Effectiveness of proactive video therapy for problematic alcohol use on treatment initiation, compliance, and alcohol intake: a randomised controlled trial in Denmark.

BACKGROUND: Few people with problematic alcohol use reach treatment and dropout is frequent. Therapy for problematic alcohol use delivered via video conference (e-alcohol therapy) might overcome treatment barriers. In this randomised study, we tested whether proactive e-alcohol therapy outperformed face-to-face alcohol therapy (standard care) regarding treatment initiation, compliance, and weekly alcohol intake at 3-month and 12-month follow-up. METHODS: In this two-arm randomised controlled trial, we recruited individuals who had problematic alcohol use, defined as a score of 8 or more on the Alcohol Use Disorders Identification Test; were 18 years or older; and had access to a personal computer, smartphone, or tablet with internet access in Denmark through online advertisements. Participants were assigned to receive alcohol therapy delivered either face-to-face or via video conference. The number, frequency, and duration of therapy sessions were individualised in both groups. Data analysis was conducted using masked data. Primary analyses were based on an intention-to-treat sample. The study is registered with ClinicalTrials.gov (NCT03116282). FINDINGS: Between Jan 22, 2018, and June 29, 2020, 816 individuals signed up for the trial and 502 (63%) were assessed for eligibility. We randomly assigned 379 to proactive e-alcohol therapy (n=187) or standard care (n=192), of which, 170 (48%) participants were female and 186 (52%) were male. In the intervention group, more participants initiated treatment (155 [88%] of 177 vs 96 [54%] of 179; odds ratio [OR] 6·3; 95% CI 2·8 to 13·8; p<0·0001 at 3 months; 151 [85%] of 177 vs 115 [64%] of 179; OR 3·2; 95% CI 1·6 to 6·2; p=0·0007 at 12 months) and complied with treatment (130 [73%] of 177 vs 74 [41%] of 179; OR 4·0; 95% CI 2·2 to 7·2; p<0·0001 at 3 months; 140 [79%] of 177 vs 95 [53%] of 179; OR 3·4; 95% CI 1·8 to 6·3; p=0·0002 at 12 months). Weekly alcohol intake was significantly lower in the intervention group only after 3 months (13·0 standard drinks per week vs 21·3 standard drinks per week; adjusted difference -6·7; 95% CI -12·3 to -1·0; p=0·019). INTERPRETATION: Proactive e-alcohol therapy was associated with increased treatment initiation and compliance and is promising as an easily accessible and effective alcohol treatment for individuals with problematic alcohol use. FUNDING: TrygFonden.

Associations between alcohol intake and hospital contacts due to alcohol and unintentional injuries in 71,025 Danish adolescents - a prospective cohort study.

Background: Alcohol is a leading risk factor to adolescent health. However, it is unclear how associations between alcohol intake and injuries are shaped. We investigated the dose-response relationship between alcohol intake and risk of hospital contacts due to alcohol and unintentional injuries in adolescents. Methods: We conducted a prospective cohort study including 71,025 Danish students aged 15-24 years, followed up for five years from 2014 to 2019. The main outcome measures were hospital contacts due to alcohol and unintentional injuries (all injuries and head injuries), obtained from hospital registers. Findings: Approximately 90% of males and females reported drinking alcohol, and the median intake among those was 11 drinks/week in males and 8 drinks/week in females. During five years of follow-up, 1.3% had an alcohol-attributable hospital contact, the majority of which were due to acute intoxication (70%). Alcohol-attributable hospital contacts were equally frequent in males and females and between age groups (15-17-year-olds vs 18-24-year-olds). Compared with never drinking, the adjusted incidence rate ratios for weekly intake of <7, 7-13, 14-20, 21-27, and >27 drinks/week were 1.70 (95% confidence interval 1.23-2.34), 1.77 (1.27-2.46), 1.91 (1.35-2.70), 2.34 (1.59-3.46), and 3.25 (2.27-4.64) for having an alcohol-attributable hospital contact within five years of follow-up. Restricting follow-up to one year more than doubled risk estimates. During the five years of follow-up, 27% incurred an unintentional injury. The most frequent types of injury were to the wrist or hand (27.6%), ankle or foot (25.2%), or head (12.4%). Injuries were more frequent among males (first-time incidence rate 110 per 1000 person-years) compared to females (82 per 1000 person-years), with no differences between age groups. Compared with never drinking, the adjusted incidence rate ratios for weekly intake of <7, 7-13, 14-20, 21-27, and >27 drinks were 1.09 (1.03-1.15), 1.14 (1.07-1.20), 1.25 (1.17-1.33), 1.38 (1.28-1.49), and 1.58 (1.47-1.69) for having a hospital contact for any type of unintentional injury within five years of follow-up. Results for the one-year follow-up period were comparable. Separate analysis for head injuries showed similar results as the analysis on all injuries. Results were generally similar in males and females. Interpretation: Adolescents' drinking is associated with a higher risk of acute harm in terms of hospital contacts due to alcohol and unintentional injuries in a dose-response relationship. Thus, increased risk was apparent in those with low alcohol intake, suggesting a need for awareness of and initiatives to prevent youth drinking. Furthermore, initiatives should include a strengthened focus on people younger than 18 years. Funding: This study was funded by the Tryg Foundation (ID: 153539) and The Helse Foundation (21-B-0359).

Acceptability Among Frontline Staff Toward Distributing an Anonymous Alcohol Survey in Emergency Departments: A Mixed Methods Study.

ABSTRACT: Emergency departments (EDs) serve as the front line when patients encounter the hospital system. Limited data are available of patients' alcohol habits collected during Danish ED visits, and no studies have, to our knowledge, examined frontline staffs' (registered nurses and medical secretaries) acceptability to deliver anonymous alcohol surveys to patients. We aimed at examining the proportion of survey respondents and the prevalence of patients' alcohol habits and also exploring frontline staff acceptability of the distribution of an anonymous survey regarding patients' alcohol habits in EDs. Intendedly, all eligible patients ≥18 years old entering two EDs in March 2019 should receive a survey based on the Alcohol Use Disorder Identification Test. The study was an explanatory, sequential, mixed methods design, and results were analyzed with descriptive statistics and a deductive content analysis based on the theoretical framework of acceptability. In total, 15% (n = 1,305) of the total 8,679 patients in the EDs returned the survey. Qualitative analysis of interviews (n = 31) with staff showed that they had been reluctant to distribute the survey primarily because of ethical concerns of anonymity, freedom of choice, and being nonjudgmental toward patients. Hence, patients with no obvious alcohol problems were more likely to receive the survey. Still, we found that 23% of the respondents had an Alcohol Use Disorder Identification Test score ≥ 8. Results indicate that frontline staffs' recognition of patients' alcohol use is inadequate, and findings show a low degree of acceptability among staff to deliver an anonymous survey, which is in line with earlier described barriers toward screening activities in EDs.

Alcohol Intake and Academic Performance and Dropout in High School: A Prospective Cohort Study in 65,233 Adolescents.

PURPOSE: During the teenage years, many adolescents start drinking alcohol, and binge drinking is prevalent. We investigated the relationship between alcohol intake and academic performance. METHODS: We conducted a longitudinal cohort study by combining data from the Danish National Youth Study on 65,233 high school students aged 15-20 years, with information on dropout and grade point average. We assessed associations between alcohol intake and academic performance using multilevel Poisson regression and linear regression, accounting for dependency between students from the same school and class. RESULTS: The average alcohol intake was 10 drinks per week, and 43.6% engaged in binge drinking 3+ times per month. During follow-up, 9.8% of the boys and 6.7% of the girls dropped out. The incidence rate ratio was higher in never drinkers, frequent binge drinkers, and those with a high weekly alcohol intake as compared to those with a low intake. For example, the incidence rate ratio was 1.47 (95% confidence level: 1.24, 1.76) in girls who drank 21-27 drinks per week and 1.29 (95% confidence level: 1.13, 1.48) in girls who never drank as compared to those who drank <7 drinks per week. Alcohol associated with a lower grade point average over the entire span of intake in a dose-dependent manner, and similarly so in boys and girls. Findings were consistent in strata of socioeconomy and individual academic ambition. DISCUSSION: Alcohol intake has implications for academic performance and poses a threat for the prospects of the individual as well as society. Policies and interventions aimed at lowering the intake among high school students are warranted.

Socioeconomic inequalities in alcohol-related harm in adolescents: a prospective cohort study of 68,299 Danish 15-19-year-olds.

Background: Evidence shows that similar levels of alcohol consumption lead to greater harm in adults with low socioeconomic position (SEP) compared to high SEP. We investigated if SEP is associated with alcohol-related hospital contacts in adolescents, and whether differences in risk can be explained by differences in levels of alcohol consumption, drinking pattern, and substance use. Methods: This is a prospective cohort study of 68,299 participants aged 15-19 years old from the Danish National Youth Cohort 2014. SEP was operationalised as parent educational level, family income and perceived financial strain in the family. Data were linked to national registers and participants were followed up for five years from 2014 to 2019. Outcomes were hospital contacts due to alcohol. Multilevel Poisson regression was used to estimate incidence rates (IR) and incidence rate ratios (IRR). Findings: During 280,010 person years of follow-up, 872 participants had an alcohol-attributable hospital contact; intoxications (n = 778, 89%) were the most common diagnosis. Low as compared to high SEP was associated with higher IRR of alcohol-attributable hospital contacts for all three SEP measures. The adjusted IRR of harm was 1.73 (95% CI: 1.29-2.33) for elementary school as the highest parent education compared to longer parent education and 1.57 (95% CI: 1.30-1.89) for family financial strain compared to those without financial strain. Adjustment for weekly alcohol intake, drinking pattern and substance use did not substantially change results. Cubic spline analysis of the association between family income and alcohol-attributable hospital contacts revealed a dose-response relationship with decreasing risk of alcohol-related harm with higher income. Interpretation: Our findings suggested that alcohol-related harm is more common in socioeconomically disadvantaged adolescents despite similar levels of alcohol consumption, regardless of differences in drinking pattern or substance use. Future preventive strategies should prioritise young adolescents, including those who are most disadvantaged. Funding: Tryg Foundation (ID: 153539).

Lack of evidence for the use of ear acupuncture in alcohol treatment.

71% of the Danish municipal alcohol treatment centres use NADA acupuncture. This status report based on recent reviews of the effect and risks of using auricular acupuncture in alcohol treatment shows that the available studies do not have sufficient strength and methodological quality to draw conclusions about effectiveness on craving, alcohol-related outcome measures or withdrawal symptoms. The results warrant a reassessment of the use of NADA in publicly funded alcohol treatment.

Alcohol-related mortality in 15-24-year-olds in Denmark (2010-2019): a nationwide exploratory study of circumstances and socioeconomic predictors.

Background: Adolescents and young adults aged 15-24 years are disproportionately affected by unnatural deaths, including accidents, suicide and interpersonal violence for which alcohol is a leading risk factor. We aimed to explore the extent of and circumstances surrounding alcohol-related deaths in young people aged 15-24 years and whether socioeconomic background and ethnicity differ in those who died due to alcohol-related causes as compared to the background population. Methods: All deaths of 15-24-year-olds occurring in Denmark from 2010 to 2019 were investigated. We manually reviewed death certificates containing information on circumstances, results from autopsies and blood tests, and statements from witnesses. Relevant information published in the media (most often newspaper articles) was included. Our main outcome measures were alcohol-related death and manner of death (accidents (transport accidents, drownings, falls, poisonings), suicide and violence). Further, we designed a population-based case-control study including 10 age- and sex-matched controls per case to test whether there was a socioeconomic gradient in alcohol-related deaths. We used parents' educational level and employment status to define socioeconomic position. Immigration status was used to assess ethnicity. Findings: Over the 10-year period, 1783 deaths occurred among 15-24-year-olds. Of those, 1067 (60%) were due to unnatural causes, corresponding to a mortality rate of 14.8 (95% confidence interval: 13.9-15.7) per 100,000. Twelve percent of unnatural deaths (n = 125) were alcohol related, corresponding to a rate of 1.7 (1.4-2.0) per 100,000, and were higher in males (2.9 [2.3-3.4]) than in females (0.6 [0.3-0.8]); thus, males accounted for 105 (84%) of alcohol-related deaths. The majority of alcohol-related deaths occurred on Fridays, Saturdays and Sundays (n = 77, 62%). Accidents accounted for 82% (n = 102) of alcohol-related deaths, followed by suicide (n = 19, 15%) and interpersonal violence (n = 4, 3%). Of all fatal accidents, 102 of 636 (16%) were alcohol related. Of all deaths caused by drownings and falls, 14 of 26 (54%) and 10 of 25 (40%), respectively, were alcohol related. Alcohol-related drownings most often occurred while the deceased was alone, whereas alcohol-related falls most often occurred in relation to parties, involving falls from a window or balcony. Those who died from alcohol-related causes more often had parents with a short education or who were unemployed, as compared to the general population. For example, odds ratios were 3.9 (2.2-7.0) and 1.8 (1.2-2.9) for having parents with short and medium as compared to long educations. The odds ratio for being of Danish origin was 4.0 (1.7-9.5) compared to being first- or second-generation immigrants. Interpretation: In 15-24-year-olds, alcohol-related deaths accounted for a substantial proportion of all unnatural deaths. There was substantial socioeconomic inequality in alcohol-related deaths, as has repeatedly been shown for chronic alcohol-related mortality in older adults. Funding: Trygfonden.

Alcohol Drinking Patterns and Risk of Developing Acute and Chronic Pancreatitis.

AIM: The aim was to analyze the effects of drinking pattern and type of alcohol on risk of acute and chronic pancreatitis. METHODS: Prospective cohort study based on data from 316,751 men and women participating in the Danish National Health Surveys 2010 and 2013. Self-reported questionnaire-based alcohol parameters and information on pancreatitis was obtained from national health registers. Cox regression models were used adjusting for baseline year, gender, age, smoking, Body Mass Index, diet and education. RESULTS: Development of acute and chronic pancreatitis increased with alcohol intake with a significant increase among abstainers and those drinking >14 drinks per week compared with individuals drinking 1-7 drinks per week. Frequent binge drinking and frequent drinking (every day) was associated with increased development of acute and chronic pancreatitis compared with those drinking 2-4 days per week. Problematic alcohol use according to the CAGE-C questionnaire was associated with increased development of acute and chronic pancreatitis.Intake of more than 14 drinks of spirits per week was associated with increased development of acute and chronic pancreatitis, and more than 14 drinks of beer per week were associated with increased development of chronic pancreatitis, whereas drinking wine was not associated with development of pancreatitis. CONCLUSION: This large prospective population study showed a J-shaped association between alcohol intake and development of pancreatitis. Drinking every day, frequent binge drinking and problematic alcohol use were associated with increased development of pancreatitis and drinking large amounts of beer and spirits might be more harmful than drinking wine.

Exenatide once weekly for alcohol use disorder investigated in a randomized, placebo-controlled clinical trial.

BackgroundAlcohol use disorder (AUD) is a chronic, relapsing brain disorder that accounts for 5% of deaths annually, and there is an urgent need to develop new targets for therapeutic intervention. The glucagon-like peptide-1 (GLP-1) receptor agonist exenatide reduces alcohol consumption in rodents and nonhuman primates, but its efficacy in patients with AUD is unknown.MethodsIn a randomized, double-blinded, placebo-controlled clinical trial, treatment-seeking AUD patients were assigned to receive exenatide (2 mg subcutaneously) or placebo once weekly for 26 weeks, in addition to standard cognitive-behavioral therapy. The primary outcome was reduction in number of heavy drinking days. A subgroup also completed functional MRI (fMRI) and single-photon emission CT (SPECT) brain scans.ResultsA total of 127 patients were enrolled. Our data revealed that although exenatide did not significantly reduce the number of heavy drinking days compared with placebo, it significantly attenuated fMRI alcohol cue reactivity in the ventral striatum and septal area, which are crucial brain areas for drug reward and addiction. In addition, dopamine transporter availability was lower in the exenatide group compared with the placebo group. Exploratory analyses revealed that exenatide significantly reduced heavy drinking days and total alcohol intake in a subgroup of obese patients (BMI > 30 kg/m2). Adverse events were mainly gastrointestinal.ConclusionThis randomized controlled trial on the effects of a GLP-1 receptor agonist in AUD patients provides new important knowledge on the effects of GLP-1 receptor agonists as a novel treatment target in addiction.Trial registrationEudraCT: 2016-003343-11. ClinicalTrials.gov (NCT03232112).FundingNovavi Foundation; Research Foundation, Mental Health Services, Capital Region of Denmark; Research Foundation, Capital Region of Denmark; Ivan Nielsen Foundation; A.P. Moeller Foundation; Augustinus Foundation; Woerzner Foundation; Grosserer L.F. Foghts Foundation; Hartmann Foundation; Aase and Ejnar Danielsen Foundation; P.A. Messerschmidt and Wife Foundation; and Lundbeck Foundation.

Bariatric Surgery and Risk of Unemployment and Sickness Absence.

BACKGROUND: Obesity is associated with adverse labor market outcomes. We examine whether undergoing bariatric surgery is associated with better labor market outcomes such as lower risks of unemployment and sickness absence. METHODS: This is a register-based cohort study of 9126 patients undergoing bariatric surgery from 2005 to 2013 and a reference group of 10,328 individuals with obesity. Age: 18-60 years, body mass index (BMI): 32-60 kg/m2. Participants were either working, unemployed, or on sickness absence at baseline. Inverse probability of treatment weighting was used to account for baseline differences between the two groups. Relative risk ratios of labor market participation were estimated at 1 year, 3 years, and 5 years of follow-up. RESULTS: Women who had undergone bariatric surgery had a higher risk of unemployment 1 year (RRR = 1.20 (95% CI: 1.02-1.41)) and 5 years (RRR = 1.23 (95% CI: 1.05-1.44)) after surgery; however, men with bariatric surgery had a lower risk of unemployment after 5 years (RRR = 0.71 (95% CI: 0.55-0.92)). The risk of sickness absence was higher at all follow-up time points for both men and women who had undergone bariatric surgery compared with non-operated references with obesity. CONCLUSIONS: Men undergoing bariatric surgery had a lower risk of unemployment 5 years after surgery compared with non-operated men with obesity; however, women presented a higher risk of unemployment after 5 years. The risk of sickness absence was higher for both men and women up to 5 years after undergoing bariatric surgery.

Demographic factors and delay of treatment for alcohol use disorders among 6584 Danish men receiving alcohol treatment.

PURPOSE: This study aimed to investigate the time lag between onset and treatment (treatment delay) for alcohol use disorders (AUD) and associations between demographic factors and treatment delay for AUD. METHODS: The study included 6,584 men registered in the Copenhagen Alcohol Cohort, containing information on civil status, employment status, estimated age at onset of alcohol problems, and age at first outpatient AUD treatment. Data on year of birth, intelligence, and educational level were obtained from the Danish Conscription Database. Information on first hospital AUD treatment was retrieved from Danish national psychiatric registers. Associations between the demographic factors and treatment delay were analysed in separate linear regression models adjusted for year of birth and in a mutually adjusted model including all demographic factors. RESULTS: The mean treatment delay for AUD was 6.9 years (SD = 4.1). After mutual adjustment, an SD increase in intelligence score was associated with 0.17 years increase in treatment delay. Educational level was unrelated to treatment delay. Men with estimated age at onset of alcohol problems at age 20 years or younger had a 5.30 years longer treatment delay than men who had estimated age at onset of alcohol problems at age 51 years or older. Employed men had shorter treatment delays than unemployed men, especially among the oldest birth cohorts. CONCLUSIONS: The treatment delay of 6.9 years highlights the necessity to promote access to AUD treatment, perhaps in particular among adolescents and young individuals. Cognitive factors may affect treatment delay more than non-cognitive personal factors.

Risk of somatic disease and mortality in individuals of parents with alcohol use disorder: a register-based cohort study.

AIMS: To estimate the risks of 12 types of somatic disease-alcohol-related, blood, cancer, circulatory, digestive, endocrine and metabolic, genitourinary, infectious, musculoskeletal, nervous, respiratory and skin-in individuals with parental alcohol use disorder (AUD) versus a reference population, and to estimate the risks of all-cause mortality and of death from an alcohol-related cause. DESIGN: Matched cohort study followed-up through nation-wide health registries. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). SETTING: Denmark. PARTICIPANTS: A total of 14 008 individuals born 1962-2003 of parents with AUD and 139 087 reference offspring randomly selected from the Danish Civil Registration System were followed from their 15th birthday and onward during 1970-2018. Follow-up time ranged between 2 423 955 and 3 208 366 person-years for somatic diseases and was 3 214 411 person-years for all-cause and alcohol-related mortality. MEASUREMENTS: Information on somatic disease was obtained from the Danish National Patient Registry. Causes of death were obtained from the Danish Cause of Death Registry. FINDINGS: Individuals of parents with AUD had a higher risk of alcohol-related diseases (HR = 2.70, 95% CI = 2.24-3.24) compared with the reference individuals. Higher HRs among individuals with parental AUD compared with reference individuals were also observed in all other somatic diseases except for cancer. All-cause mortality (HR = 1.80, 95% CI = 1.63-2.00) and alcohol-related mortality (HR = 3.28, 95% CI = 2.11-5.08) were higher among individuals of parents with AUD compared with the reference individuals. No significant differences were found in relation to the gender of either parents or offspring. CONCLUSIONS: In Denmark, parental alcohol use disorder appears to predict alcohol-related and non-alcohol-related somatic morbidity and mortality in offspring.

An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department.

BACKGROUND: Emergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED. METHODS: An ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool. RESULTS: 150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes "flow," "risky environment," and "physical spaces and artefacts" are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients' and HCPs' encounters unfold in everyday practice. Subtheme "Professional differences" showcases how nurses and doctors address patients' alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes "gut-feeling vs. clinical parameters," "ethical reasoning," and "from compliance to zero-tolerance"; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are "occupiers" and "alcoholic or party animal?". CONCLUSIONS: Unhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use-characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior-shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach.

Distinct health-related risk profiles among middle-aged and older adults with risky alcohol use from the Danish general population.

BACKGROUND: Knowledge is lacking on distinct health-related risk profiles among the substantial group of middle-aged and older adults with risky alcohol use (AU). Such profiles could inform the planning of interventions and prevention. AIMS: To 1) identify distinct health-related profiles based on different types of health-related functioning limitations and distress and 2) assess associations between these profiles and age, sex, and health-relevant behaviors (e.g., smoking). METHODS: Cross-sectional nation-wide Danish health survey with n = 6630 adults aged 55-64 and n = 7605 aged 65-74 with at least risky AU (>84 g ethanol/week in women, >168 in men). Health-related risk profiles were identified with Latent Class Analysis (LCA). Multinomial regression was applied for the association between risk profiles and auxiliary variables. RESULTS: A six-class LCA solution was found among 55-64 year-olds (classes: 'Normative' [61%], 'Distress' [6%], 'Mental health limitations [5%]', 'Pain-related distress [10%]', 'Broad limitations and pain distress [7%]', 'High overall burden' [11%]) and a five-class solution among 65-74 year-olds. Most classes were comparable across age groups. The 'Distress'-class characterized by pain-distress, tiredness-distress, and sleep-related distress (6%) only showed in the younger group. In both age groups, auxiliary covariates (high-risk AU, possible alcohol use disorder, weekly smoking) were positively associated with problematic profile membership (vs. normative class membership). CONCLUSION: Middle-aged and older adults with risky AU have distinct health-related profiles relevant for the form and content of prevention and interventions. Despite their distinct features, almost all problematic health profiles warrant careful attention regarding high-risk AU and probable alcohol use disorder.

Association between negative life events and morbidity in homeless seeking treatment for substance abuse in Greenland.

INTRODUCTION: The aim of the investigation was to describe the association between negative life events on morbidity in homeless seeking treatment for substance abuse in Greenland. METHODS: Cross sectional study on register data comparing homeless and individuals in secure housing initiating alcohol or substance abuse treatment in Greenland between 1 January 2017 and 14 December 2019, (N = 950). Results: Homeless were socio-economically disadvantaged compared to treatment seekers in secure housing. They had a heavier burden of psychiatric morbidity and suffered more negative life experiences. Controlled for having experienced abuse, most morbidity measures' predictive value was slightly less pronounced with psychiatric morbidity as an exception. CONCLUSION: The results indicate that both the morbidity and most analyzed negative life events are associated with being homeless and are mutually linked.

Age at onset and age at treatment of alcohol use disorders: Associations with educational level and intelligence.

Associations of educational level and intelligence with age at onset and age at treatment of alcohol use disorders (AUD) are sparsely investigated; however, knowledge about these associations is important for an enhanced understanding of AUD. This study aimed to examine three measures of timing of AUD: estimated age at onset of alcohol problems, age at first registration in an outpatient alcohol clinic, and age at first AUD hospital diagnosis, and to estimate associations of educational level and intelligence with each measure of timing of AUD. The aims were investigated in a register-based study comprising 7,019 Danish men seeking outpatient AUD treatment. Data on educational level and intelligence were obtained from the Danish Conscription Database. Estimated age at onset of alcohol problems and age at first registration in an outpatient alcohol clinic were obtained from the Copenhagen Alcohol Cohort. Age at first AUD hospital diagnosis was retrieved from national Danish psychiatric registers. Among individuals with information on all measures of timing of AUD, 65.8% followed the developmental sequence: estimated age at onset of alcohol problems (M = 32.08 years, SD = 9.3), age at first registration in an outpatient alcohol clinic (M = 39.89 years, SD = 9.5), and age at first AUD hospital diagnosis (M = 42.27 years, SD = 12.4). Adjusted linear regression models revealed significant associations of high educational level and high intelligence with later onset and treatment of AUD, ranging from 0.61 to 0.89 years (p < 0.0001) for educational level and from 0.10 to 0.09 years (p < 0.0001) for intelligence. In conclusion, AUD develops sequentially. High educational level and intelligence were associated with later onset and treatment of AUD, but educational level explained most unique variance. This may indicate that in addition to cognitive factors reflected by both educational level and intelligence, non-cognitive factors only reflected by educational level also are important for the timing of AUD.

Changes in relationship status following bariatric surgery.

BACKGROUND AND OBJECTIVE: Bariatric surgery is a major event associated with psychological changes such as improvements in self-esteem, increased autonomy, and better self-value. Such changes could affect the patient's interpersonal relationships; however, little is known about the impact of bariatric surgery on changes in relationship status. In this paper, we aim to test the hypothesis that bariatric surgery is associated with changes in interpersonal relationships such as becoming single for those who were in a relationship or entering a relationship among those who were single before surgery. METHODS: This register-based cohort study consisted of 12,493 patients undergoing bariatric surgery (95% gastric bypass) from 2005 to 2013 and a reference group of 15,101 individuals with obesity between the age of 18-63 with a body mass index between 32 and 60 kg/m2. Transitions between married, divorced, widowed, never-married single, and living with a partner without being married were analyzed by Poisson regression. Additionally, the outcome was dichotomized, and transitions between being single and being in a relationship were also analyzed. All analyses were weighted using inverse probability of treatment weighting based on propensity scores. RESULTS: The overall incidence rate ratio (IRR) of changing status from being single to in a relationship was 2.03 (95% CI: 1.18-2.28), and the overall IRR of changing status from being in a relationship to single was 1.66 (95% CI: 1.50-1.83). CONCLUSION: Bariatric surgery is associated with a higher chance of finding a partner among single individuals, and a higher risk of separating from a partner among individuals in a relationship.

[Alcohol-related morbidity and mortality].

Approximately 4,000 deaths are associated with a high alcohol intake in Denmark, most of them among individuals drinking more than the defined safe alcohol limits in Denmark (i.e. 14 drinks (12 g alcohol) per week for women and 21 drinks per week for men). Recent reviews and meta-analyses have generally shown an increasing mortality and morbidity in relation to a number of malignant diseases, while studies on cardiovascular disease often show a J-shaped risk function. Overall analysis of risk across health-related outcomes show that light alcohol intake (1 drink/day) is associated with a very small increase in relative risk. These facts are discussed in this review.

[Municipal alcohol treatment].

In Denmark patients requiring treatment of alcohol abuse do not need a referral in order to seek municipal treatment which is free of charge. A summary of the various forms of treatment is given in this review. Acute alcohol treatment consists of detoxification and treatment of withdrawal symptoms. Untreated withdrawal symptoms increase the risk of kindling and should be avoided. Planned treatment consists of psychosocial therapy, often in combination with pharmacological treatment. The duration of treatment varies, and there is generally good effect of treatment for alcohol use disorders.

Metabolic effects of 1-week binge drinking and fast food intake during Roskilde Festival in young healthy male adults.

AIMS/HYPOTHESIS: Metabolic effects of intermittent unhealthy lifestyle in young adults are poorly studied. We investigated the gluco-metabolic and hepatic effects of participation in Roskilde Festival (1 week of binge drinking and junk food consumption) in young, healthy males. METHODS: Fourteen festival participants (FP) were studied before, during and after 1 week's participation in Roskilde Festival. Fourteen matched controls (CTRL) who did not participate in Roskilde Festival or change their lifestyle in other ways were investigated along a similar timeline. RESULTS: The FP group consumed more alcohol compared to their standard living conditions (2.0 ± 3.9 vs 16.3 ± 8.3 units/day, P < 0.001). CTRLs did not change their alcohol consumption. AUC for glucose during OGTT did not change in either group. C-peptide responses increased in the FP group (206 ± 24 vs 236 ± 17 min × nmol/L, P = 0.052) and the Matsuda index of insulin sensitivity decreased (6.2 ± 2.4 vs 4.7 ± 1.4, P = 0.054). AUC for glucagon during oral glucose tolerance test (OGTT) increased in the FP group (1037 ± 90 vs 1562 ± 195 min × pmol/L, P = 0.003) together with fasting fibroblast growth factor 21 (FGF21) (62 ± 30 vs 132 ± 72 pmol/L, P < 0.001), growth differentiation factor 15 (GDF5) (276 ± 78 vs 330 ± 83 pg/mL, P = 0.009) and aspartate aminotransferase (AST) levels (37.6 ± 6.8 vs 42.4 ± 11 U/L, P = 0.043). Four participants (29%) developed ultrasound-detectable steatosis and a mean strain elastography-assessed liver stiffness increased (P = 0.026) in the FP group. CONCLUSIONS/INTERPRETATION: Participation in Roskilde Festival did not affect oral glucose tolerance but was associated with a reduction in insulin sensitivity, increases in glucagon, FGF21, GDF15 and AST and lead to increased liver stiffness and, in 29% of the participants, ultrasound-detectable hepatic steatosis.