiate substance use with alcohol, marijuana, and/or inhalants, and a quarter of users progress and/or inhalants, and a quarter of users progress to other illicit drugs.to other illicit drugs.

Results imply that efforts to prevent initiation and Results imply that efforts to prevent initiation and progression may need to be tailored to the progression may need to be tailored to the specific issues facing individual communities.specific issues facing individual communities.


Other Other StudiesStudies


Binge Drinking’s Effect Binge Drinking’s Effect on Health-Related on Health-Related

Quality of LifeQuality of Life

Okoro CA, et al. Okoro CA, et al. Am J Prev MedAm J Prev Med. 2004;26(3):230. 2004;26(3):230––233.233.


Objectives/MethodsObjectives/Methods To examine the association between binge To examine the association between binge

drinking (consuming drinking (consuming 5 drinks on 1 5 drinks on 1 occasion in the past month) and health-occasion in the past month) and health-related quality of life (HRQQL)related quality of life (HRQQL)

Data from the Behavioral Risk Factor Data from the Behavioral Risk Factor Surveillance SystemSurveillance System cross-sectional, random-digit-dial telephone cross-sectional, random-digit-dial telephone

survey of adults aged 18 and older nationwidesurvey of adults aged 18 and older nationwide analyses adjusted for possible confounders analyses adjusted for possible confounders


ResultsResults Frequent binge drinkers*,compared with non-Frequent binge drinkers*,compared with non-

binge drinkers, were significantly more likely to binge drinkers, were significantly more likely to experience ≥14 unhealthy days in the past experience ≥14 unhealthy days in the past month. month. Increased risk was mainly due to having more Increased risk was mainly due to having more

mentally (vs. physically) unhealthy days.mentally (vs. physically) unhealthy days.

Infrequent binge drinking** was significantly Infrequent binge drinking** was significantly associated with experiencing ≥14 unhealthy associated with experiencing ≥14 unhealthy days among women and people ≥55.days among women and people ≥55.

*had ≥3 episodes in the past month; **1–2 episodes in the past month*had ≥3 episodes in the past month; **1–2 episodes in the past month



Frequent, and sometimes infrequent, binge Frequent, and sometimes infrequent, binge drinking is associated with worse HRQOL drinking is associated with worse HRQOL and mental distress. and mental distress.

It is not clear whether binge drinking led to It is not clear whether binge drinking led to worse HRQOL or vice versa. worse HRQOL or vice versa.

Findings underscore the adverse Findings underscore the adverse consequences of binge drinking and support consequences of binge drinking and support the need effective prevention efforts. the need effective prevention efforts.


WHO Report Summarizes WHO Report Summarizes Biological Factors Related Biological Factors Related

to Substance useto Substance use

Geneva, Switzerland: World Health Organization, Geneva, Switzerland: World Health Organization, 20042004



To summarize 30 years of research To summarize 30 years of research on biological factors related to on biological factors related to substance usesubstance use


ResultsResults “…“…Substance dependence is a chronic, relapsing Substance dependence is a chronic, relapsing

disorder with a biological and genetic basis, and is disorder with a biological and genetic basis, and is not simply due to lack of will or desire to quit.” not simply due to lack of will or desire to quit.”

Tobacco, alcohol, and illicit drugs are responsible Tobacco, alcohol, and illicit drugs are responsible for 9%, 3%, and 0.4% of deaths worldwide, for 9%, 3%, and 0.4% of deaths worldwide, respectively. respectively.

Tobacco and alcohol are among the top 10 leading Tobacco and alcohol are among the top 10 leading

risk factors of avoidable disease burden, with each risk factors of avoidable disease burden, with each responsible for approximately 4% of disability responsible for approximately 4% of disability worldwide.worldwide.


Results (cont.)Results (cont.) Effective treatments for substance Effective treatments for substance

dependence are available and can be dependence are available and can be integrated into health systems, including integrated into health systems, including primary care.primary care.

Neuroscience-based knowledge of Neuroscience-based knowledge of

substance dependence can reduce the substance dependence can reduce the strong and pervasive stigma associated strong and pervasive stigma associated with substance use. with substance use.

Proper treatment of either substance Proper treatment of either substance

dependence or mental illness requires dependence or mental illness requires attention to the comorbidity of these attention to the comorbidity of these conditions. conditions.



This report summarizes what This report summarizes what researchers have known for some researchers have known for some time—there is a scientific basis for time—there is a scientific basis for the etiology and management of the etiology and management of alcohol, tobacco, and other drug use alcohol, tobacco, and other drug use disorders. disorders.

Its findings may help dispel long-Its findings may help dispel long-standing myths about the addictions.standing myths about the addictions.

Update on Alcohol and Health

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