The importance of keeping regular: accurate guidance to the public on low-risk drinking levels

Aim The aim of this study was to argue that recommendations to the general public on daily amounts for low-risk alcohol consumption must retain the word ‘regular’ in order to avoid being rejected. Method Narrative review of the evidence-base for daily limits to alcohol consumption, the guidance the public actually receives in the UK and media reactions to this guidance. Results Evidence for daily limits (not more than 3–4 units for men and 2–3 units for women) rests on epidemiological surveys that enquire about ‘average’ or ‘usual’ amounts of consumption and this is reflected by the use of ‘regular’ or ‘consistent’ in the UK Government's Sensible Drinking report in 1995 and in guidance currently issued by the English Department of Health. In contrast, guidance the public actually receives often omits the word ‘regular’ and implies that the limits in question are maximum daily amounts. Media reactions to this inaccurate information suggest that the general public is likely to find these recommendations incredible and to reject them. Conclusion If guidance to the public on daily drinking amounts is to stand any chance of being credible and effective, it must be accurate and must therefore retain the word ‘regular’

Review of \u3cem\u3eDrug War Heresies: Learning from Other Vices, Times & Places.\u3c/em\u3e Robert J. MacCoun and Peter Reuter. Reviewed by Lorraine T. Midanik.

Book review of Robert J. MacCoun and Peter Reuter, Drug War Heresies: Learning from Other Vices, Times & Places. New York: Cambridge University Press, 2002. $75.00 hardcover,$25.00 papercover

Use of heavier drinking contexts among heterosexuals, homosexuals and bisexuals: Results from a national household probability survey.

Objective: Extensive use of specific social contexts (bars and parties, for instance) by homosexuals and bisexuals is thought to be a factor in the higher rates of drinking among these groups. However, much of the empirical evidence behind these assumptions has been based on studies with methodological or sampling shortcomings. This article examines the epidemiological patterns of alcohol contexts in relation to sexual identity, using a large, national, probability population survey. Method: We used the 2000 National Alcohol Survey for these analyses. The prevalence of spending leisure time in each of two social contexts (bars and parties) that are associated with heavier drinking is examined by sexual orientation (heterosexual, homosexual, bisexual and self-identified heterosexuals with same sex partners). In addition, we compare levels of drinking within these contexts by sexual orientation within these groups. Results: Exclusively heterosexual women spent less time in these two contexts relative to all other groups of women. Gay men spent considerably more time in bars compared with the other groups of men. Heterosexual women who reported same sex partners drink more at bars, and bisexual women drink more alcohol at both bars and parties than exclusively heterosexual women. For men, there were no significant differences for average consumption in any of these contexts. Entry of background and demographic variables into logistic regression analyses did little to modify these associations. Conclusions: There is empirical evidence that some groups of homosexual and bisexual women and men spend more time than heterosexual individuals in heavier drinking contexts. The frequency of being in these two social contexts does not appear to be associated with heavier drinking within these contexts for men, but it may be related to heavier drinking in those places among some groups of women

Reports of alcohol consumption and alcohol-related problems among homosexual, bisexual and heterosexual respondents: Results from the 2000 National Alcohol Survey

Objective: Few population-based studies have explored differences in alcohol consumption by sexual orientation. This study examined the prevalence of abstinence, drinking, heavier drinking, alcohol-related problems, alcohol dependence and help-seeking among homosexual and bisexual women and men compared with heterosexuals. Method: Data are from the 2000 National Alcohol Survey, a national population-based survey of adults (N = 7,612), a Random Digit Dialing telephone survey of all 50 states of the United States and Washington, DC. Four categories of sexual orientation were created using questions on both sexual orientation self-identification and behavior: homosexual identified, bisexual identified, heterosexual identified with same sex partners and exclusively heterosexual. Five alcohol measures (past year) were used in the analyses: (1) mean number of drinks, (2) days consuming five or more drinks on a single occasion, (3) drunkenness, (4) negative social consequences (2 or more) and (5) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol dependence. A lifetime measure of help-seeking for an alcohol problem was also analyzed. Results: Few significant differences were found among men by sexual orientation. By contrast, both lesbians and bisexual women had lower abstention rates and significantly greater odds of reporting alcohol-related social consequences, alcohol dependence and past help-seeking for an alcohol problem. Conclusions: These findings suggest that alcohol dependence and alcohol-related consequences differ by sexual orientation, particularly among women. These findings also emphasize the need for the inclusion of sexual-orientation items in population-based surveys so that prevalence rates within these subgroups can be effectively monitored

Self-other differences in student drinking norms research: the role of impression management, self-deception and measurement methodology

Background: Data-driven student drinking norms interventions are based on reported normative overestimation of the extent and approval of an average student’s drinking. Self-reported differences between personal and perceived normative drinking behaviors and attitudes are taken at face value as evidence of actual levels of overestimation. This study investigates whether commonly used data collection methods and socially desirable responding may inadvertently impede establishing 'objective' drinking norms. Methods: UK students [N=421; 69% female; Mean age 20.22 years (SD = 2.5)] were randomly assigned to one of three versions of a drinking norms questionnaire: The standard multi-target questionnaire assessed respondents' drinking attitudes and behaviors (frequency of consumption, heavy drinking, units on a typical occasion) as well as drinking attitudes and behaviors for an ‘average student’. Two deconstructed versions of this questionnaire assessed identical behaviors and attitudes for participants themselves or an 'average student'. The Balanced Inventory of Desirable Responding was also administered. Results: Students who answered questions about themselves and peers reported more extreme perceived drinking attitudes for the average student compared with those reporting solely on the ‘average student’. Personal and perceived reports of drinking behaviors did not differ between multi- and single-target versions of the questionnaire. Among those who completed the multi-target questionnaire, after controlling for demographics and weekly drinking, socially desirable responding was related positively with the magnitude of difference between students’ own reported behaviors/attitudes and those perceived for the average student. Conclusions: Standard methodological practices and socially desirable responding may be sources of bias in peer norm overestimation research

“Culture of drinking” and individual problems with alcohol use

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/60339/1/ahern_culture of drinking_2008.pd

Prevalence and socio-economic distribution of hazardous patterns of alcohol drinking: study of alcohol consumption in men aged 25–54 years in Izhevsk, Russia

AIM: To estimate the prevalence of hazardous drinking and its socio-economic distribution among Russian men. DESIGN: Participants were an age-stratified, population-based random sample of men aged 25-54 years living in Izhevsk, a city in the Urals, Russia. Interviewers administered questionnaires to cohabiting proxy respondents about behavioural indicators of hazardous drinking derived from frequency of hangover, frequency of drinking beverage spirits, episodes in the last year of extended periods of drunkenness during which the participant withdraws from normal life (zapoi), consumption of alcoholic substances not intended to be drunk (surrogates) and socio-economic position. Logistic regression was used to examine associations between socio-economic position and indicators of hazardous drinking in the past year. FINDINGS: Of 1750 men, 79% drank spirits and 8% drank surrogates at least sometimes in the past year; 25% drank spirits and 4% drank surrogates at least weekly and 10% had had an episode of zapoi in the past year. After adjustment for other socio-economic factors, education was strongly associated with indicators of hazardous drinking. Men with the lowest level of education compared to the highest level of education had an odds ratio of surrogate drinking of 7.7 (95% CI 3.2-18.5), of zapoi of 5.2 (2.3-11.8) and of frequent hangover of 3.7 (1.8-7.4). These indicators of hazardous drinking were also independently strongly associated with being unemployed (versus employed) and with levels of household wealth/amenities. Associations of all these variables with daily consumption of beverage spirits were weaker. CONCLUSION: Using a novel range of indicator variables of hazardous drinking, this paper shows that the prevalence of these behaviours is high among working-age men in this Russian city. Moreover, these hazardous behaviours show very clear socio-economic patterns, with particularly high prevalence among those who have had the least education and are not in employment. In contrast, more conventional measures of heavy drinking, based on frequency of consumption of beverage spirits, are less prevalent and show much weaker associations with socio-economic position

Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

Introduction. Self-monitoring of blood pressure (BP) is an increasingly common part of hypertension management. The objectives of this systematic review were to evaluate the systolic and diastolic BP reduction, and achievement of target BP, associated with self-monitoring. Methods. MEDLINE, Embase, Cochrane database of systematic reviews, database of abstracts of clinical effectiveness, the health technology assessment database, the NHS economic evaluation database, and the TRIP database were searched for studies where the intervention included self-monitoring of BP and the outcome was change in office/ambulatory BP or proportion with controlled BP. Two reviewers independently extracted data. Meta-analysis using a random effects model was combined with meta-regression to investigate heterogeneity in effect sizes. Results. A total of 25 eligible randomized controlled trials (RCTs) (27 comparisons) were identified. Office systolic BP (20 RCTs, 21 comparisons, 5,898 patients) and diastolic BP (23 RCTs, 25 comparisons, 6,038 patients) were significantly reduced in those who self-monitored compared to usual care (weighted mean difference (WMD) systolic −3.82 mmHg (95% confidence interval −5.61 to −2.03), diastolic −1.45 mmHg (−1.95 to −0.94)). Self-monitoring increased the chance of meeting office BP targets (12 RCTs, 13 comparisons, 2,260 patients, relative risk = 1.09 (1.02 to 1.16)). There was significant heterogeneity between studies for all three comparisons, which could be partially accounted for by the use of additional co-interventions. Conclusion. Self-monitoring reduces blood pressure by a small but significant amount. Meta-regression could only account for part of the observed heterogeneity

Commentary on White and Colleagues: Trends in Alcoholâ Related Emergency Department Visits in the United States: Results from the Nationwide Emergency Department Sample, 2006 to 2014 (ACER, 2018)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142426/1/acer13593.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142426/2/acer13593_am.pd

Is alcohol dependence best viewed as a chronic relapsing disorder?

This 'For Debate' paper starts by recognizing the growing trend towards considering alcohol dependence as a chronic relapsing disorder. We argue that the adoption of this model results from focusing on those in treatment for alcohol dependence rather than considering the larger number of people in the general population who meet criteria for alcohol dependence at some point in their lives. The majority of the general population who ever experience alcohol dependence do not behave as though they have a chronic relapsing disorder: they do not seek treatment, resolve their dependence themselves and do not relapse repeatedly. We suggest that caution is therefore needed in using the chronic relapsing disorder label. Our primary concerns are that this formulation privileges biological aspects of dependence to the detriment of psychological and social contributions, it inhibits much-needed developments in understanding alcohol dependence and leads to inefficient distributions of public health and clinical care resources for alcohol dependence. We invite debate on this issue