A meta-analysis of acute use of alcohol and the risk of suicide attempt.

BACKGROUND: No review has used a meta-analytic approach to estimate common odds ratios (ORs) for the effect of acute use of alcohol (AUA) on suicide attempts. We aim to report the results of the first meta-analysis of controlled epidemiological studies on AUA and suicide attempt. METHOD: The English-language literature on Medline, PsycINFO and Google Scholar was searched for original articles and critical review on AUA and suicide attempt (period 1996-2015). Studies had to report an OR estimate for this association. Common ORs and 95% confidence intervals (CIs) from random effects in meta-analyses for any AUA and two levels of alcohol use on suicide attempt were calculated. RESULTS: In all, seven studies provided OR estimates for the likelihood of suicide attempt by AUA, compared with those who did not drink alcohol. Studies used case-control (n 3) and case-crossover designs (n 4). Meta-analysis revealed a common OR of 6.97 (95% CI 4.77-10.17) for any AUA. Using four studies, 'low levels of acute drinking' resulted in an OR of 2.71 (95% CI 1.56-4.71) and 'high levels' had an OR of 37.18 (95% CI 17.38-79.53). CONCLUSIONS: AUA is associated with increased likelihood of a suicide attempt, particularly at high doses. Such data should be incorporated into estimates of the burden of disease associated with alcohol use, which are currently limited by a consideration of only alcohol's chronic effects. Future research should focus on the mechanisms through which AUA confers risk for attempt.

Hazardous drinking and exposure to interpersonal and community violence on both sides of the U.S. -Mexico border.

Objective: Different patterns of heavy drinking occur by country and proximity to the U.S. Mexico border. Few studies describe the impact of violence on drinking between countries and along the border. Methods: Survey data is from U.S. Mexican origin adults living in Texas and Mexican border and non-border cities, N=4,796. Participants were asked about alcohol consumption, interpersonal physical violence (IPV) and exposure to community violence. Monthly hazardous drinking (5+/4+ for men/women) was the primary outcome. Multivariate logistic regression model comparisons identified best predictors. Results: In the U.S. hazardous drinking was associated with past year IPV (ORadj=2.5; 1.8-3.5) and community violence (ORadj=1.4; 1.1-1.8). In Mexico, IPV (ORadj=3.9; 2.0-7.4) and border proximity (ORadj=0.5; 0.4-0.8) were associated with hazardous drinking but not community violence. Conclusion: Hazardous drinking is associated with IPV in both countries, but violence did not explain border hazardous drinking differences where they existed in Mexico.

CAGE, RAPS4, RAPS4-QF and AUDIT screening tests for men and women admitted for acute alcohol intoxication to an emergency department: are standard thresholds appropriate?

AIMS: A number of screening instruments are routinely used in Emergency Department (ED) situations to identify alcohol-use disorders (AUD). We wished to study the psychometric features, particularly concerning optimal thresholds scores (TSs), of four assessment scales frequently used to screen for abuse and/or dependence, the cut-down annoyed guilty eye-opener (CAGE), Rapid Alcohol Problem Screen 4 (RAPS4), RAPS4-quantity-frequency and AUD Identification Test (AUDIT) questionnaires, particularly in the sub-group of people admitted for acute alcohol intoxication (AAI). METHODS: All included patients [AAI admitted to ED (blood alcohol level ≥0.8 g/l)] were assessed by the four scales, and with a gold standard (alcohol dependence/abuse section of the Mini International Neuropsychiatric Interview), to determine AUD status. To investigate the TSs of the scales, we used Youden's index, efficiency, receiver operating characteristic (ROC) curve techniques and quality ROC curve technique for optimized TS (indices of quality). RESULTS: A total of 164 persons (122 males, 42 females) were included in the study. Nineteen (11.60%) were identified as alcohol abusers alone and 128 (78.1%) as alcohol dependents (DSM-IV). Results suggest a statistically significant difference between men and women (P < 0.05) in performance of the screening tests RAPS4 (≥1) and CAGE (≥2) for detecting abuse. Also, in this population, we show an increase in TSs of RAPS4 (≥2) and CAGE (≥3) for detecting dependence compared with those typically accepted in non-intoxicated individuals. The AUDIT test demonstrates good performance for detecting alcohol abuse and/or alcohol-dependent patients (≥7 for women and ≥12 for men) and for distinguishing alcohol dependence (≥11 for women and ≥14 for men) from other conditions. CONCLUSION: Our study underscores for the first time the need to adapt, taking into account gender, the thresholds of tests typically used for detection of abuse and dependence in this population.

Alcohol in combination with illicit drugs among fatal injuries in Sao Paulo, Brazil: An epidemiological study on the association between acute substance use and injury.

Injury deaths have a major impact on public health systems, particularly in the Latin American region; however, little is known about how different drugs, in combination or not with alcohol, interact with each injury type. We tested an epidemiological protocol for investigating alcohol and other drug acute use among fatally injured victims taking into account the injury context for all injury causes in Sao Paulo, Brazil. Blood alcohol and drug content were fully screened and confirmed following a probability sample selection of decedents (n = 365) during 19 consecutive months (2014-2015). Drug concentrations, including benzodiazepines, cannabis, cocaine, and opioids were determined by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography tandem mass spectrometry (LC-MS/MS). Toxicology data were interpreted in combination with injury context retrieved from police records regarding cause, place of injury, and victims' criminal history. More than half of all fatally injured victims studied were under the influence of at least one substance (55.3%). Alcohol was the leading substance consumed before a fatal injury event (30.1%), followed by cocaine (21.9%) and cannabis (14%). Illicit drug use (cocaine and cannabis) comprised more than two thirds of all drug-related deaths. Alcohol-positive deaths are over-represented among road traffic injuries, while drug-positive deaths are more prevalent among intentional injuries. Victims who had previous criminal convictions were significantly more likely to have used illicit drugs compared to those who did not have a criminal background. We estimated that one in every two fatal injuries in the city of Sao Paulo is associated with acute substance use by the victim. The health burden attributed to alcohol- and drug-related fatal injury events has reached significant higher levels in Latin American cities such as Sao Paulo compared globally.

Alcohol and violence-related injuries: an emergency room study.

Drinking patterns, alcohol-related problems and drinking-in-the-injury event were compared between those admitted to the emergency room (ER) with and without injuries resulting from violence. A probability sample of 1770 adult casualty patients in four hospitals in a single California suburban county were breathalyzed and interviewed at the time of the ER visit. Among all males and females over 30, those with violence-related injuries were more likely than those with other injuries to have positive breathalyzer readings and to report drinking prior to the event, frequent heavy drinking, consequences of drinking, experiences associated with alcohol dependence and loss of control and prior treatment for an alcohol problem. The data suggest a need for research to test whether a brief intervention at the time of the ER visit for problem drinking or a referral for more extensive alcohol treatment can effect a reduction in alcohol-related violence and other alcohol-related problems.

Alcohol and injuries: a review of international emergency room studies.

This paper reviews emergency room (ER) studies from a number of countries which have focused on the association of alcohol and casualties. The review emphasizes studies which used probability sample of patients to represent the population of the emergency facility where the data were collected, and which separated injured patients from patients with medical conditions not due to injuries (the 'non-injured'). Reviewed here are studies concerned with: (1) estimated prevalence of positive blood alcohol at the time of the ER visit; (2) self-reported alcohol consumption prior to the event resulting in a need for ER treatment; (3) patients' descriptions of their usual drinking patterns and alcohol-related problems; (4) predictions of casualties and of alcohol-related casualties. Comparisons of findings from several countries are also presented. Comments on limitations of ER studies as well as other issues pertaining to the usefulness and interpretation of such data, and future directions for research in emergency room populations are discussed.

Alcohol and injuries resulting from violence: a review of emergency room studies.

This paper reviews emergency room (ER) studies from a number of countries which have reported findings related to the association of alcohol and injuries resulting from violence. Special attention is given to those studies which used probability samples of patients which were representative of the population served by the emergency room facility where the data were collected, and which compared those admitted to the ER with violence-related injuries with those admitted to the same ER during the same period of time with injuries unrelated to violence. Those with violence-related injuries were more likely to be admitted to the ER with a positive blood alcohol concentration, to report drinking prior to the event, to report more frequency heavy drinking and to report more alcohol-related problems than those admitted with injuries from other causes.

Alcohol and casualties: comparison of county-wide emergency room data with the county general population.

A representative sample of patients in hospital emergency rooms (ERs) in a Northern California county (n = 3731) were compared with a household probability sample of those living in the same county (n = 2101). The injured in the ER sample were more likely to be black and under 30 than those in the general population sample who reported an injury during the last year which was treated in the ER. ER injured were more likely to be abstainers than injured in the general population and among drinkers, they were also more likely to report social consequences of drinking, but were no more likely to report experiences associated with alcohol dependence. Similar differences were found between the injured and the non-injured in the two samples, with the injured more likely to be male, younger, never married and to report heavy drinking, drunkenness, social consequences of drinking and alcohol dependence experiences. The data suggest that associations of alcohol and injury found in representative samples of the ER population may be generalizable to the injured in the general population from which these patients come, with differences which do exist most likely attributable to characteristics associated with emergency room usage.

Male drinking and violence-related injury in the emergency room.

AIMS: To present epidemiological measures of associations between violence-related injuries (assaults and fights), alcohol consumption prior to the event, and drinking patterns among males attending hospital emergency rooms (ERs) in Mexico City. DESIGN: All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using a case-control design. SETTING: Eight ERs in Mexico City that were representative of the types of emergency care systems available in that city (from public, private and social security systems hospitals). PARTICIPANTS: Cases were males patients (n = 445) admitted to the ER because of a fight or an assault. The control group was comprised of patients (n = 320) admitted to the ER because of accidents that are less frequently reported a alcohol-related (i.e. work-place accidents, animal bites or recreational accidents excluding near drowning). MEASUREMENTS: A breath sample to estimate BAG, as well as an interviewer-administered questionnaire were used. FINDINGS: Alcohol consumption prior to injury was found to be a more important risk factor than usual drinking for injuries resulting from violence, while quantity of usual alcohol consumption was more predictive of violence-related injuries than frequency of drinking. CONCLUSIONS: These data suggest the importance of using more appropriate control groups when estimating associations of alcohol and violence-related injuries so that associations will not be underestimated. More research is needed to establish unbiased estimates of alcohol-related violence.

Alcohol use among primary care patients: comparing an HMO with county clinics and the general population.

A probability sample of all patients seen in the four health maintenance organization (HMO) primary care clinics in one Northern California county (N = 314) are compared to patients from all five of the county-operated primary care clinics in the same county (N = 394) and to the general population of the county (N = 3069) on demographic characteristics, drinking patterns and alcohol-related problems. The HMO clinic patients were less likely to report frequent, heavy drinking, drunkenness or alcohol-related problems during the last year compared to those in the county clinics sample, and they were also less likely to report heavy and problem drinking compared to those in the general population. These data suggest problem drinking may not be over-represented in primary care practice in general, but rather may be more closely associated with characteristics of clientele served by a primary care practice than with those characteristics associated with a need for medical attention.

Alcohol consumption and injury in the general population: from a national sample.

The association of alcohol consumption with injuries is well documented in the literature. The majority of data for non-fatal injuries has come from emergency room (ER) studies, however, and little is known of how representative ER samples are of injuries in the general population or of the actual risk at which drinking places the individual for accidental injury. Data were collected (1990) from a national probability household sample (N = 2058; weighted N = 1150) on: the respondent's most recent injury; whether treatment was obtained for that injury, and where; drinking prior to injury; quantity and frequency (Q-F) of usual drinking; frequency of drunkenness; experiences associated with alcohol dependence; and social consequences related to drinking--all during the last year. Injury for the last year was categorized as follows: without injury, untreated injury, injury treated in the ER, other treated injury. Males treated in the ER were significantly more likely to be heavy drinkers and were more likely to report alcohol dependence experiences and social consequences related to drinking than those without injuries, while females treated in the ER were more likely to report social consequences related to drinking compared to those without injuries. Age (OR = 0.87) and Q-F (OR = 1.31) were found to be predictive of reporting an injury during the last year. Among injured none of these variables were predictive of reporting treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of casualty and drinking patterns: an emergency room study of unintentional injuries.

A probability sample of 1494 adult casualty patients sampled in four hospitals in a single Californian county were breathalyzed and interviewed regarding the cause of injury, drinking prior to the injury, quantity and frequency of usual drinking, frequency of drunkenness and prior alcohol-related accidents. In the total sample, 9% were positive on the breathalyzer (4% were at or above 0.10), 17% reported drinking within 6 h prior to the injury, and 29% reported heavy drinking during the last year. Overall, 15% reported a prior alcohol-related accident and this was significantly greater among heavy drinkers than other drinkers. Cause of casualty (fall, cutting/piercing, motor vehicle accident, other collision, fire, other cause) in relation to alcohol consumption variables was analyzed separately in gender- and age-specific categories. Few significant associations were found between drinking variables and individual causes of injury. While these findings may be due to the relatively small number of cases for some causes, as well as to other variables not examined here including severity and type of injury, such baseline exploratory data are important in furthering our understanding of alcohol's involvement in casualty occurrence and point to the need for additional research on alcohol and causes of injury.

Gender, injury status and acculturation differences in performance of screening instruments for alcohol problems among US Hispanic emergency department patients.

The sensitivity and specificity of several screening instruments including the CAGE, brief MAST, AUDIT, TWEAK, RAPS, and Trauma Scale, were evaluated against both ICD-10 and DSM-IV criteria for alcohol dependence and for harmful drinking and abuse in a probability sample of 586 Hispanic emergency department patients. Screening instruments were not as sensitive for females as for males, for those in the low acculturation group, or for non-dependent drinkers. Acculturation was positively associated with the likelihood of being a current drinker and among current drinkers, was positively associated with alcohol dependence and with harmful drinking or alcohol abuse.

Drinking patterns and problems, drug use and health services utilization: a comparison of two regions in the US general population.

While substance abuse has been found to be over-represented in some primary care settings, we do not know under what circumstances this association may vary, and whether it may be linked to differences in attitudes regarding alcohol use as reflected in regional rates of abstention and heavy or problem drinking. Data are reported from the Southern and Western regions of the 1995 National Alcohol Survey. Alcohol consumption variables were not found to be predictive of primary care utilization. Main effects were found for heavier drinking on emergency room (ER) use for an injury, and interactive effects of region were found for consequences of drinking, with those in the South who reported consequences more likely to have used the ER for either an injury or illness than those in the West. These data suggest that ER utilization may be related to regional differences in drinking patterns, while primary care utilization may not be.

Screening for alcohol problems in the emergency room: a rapid alcohol problems screen.

This paper compares the sensitivity and specificity of a five-item Rapid Alcohol Problems Screen (RAPS) optimized in this sample with the CAGE, brief MAST, AUDIT, TWEAK, History of Trauma Scale and breathalyzer reading against ICD-10 criteria for alcohol dependence or harmful drinking, by gender, ethnicity and injury status in a probability sample of emergency room patients (n = 1330) from the University of Mississippi Medical Center. The RAPS performed better than all other screening instruments for the total sample of current drinkers who reported ever having had three or more drinks at one time (sensitivity of 90%, specificity of 78%), and performed consistently better across all subgroups than any other single instrument, even at alternate cut points. The Rapid Alcohol Problems Screen may hold promise for use in clinical settings in identifying those who could benefit from a brief intervention or referral for problem drinking, particularly since the instrument is short and patients need not be asked additional questions after screening positive on one of the five items. Further research is necessary to analyze and compare the performance of the RAPS with other screening instruments across demographic subgroups in other emergency room and primary care settings.

Prediction of alcohol-related casualties: a comparison of two emergency room populations.

Logistic regression was used to compare the predictive value of alcohol consumption variables on casualty occurrence in probability samples of two diverse emergency room (ER) populations who were breathalyzed and interviewed at the time of ER admission: San Francisco General Hospital (N = 1459) and four hospitals representative of a nearby California county (N = 1756). Previous analyses suggested differences in the association of alcohol consumption and injury in these two samples. Age, breathalyzer reading and feeling drunk at the time of the event were consistent predictors of injury status in both samples while breathalyzer reading, quantity and frequency of usual drinking and place of injury occurrence (workplace vs. home) were consistent predictors of alcohol-related injuries (self-reported drinking 6 h prior to event).

Drinking patterns and problems: a comparison of emergency room populations in the United States and Spain.

The association of alcohol consumption and casualties is compared in probability samples of two culturally diverse emergency room populations: Barcelona, Spain (N = 2972) and Contra Costa County, California (N = 3609). Similar methods and data collection instruments were used to breathalyze and interview patients regarding self-reported alcohol consumption 6 h prior to the injury, usual drinking patterns and alcohol-related problems. Breathalyzer reading was positively associated with injury in both Contra Costa and Barcelona, but at the legal level only in Barcelona. Self-reported alcohol intake within 6 h prior to the event was positively associated with injury only among females in Contra Costa. Frequent light drinking was associated with injuries in Barcelona while heavier drinking was associated with injuries in Contra Costa. Little association was found between social consequences of drinking and injuries in either sample, however, the Contra Costa sample reported significantly higher rates of these problems than Barcelona, among moderate and high quantity drinkers. Although few differences were found between the two samples, findings suggest that usual drinking patterns within a culture may influence the association of alcohol and casualties, and future studies should explore these differences by type and cause of injury.

Demographic and substance use factors related to violent and accidental injuries: results from an emergency room study.

OBJECTIVE: The primary goal of this study was to identify demographic and substance use factors associated with violent injuries, accidental injuries, and medical conditions or illnesses (non-injured). METHOD: Data were examined from a sample of 1701 admissions to emergency rooms at two Canadian hospitals. These patients were interviewed and provided urine samples to detect the presence of drug metabolites for alcohol, THC, benzodiazepines, barbiturates, morphine, and codeine. RESULTS: Those with violent injuries were significantly (P<0.0001) more likely to be male and have lower incomes compared with both the accidental injury and non-injury groups. About 37% of violent injuries occurred at a bar or restaurant, which was significantly more than 3% for accidental injuries and 2% for non-injuries (P<0.00001). The violent injury group was significantly more likely than the other two groups to report feeling the effects of alcohol at the time of the injury and to report negative consequences of alcohol use (P<0.00001). Furthermore, about 42% of those with violent injuries had a blood alcohol level (BAL) over 80 mg% compared to only 4% with accidental injuries (P<0.00001) and 2% of non-injuries (P<0.00001). In terms of drug tests for other substances, the violent injury group was significantly more likely to test positive for benzodiazepines than the accidental injury group (P<0.01) while all between group comparisons for other drugs were not significant.

Alcohol use and medical care utilization among health maintenance organization patients in the emergency department.

OBJECTIVE: To determine the association of an alcohol-related ED visit with medical care utilization during a two-year period surrounding the ED visit in an HMO. METHODS: A probability sample of ED patients were interviewed and underwent breath analysis in a large HMO in a Northern California county. Based on recent alcohol intake or documentation of an alcohol-related ED visit, the patients were assigned to an alcohol group (n = 91) or a non-alcohol group (n = 897). A 10% random sample of the health plan membership of the same county (n = 19,968) served as a comparison group. Utilization data were obtained from computerized files. Multiple linear regression was used to determine differences in subsequent outpatient visit rates between the alcohol and the non-alcohol groups. Logistic regression was used to compare the risks of hospitalization in the two groups. RESULTS: Annual outpatient visit rates were 7.8 in the alcohol group and 8.3 in the non-alcohol group (p = 0.65), controlling for gender, age, and injury status, and were significantly different from the visit rate of 5.5 for the random health plan sample (p = 0.0001). No difference was found between the alcohol and the non-alcohol groups for risk of hospitalization; however, those in the health plan sample were less than half as likely to be hospitalized as were those in the non-alcohol group (odds ratio 0.44, p = 0.002). CONCLUSIONS: No difference was found in utilization of medical services between the alcohol and the non-alcohol groups in this predominantly white, well-educated HMO ED population. However, both groups used significantly more inpatient and outpatient services than did the general HMO membership.

Alcohol consumption among emergency room patients: comparison of county/community hospitals and an HMO.

This study examines the associations of drinking patterns and problems to injury vs noninjury status among emergency room (ER) patients. Data come from two distinctly different health care systems in the same county: (1) the county hospital and three community hospitals (N = 2,626) and (2) the three health maintenance organization (HMO) hospitals (N = 1,102). Results indicate that alcohol's role in injury cases seen in the ER differs from its contribution to noninjury cases. Further, the demographic characteristics of ER populations--and the associated drinking patterns--also vary from site to site, and these also affect the contribution of alcohol to events requiring ER treatment. Both studies used similar methods and data collection instruments. Probability samples of patients were breath analyzed and interviewed regarding self-reported consumption (within 6 hours prior to the injury or illness), usual drinking patterns and alcohol-related problems. In both samples injured were more likely than noninjured to have positive breath-analyzer readings and to report heavy drinking, more frequent drunkenness, prior alcohol-related accidents and prior treatment for an alcohol-related problem, but were no more likely to report harmful consequences of drinking or alcohol dependence experiences during the last year. Both injured and noninjured in the county/community sample reported higher rates of heavy and problem drinking than their counterparts in the HMO sample, while those in the HMO sample reported rates for heavy and problem drinking similar to those found in the general population of the county.(ABSTRACT TRUNCATED AT 250 WORDS)