The risks associated with alcohol use and alcoholism

Alcohol consumption, particularly heavier drinking, is an important risk factor for many health problems and, thus, is a major contributor to the global burden of disease. In fact, alcohol is a necessary underlying cause for more than 30 conditions and a contributing factor to many more. The most common disease categories that are entirely or partly caused by alcohol consumption include infectious diseases, cancer, diabetes, neuropsychiatric diseases (including alcohol use disorders), cardiovascular disease, liver and pancreas disease, and unintentional and intentional injury. Knowledge of these disease risks has helped in the development of low-risk drinking guidelines. In addition to these disease risks that affect the drinker, alcohol consumption also can affect the health of others and cause social harm both to the drinker and to others, adding to the overall cost associated with alcohol consumption. These findings underscore the need to develop effective prevention efforts to reduce the pain and suffering, and the associated costs, resulting from excessive alcohol use.     

The best and worst of 2020, and hopes and fears for 2021

The highlight of 2020 was celebrating the 50th anniversary of the establishment of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) through events such as a two‐day science symposium. We now know more about how alcohol affects the brain and body across the lifespan than ever before, and we have evidence‐based interventions to prevent and treat alcohol misuse. This work has contributed to a steady decrease in underage drinking over the past two decades, and a greater understanding of the deleterious effects of prenatal alcohol exposure and the biology of alcohol use disorder and alcohol‐associated liver diseases.     

The road to a world health organization global strategy for reducing the harmful use of alcohol

Harmful alcohol use and the related health effects are a global problem and therefore need to be addressed not only by individual nations but also on an international level. For example, the World Health Organization (WHO) noted that harmful alcohol use is the third leading risk factor for premature deaths and disabilities in the world, accounting for approximately 2.5 million deaths worldwide (corresponding to 3.8 percent of all deaths) in 2004 (WHO 2010). Moreover, harmful alcohol use was considered responsible for 4.5 percent of the global burden of disease as measured in disability-adjusted life-years lost in the same year. Given this scope of the impact, the WHO initiated a series of efforts that culminated in the development of a global strategy for reducing the harmful use of alcohol. This article reviews the alcohol-related activities of the WHO over the years and summarizes the central issues addressed by the global strategy.     

The effects of prices on alcohol use and its consequences

Over the past three decades, economists and others have devoted considerable effort to assessing the impact of alcoholic-beverage taxes and prices on alcohol consumption and its related adverse consequences. Federal and State excise taxes have increased only rarely and, when adjusted for inflation, have declined significantly over the years, as have overall prices for alcoholic beverages. Yet studies examining the effects of increases of monetary prices (e.g., through raising taxes) on alcohol consumption and a wide range of related behavioral and health problems have demonstrated that price increases for alcoholic beverages lead to reduced alcohol consumption, both in the general population and in certain high-risk populations, such as heavier drinkers or adolescents and young adults. These effects seem to be more pronounced in the long run than in the short run. Likewise, price increases can help reduce the risk for adverse consequences of alcohol consumption and abuse, including drinking and driving, alcohol-involved crimes, liver cirrhosis and other alcohol-related mortality, risky sexual behavior and its consequences, and poor school performance among youth. All of these findings indicate that increases in alcoholic-beverage taxes could be a highly effective option for reducing alcohol abuse and its consequences.     

“How Could I Have Done This?” Thoughts of Mothers of Children with Fetal Alcohol Syndrome

Biological mothers of children with fetal alcohol syndrome (FAS) must cope with the struggles of parenting a child with special needs with the knowledge that their children’s problems are due to their alcohol use during pregnancy. Qualitative interviews were conducted by telephone with 11 biological mothers of children with FAS. This group of mothers understood their use of alcohol during pregnancy through reliance on the disease model, inaccurate or incomplete knowledge of the consequences of drinking during pregnancy, the advice of others, and a lack of awareness of the pregnancy.     

Is screening and brief advice for problem drinkers by clergy feasible? A survey of clergy

Routine screening for alcohol abuse in primary care, with brief advice to stop drinking for those screening positive, can detect individuals with alcohol problems and reduce alcohol use and alcohol induced problems in those detected. Not everyone with alcohol problems sees a physician regularly, however, and not all respond to a physician's brief advice. To explore the feasibility of expanding screening for alcohol problems to clergy, we did a mailed survey to 315 clergy at Christian churches in Cleveland, Ohio. Clergy reported a variety of views about alcohol use and abuse, but most agreed that alcoholism is a disease. They indicated counseling a significant number of parishioners, and were receptive to learning brief screening questions to detect alcohol problems. We conclude that many clergy would be interested in a strategy of screening and then giving brief advice or referral to individuals found to have alcohol problems.     

Do designated drivers and workplace policies effect alcohol consumption?

Is there a link between designated driver usage and alcohol consumption? We hypothesize that the use of a designated driver lowers the cost of drinking which, in turn, increases alcohol consumption. We examine the effect on drinking intensity (which incorporates low levels of alcohol use) and binge drinking (which measures greater alcohol use), using a proxy for designated driver usage. If workplace rules forbid alcohol use for safety or other reasons, a large potential cost of drinking is the possible job loss (or other penalty) incurred if an employed person tests positive for alcohol. We add variables to our model related to workplace policies on alcohol use by workers to ascertain if designated drivers still influence drinking. We test these hypotheses utilizing a large dataset from the 2006 and 2007 National Survey on Drug Use and Health (NSDUH) which includes several measures of alcohol use, in addition to a host of other correlates. Findings reveal that our proxy for designated driver use increases the incidence of drinking and the results hold even after controlling for workplace alcohol testing.     

Alcoholism starts in youth,so it should be screened for

Alcohol use disorder (AUD) — what used to be called alcoholism, but a condition which by definition is sometimes used to apply to everyone who drinks alcohol and is underage — is not a disease of adults only. It starts in childhood, and that's why Scott E. Hadland, M.D., and colleagues argue for screening in the February issue of Pediatrics.     

The Political,Social, and Public Health Problems of Binge Drinking in College

Abstract

Despite extensive efforts to decrease alcohol abuse among college students, prevention approaches have had limited success. This study attempted to clarify reasons for this limited success and to identify directions for future interventions by directly interviewing college students on this topic. Five issues were discussed in the focus group interviews: (1) reasons for drinking alcohol, (2) reasons for not drinking alcohol, (3) circumstances surrounding overconsumption of alcohol, (4) topics and methods for prevention, and (5) gender differences in drinking patterns.

The focus group interviews were found to be a valid tool for elucidating sensitive aspects of these issues and the relative importance of these issues to each other. The students revealed how susceptible they are to societal pressures to drink alcohol and how the limitations of their intrapersonal skills affect their alcohol consumption, most notably regarding sexuality issues. The authors contend that improving intrapersonal skills should be a major focus of programs to prevent alcohol abuse.     

Disease versus social-learning models of alcoholism in the prediction of alcohol problem recognition, help-seeking, and stigma

Subjects (N = 254) were presented with either a disease or social-learning view of alcoholism and their subsequent attitudes were examined. Presentation of a disease view strengthened endorsement of that model, but attitudes toward alcoholics, treatment effectiveness, problem recognition, and help-seeking were not significantly different between the experimental conditions. Differences in attitudes between high and low disease and social-learning belief subjects were examined in 2 x 2 ANOVAs. Separate multiple regression analyses with alcohol problem recognition, help-seeking, and stigma as composite dependent variables and etiologic beliefs, drinking measures, family history of alcoholism, and responsibility for drinking problems as independent variables were performed. Results show that neither disease nor social-learning beliefs are particularly effective in predicting the dependent variables.     

Differences in health-related quality of life among persons living with HIV/AIDS

We sought to identify differences in health-related quality of life (HRQoL) among a sample of HIV positive individuals receiving case management services in northern Florida. Our study consisted of 97 individuals receiving HIV case management that included 56 males (57.7%) and 81 African Americans (83.5%) who were 47.05 years old (SD = 9.33). HRQoL was measured using the HIV/AIDS Targeted-Quality of Life scale (HAT-QOL). Results show significant group differences in HRQoL by race, income, tobacco use, alcohol use, drug use, and CD4 cell count, despite only 43% of this sample being able to recall their most recent CD4 count. Translating these findings to inform practice, HIV care providers need to provide continuing education to patients about their disease status, knowledge, and treatment as it relates to self-care. Also, HIV care providers should be especially cognizant of the impact that tobacco, alcohol, and illicit drug use has on HRQoL for persons living with HIV/AIDS (PLHA) by working to assess social support, identify readiness for change, and make appropriate referrals for treatment.     

Alcohol: Prominent role in shorter lives of Americans

Alcohol‐related liver disease is claiming the lives of more and more Americans, a recent study has found. From 1999–2017, death rates for alcoholic liver disease increased by 40.6% (from 6.4 deaths/100,000 to 8.9 deaths/100,000), according to “Life Expectancy and Mortality Rates in the United States, 1959–2017,” which focused on midlife (ages 25 to 64 years), published in the Journal of the American Medical Association Nov. 26. Data for the study came from the National Center for Health Statistics, the federal Centers for Disease Control and Prevention and a literature review.     

Development and correlates of alcohol use from ages 13-20

This study examined alcohol use development from ages 13-20 years. The sample comprised 256 youth (50.4% female; 51.2% White, 48.8% African American) assessed annually for 6 years. A cohort-sequential latent growth model was used to model categorical alcohol use (non-use vs. use). Covariates included gender, race, income, parent marital status, risk taking, spiritual beliefs, parent alcohol use, family alcohol problems, family cohesion, friends' alcohol use, and normative peer use. The alcohol use trajectory increased steadily with age. Risk taking, friends' alcohol use, and normative peer use were positively associated with higher initial rates of alcohol use. Initial parent alcohol use and positive change in parents' and friends' alcohol use over time were related to an increase in alcohol use from ages 13-20 years.     

Gender differences in cardiovascular disease prevention

Risk factors are generally shared between men and women with the major differences being hormonal. Nine modifiable risk factors account for over 90% of the risk of a coronary event in men and women--smoking, hypertension, hyperlipidaemia, diabetes, abdominal obesity, lack of exercise, alcohol excess, reduced intake of fruit and vegetables, and psychosocial issues. Approximately half the decline in deaths from coronary heart disease (CHD), between 1980 and 2000, can be attributed to a reduction in the major risk factors and the other half to the use of evidence-based management. As educational efforts to increase awareness of cardiovascular disease (not cancer) to be the leading cause of death and disability in women are also associated with preventative action, it is important that health-care professionals educate themselves about CHD in women and communicate with women themselves, so that women can come forward for advice and evaluation.     

The role of perceptions of partner's alcohol use in heavy alcohol use and alcohol reduction intervention preferences among LGBQ adults in primary,romantic relationships

Correlates of heavy episodic alcohol and alcohol reduction intervention preferences were examined among lesbian, gay, bisexual, and queer (LGBQ) adults in romantic relationships. Anonymous data were collected online; analyses included logistic and multinomial regression models. One-fourth of participants reported recent heavy episodic alcohol use. Perceptions of partners' engaging in heavy alcohol use was associated with an increased odds of engaging in heavy alcohol use. Perceptions of partners' heavy alcohol use was associated with an increased odds of preferring a couples-based alcohol intervention compared to preferring no intervention. Findings highlight the need to consider partners in alcohol interventions for LGBQ couples.     

An Exploratory Study of a Computer-Assisted Alcohol Education Program

In many alcohol prevention and treatment programs, education is one of the components employed to change attitudes towards alcohol and drinking behavior. This exploratory research sought to determine whether brief exposure to a computer-based alcohol education program can improve attitudes toward alcohol and self-awareness of alcohol's effects. Seventy-one students were randomly assigned to (a) alcohol education via computer-assisted instruction (CAI), (b) alcohol education via traditional written materials, or (c) placebo/control. Results indicated that the CAI and written materials were about equally effective in improving subjects' attitudes toward alcohol although the computer program was rated most interesting.     

SOCIAL WORK EDUCATION: THE AVAILABILITY OF ALCOHOL‐RELATED COURSE CURRICULUM AND SOCIAL WORKERS' ABILITY TO WORK WITH PROBLEM DRINKERS

An explanatory cross‐sectional investigation was employed to assess how well masters‐level social work (MSW) programs in the State of New York prepare students for practice with problem drinkers. The following areas were explored: (1) the incorporation of alcohol‐related coursework and field placement opportunities within MSW programs; (2) the relationship between students' completion of alcohol‐related courses and field placements and their subsequent ability to diagnose clients with alcohol problems, their willingness to work with problem drinkers, and their levels of alcohol‐related knowledge; and (3) subjects' levels of alcohol‐related knowledge in relation to their diagnostic ability and their willingness to work with problem drinkers. The sample consisted of 89 MSW‐level social work practitioners, who were active members of the New York State Chapter of the National Association of Social Workers (NASW) during the fall of 2005. Fewer than 3% of the sample reported the completion of an alcohol‐related course as a mandatory degree requirement and only 29.5% of the sample acknowledged the completion of an alcohol‐related field placement. These findings suggest that a possible gap exists in what social workers are being taught and what they need to know to successfully work with problem drinkers. The findings indicate that clients with alcohol problems are at risk of going untreated due to social workers' inability to correctly diagnose them as a result of insufficient training in the area of alcohol studies.     

Profiles of African American College Students’ Alcohol Use and Sexual Behaviors: Associations With Stress,Racial Discrimination,and Social Support

Though studies show that alcohol use and sexual activity increase during emerging adulthood, few studies examine within–ethnic group differences, particularly among African American college students. This investigation utilized a latent class analytic methodology to identify risk behavior profiles of alcohol use (frequency and amount of alcohol consumed), sexual activity (number of intimate partners), and co-occurring risk behaviors (drinking before sexual intercourse) among 228 African American college students. This investigation also examined whether identified risk behavior profiles were associated with stress (interpersonal, intrapersonal, academic, and environmental), experiences of racial discrimination, and social support (from family, friends, and the college community). Results identified five distinct profiles within this sample: (a) High Sexual Risk—above-average sexual activity; (b) Abstainers—below-average alcohol use and sexual activity; (c) Low Risk—average alcohol use and sexual activity; (d) Alcohol Risk—above-average alcohol use and below-average sexual activity; and (e) Co-Occurring Risk—above-average alcohol use and sexual activity. Identified profiles differed across interpersonal and environmental stress, and self-reported frequency of experiences with racial discrimination. Implications for prevention programs and interventions aimed at reducing alcohol and sexual activity for African American college students are discussed.     

Briefly Noted

Compared to light drinkers, heavy drinkers have brains that have less energy due to decreases in glucose metabolism, researchers at the National Institutes of Health have found. In a study published online last week in Nature Communications, the researchers combined measures of the left brain (activity) and the right brain (glucose consumption) to better understand the effects of alcohol on people. “The brain uses a lot of energy compared to other body organs, and the association between brain activity and energy utilization is an important marker of brain health,” said George F. Koob, Ph.D., director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in a statement accompanying the release of the results. “This study introduces a new way of characterizing how brain activity is related to its consumption of glucose, which could be very useful in understanding how the brain uses energy in health and disease.” The research was led by Ehsan Shokri‐Kojori, Ph.D., and Nora D. Volkow, M.D., both of the NIAAA Laboratory of Neuroimaging. Volkow is also the director of the National Institute on Drug Abuse. “The findings from this study highlight the relevance of energetics for ensuring normal brain function and reveal how it is disrupted by excessive alcohol consumption,” said Volkow. “We measured power by observing to what extent brain regions are active and use energy,” explained Shokri‐Kojori. “We measured cost of brain regions by observing to what extent their energy use exceeds their underlying activity.” Using a group of healthy volunteers, researchers showed that different brain regions have different power and cost. They then looked at the effects of alcohol on these measures by assessing a group that included light and heavy drinkers, and found that both acute and chronic use affected brain power and cost. “In heavy drinkers, we saw less regional power, for example, in the thalamus, the sensory gateway and frontal cortex of the brain, which is important for decision‐making,” said Shokri‐Kojori. “These decreases in power were interpreted to reflect toxic effects of long‐term exposure to alcohol on the brain cells.” There was also a disruption of visual processing during acute alcohol exposure, and significant decreases in cost of activity during alcohol intoxication.