Age of Onset and DSM-5 Alcohol Use Disorder in Late Adolescence - A Cohort Study From Sweden.

PURPOSE: To examine if the prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alcohol use disorder (AUD) differs between two groups with different age of onset of alcohol use and if endorsement of different AUD criteria differs between the two groups. METHODS: A two-wave longitudinal prospective cohort survey conducted in Sweden (2017-2019) with a nationwide sample of 3,999 adolescents aged 15/16 years at baseline (T1), and 17/18 years at follow-up (T2); 2,778 current drinkers at T2 were analysed. Participants were categorized into early onset of drinking (drinking already at T1 54.3%) or late onset (not drinking at T1 but at T2, 45.8%). AUD was measured with questions corresponding to the 11 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for AUD. Potential confounding factors measured at T1 were sex, sensation-seeking, impulsivity, emotional symptoms, peer problems, conduct problems, and hyperactivity. RESULTS: The early onset group had a higher prevalence of AUD at T2 compared to the late onset group (36.3% vs. 23.1%, p < .001). The higher risk of AUD remained significant in a linear probability model with control for additional confounding factors (ß = 0.080, p < .001). All individual criteria were reported more in the early onset group, and there was no evidence of differential item functioning. DISCUSSION: The age of onset of alcohol use was a significant predictor of AUD in late adolescence among Swedish adolescents. Those with an earlier onset of alcohol use had a higher prevalence of AUD and of all individual criteria. The items in the scale were similarly predictive of AUD in both groups.

Modelling the impacts of volumetric and minimum unit pricing for alcohol on social harms in Australia.

AIMS: Alcohol pricing policies may reduce alcohol-related harms, yet little work has been done to model their effectiveness beyond health outcomes especially in Australia. We aim to estimate the impacts of four taxation and minimum unit pricing (MUP) interventions on selected social harms across sex and age subgroups in Australia. METHODS: We used econometrics and epidemiologic simulations using demand elasticity and risk measures. We modelled four policies including (A) uniform excise rates (UER) (based on alcohol units) (B) MUP $1.30 on all alcoholic beverages (C) UER + 10 % (D) MUP$ 1.50. People who consumed alcohol were classified as (a) moderate (≤ 14 Australian standard drinks (SDs) per week) (b) Hazardous (15-42 SDs per week for men and 14-35 ASDs for women) and (c) Harmful (> 42 SDs per week for men and > 35 ASDs for women). Outcomes were sickness absence, sickness presenteeism, unemployment, antisocial behaviours, and police-reported crimes. We used relative risk functions from meta-analysis, cohort study, cross-sectional survey, or attributable fractions from routine criminal records. We applied the potential impact fraction to estimate the reduction in social harms by age group and sex after implementation of pricing policies. RESULTS: All four modelled pricing policies resulted in a decrease in the overall mean baseline of current alcohol consumption, primarily due to fewer people drinking harmful amounts. These policies also reduced the total number of crimes and workplace harms compared to the current taxation system. These reductions were consistent across all age and sex subgroups. Specifically, sickness absence decreased by 0.2-0.4 %, alcohol-related sickness presenteeism by 7-9 %, unemployment by 0.5-0.7 %, alcohol-related antisocial behaviours by 7.3-11.1 %, and crimes by 4-6 %. Of all the policies, the implementation of a $1.50 MUP resulted in the largest reductions across most outcome measures. CONCLUSION: Our results highlight that alcohol pricing policies can address the burden of social harms in Australia. However, pricing policies should just form part of a comprehensive alcohol policy approach along with other proven policy measures such as bans on aggressive marketing of alcoholic products and enforcing the restrictions on the availability of alcohol through outlet density regulation or reduced hours of sale to have a more impact on social harms.

Long-term effects of alcohol consumption on anxiety in adults: A systematic review.

OBJECTIVE: Despite the high prevalence and comorbidity of alcohol consumption and anxiety, it is unclear whether alcohol consumption influences long-term anxiety. This study aimed to systematically review the literature on the long-term longitudinal effects of alcohol consumption on anxiety in adults. METHODS: EMBASE, PsychInfo, Medline, and Web of Science databases were systematically searched from inception to April 12th, 2024. Articles analysing the relationship between alcohol consumption and anxiety symptoms or anxiety disorder diagnosis at least three-months later in adults were eligible. Articles were screened and extracted by two independent reviewers with study quality assessed using the Mixed Methods Appraisal Tool. RESULTS: From 884 records, eight studies of mixed quality met inclusion criteria. One study using a sample representative of the USA population found low volume consumption was associated with lower long-term anxiety. All other studies used a convenience sample or a specific medical population sample. The significance and direction of the relationship between alcohol consumption and long-term anxiety in these studies varied, likely due to differences in alcohol consumption thresholds used and populations studied. CONCLUSIONS: A paucity of research on the longitudinal effects of alcohol consumption on anxiety was found, highlighting a significant gap in the research literature. Furthermore, existing research, primarily focussed on clinical subpopulations, has yielded mixed results. Further research is needed to explore the longitudinal dose dependent impact of alcohol consumption on anxiety using samples representative of national populations.

Test purchasing of same day and rapid online alcohol home delivery in two Australian jurisdictions.

OBJECTIVE: With same day online alcohol sales increasing, there is a need to study their regulation. Test purchasing of alcohol home delivery was conducted to measure compliance with regulations for identification checks and unattended deliveries in two Australian jurisdictions (Perth, Western Australia and Geelong, Victoria), which have differing regulations. METHOD: Alcohol orders for same day or rapid (<2 hours) delivery on Friday and Saturday nights were made by research assistants aged 18-24 years in Perth (n=34) and Geelong (n=29). An observation checklist was used to record the delivery interaction, with a specific focus on checking of photo identification at time of delivery and whether deliveries were left unattended. RESULTS: Average time from order to delivery for rapid deliveries was less than one hour in both sites (Perth = 50 minutes; Geelong = 36 minutes). More than 20% of deliveries were made without an identification check in both sites (Perth = 24%; Geelong = 21%). CONCLUSIONS: This pilot study showed alcohol can be delivered to the home within one hour, and not all deliveries include an identification check at point of delivery. These findings indicate a need for policies that empower regulators and police to undertake 'mystery shopper' monitoring to reduce potential harms and improve compliance with alcohol delivery policy.

Where do high-risk drinking occasions occur more often? A cross-sectional, cross-country study.

INTRODUCTION: The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off-premise locations. Comparisons are made between high-income countries: Australia, New Zealand, England and Scotland, and across drinker-types: high-risk and lower-risk. METHODS: Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross-national survey measures location and beverage-specific alcohol consumption. The number of drinking occasions and mean consumption across on- and off-premise locations and the proportion of drinking occasions that high- and lower-risk drinkers had at on- and off-premise locations was estimated for each country. RESULTS: The majority of drinking occasions among high-risk drinkers occurred at off-premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High-risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off-premise locations compared to England and Scotland. Across all countries, high-risk drinkers and lower-risk drinkers consumed significantly larger quantities of alcohol per occasion at off-premise locations compared to on-premises locations. Finally, the majority of total alcohol consumed occurred at off-premise locations across all countries for high- and lower-risk drinkers. DISCUSSION AND CONCLUSIONS: As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off-premise.

How well do DSM-5 criteria measure alcohol use disorder in the general population of older Swedish adolescents? An item response theory analysis.

BACKGROUND: This study assesses the psychometric properties of DSM-5 criteria of AUD in older Swedish adolescents using item response theory models, focusing specifically on the precision of the scale at the cut-offs for mild, moderate, and severe AUD. METHODS: Data from the second wave of Futura01 was used. Futura01 is a nationally representative cohort study of Swedish people born 2001 and data for the second wave was collected when participants were 17/18 years old. This study included only participants who had consumed alcohol during the past 12 months (n = 2648). AUD was measured with 11 binary items. A 2-parameter logistic item response theory model (2PL) estimated the items' difficulty and discrimination parameters. RESULTS: 31.8% of the participants met criteria for AUD. Among these, 75.6% had mild AUD, 18.3% had moderate, and 6.1% had severe AUD. A unidimensional AUD model had a good fit and 2PL models showed that the scale measured AUD over all three cut-offs for AUD severity. Although discrimination parameters ranged from moderate (1.24) to very high (2.38), the more commonly endorsed items discriminated less well than the more difficult items, as also reflected in less precision of the estimates at lower levels of AUD severity. The diagnostic uncertainty was pronounced at the cut-off for mild AUD. CONCLUSION: DSM-5 criteria measure AUD with better precision at higher levels of AUD severity than at lower levels. As most older adolescents who fulfil an AUD diagnosis are in the mild category, notable uncertainties are involved when an AUD diagnosis is set in this group.

Different measures of alcohol use as predictors of DSM-5 alcohol use disorder among adolescents - A cohort study from Sweden.

BACKGROUND AND AIMS: This study addresses a significant gap in existing research by investigating the longitudinal relationship between various measures of alcohol use and the development of alcohol use disorders (AUDs) in a cohort of Swedish adolescents. METHODS: A prospective longitudinal survey was conducted on 3999 adolescents in Sweden who were in 9th grade in 2017 and were followed up in 2019. Baseline assessments included lifetime alcohol use, recent use (past 30 days), risky drinking (AUDIT-C), and heavy episodic drinking (HED). Follow-up assessments comprised eleven items measuring DSM-5 AUD criteria. The study explores prospective associations between these diverse alcohol use measures and the occurrence of AUD, while also calculating population attributable fractions (PAF). FINDINGS: The proportion of alcohol consumers who met the criteria for AUD at follow-up was 31.8%. All baseline measures of alcohol use exhibited associations with subsequent AUD. Notably, the HED group demonstrated the highest prevalence of AUD at 51.4% (p<.001). However, when calculating PAFs, any lifetime alcohol use emerged as the most substantial contributor, accounting for 10.8% of all subsequent AUD cases. CONCLUSIONS: This study underscores that alcohol use during mid-adolescence heightens the risk of developing AUD in late adolescence. Among the various measures, heavy episodic drinking presents the highest risk for later AUD. From a public health perspective, preventing any alcohol use emerges as the most effective strategy to mitigate the population-level burden of disease of AUD.

Exploring the relationship between solitary drinking and living without other adults on alcohol consumption during the COVID-19 pandemic.

AIMS: The COVID-19 pandemic presents the opportunity to learn about solitary drinking as many people were forced to spend time at home. The aim of this study is to examine the relationship between solitary drinking and living without other adults on alcohol consumption. METHODS: A longitudinal study with four survey waves (between May and November 2020) obtained seven-day drinking diary data from Australian adults living in New South Wales. In May, a convenience sample of 586 participants (Mage = 35.3, SD = 14.8; 65.3% women) completed the first wave. Participants then completed a survey in June (n = 319, 54.4% response rate), July/August (n = 225, 38.4% response rate), and November (n = 222, 37.9% response rate). Information about alcohol consumption including risky drinking (more than four drinks on one occasion), household structure, solitary drinking, and demographics were collected. We conducted random-effects panel bivariate and multivariable regression analyses predicting the number of standard drinks and risky drinking. RESULTS: Participants with solitary drinking occasions consumed more and had more risky drinking occasions than participants with no solitary drinking occasions, which was also found to be the case during lockdown. Living without other adults was associated with less consumption and less risky drinking than living with other adults. However, participants who lived without other adults and had frequent solitary drinking occasions (solitary drinking in >50% drinking occasions) reported more consumption than participants without a solitary drinking occasion. CONCLUSIONS: Individuals who consume alcohol alone and live without other adults or spend long periods of time at home may be more at risk of alcohol-related harm.

Drinking alcohol at home feels different from drinking in public places: a qualitative study of midlife Australians.

This paper shows how drinking in one's own home affords different affective experiences to drinking in public settings such as bars, pubs and restaurants. A thematic analysis of interviews with 40 Australians aged 30-65 identified three main variations in alcohol-associated feelings, sensations and urges. Alcohol was used at home to decelerate, but in contrast, people were enlivened when drinking in public venues. Drinking in public generated a sense of vigilance and greater requirement to self-monitor than usually felt necessary at home. For some, drinking at home seemed more habitual; governed by urges rather than intentionality, than drinking outside it did. Policy and interventions that target drinking in the home should be prioritised, such as those focussed on off-premise pricing and availability.

How did COVID-19 restrictions impact alcohol consumption in Australia? A longitudinal study.

INTRODUCTION: The state of Victoria experienced more stringent public health measures than other Australian states during the COVID-19 pandemic. This study investigated how these public health measures impacted: (i) total alcohol consumption; (ii) location-specific consumption; and (iii) consumption among different pre-pandemic drinking groups, in Victoria compared to the rest of Australia during the first year of the pandemic. METHOD: A longitudinal study with six survey waves was conducted between April and December 2020. A total of 775 adults completed data on alcohol use, including detailed consumption location information. Based on their 2019 consumption, participants were classified into low, moderate or high-risk groups. Data were analysed descriptively. RESULTS: There was no difference in total alcohol consumption from 2019 levels among Victorians and those from the other Australian states when Victoria was the only state in lockdown. Location-specific consumption was relatively similar for Victoria and the rest of Australia, with an increase in home drinking, and a decrease in consumption in someone else's home, licensed premises and public spaces during lockdown compared with 2019. Participants in the high-risk group reported a reduction of two standard drinks per day in November 2020 compared with 2019. In contrast, consumption remained relatively stable for participants in the low and moderate-risk groups once accounting for regression to the mean. DISCUSSION AND CONCLUSION: Contrary to expectations, restrictions on licensed premises appeared to impact high-risk drinkers more than low and moderate-risk drinkers. Reducing availability of on-premise alcohol may be an effective way to reduce consumption in heavier drinkers.

Development and Validation of the Cheers Attitudes towards Non-drinkers Scale (CANS).

Non-drinkers report experiencing stigma, which can act as a barrier to non-drinking. Two studies were undertaken to develop and test a new scale to measure attitudes towards non-drinkers. In Study 1, 29 items were presented to 426 Australian drinkers. In Study 2, the refined 12-item Cheers Attitudes to Non-drinkers Scale (CANS) was presented to 389 drinkers. Alcohol consumption, Harm and the Regan Attitudes towards Non-drinkers Scale (RANDS) were presented for scale validation. Exploratory factor analysis revealed three factors representing the Threats to Fun, Connection and Self that drinkers perceive non-drinkers to pose. Confirmatory factor analysis showed that the scale meets the required fit indices and had good reliability (α = 0.842). Evidence of validity was shown through significant correlations with Alcohol Consumption, Harm and the RANDS. These studies show the CANS to be a reliable and valid measure that could be utilised to understand and modify the stigma experienced by non-drinkers.

Characteristics of high- and low-risk drinkers who use online alcohol home delivery in Western Australia.

INTRODUCTION: Variation in alcohol availability is an important driver of levels of consumption and harm, with recent increases in online alcohol home delivery use expanding availability. There is limited research on the impacts of these changes and the characteristics of consumers who use alcohol home delivery. METHODS: This study presents findings from an online survey (n = 465) of Western Australian adults who had purchased alcohol for home delivery within the past 6 months. Analyses compared high-risk and low-risk drinkers on use of, and exposure to, alcohol home delivery. RESULTS: Compared to low-risk drinkers, high-risk drinkers were significantly more likely to make more frequent online purchases (odds ratio 5.42), utilise same day delivery (odds ratio 2.91) and purchase through specialised online-only retailers (odds ratio 2.69). High-risk drinkers also reported receiving deliveries while intoxicated more often (odds ratio 11.62), and ordering alcohol for delivery to continue a current drinking session (odds ratio 7.47). High-risk drinkers also received advertising for alcohol home delivery more frequently (odds ratio 1.60) than low-risk drinkers. High-risk drinkers also ordered larger quantities of alcohol than low-risk drinkers (M = 49 vs. 32 standard drinks). DISCUSSION AND CONCLUSIONS: Findings from this study indicate that these services are popular with high-risk drinkers and potentially undermine other policy efforts to reduce drinking. Within Australia, stronger legislation (such as mandatory delay between order and delivery) and monitoring (e.g., test purchasing for compliance) are recommended.

Examining the association between psychological distress and alcohol use in Australian adolescents over a period of declining consumption.

INTRODUCTION: Youth drinking rates have declined over the past 15 years while self-reported psychological distress has increased, despite a well-recognised positive relationship between the two. The current study aimed to identify changes in the relationship between psychological distress and alcohol use in adolescents from 2007 to 2019. METHODS: This study used survey responses from 6543 Australians aged 14-19 years who completed the National Drug Strategy Household Survey in 2007, 2010, 2013, 2016 or 2019. Logistic and multivariable linear regressions with interactions (psychological distress × survey wave) predicted any alcohol consumption, short-term risk and average quantity of standard drinks consumed per day. RESULTS: Psychological distress was a positive predictor of alcohol use and this association remained stable across survey waves as alcohol consumption decreased. DISCUSSION AND CONCLUSIONS: The relationship between distress and alcohol consumption remained relatively steady, even as youth drinking declined and distress increased. The proportion of drinkers experiencing distress did not increase as consumption rates dropped, suggesting that the decline in youth drinking is occurring independently of the increase in self-reported and diagnosed mental health issues.

Have the personality and socio-demographic profiles of Australian adolescent drinkers changed?

INTRODUCTION: Adolescent alcohol consumption has been declining across many countries, with rates of abstinence also increasing among younger cohorts. A range of socio-demographic variables and personality traits are associated with alcohol use; however, no study has examined whether the relationship between personality and drinking has changed over time as adolescent drinking has declined. METHODS: Data from 15- to 17-year-old respondents were extracted from four waves (2004/2005, 2008/2009, 2012/2013, 2016/2017) of a long running Australian cohort study. Logistic regression analyses with interaction terms were used to determine whether personality traits (openness, conscientiousness, extraversion, agreeableness and emotional stability) and socio-demographic variables (age, gender, equivalised income, family structure, cultural background, school attendance and regionality) significantly differed between drinkers and abstainers and whether these relationships changed across cohorts. RESULTS: The prevalence of drinking for 15- to 17-year-olds significantly declined over each survey wave from 54% in 2004/2005 to 24% in 2016/2017. Conscientiousness (odds ratio [OR] 0.82, confidence interval [CI] = 0.73, 0.93), extraversion ([OR] 1.25, [CI] = 1.11, 1.40) and emotional stability ([OR] 0.73, [CI] = 0.64, 0.83) were all significant predictors of alcohol consumption. No significant interactions between cohort and personality traits or socio-demographic variables were found. DISCUSSION AND CONCLUSIONS: The study found no evidence to indicate that the relationship between adolescent alcohol consumption and personality has changed. Similarly, socio-demographic relationships with drinking were stable as drinking prevalence dropped by more than half. This adds to the evidence that drinking declines among adolescents are spread broadly across the population and not concentrated within identifiable sub-groups of young people.

Shifts in the Australian public's opinions towards alcohol policies: 2004-2019.

INTRODUCTION: After a period of stagnation, alcohol policy in Australia has received increased attention in the past decade, with Sydney's lockout laws and Queensland's restrictions on trading hours garnering media attention. This study will investigate any changing trends in support towards alcohol policy and identify any demographic-specific shifts. METHODS: Respondents from the National Drug Strategy Household Survey (conducted every 3 years from 2004 to 2019) were asked to gauge their level of support for 16 alcohol policy items proposed to reduce the problems associated with excessive alcohol use. Mean levels of support for various policy options, as well as demographic predictors of support, were assessed. RESULTS: After an increase from 2004 to 2013, support for more evidence-based policies on alcohol (e.g., restricting the availability of alcohol) has decreased since 2013. Support for policy items that focus less on the restriction of the availability of alcohol and more on education remained relatively stable in comparison. While demographic groups continue to vary in their extent of support, shifts appear to be occurring fairly uniformly across sex, age, states and drinking groups. DISCUSSION AND CONCLUSIONS: Support for public health-oriented alcohol policies has been decreasing since 2013. The introduction of high-profile policies and less of a media focus on alcohol may be contributing to decreases in support.

Dose-response relationship between alcohol consumption and workplace absenteeism in Australia.

INTRODUCTION: Workplace absenteeism is a burden in Australia. The estimated productivity losses due to alcohol were around $4.0 billion in 2017, with absenteeism driving 90% of these costs. We aim to determine the dose-response relationship between average daily alcohol consumption and heavy episodic drinking (HED) frequency and workplace absenteeism amongst Australian workers. METHODS: We used the 2019 National Drug Strategy Household Survey of Australian employed workers aged ≥20 years to 69 years old. Respondents' average daily alcohol consumption was categorised into four: abstainers, light to moderate (1-20 g of alcohol/day), risky (>20-40 g of alcohol/day) and high-risk (>40 g of alcohol/day). HED was classified into four frequency measures (never, less than monthly, monthly, weekly). The outcome variables came from dichotomised measures of: (i) absence due to alcohol consumption; and (ii) broader sickness absence-absence due to illness or injury in the previous 3 months. RESULTS: Risky (adjusted odds ratio 4.74 [95% CI 2.93-7.64]) and high-risk drinking (adjusted odds ratio 6.61 [95% CI 4.10-10.68]) were linked to increased odds of alcohol-related absence. Higher HED frequency was significantly associated with alcohol-related and broader sickness absenteeism. No significant associations exist between regular alcohol consumption and broader sickness absence in fully adjusted models. DISCUSSION AND CONCLUSIONS: Findings suggest that only HED is linked to broader sickness absence. However, there is a strong dose-response association between alcohol consumption and alcohol-related absences for both consumption measures amongst Australian workers. Population-level policies that reduce alcohol consumption to moderate level and less frequent HED might address workplace absenteeism.

Who supports drug-checking services in Australia? An analysis of 2019 National Drug Strategy Household Survey data.

INTRODUCTION: Drug-checking services can minimise the potential harms from drug use and have received increased attention in recent policy debates in Australia. In this brief report, we aim to better understand the prevalence of support for drug-checking services among individuals of certain demographic groups, social status and social attitudes towards drug and alcohol policy. METHODS: This report uses data from the 2019 National Drug Strategy Household Survey, a national population study of alcohol and other drug use conducted triennially in Australia. We examined support for drug-checking services descriptively, alongside associations between demographic, social and substance use variables and support of drug-checking using Generalised Linear Model analyses with a Poisson distribution and log link. RESULTS: Overall, 56% of the sample supported policies related to drug-checking services. Support was highest among those aged 25-34 years (62%), most socioeconomically advantaged (66%), with an income over $104,000 (64%), with a bachelor's degree or higher (65%), living in major cities (58%), recent consumers of commonly tested drugs (88%) and other drugs (77%), and risky drinkers (64%). In the multivariable model, those who were younger, women and had the highest level of education were more likely to support the policy compared to those who were aged 55+ years, men and had lower levels of education. DISCUSSION AND CONCLUSION: This report highlights that, while there were different degrees of support based on demographic characteristics, substance use status and social attitudes towards drug and alcohol policy, the overall majority of the sample supported the provision of drug-checking services.

Beverage-specific consumption trends: A cross-country, cross-sectional comparison.

INTRODUCTION: The price of alcoholic beverages can vary for a range of reasons, including tax. Risky drinkers purchase more low-cost alcoholic drinks than moderate drinkers, contributing to beverage-specific risks for that category. The study aimed to examine the proportion of total alcohol consumption comprised by each beverage type and their correlates. Australian and New Zealand populations were compared, where drinking cultures are similar, but taxation of alcohol differs. METHOD: Data was taken from the International Alcohol Control study in Australia (N=1580) and New Zealand (N =1979), a cross national survey that asks questions on beverage specific alcohol consumption at a range of different locations. Tax rates were obtained from previous analyses run on the dataset. RESULTS: Ready to Drink (pre-mixed) beverages are more popular in New Zealand and the proportion of these drinks consumed out of total alcohol consumption by risky drinkers was correspondingly higher there. Conversely, the proportion of wine consumed by risky drinkers was higher in Australia. The consumption of spirits and beer by risky drinkers was similar in both countries. DISCUSSION: Differences found for the proportion of beverages consumed by risky drinkers between the countries are fairly well aligned with differences in the taxation of each drink type. Future adaptations in taxation systems should consider the impact of taxes on preferential beverage choice and associated harms.