Alcohol abuse in patients with dilated cardiomyopathy. Laboratory vs clinical detection.

Detection of alcohol abuse is of utmost importance in the diagnosis and management of alcoholic cardiomyopathy. The ability of laboratory tests and clinical signs to detect alcohol abuse was compared in 31 patients with severe heart failure due to underlying dilated cardiomyopathy. Alcoholic cardiomyopathy was diagnosed in 13 patients and a variety of nonalcoholic cardiomyopathies were diagnosed in the remaining 18 patients. At the time of hospital admission, all patients received a complete cardiovascular examination as well as routine hematologic and biochemical tests. Details concerning past and recent alcohol intake were obtained by an individual who was unaware of the diagnostic status of the patients. The two groups of patients did not differ with respect to clinical presentation, self-report of recent drinking patterns, or clinical signs and medical history items that have been found to be associated with chronic alcohol abuse. However, the group with alcoholic cardiomyopathy had significantly higher values for mean corpuscular volume and gamma-glutamyltranspeptidase. Our results suggest that a combination of routine laboratory tests may be effective in the detection of alcohol abuse in patients with dilated cardiomyopathy.

Failure to find differences in drinking behavior as a function of familial risk for alcoholism: a replication.

Groups of high-risk (alcoholic fathers), middle-risk (second-degree alcoholic relatives) and low-risk (no first- or second-degree alcoholic relatives) male college students were compared with respect to drinking behavior, sociodemographic variables, personality, cognitive functioning, and mental health and drug use problems in themselves and in family members. The groups differed significantly on only one of a number of sociodemographic variables. No significant group differences were revealed in drinking behavior, or alcohol-related symptoms or consequences. High-risk subjects reported significantly more childhood attentional and social problems than did low-risk subjects. No group differences were found with respect to other childhood problem behaviors, cognitive functioning, subject or family drug use, or mental health problems. The findings are discussed in terms of the questions they raise concerning the results of high-risk studies and the contribution of genetic factors to alcoholism.

Comparison of drinking patterns measured by daily reports and timeline follow back.

The major objective of this study was to compare near real-time daily alcohol consumption data over the course of 366 consecutive days with retrospective reports by means of the timeline follow-back (TLFB). Participants (N = 33) responded for 366 days on an interactive voice response (IVR) system by entering alcohol consumption data daily using the touch-tone pads of their telephones. In-person interviews were conducted every 13 weeks during which participants were administered the TLFB. The correlations between the IVR and TLFB for amount consumed, drinking days, and heavy drinking days were modest. There was a wide variability across participants in their individual correlations for these variables. Participants who were diagnosable with a lifetime DSM-IV alcohol disorder at baseline significantly underreported their drinking compared with participants who were not diagnosable. The authors were unable to ascertain variables that influenced accurate reporting on the TLFB.

Comparability of self-report of familial alcoholism among male and female college students.

There is a general impression in the literature that women are more accurate reporters of familial psychiatric history. In this regard, this study presents data from a large cohort of young men (n = 427) and women (n = 607) who in answering a questionnaire self-reported alcohol abuse symptoms for various biological relatives. No significant gender differences emerged for any of the family history comparisons including reports for father, mother, either parent, any first- or second-degree relatives, or men or women relatives. The findings are discussed in the context of the existing literature.

Individual differences in alcohol responsivity: physiological, psychomotor and subjective response domains.

OBJECTIVE: Psychometrically stable measures of individual differences in response to consuming alcohol were developed as part of an ongoing project investigating "high-tolerant" drinking drivers. The derived measures were correlated with diagnostic criteria of alcohol abuse and dependence, as well as drinking frequency, heavy drinking and tolerance estimations. METHOD: Male subjects (N = 94), 21 to 59 years old, participated in each of two identical alcohol consumption sessions (mean dose = 0.78 g/kg). Multiple response measures obtained before and after drinking (mean BAC = 78 mg/dl, descending) were used to compute postconsumption regression residuals that were factor analyzed. RESULTS: Factors reflecting psychomotor, subjective and physiological responsivity to alcohol were extracted. Confirmatory factor analyses indicated consistent psychomotor and physiological factor structures across the two testing sessions, but a bifurcation of the subjective measures. Test-retest correlations of the responsivity residuals indicated medium to moderately large effect sizes (mean = .32, range = .15-.51). Residuals summated within each response domain indicate moderate internal consistency (mean = .56, range = .45-.72) and higher reliabilities than single measure indices (range = .53-.59). Summated residuals within the response domains suggest diminished responsivity is associated with more severe alcohol-use diagnoses and were differentially predictive of self-reported drinking practices. CONCLUSIONS: Alcohol responsivity is multidimensional. Individual differences across different domains can be measured reliably and are associated with different patterns of alcohol use and abuse. Greater attention should be given to the specific domain of alcohol responsivity measures obtained in past and future research that relates individual differences to alcohol-related problems.

Validation of daily self-reported alcohol consumption using interactive voice response (IVR) technology.

OBJECTIVE: This study assesses the validity of daily self-reported drinking data obtained using an automated touch-tone interactive voice response (IVR) system. METHOD: Subjects (N = 30) reported alcohol consumption daily for 28 days using the IVR system. Concurrently, breath and saliva samples were obtained each night for objective determination of blood alcohol concentrations (BACs). Partners living with the subjects provided collateral reports daily. Retrospective drinking records were obtained from both partners at the outset of the study and from the target subjects at the end of the study, using timeline follow-back procedures referencing the target subjects' drinking over the previous 28-day period. RESULTS: Subjects reported drinking on 55.2% of the 840 possible subject days, and positive BAC readings were obtained on 25.9% of these days. The overall correlation between self-report and measured BAC was .72. Within-subject correlations between daily IVR reports and measured BACs ranged from -.07 to .92, with a mean of .57. The correlations between self-reported drinking and the collateral reports ranged from .18 to 1.0, with a mean of .89. Correlations between the daily self-reports and the timeline follow-back records obtained at the end of the study ranged from -.22 to .96, with a mean of .51. CONCLUSIONS: IVR technology provides an innovative, user-friendly methodology for obtaining valid measures of daily alcohol consumption. The validity of these measures may be differentially highest for frequent, heavy drinkers, a group for whom traditional assessment methods often produce the most biased underestimates.

Cycles of alcohol dependence: frequency-domain analyses of daily drinking logs for matched alcohol-dependent and nondependent subjects.

OBJECTIVE: This study was undertaken to evaluate possible differences in the patterns of daily alcohol use, in terms of periodicity or rhythmicity of consumption, between alcohol-dependent and nondependent drinkers otherwise matched on the basis of quantity and frequency of alcohol use. METHOD: Frequency-domain time-series analysis was applied to daily drinking logs of six alcohol-dependent and six nondependent male subjects matched for consumption quantity and frequency who had participated in a larger 112-day study of alcohol consumption patterns using an innovative touch-tone telephone method of daily self-report. Spectral analysis partitioned variance in the drinking logs among statistically independent frequency cycles of relatively heavier and lighter drinking. The percentage of variance accounted for by fast (< 4 days), medium (7 +/- 3 days) and slow (> 10 days) cycle periods was compared for diagnostic group differences. RESULTS: Effective matching precluded consumption quantity, frequency or variability differences between the groups. Spectral analysis of the time-series data revealed group differences in the rhythmicity, or cyclical characteristics, of the drinking logs. The drinking logs of alcohol-dependent subjects exhibited more pronounced weekly cycles, whereas drinking logs of nondependent subjects fluctuated over longer periods. CONCLUSIONS: Temporal patterns of regular alcohol use may be an important behavioral variable influencing the seriousness of consequences associated with drinking, which may partly elucidate the relatively weak relationship between dependence symptomatology and consumption quantity-frequency.

Self-report of drinking using touch-tone telephone: extending the limits of reliable daily contact.

OBJECTIVE: Retrospective self-reports of alcohol consumption are ubiquitous in the alcohol research field. Time frames of these reports range from a week to a year or longer and are subject to several influences of bias that may have important clinical, epidemiological and methodological consequences. In order to specify drinking patterns more precisely, a study was conducted to monitor alcohol consumption on a daily basis. METHOD: Subjects (N = 51) responded for 112 days on an Interactive Voice Response system by entering their data daily using the touch-tone pad of their telephone. Each day, subjects answered 11 questions relating to drinking (including quantity) and to variables believed to affect consumption (e.g., stress level). RESULTS: The overall response rate was 93.0%. Subjects reported consuming at least one drink on 51.2% of all 5,151 reporting days (mean number of drinks reported = 4.6). Following completion of the study, subjects were also asked to recall consumption retrospectively using a standard quantity-frequency questionnaire. CONCLUSIONS: The present study demonstrated that: (1) data can be collected on a daily basis efficiently, and (2) traditional methods of data collection (e.g., quantity-frequency) result in a significant underreporting bias for heavier drinkers.

Personality pathology and drinking in young men at high and low familial risk for alcoholism.

OBJECTIVE: Three groups varying in familial alcoholism risk were compared with respect to amount of alcohol consumption, presence of personality pathology, and the relationship between personality pathology and alcohol consumption. METHOD: Research subjects were young adult men recruited from local colleges, a trade school and the community. The risk groups included (1) a group with a biological alcoholic father and significant additional familial alcoholism (n = 106); (2) subjects with an alcoholic father, but without significant additional familial alcoholism (n = 100); and (3) a group with no paternal alcoholism and at most only one second/third-degree alcoholic relative (n = 190). Absolute daily ounces of alcohol was determined using a standard quantity-frequency scale. Prevalence of DSM-III-R personality disorders (PDs) was evaluated using the Personality Disorder Questionnaire-Revised both with and without application of an impairment and distress scale. Familial risk determination was based on agreement between four separate self-report assessments. RESULTS: The first group consumed significantly more alcohol than the other two groups, which did not differ in alcohol consumption. The first group's subjects were more likely to meet criteria for virtually all of the PD diagnoses than were the other two groups. A greater proportion of the second group's subjects qualified for various PDs than did the third group's subjects. Personality pathology was consistently or usually associated with more drinking in the first and third groups, respectively, but associated with less consumption in the second group. CONCLUSIONS: Young men with high-density familial alcoholism are at greater risk for the development of alcoholism than those with alcoholic fathers and little additional familial alcoholism. Relationships between personality pathology and alcohol consumption, and possibly the development of alcoholism, differ for the three risk groups.

Using interactive voice response technology and timeline follow-back methodology in studying binge eating and drinking behavior: different answers to different forms of the same question?

As part of a study of the relationship of binge eating, alcohol use, mood, and stressors, we compared the results of two forms of reporting on binge eating and drinking behavior. Forty-three first-year college women participated in an interactive voice response (IVR) study for 12 weeks. Participants answered computer-administered questions daily via IVR technology on number of eating binges and number of alcoholic drinks consumed. After 12 weeks, participants completed a Timeline Follow-back (TLFB) interview retrospectively for number of binges and drinks in the past 12 weeks. Results of this distally retrospective methodology (commonly used in drinking research and applied here also to binge eating) were compared to the results of daily IVR reporting. There was convergence across measures for drinking behavior, but divergence between IVR and TLFB for binge eating reports. TLFB reports underrepresented actual binge eating frequency, which calls into question the validity of applying this methodology to the assessment of binge eating.

Heavy drinking and its correlates in young men.

This study examined the drinking behavior of a sample of 98 college men and the relationship to drinking of a variety of subject variables. The subjects reported drinking an average of nearly eight days a month, about five drinks each time, and were intoxicated more than three times monthly. Nearly half reported having experienced two or more drinking-related adverse consequences within the past year and over a third were intoxicated four or more times monthly. Forty percent of the subjects could be described as problem drinkers. Illicit drug use and the disinhibition factor of the sensation seeking scale were the most consistent correlates of drinking behavior and its adverse consequences, although belonging to a fraternity, consuming alcohol/drugs before age 15, the Macandrew Alcoholism Scale score, and a family member having received alcoholism treatment were also found to be consistently associated with drinking in the subjects. Sociodemographic characteristics, physical health, mental health treatment, childhood behavior problems, adolescent antisocial behavior, and familial alcoholism were by and large not found to be related to drinking behavior. A stepwise multiple regression analysis revealed that five variables accounted for 51% of the total variance in drinking behavior. The significant predictors included a heavy drug use factor, a smoking factor, fraternity membership, drug/alcohol use before age 15, and having a family member who had received alcoholism treatment. Thus, four of the five significant predictor variables were reflective of drug use in the subject or his family. The findings underline the need for further prospective longitudinal research to understand the origins of problem drinking and its relationship to alcoholism.

Differential attrition rates in alcohol abusing and nonabusing schizophrenic inpatients: a methodological note.

This study investigates the impact of the screening process on the composition of the final sample of alcohol abusing and nonabusing hospitalized schizophrenics. The group of nonabusing schizophrenics had higher rates of study rejections by staff, refusals, inappropriate subjects, and a lower rate of study completers. The findings suggest that these differential attrition rates may have a significant impact on the interpretation of results of studies focusing on substance use in schizophrenic samples.

The detection of alcoholism in hospitalized schizophrenics: a comparison of the MAST and the MAC.

The Michigan Alcoholism Screening Test (MAST) and the MacAndrew Alcoholism Scale (MAC) were administered to forty-one schizophrenic inpatients also meeting DSM-III criteria for either alcohol abuse or alcohol dependence and 29 schizophrenic inpatients who did not qualify for an additional substance abuse diagnosis other than marijuana abuse/dependence. The MAC failed to differentiate between the alcoholic and nonalcoholic groups and both groups scored above the recommended cutting score. The MAST significantly differentiated the alcoholic and nonalcoholic schizophrenic patients and was as sensitive to a history of alcohol abuse as to alcohol dependence. Neither the MAST nor MAC was sensitive to recent versus more remote drinking. The overall classificatory accuracy of the MAST was found to be 80% and that of the MAC was 56%. A logistic regression analysis revealed that the use of just four MAST items can yield a group classificatory rate of 83%. It was concluded that the MAST exhibited sufficient sensitivity and specificity to be used as an initial screening instrument for alcoholism in schizophrenic patients.