Women suffer more severe consequences related to heavy drinking than men. Relative to men, women who are heavy drinkers experience higher severity of medical, psychiatric, and social problems, even when they have fewer years drinking. Currently there are few gender-specific, evidence-based interventions for heavy drinking among women.A randomized clinical trial was conducted with 215 women with alcohol problems. Half were randomly assigned to receive a 9-session, "Intensive Motivational Interviewing" (IMI) intervention (N=107) and half were randomly assigned to a standard single session of MI (SMI) along with 8 sessions of nutritional education (N=108) to achieve time equivalence. Both conditions received weekly outpatient group counseling. Follow-up interviews were conducted at 2 months. Primary outcomes included percent drinking days (PDD), percent heavy drinking days (PHDD, 4+ drinks), and the Addiction Severity Index (ASI) Alcohol scale. Longitudinal changes were assessed using generalized estimating equations (GEE).The sample was predominantly white (83.3%), college educated (61.4%), and married (53.5%). The mean age was 50.9 (sd = 11.3). Relative to baseline, both study conditions showed significant reductions in PDD, PHDD, and ASI alcohol severity (p<.001). Among heavy drinkers, defined as women drinking 14+ days to the point of intoxication over the past 30 days at baseline (N=153), those assigned to IMI (n=67) showed larger reductions in PDD (p<.01) and PHDD (p<.05) at 2-months compared to women receiving SMI.Findings support the efficacy of IMI for heavy drinking among women. Additional studies are needed that assess drinking over longer time periods.
An intensive, 9-session motivational interviewing (IMI) intervention was assessed using a randomized clinical trial of 217 methamphetamine (MA) dependent individuals. Intensive motivational interviewing (IMI) was compared with a single standard session of MI (SMI) combined with eight nutrition education sessions. Interventions were delivered weekly over 2 months. All study participants also received standard outpatient group treatment three times per week. Both study groups showed significant decreases in MA use and Addiction Severity Index drug scores, but there were no significant differences between the two groups. However, reductions in Addiction Severity Index psychiatric severity scores and days of psychiatric problems during the past 30 days were found for clients in the IMI group but not the SMI group. SMI may be equally beneficial to IMI in reducing MA use and problem severity, but IMI may help alleviate co-occurring psychiatric problems that are unaffected by shorter MI interventions. Additional studies are needed to assess the problems, populations, and contexts for which IMI is effective.
Background: Previous research has documented a relationship between child sexual abuse and alcohol dependence. This paper extends that work by providing a comprehensive description of past year and lifetime alcohol consumption patterns, consequences, and dependence among women reporting either physical and sexual abuse in a national sample. Methods: This study used survey data from 3,680 women who participated in the 2005 U.S. National Alcohol Survey. Information on physical and sexual child abuse and its characteristics were assessed in relation to 8 past year and lifetime alcohol consumption measures. Results: Child physical or sexual abuse was significantly associated with past year and lifetime alcohol consumption measures. In multivariate analyses, controlling for age, marital status, employment status, education, ethnicity, and parental alcoholism or problem drinking, women reporting child sexual abuse vs. no abuse were more likely to report past year heavy episodic drinking (ORadj = 1.7; 95% CI 1.0 to 2.9), alcohol dependence (ORadj = 7.2; 95% CI 3.2 to 16.5), and alcohol consequences (ORadj = 3.6; 95% CI 1.8 to 7.3). Sexual abuse (vs. no abuse) was associated with a greater number of past year drinks (124 vs. 74 drinks, respectively, p = 0.002). Sexual child abuse was also associated with lifetime alcohol–related consequences (ORadj = 3.5; 95% CI 2.6 to 4.8) and dependence (ORadj = 3.7; 95% CI 2.6 to 5.3). Physical child abuse was associated with 4 of 8 alcohol measures in multivariate models. Both physical and sexual child abuse were associated with getting into fights, health, legal, work, and family alcohol–related consequences. Alcohol-related consequences and dependence were more common for women reporting sexual abuse compared to physical abuse, 2 or more physical abuse perpetrators, nonparental and nonfamily physical abuse perpetrators, and women reporting injury related to the abuse. Conclusion: Both child physical and sexual abuse were associated with many alcohol outcomes in adult women, even when controlling for parental alcohol problems. The study results point to the need to screen for and treat underlying issues related to child abuse, particularly in an alcohol treatment setting.
Objective: The purpose of this study was to examine the relations between drinking (mean quantity and heavy drinking patterns) and alcohol use disorders (AUDs) in the U.S. general population. Method: Data from three telephone National Alcohol Surveys (in 2000, 2005, and 2010) were pooled, with separate analyses for men and women restricted to current drinkers (ns = 5,922 men, 6,270 women). Predictors were 12-month volume (mean drinks per day), rates of heavy drinking (5+/4+ drinks in a day for men/women), and very heavy drinking (8+, 12+, and 24+ drinks in a day). Outcomes were negative alcohol-related consequences constituting abuse (1+ of 4 DSM-IV–based domains assessed by 13 items) and alcohol dependence (symptoms in 3+ of 7 DSM-IV–based domains), together taken to indicate an AUD. Segmentation analyses were used to model risks of problem outcomes from drinking patterns separately by gender. Results: In the general population, men and women who consumed ≤1 drink/day on average with no heavy drinking days did not incur substantial risks of an AUD (<10%). Men who drank from 1 to 2 drinks/day on average but never 5+ incurred a 16% risk of reporting an AUD (3.5% alcohol dependence). At higher volumes, men and women who indicated higher rates of drinking larger amounts per day and/or involving 8+ and 12+ drinks/day (and even 24+ drinks/day for men) showed much higher risks of experiencing AUDs. Conclusions: The findings provide quantitative guidance for primary care practitioners who wish to make population-based recommendations to patients who might benefit by reducing both overall intake and amounts per occasion in an effort to lower their risks of developing AUDs.
Background Few studies assess reliability and validity of lifetime alcohol measures. We undertook extended test–retest analyses of retrospective lifetime drinking measures and of incremental predictive ability of lifetime heavy drinking (days 5+ drinks) in teens, 20s, and 30s for current (12‐month) alcohol use disorders ( AUD s). Methods A subset (31.4%; 962 men, 1,220 women) of the 2005 U.S. National Alcohol Survey ( NAS ; N 11) completed a follow‐up survey ( N 11 T ) by phone or mail (mean delay of 2.7 years). Both surveys assessed lifetime drinking. Results In N 11 T , drinking status was reported consistently by 94.7% of N 11 current drinkers, 85.5% of ex‐drinkers, and 74.4% of lifetime abstainers (93.5% overall). Cumulative number of prior heavy drinking days (teens through 30s) were moderately consistent (Pearson's ρ = 0.6, p < 0.001, n = 1,636). Reliability was lower for younger respondents under 30 and higher for Whites versus Blacks and Hispanics ( ρ = 0.68 vs. ρ = 0.56 vs. ρ = 0.56, both p = 0.01), but did not differ by gender. Heavy drinking days in teens correlated 0.63 ( p < 0.001) for those aged 20 or older, higher for women than men and for Whites versus ethnic minorities. Heavy drinking days in the 20s and 30s reported by those 30 and older and 40 and older correlated at 0.63 and 0.67, respectively, being higher for Whites. Age of drinking onset and of lifetime maximum quantity reports were also consistent (0.65, 0.73), higher for women versus men, for those older than 29 versus younger, and for Whites versus Blacks and Hispanics. In N 11, controlling for gender, age, ethnicity, and current 5+ frequency, cumulative prior 5+ days (teens to age 39) predicted current alcohol‐related consequences and dependence (both p = 0.003). Conclusions Measurements of earlier heavy drinking are feasible, efficient, and reasonably reliable, albeit with some individual imprecision. Prior drinking data improve prediction of current AUD s, adjusting for demographics and current drinking.
To evaluate the efficacy of an innovative, self-administered, electronic Screening and Brief Intervention (e-SBI) in English and Spanish, "DrinkWise," for reducing drinking among nonpregnant women of childbearing age.A parallel design, phase 1 trial included 185 nonpregnant women reporting risky drinking (8 or more drinks in a week or 3 or more drinks in a day) who were recruited from 2 publicly funded Nutritional Assistance for Women, Infants and Children (WIC) program sites in the United States from 2016 to 2017. Participants were 18 to 44 years in age, 75% of Hispanic ethnicity, 44% Spanish speakers, 30% had not completed high school, and 15% were currently breastfeeding. Participants were randomized to receive (intervention condition, n = 99) or not receive (control condition, no intervention, n = 86) DrinkWise and followed at 3 and 6 months.Women receiving DrinkWise had greater reductions in the odds of self-reported weekly alcohol use (odds ratio [OR] = 0.22, SE = 0.12, P < 0.01) and heavy alcohol use (OR = 0.23, SE = 0.14, P < 0.05) at 6-month follow-up than controls, with no group differences at 3-month follow-up. Compared with heavy drinking controls, heavy drinkers receiving DrinkWise showed a trend (P = 0.06) for greater reductions in drink (pour) size from 3- to 6-month follow-up.DrinkWise may be efficacious in reducing drinking among low-income women of childbearing age and provides a low-cost tool for increasing access to recommended SBI among childbearing-age women. Studies should continue to build DrinkWise's evidence base.ClinicalTrials.gov, https://clinicaltrials.gov/ct2/show/NCT02337361.
Preference for on-premise drinking affects likelihood of aggression, but how venue affects victimization by other drinkers is less studied. We investigated influence of heavy consumption in specific venues on fighting and assaults by other drinkers in the 2000 U.S. National Alcohol Survey, a representative telephone survey of adults (n = 7,612). In the prior year 4.5% current drinkers were assaulted by drinkers, while < 2% reported fighting while drinking. Logistic regression analyses showed that where one drank most, and usual and peak amounts drunk there, each influenced risks of fighting and (less) being assaulted. For drinking and fighting, heaviest context, usual amount, and difference between usual and peak were all highly significant, but adding age and impulsivity/sensation seeking eliminated effect of venue. Victimization risk curves for maximum were exponential: A peak of 10+ drinks showed odds ratios when at another's home, one's own home, and a bar of 4.5, 5.3 and 10.3, respectively (reference 1–2 home drinks); risk curves were steeper for fighting. Maximum amount consumed dominates the venue in which one drinks the most, once selectivity based on personal characteristics is attended to. We suggest interventions should emphasize ways of addressing overdrinking within a range of settings.
This study examined factors associated with hesitancy in medical students to assess patients for history of victimization by interpersonal violence. A survey on preferences regarding assessment of victimization history and attitudes toward victims and perpetrators of interpersonal violence was completed by 102 senior undergraduate medical students. Most students disagreed with routine screening of patients. There were no differences in hesitancy to assess patient history of victimization by gender, year of training, personally knowing a victim, or witnessing adult violence in the home. Negative attitudes toward victims and lower knowledge of characteristics and consequences of violence, particularly that related to rape, were associated with increasing hesitancy to assess history of victimization. Victim blaming alone emerged as a significant predictor of student hesitancy. Training in interpersonal violence issues for medical students must focus on student attitudes in order to assist them in appropriate assessment of and intervention with victims of violence.
