Drug and Alcohol Review (Drug Alcohol Rev )

Publisher: Australasian Professional Society on Alcohol and other Drugs, Taylor & Francis


Now in its eighteenth year of publication Drug and Alcohol Review is an international meeting ground for the views, expertise and experience of all those involved in the study of treatment of alcohol, tobacco and drug problems. Contributors to the journal examine and report on alcohol and drug abuse from a wide range of clinical, biomedical, psychological and sociological standpoints. Drug and Alcohol Review particularly encourages the submission of papers which have a harm reducation perspective. However, all philosophies will find a place in the journal: the principal criterion for publication of papers is their quality.

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction and AimsThe rate of alcohol-related emergency department (ED) presentations in young people has increased dramatically in recent decades. Injuries are the most common type of youth alcohol-related ED presentation, yet little is known about these injuries in young people. This paper describes the characteristics of alcohol-related ED injury presentations in young people over a 13-year period and determines if they differ by gender and/or age group (adolescents: 12–17 years; young adults: 18–24 years).Design and Method The Queensland Injury Surveillance Unit (QISU) database collects injury surveillance data at triage in participating EDs throughout Queensland, Australia. A total of 4667 cases of alcohol-related injuries in young people (aged 12–24 years) were identified in the QISU database between January 1999 and December 2011, using an injury surveillance code and nursing triage text-based search strategy.ResultsOverall, young people accounted for 38% of all QISU alcohol-related ED injury presentations in patients aged 12 years or over. The majority of young adults presented with injuries due to violence and falls, whereas adolescents presented due to self-harm or intoxication without other injury. Males presented with injuries due to violence, whereas females presented with alcohol-related self-harm and intoxication.Discussion and Conclusions There is a need for more effective ways of identifying the degree of alcohol involvement in injuries among young people presenting to EDs. [Hides L, Limbong J, Vallmuur K, Barker R, Daglish M, Young RMcD. Alcohol-related emergency department injury presentations in Queensland adolescents and young adults over a 13-year period. Drug Alcohol Rev 2014]
    Drug and Alcohol Review 11/2014;
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    ABSTRACT: IssueSince the mid-1990s, there have been calls to make naloxone, a prescription-only medicine in many countries, available to heroin and other opioid users and their peers and family members to prevent overdose deaths.ContextIn Australia there were calls for a trial of peer naloxone in 2000, yet at the end of that year, heroin availability and harm rapidly declined, and a trial did not proceed. In other countries, a number of peer naloxone programs have been successfully implemented. Although a controlled trial had not been conducted, evidence of program implementation demonstrated that trained injecting drug-using peers and others could successfully administer naloxone to reverse heroin overdose, with few, if any, adverse effects.ApproachIn 2009 Australian drug researchers advocated the broader availability of naloxone for peer administration in cases of opioid overdose. Industrious local advocacy and program development work by a number of stakeholders, notably by the Canberra Alliance for Harm Minimisation and Advocacy, a drug user organisation, contributed to the rollout of Australia's first prescription naloxone program in the Australian Capital Territory (ACT). Over the subsequent 18 months, prescription naloxone programs were commenced in four other Australian states.ImplicationsThe development of Australia's first take-home naloxone program in the ACT has been an ‘ice-breaker’ for development of other Australian programs. Issues to be addressed to facilitate future scale-up of naloxone programs concern scheduling and cost, legal protections for lay administration, prescribing as a barrier to scale-up; intranasal administration, administration by service providers and collaboration between stakeholders. [Lenton S, Dietze P, Olsen A, Wiggins N, McDonald D, Fowlie C. Working together: Expanding the availability of naloxone for peer administration to prevent opioid overdose deaths in the Australian Capital Territory and beyond. Drug Alcohol Rev 2014]
    Drug and Alcohol Review 10/2014;
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    ABSTRACT: Introduction and AimsThe US Drug Enforcement Agency classifies marijuana as an illegal substance, yet in 22 states marijuana is legal for medicinal use. In 1996, California legalised the use of marijuana for medicinal purposes, but population-based data describing medical marijuana users in the state has not been available. Our aim was to examine the demographic differences between users and non-users of medical marijuana in California utilising population-based data.Design and Methods We used data from the California Behavioral Risk Factor Surveillance System 2012, an annual, random-digit-dial state-wide telephone survey that collects health data from a representative adult sample (n = 7525). Age-adjusted prevalence rates were estimated.ResultsFive percent of adults in California reported ever using medical marijuana, and most users believed that medical marijuana helped alleviate symptoms or treat a serious medical condition. Prevalence was similar when compared by gender, education and region. Prevalence of ever using medical marijuana was highest among white adults and younger adults ages 18–24 years, although use was reported by every racial/ethnic and age group examined in our study and ranged from 2% to 9%.Conclusions Our study's results lend support to the idea that medical marijuana is used equally by many groups of people and is not exclusively used by any one specific group. As more states approve marijuana use for medical purposes, it is important to track medical marijuana use as a health-related behaviour and risk factor. [Ryan-Ibarra S, Induni M, Ewing D. Prevalence of medical marijuana use in California, 2012. Drug Alcohol Rev 2014]
    Drug and Alcohol Review 10/2014;
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    ABSTRACT: Introduction and AimsWastewater analysis (WWA) is intended to be a direct and objective method of measuring substance use in large urban populations. It has also been used to measure prison substance use in two previous studies. The application of WWA in this context has raised questions as to how best it might be used to measure illicit drug use in prisons, and whether it can also be used to measure prescription misuse. We applied WWA to a small regional prison to measure the use of 12 licit and illicit substances. We attempted to measure the non-medical use of methadone and buprenorphine and to compare our findings with the results of the prison's mandatory drug testing (MDT).Design and Methods Representative daily composite samples were collected for two periods of 12 consecutive days in May to July 2013 and analysed for 18 drug metabolites. Prescription data and MDT results were obtained from the prison and compared with the substance use estimates calculated from WWA data.ResultsDaily use of methamphetamine, methadone, buprenorphine and codeine was detected, while sporadic detection of ketamine and methylone was also observed. Overall buprenorphine misuse appeared to be greater than methadone misuse.Discussion and Conclusions Compared with MDT, WWA provides a more comprehensive picture of prison substance use. WWA also has the potential to measure the misuse of medically prescribed substances. However, a great deal of care must be exercised in quantifying the usage of any substance in small populations, such as in prisons. [van Dyken E, Lai FY, Thai PK, Ort C, Bruno R, Hall W, Kirkbride KP, Mueller JF, Prichard J. Challenges and opportunities in using wastewater analysis to measure drug use in a small prison facility. Drug Alcohol Rev 2014]
    Drug and Alcohol Review 10/2014;
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    ABSTRACT: IssuesEffectiveness of alcohol policy interventions varies across times and places. The circumstances under which effective polices can be successfully transferred between contexts are typically unexplored with little attention given to developing reporting requirements that would facilitate systematic investigation.ApproachUsing purposive sampling and expert elicitation methods, we identified context-related factors impacting on the effectiveness of population-level alcohol policies. We then drew on previous characterisations of alcohol policy contexts and methodological-reporting checklists to design a new checklist for reporting contextual information in evaluation studies.Key FindingsSix context factor domains were identified: (i) baseline alcohol consumption, norms and harm rates; (ii) baseline affordability and availability; (iii) social, microeconomic and demographic contexts; (iv) macroeconomic context; (v) market context; and (vi) wider policy, political and media context. The checklist specifies information, typically available in national or international reports, to be reported in each domain.ImplicationsThe checklist can facilitate evidence synthesis by providing: (i) a mechanism for systematic and more consistent reporting of contextual data for meta-regression and realist evaluations; (ii) information for policy-makers on differences between their context and contexts of evaluations; and (iii) an evidence base for adjusting prospective policy simulation models to account for policy context.Conclusions Our proposed checklist provides a tool for gaining better understanding of the influence of policy context on intervention effectiveness. Further work is required to rationalise and aggregate checklists across interventions types to make such checklists practical for use by journals and to improve reporting of important qualitative contextual data. [Holmes J, Meier PS, Booth A, Brennan A. Reporting the characteristics of the policy context for population-level alcohol interventions: A proposed ‘Transparent Reporting of Alcohol Intervention ContExts’ (TRAICE) checklist. Drug Alcohol Rev 2014]
    Drug and Alcohol Review 10/2014;
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    ABSTRACT: IssuesRates of non-attendance are among the highest in substance misuse services. Non-attendance is costly and results in the inefficient use of limited resources. Patients who frequently miss their appointments have worse outcomes including treatment dropout and decreased likelihood of achieving long-term abstinence.ApproachThis narrative review evaluates interventions targeting non-attendance in addiction services and draws upon the wider health-care literature to identify interventions that could be adapted for substance-abusing populations.Key FindingsBoth fixed value and intermittent reinforcement contingency management demonstrate potential for improving attendance. However, small sample sizes and heterogeneous populations make it difficult to draw firm conclusions. Appointment reminders by letter or telephone have demonstrated moderate evidence for improving attendance in substance-abusing populations. Text message appointment reminders are extensively utilised in general health-care settings and consistently improve attendance; however, there is a paucity of research examining the feasibility and effectiveness of text message reminders in addiction services.ImplicationsA lack of evidence for methods to improve attendance is reflected in the continuing challenge faced by addiction services attempting to manage high rates of non-attendance.Conclusions Non-attendance remains a persistent issue for addiction services. While there is limited evidence that contingency management improves attendance, more rigorous research is needed to determine the optimal intervention components and effectiveness in different populations, particularly those receiving maintenance treatments. Multicomponent text message interventions incorporating different delivery and content strategies demonstrate a promise for improving non-attendance and poor engagement.
    Drug and Alcohol Review 10/2014;
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    ABSTRACT: Introduction and AimsThere is substantial research showing that low socioeconomic position is a predictor of negative outcomes from alcohol consumption, while alcohol consumption itself does not exhibit a strong social gradient. This study aims to examine socioeconomic differences in self-reported alcohol-related risk-taking behaviour to explore whether differences in risk-taking while drinking may explain some of the socioeconomic disparities in alcohol-related harm.Design and Methods Cross-sectional data from current drinkers (n = 21 452) in the 2010 wave of the Australian National Drug Strategy Household Survey were used. Ten items on risk-taking behaviour while drinking were combined into two risk scores, and zero-inflated Poisson regression was used to assess the relationship between socioeconomic position and risk-taking while controlling for age, sex and alcohol consumption.ResultsSocioeconomically advantaged respondents reported substantially higher rates of alcohol-related hazardous behaviour than socioeconomically disadvantaged respondents. Controlling for age, sex, volume of drinking and frequency of heavy drinking, respondents living in the most advantaged quintile of neighbourhoods reported significantly higher rates of hazardous behaviour than those in the least advantaged quintile. A similar pattern was evident for household income.Discussion and Conclusions Socioeconomically advantaged Australians engage in alcohol-related risky behaviour at higher rates than more disadvantaged Australians even with alcohol consumption controlled. The significant socioeconomic disparities in negative consequences linked to alcohol consumption cannot in this instance be explained via differences in behaviour while drinking. Other factors not directly related to alcohol consumption may be responsible for health inequalities in outcomes with significant alcohol involvement. [Livingston M. Socioeconomic differences in alcohol-related risk-taking behaviours. Drug Alcohol Rev 2014]
    Drug and Alcohol Review 10/2014;
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    ABSTRACT: Introduction and AimsIllicit drug use is known to occur among inmate populations of correctional (prison) facilities. Conventional approaches to monitor illicit drug use in prisons include random urinalyses (RUA). Conventional approaches are expected to be prone to bias because prisoners may be aware of which days of the week RUAs are conducted. Therefore, we wanted to compare wastewater loads for methamphetamine and cocaine during days with RUA testing and without.Design and Methods We collected daily 24-h composite samples of wastewater by continuous sampling, computed daily loads for 1 month and compared the frequency of illicit drug detection to the number of positive RUAs. Diurnal data also were collected for 3 days to determine within-day patterns of illicit drugs excretion.ResultsMethamphetamine was observed in each sample of prison wastewater with no significant difference in daily mass loads between RUA testing and non-testing days. Cocaine and its major metabolite, benzoylecgonine, were observed only at levels below quantification in prison wastewater. Six RUAs were positive for methamphetamine during the month while none were positive for cocaine out of the 243 RUAs conducted.Discussion and Conclusions Wastewater analyses offer data regarding the frequency of illicit drug excretion inside the prison that RUAs alone could not detect.
    Drug and Alcohol Review 09/2014;
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    ABSTRACT: Introduction and AimsThis article reports a content analysis of Internet websites related to an emerging designer drug, synthetic cannabinoids. The number of synthetic cannabinoids searchers in the USA has steadily increased from November 2008 to November 2011.Design and Methods To determine the information available on the Internet in relation to synthetic cannabinoids, sites were identified using the Google search engine and the search term ‘herbal incense’. The first 100 consecutive sites were visited and classified by two coders. The websites were evaluated for type of content (retail, information, news, other). US unique monthly visitor data were examined for the top 10 retail sites, and these sites were coded for the quality of information available regarding the legality of synthetic cannabinoids sale and use.ResultsThe Google search yielded 2 730 000 sites for ‘herbal incense’ (for comparison of search terms: ‘synthetic marijuana’, 1 170 000; ‘K2 Spice’, 247 000; and ‘synthetic weed’, 122 000). Moreover, in the Google search, 87% of the sites were retail sites, 5% news, 4% informational and 4% non-synthetic cannabinoid sites.Discussion and Conclusions Many tools found within Google free services hold promise in providing a technique to identify emerging drug markets. We recommend continued surveillance of the Internet using the online tools presented in this brief report by both drug researchers and policy-makers to identify the emerging trends in synthetic drugs' availability and interest.
    Drug and Alcohol Review 09/2014;
  • Drug and Alcohol Review 09/2014; 33(5).
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    ABSTRACT: Introduction and AimsTo investigate the predictors of both initiation of cannabis use and transition to cannabis use disorder (CUD) in a nationally representative sample using discrete-time survival analyses.Design and Methods Data from a nationally representative sample of 6935 Australian adults. Retrospective data on age of first cannabis use and onset of CUD were used to construct pseudo-longitudinal datasets and survival models used to evaluate factors associated with age of first use and time from first use to onset of CUD.ResultsThe oldest cohort (born 1942–1951) had lower cannabis use than younger cohorts, with first use also occurring at an older age. Multivariable discrete-time survival models showed other substance use, tobacco and alcohol use at very young ages, and mental disorders were associated with increased risk of cannabis use. There were 7.5% of those <65 years old at interview who had a lifetime CUD; mean time from first use to the onset of CUD was 3.3 years, with 90% of cases within eight years. Younger age of initiation and other substance use were strong predictors of the transition from use to CUD. Women with depression were more likely to develop a CUD; social phobia and panic disorder were also associated with transition from cannabis use to CUD.Discussion and Conclusions Patterns of cannabis use differ across birth cohorts. There are multiple factors associated with use and transition to CUD, with other substance use a strong predictor. Mental disorders also predict initiation and progression to CUD. [Butterworth P, Slade T, Degenhardt L. Factors associated with the timing and onset of cannabis use and cannabis use disorder: Results from the 2007 Australian National Survey of Mental Health and Well-Being. Drug Alcohol Rev 2014;33:555-563]
    Drug and Alcohol Review 09/2014; 33(5).
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    ABSTRACT: Introduction and AimsThe present analysis contributes to understanding the societal distribution of alcohol-attributable harm by investigating socioeconomic inequality and related gender differences in alcohol-attributable mortality.Design and MethodsA systematic literature search was performed on Web of Science, MEDLINE, PsycINFO and ETOH from their inception until February 2013. Articles were included when they reported data on alcohol-attributable mortality by socioeconomic status (SES), operationalised as education, occupation, employment status or income. Gender-specific relative risks (RR) comparing low with high SES were pooled using random effects meta-analyses. Gender differences were additionally investigated in random effects meta-regressions.ResultsNineteen articles from 14 countries were included. For women, significant RRs across all measures of SES, except employment status, were found, ranging between 1.75 [95% confidence interval (CI) 1.21–2.54; occupation] and 4.78 (95% CI 2.57–8.87; income). For men, all measures of SES showed significant RRs ranging between 2.88 (95% CI 2.45–3.40; income) and 12.25 (95% CI 11.45–13.10; employment status). While RRs for men were in general slightly higher, only for occupation this gender difference was above chance (P = 0.01). Results refer to deaths 100% attributable to alcohol.Discussion and Conclusions The results are predominantly based on data from high-income countries, limiting generalisability. Alcohol-attributable mortality is strongly distributed to the disadvantage of persons with a low SES. Marked gender differences in this inequality were found for occupation. Possibly male-dominated occupations of low SES were more strongly related to risky drinking cultures compared with female-dominated occupations of the same SES.
    Drug and Alcohol Review 09/2014;
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    ABSTRACT: Introduction and AimsPsychoactive prescription drug (PPD) abuse-related overdose deaths have increased in many countries in recent decades. We aimed to investigate the role of personally prescribed psychoactive drugs in abuse-related overdose mortality and explore any associations with level of social disadvantage.Design and Methods This register linkage study included all 243 people who had died of abuse-related drug-induced poisoning in Finland in 2000 and 2008. Data on registered purchases of psychoactive drugs within one and three years of death were linked to data on the psychoactive drug/s contributing to death in each case. Social disadvantage was measured by receipt of income support, long-term unemployment and disability pension.ResultsThirty-six percent of those abusers who had died of a drug overdose had purchased a similarly acting drug within three years of death. In all overdoses, the proportion increased from 20% in 2000 to 49% in 2008 (P < 0.001). A similar increase was seen in purchases within one year of death; from one-tenth in 2000 to one-third of all cases in 2008 (P < 0.001). The majority (83%) of the deceased had received income support, while only 13–14% were long-term unemployed or on disability pension. Disability pension recipients had significantly more prescribed psychoactive drug purchases than non-recipients (P < 0.001 for three and one years within death).Discussion and Conclusions Personally prescribed PPDs pose a potential threat to people who abuse drugs. Health-care services should invest greater effort in identifying people who abuse drugs and in monitoring their drug prescriptions. [Rönkä S, Karjalainen K, Vuori E, Mäkelä P. Personally prescribed psychoactive drugs in overdose deaths among drug abusers: A retrospective register study. Drug Alcohol Rev 2014]
    Drug and Alcohol Review 09/2014;
  • Drug and Alcohol Review 09/2014;
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    ABSTRACT: Introduction and AimsPrescription drug misuse is a considerable problem among young adults, and the identification of types of misuse among this population remains important for prevention and intervention efforts. We use latent class analysis to identify possible distinct latent groups of prescription drug misusers across multiple prescription drug types (pain killers, sedatives and stimulants).Design and Methods Our data are comprised of a sample of 404 young adults recruited from nightlife scenes via time–space sampling. Through the specification of a zero-inflated Poisson latent class analysis, we evaluate differences in class membership by various demographic factors as well as assess the relationship between class membership and health outcomes, including indications of dependence, problems associated with substance use and mental health.ResultsOur assessment of fit indices led to a four-class solution (dabblers, primary stimulant users, primary downers users and extensive regulars). No demographic differences existed between latent classes. The extensive regular class report the greatest number of symptoms related to dependence, greatest number of problems related to misuse and the greatest mental health problems. The dabblers report the fewest problems and symptoms, while the other two classes experiences problems and symptoms in between the classes on the extremes.Discussion and Conclusions Prevention efforts should take into account that young adults who misuse prescription drug have different profiles of misuse, and there may be a need for varied interventions to target these different types of misuse.
    Drug and Alcohol Review 09/2014;
  • Drug and Alcohol Review 09/2014; 33(5).
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    ABSTRACT: Introduction and AimsThe medical complications of injecting preparations from crushed tablets can be severe, and most can be attributed to the injection of insoluble particles and micro-organisms. Previously we have shown that most of the particles can be removed by filtration, but it was not known whether bacteria could also be filtered in the presence of a high particle load. This study aims to determine the feasibility of filtration to remove bacteria from injections prepared from tablets.Design and Methods Injections were prepared from crushed slow-release morphine tablets, in mixed bacterial suspensions of Staphylococcus aureus, Streptococcus pyogenes and Pseudomonas aeruginosa. The injection suspensions were passed through syringe filters of porosity 0.45 or 0.20 μm, or combined 0.8 then 0.2 μm, and the bacterial load was counted.ResultsBacterial concentrations in unfiltered injections were 2.5–4.3 × 106 colony forming units mL−1. Both the 0.20 and 0.45 μm filters blocked unless a prefilter (cigarette filter) was used first. The 0.2 μm filter and the combined 0.8/0.2 μm filter reduced the bacteria to the limit of detection (10 colony forming units mL−1) or below. Filtration through a 0.45 μm filter was slightly less effective.Discussion and Conclusions Use of a 0.2 μm filter, together with other injection hygiene measures, offers the prospect of greatly reducing the medical complications of injecting crushed tablets and should be considered as a highly effective harm reduction method. It is very likely that these benefits would also apply to other illicit drug injections, although validation studies are needed.
    Drug and Alcohol Review 09/2014;
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    ABSTRACT: IssuesReviews recommend controlling alcohol availability to limit alcohol-related harm. However, the translation of this evidence into policy processes has proved challenging in some jurisdictions.ApproachThis paper presents a critical review of empirical spatial and temporal availability research to identify its features and limitations for informing alcohol availability policies. The UK is used as an example jurisdiction. It reviews 138 studies from a 2008 systematic review of empirical availability research and our update of this to January 2014. Data describing study characteristics (settings, measures, design) were extracted and descriptively analysed.Key FindingsImportant limitations in current evidence were identified: (i) outlet-level temporal availability was only measured in three studies, and there has been little innovation in measurement of spatial availability; (ii) empirical analyses focus on acute harms with few studies of longer-term harms; (iii) outlets are typically classified at aggregated levels with little empirical analysis of variation within outlet categories; (iv) evidence comes from a narrow range of countries; and (v) availability away from home, online availability and interactions between availability, price and place are all relatively unexamined.ImplicationsGreater innovation in study and measure design and enhanced data quality are required. Greater engagement between researchers and policy actors when developing studies would facilitate this.Conclusions Research and data innovations are needed to address a series of methodological gaps and limitations in the alcohol availability evidence base, advance this research area and enable findings to be translated effectively into policy processes. [Holmes J, Guo Y, Maheswaran R, Nicholls J, Meier PS, Brennan A. The impact of spatial and temporal availability of alcohol on its consumption and related harms: A critical review in the context of UK licensing policies. Drug Alcohol Rev 2014;33:515–25]
    Drug and Alcohol Review 09/2014; 33(5).
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    ABSTRACT: Introduction and AimsThis study identifies the correlates of caring for harmful drinkers and others, and examines how caring for that person impacts on respondents' well-being and use of services.Design and Methods The study utilises the data from the 2008 Australian Alcohol Harm to Others Survey (n = 2649), in which 778 respondents reported they were harmed because of the drinking of someone they knew. Respondents were asked about the person they were most adversely affected by and whether they spent time caring for this person because of their drinking. Logistic regression models are developed to examine which factors were associated with the prevalence of caring for others.ResultsThe study reveals that the respondents who cared for others because of the other's drinking reported lower quality of life than the respondents who did not have to do this. The results of the logistic regression suggest that respondents were more likely to care for the drinker if the drinker drank more (as the usual quantity of alcohol consumed increased), but less likely to care for the drinker if the drinker drank five or more drinks on more than four days per week.Discussion and Conclusions The findings of the study suggest that the drinking of family and friends can be a substantial burden for their households, families, friends and others. Policy approaches that reduce the amount of heavy drinking, particularly heavy drinking in a single occasion, are likely to reduce the burden of caring for others because of other's drinking.
    Drug and Alcohol Review 08/2014;