Relationship Between Level of Consumption and Harms in Assessing Drink Cut-Points for Alcohol Research: Commentary on "Many College Freshmen Drink at Levels Far Beyond the Binge Threshold" by White et al
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA. Alcoholism Clinical and Experimental Research
(Impact Factor: 3.21).
07/2006; 30(6):922-7. DOI: 10.1111/j.1530-0277.2006.00124.x
In this commentary, we describe the use of a 5/4 drink summary measure of heavy episodic alcohol consumption, or "binge" drinking, in survey research and its usefulness for preventing negative alcohol-related consequences. Data from 4 nationally representative surveys of more than 50,000 college students are utilized to examine the utility of this measure in comparison with alternative cut-points. Our analysis demonstrates that while higher drink threshold measures incrementally improve the ability to identify correctly students who experience harms or who meet DSM-IV diagnostic criteria of alcohol abuse and dependence, they capture only a small proportion of those college students experiencing harms. We conclude that the selection of a measurement tool should be consistent with the purpose for which it is to be used. The 5/4 measure of binge drinking provides a valuable means for understanding and preventing alcohol-related harms in a college population and can be utilized as a screen to identify students who may need additional clinical assessment for intervention.
Available from: Richard L Bell
- "Earlier clinical definitions did not always make this distinction, with the number of these instances increasing as one retrospectively examines the literature (c.f., Plant & Plant, 2006). In addition, despite its general acceptance, there is still some controversy over the 4/5 rule of the NIAAA definition (2004; for some pros and cons see Goldman, 2006; Wechsler & Nelson, 2006; White et al., 2006). On the other hand, as reviewed by Bell et al. (2013) "
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ABSTRACT: Binge alcohol drinking continues to be a public health concern among today's youth and young adults. Moreover, an early onset of alcohol use, which usually takes the form of binge drinking, is associated with a greater risk for developing alcohol use disorders. Given this, it is important to examine this behavior in rat models of alcohol abuse and dependence. Toward that end, the objective of this article is to review findings on binge-like drinking by selectively bred alcohol-preferring (P) and high-alcohol-drinking (HAD) lines of rats. As reviewed elsewhere in this special issue, the P line meets all, and the HAD line meets most, of the proposed criteria for an animal model of alcoholism. One model of binge drinking is scheduled ethanol access during the dark cycle, which has been used by our laboratory for over 20 years. Our laboratory has also adopted a protocol involving the concurrent presentation of multiple ethanol concentrations. When this protocol is combined with limited access, ethanol intake is maximized yielding blood ethanol levels (BELs) in excess, sometimes greatly in excess, of 80 mg%. By extending these procedures to include multiple scheduled ethanol access sessions during the dark cycle for 5 consecutive days/week, P and HAD rats consume in 3 or 4 h as much as, if not more than, the amount usually consumed in a 24 h period. Under certain conditions, using the multiple scheduled access procedure, BELs exceeding 200 mg% can be achieved on a daily basis. An overview of findings from studies with other selectively bred, inbred, and outbred rats places these findings in the context of the existing literature. Overall, the findings support the use of P and HAD rats as animal models to study binge-like alcohol drinking and reveal that scheduled access procedures will significantly increase ethanol intake by other rat lines and strains as well.
- "In response to these criticisms, a series of studies have been undertaken to assess the validity of the US threshold. Using survey data, both Wechsler et al. and Weitzman et al. find no evidence that a higher threshold for defining episodic risky drinking is more valid, with increases in the threshold resulting in more accurate prediction of harm rates amongst the 'risky drinking' group, but also higher rates of false negatives (i.e., non-risky drinkers who report harm; Wechsler and Nelson, 2006; Weitzman and Nelson, 2004). Framing their results in terms of the prevention paradox, Weitzman et al. argue that the use of a lower risky-drinking threshold is the most likely to reduce alcohol-related harms as, while prevalence of harm is higher among the heaviest drinking young people, the number of lower-level drinkers is so much higher that they account for the majority of harms experienced (Weitzman and Nelson, 2004). "
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Studies of episodic drinking typically use a measure based on the frequency of drinking five or more standard drinks (a definition which itself varies based on the standard units being used). While this threshold clearly defines drinking behaviour with a range of risks and negative consequences, there has been limited research outside of US college-based studies to determine the appropriateness of this definition. This study examines fifteen different risky-drinking thresholds to assess which definitions of risky drinking best predict negative outcomes.
This paper presents an analysis of a national survey sample of 19,757 drinkers. The appropriateness of each threshold is assessed using basic risk-curves, specificity and sensitivity analyses and the performance of each threshold definition in multivariate logistic regression models. Risky drinking was defined in fifteen ways (based on frequency and volume) and tested against a series of self-reported negative outcomes and risky behaviours.
The study finds that the most appropriate risky drinking threshold for these data varies based on the mode of analysis and on the type of outcome being considered. Across all approaches used, risky drinking thresholds of seven or fewer drinks performed better than higher thresholds.
While individual level risks peak at higher levels of consumption, these findings support the continuing use of relatively low thresholds for defining risky-drinking, as risk across the total population is highest at these levels.
Available from: David A Leon
- "For example, in 2004 the US National Institute on Alcohol Abuse and Alcoholism (NIAAA) defined binge drinking as "a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 gram percent or above. For the typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours". While almost all episodes of zapoi would meet this definition of a binge, very few episodes of binge drinking in Western countries would be classed as zapoi. "
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ABSTRACT: In the post-Soviet period, Russian working-age men have suffered unusually high mortality rates. Earlier quantitative work found that part of this is attributable to hazardous and harmful patterns of alcohol consumption, which increased in the period of transition at a time of massive social and economic disruption and uncertainty. However, there has been very little work done to document and understand in detail the downward life trajectories of individual men who died prematurely from alcohol-related conditions. Building on an earlier case-control study, this unique qualitative study investigates the perceived interplay between men's drinking careers, their employment and family history, health and eventual death.
In-depth interviews were conducted with close relatives (most often the widow) of 19 men who died between 2003 and 2005 aged 25-54 years whose close relatives reported that alcohol contributed to their death. The study was conducted in a typical medium-sized Russian city. The relative's accounts were analysed using thematic content analysis.
The accounts describe how hazardous drinking both contributed to serious employment, family and health problems, and was simultaneously used as a coping mechanism to deal with life crises and a decline in social status. The interviews highlighted the importance of the workplace and employment status for shaping men's drinking patterns. Common themes emerged around a culture of drinking in the workplace, peer pressure from colleagues to drink, use of alcohol as remuneration, consuming non-beverage alcohols, Russian-specific drinking patterns, attitudes to treatment, and passive attitudes towards health and drinking.
The study provides a unique insight into the personal decline that lies behind the extremely high working-age mortality due to heavy drinking in Russia, and highlights how health status and hazardous drinking are often closely intertwined with economic and social functioning. Descriptions of the development of drinking careers, hazardous drinking patterns and treatment experiences can be used to plan effective interventions relevant in the Russian context.
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