Mortality risk among individuals treated for alcohol use disorders: results of a longitudinal study from 1978 to 2016 in Northern Italy.

OBJECTIVE: The aim of this study was to examine the mortality trends and causes of death in Northern Italy in a cohort of a population of individuals treated for alcohol use disorder (AUD) over a 38-year follow-up period (1978-2016). MATERIALS AND METHODS: 6,198 patients attending eighteen centres for addiction treatment (CATs) for AUD were recruited. RESULTS: During the follow-up period, 19.5% of the whole cohort died. The crude mortality rates (CMRs) were elevated (21.34 x 1000 person-years [PY]), higher for men and increasing with age group. The CMRs were higher for all cancers, followed by digestive system diseases, diseases of the circulatory system, transport accidents, and suicide. The standardised mortality ratios (SMRs) were at least three times higher for women and for men, and they were more elevated in younger patients and have been falling since 2009. Multivariate analysis confirmed that the mortality risk was higher for males and increased with age and decreased over time. The patients' main characteristics changed over time and, along with a greater presence of women and non-natives, fewer marginalised people and more socially integrated people turned to CATs. CONCLUSIONS: The mortality risk in treated AUD is confirmed to be higher when compared with the general population, although it is decreasing. In addition, there is enough epidemiological data to assert that, independent of age and gender, the major causes of death in AUD patients are cancers, gastrointestinal disease, cardiovascular disease (CVD), and injuries.

Identification of harmful drinking in subjects who have had their driving license suspended due to alcohol use: a retrospective Italian study.

OBJECTIVE: Early identification of Harmful Drinking (HD) is difficult, and underestimated. The aim of our retrospective study was to investigate the presence of HD in a population of subjects who had their driving license suspended due to driving under the influence of alcohol. MATERIALS AND METHODS: We retrospectively recruited 979 subjects. During the first appointment (T0), clinical and laboratory characteristics of patients were evaluated, and the AUDIT questionnaire was administered. Two groups were then defined: Harmful Drinking (HD) and non-HD, and all subjects underwent a brief interview for 5-10 minutes before being assigned to a group. RESULTS: 95.9% of our sample were identified as non-HD, whereas 4.1% of them were HD; twenty-one (2.1%) of the HD underwent a control appointment (T1), and 17 (1.7%) of them were diagnosed with alcohol use disorder (AUD); there was a statistically significant reduction in mean daily alcohol intake (p<0.009), and in the mean values of the blood markers of HD between T0 and T1 in HD. CONCLUSIONS: The present study shows that 4.1%, and 1.7% of subjects presented a diagnosis of HD and AUD, respectively, and their entry in a protocol of drinking monitoring proved beneficial in reducing alcohol intake. Thus, the implementation of strict surveillance of subjects found driving under the influence of alcohol involving a network of professional figures (from police forces to specialists in alcohol addiction treatment) may help to detect and to treat subjects with HD and AUD, and to monitor their alcohol use over time.