HPA axis stress reactivity and hair cortisol concentrations in recently detoxified alcoholics and healthy controls with and without childhood maltreatment.

Childhood maltreatment (CM) is a strong risk factor for alcohol dependence (AD) and is associated with a more severe course of the disease. Alterations of the hypothalamic-pituitary-adrenal (HPA) axis may play an important role in this relationship. The aim of the present study was to systematically investigate potential alterations in HPA functioning associated with AD diagnosis and CM. Four study groups were recruited: AD patients with (n = 29; 10♀) and without (n = 33; 8♀) CM and healthy controls with (n = 30; 20♀) and without (n = 38; 15♀) CM. Cumulative cortisol secretion was measured by hair cortisol concentration (HCC). To measure HPA axis response to the Trier social stress test (TSST), saliva and blood samples were analysed for adrenocorticotropic hormone (ACTH) and cortisol. In the AD groups, the period of hair growth covered acute alcohol consumption and withdrawal. The TSST was scheduled after completion of withdrawal. Irrespective of CM, higher HCCs and reduced ACTH and cortisol levels before and after TSST were observed in AD patients. The analyses did not reveal any differences between AD patients with and without CM. Healthy controls with CM had lower plasma cortisol levels compared with those without CM. The results suggest that AD is strongly related to HPA axis functioning, which may superimpose possible differences between AD patients with and without CM. Future studies should investigate whether biologically different subtypes of AD with and without CM can be identified in earlier stages or before the development of AD.

Assessment of genotoxicity amongst smokers, alcoholics, and tobacco chewers of North India using micronucleus assay and urinary 8-hydroxyl-2'-deoxyguanosine, as biomarkers.

The main objective of the present study was to screen the genotoxicity caused by individual and combined habits of smoking, tobacco chewing, and alcohol consumption in human population of North India. Study recruited 67 male subjects aged 25 to 65 years. Buccal mucosal cells were subjected to micronucleus (MN) assay, and 8-hydroxyl-2-deoxyguanosine (8-OHdG) was estimated in their urine samples. Number and shape of the MN cells varied in the buccal epithelium of different groups. Maximum number of MN (0.47%) were found in tobacco chewers followed by smokers (0.45%) and alcoholics (0.44%) (P < 0.05). These results reciprocated the concentration of urinary 8-OHdG. Maximum value for 8-OHdG was also recorded in tobacco chewers (21.07 ± 5.51 mg/mg creatinine) followed by smokers (20.25 ± 3.96 mg/mg creatinine) and alcoholics (19.06 ± 3.41 mg/mg creatinine) (P < 0.05). Combined effects of these agents were found to be statistically different from individual effects. Carcinogenic compounds present in cigarette smoke, nitrosamines found in solid tobacco, and acetaldehyde, a metabolic product of alcohol, induce oxidative stress that manifests into genotoxicity. In conclusion, demographical differences occur in the genotoxicity caused by these three habits. MN assay and urinary 8-OHdG are simple, noninvasive, and reliable biomarkers of genotoxicity.

Addiction, drinking behavior, and driving under the influence.

Using a survey of drinkers (N = 1,634), we evaluated alternative explanations of heavy and binge drinking, driving under the influence (DUI), DUI arrests, speeding citations, and chargeable accidents. Explanations included socializing, short-term decision-making, unrealistic optimism, risk preferring behavior, and addiction. Most consistent relationships were between substance use and alcohol addiction and dependent variables for (1) binge drinking and (2) DUI episodes. Respondent characteristics (age, marital and employment status, race, etc.) had important roles for DUI arrests. Drinker-drivers and those arrested for DUI are partially overlapping groups with implications for treatment and policies detecting and incapacitating persons from drinking and driving.

Epidemiology of drug use among biracial/ethnic youth and young adults: results from a U.S. population-based survey.

This study estimates the prevalence of cigarette, alcohol, and marijuana use in a nationally representative sample of monoracial/ethnic and biracial/ethnic youth and young adults. The authors consider 16 racial/ethnic categories and used four waves of data from the National Longitudinal Study of Adolescent Health. The analysis sample consists of 20,745 individuals in Wave 1. The primary statistical methodology used in the present study is logistic regression with sample weights. Findings suggest that participants who self-report two races/ethnicities have prevalence rates that are intermediate to those of the two corresponding monoracial/ethnic rates. For example, Black-American Indians reported cigarette smoking rates that were significantly lower than rates reported by American Indians but significantly higher than rates reported by Blacks. Groups with the highest prevalence of cigarette smoking at Wave 1 were American Indian, White-American Indian, White, and Multiracial (people reporting three or more races/ethnicities). Groups with the highest prevalence of alcohol drinking at Wave 1 were White-American Indian, Multiracial, Hispanic, White, and White-Hispanic. Groups with the highest prevalence of marijuana smoking at Wave 1 were Black-Asian and American Indian. The authors found an interaction effect between race/ethnicity and socioeconomic status. Lower-class SES status may serve as a risk factor for biracial/ethnic adolescents while upper-class SES may serve as a protective factor for these youth. In general, biracial/ethnic individuals have prevalence rates that are intermediate to those of the two corresponding monoracial/ethnic rates.

[Comparison between alcoholic patients and primary care patients for the use of the ambulance].

OBJECTIVE: Though heavy drinkers and patients with alcohol dependence make use of the ambulance more frequently as compared with the general population, there are few data on the alcohol-related use of the emergency department (ED) in Japan. METHOD: A cross sectional study was conducted. 170 patients with alcohol dependence in one clinic and 306 primary care patients across two clinics provided demographic data and answered some questions about the use of emergency ambulance services over the age of 20. The questions asked included whether use of the ambulance caused injuries, as well as AUDIT-C (primary care patients only). In this study, multiple logistic regression analysis was used. RESULT: The use of emergency ambulance services by patients with alcohol dependence was 4.68 times more than primary care patients, and the occurrence of ambulance-caused injuries was 6.03 times higher, as determined by multiple logistic regression. Among primary care patients, AUDIT-C positive patients (male; 5 points or more, female; 3 points or more) were 37 (12.2%), and the occurrence of ambulance-caused injuries was 3.32 times higher. CONCLUSION: Like with other countries, in Japan, heavy drinkers and patients with alcohol dependence lead to a significant increase in the use of emergency ambulance services as well as ambulance-caused injuries.

[Survey of institutional staff's views concerning heterosexuality and recovery by alcoholics].

The objective of this study was to identify how staff working in institutions for the treatment of and recovery from alcoholism view the relationship between heterosexuality and recovery on the part of alcoholics, how they deal with this relationship, and issues the staff face. Data were collected from 89 staff members (36 men, 52 women, 1 unknown gender) residing in the Kanto region and working at hospitals or local institutions. Over half the staff reported dealing with the issue of heterosexuality respectfully, but in terms of their views, a large majority of the staff was highly concerned about relapse due to heterosexuality. Half of the staff believed that heterosexuality might prevent continued abstinence. They also believed that the risk of relapse was increased further if the period of abstinence was short, the person was unemployed, both partners were alcoholics, the person had yet to admit their alcoholism, or if the relationship was an extramarital affair or with someone in the early stages of recovery. Medical staffs were more likely than other staff to respect the heterosexuality of alcoholics while being highly concerned about the risk of relapse. The results also showed that as alcoholics were unlikely to refrain from heterosexuality even if advised to do so, staff would probably use an appropriate method of guidance if one were available. These findings indicate the need to develop more practical and firmly held specialist therapies for heterosexuality among alcoholics, which has been regarded negatively as frequently leading to relapse, based on studies from the perspectives of both alcoholics and staff.

A study on socio-demographic characteristics of alcoholics attending the de-addiction center at Burdwan medical college and hospital in West Bengal.

Prevalence of alcohol use in India is reported to be 21.4% and there is increasing alcohol intake among the young people. The present study was undertaken to study the socio-demographic characteristics of patients having alcohol-related disorders attending the de-addiction center at Burdwan Medical College in West Bengal and to find out some factors responsible for that. A clinic-based descriptive cross-sectional study was conducted among 187 patients with the help of pre-tested pre-designed schedule after obtaining informed consent. Data analysis was carried out with the help of Epi info software version 6. Majority of the patients were male, in productive age group and married. Age of initiation and amount of alcohol intake were significantly associated with positive family history of alcoholism. Children having family history of alcoholism should be counseled to prevent development of alcoholism.

Ischemic heart disease mortality and morbidity rates in former drinkers: a meta-analysis.

Current abstainers from alcohol have been identified as an inadequate reference group in epidemiologic studies of the effects of alcohol, because inclusion of former drinkers might lead to overestimation of the protective effects and underestimation of the detrimental effects of drinking alcohol. The authors' objective in the current study was to quantify this association for ischemic heart disease (IHD). Electronic databases were systematically searched for relevant case-control or cohort studies published from 1980 to 2010. Thirty-eight articles fulfilled the inclusion criteria, contributing a total of 5,613 IHD events and 12,097 controls among case-control studies and 1,387 events with combined endpoints and 7,183 events stratified by endpoint among 232,621 persons at risk among cohort studies. Pooled estimates for the subset stratified by sex and endpoint showed a significantly increased risk among former drinkers compared with long-term abstainers for IHD mortality ( among men; relative risk = 1.25, 95% confidence interval: 1.15, 1.36; among women relative risk = 1.54, 95% confidence interval: 1.17, 2.03). For IHD morbidity, the estimates for both sexes were close to unity and not statistically significant. Results were robust in several sensitivity analyses. In future studies, researchers should separate former drinkers from the reference category to obtain unbiased effect estimates. Implications for the overall beneficial and detrimental effects of alcohol consumption on IHD are discussed below.

Predictors and outcome of aftercare participation of alcohol and drug users completing residential treatment.

This study attempts to identify factors associated with greater aftercare participation for 367 adults who completed abstinence-based residential addiction treatment between 2004 and 2007 at Bellwood Health Services in Toronto, Canada. Pre-treatment substance use, number of days spent in residential treatment, motivation, treatment satisfaction, and demographics were used to determine which characteristics predicted greater aftercare participation. The duration of residential treatment and treatment satisfaction emerged as significant predictors of aftercare attendance. Regular aftercare attendance was associated with lower levels of substance use at 6-month follow-up. Results suggest that a longer duration of residential treatment can influence continuing care engagement and highlight the importance of initial treatment retention for long-term recovery.

The prevalence of current smokers and alcohol drinkers among cancer survivors and subjects with no history of cancer among participants in a community-based cardiometabolic screening program in Miyagi prefecture, Japan: a comparison with nationally representative surveys in other countries.

BACKGROUND: We determined the prevalence of current cigarette smokers and alcohol drinkers among cancer survivors and subjects with no history of cancer in Japan and compared the findings with nationally representative studies in other countries. METHODS: We conducted a cross-sectional study of baseline data from a prospective cohort study. A self-administered questionnaire was surveyed during 2013-2015 with residents aged ≥20 years attending a community-based cardiometabolic screening program in Miyagi prefecture in north-eastern Japan. Subjects with past cancer histories were classified as cancer survivors. Sex-specific, age-standardized prevalence of current smokers, and drinkers were calculated. Age-adjusted prevalence ratios (PRs: the cancer survivors' rate divided by the rate of subjects with no history of cancer) and 95% confidence intervals (CIs) were estimated with log-binomial regressions. RESULTS: 36,786 subjects, including 2760 cancer survivors, responded and provided usable information (58.9% of recruited subjects). For men, the age-standardized prevalence of current smokers and drinkers among survivors was 18.8% and 74.4%, respectively, with an age-adjusted PR (95%CI) of 0.76 (0.66-0.86, p < 0.001) and 0.95 (0.91-0.98, p = 0.002), respectively. For women, the figures were 6.1%, 37.9%, 0.84 (0.67-1.06, p = 0.138) and 0.96 (0.90-1.03, p = 0.313), respectively. The U.S., the U.K, and Australian studies generally showed no substantially lower prevalence of current smokers or drinkers in survivors than in subjects with no history of cancer (PR ≥ 0.75), while Korean studies did (PR < 0.75). CONCLUSIONS: A considerable proportion of Japanese cancer survivors, especially men, remained currently smoking and drinking. Consistent with Western studies, the rates were not substantially lower than those among subjects with no history of cancer.

Biochemical changes in chronic alcoholics in Port Harcourt: the report of a pilot survey.

AIMS AND OBJECTIVES: Alcohol abuse is a major public health problem and one of the leading causes of preventable death. Data on the frequency of biochemical abnormalities among alcoholics in the Niger Delta region is unavailable. We therefore conducted this pilot study to determine the type of biochemical abnormalities amongst a group of chronic alcoholics in Port Harcourt, Nigeria. SUBJECTS AND METHODS: Thirty (30) subjects aged 40 50 years with a daily alcohol consumption of more than 100g formed the study group. Thirty (30) aged matched controls from the same locality who were non-alcoholics were also recruited. Ten mls (10mls) of venous blood was collected from both subjects and controls from the antecubital fossa after obtaining informed consent into lithium heparin bottles. The plasma was harvested and stored at -20 degrees C until assayed. Plasma bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, gamma glutamyl transferase, glucose, total protein, albumin, magnesium, calcium and inorganic phosphorus were estimated using standard kit methods while plasma potassium was determined by flame photometry. Routine laboratory accuracy and precision controls were utilised. RESULTS: Alcohol abuse was associated with a significantly lower body weight, body mass index and percentage body fat. The plasma sodium, inorganic phosphate, gamma glutamyl transferase were significantly higher in chronic alcohol abuse when compared with normal subjects. On the other hand, the plasma magnesium, potassium, calcium, total protein, albumin and glucose were significantly reduced in the study subjects. CONCLUSION: Biochemical abnormalities are common among chronic alcoholics in this region. They include hypernatraemia, hypoglycaemia, hypocalcaemia, hypomagnesaemia, hypokalaemia, hypoalbuminaemia and hyperphosphataemia. Aspartate transaminase and gamma glutamyl transferase are usually elevated and suggests alcoholic liver damage. Efforts should be made to identify these abnormalities and treat them as it may go a long way towards improving morbidity and mortality of alcohol related diseases.

Handgrip strength and lean mass are independently related to brain atrophy among alcoholics.

BACKGROUND: In neurodegenerative disorders or in normal aging humans a relationship between muscle mass and/or performance and brain volume was observed, that is not dependent on age or other confounding factors. The aim of the present study is to analyse the relationship between lean mass and handgrip strength in alcoholics, who frequently show brain and muscle atrophy. METHODS: It was included 101 male patients aged 58.35 ± 11.59 years, and 44 controls, all of them workers of our hospital, drinkers of less than 20 g ethanol/day, of similar age. Patients and controls underwent dominant handgrip assessment with a Collins' dynamometer, whole body composition analysis by densitometry, and brain computed tomography (CT) examination, with further calculation of several indices indicative of brain atrophy. MAIN RESULTS: 1) Brain atrophy is a very common finding among alcoholics, both among cirrhotics and non-cirrhotics. 2) Alcoholics show a marked reduction in handgrip strength, and also in lean mass, especially at the arms and legs -but not in the trunk, even if patients with ascites were excluded.3) There is a relationship between reduced lean mass and brain atrophy, and a close correlation between handgrip strength and brain atrophy, that is independent of age and liver function. 4) Total fat amount is not different among alcoholics and controls, but there are marked differences in fat distribution: alcoholics show less fat in arms, but more fat in trunk, so that if we calculate the peripheral fat/trunk fat index, marked differences were observed among alcoholics and controls. Neither total fat nor fat distribution were related to brain atrophy. CONCLUSION: among alcoholics, as in other neurodegenerative conditions, there is a relationship between reduced lean mass and brain atrophy, and a close correlation between handgrip strength and brain atrophy, that is independent of age, duration of ethanol consumption and liver function.

Comparing diagnostic outcomes of children with fetal alcohol syndrome in South Africa with diagnostic outcomes when using the updated Institute of Medicine diagnostic guidelines.

INTRODUCTION: During fetal alcohol spectrum disorder (FASD) prevalence studies in South Africa, cases of fetal alcohol syndrome (FAS) were identified that presented differently from the 2016 Hoyme et al. modified Institute of Medicine (IOM) criteria. We compared diagnostic outcomes of children diagnosed with FAS using a combination of the 2005 Hoyme et al. criteria and the "gestalt method" in South Africa to the diagnosis they would have received using the latest Hoyme et al. criteria. The frequency with which dysmorphic features presented was compared to the frequency with which they were reported in the revised criteria which drew on a larger sample. METHODS: Data were gathered from four South African FASD prevalence studies. Dysmorphology data, anthropometric data, and final diagnosis for participants (N = 917) were extracted. RESULTS: Of the 390 participants with diagnoses of "full FAS," 175 would not have received a "full FAS" diagnosis using the 2016 criteria. Of these, 21 would have received a pFAS diagnosis, and 154 would have received a diagnosis of ARND or a "no-FASD" diagnosis. The frequency of all but five dysmorphic features differ significantly between this sample and the sample examined for the 2016 criteria. There is more variability in the features present in the current sample. DISCUSSION: Differences regarding diagnostic outcomes and prevalence of dysmorphic features suggest that strict application of the diagnostic criteria may miss children who present with FAS. We recommend including gestalt-based screening in a research setting where the clinical experience is available to inform future guidelines.

Características sociodemográficas, de trabalho e saúde de homens e mulheres deficientes residentes em contexto rural / Características sociodemográficas, de trabajo y salud de hombres y mujeres discapacitados residentes en un contexto rural / Sociodemographic characteristics of work and health of disabled men and women living in a rural setting

RESUMO Objetivo: Comparar as características sociodemográficas, de saúde e de trabalho de homens e mulheres com deficiência que residem em contexto rural. Método: Estudo transversal analítico, com 276 pessoas com deficiência residentes em cenário rural de oito municípios da região noroeste do Estado do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de um questionário fechado, com variáveis sociodemográficas, de trabalho e saúde, aplicado na residência dos participantes nos meses de setembro de 2018 a julho de 2019. Esses foram digitados e analisados no programa estatístico software Statistical Package for the Social Sciences for Windows, versão 18.0 por meio de estatística analítica descritiva (comparação de frequência). Para comparar os dois grupos (homens e mulheres) empregou-se o teste Qui-Quadrado. Resultados: Dos homens, 27,8% apresentaram deficiência física e a deficiência múltipla foi mais frequente na mulher (p<0,001). O trabalho na agricultura e do lar eram mais frequentes no sexo feminino e as atividades autônomas e empregatícias, no sexo masculino. Ambos recebiam BPC, ainda que 18% não tivessem nenhum tipo de benefício. Homens tinham duas vezes mais chance de serem tabagistas e quase três vezes maior risco de etilismo que as mulheres (p<0,001). Conclusão: As características de pessoas com deficiência que residem em contexto rural se diferenciam entre os sexos, no que se refere à deficiência, trabalho e hábitos que vulnerabilizam a saúde.

RESUMEN Objetivo: comparar las características sociodemográficas, de salud y de trabajo de hombres y mujeres con discapacidad que residen en contexto rural. Método: estudio transversal analítico, con 276 personas con discapacidad residentes en escenario rural de ocho municipios de la región noroeste del Estado de Rio Grande do Sul, Brasil. Los datos fueron recogidos a través de un cuestionario cerrado, con variables sociodemográficas, de trabajo y salud, aplicado en la residencia de los participantes en los meses de septiembre de 2018 a julio de 2019. Estos fueron introducidos y analizados en el programa estadístico software StatisticalPackageforthe Social Sciencesfor Windows, versión 18.0. por medio de estadística analítica descriptiva (comparación de frecuencia). Para comparar los dos grupos (hombres y mujeres) se empleó la Prueba de chi-cuadrado. Resultados: de los hombres, el 27,8% presentó discapacidad física y la discapacidad múltiple fue más frecuente en la mujer (p<0,001). El trabajo en la agricultura y en el hogar eran más frecuentes en el sexo femenino y las actividades autónomas y de empleo, en el sexo masculino. Ambos recibían BPC, aunque el 18% no tenía ningún tipo de beneficio. Los hombres tenían dos veces más probabilidades de ser fumadores y casi tres veces mayor riesgo de etilismo que las mujeres (p<0,001). Conclusión: las características de las personas con discapacidad que residen en un contexto rural se diferencian entre los sexos, en lo que se refiere a la discapacidad, trabajo y hábitos que vulneran la salud.

ABSTRACT Objective: Comparing the sociodemographic characteristics of health and work of men and women with disabilities living in a rural context. Method: A cross-sectional analytical study with 276 people with disabilities living in a rural setting in eight cities in the Northwest Region of the State of Rio Grande do Sul, Brazil. Data were collected through a closed questionnaire with sociodemographic, work and health variables applied at the participants' residence from September 2018 to July 2019. These were typed and analyzed in the software Statistical Package for the Social Sciences for Windows, version 18.0 by means of descriptive analytical statistics (frequency comparison). To compare the two groups (men and women) the Chi-Square test was used. Results: Of the men, 27.8% had physical disabilities and multiple disability was more frequent in women (p<0.001). Work in agriculture and home was more frequent in females and autonomous and employment activities in males. Both received PB, although 18% did not have any kind of benefit. Men were twice as likely to be smokers and almost three times higher risk of alcohol than women (p<0.001). Conclusion: The characteristics of people with disabilities living in a rural setting differ between the genders, with regard to disability, work and habits that make health vulnerable.

Tackling TB in low-incidence countries: improving diagnosis and management in vulnerable populations.

In low tuberculosis incidence regions, tuberculosis is mainly concentrated among hard-to-reach populations like migrants, homeless people, drug or alcohol abusers, prisoners and people living with HIV. To be able to eliminate tuberculosis from these low incidence regions tuberculosis screening and treatment programs should focus on these hard-to-reach populations. Here we discuss the barriers and facilitators of health care-seeking, interventions improving tuberculosis screening uptake and interventions improving treatment adherence in these hard-to-reach populations.

Subdural Hemorrhage, a Retrospective Review with Emphasis on a Cohort of Alcoholics.

Subdural hemorrhage (SDH) is a common cause of death. As external evidence of injury may be absent, an autopsy is frequently needed to detect it. We conducted a 3-year review of SDH from the New York City Office of Chief Medical Examiner, with emphasis on a cohort of alcoholics. Our study population of 1942 included 1588 alcoholics. Of the alcoholics, c. 8% had SDH (26% of the total number of SDH). Of the alcoholics with SDH, 57% had associated brain injuries. As alcohol intoxication is frequently associated with aggressive and violent behavior, we are concerned that 6% of alcoholics in our review had no autopsy or imaging studies. It is possible that a portion of these may have had a SDH due to an unrecognized inflicted injury. We recommend that autopsies be performed on all alcoholics without a clear cause or mechanism of death.

Social hidden groups size analyzing: application of count regression models for excess zeros.

BACKGROUND: In the case of sensitive questions such as number of alcoholics known, majority of respondents might give an answer of zero. Poisson regression model (P) is the standard tool to analyze count data. However, P provides poor fit in the case of zero inflated counts, when over-dispersion exists. Therefore, the questions to be addressed are to compare performance of alternative count regression models; and to investigate whether characteristics of respondents affect their responses. METHODS: A total of 700 participants were asked about number of people they know in hidden groups; alcoholics, methadone users, and Female Sex Workers (FSW). Five regression models were fitted to these outcomes: Logistic, P, Negative Binomial (NB), Zero Inflated Poisson (ZIP), and Zero Inflated Negative Binomial (ZINB). Models were compared in terms of Likelihood Ratio Test (LRT), Vuong, AIC and Sum Square of Error (SSE). RESULTS: Percentages of zero were 35% for number of alcoholics, 50% for methadone users, and 65% for FSWs. ZINB provided the best fit for alcoholics, and NB provided the best fit for other outcomes. In addition, we noticed that young respondents, male and those with low education were more likely to know or reveal sensitive information. CONCLUSIONS: Although P is the first choice for modeling of count data in many cases, it seems because of over-dispersion of zero inflated counts in the case of sensitive questions, other models, specifying NB and ZINB, might have better goodness of fit.

Active case finding for tuberculosis among high-risk groups in low-incidence countries.

In low-incidence countries, tuberculosis (TB) is now largely concentrated in high-risk groups such as migrants, homeless people, illicit drug users, alcoholics and prisoners. This has led to increased efforts to implement targeted active case finding for TB among specific populations. This review examines the evidence supporting active case finding in migrants and social risk groups, as well as the cost-effectiveness of interventions. While data from observational studies support active case finding in defined high-risk groups, further research to determine the effectiveness of specific tools and the cost-effectiveness of screening strategies is needed to inform evidence-based control methods in low-incidence countries. Inevitably, addressing TB in low-incidence countries will depend on effective disease control in high-burden countries.

Opportunities for prevention of alcohol-related death in primary care: results from a population-based cross-sectional study.

The mortality rate from alcohol-related conditions has risen sharply in the United Kingdom and it is not known whether opportunities for preventive interventions could be improved. The purpose of our study was to identify opportunities to detect, assess, and manage alcohol problems in primary care according to evidence-based guidelines. We carried out a cross-sectional study on patients who died from alcohol-related conditions in the calendar year 2003 within National Health Service Greater Glasgow Health Board area, Scotland (population 920,000). We described patient characteristics and care recorded in health service records, comparing it with best evidence-based practice in Scottish Intercollegiate Guidelines Network and Health Technology Board for Scotland recommendations on the management of harmful drinking and alcohol dependence. 501 deaths occurred from an alcohol-related cause. The mean age at death was 57.5 years and 72% were male. The most common causes of death, recorded by the International Classification of Diseases, revision 10, excluding accidents, were alcoholic liver disease (290, 57.9%) and mental and behavioural disorders due to alcohol (70, 14.0%). Lifetime mean consultations at primary care general practitioner and hospital outpatient departments were 24 in males and 5 in females. All individuals who died from an alcohol-related cause had at least one biochemical or physical indicator suggestive of alcohol misuse. 21% (95% CI 13-33%) had no record of having been advised to abstain from alcohol and 23% (95% CI 15-35%) had received brief interventions. 58% (95% CI 46-70%) had been referred to specialist alcohol services but a third of them did not attend. The majority of patients (83%, 95% CI 72-90%) had no evidence of shared health service and social work care. We concluded that individuals who died from alcohol-related conditions were usually in contact with statutory and voluntary services but further efforts were required to use these opportunities to detect, assess, and manage serious alcohol problems according to evidence-based guidelines.