People often arrive in substance abuse treatment programs with multiple problems—including dependency on or addiction to both alcohol and drugs. National data from the Treatment Episode Data Set (TEDS) for 2009 show that 730,228 substance abuse treatment admissions (37.2 percent) reported abuse of alcohol and at least one other drug; 23.1 percent of all admissions reported the abuse of alcohol and one other drug, and 14.1 percent reported the abuse of alcohol and two other drugs.When alcohol is used with other drugs, it tends to be ingested in greater quantities than when used in their absence.2 Combining alcohol with other drugs is dangerous. For example, taking benzodiazepines concomitantly with alcohol increases the chances of benzodiazepine-involved death. It is important for treatment providers to identify patients who use alcohol with other drugs since that is an especially dangerous usage pattern.
Source: PLoS ONE
High levels of alcohol consumption and increases in heavy episodic drinking (binge drinking) are a growing public concern, due to their association with increased risk of personal and societal harm. Alcohol consumption has been shown to be sensitive to factors such as price and availability. The aim of this study was to explore the influence of glass shape on the rate of consumption of alcoholic and non-alcoholic beverages.
This was an experimental design with beverage (lager, soft drink), glass (straight, curved) and quantity (6 fl oz, 12 fl oz) as between-subjects factors. Social male and female alcohol consumers (n = 159) attended two experimental sessions, and were randomised to drink either lager or a soft drink from either a curved or straight-sided glass, and complete a computerised task identifying perceived midpoint of the two glasses (order counterbalanced). Ethical approval was granted by the Faculty of Science Research Ethics Committee at the University of Bristol. The primary outcome measures were total drinking time of an alcoholic or non-alcoholic beverage, and perceptual judgement of the half-way point of a straight and curved glass.
Participants were 60% slower to consume an alcoholic beverage from a straight glass compared to a curved glass. This effect was only observed for a full glass and not a half-full glass, and was not observed for a non-alcoholic beverage. Participants also misjudged the half-way point of a curved glass to a greater degree than that of a straight glass, and there was a trend towards a positive association between the degree of error and total drinking time.
Glass shape appears to influence the rate of drinking of alcoholic beverages. This may represent a modifiable target for public health interventions.
See: Stein, Tankard, Pint, Boot: Different beer glasses affect drinking speed (EveryONE blog)
Alcohol Use and Binge Drinking Among Women of Childbearing Age — United States, 2006–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Alcohol use during pregnancy is a leading preventable cause of birth defects and developmental disabilities. Alcohol-exposed pregnancies (AEPs) can lead to fetal alcohol syndrome and other fetal alcohol spectrum disorders (FASDs), which result in neurodevelopmental deficits and lifelong disability (1). In 2005, the Surgeon General issued an advisory urging women who are pregnant or who might become pregnant to abstain from alcohol use (2). Healthy People 2020 set specific targets for abstinence from alcohol use (MICH-11.1) and binge drinking (MICH-11.2) for pregnant women (3). To estimate the prevalence of any alcohol use and binge drinking in the past 30 days among women aged 18–44 years, CDC analyzed 2006–2010 Behavioral Risk Factor Surveillance System (BRFSS) data. Based on their self-reports, an estimated 51.5% of nonpregnant women used alcohol, as did 7.6% of pregnant women. The prevalence of binge drinking was 15.0% among nonpregnant women and 1.4% among pregnant women. Among pregnant women, the highest prevalence estimates of reported alcohol use were among those who were aged 35–44 years (14.3%), white (8.3%), college graduates (10.0%), or employed (9.6%). Among binge drinkers, the average frequency and intensity of binge episodes were similar, approximately three times per month and six drinks on an occasion, among those who were pregnant and those who were not. Clinical practices that advise women about the dangers associated with drinking while pregnant, coupled with community-level interventions that reduce alcohol-related harms, are necessary to mitigate AEP risk among women of childbearing age and to achieve the Healthy People 2020 objectives.
Source: Agency for Healthcare Research and Quality
Alcohol misuse, which includes the full spectrum from drinking above recommended limits (i.e., risky/hazardous drinking) to alcohol dependence, is associated with numerous health and social problems and more than 85,000 deaths per year in the United States and an estimated annual cost to society of more than $220 billion. Alcohol misuse is estimated to be the third leading cause of preventable mortality in the United States following tobacco use and being overweight. Alcohol misuse contributes to a variety of conditions, including hypertension, cirrhosis, gastritis and gastric ulcers, pancreatitis, breast cancer, neuropathy, cardiomyopathy, anemia, osteoporosis, cognitive impairment, depression, insomnia, anxiety, and suicide. Excessive alcohol consumption is a major factor in injury and violence.
Though estimating the prevalence of alcohol misuse is challenging, it has been estimated that about 30 percent of the U.S. population is affected, with the majority of these individuals engaging in what is considered risky drinking. Older studies report a range of risky drinkers from 4 to 29 percent across primary care populations, with prevalence estimates of 0.3 to 10.0 percent for harmful drinkers and 2.0 to 9.0 percent for alcohol dependence. More recent data from the American Academy of Family Physicians National Research Network reveal that 21.3 percent of primary care patients reported risky/hazardous drinking (based on the three quantity and frequency questions from the Alcohol Use Disorders Identification Test [AUDIT-C]). Alcohol dependence has lifetime prevalence rates on the order of 17 percent for men and 8 percent for women;16 prevalence of current dependence (within the last 12 months and as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) is approximately 4 percent in the general adult population.17 Some studies have reported that one in five of those who screen positive for unhealthy alcohol use in primary care will have alcohol dependence (four in five will not). Rates of alcohol-use disorders among medical outpatients are similar to those seen in the general population and are generally higher in males and younger people of all races/ethnicities.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has proposed epidemiologically based alcohol-use guidelines to limit risks for drinking-related consequences by establishing age- and sex-specific recommended consumption thresholds. Maximum recommended consumption is three or fewer standard drinks per day (seven per week) for adult women and for anyone older than 65 years of age, and four or fewer standard drinks per day (14 per week) for adult men. A standard drink is defined as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits. These guidelines do not apply to certain people (such as adolescents, pregnant women, and people with alcohol dependence or medical conditions or medication use) for whom alcohol intake is contraindicated, or to circumstances (driving) in which no consumption is considered safe.
Source: Substance Abuse and Mental Health Services Administration
Discusses the role of alcohol biomarkers in the clinical, medical, and forensic settings and examines strategies for their use and interpretation in varying circumstances such as clinical, criminal justice, and impaired healthcare provider settings.
Youth Risk Behavior Surveillance — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.
Reporting Period Covered: September 2010–December 2011.
Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9–12.
Results: Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.
Interpretation: Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.
Public Health Action: YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.
Further study on the affordability of alcoholic beverages in the EU: A focus on excise duty pass-through, on- and off-trade sales, price promotions and statutory regulations
Source: RAND Corporation
Policies related to alcohol pricing, promotion and discounts provide opportunities to address harms associated with alcohol misuse. However, there are important gaps in information and knowledge about the regulations in place across parts of Europe and their impacts on consumer prices and locations of purchase.
Using market data, we explored the overall scale and trend of price promotions and discounts in the off-premise (e.g. supermarket) and on-premise (e.g. restaurants, pubs) across five EU Member States. To better understand the factors that may influence sales in the on- vs. off-premises, we performed regression analysis for four EU Member States with relevant data. This found that increases in broadband penetration and population density were associated with relatively higher levels of off-premise alcohol purchases and that increases in income were associated with relatively higher levels of on-premise purchases of alcohol. There was no statistically significant relationship for female higher education.
We further used time-series methods, drawing on data for Ireland, Latvia, Slovenia and Finland, to estimate the impact of changes in excise duty on price (‘pass-through’). This showed that a €1 increase in excise duty increased beer prices by €0.50-€2.50 in the off-premise, and increased spirits prices by €0.70-€1.40 in the off-premise. These findings suggest that, depending on the price sensitivity of consumers and other strategies employed by suppliers (e.g. advertising), changes in excise duty may be an effective instrument to reduce harmful alcohol consumption.
Many policy measures to control the obesity epidemic assume that people consciously and rationally choose what and how much they eat and therefore focus on providing information and more access to healthier foods. In contrast, many regulations that do not assume people make rational choices have been successfully applied to control alcohol, a substance — like food — of which immoderate consumption leads to serious health problems. Alcohol-use control policies restrict where, when, and by whom alcohol can be purchased and used. Access, salience, and impulsive drinking behaviors are addressed with regulations including alcohol outlet density limits, constraints on retail displays of alcoholic beverages, and restrictions on drink “specials.” We discuss 5 regulations that are effective in reducing drinking and why they may be promising if applied to the obesity epidemic.
Nearly half of all substance abuse treatment admissions involving college students were primarily for treating alcohol disorders
A new report shows that nearly half (46.6 percent) of all substance abuse treatment admissions involving college or other post secondary school students ages 18 to 24 were primarily related to alcohol disorders. The rate of primary alcohol-related treatment admissions is far higher among college students than for non-college students in the same age bracket (46.6 percent versus 30.6 percent) according to this new report by the Substance Abuse and Mental Health Services Administration (SAMHSA).…The SAMHSA report shows that in 2009 there were 12,000 treatment admissions involving college students. While the rate of college student treatment admissions linked primarily to alcohol was far higher than for non-college students, both groups had similar admission rates for primary marijuana-related problems – 30.9 percent for college students versus 30 percent for non-college students.
+ Full Report (PDF)
Binge Drinking: Nationwide Problem, Local Solutions
Source: Centers for Disease Control and Prevention
New estimates show that binge drinking is a bigger problem than previously thought. More than 38 million US adults binge drink, about 4 times a month, and the largest number of drinks per binge is on average 8. This behavior greatly increases the chances of getting hurt or hurting others due to car crashes, violence, and suicide. Drinking too much, including binge drinking, causes 80,000 deaths in the US each year and, in 2006 cost the economy $223.5 billion. Binge drinking is a problem in all states, even in states with fewer binge drinkers, because they are binging more often and in larger amounts.
Marijuana use continues to rise among U.S. teens, while alcohol use hits historic lows (PDF)
Source: Monitoring the Future Study (University of Michigan)
Among the more important findings from this year’s Monitoring the Future survey of U.S. secondary school students are the following:
- Marijuana use among teens rose in 2011 for the fourth straight year—a sharp contrast to the considerable decline that had occurred in the preceding decade. Daily marijuana use is now at a 30-year peak level among high school seniors.
- “Synthetic marijuana,” which until earlier this year was legally sold and goes by such names as “K2” and “spice,” was added to the study’s coverage in 2011; one in every nine high school seniors (11.4%) reported using that drug in the prior 12 months.
- Alcohol use—and, importantly, occasions of heavy drinking—continued a long-term gradual decline among teens, reaching historically low levels in 2011.
- Energy drinks are being consumed by about one third of teens, with use highest among younger teens.
Policing licensed premises in the Australian Capital Territory
Source: Australian Institute of Criminology
There is an old joke that says that an Australian’s definition of a drinking problem is being in a situation where you can’t get a drink. This reflects Australia’s well-established reputation for being a community where the consumption of alcohol, frequently at excessive and harmful levels, is associated with many forms of entertainment and participation in social events. In other words, the association between alcohol consumption and the enjoyment of social activity is a deeply embedded cultural phenomenon.
However, the evidence relating to the range of individual and social harms associated with alcohol misuse is strong. In 2007, one in four Australians were a victim of alcohol-related verbal abuse, 13 percent were put in fear and 4.5 percent of Australians aged 14 years or older had been physically abused by someone under the influence of alcohol (AIHW 2008). The rates of physical and verbal abuse by a person affected by alcohol are more than twice the rate for other drug types. Alcohol-related crime and disorder also has a significant adverse impact upon the perceptions of safety among the broader community.
At the same time, Australia also has a substantial reputation for developing and implementing innovative policy approaches to trying to reduce the harms associated with excessive alcohol use and violence in particular. Many of these initiatives have been focused on regulatory responses that target licensed premises and liquor outlets. Licensed premises are a high-risk setting for alcohol-related violence, with a large proportion of assaults occurring in or within very close proximity to hotels and nightclubs. Furthermore, both patrons and staff of licensed premises are at a heightened risk of becoming involved in a violent incident compared with other locations.
Over the years, police and liquor regulatory authorities, often in partnership with liquor licensees, have committed significant effort and resources to efforts to improve the overall safety of drinking venues and the overall amenity of the nearby community. Unfortunately, often what has been missing from such efforts has been any systematic assessment of their relative effectiveness and methods for sharing the lessons learned.
This report is part of an attempt to redress this knowledge deficit. Undertaken in close partnership with Australian Capital Territory Policing (ACTP), the project was a detailed study of the effectiveness of a series of policing measures implemented by the ACTP over several months to reduce and prevent alcohol-related violence in and around licensed premises and entertainment precincts in the ACT.
As with similar studies previously conducted here and overseas, the project found mixed results in relation to effectiveness. However, the project was able to help identify and explain what things were working and why, thereby providing a series of evidence-based recommendations for future policing in this area, many of which it is pleasing to note have already been adopted by ACTP.