A 22-Year Follow-Up (Range 16 to 23) of Original Subjects with Baseline Alcohol Use Disorders from the Collaborative Study on Genetics of Alcoholism.

BACKGROUND: Recent reports indicate higher-than-expected problematic drinking in older populations. However, few data describe how to predict which older individuals are most likely to demonstrate alcohol-related problems, including those with earlier alcohol use disorders (AUDs). These analyses evaluate predictors of alcohol outcomes in individuals with earlier AUDs in the Collaborative Study on Genetics of Alcoholism (COGA). METHODS: Original COGA participants with baseline AUDs at about age 40 were interviewed 13 to 26 years later and placed into clinically derived outcome categories. Chi-square and analysis of variance evaluated baseline differences across 4 outcome groups, with significant items entered into binary logistic regression backwards elimination analyses predicting outcomes. RESULTS: Low-Risk Drinkers (N = 100) at follow-up were predicted by baseline higher levels of response to alcohol (high LRs), lower histories of alcohol treatment, experience with fewer types of illicit drugs, and were more likely to have been widowed. At follow-up, Problem Drinkers (N = 192) differed from High-Risk Drinkers (N = 93) who denied multiple alcohol problems by exhibiting baseline lower LRs, higher Sensation Seeking, and a higher proportion who were widowed. Abstinent (N = 278) outcomes were predicted by a history of higher baseline AUD treatments, higher alcohol problems, lower usual drinks, as well as older age and European American heritage. Thirty-four subjects (4.9%) could not be classified and were not included in these analyses. CONCLUSIONS: These results generated from AUD individuals from both treatment and nontreatment settings reinforce low probabilities of recent Low-Risk Drinking in individuals with AUDs, but also suggest many individuals with AUDs demonstrate good outcomes 2 decades later.

A Prospective Comparison of How the Level of Response to Alcohol and Impulsivity Relate to Future DSM-IV Alcohol Problems in the COGA Youth Panel.

BACKGROUND: Alcohol problems reflect both environmental and genetic characteristics that often operate through endophenotypes like low levels of response (low LRs) to alcohol and higher impulsivity. Relationships of these preexisting characteristics to alcohol problems have been studied, but few analyses have included both low LR and impulsivity in the same model. METHODS: We extracted prospective data from 1,028 participants in the Prospective Youth Sample of the Collaborative Study on the Genetics of Alcoholism (COGA). At Time 1 (age 18), these drinking but non-alcohol-dependent males and females completed the Barratt Impulsivity Scale and the Self-Report of the Effects of Alcohol questionnaire regarding drinks required for effects the first 5 times of drinking (SRE5-LR). Two years later, they reported perceived drinking patterns of peers (PEER), their own alcohol expectancies (EXPECT), and their drinking to cope with stress (COPE). Subsequently, at Time 3, participants reported numbers of up to 11 DSM-IV alcohol criterion items experienced in the 2 years since Time 2 (ALC PROBS). Data were analyzed using structural equation modeling (SEM). RESULTS: In the SEM, Baseline SRE5-LR and impulsivity were weakly related and did not interact in predicting later ALC PROBS. LR was directly linked to Time 3 ALC PROBS and to PEER, but had no direct path to EXPECT, with partial mediation to ALC PROBS through PEER to EXPECT and via COPE. Impulsivity did not relate directly to ALC PROBS or PEER, but was directly related to EXPECT and COPE, with effects on ALC PROBS also operating through EXPECT and COPE. CONCLUSIONS: Low LRs and impulsivity related to Time 3 ALC PROBS through somewhat different paths. Education- and counseling-based approaches to mitigate future alcohol problems may benefit from emphasizing different potential mediators of adverse alcohol outcomes for youth with low LRs versus those with high impulsivity or both characteristics.

Latent Trajectories of Persistence of Cannabis Use Across Four Decades in 329 Men From the San Diego Prospective Study.

OBJECTIVE: These analyses use data from a 40-year prospective study to extend information into the sixth and seventh decades of life regarding latent trajectory classes of cannabis use and predictors of those classes. METHOD: Data from the San Diego Prospective Study were analyzed for 329 men of European and Hispanic ethnicity who had used cannabis at about age 23 at study entry (Time 1) and who were interviewed about every 5 years through about age 60 to 70. Latent classes of cannabis use trajectories were evaluated using latent class growth analyses, baseline predictors of class membership were determined, and significant predictors of each class were established using logistic regression analyses. RESULTS: Four latent classes were identified ranging from 12.5% with cannabis use at every follow-up to 25.8% with no use after Time 1. Eight of 14 Time 1 predictors differed significantly across the trajectory classes, including five (age, marital status, religious identity, intensity of cannabis use, and sensation seeking) that significantly contributed to regression analyses when all significant predictors were considered together. DISCUSSION: Forty-two percent of participants continued using cannabis long-term, including one in eight who used it at every follow-up. Predictors of continued use and identification of those most likely to stop required gathering information on a range of demographic, prior substance use, and personality characteristics. CONCLUSIONS: Considering the potential enhanced dangers of cannabis use in later life, the high rate of continued use over four decades implies that clinicians should ask all older patients about recent cannabis use, especially if they had used it in their 20s.

Changes over time in endorsement of 11 DSM-IV alcohol use disorder (AUD) criteria in young adults with persistent or recurrent AUD in The Collaborative Study on the Genetics of Alcoholism.

BACKGROUND: Endorsement of specific Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) alcohol use disorder (AUD) criteria have been shown to change significantly over time in men in their thirties who have persistent or recurrent AUD. However, few studies have documented whether the endorsement of AUD items changes over time in younger individuals or in women. We evaluated changes in the endorsement of AUD criteria in 377 men and women with persistent or recurrent AUD during their twenties. METHODS: Information on AUD-item endorsement over time was available for 223 men and 154 women aged 20-25 with persistent or recurrent AUD in at least three interviews in the Collaborative Study on the Genetics of Alcoholism. The statistical significance of endorsement changes over time was evaluated using the related-sample Cochran's Q test for the full sample and for men and women separately. Additional analyses evaluated sex differences in the patterns of change. RESULTS: In the full sample, the predominant pattern was for a significant increase in the rates of endorsement for six of the seven alcohol dependence criteria but not in the four abuse criteria. A similar pattern was seen within men, but women had significant changes in only three of the seven dependence criteria. CONCLUSIONS: Endorsement of the seven alcohol dependence criteria among individuals with persistent or recurrent AUD in their twenties generally increased, but few changes were observed in the rates of endorsement of the four abuse criteria. These results are discussed in terms of how they reflect on the nature of AUD and the DSM criteria.

Do personality characteristics predict future alcohol problems after considering current demography, substance use, and alcohol response?

BACKGROUND: Several personality traits predict future alcohol problems but also relate to demographic and substance-related variables that themselves correlate with later adverse alcohol outcomes. Few prospective studies have evaluated whether personality measures predict alcohol problems after considering current demographic and substance-related variables. METHODS: Data from 414 drinkers without alcohol use disorder (AUD) from the Collaborative Study on the Genetics of Alcoholism (average age 20, 44% male) were followed over an average of 9 years. Time 1 (baseline) demography, AUD family history (FH), substance use and problems, and psychiatric histories were gathered using a standardized interview; the Level of Response (LR) to alcohol was measured by the Self-Report of the Effects of alcohol (SRE) questionnaire; and seven personality dimensions were extracted from the NEO Five-Factor Personality, Barratt, and Zuckerman scales. Analyses involved product-moment correlations of each baseline measure with the highest number of DSM-IV AUD criteria endorsed in any follow-up period, and hierarchical regression analyses evaluated whether the personality domains added significantly to the prediction of the outcome after adjusting for other baseline variables. RESULTS: Significant correlations with the outcome were observed for baseline age, sex, length of follow-up, AUD family history, past cannabis use, and all alcohol-related baseline variables, including SRE-based LR, but not prior mood or anxiety disorders. All personality characteristics except extraversion also correlated with outcomes. A hierarchical regression analysis that included all relevant personality scores together demonstrated significant contributions to the prediction of future alcohol problems for demographics in Step 1; demographics and most baseline alcohol items, including response level, in Step 2; and cannabis use in Step 3; after which demographics, LR, baseline alcohol problems, cannabis use, and higher sensation seeking added significantly in Step 4. Regression for each personality domain separately revealed significant contributions to Step 4 for all personality domains except openness. Lower levels of response to alcohol added significantly to all regression analyses. CONCLUSIONS: Most tested personality scores and lower levels of response to alcohol contributed to predictions of later alcohol problems even after considering baseline demographic and substance use measures.

Externalizing disorders in the offspring from the San Diego prospective study of alcoholism.

OBJECT: Conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD) may be more prevalent in relatives of alcoholics and may predict alcohol and drug problems, but not all studies agree. This paper evaluates these questions in well-educated families of alcoholics and controls. METHODS: Data from 165, 14-25-year-old offspring in the San Diego Prospective Study were used to create Group 1 (n=17) with CD or ADHD and Group 2 (n=148) with no such diagnoses. Correlations and hierarchical logistic regressions evaluated characteristics associated with these disorders, comparing the impact of CD and ADHD. RESULTS: The rates of CD (6.1%) and of ADHD (4.8%) were not strikingly elevated, and did not relate to the family history of alcohol or drug use disorders. Group 1 offspring were more likely to have divorced parents, a relative with bipolar disorder, a higher intake of alcohol and illicit substances, and associated problems.

The prognostic implications of DSM-IV abuse criteria in drinking adolescents.

BACKGROUND: The validity of the DSM-IV diagnostic criteria for alcohol abuse has been questioned, and additional issues have been raised regarding the performance of this label in adolescents. While future diagnostic manuals might alter the approach to abuse, it is worthwhile to evaluate the implications of the current definition that has been in place since 1994. METHODS: Six hundred and sixteen 12-19-year-old subjects (mean 16.5 years) were offspring identified in the Collaborative Study on the Genetics of Alcoholism (COGA) protocol who had ever consumed a full drink and who were followed up 5 years later using age-appropriate semi-structured interviews. Following the guidelines for evaluating the utility of the diagnostic labels of Robins and Guze [Robins, E., Guze, S.B., 1970. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am. J. Psychiat. 126, 983-987], the subjects with alcohol abuse were compared with other groups regarding clinical validators and clinical course. RESULTS: At initial interview, the pattern of most alcohol use and problem variables were least severe for teenagers with no diagnosis, intermediate for those with abuse, and the highest for individuals with alcohol dependence. At follow-up, 50% of those with initial abuse maintained that diagnosis, 19% developed dependence, and 31% had no DSM-IV diagnosis. Baseline alcohol abuse predicted follow-up diagnosis even when evaluated along with initial demographic and substance use characteristics. CONCLUSIONS: These results support some assets for the DSM-IV alcohol abuse criteria in these adolescents, including indications of both cross-sectional and predictive validities. Additional studies will need to compare the current abuse label with other possible approaches.

Alcohol-related blackouts among college students: impact of low level of response to alcohol, ethnicity, sex, and environmental characteristics.

Objective: To explore how a genetically-influenced characteristic (the level of response to alcohol [LR]), ethnicity, and sex relate to environmental and attitudinal characteristics (peer drinking [PEER], drinking to cope [COPE], and alcohol expectancies [EXPECT]) regarding future alcohol-related blackouts (ARBs). Methods: Structural equation models (SEMs) were used to evaluate how baseline variables related to ARB patterns in 462 college students over 55 weeks. Data were extracted from a longitudinal study of heavy drinking and its consequences at a U.S. university. Results: In the SEM analysis, female sex and Asian ethnicity directly predicted future ARBs (beta weights 0.10 and -0.11, respectively), while all other variables had indirect impacts on ARBs through alcohol quantities (beta weights ~ 0.23 for European American ethnicity and low LR, 0.21 for cannabis use and COPE, and 0.44 for PEER). Alcohol quantities then related to ARBs with beta = 0.44. The SEM explained 23% of the variance. Conclusion: These data may be useful in identifying college students who are more likely to experience future ARBs over a 1-year period. They enhance our understanding of whether the relationships of predictors to ARBs are direct or mediated through baseline drinking patterns, information that may be useful in prevention strategies for ARBs.

Predictors of Patterns of Alcohol-Related Blackouts Over Time in Youth From the Collaborative Study of the Genetics of Alcoholism: The Roles of Genetics and Cannabis.

OBJECTIVE: Alcohol-related blackouts (ARBs) are anterograde amnesias related to heavy alcohol intake seen in about 50% of drinkers. Although a major determinant of ARBs relates to blood alcohol concentrations, additional contributions come from genetic vulnerabilities and possible impacts of cannabis use disorders (CUDs). We evaluated relationships of genetics and cannabis use to latent class trajectories of ARBs in 829 subjects from the Collaborative Study of the Genetics of Alcoholism (COGA). METHOD: The number of ARBs experienced every 2 years from subjects with average ages of 18 to 25 were entered into a latent class growth analysis in Mplus, and resulting class membership was evaluated in light of baseline characteristics, including CUDs. Correlations of number of ARBs across assessments were also compared for sibling pairs versus unrelated subjects. RESULTS: Latent class growth analysis identified ARB-based Classes 1 (consistent low = 42.5%), 2 (moderate low = 28.3%), 3 (moderate high = 22.9%), and 4 (consistent high = 6.3%). A multinomial logistic regression analysis within latent class growth analysis revealed that baseline CUDs related most closely to Classes 3 and 4. The number of ARBs across time correlated .23 for sibling pairs and -.10 for unrelated subjects. CONCLUSIONS: Baseline CUDs related to the most severe latent ARB course over time, even when considered along with other trajectory predictors, including baseline alcohol use disorders and maximum number of drinks. Data indicated significant roles for genetic factors for alcohol use disorder patterns over time. Future research is needed to improve understanding of how cannabis adds to the ARB risk and to find genes that contribute to risks for ARBs among drinkers.

An evaluation of the performance of the self-rating of the effects of alcohol questionnaire in 12- and 35-year-old subjects.

OBJECTIVE: A low level of response (LR) to alcohol was originally established through evidence of less alcohol-related change in several parameters at a given blood alcohol level. This is a genetically influenced phenotype associated with an increased risk for alcoholism. When measured by a retrospective questionnaire (the Self-Rating of the Effects of Alcohol [SRE] scale), a lower LR (here indicated by a report that more drinks were historically needed for various effects) correlates with a family history of alcoholism and numerous alcohol use-related variables. The current analyses address the questions of how higher SRE scores (as indicators of a low LR) relate to alcohol use and problems across different age groups and when considered in the context of demography (e.g., age, gender, and weight), as well as the number of items endorsed on the questionnaire. METHOD: SRE data (scores and numbers of items endorsed), demography, and alcohol-related variables (quantity, frequency, and problems) were evaluated in two populations. The first population included 334 12-year-old children from the Avon Longitudinal Study of Parents and Children, and the second included more than 400 35-year-old men from the San Diego Prospective Study. In each group, Pearson correlations were established among all variables, and items that were significantly linked to alcohol-related outcomes were entered into regression analyses as predictors of these outcomes. RESULTS: In both samples, SRE scores correlated with all alcohol-related outcomes, with the highest values for the maximum quantity of alcohol consumed. Relationships between the SRE score and alcohol-related variables remained robust in both populations when entered into regression analyses incorporating demography and the number of SRE items answered by subjects. CONCLUSIONS: The SRE score appears to perform relatively similarly across the two populations regarding relationships with alcohol quantity, frequency, and problems. The most consistent results were observed for the maximum quantity of alcohol consumed.

Prospective evaluation of the four DSM-IV criteria for alcohol abuse in a large population.

OBJECTIVE: In 1994 DSM-IV presented new criteria for substance abuse as repetitive problems in any one of four areas reflecting social, interpersonal, and legal difficulties. The authors systematically evaluate the performance of each of the four diagnostic criteria for alcohol abuse (problems in role functioning, alcohol use in hazardous situations, alcohol-related legal problems, and social or interpersonal problems) and determine the prognosis associated with a threshold of one versus two or more criterion endorsements. METHOD: Baseline and 5-year follow-up data were analyzed for 2,596 men and women from the Collaborative Study on the Genetics of Alcoholism, including 1,881 individuals with no alcohol-related diagnosis, and 715 with alcohol abuse, after excluding subjects with alcohol dependence. Performance of each criterion was analyzed for the entire group and for the 565 individuals who endorsed only one criterion at baseline. RESULTS: One alcohol abuse criterion was endorsed by 79% of subjects with alcohol abuse, 18.5% endorsed two, and 2.5% endorsed three. Compared with subjects who endorsed no criteria, individuals who reported any of the four diagnostic criteria at baseline had higher rates of alcohol and drug intake and related problems and higher rates of future difficulties. Diagnostic thresholds of one versus two abuse criteria at baseline performed equally well regarding most outcomes, although endorsement of two criteria predicted a higher risk for progression to dependence. The criterion most frequently endorsed--hazardous use--was associated with baseline substance use characteristics and problematic outcomes similar to those for the other criteria. CONCLUSIONS: The four DSM-IV alcohol abuse criteria performed well regarding both cross-sectional characteristics and the prediction of future problems, but no single diagnostic criterion was superior to any other. The similarity of outcomes for subjects with diagnostic thresholds of one versus two or more criteria may favor the continued use of a threshold of one criterion in the diagnosis of alcohol abuse.

Correlations among first-degree relatives for responses on the Self-Rating of the Effects of Alcohol Questionnaire in teenagers.

OBJECTIVE: The level of response (LR) to alcohol is an intermediate phenotype related to the alcoholism risk, with a heritability of at least 0.4 as estimated from alcohol challenge experiments. A measure of LR that can be used in adolescence at a time close to the first drinking experience, and that is less expensive than alcohol challenge experiments, is the Self-Rating of the Effects of Alcohol (SRE) Questionnaire. This questionnaire contains questions related to the number of drinks required for up to four different effects early in the drinking career ("first five" score). The familial characteristics of SRE responses have been estimated in adults; however, no study has evaluated familial and potential genetic components of the first five SRE score in adolescents. This article presents data regarding the familial nature of SRE-based scores among a sample of teenagers. METHOD: As part of the Collaborative Study on the Genetics of Alcoholism Phase II (follow-up) Protocol, SRE scores were available on 251 females and 236 males ages 13-19 years. These analyses compare the correlations among father-offspring, mother-offspring, sibling pairs and comparable unrelated individuals. RESULTS: For the 487 subjects, correlations among first-degree relatives ranged from 0.14 to 0.22 and were all significant. Correlations among comparable unrelated pairs ranged from 0.02 to 0.06 and were nonsignificant. When males and females were evaluated separately, the pattern of results, with higher correlations among first-degree relatives than among unrelated individuals, was similar, although, perhaps reflecting fewer subjects, correlations were more variable. CONCLUSIONS: Although not providing a definitive evaluation of heritability, the results are consistent with a potential proportion of the variance related to genes for first five SRE scores of between 0.3 and 0.4. These results parallel previously published data in adults and are similar to heritability estimates for LR on alcohol challenges. The data support the potential use of the first five SRE score in adolescents as a measure of LR in genetic and environmental model-based studies in young populations for whom the evaluation of LR is taking place at a time close to the onset of drinking.

Evaluation of a level of response to alcohol-based structural equation model in adolescents.

OBJECTIVE: A low level of response (LR) to alcohol relates to a family history of alcoholism and predicts future heavier drinking and alcohol-related problems. The current analyses evaluate how LR functions within the context of a Social Information Processing Model, using 238 subjects aged 13 to 19 years from the Collaborative Study on the Genetics of Alcoholism (COGA). METHOD: A structural equation model (SEM) was used to evaluate the relationship among (1) a family history (FH) of alcoholism, (2) the LR to alcohol, (3) expectations as measured by the Alcohol Expectancy Questionnaire and (4) the recent pattern of drinking among parents in the home as predictors of the maximum recent quantity of drinking, the maximum number of drinks ever consumed in 24 hours and the number of alcohol problems in the teenage subjects. RESULTS: When tested in the SEM, LR functioned as a mediator of the relationship between an FH of alcoholism and alcoholic outcome, and expectancy functioned as a partial mediator of the relationship between LR and outcome. Invariance testing revealed that the SEM performed similarly in light and heavy drinkers, the two sexes, and older versus young subjects. Both the measurement model and SEM had good characteristics of fit, and direct paths within the model explained 49% of the variance of outcome. CONCLUSIONS: Consistent with results from the San Diego Prospective Study, when tested in the more heterogeneous COGA population, LR functioned as a mediator of the relationship between the FH and alcoholic outcome. In these adolescents, LR not only had a direct relationship to alcoholic outcome but, in contrast to prior results in adults, also appeared to operate through expectations of the effects of alcohol in predicting heavier drinking and a higher rate of alcohol-related problems among teenagers.

Predictors and correlates of suicide attempts over 5 years in 1,237 alcohol-dependent men and women.

OBJECTIVE: In previous studies, factors related to a history of suicide attempts in persons with alcohol dependence have included sociodemographic variables, a more severe course of alcoholism, additional substance use disorders, and psychiatric comorbidity. This 5-year prospective study evaluated attributes associated with suicide attempts in a group of treatment-seeking persons with alcohol dependence. Psychiatric comorbidity was examined in terms of a distinction between substance-induced and independent psychiatric disorders. METHOD: Semistructured interviews were conducted with 1,237 alcohol-dependent subjects from the Collaborative Study on the Genetics of Alcoholism both at an initial evaluation and at a 5-year follow-up. Clinically relevant information was gathered at baseline, and suicidal behavior, aspects of alcohol dependence, and drug use were evaluated at the follow-up interview. RESULTS: Alcohol-dependent subjects (N=56) with suicide attempts during the follow-up period were more likely than subjects with no suicide attempts (N=1,181) to have made prior attempts. Other factors related to future suicide attempts in univariate analyses included younger age, being separated or divorced, other drug dependence, substance-induced psychiatric disorders, and indicators of a more severe course of alcoholism. Gender did not predict future attempts. CONCLUSIONS: A 5-year prospective evaluation of attributes associated with suicide attempts among alcohol-dependent persons identified factors that contributed to a small but significant proportion of the variance for future suicidal behavior.

Patterns of drug-related disorders in a prospective study of men chosen for their family history of alcoholism.

OBJECTIVE: Alcohol use disorders (AUDs) and abuse or dependence on illicit substances often co-exist. Most studies evaluating these phenomena have focused on less well-educated individuals, using cross-sectional designs. This study controls for several factors that might contribute to a propensity toward both alcohol and substance-related conditions in a prospective follow-up of middle-class men. METHOD: The subjects (N = 249) were white sons of alcoholics and controls, followed for 20 years using structured interviews. They were evaluated at baseline and again 10, 15 and 20 years later. RESULTS: One in five subjects developed an illicit substance-related disorder by the 20-year follow-up, most commonly abuse or dependence on cannabinoids and/or stimulants. The men with these diagnoses were more likely to be recent smokers, to also fulfill criteria for alcoholism and to have a family history of a stimulant use disorder. They were not more likely to have family histories of alcoholism, did not have a lower response to alcohol at age 20 and had no enhanced risk for independent psychiatric disorders, although they did have relatives with manic depressive disease. CONCLUSIONS: Disorders related to illicit substances were common in this well-educated, highly functional population. Substance-related comorbidity with alcoholism did not seem to reflect several factors known to predict AUDs (e.g., family history of alcoholism and a low response to alcohol). The diagnostic overlap between AUDs and illicit substance-related disorders might reflect concomitant family histories of alcoholism and substance-related conditions and, perhaps, family histories of manic depressive disease.

Predictors of subgroups based on maximum drinks per occasion over six years for 833 adolescents and young adults in COGA.

OBJECTIVE: A person's pattern of heavier drinking often changes over time, especially during the early drinking years, and reflects complex relationships among a wide range of characteristics. Optimal understanding of the predictors of drinking during times of change might come from studies of trajectories of alcohol intake rather than cross-sectional evaluations. METHOD: The patterns of maximum drinks per occasion were evaluated every 2 years between the average ages of 18 and 24 years for 833 subjects from the Collaborative Study on the Genetics of Alcoholism. Latent class growth analysis identified latent classes for the trajectories of maximum drinks, and then logistic regression analyses highlighted variables that best predicted class membership. RESULTS: Four latent classes were found, including Class 1 (69%), with about 5 maximum drinks per occasion across time; Class 2 (15%), with about 9 drinks at baseline that increased to 18 across time; Class 3 (10%), who began with a maximum of 18 drinks per occasion but decreased to 9 over time; and Class 4 (6%), with a maximum of about 22 drinks across time. The most consistent predictors of higher drinking classes were female sex, a low baseline level of response to alcohol, externalizing characteristics, prior alcohol and tobacco use, and heavier drinking peers. CONCLUSIONS: Four trajectory classes were observed and were best predicted by a combination of items that reflected demography, substance use, level of response and externalizing phenotypes, and baseline environment and attitudes.

Alcohol-related blackouts among college students: impact of low level of response to alcohol, ethnicity, sex, and environmental characteristics

Objective: To explore how a genetically-influenced characteristic (the level of response to alcohol [LR]), ethnicity, and sex relate to environmental and attitudinal characteristics (peer drinking [PEER], drinking to cope [COPE], and alcohol expectancies [EXPECT]) regarding future alcohol-related blackouts (ARBs). Methods: Structural equation models (SEMs) were used to evaluate how baseline variables related to ARB patterns in 462 college students over 55 weeks. Data were extracted from a longitudinal study of heavy drinking and its consequences at a U.S. university. Results: In the SEM analysis, female sex and Asian ethnicity directly predicted future ARBs (beta weights 0.10 and -0.11, respectively), while all other variables had indirect impacts on ARBs through alcohol quantities (beta weights ~ 0.23 for European American ethnicity and low LR, 0.21 for cannabis use and COPE, and 0.44 for PEER). Alcohol quantities then related to ARBs with beta = 0.44. The SEM explained 23% of the variance. Conclusion: These data may be useful in identifying college students who are more likely to experience future ARBs over a 1-year period. They enhance our understanding of whether the relationships of predictors to ARBs are direct or mediated through baseline drinking patterns, information that may be useful in prevention strategies for ARBs.

A quasi-randomized group trial of a brief alcohol intervention on risky single occasion drinking among secondary school students.

OBJECTIVES: To show the effectiveness of a brief group alcohol intervention. Aims of the intervention were to reduce the frequency of heavy drinking occasions, maximum number of drinks on an occasion and overall weekly consumption. METHODS: A cluster quasi-randomized control trial (intervention n = 338; control n = 330) among 16- to 18-year-old secondary school students in the Swiss Canton of Zürich. Groups homogeneous for heavy drinking occasions (5+/4+ drinks for men/women) consisted of those having medium risk (3-4) or high risk (5+) occasions in the past 30 days. Groups of 8-10 individuals received two 45-min sessions based on motivational interviewing techniques. RESULTS: Borderline significant beneficial effects (p < 0.10) on heavy drinking occasions and alcohol volume were found 6 months later for the medium-risk group only, but not for the high-risk group. None of the effects remained significant after Bonferroni corrections. CONCLUSIONS: Group intervention was ineffective for all at-risk users. The heaviest drinkers may need more intensive treatment. Alternative explanations were iatrogenic effects among the heaviest drinkers, assessment reactivity, or reduction of social desirability bias at follow-up through peer feedback.

An evaluation of the full level of response to alcohol model of heavy drinking and problems in COGA offspring.

OBJECTIVE: The low level of response (LR) to alcohol is an endophenotype related to heavier drinking and alcohol problems. Structural equation models (SEMs) indicate LR affects alcohol outcomes (ALCOUT) both directly and through mediation by drinking in peers (PEER), alcohol expectancies (EXPECT), and drinking to cope with stress (COPE), with some variation depending on the sample tested. This article presents the first full test of this LR-based model in young subjects from the Collaborative Study on the Genetics of Alcoholism (COGA). METHOD: Data were generated from 325 12- to 22-year-old (47.4% male) drinking offspring from COGA families, using the Self-Report of the Effects of Alcohol questionnaire to determine LR early in the drinking career and a validated, structured interview for demography and alcohol use/problem patterns. Standardized questionnaires were used to measure PEER, EXPECT, and COPE, with the model tested through the maximum likelihood estimation for analyses of the variance/covariance matrix using both Amos and Mplus. RESULTS: The SEM yielded good fit characteristics and explained 59% of the variance, with LR relating both directly to ALCOUT and as partially mediated by PEER and COPE. Although GENDER related to both LR and ALCOUT in the model, and AGE related to ALCOUT, the SEM results were invariant across both AGE and GENDER, with generally similar invariant results regarding the presence or absence of an alcohol-use disorder diagnosis. CONCLUSIONS: The results support the applicability of the LR-based model of heavy drinking and alcohol problems in the COGA offspring, a group with different demography compared with the two other samples of adolescents tested to date. The modest differences observed across samples will be evaluated in future research to enhance understanding of how the model operates across socioeconomic groups.

Clinical implications of tolerance to alcohol in nondependent young drinkers.

BACKGROUND: Ten percent of teenagers and young adults with no alcohol diagnosis and a third of those with alcohol abuse report tolerance to alcohol. However, relatively few data are available on the clinical implications of tolerance in nondependent men and women. METHODS: Data were gathered from 649 18-to-22-year-old drinking offspring from the Collaborative Study on the Genetics of Alcoholism (COGA) families. The prevalence and clinical correlates of tolerance were evaluated across subjects with no DSM-IV alcohol abuse and no tolerance, similar individuals with tolerance, subjects with alcohol abuse but no tolerance, and individuals with both alcohol abuse and tolerance. RESULTS: Tolerance was associated with an almost doubling of the number of drinks needed to feel alcohol's effects, and correlated with additional alcohol-related problems. In regression analyses, the most consistent and robust correlates of tolerance were the maximum number of drinks and alcohol problems, and tolerance remained informative after covarying for drinking quantity. CONCLUSIONS: Tolerance to alcohol may be a useful concept regarding nondependent drinkers that is not just a proxy for alcohol quantity but also reflects the presence of additional problems.