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The Psycho-Social Rehabilitation of Patients with Alcohol-Related Brain Damage in the Community
published on April 20th, 2012 at 01:24 PM
Aims: To describe the clinical presentation, course and psycho-social outcome of patients with alcohol-related brain damage (ARBD) referred from acute general hospital inpatient settings to a newly commissioned community team. Methods: A follow-up study of a consecutive series of 41 patients subjected to a developing, phased rehabilitation programme in community settings. Results: Patients were followed for an average of 25 months. Thirty-two patients were either abstinent or categorized as ‘controlled drinkers’ and were placed in appropriate community settings. Acute hospital admissions were reduced by 85%. The various domains of a neuropsychiatric assessment tool, the health of the nation outcome scale-acquired brain damage, improved with the exception of concomitant mental illness and self-directed harmful behaviour. Conclusions: A community team with experience in working with younger people with cognitive impairment can provide a service for people with ARBD. Such a service is not dependent on pre-designated specialist institutions but relies on person-centred care planning, close follow-up and collaborative work with a variety of community agencies. A structured rehabilitation programme provides a framework for intervention.
Assessing Self-Efficacy to Reduce One's Drinking: Further Evaluation of the Alcohol Reduction Strategies-Current Confidence Questionnaire
published on April 20th, 2012 at 01:24 PM
Aims: To evaluate the psychometric properties of a previously published questionnaire designed to assess young drinkers’ self-efficacy to employ 31 cognitive-behavioral alcohol reduction strategies. Methods: Undergraduates (n = 353) recruited from a large Midwestern university completed the previously published Alcohol Reduction Strategies-Current Confidence questionnaire (and other measures) for a self-selected heavy drinking setting. Results: Item loadings from a principal components analysis, a high internal consistency reliability coefficient, and a moderate mean inter-item correlation suggested that all 31 items comprised a single scale. Correlations of questionnaire scores with selected aspects of drinking history and personality provided support for criterion and discriminant validity, respectively. Women reported higher current confidence to use these strategies than did men, but current confidence did not vary as a function of recent binge status. Conclusion: Given this further demonstration of its psychometric qualities, this questionnaire holds promise as a clinical tool to identify clients who lack confidence in their ability to employ cognitive-behavioral coping strategies to reduce their drinking.
Characteristics of Alcoholics Attending 'Clubs of Alcoholics in Treatment' in Italy: A National Survey
published on April 20th, 2012 at 01:24 PM
Aims: To provide an overview of alcoholics attending a socio-ecological treatment programme [Clubs of Alcoholics in Treatment (CATs)] and to identify factors associated with abstinence and self-perceived improvement in lifestyle. Methods: A national sample of 7522 subjects (76% males and 24% females, mean age 53.2 ± 11.3 years ± SD) attending CATs was evaluated using a self-administered questionnaire completed at a weekly meeting in 2006. Results: Of participants, >70% reported no alcohol use in the last year and around 90% indicated no use in the previous month, whereas 4% of them declared no alcohol use before club attendance. Abstinence and lifestyle improvement were related positively to the number of years of club attendance but negatively to the presence of other problems in addition to the alcohol-related one. Moreover, being older or female was associated with more likely achievement of abstinence as well as with the perception of a better lifestyle. Finally, attending the club with one or more family members was associated with achievement of better lifestyle. Conclusion: These data provide an overview of alcoholics attending the CAT programme and are a first step toward developing a surveillance system. In addition, on the basis of this preliminary picture further research (notably longitudinal studies) can be planned considering this method and its effectiveness.
Alcohol, Mortality and Cardiovascular Events in a 35 Year Follow-up of a Nationwide Representative Cohort of 50,000 Swedish Conscripts up to Age 55
published on April 20th, 2012 at 01:24 PM
Aims: To assess the association between drinking patterns and mortality, and cardiovascular disease in a large cohort of young- and middle-aged men and to assess whether the net balance of harm and protective effect implies protective effect or not. Methods: Information from health examinations, psychological assessments and alcohol use background in a nationally representative birth cohort of 49,411 male military conscripts aged 18–20 years in 1969/1970, were linked to mortality and hospitalization data through 2004. Cox regression analyses were conducted and attributable proportions (APs) calculated. Confounders (baseline social status, intelligence, personality and smoking) were taken into account. Results: Increasing alcohol use was associated with increasing mortality (2614 deceased) and with decreasing risk for myocardial infarction (MI). The hazard ratio (HR) for mortality was 1.42 [95% confidence interval (CI) 1.10–1.82] with a consumption corresponding to 30 g 100% ethanol/day or more in multivariate analysis. The risk for non-fatal MI was significantly reduced at 60 g 100% ethanol/day (HR 0.37, 95% CI 0.15–0.90), not reduced for fatal MI, and non-significantly reduced for total MI. There was a marked association between alcohol use at conscription and mortality and hospitalization with alcohol-related diagnosis. APs indicate that alcohol caused 420 deaths, 61 cases of non-fatal stroke and protected from 154 cases on non-fatal MI. Conclusion: Many more deaths were caused by alcohol than cases of non-fatal MI prevented. From a strict health perspective, we find no support for alcohol use in men below 55 years.
Impact of Different Reference Period Definitions in the Quantification of Alcohol Consumption: Results from a Nationwide STEPS Survey in Mozambique
published on April 20th, 2012 at 01:24 PM
Aims: To compare the estimates of alcohol consumption in Mozambique obtained with different reference period definitions. This is a critical methodological aspect when measuring alcohol consumption and its impact is likely to vary across settings. Methods: A nationally representative sample of 3264 Mozambicans aged 25–64 years was evaluated in a community-based cross-sectional study conducted between September and November 2005. Face-to-face interviews were conducted following the World Health Organization-Stepwise approach to Surveillance methodology. The amount of alcohol consumed was estimated among current drinkers, using the previous week (1W) and the 12 months (12M) prior to the data collection as the reference. Results: Among drinkers, the prevalence of consumption of >14 drinks/week was higher in men (12M: 18.6 vs. 7.8%; 1W: 16.3 vs. 6.1%), although the prevalence of excessive weekly intake (>7 drinks for women and >14 drinks for men) was higher among women (12M: 25.9 vs. 18.6%; 1W: 18.1 vs. 16.3%). The concordance between the reported intakes according to the reference period was low ( = 0.25). Conclusion: In this setting where alcohol consumption is a male-dominated behaviour, among drinkers the prevalence of gender-defined excessive amounts was higher in women. The concordance between different recall periods was low and this needs to be taken into account when comparing results from different studies.
Alcohol Consumption and Mortality Risks in the USA
published on April 20th, 2012 at 01:24 PM
Aims: To estimate all-cause and cause-specific mortality risks by alcohol consumption level for the US population. Methods: The survival analysis of data from National Health Interview Survey participants from 1997 to 2004 who were followed for mortality through 2006. Hazard ratios (HRs) adjusted for available demographic and health characteristics were calculated by alcohol consumption level for all-cause mortality and for mortality from circulatory and external causes. Alcohol consumption levels were generally defined as ‘never drinker’ (<12 drinks in life), ‘former drinker’ (0 drinks during last year), ‘infrequent drinker’ (<12 drinks in any year), ‘light drinker’ (1 drink per drinking day), ‘moderate drinker’(2 drinks) and ‘heavy drinker’ (3+ drinks). Results: Adjusted mortality hazards for lifetime infrequent drinkers were much lower than the hazards for never drinkers among women, so lifetime infrequent drinkers were used as the reference category in survival analysis to estimate the mortality effects of alcohol consumption. Estimated all-cause mortality HRs for moderate drinkers were generally somewhat lower when compared with infrequent drinkers [HR for male moderate drinkers = 0.87, 95% confidence interval (CI) = 0.75–1.01 and HR for female occasional moderate drinkers = 0.80, 95% CI = 0.69–0.93]. Former drinkers and regular heavy drinkers had higher mortality hazards among both men and women. Conclusion: US light to moderate drinkers may have reduced mortality risks, but some portion of their previously observed lower mortality may be due to factors other than alcohol consumption such as medical care and social integration, particularly among women. Alcohol consumption among former and heavy drinkers appears to have increased their mortality risks.
Ethnic Drinking Cultures and Alcohol Use among Asian American Adults: Findings from a National Survey
published on April 20th, 2012 at 01:24 PM
Aims: To investigate the influence of ethnic drinking cultures on alcohol use by Asian Americans and how this influence may be moderated by their level of integration into Asian ethnic cultures. Methods: A nationally representative sample of 952 Asian American adults extracted from the Wave 2 National Epidemiologic Survey of Alcohol and Related Conditions data was used. Multiple logistic and linear regression models were fitted, some of which were stratified by nativity. Results: Controlling for financial stress, discrimination and demographic variables, a hypothesized, positive relationship between ethnic drinking cultures and alcohol outcomes held for most drinking outcomes. A hypothesis on the moderating effect of integration into ethnic cultures indicated by ethnic language use was supported for US-born Asian Americans. Conclusion: Ethnic drinking cultures may significantly influence alcohol use by Asian Americans. The influence of ethnic drinking cultures may be conditioned by the degree of integration into the ethnic cultures. To inform alcohol interventions for reducing harmful and hazardous alcohol use among immigrants, future research needs to explore the cultural and social processes occurring in immigrant communities that might significantly influence drinking.
Changing Parental Behaviour to Reduce Risky Drinking Among Adolescents: Current Evidence and Future Directions
published on April 20th, 2012 at 01:24 PM
Aims: Risky drinking among young people is an issue of public concern globally. In Australia and elsewhere, there has been a steady increase in alcohol-related harms among young people in recent years. The aims of this study were to review the nature of parental supply of alcohol to adolescents aged 13–17 years, explore parental social networks as a potential avenue for intervention, and propose future directions for research with a view to informing public policy and the development of interventions to reduce risky drinking. Methods: Narrative review. Results: While a large literature exists concerning parental influence on children's drinking, exploration of the volume of alcohol and context of parental supply is lacking. Results from cross-sectional and longitudinal studies on the impact of parental factors such as monitoring, rule setting, alcohol supply and supervision of drinking present an unclear picture. Consequently, translation of research findings into advice for parents is problematic. Conclusion: We propose that future research seeks to (a) gain a better understanding of the volume and contexts of parental supply of alcohol, (b) explore the structure of social networks among adolescents and their parents, (c) determine the accuracy of parents' perceptions of other parents' behaviours and beliefs, (d) develop an analytic approach for quantifying aspects of parental networks and (e) evaluate low-intensity parental interventions including web programmes.
Home Drinking in the UK: Trends and Causes
published on April 20th, 2012 at 01:24 PM
Aims: To explore the trend in the UK to consume alcohol at home rather than at licensed premises. Methods: A Medline search entering the terms ‘home drinking’, ‘alcohol’ and ‘adult’ covering the period 2000–2011yielded 48 articles, of which 6 met the criteria to be included in the review. Grey literature including survey and market research data were reviewed. Results: In the UK, since 1970 there has been trend for beer to be consumed at home more often than in licensed premises and that the overall trend towards greater home drinking has increased since 2000. The main reasons given are convenience, cost, safety, autonomy and stress relief. There has also been an increase in the practice known as ‘pre-loading’ (drinking before going out). Adults who drink mainly at home report that they are aware that they run a risk of higher overall alcohol consumption but tend to play down the possibility that increased consumption may lead to longer-term harm. Conclusion: Home drinking trends may have long-term public health consequences. Greater understanding of the drivers of this trend will help policy-makers to respond to these societal changes.
Practicing Harm Reduction Psychotherapy. An Alternative Approach to Addictions
published on April 20th, 2012 at 01:24 PM

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