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Update on Alcohol and Health

Update on Alcohol and Health. Alcohol and Health: Current Evidence May – June 2004. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis Beich A, et al. BMJ . 2003;327(7414):536 – 542. Objectives/Methods.

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Update on Alcohol and Health

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  1. Update on Alcohol and Health Alcohol and Health: Current Evidence May–June 2004 www.alcoholandhealth.org

  2. Screening in brief intervention trials targeting excessive drinkers in general practice: systematic review and meta-analysis Beich A, et al. BMJ. 2003;327(7414):536 – 542 www.alcoholandhealth.org

  3. Objectives/Methods • To examine the efficiency of screening and efficacy of subsequent brief intervention (BI) for risky drinkers • Systematic review and meta-analysis of 8 randomized clinical trials that used screening as a precursor to BI for risky drinkers www.alcoholandhealth.org

  4. Results • 9% screened drank risky amounts; 3% received BI. • Pooled absolute risk reduction= 10.5% (from 69% of patients drinking risky amounts to 57%) • 10 risky drinkers need BI to yield 1 patient no longer drinking risky amounts. • Screening 1000 patients and giving BI to 1/3 of patients with positive screens (the average in the studies reviewed) would yield 2 –3 patients no longer drinking risky amounts. *Proportion of sensible drinkers at follow-up www.alcoholandhealth.org

  5. Conclusions/Comments • Many must be screened for risky drinking (like other conditions) to identify the few who will benefit from intervention. • BI in general practice decreases alcohol use by risky drinkers and is at least as effective as other preventive health measures. www.alcoholandhealth.org

  6. Different measures of alcohol consumption and risk of coronary heart disease and all-cause mortality: 11-year follow-up of the Whitehall II Cohort Study Britton A, et al. Addiction. 2004;99:109 – 116 www.alcoholandhealth.org

  7. Objectives/Methods • To investigate the contributions of alcohol consumption patterns on all-cause mortality and CHD • Analysis of self-reported drinking habits and CHD events (angina or fatal/non-fatal myocardial infarction) of • 10,308 London-based civil servants • followed for a median of 11 years www.alcoholandhealth.org

  8. Results • Relationship between average consumption and all-cause mortality and CHD was U-shaped. • Moderate consumption→ lowest death & CHD rates www.alcoholandhealth.org

  9. Conclusions/Comments • Findings support a U-shaped relationship between average alcohol consumption and all-cause mortality and CHD. • Drinking frequency may be an independent predictor of all-cause mortality (further study is needed). • Drinking frequency may not have been adequately separated from total volume of consumption in statistical analyses. www.alcoholandhealth.org

  10. Brief interventions for hazardous drinkers delivered in primary care are equally effective in men and women Ballesteros J, et al. Addiction. 2004;99:103 – 108 www.alcoholandhealth.org

  11. Objectives/Methods • To examine whether BI in primary care for excessive, non-dependent drinkers is equally effective in men and women • Meta-analysis of randomized controlled trials of BI in primary care settings that reported outcomes separately by sex • Outcomes= consumption at 6- to 12-month follow-up • 6 trials including 1980 men and 1001 women www.alcoholandhealth.org

  12. Results • Reductions in drinking associated with BI were similar for both men and women. • As assessed in 4 studies, BI increased odds of drinking below hazardous levels (defined variably in each study). • Men (OR 2.3; 95% CI, 1.8 – 2.9) • Women (OR 2.3; 95% CI, 1.6 – 3.2) www.alcoholandhealth.org

  13. Conclusions/Comments • BI moderates hazardous drinking equally well in men and women. • More studies are needed to determine whether BI works equally well for men and women of diverse ethnic, racial, and national backgrounds. www.alcoholandhealth.org

  14. Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO Mertens JR, et al. Arch Intern Med. 2003;163:2511 – 2517 www.alcoholandhealth.org

  15. Objectives/Methods • To assess the 12-month prevalence of co-occurring conditions in patients receiving treatment for alcohol and/or other drug (AOD) problems through managed care programs • Patient questionnaires and clinical records of • 747 patients entering treatment • age- and sex-matched controls from the same large HMO www.alcoholandhealth.org

  16. Depression (29% vs. 3%) Anxiety (17% vs. 2%) Injury/overdoses (26% vs. 12%) Major psychoses (7% vs. 0.4%) Lower back pain (11% vs. 6%) Headache (9% vs. 4%) Asthma (7% vs. 3%) Hypertension (7% vs. 3%) Acid-related disorder (5% vs. 2%) Arthritis (4% vs. 1%) Results Compared with controls, patients receiving treatment for AOD problems had a higher prevalence of the following: Findings were similar among patients with alcohol dependence, who were also more likely to have liver cirrhosis (1% vs. 0.1%). www.alcoholandhealth.org

  17. Conclusions/Comments • In private managed care (as in other settings), common medical conditions are more prevalent among patients with AOD problems. • These findings support the practice of screening for AOD problems in medical clinics and for medical problems in AOD treatment programs. www.alcoholandhealth.org

  18. The TWEAK is weak for alcohol screening among female veterans affairs outpatients Bush KR, et al. Alcohol Clin Exp Res. 2003;27(12):1971 – 1978 www.alcoholandhealth.org

  19. Objectives/Methods • To evaluate the TWEAK, AUDIT, and AUDIT-C questionnaires to detect alcohol problems in a female outpatient population • Self-administered TWEAK, AUDIT, and AUDIT-C questionnaires to 393 female veteran outpatients • Results were compared to an interview reference standard. www.alcoholandhealth.org

  20. Results • 23% met criteria for hazardous drinking (i.e., amounts that placed them at risk for consequences) and/or alcohol abuse or dependence. • 10% met criteria for active alcohol abuse or dependence alone. • Each questionnaire had a greater sensitivity for detecting active alcohol abuse or dependence than for detecting the whole spectrum including hazardous drinking, abuse, or dependence. www.alcoholandhealth.org

  21. Results (cont.) Detecting Hazardous Drinking and/or Active Alcohol Abuse or Dependence www.alcoholandhealth.org

  22. Conclusions/Comments • Of the questionnaires tested, the AUDIT-C appears to be the best for detecting hazardous drinking and alcohol use disorders in women. • Findings need to be replicated in other groups before widespread use is recommended. • The AUDIT-C’s brevity may help solve the greatest deficiency in screening– the failure to use any validated questionnaire at all. www.alcoholandhealth.org

  23. Effectiveness of opportunistic brief interventions for problem drinking in a general hospital setting: systematic review Emmen MJ, et al. BMJ. 2004;328(7435):318 www.alcoholandhealth.org

  24. Objectives/Methods • To test the efficacy of brief intervention (BI) in general hospitals • Systematic review of 8 controlled trials comparing effects of BI to usual care in 1597 men and women in general hospitals • 2 studies with hospital outpatients; 6 with inpatients on orthopedics, medicine, and surgery services for various reasons • BIs ranged from education to simple advice to counseling (or a combination of these). www.alcoholandhealth.org

  25. Results BI was associated with • decreases in alcohol-related problems in 4 of 6 studies; • decrease in consumption in only 1 study (which was of outpatients) of 7 studies; • significant decreases in serum gamma-glutamyltransferase levels in 2 of 4 studies. www.alcoholandhealth.org

  26. Conclusions/Comments • It is notable that any benefit was found in these studies, given their diversity. • Universal screening and intervention for all general hospital inpatients may be effective, but evidence is inconclusive. www.alcoholandhealth.org

  27. Drinking to cope in socially anxious individuals: a controlled study Thomas SE, et al. Alcohol Clin Exp Res. 2003;27(12):1937 – 1943 www.alcoholandhealth.org

  28. Objectives/Methods • To investigate whether people who are socially anxious are more likely to drink to cope with their social fears than are those without anxiety • Survey about alcohol use in social situations administered to 23 patients w/ high social anxiety and 23 matched controls w/out social anxiety www.alcoholandhealth.org

  29. Results www.alcoholandhealth.org

  30. Conclusions/Comments • People who are socially anxious intentionally drink alcohol to cope with their social fears. • Data do not explain whether the relationship between social anxiety and alcohol use is causally related to developing dependence. • Given reported associations, primary care clinicians should consider social anxiety a risk factor for alcohol problems. www.alcoholandhealth.org

  31. Treatment of sleep disturbance in alcohol recovery: a national survey of addiction medicine physicians Friedmann PD, et al. J Addict Dis. 2003;22(2):91 – 103 www.alcoholandhealth.org

  32. Objectives/Methods • To investigate how physicians manage sleep disturbance in patients in recovery from alcoholism • Survey of a random sample of physician members of the American Society of Addiction Medicine • 311 respondents (62% response rate) www.alcoholandhealth.org

  33. Results Physicians reported 65% of their patients in the first 3 months after detox had a sleep disturbance. • 64% of physicians recommended meds to at least 1 patient to improve sleep. • Only 22% offered meds to more than half of these patients. www.alcoholandhealth.org

  34. Results (cont.) www.alcoholandhealth.org

  35. Conclusions/Comments • Physicians appear reluctant to offer pharmacotherapy for sleep disturbance following detox. • Whether treatment of sleep disturbance in early recovery will lower the likelihood of recurrent drinking awaits empiric evaluation. • Despite its limitations, this study describes current practices and highlights our limited understanding of pharmacotherapy’s effectiveness for sleep disturbance post-detox. www.alcoholandhealth.org

  36. Physicians’ attitudes regarding reporting alcohol-impaired drivers Mello MJ, et al. Subst Abus. 2003;24(4):233 – 242 www.alcoholandhealth.org

  37. Objectives/Methods • To examine physicians’ attitudes about reporting alcohol-impaired drivers • Questionnaire to physicians of 3 case scenarios involving an alcohol-impaired male driver who presents with minor injuries 1 hour after a motor vehicle crash and has 1 of 3 levels of intoxication • clinical diagnosis of intoxication • blood alcohol concentration (BAC) of 80 mg/dL • BAC of 240 mg/dL • 261 responded; 49% response rate www.alcoholandhealth.org

  38. Results • Respondents preferred to report the driver to a medical review board of the DMV than to police • 66% vs. 36% if clinical diagnosis • 63% vs. 32% if BAC 80 mg/dL • 81% vs. 53% if BAC 240 mg/dL • Most common reasons for not reporting= physician-patient confidentiality and perceived threat of civil action • Comfort with reporting did not differ among specialties (PCPs, emergency medicine physicians, and general surgeons). www.alcoholandhealth.org

  39. Conclusions/Comments • Physicians are willing to report alcohol-impaired drivers to authorities but prefer using a DMV medical board rather than the police. • Physician preferences should be heeded when reporting systems in clinical settings are developed and implemented. www.alcoholandhealth.org

  40. Alcohol consumption during pregnancy and the risk of preterm delivery Albertsen K, et al. Am J Epidemiol. 2004;159(2):155 – 161 www.alcoholandhealth.org

  41. Objectives/Methods • To examine the relationship between alcohol consumption during pregnancy and preterm delivery • Data from 40,892 women in the Danish National Birth Cohort (a study of pregnant women and offspring) who • completed a computer-assisted telephone interview while pregnant • gave birth to a liveborn singleton www.alcoholandhealth.org

  42. Results • 1,880 preterm births (<37 weeks gestation) www.alcoholandhealth.org

  43. Results (cont.) • 1 or more drinks/week increased risk of very preterm birth (<32 weeks gestation), but not significantly. • e.g., RR 3.3 for 7 or more drinks/week • Type of alcoholic beverage was not associated with preterm birth. www.alcoholandhealth.org

  44. Conclusions/Comments • Increases in preterm birth associated with consuming 4 or more drinks/week were not statistically significant, but are consistent with findings from some previous studies. • Advising pregnant women to abstain remains the safest approach. • But, patients who have an occasional drink during pregnancy may not be increasing their risk of preterm birth. www.alcoholandhealth.org

  45. Sociodemographic factors associated with comorbid major depressive episodes and alcohol dependence in the general population Wang JL, et al. Can J Psychiatry. 2004;49(1):37 – 44 www.alcoholandhealth.org

  46. Objectives/Methods • To examine the association between alcohol dependence (AD) and major depressive episodes (MDEs) in the general population • Analysis of interview data from 72,940 people aged 12 and older who participated in the Canadian National Population Health Survey www.alcoholandhealth.org

  47. Results • Of participants with MDEs, 9% had comorbid AD (compared to 2% without MDE). • Of participants with AD, 20% reported having at least one MDE (compared to 4% without AD). • Those with comorbidity were much more likely than those with pure AD to use mental health services in the past year (47% vs. 8%, respectively). www.alcoholandhealth.org

  48. Results (cont.) Analyses adjusted for sex, education, and employment www.alcoholandhealth.org

  49. Conclusions/Comments • This study confirms that AD and MDEs often coexist and that certain people have a greater risk of comorbidity. • The risk factors for comorbidity reported can help clinicians identify patients in greatest need of mental health services, and hopefully increase receipt of appropriate care. www.alcoholandhealth.org

  50. Folate, methyl-related nutrients, alcohol, and theMTHFR 677C→T polymorphism affect cancer risk: intake recommendations Bailey LB. J Nutr. 2003;133:3748S – 3753S www.alcoholandhealth.org

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