Disparities in Alcoholics Anonymous Participation from 2000 to 2020 Among U.S. Residents With an Alcohol Use Disorder in the National Alcohol Survey.

OBJECTIVE: Mutual-help groups (MHGs) like Alcoholics Anonymous (AA) are effective for resolving alcohol use disorders (AUDs), but few studies have examined disparities in MHG participation, particularly recently. We used five waves of National Alcohol Survey data to investigate whether prevalence of AA attendance among those with a lifetime AUD differed by race/ethnicity, age, and sex, directly testing whether these associations varied with time. METHOD: Analyses pooled weighted data from 2000 to 2020, including only participants with a lifetime AUD and identifying as non-Hispanic White, Latinx/Hispanic, or non-Hispanic Black/African American (N = 8,876). Logistic regression models examined associations between lifetime AA attendance and survey year, race/ethnicity, age, and sex; models also tested for differences in demographic effects across survey year using interaction terms. RESULTS: In bivariate models, AA attendance was significantly less prevalent among participants identifying as Latinx/Hispanic (vs. White); ages 18-29 (vs. 30-64); and female (vs. male). Survey year was unrelated to AA attendance, and all interactions involving survey year were nonsignificant. In the final multivariate model (which controlled for severity and other help-seeking), disparities persisted for those identifying as Latinx/Hispanic (vs. White; adjusted odds ratio [aOR] = 0.63) and ages 18-29 (vs. 30-64; aOR = 0.35); AA attendance was also less prevalent among Black/African American (vs. White) participants (aOR = 0.59), but sex became nonsignificant. CONCLUSIONS: Results replicate and extend sparse findings regarding disparities in MHG attendance and suggest a stagnation in AA's growth and reach to underserved populations. Findings highlight the need to more effectively facilitate MHG attendance (and perhaps broader social network change) among racial/ethnic minorities and emerging adults.

Mapping COVID vulnerability in relation to drug and alcohol recovery residence availability across the United States.

Recovery housing is an important resource for those in recovery from substance use disorders. Unfortunately, we know little about its relationship to key community health risk and protective factors, potentially limiting the role it could play as a broader health resource. Leveraging county-level data on recovery residences from the National Study of Treatment and Addiction Recovery Residences (NSTARR), this study used multilevel modeling to examine Community COVID Vulnerability Index (CCVI) scores as well as availability of COVID testing and vaccination sites in relation to recovery housing. CCVI composite scores were positively associated with recovery housing availability. Analyses using CCVI thematic sub-scores found that population density and number of churches were positively associated with recovery housing availability, while epidemiological factors and healthcare system factors were negatively associated with recovery housing availability. In counties with recovery housing, there also was a positive association between CCVI and both COVID testing and vaccination availability. Recovery residences tend to be located in areas of high COVID vulnerability, reflecting effective targeting in areas with higher population density, more housing risk factors, and other high-risk environments and signaling a key point of contact to address broader health issues among those in recovery from substance use disorders.

Estimating Web Survey Mode and Panel Effects in a Nationwide Survey of Alcohol Use.

Random-digit dialing (RDD) telephone surveys are challenged by declining response rates and increasing costs. Many surveys that were traditionally conducted via telephone are seeking cost-effective alternatives, such as address-based sampling (ABS) with self-administered web or mail questionnaires. At a fraction of the cost of both telephone and ABS surveys, opt-in web panels are an attractive alternative. The 2019-2020 National Alcohol Survey (NAS) employed three methods: (1) an RDD telephone survey (traditional NAS method); (2) an ABS push-to-web survey; and (3) an opt-in web panel. The study reported here evaluated differences in the three data-collection methods, which we will refer to as "mode effects," on alcohol consumption and health topics. To evaluate mode effects, multivariate regression models were developed predicting these characteristics, and the presence of a mode effect on each outcome was determined by the significance of the three-level effect (RDD-telephone, ABS-web, opt-in web panel) in each model. Those results were then used to adjust for mode effects and produce a "telephone-equivalent" estimate for the ABS and panel data sources. The study found that ABS-web and RDD were similar for most estimates but exhibited differences for sensitive questions including getting drunk and experiencing depression. The opt-in web panel exhibited more differences between it and the other two survey modes. One notable example is the reporting of drinking alcohol at least 3-4 times per week, which was 21 percent for RDD-phone, 24 percent for ABS-web, and 34 percent for opt-in web panel. The regression model adjusts for mode effects, improving comparability with past surveys conducted by telephone; however, the models result in higher variance of the estimates. This method of adjusting for mode effects has broad applications to mode and sample transitions throughout the survey research industry.

Higher Concentration of Marijuana Dispensaries in Neighborhoods with More Disadvantage Following Legalization in Washington.

Washington is one of 21 states that have legalized recreational marijuana resulting in neighborhoods that have experienced a change in physical environment with the emergence of dispensaries. This study examines the selection of dispensaries into disadvantage area, incorporating local policies and neighborhood characteristics. Marijuana and alcohol sales data were from the Washington State Liquor and Cannabis Board; and neighborhood characteristics were drawn from the American Community Survey 2010-2016 5-year estimates. Using factor analysis we created a neighborhood disadvantage index where census tracts were stratified into disadvantaged tertiles; and counties were stratified by urban/rural status. We examined the association between dispensaries, neighborhood characteristics, and local marijuana policies using Negative Binomial Regression with a natural log of land area as an offset, separately for 2014-2016. Dispensaries opened in high-disadvantaged CTs in 2014 and then dispersed across the state while retaining higher concentrations in disadvantaged urban CTs. Marijuana-specific policies (allotted dispensaries and retail cap) were found to be predictors of marijuana dispensary density. This study provides evidence that marijuana dispensaries were disproportionately located in areas with greater disadvantage. State and local marijuana policies emerged as important predictors, underscoring the importance of designing thoughtful and equitable license allocation procedures and policies.

Inequitable access to general and behavioral healthcare in the US during the COVID-19 pandemic: A role for telehealth?

Wide-ranging effects of the COVID-19 pandemic have led to increased psychological distress and alcohol consumption, and disproportionate hardship for disadvantaged groups. Early in the pandemic, telehealth services were expanded to maintain healthcare access amidst lockdowns, medical office closures, and fear of infection. This study examines general and behavioral healthcare access and disparities during the first year of the pandemic. Data are from the 2019-2020 US National Alcohol Survey (collected February 2019 to April 2020) and its COVID follow-up survey conducted January 30 to March 28, 2021 (N = 1819). General and behavioral healthcare-related outcomes were assessed at follow-up, and included perceived need for and receipt of care, delayed care, and use of telehealth since April 1, 2020. Results indicate that the majority of respondents with perceived need for healthcare received some behavioral healthcare (reported by 63%) and particularly general healthcare (88%), but nearly half (48%) delayed needed care. Delays were mostly due to COVID-related reasons, but cost barriers also were common and significantly impeded care-seeking by uninsured persons, young adults, rural residents, and persons whose employment was reduced by the pandemic. Disparities in the receipt of healthcare were pronounced for Hispanic/Latinx (vs. White) and lower-income (vs. higher-income) groups (AORs <0.37, p's < 0.05). Notably, telehealth was commonly used by Hispanic/Latinx and lower-income groups for general and particularly behavioral healthcare. Results suggest that telehealth has provided an important bridge to healthcare for certain medically underserved groups during the pandemic, and may be vital to future efforts to increase equity in healthcare access.

Do neighborhood characteristics of sober living houses impact recovery outcomes? A multilevel analysis of observational data from Los Angeles County.

OBJECTIVE: To identify neighborhood factors associated with recovery outcomes for sober living house (SLH) residents. METHODS: Six-month longitudinal data for new SLH residents (n = 557) was linked with census tract data, services available, alcohol outlets, and Walk Scores® (0-100 score indicating access to neighborhood resources) for 48 SLHs in 44 neighborhoods in Los Angeles County. RESULTS: Non-significant neighborhood characteristics in separate regressions for all outcomes were residents' ratings of perceived risk, percentage of residences with access to a car, percentage of homes over $500,000, percentage of renter-occupied units, percentage with income less than $25,000, percentage that were non-white, the density of substance inpatient within 10 miles, and transit scores from Walk Score®. Multilevel regressions found outpatient substance abuse treatment and density of AA groups were positively associated with more abstinent days. No neighborhood variables were associated with psychiatric symptoms. Higher perceived neighborhood cohesion, lower crime ratings, and better transportation ratings were associated with higher recovery capital. CONCLUSION: Greater neighborhood densities of substance abuse services and AA groups may help residents achieve more days abstinent. While residents may achieve better substance use outcomes even with negative perceptions of the neighborhood, positive perceptions of the neighborhoods may help them acquire more recovery capital.

Consumer Knowledge of Insurance Coverage of Alcohol Treatment Services in the United States: Changes Since 2015.

OBJECTIVE: Aims of this study are to examine (a) whether consumer knowledge about their health insurance coverage for alcohol-related services has changed over time and (b) whether racial, ethnic, and income disparities in known coverage have changed over time. METHOD: This was a general population study comparing the 2015 and 2020 National Alcohol Surveys (N = 12,076 combined 2015 and 2020; 7,215 women, 4,858 men). Knowledge of alcohol treatment coverage (insured with coverage, insured without coverage, insured with coverage unknown, uninsured, or insurance status unknown) was estimated and compared for the total sample ages 18-64 and compared separately by subgroups. Multinomial logistic regression was used to formally test changes in knowledge of coverage over time. Regression models were adjusted for sociodemographics, health insurance type, and current alcohol use disorder. All bivariate and multivariable analyses were survey-weighted to account for probability of selection. RESULTS: Between 2015 and 2020, the prevalence of those reporting being insured without alcohol treatment coverage decreased (-2.8%, p < .001), and the prevalence of those insured with coverage unknown increased (8.1%, p < .001). Compared with White respondents, foreign-born Hispanic respondents were more likely to report being insured without coverage, and Black or African American respondents were less likely to be insured with coverage and had a steeper decrease in knowledge of coverage status over time. CONCLUSIONS: Results suggest some persistent disparities in known alcohol treatment coverage. They also suggest a need for both greater insurance coverage of alcohol-related services and greater efforts by employers, insurers, and practitioners to inform their constituents and increase knowledge about what alcohol-related services are available to them.

Longitudinal assessment of drinking changes during the pandemic: The 2021 COVID-19 follow-up study to the 2019 to 2020 National Alcohol Survey.

BACKGROUND: Surveys of changes in drinking during the COVID-19 pandemic have primarily relied on retrospective self-report. Further, most such surveys have not included detailed measures of alcohol use patterns, such as beverage-specific consumption, nor measures of alcohol use disorder (AUD) symptoms that would allow a comprehensive understanding of changes in alcohol use. METHODS: Data from 1819 completed interviews from the N14C follow-up survey to the 2019 to 2020 National Alcohol Survey (N14) were conducted between January 30 and March 28, 2021. Questions on alcohol use from the Graduated Frequency series, beverage-specific quantity and frequency, and DSM-5 AUD items were asked in both surveys and used to estimate changes from pre-pandemic drinking to drinking during the pandemic. Analyses focus on changes in these measures over time and comparisons between key subgroups defined by gender, race/ethnicity, and age. RESULTS: Key findings include particularly large increases in drinking and AUD for African Americans and women, reduced drinking and heavy drinking prevalence among men and White respondents, and a concentration of increased drinking and AUD among respondents aged 35 to 49. Increases in alcohol use were found to be driven particularly by increases in drinking frequency and the consumption of spirits. CONCLUSIONS: Results confirm prior findings of overall increases and subgroup-specific changes, and importantly, provide detailed information on the patterns of change across major socio-demographic subgroups. Substantial increases in the prevalence of DSM-5 moderate to severe AUDs are a novel finding that is of particular concern.

Substance use and misuse patterns and disability status in the 2020 US National Alcohol Survey: A contributing role for chronic pain.

BACKGROUND: Evidence about substance use and misuse among adults with disabilities is still emerging, despite increased risk of chronic pain and mental health problems, which are in turn risk factors for substance use and misuse. OBJECTIVE: We examined substance use and misuse among adults with selected self-reported disability (versus without), controlling for sociodemographics, depression/anxiety, physical health, and chronic pain, and assessed whether associations could be attributed to chronic pain. METHODS: Data are from the nationally representative 2020 US National Alcohol Survey. Disability indicators included sensory or mobility impairment, receiving Medicare before age 65, and/or unemployment due to disability. Regression analyses determined associations of disability with past-year substance use and misuse. Mediation analyses examined the role of chronic pain. RESULTS: Approximately 18% met 1+ disability criterion, representing 42.8 million adults. Disability was associated with reduced odds of current drinking (OR = 0.77, p < 0.01), but greater odds of daily nicotine use (OR = 1.43, p < 0.01), any drug use (OR = 1.32 p < 0.01), prescription drug misuse (OR = 1.99, p < 0.001), and other drug use (OR = 2.02, p < 0.001). Disability was not associated with high-intensity drinking or marijuana use. Chronic pain accounted for 17-38% of the association between disability and nicotine use, any drug use, prescription drug misuse, and other drug use. CONCLUSIONS: Findings indicated higher rates of substance use and misuse among people with disabilities, accounting for depression/anxiety, physical health, and chronic pain, with pain being a significant mediator. Substance use screening, brief intervention, and treatment should include appropriate accommodations for disabilities, inclusive of comprehensive pain management options.

Mental health and drinking to cope in the early COVID period: Data from the 2019-2020 US National Alcohol Survey.

BACKGROUND: Studies show drinking to cope and mental health problems have increased during the COVID-19 pandemic, however, their samples have been limited by convenience sampling or lack of a pre-pandemic measure. We examined the early impact of the COVID-19 pandemic on mental health, drinking to cope and their association using a probability-based sample of the US adult population. METHODS: Data was drawn from the probability samples of the 2019-2020 National Alcohol Survey (N = 7,233) to examine differences in drinking to cope and symptoms of depression and anxiety. Analyses compared participants who responded to the survey just prior to the widespread onset of the pandemic to those who responded after March 2020, in the total sample and by sex. RESULTS: Respondents in the early- vs. pre-COVID-19 period had a 1.48 higher odds (p = 0.03) of higher agreement with drinking to forget one's worries and problems, with a significant association observed among women only. Respondents with symptoms of depression and anxiety had a 2.94 and 1.56 higher odds, respectively, of higher agreement with drinking to forget one's worries. We observed significant associations between early- vs. pre-COVID-19 period, depression and anxiety symptoms, and drinking to forget one's worries among women only; however, moderation by sex in the total sample was not statistically significant. CONCLUSIONS: We observed higher prevalence of depression and anxiety symptoms and greater drinking to forget worries in the early months of COVID restrictions relative to the period just prior, with some effects more prominent among women. These observations call for sustained monitoring of and support for the mental health of the general population, and of women in particular during the course of the pandemic.

School and Community Factors Associated With the Adoption of 100% Smoke-free Policy by California Community Colleges, 2003-2019.

PURPOSE: Smoke- and tobacco-free policy (SFP) is an effective strategy that can reduce tobacco-related health disparities among young adults. DESIGN: Longitudinal design using administrative, survey, policy data sources, and geocoded tobacco outlet and American Community Survey data. SETTING: California community colleges (CC) and cities/communities where colleges are located, 2003-2019. SAMPLE: 114 California CCs. DATA: School-level (i.e., student population and demographics) and community-level data (socio-demographics, local tobacco control policy, tobacco-related norms and availability, and health resources) from 2003 to 2019. MEASURES: Key outcome is the year CC adopted a 100% SFP. ANALYSIS: Bivariate and multivariate Cox survival models were used to analyze timing of SFP adoption. RESULTS: By 2019, 61 out of 114 (53.5%) CCs were 100% SFP. While community smoking prevalence and tobacco availability were not significant, CCs in rural areas were less likely to be smoke-free. CCs located in cities with stronger tobacco policies (hazard ratio (HR) = 1.08, P < .05), which reported higher student health fees (HR = 2.00, P < .05) and received technical assistance for SFP (HR = 4.59, P < .01) were significantly associated with having 100% SFP. CONCLUSION: Findings suggest that key community factors (strong city tobacco policies) and school and community resources (student health fees, SFP technical assistance) are associated with the presence of 100% SFP at CCs. Resources from the community or within a college might support remaining CCs in becoming 100% smoke-free.

Identifying the availability of recovery housing in the U.S.: The NSTARR project.

BACKGROUND: Home is essential to recovery, and recovery housing can play an important role for individuals seeking a supportive environment. The National Study of Treatment and Addiction Recovery Residences (NSTARR) Project constitutes the largest and most diverse study of recovery housing to date. We describe the development of a national sampling frame to study recovery housing, as well as findings on availability and distribution of recovery housing across the U.S. METHODS: Data from publicly available sources and lists maintained by entities tracking recovery housing were compiled. Residences for which locating information was available were geocoded and linked with U.S. Census data and drug and alcohol mortality data. We used hot spot analysis and multilevel models to describe the geographic distribution of recovery residences and assess whether residences are located in areas of high need. RESULTS: The NSTARR database contains information on 10,358 residences operated by 3628 providers in all 50 states. Residences were more likely (p < 0.05) to be in urban areas and in counties with higher substance use mortality; they were less likely to be in economically disadvantaged areas. Recovery housing density also was greater in urban areas and areas with a greater proportion of non-White residents, but lower in economically disadvantaged areas. CONCLUSIONS: Despite a wealth of research on some types of recovery housing, critical gaps in the field's understanding about the nature of recovery housing remain. The NSTARR Project represents an important first step to expand research on recovery housing across the country.

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000-2015 National Alcohol Surveys.

OBJECTIVE: The purpose of this study was to examine associations with high-intensity drinking (HID) in American Indian/Alaska Native (AI/AN) populations and compare them to White and other minority groups using four National Alcohol Surveys, 2000 to 2015 (total N = 29,571; AI/ANs = 434). METHOD: Current drinking and HID (8+ and 12+ drinks on any day) from maximum drinks in the prior 12 months were analyzed with independent variables and race/ethnicity (AI/AN, non-Hispanic White, and other racial/ethnic groups combined). Adjusted logistic regression models comprised gender, age, marital status, employment, education, survey year, rurality, and especially, childhood trauma (physical/sexual abuse), and biological family alcohol problem history (each dichotomous). RESULTS: In adjusted population models, Whites had twice the odds of current drinking as AI/ANs, with no difference between other racial/ethnic groups and AI/ANs. Descriptively, AI/AN drinkers consumed at higher intensity levels than other groups, with higher prevalence of childhood trauma and family problem drinking than others. However, on a population basis, adjusting for all factors, apparent differences between AI/AN and White HID were eliminated; other minority groups together, compared with AI/ANs, showed lower odds of consuming 8+ drinks. CONCLUSIONS: AI/ANs had a higher prevalence of childhood trauma and family alcohol problems as well as lower current drinking likelihood compared with Whites. In adjusted population models, the combined other minorities group was less likely to ever consume 8+ drinks than AI/ANs. In all populations, childhood trauma and family alcohol problems increased the risk of HID, strongly so in AI/ANs. Addressing childhood trauma and family problems is important among AI/ANs to break generational cycles of drinking extreme amounts per occasion.

Extending the Harm to Others Paradigm: Comparing Marijuana- and Alcohol-Attributed Harms in Washington State.

Harms attributed to others' alcohol use have been extensively studied in the US and internationally, but no studies have measured harms from others' marijuana use. We utilize data from five cross-sectional waves of a survey series with representative samples of Washington state residents conducted every 6 months from 2014 to 2016, after the legalization of adult use marijuana. Harms attributed to others' drinking and to others' marijuana use included family and financial problems, assault, harassment, and vandalism experiences, and accidents due to impaired drivers. Past year harms attributed to others' marijuana use were reported by 8.4% of the sample, while 21.3% reported alcohol-attributed harms and 4.3% experienced both. Women were more likely to experience harms from either substance. While heavy drinkers were most likely to experience alcohol harms from others' use, frequent marijuana users reported the least harms from others. About three times as many individuals reported harassment, vandalism, or family problems attributed to someone's alcohol use compared to those harms attributed to someone's marijuana use, with a smaller ratio seen for financial trouble and a wider ratio for physical harm. Harms attributed to other's marijuana use in Washington were found to be substantial, but lower than harms from others' drinking.

State Alcohol Policies, Binge Drinking Prevalence, Socioeconomic Environments and Alcohol's Harms to Others: A Mediation Analysis.

AIMS: Alcohol policy effects on alcohol's harms due to others' drinking (AHTO) and contextual factors that may mediate such policy effects have been understudied. This study examines state binge drinking prevalence as a mediator of the relationship between state alcohol policy and socioeconomic environments and individual-level AHTO. METHODS: A nationally representative sample of US adults (N = 32,401; 13,873 males, 18,528 females) from the 2000, 2005, 2010 and 2015 National Alcohol Surveys and the 2015 National Alcohol's Harm to Others Survey, administered in telephone interviews and based on random digit dialed sampling, were linked with state-level Alcohol Policy Scale (APS) scores, binge drinking prevalence and socioeconomic status (SES) data. Three 12-month AHTO measures were family/marriage difficulties, assault or vandalism and riding with drunk driver or having traffic accident. Three-level mediation analyses were conducted, controlling for gender, race, education, marital status, family problem-drinking history and state policing rate. RESULTS: The effects of the APS on reduced risks for assault/vandalism and drinking-driving harms were significantly mediated by reduced state binge drinking prevalence. The APS had no direct or indirect effect on family/marital trouble. State SES had significant indirect effects on increased risks for assault/vandalism and driving-related harm through increased state binge drinking prevalence and a direct effect on reduced family/marital problems. CONCLUSIONS: A more stringent alcohol policy environment could reduce assault/vandalism and driving-related harm due to another drinker by lowering state binge drinking rates. Alcohol policies may not be effective in reducing family problems caused by another drinker more prevalent in low-SES states.

Recovery in context: Sober living houses and the ecology of recovery.

Sober living houses (SLHs) are an increasingly common element of the recovery support services landscape, yet little is known about their neighborhood context. This study describes neighborhoods in which SLHs are located and examines differences by house characteristics. SLHs in Los Angeles County (N = 297) were geocoded and linked with U.S. Census, alcohol outlet, recovery resources, and accessibility data. Regression analyses tested differences by house characteristics. Co-ed houses were in neighborhoods that were less ethnically diverse and farther away from recovery resources. Larger house capacity was associated with increased density of off-premise alcohol outlets but also increased proximity to treatment. Higher fees were associated with lower neighborhood disadvantage and off-premise alcohol outlet density but the greater distance from treatment programs and other recovery resources. House characteristics are associated with neighborhood factors that both support recovery and place residents at risk.

Relationships between US state alcohol policies and alcohol outcomes: differences by gender and race/ethnicity.

BACKGROUND AND AIMS: Alcohol taxation and availability restrictions are among the most effective methods for reducing alcohol use and problems, yet may affect demographic subgroups differently. Understanding who responds to specific policies can inform approaches for reducing disparities. We examined how state-level beverage-specific taxes and availability restrictions in the United States are associated with consumption and alcohol-related problems across subgroups defined by gender and race/ethnicity. DESIGN, SETTING AND PARTICIPANTS: Data came from the 2000-15 National Alcohol Surveys (n = 28 251), computer-assisted telephone cross-sectional surveys of United States residents aged 18+. African Americans and Hispanics were oversampled. MEASUREMENTS: Primary outcomes were beverage-specific (beer, wine, spirits and total) volume, DSM-IV alcohol dependence and alcohol-related consequences. Analyses entailed survey-weighted log-log and logistic regressions adjusting for state-level beer tax, spirits tax, government-controlled spirits sales and sales tax; respondent ZIP-code-level density of off-premise beer outlets, off-premise spirits outlets and on-premise bars; respondent individual-level age, marital status, education, employment and income; and fixed effects for wet/moderate/dry US region and year. FINDINGS: Higher beer tax was significantly (P < 0.05) associated with lower odds of any drinking among white women [odds ratio (OR) = 0.98] and lower beer volume (price-elasticity = -0.40), total volume (price-elasticity = -0.50) and odds of alcohol-related consequences (OR = 0.84) among African American women. Higher spirits tax was significantly (P < 0.05) associated with both lower beer and total volume among Hispanic women (price-elasticities = -0.73 and - 1.04, respectively) and men (price-elasticities = -1.19 and - 0.92, respectively) and decreased wine volume among Hispanic women (price-elasticity = -0.62). Apparent protective effects of living in a state with government-controlled spirits sales or a neighborhood with lower bar density was greater among white men than other groups. CONCLUSIONS: The effects of beverage-specific taxes and alcohol availability policies may vary across subgroups, highlighting the importance of considering differential policy impacts in future research and intervention.

The Relationship Between the U.S. State Alcohol Policy Environment and Individuals' Experience of Secondhand Effects: Alcohol Harms Due to Others' Drinking.

BACKGROUND: Although restrictive state alcohol policy environments are protective for individuals' binge drinking, research is sparse on the effect of alcohol policies on alcohol's harms to others (AHTO). We examined the lagged associations between efficacy of U.S. state alcohol policies and number of harms from others' drinking 1 year later. METHODS: Individuals with AHTO data in a nationally representative sample of U.S. adults (analytic sample n = 26,744) that pooled the 2000, 2005, 2010, and 2015 National Alcohol Surveys and a 2015 National Alcohol's Harm to Others Survey were linked with prior-year state policy measures. We used 2 measures from the Alcohol Policy Scale (APS)-effectiveness in reducing (i) binge drinking and (ii) impaired driving, based on experts' efficacy judgments regarding 29 state alcohol policies. Three 12-month AHTO measures (due to another drinker) were experiencing: (i) either family/marriage difficulties or financial troubles; (ii) being assaulted or vandalized; and (iii) passenger with drunk driver or traffic accident. Multilevel models accounting for clustering within states and stratified by age-groups (<40 vs. ≥40) examined associations between the APS and AHTO measures, controlling for individual covariates (gender, race, education, employment and marital status, family problem-drinking history) of the victim. RESULTS: Only for those aged <40, the lagged APS-Binge drinking and APS-Impaired driving scores were each inversely associated with aggression-related harms and, separately, with drunk driving-related harm from someone else's drinking (ps < 0.05 to < 0.01). Family/financial harms were not associated with APS scores for either age-group. Composite AHTO measures (any of 3 harm-types) also were inversely associated with stronger state alcohol policy environments (ps < 0.05 to <0.01). CONCLUSIONS: State alcohol policies may be effective in reducing, to a meaningful degree, aggression-related harms and vehicular hazards due to other drinkers, but mainly in those under 40.

Alcohol's Secondhand Harms in the United States: New Data on Prevalence and Risk Factors.

OBJECTIVE: This study examined a range of indicators of alcohol's harm to others (AHTO) among U.S. adults and assessed sociodemographic and alcohol-related risk factors for AHTO. METHOD: The data came from 8,750 adult men and women in two parallel 2015 U.S. national surveys conducted in English and Spanish. Both surveys used computer-assisted telephone interviews and two-stage, stratified, list-assisted, random samples of adults ages 18 and older. RESULTS: One in five adults experienced at least one of ten 12-month harms because of someone else's drinking. The prevalence of specific harm types and characteristics differed by gender. Women were more likely to report harm due to drinking by a spouse/partner or family member, whereas men were more likely to report harm due to a stranger's drinking. Being female also predicted family/financial harms. Younger age increased risk for all AHTO types, except physical aggression. Being of Black/other ethnicity, being separated/widowed/divorced, and having a college education without a degree each predicted physical aggression harm. The harmed individual's own heavy drinking and having a heavy drinker in the household increased risk for all AHTO types. The risk for physical aggression due to someone else's drinking was particularly elevated for heavy drinking women. CONCLUSIONS: Secondhand effects of alcohol in the United States are substantial and affected by sociodemographics, the harmed individual's own drinking, and the presence of a heavy drinker in the household. Broad-based and targeted public health measures that consider AHTO risk factors are needed to reduce alcohol's secondhand harms.

Cannabis use during alcohol treatment is associated with alcohol-related problems one-year post-treatment.

BACKGROUND: Prior research shows that cannabis use during treatment for Alcohol Use Disorders (AUD) is related to fewer abstinent days from alcohol, although only among those who use cannabis 1-2x/month. Here we extend prior research by assessing the relationship between the frequency of cannabis use during AUD treatment and post-treatment alcohol-related consequences. METHODS: Data come from the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study, a large US randomized control trial of treatments for AUD. The current analyses include 206 cannabis users and 999 cannabis abstainers and compare longitudinal drinking data between those who used cannabis versus those who abstained during COMBINE treatment. The primary exposure was quartiles of cannabis use (Q1: less than 1x/month during treatment, Q2: 1-2x/month, Q3: 4-8x/month, Q4: 12x/month or more), with cannabis abstainers as the reference group. Outcomes were alcohol-related problems at the end of treatment and one-year post-treatment as measured by the Drinker Inventory Consequences. RESULTS: Compared to cannabis abstinence, the most frequent use during treatment was related to 1.44 times as many physical consequences one-year post-treatment. Cannabis use was not related to physical consequences immediately after treatment, or to intrapersonal, interpersonal, social responsibility or impulse control problems at either post-treatment time point. CONCLUSIONS: In a sample of individuals in treatment for AUD, using cannabis 12x/month or more during treatment is associated with increased rates of physical consequences attributed to alcohol use. Individuals in treatment for AUD who also use cannabis might benefit from reducing or stopping cannabis use to avoid alcohol-related physical problems.