Abstinence Among Alcohol Use Disorder Patients During the COVID-19 Pandemic: Insights From Spain.

BACKGROUND: Patients with alcohol use disorder (AUD) are likely to suffer disproportionate harms related to the COVID-19 pandemic and related policy measures. While many surveys have been conducted, most are focused on drinking changes in the general population and validation with biological markers is lacking. METHOD: We performed a retrospective cohort study among patients with AUD attending a urine drug screening program. With mixed-effects logistic regression models, we assessed the probability of screening positive for ethyl glucuronide according to patients' main clinical characteristics and time of analysis (either prior to or after a lockdown was implemented in Spain). RESULTS: A total of 362 patients provided 2,040 urine samples (1,295 prior to lockdown, 745 during lockdown). The mean age of participants was 52.0 years (SD 12.6), and 69.2% were men. Of the 43% of patients tested for other drugs 22% screened positive. After adjusting for all covariates, the odds of screening positive for ethyl glucuronide during lockdown almost doubled (OR = 1.99, 95% CI 1.20 to 3.33, p = 0.008). Other significant covariates included testing positive for other drugs (OR = 10.79, 95% CI 4.60 to 26.97) and length of treatment (OR = 0.59, 95% CI 0.47 to 0.74). CONCLUSIONS: Our data support an association between the lockdown due to COVID-19 and increased alcohol use in patients with AUD. Thus, addiction healthcare systems could face significant challenges ahead. In light of these findings, it is essential to evaluate prospectively how patients with AUD are affected by the pandemic and how health systems respond to their needs.

Do Social Cognition Deficits Recover with Abstinence in Alcohol-Dependent Patients?

BACKGROUND: Despite growing evidence of the presence and clinical relevance of deficits in social cognition in individuals with alcohol use disorder (AUD), less is known about the potential of "natural" recovery with abstinence in this neurocognitive domain. This study investigated the abstinence-based recovery of neurocognitive social abilities in alcohol-dependent patients (ADP) using a prospective longitudinal design with follow-up assessment under controlled conditions of abstinence during alcohol dependence inpatient treatment. METHODS: Seventy-seven participants (42 ADP and 35 healthy controls [HC]) performed social cognition testing, including facial emotion recognition, perspective taking, and affective responsiveness twice (baseline/T1 and follow-up/T2) during comparable follow-up periods. Assessment of social cognition in abstinent ADP was conducted at the beginning (T1; within the first 2 weeks) and at the end (T2; within the last 2 weeks) of long-term (2 months) abstinence-oriented alcohol dependence inpatient treatment. Only patients abstinent for >14 days (last heavy drinking day >21 days) at baseline (T1) and who remained abstinent at follow-up (T2) were included. RESULTS: ADP, who on average were nearly 2 months abstinent at T1, showed poorer social cognition in all 3 areas (emotion recognition, perspective taking, and affective responsiveness) than HC. There was no difference between groups on the change in performance over time, and group differences (ADP vs. HC) remained significant at T2, indicating persistent social cognition deficits in ADP following controlled abstinence during inpatient treatment. CONCLUSIONS: Our findings indicate no natural recovery of social cognition impairments in ADP during an intermediate to long-term period of abstinence (2+ months), the usual active treatment phase. Research aimed at developing interventions that focus on the improvement of social cognition deficits (e.g., social cognition training) and determining whether they benefit short- and long-term clinical outcomes in AUD seems warranted.

Distinct Whole-Body Movements in Response to Alcohol and Sexual Content in Alcohol Use Disorder.

BACKGROUND: Spontaneous motor responses of approach and avoidance toward stimuli are important in characterizing psychopathological conditions, including alcohol use disorder (AUD). However, divergent results have been reported, possibly due to confounded parameters (e.g., using a symbolic vs. a sensorimotor task, implementation of approach-avoidance as a measure vs. a manipulation). METHODS: We studied whole-body/posturometric changes by using a sensorimotor measure relying on embodied cognition principles to assess forward (approach) and backward (avoidance) spontaneous leaning movements. Over a 12-second period, 51 male patients with AUD and 29 male control participants were instructed to stand still in response to both alcohol and sexual visual content. Patients with AUD were then divided into "abstainers" and "relapsers," depending on their continuous abstinence at 2 weeks postdischarge (obtained via a telephone follow-up interview). The effects of the group, the stimulus type, the experimental period, and their interactions on the posturometric changes were tested using mixed Analyses of variance (ANOVAs), with a significance threshold set at 0.05. RESULTS: Contrary to our expectations, patients and controls did not show significant difference in their forward/backward micromovements while passively viewing alcohol or sexual content (p > 0.1). However, in line with our hypothesis, patients who relapsed several weeks following discharge from the rehabilitation program were significantly more reactive and more likely to lean back during the first seconds of viewing alcohol cues (p = 0.002). Further, "relapsers" were more likely to lean forward during exposure to sexual content than participants who remained abstinent (p < 0.001). CONCLUSIONS: Among individuals with AUD, there are distinct pattern of spontaneous movements that differentiate "abstainers" and "relapsers," findings that can be understood in light of existing data and theories on action tendencies.

Assessment of Changes in Alcohol and Marijuana Abstinence, Co-Use, and Use Disorders Among US Young Adults From 2002 to 2018.

Importance: Recent information on the trends in past-year alcohol abstinence and marijuana abstinence, co-use of alcohol and marijuana, alcohol use disorder, and marijuana use disorder among US young adults is limited. Objectives: To assess national changes over time in past-year alcohol and marijuana abstinence, co-use, alcohol use disorder, and marijuana use disorder among US young adults as a function of college status (2002-2018) and identify the covariates associated with abstinence, co-use, and marijuana use disorder in more recent cohorts (2015-2018). Design, Setting, and Participants: This study examined cross-sectional survey data collected in US households annually between 2002 and 2018 as part of the National Survey on Drug Use and Health. The survey used an independent, multistage area probability sample for all states to produce nationally representative estimates. The sample included 182 722 US young adults aged 18 to 22 years. The weighted screening and weighted full interview response rates were consistently above 80% and 70%, respectively. Main Outcomes and Measures: Measures included past-year abstinence, alcohol use, marijuana use, co-use, alcohol use disorder, marijuana use disorder, prescription drug use, prescription drug misuse, prescription drug use disorder, and other drug use disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Results: The weighted sample comprised 51.1% males. Between 2002 and 2018, there was an annual increase in past-year alcohol abstinence among young adults (college students: 0.54%; 95% CI, 0.44%-0.64%; non-college students: 0.33%; 95% CI, 0.24%-0.43%). There was an annual increase in marijuana use from 2002 to 2018 (college: 0.46%; 95% CI, 0.37%-0.55%; non-college: 0.49%; 95% CI, 0.40%-0.59%) without an increase in marijuana use disorder for all young adults. Past-year alcohol use disorder decreased annually (college: 0.66%; 95% CI, 0.60%-0.74%; non-college: 0.61%; 95% CI, 0.55%-0.69%), while co-use of alcohol and marijuana increased annually between 2002 and 2018 among all young adults (college: 0.60%; 95% CI, 0.51%-0.68%; non-college: 0.56%; 95% CI, 0.48%-0.63%). Young adults who reported co-use of alcohol and marijuana or met criteria for alcohol use disorder and/or marijuana use disorder accounted for 82.9% of young adults with prescription drug use disorder and 85.1% of those with illicit drug use disorder. More than three-fourths of those with both alcohol use disorder and marijuana use disorder reported past-year prescription drug use (78.2%) and illicit drug use (77.7%); 62.2% reported prescription drug misuse. Conclusions and Relevance: The findings of this study suggest that US colleges and communities should create and maintain supportive resources for young adults as the substance use landscape changes, specifically as alcohol abstinence, marijuana use, and co-use increase. Interventions for polysubstance use, alcohol use disorder, and marijuana use disorder may provide valuable opportunities for clinicians to screen for prescription drug misuse.

Patterns of transitions between relapse to and remission from heavy drinking over the first year after outpatient alcohol treatment and their relation to long-term outcomes.

OBJECTIVES: Studying clinical course after alcohol use disorder (AUD) treatment is central to understanding longer-term recovery. This study's two main objectives were to (a) replicate a recent study that identified heterogeneity in patterns of remission from/relapse to heavy drinking during the first year after outpatient treatment in an independent data set and (b) extend these recent findings by testing associations between patterns of remission/relapse and long-term alcohol-related and functioning outcomes. METHOD: Latent profile analyses were conducted using data from Project MATCH (N = 952; M age = 38.9; 72.3% female) and COMBINE (N = 1,383; M age = 44.4; 69.1% male). Transitions between heavy and nonheavy drinking within consecutive 2-week periods over a 1-year posttreatment period were characterized for each participant. From this, latent profiles were identified based on participants' initial 2-week heavy drinking status, the number of observed transitions between 2-week periods of relapse and remission, and the average duration of observed remission/relapse episodes. RESULTS: In both MATCH and COMBINE, we identified six profiles: (a) "continuous remission," 25.3% of COMBINE sample/25.3% of MATCH sample; (b) "transition to remission," 19.6%/9.6%; (c) "few long transitions," 15.9%/33.7%; (d) "many short transitions," 13.2%/13.6%; (e) "transition to relapse," 7.2%/7.1%; and (f) "continuous relapse," 18.8%/10.5%. Profiles 1 and 2 had the best long-term outcomes, Profiles 5 and 6 had the worst, and Profiles 3 and 4 fell between these groups. CONCLUSIONS: That many individuals can remit from heavy drinking following one or more relapses to heavy drinking may be of direct interest to individuals in recovery from AUD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The physiological responses to acute stress in alcohol-dependent patients: A systematic review.

Dysregulation of physiological stress reactivity plays a key role in the development and relapse risk of alcohol dependence. This article reviews studies investigating physiological responses to experimentally induced acute stress in patients with alcohol dependence. A systematic search from electronic databases resulted in 3641 articles found and after screening 62 articles were included in our review. Studies are analyzed based on stress types (i.e., social stress tasks and nonsocial stress tasks) and physiological markers (i.e., the nervous system, the endocrine system, somatic responses and the immune system). In studies applying nonsocial stress tasks, alcohol-dependent patients were reported to show a blunted stress response compared with healthy controls in the majority of studies applying markers of adrenocorticotropic hormone and cortisol. In studies applying social stress tasks, findings are inconsistent, with less than half of the studies reporting altered physiological stress responses in patients. We discuss the impact of duration of abstinence, comorbidities, baseline physiological arousal and intervention on the discrepancy of study findings. Furthermore, we review evidence for an association between blunted physiological stress responses and the relapse risk among patients with alcohol dependence.

Alcoholics Anonymous and 12-Step Facilitation Treatments for Alcohol Use Disorder: A Distillation of a 2020 Cochrane Review for Clinicians and Policy Makers.

AIMS: A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy. METHODS: Cochrane review methods were followed. Searches were conducted across all major databases (e.g. Cochrane Drugs and Alcohol Group Specialized Register, PubMed, Embase, PsycINFO and ClinicalTrials.gov) from inception to 2 August 2019 and included non-English language studies. Randomized controlled trials (RCTs) and quasi-experiments that compared AA/TSF with other interventions, such as motivational enhancement therapy (MET) or cognitive behavioral therapy (CBT), TSF treatment variants or no treatment, were included. Healthcare cost offset studies were also included. Studies were categorized by design (RCT/quasi-experimental; nonrandomized; economic), degree of manualization (all interventions manualized versus some/none) and comparison intervention type (i.e. whether AA/TSF was compared to an intervention with a different theoretical orientation or an AA/TSF intervention that varied in style or intensity). Random-effects meta-analyses were used to pool effects where possible using standard mean differences (SMD) for continuous outcomes (e.g. percent days abstinent (PDA)) and the relative risk ratios (RRs) for dichotomous. RESULTS: A total of 27 studies (21 RCTs/quasi-experiments, 5 nonrandomized and 1 purely economic study) containing 10,565 participants were included. AA/TSF interventions performed at least as well as established active comparison treatments (e.g. CBT) on all outcomes except for abstinence where it often outperformed other treatments. AA/TSF also demonstrated higher health care cost savings than other AUD treatments. CONCLUSIONS: AA/TSF interventions produce similar benefits to other treatments on all drinking-related outcomes except for continuous abstinence and remission, where AA/TSF is superior. AA/TSF also reduces healthcare costs. Clinically implementing one of these proven manualized AA/TSF interventions is likely to enhance outcomes for individuals with AUD while producing health economic benefits.

Current and potential pharmacological treatment options for insomnia in patients with alcohol use disorder in recovery.

Alcohol use disorder (AUD) is characterized by dysfunction in motivational, mood-stress regulation, and sleep systems that interact in complex ways to heighten the risk of relapse during abstinence. Emerging data suggest that excessive and chronic alcohol use disrupts sleep homeostasis and, in abstinence, subjects with AUD are known to experience insomnia that may persist for weeks to years, which we propose to refer to as insomnia associated with alcohol cessation (IAAC). The purpose of this review is to provide an update of pharmacological approaches to therapy including compounds in development, to raise awareness of the prevalence of and unmet need in IAAC and highlight differences in treatment consideration for IAAC as compared to insomnia disorder. We performed a search of select electronic databases to identify studies of pharmacological agents used to treat sleep disturbances in abstinent or treatment-seeking patients with alcohol use disorder. The search, conducted in June 2019 and updated in December 2019, yielded 1,188 abstracts after duplicates were removed, of which 36 full-text articles were assessed for eligibility. Eighteen studies were included, 15 randomized controlled trials and three open-label studies. Several classes of medications including antidepressants, anticonvulsants, and antipsychotics have been evaluated for their effectiveness in treating sleep disturbances in abstinent or treatment-seeking patients with AUD. None of these medications are approved by the FDA for the treatment of IAAC, and the currently available evidence for these agents is limited. Randomized, controlled clinical trials are warranted to evaluate the efficacy and safety of medications in the treatment of IAAC.

Cerebellar Morphometry and Cognition in the Context of Chronic Alcohol Consumption and Cigarette Smoking.

BACKGROUND: Cerebellar atrophy (especially involving the superior-anterior cerebellar vermis) is among the most salient and clinically significant effects of chronic hazardous alcohol consumption on brain structure. Smaller cerebellar volumes are also associated with chronic cigarette smoking. The present study investigated effects of both chronic alcohol consumption and cigarette smoking on cerebellar structure and its relation to performance on select cognitive/behavioral tasks. METHODS: Using T1-weighted Magnetic Resonance Images (MRIs), the Cerebellar Analysis Tool Kit segmented the cerebellum into bilateral hemispheres and 3 vermis parcels from 4 participant groups: smoking (s) and nonsmoking (ns) abstinent alcohol-dependent treatment seekers (ALC) and controls (CON) (i.e., sALC, nsALC, sCON, and nsCON). Cognitive and behavioral data were also obtained. RESULTS: We found detrimental effects of chronic drinking on all cerebellar structural measures in ALC participants, with largest reductions seen in vermis areas. Furthermore, both smoking groups had smaller volumes of cerebellar hemispheres but not vermis areas compared to their nonsmoking counterparts. In exploratory analyses, smaller cerebellar volumes were related to lower measures of intelligence. In sCON, but not sALC, greater smoking severity was related to smaller cerebellar volume and smaller superior-anterior vermis area. In sALC, greater abstinence duration was associated with larger cerebellar and superior-anterior vermis areas, suggesting some recovery with abstinence. CONCLUSIONS: Our results show that both smoking and alcohol status are associated with smaller cerebellar structural measurements, with vermal areas more vulnerable to chronic alcohol consumption and less affected by chronic smoking. These morphometric cerebellar deficits were also associated with lower intelligence and related to duration of abstinence in sALC only.

Drinking, Social Abstaining, and Refusing Invitations: Demographic Differences Persist Across College.

BACKGROUND: Alcohol use and misuse are prevalent on many college campuses. The current study examined participation in college environments where alcohol is present and being consumed. We documented students' alcohol consumption, social abstaining (i.e., attending an alcohol-present event, but not drinking), and refusing invitations to drinking events. We tested for differences by parental education, immigrant status, race-ethnicity, and gender. We charted longitudinal change across college. METHODS: First-year students attending a large public US university (n = 681, 18% first-generation college student, 16% first-generation immigrant, 73% racial-ethnic minority group member, 51% women) were recruited and followed longitudinally for 7 semesters. Each semester, students completed up to 14 daily surveys; responses were aggregated to the semester level (n = 4,267). RESULTS: Multilevel logistic regression models demonstrated that first-generation college students were less likely to drink and refuse invitations to drinking events than students with a college-educated parent (Adjusted Odds Ratios [AORs]: 0.66, 0.72, respectively). Similarly, first-generation immigrants were less likely to drink, socially abstain, and refuse invitations (AORs: 0.58 to 0.73). Compared with White students, Black and Asian American students were less likely to drink (AORs: 0.55, 0.53) and refuse invitations to drinking events (AORs: 0.68, 0.66). The proportion of days spent drinking increased across college, and refusing invitations was the most common at the start and end of college. CONCLUSIONS: First-generation college students, first-generation immigrant students, and Black and Asian students participated less in prodrinking environments during college. These findings indicate that on drinking and nondrinking days, students' participation in alcohol-present situations differed by background. Furthermore, our results indicate that the students who are most likely to refuse invitations to drinking events are the same students who drink most frequently.

Trends in binge drinking and alcohol abstention among adolescents in the US, 2002-2016.

BACKGROUND: Binge drinking accounts for several adverse health, social, legal, and academic outcomes among adolescents. Understanding trends and correlates of binge drinking and alcohol abstention has important implications for policy and programs and was the aim of this study. The current study examined trends in adolescent binge drinking and alcohol abstention by age, gender, and race/ethnicity over a 15-year period. METHODS: Respondents between the ages of 12 and 17 years who participated in the National Survey on Drug Use and Health (NSDUH) between 2002 and 2016 were included in the sample of 258,309. Measures included binge drinking, alcohol abstention, and co-morbid factors (e.g., marijuana, other illicit drugs), and demographic factors. RESULTS: Logistic regression analyses were conducted to examine the significance of trend changes by sub-groups while controlling for co-morbid and demographic factors. Findings indicated that binge drinking decreased substantially among adolescents in the US over the last 15 years. This decrease was shown among all age, gender, and racial/ethnic groups. In 2002, Year 1 of the study, 26% of 17-year-olds reported past-month binge drinking; in 2016, past-month binge drinking dropped to 12%. Findings also indicated comparable increases in the proportion of youth reporting abstention from alcohol consumption across all subgroups. Black youth reported substantially lower levels of binge alcohol use and higher levels of abstention, although the gap between Black, Hispanic and White youth narrowed substantially between 2002 and 2016. CONCLUSION: Study findings are consistent with those of other research showing declines in problem alcohol- use behavior among youth.

Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study.

BACKGROUND: Alcohol use is a leading risk factor for global disease burden, and data on alcohol exposure are crucial to evaluate progress in achieving global non-communicable disease goals. We present estimates on the main indicators of alcohol exposure for 189 countries from 1990-2017, with forecasts up to 2030. METHODS: Adult alcohol per-capita consumption (the consumption in L of pure alcohol per adult [≥15 years]) in a given year was based on country-validated data up to 2016. Forecasts up to 2030 were obtained from multivariate log-normal mixture Poisson distribution models. Using survey data from 149 countries, prevalence of lifetime abstinence and current drinking was obtained from Dirichlet regressions. The prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) was estimated with fractional response regressions using survey data from 118 countries. FINDINGS: Between 1990 and 2017, global adult per-capita consumption increased from 5·9 L (95% CI 5·8-6·1) to 6·5 L (6·0-6·9), and is forecasted to reach 7·6 L (6·5-10·2) by 2030. Globally, the prevalence of lifetime abstinence decreased from 46% (42-49) in 1990 to 43% (40-46) in 2017, albeit this was not a significant reduction, while the prevalence of current drinking increased from 45% (41-48) in 1990 to 47% (44-50) in 2017. We forecast both trends to continue, with abstinence decreasing to 40% (37-44) by 2030 (annualised 0·2% decrease) and the proportion of current drinkers increasing to 50% (46-53) by 2030 (annualised 0·2% increase). In 2017, 20% (17-24) of adults were heavy episodic drinkers (compared with 1990 when it was estimated at 18·5% [15·3-21·6%], and this prevalence is expected to increase to 23% (19-27) in 2030. INTERPRETATION: Based on these data, global goals for reducing the harmful use of alcohol are unlikely to be achieved, and known effective and cost-effective policy measures should be implemented to reduce alcohol exposure. FUNDING: Centre for Addiction and Mental Health and the WHO Collaborating Center for Addiction and Mental Health at the Centre for Addiction and Mental Health.

Outcome in Relation to Drinking Goals in Alcohol-Dependent Individuals: A Follow-up Study 2.5 and 5 Years After Treatment Entry.

AIMS: To evaluate the long-term treatment outcome (up to 5 years) with respect to different drinking goals of patients. METHODS: Alcohol-dependent individuals (n = 349) were recruited from three alcohol treatment units. They were interviewed using the Addiction Severity Index (ASI). They were sub-grouped according to their goal at treatment entry: abstinence, low- risk drinking and no decided goal. RESULTS: Patients with abstinence as a goal at treatment entry reported at 2.5 years follow-up a higher abstinence rate, a more pronounced reduction in alcohol consumption, reduction in total number of DSM-IV criteria, higher frequency of low-risk drinking and fewer diagnoses of alcohol dependence compared to the groups who had low risk drinking as a goal or no decided goal. This improvement remained basically unchanged in all three groups at 5 years follow-up, suggesting long-term stability after the treatment interventions. CONCLUSIONS: The findings suggest that: (1) alcohol-dependent patients who have abstinence as their own drinking goal have a more favorable treatment outcome than those who have low-risk drinking as a goal or no decided goal. (2) Abstinence as a drinking goal should be considered for those who have a longer duration (for example more than 10 years) of their alcohol-related problems. (3) Patients who have no decided goal should be recommended abstinence as a drinking goal.

Emotional and autonomic dysregulation in abstinent alcoholic men: An idiosyncratic profile?

Men who misuse alcohol tend to experience negative affect, which may entail difficulties in regulating emotions to cope effectively with stressful or anxiety-provoking situations, thus increasing the risk of alcohol relapse. This dysphoric state has been associated with alexithymia, which compromises an individual's abilities to acknowledge, recognize, and regulate emotional states. A physiological correlate of emotional regulation is autonomic flexibility, as shown by emotional dysregulation in men who misuse alcohol being correlated with reduced parasympathetic activation to control heart rate variability during stress and/or conflict situations. Hence, the main aim of this study was to investigate whether long-term abstinent alcoholic (LTAA) men exhibit higher levels of negative affect and sympathetic activation (cardiovascular and electrodermal) in response to acute standardized laboratory stress than non-alcoholic controls. In addition, we hypothesized that the higher the alexithymic traits, the greater would be the increase in negative affect and sympathetic activation in response to stress, especially in LTAAs. Our data demonstrated that LTAAs experienced slightly greater increases in anxiety, states of anger, and worsening of mood than controls. Moreover, they exhibited lower high-frequency heart rate variability, respiratory sinus arrhythmia values, shorter pre-ejection periods, and higher respiratory rates than controls. Finally, alexithymic traits imply greater worsening of mood and sympathetic predominance (shorter pre-ejection periods and smaller magnitude of response), with the associations being stronger in LTAAs. These findings indicate a different emotional and cardiovascular response to psychosocial stress in LTAA than non-alcoholic men. Improving our knowledge of the way this population reacts to stress may help identify risk factors for alcohol relapse.

Patterns in Reduction or Cessation of Drinking in Australia (2001-2013) and Motivation for Change.

AIMS: This paper examines: (a) change over time (2001-2013) in recently reducing or ceasing drinking in the Australian population and (b) the reasons given for reducing or ceasing drinking in the most recent survey (2013); stratified by sex and age group. SHORT SUMMARY: Rates of reducing and ceasing drinking increased between 2001 and 2013 in Australia. Young people were more likely to modify drinking due to lifestyle and enjoyment reasons; older groups were more likely to report health reasons. These trends contribute to the broader context of declining alcohol consumption in Australia. METHODS: Data are from five waves of the National Drug Strategy Household Survey (N = 119,397). Logistic regression models with interaction terms were used to identify a shift in sex or age over time in predicting reduction or cessation of drinking and to predict motivations for reducing or ceasing drinking by sex and age. RESULTS: Reports of recently reducing the quantity or frequency of drinking increased from 2001 to 2007 and remained stable between 2007 and 2013. There was a steady increase in the number of Australians reporting recently ceasing drinking from 2001 to 2013, with a significant effect for age (younger groups more likely than older groups to cease drinking in the past two waves). Reasons for reducing or ceasing drinking varied by age, with older people more likely to report health reasons and younger people more likely to report lifestyle reasons or enjoyment. CONCLUSION: Increases over time in reports of reduction or cessation of drinking due to health, lifestyle, social and enjoyment reasons suggest that the social position of alcohol in Australia may be shifting, particularly among young people.

U.S. College Students' Social Network Characteristics and Perceived Social Exclusion: A Comparison Between Drinkers and Nondrinkers Based on Past-Month Alcohol Use.

OBJECTIVE: There is a general perception on college campuses that alcohol use is normative. However, nondrinking students account for 40% of the U.S. college population. With much of the literature focusing on intervening among drinkers, there has been less of a focus on understanding the nondrinker college experience. The current study has two aims: to describe the social network differences between nondrinkers and drinkers in a college setting, and to assess perceived social exclusion among nondrinkers. METHOD: First-year U.S. college students (n = 1,342; 55.3% female; 47.7% non-Hispanic White) were participants in a larger study examining a social network of one college class and network associations with alcohol use. Alcohol use, sociocentric and egocentric network ties were assessed, as were experiences of social exclusion related to nondrinking. RESULTS: Drinking homophily based on past-month use was found; students tended to associate with others with a similar drinking status. Compared with drinkers, nondrinkers received fewer network nominations within the first-year network and made more nominations outside the first-year network. Nondrinkers' perceived social exclusion was positively related to the number of drinkers in their social networks, such that those with more drinkers in their network reported more social exclusion. CONCLUSIONS: College students' past-month drinking status in the first semester of college is related to their network position and perception of social exclusion. Nondrinking students who are part of a nondrinking community are less likely to feel socially excluded. Improving our understanding of the nondrinker college experience should improve support services for these students.

Elderly alcoholics compared to middle-aged alcoholics in outpatient treatment - 6-month follow-up.

PURPOSE: This study examined 6-month drinking outcomes of elderly patients compared with middle-aged patients in a clinical sample after initiation of outpatient treatment for alcoholism. MATERIALS AND METHODS: In a clinical prospective cohort study, 1398 consecutive patients from a municipality outpatient alcohol clinic were included. A total of 208 elderly patients aged from 60 to 82 years and 1190 middle-aged patients from 40 to 59 years participated in the study. The following psychosocial treatment interventions were offered: cognitive behavioral therapy, family therapy and supportive consultations. Using an 'intention-to-treat' method, primary outcomes included drinking outcomes (self-reported abstinence rates, drinking 3 drinks or less per day, and change in Addiction Severity Index [ASI] composite scores) during the 30 days prior to 6-month follow-up; secondary outcome was compliance to the recommended treatment. RESULTS: Compared to middle-aged, among elderly patients a higher proportion were females (33.5% vs. 42.8%) and had a lower family/social ASI-composite score (0.17 vs. 0.12) at baseline. Higher alcohol and family/social ASI-composite scores were inversely correlated with abstinence. Elderly patients had a higher chance for abstinence compared to middle-aged patients (Odds ratio 95% [confidence interval]) 1.40 (1.03-1.92). The proportion of elderly patients that drank 3 or less drinks per day was 17.8%, compared to 10.8% among middle-aged (p < .01). Finally, elderly patients obtained a higher compliance, which was similarly associated with abstinence (OR =2.46 (1.95-3.11)). DISCUSSION AND CONCLUSIONS: Elderly patients, who receive psychosocial outpatient treatment for alcoholism, have better 6-month outcomes within a range of drinking outcome measures compared to middle-aged patients.

Investigating the growing trend of non-drinking among young people; analysis of repeated cross-sectional surveys in England 2005-2015.

BACKGROUND: Non-drinking among young people has increased over the past decade in England, yet the underlying factor driving this change is unknown. Traditionally non-drinking has been found to be associated with lower socio-economic status and poorer health. This study explores among which sub-groups non-drinking has increased, and how this correlates with changes in drinking patterns, to identify whether behaviours are becoming more polarised, or reduction is widespread among young people. METHODS: Among participants aged 16 to 24 years (N = 9699), within the annual cross-sectional nationally-representative Health Survey for England 2005-2015 datasets, the following analyses were conducted: 1) The proportion of non-drinkers among social-demographic and health sub-groups by year, and tests for linear trends among sub-groups, adjusting for age were calculated. In pooled analyses, an interaction between year and each variable was modelled in sex- and age-adjusted logistic regression models on the odds of being a non-drinker versus drinker 2) At the population level, spearman correlation co-efficients were calculated between the proportion non-drinking and the mean alcohol units consumed and binge drinking on the heaviest drinking day, by year. Ordinary least squares regression analyses were used, modelling the proportion non-drinking as the independent variable, and the mean units/binge drinking as the dependent variable. RESULTS: Rates of non-drinking increased from 18% (95%CI 16-22%) in 2005 to 29% (25-33%) in 2015 (test for trend; p < 0.001), largely attributable to increases in lifetime abstention. Not drinking in the past week increased from 35% (32-39%) to 50% (45-55%) (p < 0.001). Significant linear increases in non-drinking were found among most sub-groups including healthier sub-groups (non-smokers, those with high physical activity and good mental health), white ethnicity, north and south regions, in full-time education, and employed. No significant increases in non-drinking were found among smokers, ethnic minorities and those with poor mental health. At the population-level, significant negative correlations were found between increases in non-drinking and declines in the mean units consumed (ρ = - 0.85, p < 0.001), and binge drinking (ρ = - 0.87, p < 0.001). CONCLUSION: Increases in non-drinking among young people has coincided with a delayed initiation into alcohol consumption, and are to be welcomed. Future research should explore attitudes towards drinking among young people.

Emotional Communication in Long-Term Abstained Alcoholics.

BACKGROUND: Alcoholism is associated with difficulties in perceiving emotions through nonverbal channels including prosody. The question whether these difficulties persist to long-term abstinence has, however, received little attention. METHODS: In a 2-part investigation, emotional prosody production was investigated in long-term abstained alcoholics and age- and education-matched healthy controls. First, participants were asked to produce semantically neutral sentences in different emotional tones of voice. Samples were then acoustically analyzed. Next, naïve listeners were asked to recognize the emotional intention of speakers from a randomly collected subset. Voice quality indicators were also assessed by the listeners. RESULTS: Findings revealed emotional prosody production differences between the 2 groups. Differences were particularly apparent when looking at pitch use. Alcoholics' mean and variability of pitch differed significantly from controls' use. The use of loudness was affected to a lesser extent. Crucially, naïve raters confirmed that the intended emotion was more difficult to recognize from exemplars produced by alcoholics. Differences between the 2 groups were also found with regard to voice quality. CONCLUSIONS: These results suggest that emotional communication difficulties can persist long after alcoholics have quit drinking.

Tension reduction and affect regulation: An examination of mood indices on drinking and non-drinking days among university student drinkers.

Several theories posit problematic alcohol use develops through mechanisms of positive and negative reinforcement. However, the literature on these mechanisms remains inconsistent. This may be due to a number of issues including a failure to disaggregate negative mood or a failure to account for mood functioning (i.e., stability in mood). Alternatively, there may be differences in typical postdrinking/evening mood on drinking and nondrinking days, however, this has yet to be fully explored. We examined multiple indices of distinct mood states prior to and after typical drinking onset times on drinking and nondrinking days using ecological momentary assessment. College student drinkers (n = 102) carried personal data devices for 15 days. They reported on mood and alcohol use several times per day. Tonic positive mood was higher on drinking days than nondrinking days prior to typical drinking initiation. After typical drinking times, positive mood was higher on drinking days than nondrinking days. Similarly, negative moods (anxiety, stress, anger, and stress instability) indicated a pattern of lower levels relative to both predrinking mood on drinking days, and matched mood time-points on nondrinking days; though, not all of these differences were statistically different. Results suggest positive and negative reinforcing mechanisms may be at play-though the negative reinforcement effects may manifest through subjectively "better" mood on drinking versus nondrinking days. (PsycINFO Database Record