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.

Investigating the added effects of guidance in digital psychological self-care for alcohol problems (ALVA)-protocol for a randomized factorial optimization trial.

BACKGROUND: The continual development and implementation of effective digital interventions is one important strategy that may serve to bridge the well-known treatment gap related to problematic alcohol use. Research suggests that clinician guidance, provided in different ways during the digital intervention (i.e., written weekly messages, phone calls etc.), can boost intervention engagement and effects. Digital psychological self-care (DPSC) is a new delivery format wherein an unguided digital intervention is provided within the framework of a structured care process that includes initial clinical assessment and follow-up interviews. In a recent feasibility study, a DPSC intervention for problematic alcohol use, ALVA, provided without any extra guidance, was found safe and credible and to have promising within-group effects on alcohol consumption. The aim of the current study is to gather information on the effects and efficiency of different forms of guidance added to ALVA, in order to optimize the intervention. METHODS: This protocol describes a randomized factorial trial where the effects of two different ways of providing guidance (mid-treatment interview, weekly written messages, respectively) in DPSC for problematic alcohol use are investigated. Optimization criteria will be applied to the results regarding how effective the intervention is at reducing alcohol consumption measured by the number of standard drinks per week together with the clinician time spent on guidance. DISCUSSION: This study will investigate the added benefit of different forms of guidance to DPSC for problematic alcohol use. These added effects will be compared to the added cost of guidance, according to pre-defined optimization criteria. TRIAL REGISTRATION: Clinicaltrials.gov: NCT05649982. Registered on 06 December 2022. Prospectively registered.

Age Specificity of Effects of Health Problems on Drinking Reduction: A Lifespan Developmental Analysis.

Older adult drinking poses a growing public health concern, especially given the ongoing aging of the United States population. As part of a larger lifespan developmental project contrasting predictors of drinking reductions across different periods of adulthood, we tested age differences in effects of health problems on drinking declines across young adulthood, midlife, and older adulthood. We predicted these effects to be developmentally specific to midlife and older adulthood. We also tested moderation by alcohol use disorder (AUD) symptomatology and by indices of sociodemographic disadvantage (sex and race/ethnicity). Analyses used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), leveraging NESARC's vast age range (18-90 + ; N = 43,093) and two waves of longitudinal data. Multiple-group cross-lag models tested differences across age groups in cross-lag paths between health problems and alcohol consumption. As hypothesized, health problem effects on drinking reductions were developmentally specific to midlife and older adulthood. However, models testing moderation by AUD symptomatology showed that these adaptive effects of health problems on drinking reductions did not extend to those with one or more AUD symptoms. Little evidence was found for moderation by sex or race/ethnicity. Findings support the notion of health concerns as a pathway to drinking reduction that increases in importance across the adult lifespan. However, given the moderation by AUD symptoms, findings also highlight a need to understand barriers to health-related pathways to drinking reduction among relatively severe midlife and older adult drinkers. These findings hold implications for lifespan developmental tailoring of clinical, public health, and policy interventions.

Towards a New Definition of the Typical Day in the Alcohol Use Disorder Identification Test-Consumption.

INTRODUCTION: The standard screening instrument for alcohol problems in the current primary care, the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), contains a question about alcohol consumption "on a typical day." Since this is a term that leaves room for multiple interpretations and the differences between alcohol consumption on weekends and weekdays are not taken into account, this study examines whether the latter distinction improves the prediction validity of the screening instrument. METHODS: A subgroup of 852 participants of the Dutch version of Dry January ("NoThanks") 2022 got the annual "NoThanks" survey, including questions about their alcohol consumption on weekends and weekdays, and the original ten AUDIT questions. The full AUDIT was used as golden standard. Sensitivity, specificity, and receiver operating characteristic curves were calculated for the original and different versions of the AUDIT-C. RESULTS: Of all participants, 67 percent were hazardous drinkers (AUDIT ≥8) and 27 percent were harmful drinkers (AUDIT ≥16). For the original AUDIT-C, the cut-off score with the most balanced combination of sensitivity and specificity for hazardous drinking in men was 7 and in women was 6. For harmful drinking, this was 8 and 7, respectively. Certain versions performed equally well as the original. For harmful drinkers, the highest area under the receiver operating characteristic curve (AUROC) was 0.814 and 0.866 for the original AUDIT-C, for men and women, respectively. Only for hazardous drinking men, the AUDIT-C with weekend day (AUROC = 0.887) performed slightly better than the original. CONCLUSION: Distinguishing weekend- and weekday alcohol consumption in the AUDIT-C does not lead to better predictions of problematic alcohol use. However, the distinction between weekends and weekdays provides more detailed information for healthcare professionals and can be used without having to compromise too much on validity.

Calibrating the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for detecting alcohol-related problems among Canadian, UK and US soldiers: cross-sectional pre-deployment and post-deployment survey results.

OBJECTIVES: Excessive alcohol use can bring about adverse health and work-related consequences in civilian and military populations. Screening for excessive drinking can help identify individuals at risk for alcohol-related problems who may require clinical interventions. The brief validated measures of alcohol use such as the Alcohol Use Disorders Identification Test (AUDIT), or abbreviated AUDIT-Consumption (AUDIT-C), are often included in military deployment screening and epidemiologic surveys, but appropriate cut-points must be used to effectively identify individuals at risk. Although the conventional AUDIT-C cut-points ≥4 for men and ≥3 for women are commonly used, recent validation studies of veterans and civilians recommend higher cut-points to minimise misclassification and overestimation of alcohol-related problems. This study aims to ascertain optimal AUDIT-C cut-points for detecting alcohol-related problems among serving Canadian, UK and US soldiers. DESIGN: Cross-sectional pre/post-deployment survey data were used. SETTINGS: Comprised Army locations in Canada and UK, and selected US Army units. PARTICIPANTS: Included soldiers in each of the above-mentioned settings. OUTCOME MEASURES: Soldiers' AUDIT scores for hazardous and harmful alcohol use or high levels of alcohol problems served as a benchmark against which optimal sex-specific AUDIT-C cut-points were assessed. RESULTS: Across the three-nation samples, AUDIT-C cut-points of ≥6/7 for men and ≥5/6 for women performed well in detecting hazardous and harmful alcohol use and provided comparable prevalence estimates to AUDIT scores ≥8 for men and ≥7 for women. The AUDIT-C cut-point ≥8/9 for both men and women performed fair-to-good when benchmarked against AUDIT ≥16, although inflated AUDIT-C-derived prevalence estimates and low positive predictive values were observed. CONCLUSION: This multi-national study provides valuable information regarding appropriate AUDIT-C cut-points for detecting hazardous and harmful alcohol use, and high levels of alcohol problems among soldiers. Such information can be useful for population surveillance, pre-deployment/post-deployment screening of military personnel, and clinical practice.

Evidence for an alcohol-related "harm paradox" in individuals with internalizing disorders: Test and replication in two independent community samples.

BACKGROUND: Internalizing (anxiety and mood) disorders (INTD) commonly co-occur (are "comorbid") with alcohol use disorder (AUD). The literature suggests that excessive alcohol use aimed at coping with INTD symptoms is, at best, a partial explanation for the high comorbidity rates observed. We hypothesized that individuals with INTD experience greater susceptibility to developing AUD symptoms due to the partially shared neurobiological dysfunctions underlying both conditions. We probe this hypothesis by testing the prediction that, after accounting for the volume of alcohol intake, individuals with INTD experience higher levels of alcohol-related symptoms. METHODS: Data from the National Epidemiological Survey on Alcohol-Related Conditions (NESARC) Wave 3 were used for the primary analyses, and NESARC Wave 1 data were used for independent replication analyses. Individuals who reported any alcohol use in the prior year were categorized as: (1) never having had an INTD diagnosis ("INTD-Never"); (2) having a remitted INTD diagnosis only ("INTD-Remitted"); or (3) having current INTD diagnosis ("INTD-Current"). Between-group contrasts of alcohol-related symptoms controlled for total alcohol intake (past year), drinking pattern (e.g., binging) and variables previously shown to mark exaggerated AUD symptoms relative to drinking amount (e.g., SES, gender, and family history). RESULTS: With all covariates in the model, individuals in the INTD-Current group and the INTD-Remitted group reported significantly greater alcohol-related symptoms than those in the INTD-Never group but did not themselves differ in level of alcohol-related symptoms. These results were replicated in the NESARC 1 dataset. CONCLUSIONS: Individuals with INTD experience more alcohol-related symptoms than those who drink at the same level. While considering other explanations, we argue that this "harm paradox" is best explained by the view that INTD confers a neurobiologically mediated susceptibility to the development of AUD symptoms.

Using the alcohol use disorders identification test to predict hospital admission for alcohol-related conditions in the Danish general population: a record-linkage study.

BACKGROUND AND AIMS: Most studies validating the alcohol use disorders identification test (AUDIT) have either assessed its factor structure and/or test-retest reliability or used diagnostic interviews as validators of current alcohol use disorders. The aim of the present study was to determine whether AUDIT and AUDIT-Consumption (AUDIT-C) scores are associated with subsequent risk of hospital admission for alcohol-related disorders and diseases (ARDDs). DESIGN: We used a historical cohort study. Using national registers, survey respondents were tracked from 1 September 2011 to hospitalization for an ARDD, emigration, death, or 31 December 2018, whichever occurred first. SETTING: Denmark. PARTICIPANTS: Respondents (n = 4522) from a Danish national survey conducted in autumn 2011. MEASUREMENTS: Outcome was incident ARDD admission recorded in the National Patient Register. Predictors were AUDIT and AUDIT-C scores, and covariates were age, gender, highest level of education and previous psychiatric disorder. FINDINGS: During the study period, 56 respondents had a first-time ARDD admission. Respondents who scored above the 8-point AUDIT cut-off and respondents who scored above the 5-point AUDIT-C cut-off had a significantly increased risk of being admitted for an ARDD compared with respondents who scored below the cut-offs, (AUDIT: hazard ratio (HR), 4.72; 95% CI, 2.59-8.60; AUDIT-C: HR, 7.97; 95% CI, 3.66-17.31). CONCLUSIONS: Scores above alcohol use disorders identification test (AUDIT) and AUDIT-Consumption (AUDIT-C) cut-offs are associated with an increased risk of long-term alcohol-related hospital admissions. At widely used cut-offs, the AUDIT-C is a better predictor of alcohol-related hospitalizations among members of the general population than the full AUDIT.

Conceptualization of Alcohol Use Disorder (AUD): Can Theoretical or Data Driven Approaches Improve the Construct Validity of AUD?

The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) definition of alcohol use disorder (AUD) has been criticized on the ground that it leads to high prevalence rates and a highly heterogeneous group. Failure of the DSM to consider development may exacerbate these issues (e.g., conflating experimentation with problematic drinking). Wakefield and Schmitz (2015) proposed a definition of AUD that comports to the harmful dysfunction (HD) theory of mental disorders while data-driven approaches have suggested that key symptoms like craving, failure to fulfill obligations, hazardous use, and alcohol use despite interpersonal consequences are optimal (OPT) criteria for AUD (Stevens et al., 2019). Prior work suggests both may reduce the likelihood of conflating experimentation with problematic drinking during key developmental periods. Continuous and categorical structural equation models of DSM, HD, and OPT criteria were compared on A) prevalence, B) patterns of alcohol use in adolescence (age 10-18 years) C) early AUD symptoms in adolescence (age 13-15) and D) concurrent alcohol use and alcohol consequences to assess prospective and concurrent convergent validity using a longitudinal design (N = 765; ages 10-21 years). Results supported prior literature that the HD and OPT criteria produced a smaller diagnostic class than the DSM. Furthermore, the HD and OPT criteria had larger and more consistent effects with validators than the DSM with the OPT criteria having the largest effects and the least criteria. Future work should consider whether the OPT or HD criteria better reflect AUD severity than the DSM across development.

Alcohol-related liver disease mortality and missed opportunities in secondary care: A United Kingdom retrospective observational study.

INTRODUCTION: Alcohol-related liver disease (ARLD) is a preventable cause of mortality. Historical epidemiological studies on ARLD often lack a detailed linked assessment of health-related contacts prior to death which limits understanding of opportunities for intervention. We aimed to analyse retrospective population-based data of all adult residents of Nottinghamshire dying from ARLD to determine the factors associated with delayed diagnosis of ARLD and the potential missed opportunities for interventions. METHODS: We linked the Office for National Statistics and Hospital Episode Statistics databases to identify adult (≥18 years) residents of Nottinghamshire, who died of ARLD over the 5-year period (1 January 2012 to 31 December 2017). Death was used as the primary outcome, and logistic regression analysis was conducted to test the association between key variables and mortality due to ARLD. RESULTS: Over 5 years, 799 ARLD deaths were identified. More than half had no diagnosis or a diagnosis of ARLD less than 6 months before death. Emergency presentation at first ARLD diagnosis and White ethnicity were significantly associated with a delay in diagnosis. Overall, the cohort had a median of five hospital admissions, four accident and emergency attendances and 16 outpatient appointments in the 5 years before death. Treatment was provided by a range of specialities, with general medicine the most common. Alcohol was associated with most admissions. DISCUSSION AND CONCLUSIONS: This study identified deficiencies in ARLD secondary care and provides us with a powerful methodology that can be used to evaluate and improve how alcohol issues are managed and where action can be best targeted.

Age-based differences in quantity and frequency of consumption when screening for harmful alcohol use.

BACKGROUND AND AIMS: Survey questions on usual quantity and frequency of alcohol consumption are regularly used in screening tools to identify drinkers requiring intervention. The aim of this study was to measure age-based differences in quantity and frequency of alcohol consumption on the Alcohol Use Disorders Identification Test (AUDIT) and how this relates to the prediction of harmful or dependent drinking. DESIGN: Cross-sectional survey. SETTING: Australia. PARTICIPANTS: Data were taken from 17 399 respondents who reported any alcohol consumption in the last year and were aged 18 and over from the 2016 National Drug Strategy Household Survey, a broadly representative cross-sectional survey on substance use. MEASUREMENT: Respondents were asked about their frequency of consumption, usual quantity per occasion and the other items of the AUDIT. FINDINGS: In older drinkers, quantity per occasion [ß = 0.53, 95% confidence interval (CI) = 0.43, 0.64 in 43-47-year-olds as an example] was a stronger predictor of dependence than frequency per occasion (ß = 0.24, 95% CI = 0.17, 0.31). In younger drinkers the reverse was true, with frequency a stronger predictor (ß = 0.54, 95% CI = 0.39, 0.69 in 23-27-year-olds) than quantity (ß = 0.26, 95% CI = 0.18, 0.34 in 23-27-year-olds). Frequency of consumption was not a significant predictor of dependence in respondents aged 73 years and over (ß = -0.03, 95% CI = -0.08, 0.02). Similar patterns were found when predicting harmful drinking. Despite this, as frequency of consumption increased steadily with age, the question on frequency was responsible for at least 65% of AUDIT scores in drinkers aged 53 years and over. CONCLUSIONS: In younger drinkers, frequent drinking is more strongly linked to dependence and harmful drinking subscale scores on the Alcohol Use Disorders Identification Test (AUDIT) than quantity per occasion, yet quantity per occasion has a stronger influence on the overall AUDIT score in this group. In older drinkers, frequency of consumption is not always a significant predictor of the AUDIT dependence subscale and is a weak predictor of the harmful drinking subscale.

Alcohol use, behavioral and mental health help-seeking, and treatment satisfaction among sexual minority women.

BACKGROUND: Sexual minority women (SMW) report higher rates of heavy episodic drinking (HED) and adverse alcohol-related outcomes, including poor mental health, than heterosexual women. These disparities indicate a greater need for behavioral and mental health treatment for SMW. This study examined associations among alcohol outcomes, behavioral and mental health help-seeking, and treatment satisfaction among SMW by age, sexual identity, race/ethnicity, and income. METHODS: Participants included a community sample of 695 SMW (Mage  = 40.0, SD = 14.1; 74.1% lesbian, 25.9% bisexual; 37.6% White, 35.8% Black, 23.2% Latinx; 26.3% annual income $14,999 or less). We used bivariate analyses to characterize the sample's demographic characteristics and multivariable logistic regression analyses to examine associations among variables. RESULTS: SMW subgroups based on age, race/ethnicity, and annual income differed in alcohol outcomes (i.e., HED, DSM-IV alcohol dependence, alcohol-related problem consequences, alcohol problem recognition, and motivation to reduce drinking); help-seeking; and treatment satisfaction. SMW who engaged in help-seeking for alcohol-related concerns were more likely than those who did not to meet criteria for DSM-IV alcohol dependence (adjusted odds ratio [aOR] = 7.13; 95% CI = 2.77; 18.36), endorse alcohol-related problem consequences (aOR = 11.44; 95% CI = 3.88; 33.71), recognize problematic drinking (aOR = 14.56; 95% CI = 3.37; 62.97), and report motivation to reduce drinking (aOR = 5.26; 95% CI = 1.74; 15.88). SMW's alcohol outcomes did not differ based on their satisfaction with treatment or with providers. CONCLUSIONS: This study's findings confirm SMW's elevated risk for HED and other alcohol-related outcomes and underscore the importance of identity-affirmative and accessible behavioral and mental health treatment for young, Black, and low-income SMW. Clinicians and intervention scientists should develop or enhance existing brief behavioral and mental health treatments for SMW engaging in HED who may not recognize that their drinking is problematic or who are not motivated to reduce drinking.

Is lower severity alcohol use disorder qualitatively different than more severe manifestations? An evaluation of multivariate symptom clusters.

BACKGROUND AND AIMS: Alcohol use disorder (AUD), since the release of DSM-V, is conceptualized and studied as a unidimensional construct. However, previous research has identified clusters of AUD symptoms related to excessive consumption/tolerance, loss of control/social dysfunction and withdrawal/craving that have shown differential genetic risks, personality associations and predictive ability. Although past 'variable-centered' (e.g. factor-analytic) studies have demonstrated the importance of these clusters, the current study aimed to examine how these clusters commonly manifest using a 'person-centered' approach (e.g. latent class). DESIGN: Cross-sectional in-person assessment. SETTING: Indiana, USA. PARTICIPANTS: A convenience sample of 1390 young adults (mean age = 21.43, SD = 2.47) recruited for an over-representation of alcohol problems (65% with AUD). MEASUREMENTS: Latent class analysis (LCA) was conducted on 23 criteria from the Semi-Structured Interview on the Genetics of Alcoholism (SSAGA) that align with DSM-V AUD symptoms. Identified latent classes were characterized using multinomial regressions to examine the association of class and measures of alcohol use, other externalizing psychopathology, internalizing problems and personality. FINDINGS: LCA results identified a 'Low Problems' class (34% of sample), a 'Heavy Consumption' class (26%) characterized by high endorsement probabilities of essentially only consumption/tolerance symptoms, a 'Consumption and Loss of Control' class (31%) characterized by endorsing consumption/tolerance and loss of control/social dysfunction symptoms, and finally a 'Consumption, Loss of Control and Withdrawal' class (9%) characterized by high endorsement probabilities of all symptom clusters. Multinomial regression results indicated an increasing spectrum of severity in terms of psychological impairment. CONCLUSIONS: AUD appears to manifest as different clusters of symptoms at different severity levels.

Demographic factors and delay of treatment for alcohol use disorders among 6584 Danish men receiving alcohol treatment.

PURPOSE: This study aimed to investigate the time lag between onset and treatment (treatment delay) for alcohol use disorders (AUD) and associations between demographic factors and treatment delay for AUD. METHODS: The study included 6,584 men registered in the Copenhagen Alcohol Cohort, containing information on civil status, employment status, estimated age at onset of alcohol problems, and age at first outpatient AUD treatment. Data on year of birth, intelligence, and educational level were obtained from the Danish Conscription Database. Information on first hospital AUD treatment was retrieved from Danish national psychiatric registers. Associations between the demographic factors and treatment delay were analysed in separate linear regression models adjusted for year of birth and in a mutually adjusted model including all demographic factors. RESULTS: The mean treatment delay for AUD was 6.9 years (SD = 4.1). After mutual adjustment, an SD increase in intelligence score was associated with 0.17 years increase in treatment delay. Educational level was unrelated to treatment delay. Men with estimated age at onset of alcohol problems at age 20 years or younger had a 5.30 years longer treatment delay than men who had estimated age at onset of alcohol problems at age 51 years or older. Employed men had shorter treatment delays than unemployed men, especially among the oldest birth cohorts. CONCLUSIONS: The treatment delay of 6.9 years highlights the necessity to promote access to AUD treatment, perhaps in particular among adolescents and young individuals. Cognitive factors may affect treatment delay more than non-cognitive personal factors.

Relationship between sensation seeking, alcohol problems and bulimic symptoms: a community-based, longitudinal study.

PURPOSE: The association of bulimic symptoms with sensation seeking is uncertain; however, both behaviors have been linked to alcohol problems. We assessed in a longitudinal, community-based setting whether sensation seeking in adolescence is associated with bulimic symptoms in early adulthood, also accounting for alcohol problems. METHODS: Finnish men (N = 2000) and women (N = 2467) born between 1974-1979 completed Zuckerman's sensation seeking scale (SSS) at age 18. Alcohol problems (Malmö-modified Michigan alcoholism screening test (Mm-MAST) and bulimic symptoms [eating disorder inventory-2, bulimia subscale (EDI-Bulimia), population and clinical scoring systems] were defined at age 22-27. We examined relationships between SSS, Mm-MAST, and EDI-Bulimia using Pearson's correlation coefficient (r) and linear regression. RESULTS: Alcohol problems were moderately correlated with sensation seeking and bulimic symptoms (population scoring) among women and men (r = 0.21-0.31). The correlation between sensation seeking and bulimic symptoms (population scoring) was weak among men (r = 0.06, p = 0.006) and even weaker and non-significant among women (r = 0.03, p = 0.214). Adjustment for alcohol problems removed the association between sensation seeking and bulimic symptoms among men. Furthermore, there were no significant correlations between sensation seeking and bulimic symptoms when assessing EDI-Bulimia clinical scoring. CONCLUSION: Sensation seeking and bulimic symptoms were not associated among women. The association between sensation seeking and bulimic symptoms among men was entirely attributable to increased alcohol problems among those with higher sensation seeking. While this association may be important on the population level, its clinical significance may be minor. LEVEL OF EVIDENCE: Level III, well-designed cohort study.

The Prognostic Role of DSM-5 Alcohol Use Disorder Severity and Age of Onset in Treatment Outcome Among Adults Aged 60.

AIMS: To investigate among older adults with DSM-5 alcohol use disorder (AUD) the relevance of (1) baseline DSM-5 AUD severity, (2) age of DSM-5 AUD onset, and (3) the interactions of DSM-5 AUD severity*treatment condition and age of DSM-5 AUD onset*treatment condition for the prediction of AUD treatment outcomes. METHODS: The international multicenter RCT "ELDERLY-Study" compared outpatient motivational enhancement therapy (4 sessions) with outpatient motivational enhancement therapy followed by community reinforcement approach for seniors (8 sessions) in adults aged 60+ with DSM-5 AUD. Baseline and 1-, 3-, and 6-month follow-up data from the German and Danish ELDERLY-sites (n = 544) were used (6-month participation rate: 75.9%). DSM-5 AUD diagnoses were obtained using the Mini International Neuropsychiatric Interview and alcohol use using Form 90. Associations between DSM-5 AUD severity and age of onset and AUD treatment outcomes were investigated using multiple logistic regression and generalized linear models. RESULTS: The sample was diverse in AUD severity (severe: 54.9%, moderate: 28.2%, mild: 16.9%) and age of onset (median: 50 years; 12-78 years). Overall, with few exceptions, neither AUD severity, nor age of onset, nor their respective interactions with treatment condition significantly predicted drinking outcomes at the different follow-ups ( P ≥ 0.05). CONCLUSIONS: No indication was found for the need to tailor treatment content according to DSM-5 AUD severity and earlier onset in older adults.

Practical Assessment of Alcohol Use Disorder in Routine Primary Care: Performance of an Alcohol Symptom Checklist.

BACKGROUND: Alcohol use disorder (AUD) is highly prevalent but underrecognized and undertreated in primary care settings. Alcohol Symptom Checklists can engage patients and providers in discussions of AUD-related care. However, the performance of Alcohol Symptom Checklists when they are used in routine care and documented in electronic health records (EHRs) remains unevaluated. OBJECTIVE: To evaluate the psychometric performance of an Alcohol Symptom Checklist in routine primary care. DESIGN: Cross-sectional study using item response theory (IRT) and differential item functioning analyses of measurement consistency across age, sex, race, and ethnicity. PATIENTS: Patients seen in primary care in the Kaiser Permanente Washington Healthcare System who reported high-risk drinking on the Alcohol Use Disorder Identification Test Consumption screening measure (AUDIT-C ≥ 7) and subsequently completed an Alcohol Symptom Checklist between October 2015 and February 2020. MAIN MEASURE: Alcohol Symptom Checklists with 11 items assessing AUD criteria defined in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5), completed by patients during routine medical care and documented in EHRs. KEY RESULTS: Among 11,464 patients who screened positive for high-risk drinking and completed an Alcohol Symptom Checklist (mean age 43.6 years, 30.5% female), 54.1% reported ≥ 2 DSM-5 AUD criteria (threshold for AUD diagnosis). IRT analyses demonstrated that checklist items measured a unidimensional continuum of AUD severity. Differential item functioning was observed for some demographic subgroups but had minimal impact on accurate measurement of AUD severity, with differences between demographic subgroups attributable to differential item functioning never exceeding 0.42 points of the total symptom count (of a possible range of 0-11). CONCLUSIONS: Alcohol Symptom Checklists used in routine care discriminated AUD severity consistently with current definitions of AUD and performed equitably across age, sex, race, and ethnicity. Integrating symptom checklists into routine care may help inform clinical decision-making around diagnosing and managing AUD.

The experience of physiological and psychosocial alcohol-related harms across adolescence and its association with alcohol use disorder in early adulthood: A prospective cohort study.

BACKGROUND: Different forms of alcohol-related harm (e.g., hangovers, fighting) may confer differential risk of clinically relevant alcohol problems. We examine: (i) patterns of transition in experiencing alcohol-related harms across adolescence; (ii) whether factors in early adolescence predict transition patterns; and (iii) whether transition patterns predict later alcohol use disorder (AUD) symptoms. METHODS: We used a longitudinal Australian cohort (n = 1828) to model latent class transition patterns of alcohol-related harms across three timepoints (Mage  = 13.9, 16.8, 18.8 years). Regression models assessed whether child, peer, and parent factors in early adolescence (Mage  = 12.9) predicted harms transition patterns and whether these patterns predicted AUD symptoms in early adulthood (Mage  = 19.8). RESULTS: Five transition patterns characterized most of the cohort (n ≈ 1609, 88.0%): (i) minimal harms (n ≈ 381, 20.8%); (ii) late physiological harms (n ≈ 702, 38.4%); (iii) early physiological harms (n ≈ 226, 12.4%); (iv) late all harms (n ≈ 131, 7.2%); and (v) gradual all harms (n ≈ 169, 9.2%). With late physiological harms as the reference, females had increased risk of experiencing early physiological harms (relative risk [RR]: 2.15; 99.5% CI: 1.19, 3.90). Late all harms (RR: 1.71; CI: 1.19, 2.47) and gradual all harms (RR: 1.84; CI: 1.37, 2.47) were each associated with increased odds of meeting criteria for AUD, even when patterns of alcohol consumption are considered. CONCLUSIONS: Adolescents display heterogeneous transition patterns across physiological and psychosocial alcohol-related harms. Females are at greater risk of experiencing early physiological harms. Experience of both physiological and psychosocial harms in late adolescence is an important and potentially modifiable precursor to clinically relevant alcohol problems in early adulthood.

Genetic and environmental influences on the progression from alcohol use disorder to alcohol-related medical conditions.

BACKGROUND: Medical conditions related to alcohol use disorders (AUD) represent a substantial public health concern. However, only a subset of individuals with AUD develop these conditions and the extent to which genetic and environmental factors that are shared with AUD, versus those distinct from it, contribute to this progression has not yet been determined. METHODS: Using data from Swedish national registries for a cohort born from 1932 to 1970 (N = 1,319,214, 48.9% women), we conducted twin-sibling biometric model fitting to examine the genetic and environmental sources of variance that contribute to the liability to alcohol-related medical conditions (AMC). Progression to AMC, determined using medical registry data, was contingent on an AUD registration, which was determined using medical and criminal registry data. RESULTS: We identified AUD registrations in 3.2% of women and 9.2% of men. Among individuals with an AUD registration, 14.4% of women and 15.4% of men had an AMC registration. In the final models, we constrained the beta pathway from AUD to AMC and the genetic and unique environmental paths to be equal across sexes. The beta path was estimated at 0.59. AMC was modestly heritable in women (A = 0.32) and men (A = 0.30). The proportion of total heritability unique to AMC was 39.6% among women and 41.3% among men. A higher proportion of total environmental variance was unique to AMC: 76.7% for women and 77.2% for men. In a sensitivity analysis limited to liver-related AMC, we observed similar results, with a slightly lower beta path from AUD to AMC (0.46) and higher proportions of AMC-specific genetic (70.0% in women; 71.7% in men) and environmental (84.5% in both sexes) variance. CONCLUSIONS: A moderate-to-substantial proportion of genetic and environmental variance that contributes to AMC risk is not shared with AUD, underscoring the need for additional gene identification efforts for AMC. Furthermore, the prominent influence of environmental factors specific to AMC provides a promising area for the identification of prevention targets. We did not observe significant sex differences in the etiology of AMC, although follow-up is warranted in other well-powered studies.

Residual alcohol use disorder symptoms after treatment predict long-term drinking outcomes in seniors with DSM-5 alcohol use disorder.

BACKGROUND: Risk of relapse within the first months after alcohol use disorder (AUD) interventions is substantial among older adults. For this vulnerable group, little information exists on how this risk is associated with residual DSM-5 AUD symptoms after treatment. AIMS: To investigate among older adults who received short-term treatment for DSM-5 AUD (1) the prediction of drinking behaviors and quality of life 12 months after treatment initiation by 6-month DSM-5 AUD symptoms, AUD severity, and AUD remission, and (2) whether these DSM-5 AUD indicators provide prognostic information beyond that gained from 6-month alcohol use (AU) status. METHODS: The international multicenter RCT "ELDERLY-Study" enrolled adults aged 60+ with DSM-5 AUD. We used data from the subsample of 323 German and Danish participants with complete DSM-5 AUD criterion information 6 months after treatment initiation (61% male; mean age = 65.5 years). AU was assessed with Form 90, DSM-5 AUD with the M.I.N.I., and quality of life with the WHOQOL-BREF. Generalized linear models were applied to investigate the associations between 6-month AUD indicators and 12-month AU and quality of life. RESULTS: Independent of AU at 6 months, having 1 (vs. no) residual AUD symptom at 6 months predicted a 12-month "slip," defined as exceeding a blood alcohol concentration of 0.05% at least once during that time (OR: 3.7, 95% CI: 1.5 to 9.0), heavy episodic drinking, and hazardous use (p < 0.05). AUD remission was associated with a lower risk of a "slip" at 12 months (p < 0.05). Failed reduction/cessation was associated with poorer physical health (Coef.: -0.4, 95% CI -0.7 to -0.1). CONCLUSION: For older adults, residual AUD symptoms in the first months after short-term treatment predict problematic AU outcomes during the first 12 months after treatment entry. Thus, residual symptoms should be addressed in this patient population during posttreatment screenings.