1. www.alcoholandhealth.org1 Update on Alcohol and Health Alcohol and Health: Current Evidence July–August 2004

2. www.alcoholandhealth.org2 Studies on Alcohol and Health Conditions

3. www.alcoholandhealth.org3 Alcohol, Hypertension, and Cardiovascular Disease Mortality Malinski MK, et al. Arch Intern Med. 2004;164(6):623–628.

4. www.alcoholandhealth.org4 Objectives/Methods To assess the relationship between drinking and mortality among patients with hypertension To assess the relationship between drinking and mortality among patients with hypertension Self-reported data from the Physicians’ Health Study Self-reported data from the Physicians’ Health Study 14,125 males with a history of current or past treatment for hypertension and without myocardial infarction, stroke, cancer, or liver disease at baseline 14,125 males with a history of current or past treatment for hypertension and without myocardial infarction, stroke, cancer, or liver disease at baseline analyses adjusted for potential confounders (e.g., age, smoking, diabetes) analyses adjusted for potential confounders (e.g., age, smoking, diabetes)

5. www.alcoholandhealth.org5 Results Amount ConsumedRelative Risk (RR)* of Cardiovascular Disease Death RR of Total Death 1–6 drinks per week 0.60.7 ≥1 drinks per day 0.60.7 *Compared with Those who Rarely or Never Drank

6. www.alcoholandhealth.org6 Conclusions/Comments In this cohort of physicians with hypertension who consumed low amounts, moderate alcohol consumption reduced risk of CVD mortality and total mortality. In this cohort of physicians with hypertension who consumed low amounts, moderate alcohol consumption reduced risk of CVD mortality and total mortality. There are limits to applying these results to broader primary care populations. There are limits to applying these results to broader primary care populations. Clinicians should individualize recommendations about alcohol use and help patients determine whether the cardiovascular benefits from moderate drinking outweigh any potential risks. Clinicians should individualize recommendations about alcohol use and help patients determine whether the cardiovascular benefits from moderate drinking outweigh any potential risks.

7. www.alcoholandhealth.org7 Changes in Alcohol Consumption and Their Effects on Mortality, Cancer, and Coronary Heart Disease Coronary Heart Disease Grønbaek M, et al. Epidemiology. 2004;15(2):222–228.

8. www.alcoholandhealth.org8 Objectives/Methods To examine how changes in intake affect risk of mortality, coronary heart disease (CHD), and cancer To examine how changes in intake affect risk of mortality, coronary heart disease (CHD), and cancer Data from a longitudinal study Data from a longitudinal study 6644 men and 8010 women 6644 men and 8010 women completed 2 health exams at 5-year intervals completed 2 health exams at 5-year intervals analyses adjusted for possible confounders (e.g., age, sex, smoking) analyses adjusted for possible confounders (e.g., age, sex, smoking)

9. www.alcoholandhealth.org9 Results Risk of All-Cause Mortality Risk of CHD Mortality Risk of Cancer Mortality Stable drinking U-shaped, with non-drinkers and heavy drinkers having the highest mortality No significant association with amount consumed Borderline significant risk in non-drinkers Significantly higher in heavy drinkers Increases or decreases in intake Significantly higher when intake decreased to <1 drink per week No significant association with increases Borderline significant risk for light drinkers who decreased intake to <1 drink per week No significant association Non-drinkers consumed <1 drink per week. Light drinkers consumed 1-6 drinks per week. Heavy drinkers consumed >13 drinks per week.

10. www.alcoholandhealth.org10 Conclusions/Comments This study found that moderate drinkers who decreased their consumption to little or no alcohol increased their risk of death from all causes. This study found that moderate drinkers who decreased their consumption to little or no alcohol increased their risk of death from all causes. According to these findings, adult moderate drinkers—to lower their risk of death—should not be advised to reduce their intake or to abstain. According to these findings, adult moderate drinkers—to lower their risk of death—should not be advised to reduce their intake or to abstain.

11. www.alcoholandhealth.org11 Drinking Patterns— Not Just Total Amount— Affect Risk Trevisan M, et al. Addiction. 2004;99(3):313–322. Tolstrup JS, et al. Addiction. 2004;99(3):323–330.

12. www.alcoholandhealth.org12 Objectives/Methods Trevisan study: To determine the effect of drinking patterns on the risk of myocardial infarction (MI) To determine the effect of drinking patterns on the risk of myocardial infarction (MI) Case-control study Case-control study 427 white males with incident MI 427 white males with incident MI 905 healthy white male controls selected randomly from 2 Western New York counties 905 healthy white male controls selected randomly from 2 Western New York counties analyses adjusted for multiple risk factors (e.g., age, smoking, diet, physical activity) analyses adjusted for multiple risk factors (e.g., age, smoking, diet, physical activity)

13. www.alcoholandhealth.org13 Results Risk of MI among Current Drinkers* compared with Lifetime Abstainers Drank <1 time during the week OR 0.5 Drank daily 0.4 Drank on weekdays and weekends (compared with only on weekends) 0.5 Drank mainly with food 0.5 *past 1-2 years

14. www.alcoholandhealth.org14 Objectives/Methods Tolstrup study: To learn how drinking patterns affect risk of all- cause mortality To learn how drinking patterns affect risk of all- cause mortality Questionnaire data from a population-based Danish cohort Questionnaire data from a population-based Danish cohort 26,909 men and 29,626 women 26,909 men and 29,626 women analyses adjusted for multiple risk factors (e.g., age, smoking, diet, physical activity) analyses adjusted for multiple risk factors (e.g., age, smoking, diet, physical activity)

15. www.alcoholandhealth.org15 Results Frequent drinkers (≥2 times per week) had a lower hazard of death than non-frequent drinkers. Frequent drinkers (≥2 times per week) had a lower hazard of death than non-frequent drinkers. Compared with males drinking <1 drink per week, male frequent drinkers who consumed 1– 20 drinks per week had significantly lower mortality. Compared with males drinking <1 drink per week, male frequent drinkers who consumed 1– 20 drinks per week had significantly lower mortality. Compared with females drinking <1 drink per week, female frequent drinkers who consumed larger amounts did not have significantly lower mortality. Compared with females drinking <1 drink per week, female frequent drinkers who consumed larger amounts did not have significantly lower mortality.

16. www.alcoholandhealth.org16 Conclusions/Comments These studies add to the accumulating evidence that drinking patterns do matter. These studies add to the accumulating evidence that drinking patterns do matter. Result of these and similar studies should be viewed with caution because small numbers of infrequent drinkers in the high consumption categories make it difficult to adjust adequately for total alcohol intake. Result of these and similar studies should be viewed with caution because small numbers of infrequent drinkers in the high consumption categories make it difficult to adjust adequately for total alcohol intake. While they wait for better data, clinicians should steer moderate drinkers towards more frequent drinking of small amounts rather than less frequent drinking of larger amounts. While they wait for better data, clinicians should steer moderate drinkers towards more frequent drinking of small amounts rather than less frequent drinking of larger amounts.

17. www.alcoholandhealth.org17 Risky Sex: It’s the Alcohol Ehrenstein V, et al. Drug Alcohol Depend. 2004;73(2)159–166.

18. www.alcoholandhealth.org18 Objectives/Methods To better understand alcohol’s effect on inconsistent condom use To better understand alcohol’s effect on inconsistent condom use Data from a prospective cohort of adults with HIV and current or past alcohol problems Data from a prospective cohort of adults with HIV and current or past alcohol problems 345 subjects 345 subjects analyses adjusted for possible confounders (e.g., race, education, other drug use) analyses adjusted for possible confounders (e.g., race, education, other drug use)

19. www.alcoholandhealth.org19 Results Alcohol consumption was significantly associated with inconsistent condom use (<100% over the last 6 months). Alcohol consumption was significantly associated with inconsistent condom use (<100% over the last 6 months). % Reporting Inconsistent Condom Use Heavier drinkers (>14 drinks per week for men, >7 for women) 51% Moderate drinkers 41% Abstainers32%

20. www.alcoholandhealth.org20 Results (cont.) heavier drinking in users of injection drugs heavier drinking in users of injection drugs being female being female identifying as gay or lesbian identifying as gay or lesbian living with a partner living with a partner having 2 or more sexual partners having 2 or more sexual partners agreeing that condoms are a hassle to use agreeing that condoms are a hassle to use Factors associated with significant increases in risk of inconsistent condom use (odds ratios between 2 and 4): Factors associated with borderline significant increases in risk: recently testing HIV-positive, selling sex for drugs or money, having a higher CD4 cell count

21. www.alcoholandhealth.org21 Conclusions/Comments Whether the findings in this cohort (30% employed, 67% non-white, 29% homeless) will hold true for others with HIV is unknown. Whether the findings in this cohort (30% employed, 67% non-white, 29% homeless) will hold true for others with HIV is unknown. Drinking >1–2 drinks per day appears to increase risk of inconsistent condom use, particularly among users of injection drugs. Drinking >1–2 drinks per day appears to increase risk of inconsistent condom use, particularly among users of injection drugs. When addressing this risk, clinicians, public health practitioners, and others must consider factors that contribute to inconsistent use— many of which are modifiable. When addressing this risk, clinicians, public health practitioners, and others must consider factors that contribute to inconsistent use— many of which are modifiable.

22. www.alcoholandhealth.org22 Lasting Effects of Alcohol on Cognitive Function in HIV Infection Green JE, et al. Am J Psychiatry. 2004;161(2):249–254.

23. www.alcoholandhealth.org23 Objectives/Methods To better understand the effects of heavy alcohol use on cognitive function in people infected with HIV To better understand the effects of heavy alcohol use on cognitive function in people infected with HIV Assessment of various neuropsychological functions and symptoms of anxiety and depression in 80 gay or bisexual men Assessment of various neuropsychological functions and symptoms of anxiety and depression in 80 gay or bisexual men 50 with HIV (21 who also had past alcohol abuse or dependence) 50 with HIV (21 who also had past alcohol abuse or dependence) 30 without HIV (12 who had past alcohol abuse or dependence) 30 without HIV (12 who had past alcohol abuse or dependence)

24. www.alcoholandhealth.org24 Results Overall cognitive impairment did not differ significantly between those with and without HIV. Overall cognitive impairment did not differ significantly between those with and without HIV. Men with past alcohol abuse or dependence, compared with those without, showed cognitive impairment on a significantly greater number of measures. Men with past alcohol abuse or dependence, compared with those without, showed cognitive impairment on a significantly greater number of measures. Mean # of Measures indicating Cognitive Impairment Those with past abuse/dependence and HIV 5 Those with past abuse/dependence without HIV 3.8 Those without past abuse/dependence but with HIV 3.5 Those with neither past abuse/dependence nor HIV 2.9

25. www.alcoholandhealth.org25 Conclusions/Comments This study’s strength is its detailed assessments of participants. This study’s strength is its detailed assessments of participants. Given the study’s small sample size, researchers could not adjust for factors that could have explained the association between past alcohol use disorders and cognitive impairment. Given the study’s small sample size, researchers could not adjust for factors that could have explained the association between past alcohol use disorders and cognitive impairment. Nonetheless, the findings suggest that the association between alcohol abuse or dependence and cognitive dysfunction in HIV- infected men is particularly pronounced. Nonetheless, the findings suggest that the association between alcohol abuse or dependence and cognitive dysfunction in HIV- infected men is particularly pronounced.

26. www.alcoholandhealth.org26 Another Complication of Drinking during Pregnancy Avaria MD, et al. J Pediatr. 2004;144(3)338–343.

27. www.alcoholandhealth.org27 Objectives/Methods To examine the effects of alcohol exposure in utero on the peripheral nervous system To examine the effects of alcohol exposure in utero on the peripheral nervous system Study of 30 neonates born to women identified during prenatal care Study of 30 neonates born to women identified during prenatal care 17 exposed neonates; 13 unexposed 17 exposed neonates; 13 unexposed

28. www.alcoholandhealth.org28 Results No neonates had classic signs of fetal alcohol syndrome; 1 had possible fetal alcohol effects. No neonates had classic signs of fetal alcohol syndrome; 1 had possible fetal alcohol effects. Alcohol-exposed neonates had significantly slower nerve conduction velocities and response amplitudes in some nerves. Alcohol-exposed neonates had significantly slower nerve conduction velocities and response amplitudes in some nerves. Differences were significant in the ulnar motor nerve and borderline significant in the tibial motor nerve. Differences were significant in the ulnar motor nerve and borderline significant in the tibial motor nerve. No significant differences were found in peroneal, median, or sensory nerve conduction. No significant differences were found in peroneal, median, or sensory nerve conduction.

29. www.alcoholandhealth.org29 Conclusions/Comments This small study could not determine the length and intensity at which alcohol exposure causes harm, nor could it inform us of the clinical implications of its findings. This small study could not determine the length and intensity at which alcohol exposure causes harm, nor could it inform us of the clinical implications of its findings. Despite its sample size, the study did demonstrate yet another complication of alcohol consumption during pregnancy. Despite its sample size, the study did demonstrate yet another complication of alcohol consumption during pregnancy. The best advice to pregnant women or to those planning pregnancy is abstinence. The best advice to pregnant women or to those planning pregnancy is abstinence.

30. www.alcoholandhealth.org30 Alcohol Consumption and Diabetes Mellitus Howard AA, et al. Ann Intern Med. 2004;140(3):211–219.

31. www.alcoholandhealth.org31 Objectives/Methods To summarize the findings of studies on alcohol consumption and the risk and control of diabetes To summarize the findings of studies on alcohol consumption and the risk and control of diabetes Systematic review Systematic review 32 studies, 27 involving type 2 diabetes only 32 studies, 27 involving type 2 diabetes only

32. www.alcoholandhealth.org32 Results Moderate drinking (defined variably in each study), compared with not drinking, reduced diabetes risk in 11 of 18 studies. Moderate drinking (defined variably in each study), compared with not drinking, reduced diabetes risk in 11 of 18 studies. Drinking (defined variably, but as little as 1.4 drinks per day) significantly increased diabetes risk in 4 of 18 studies. Drinking (defined variably, but as little as 1.4 drinks per day) significantly increased diabetes risk in 4 of 18 studies. Consumption (about 1–6 drinks on an occasion under experimental conditions) did not impair, and sometimes improved, glycemic control. Consumption (about 1–6 drinks on an occasion under experimental conditions) did not impair, and sometimes improved, glycemic control.

33. www.alcoholandhealth.org33 Results (cont.) In patients with diabetes, moderate drinking, compared with not drinking, significantly decreased risk of In patients with diabetes, moderate drinking, compared with not drinking, significantly decreased risk of death from coronary heart disease (CHD) (by up to 79% in 3 of 4 studies); death from coronary heart disease (CHD) (by up to 79% in 3 of 4 studies); CHD-related events (by up to 55% in 2 of 3 studies). CHD-related events (by up to 55% in 2 of 3 studies). Consuming about 3 drinks on an occasion with troglitazone or a sulfonylurea did not affect glycemic control. Consuming about 3 drinks on an occasion with troglitazone or a sulfonylurea did not affect glycemic control. Heavy use (defined variably) significantly increased diabetic retinopathy in 1 study and had no effect in another. Heavy use (defined variably) significantly increased diabetic retinopathy in 1 study and had no effect in another.

34. www.alcoholandhealth.org34 Conclusions/Comments Moderate alcohol use may decrease risk of type 2 diabetes and diabetes-related cardiovascular events. Moderate alcohol use may decrease risk of type 2 diabetes and diabetes-related cardiovascular events. However, results from this review are inconsistent, and some included studies suggest increased risk at drinking levels often considered to be moderate. However, results from this review are inconsistent, and some included studies suggest increased risk at drinking levels often considered to be moderate. Given current evidence, it is likely safe for people with type 2 diabetes to follow usual drinking recommendations (≤1 drink per day for women and people over 65 years; ≤ 2 drinks per day for men aged 65 and under). Given current evidence, it is likely safe for people with type 2 diabetes to follow usual drinking recommendations (≤1 drink per day for women and people over 65 years; ≤ 2 drinks per day for men aged 65 and under).

35. www.alcoholandhealth.org35 Studies on Interventions

36. www.alcoholandhealth.org36 Efficacy of Brief Interventions in Primary Care Primary Care to Reduce Risky and Harmful Alcohol Use Harmful Alcohol Use Whitlock EP, et al. Ann Intern Med. 2004;140(7):557–568.

37. www.alcoholandhealth.org37 Objectives/Methods To inform clinical guidelines of the U.S. Preventive Services Task Force (USPSTF) about brief behavioral counseling interventions To inform clinical guidelines of the U.S. Preventive Services Task Force (USPSTF) about brief behavioral counseling interventions Systematic review of studies on the efficacy of these interventions Systematic review of studies on the efficacy of these interventions 12 controlled trials included 12 controlled trials included

38. www.alcoholandhealth.org38Results Those receiving brief multi-contact interventions (initial session up to 15 minutes and at least 1 follow-up) reduced their average weekly alcohol intake by 13%–34% more than controls in 4 of 7 trials. Those receiving brief multi-contact interventions (initial session up to 15 minutes and at least 1 follow-up) reduced their average weekly alcohol intake by 13%–34% more than controls in 4 of 7 trials. 10%–19% more intervention participants than controls drank safe amounts. 10%–19% more intervention participants than controls drank safe amounts. Very brief (up to 5 minutes) or brief single-contact interventions were ineffective or less effective in reducing risky or harmful alcohol use. Very brief (up to 5 minutes) or brief single-contact interventions were ineffective or less effective in reducing risky or harmful alcohol use.

39. www.alcoholandhealth.org39 Results (cont.) All effective interventions included at least 2 of 3 key elements: All effective interventions included at least 2 of 3 key elements: feedback, advice, and goal setting. feedback, advice, and goal setting. No significant differences were found among men and women receiving brief interventions. No significant differences were found among men and women receiving brief interventions.

40. www.alcoholandhealth.org40 Conclusions/Comments USPSTF gave a grade B recommendation (at least fair evidence of improved health outcomes and benefits outweighing potential harms) to screening and brief counseling in primary care to reduce risky or harmful alcohol use among adults. USPSTF gave a grade B recommendation (at least fair evidence of improved health outcomes and benefits outweighing potential harms) to screening and brief counseling in primary care to reduce risky or harmful alcohol use among adults. Better strategies to implement screening and more effective brief interventions in actual clinical practice must be developed. Better strategies to implement screening and more effective brief interventions in actual clinical practice must be developed.

41. www.alcoholandhealth.org41 Alcohol Screening and Referral on College Campuses Foote J, et al. J Am Coll Health. 2004;52(4):149–157.

42. www.alcoholandhealth.org42 Objectives/Methods To assess alcohol screening and referral on college campuses To assess alcohol screening and referral on college campuses Survey of a state-stratified random sample of 4-year colleges/universities with health centers Survey of a state-stratified random sample of 4-year colleges/universities with health centers 76% response rate; 234 schools analyzed 76% response rate; 234 schools analyzed

43. www.alcoholandhealth.org43 Results 33% of the schools conducted routine alcohol screening of most or all (96%) students visiting their health centers. 33% of the schools conducted routine alcohol screening of most or all (96%) students visiting their health centers. Urban, large, and especially public schools were significantly more likely to routinely screen. Urban, large, and especially public schools were significantly more likely to routinely screen. Screening was typically part of a standard medical history and physical. Screening was typically part of a standard medical history and physical. 12% of schools used a standardized instrument (most often the CAGE) to screen. 12% of schools used a standardized instrument (most often the CAGE) to screen.

44. www.alcoholandhealth.org44 Results (cont.) On average, health centers offered 3 referral options. The most common included On average, health centers offered 3 referral options. The most common included the campus counseling center; the campus counseling center; substance abuse treatment in the community; substance abuse treatment in the community; 12-step programs; 12-step programs; individual therapy. individual therapy.

45. www.alcoholandhealth.org45 Conclusions/Comments These findings highlight both the lack of alcohol screening in college health centers as well as potential inadequacies in practices used by those who do screen. These findings highlight both the lack of alcohol screening in college health centers as well as potential inadequacies in practices used by those who do screen. Given the harm caused by—and few successful strategies to curb—heavy drinking, college health centers should receive the necessary support to implement effective screening and referral. Given the harm caused by—and few successful strategies to curb—heavy drinking, college health centers should receive the necessary support to implement effective screening and referral.

46. www.alcoholandhealth.org46 Does Experience Influence Hospitals’ Resource Use in Treating Alcohol and Other Drug Diagnoses Bramble JD, et al. J Gen Intern Med. 2004;19(1):36–42.

47. www.alcoholandhealth.org47 Objectives/Methods To investigate whether a hospital’s experience with alcohol and other drug diagnoses or its teaching status impacts resource use To investigate whether a hospital’s experience with alcohol and other drug diagnoses or its teaching status impacts resource use National data from 1996 Healthcare Costs and Utilization Project and other large administrative databases National data from 1996 Healthcare Costs and Utilization Project and other large administrative databases Analyses adjusted for multiple hospital and patient characteristics Analyses adjusted for multiple hospital and patient characteristics

48. www.alcoholandhealth.org48 Results Relative experience was significantly associated with lower charges but also associated (borderline significance) with greater length of stay. Relative experience was significantly associated with lower charges but also associated (borderline significance) with greater length of stay. Teaching hospital status was not significantly associated with either charges or length of stay. Teaching hospital status was not significantly associated with either charges or length of stay.

49. www.alcoholandhealth.org49 Conclusions/Comments The authors speculated that the lower charges and longer lengths of stay in high volume hospitals might have resulted from managing patients with substance-related disorders in less expensive settings. The authors speculated that the lower charges and longer lengths of stay in high volume hospitals might have resulted from managing patients with substance-related disorders in less expensive settings. They did not address the quality of care, readmissions, or other outcomes. They did not address the quality of care, readmissions, or other outcomes. Thus, whether this less expensive care leads to better or worse clinical outcomes remains unknown. Thus, whether this less expensive care leads to better or worse clinical outcomes remains unknown.

50. www.alcoholandhealth.org50 Studies on Special Populations

51. www.alcoholandhealth.org51 Drinking Patterns and Rates of Alcohol-Related Problems in Three Urban Populations Bobak M, et al. J Epidemiol Community Health. 2004;58(3):238–242.

52. www.alcoholandhealth.org52 Objectives/Methods To examine whether drinking patterns, in addition to overall consumption, contributed to differences in alcohol-related problems To examine whether drinking patterns, in addition to overall consumption, contributed to differences in alcohol-related problems Interview data from 1118 men and 1125 women randomly selected from Russian, Czech Republic, and Polish population registries Interview data from 1118 men and 1125 women randomly selected from Russian, Czech Republic, and Polish population registries

53. www.alcoholandhealth.org53 Results Russian Men Czech Men Polish Men Reported ≥2 positive responses to the CAGE 35%19%14% Reported ≥2 negative consequences related to consumption 18%10%8% Mean annual intake 5 liters9 liters4 liters Drinking sessions per year 6717979 Average consumption per drinking session mean 71 g45 g46 g Russian men were also significantly more likely to drink ≥80, ≥120, or ≥160 g of alcohol on an occasion.

54. www.alcoholandhealth.org54 Conclusions/Comments In this study, consuming large amounts per drinking session explained a substantial part of the differences in negative consequences among the 3 populations. In this study, consuming large amounts per drinking session explained a substantial part of the differences in negative consequences among the 3 populations. These findings suggest that average consumption alone does not determine alcohol- related problems at the population level. These findings suggest that average consumption alone does not determine alcohol- related problems at the population level.

55. www.alcoholandhealth.org55 Alcohol and Other Drug Use Initiation in American Indian Adolescents Novins DK, et al. J Am Acad Child Adolesc Psychiatry. 2004;43(3):316–324.

56. www.alcoholandhealth.org56 Objectives/Methods To examine the risk of initiation and progression of substance use in American Indian adolescents To examine the risk of initiation and progression of substance use in American Indian adolescents Semiannual survey data collected over 3 years from 14 to 20 year olds at 7 predominantly American Indian high schools Semiannual survey data collected over 3 years from 14 to 20 year olds at 7 predominantly American Indian high schools

57. www.alcoholandhealth.org57 Results Of 568 adolescents who were abstinent at baseline, 42% initiated use with alcohol, marijuana, and/or inhalants; 7% initiated use with other illicit drugs (e.g., cocaine). Initiation of use peaked at approximately age 18. Alcohol was the most common first substance used.

58. www.alcoholandhealth.org58 Results (cont.) Of 1244 adolescents who used alcohol, marijuana, and/or inhalants at baseline, 24% progressed to other illicit drug use. Adolescents who had initiated substance use with marijuana or inhalants (versus alcohol) were significantly more likely to progress to other illicit drug use. Risk of initiation and progression significantly differed by tribal group and season.

59. www.alcoholandhealth.org59 Conclusions/Comments All American Indian adolescents will not necessarily follow the specified patterns of substance use initiation and progression. All American Indian adolescents will not necessarily follow the specified patterns of substance use initiation and progression. The findings of this study, however, do suggest that almost half of American Indian adolescents initiate substance use with alcohol, marijuana, and/or inhalants, and a quarter of users progress to other illicit drugs. The findings of this study, however, do suggest that almost half of American Indian adolescents initiate substance use with alcohol, marijuana, and/or inhalants, and a quarter of users progress to other illicit drugs. Results imply that efforts to prevent initiation and progression may need to be tailored to the specific issues facing individual communities. Results imply that efforts to prevent initiation and progression may need to be tailored to the specific issues facing individual communities.

60. www.alcoholandhealth.org60 Other Studies

61. www.alcoholandhealth.org61 Binge Drinking’s Effect on Health-Related Quality of Life Okoro CA, et al. Am J Prev Med. 2004;26(3):230–233.

62. www.alcoholandhealth.org62 Objectives/Methods To examine the association between binge drinking (consuming  5 drinks on 1 occasion in the past month) and health-related quality of life (HRQQL) To examine the association between binge drinking (consuming  5 drinks on 1 occasion in the past month) and health-related quality of life (HRQQL) Data from the Behavioral Risk Factor Surveillance System Data from the Behavioral Risk Factor Surveillance System cross-sectional, random-digit-dial telephone survey of adults aged 18 and older nationwide cross-sectional, random-digit-dial telephone survey of adults aged 18 and older nationwide analyses adjusted for possible confounders analyses adjusted for possible confounders

63. www.alcoholandhealth.org63 Results Frequent binge drinkers*,compared with non-binge drinkers, were significantly more likely to experience ≥14 unhealthy days in the past month. Frequent binge drinkers*,compared with non-binge drinkers, were significantly more likely to experience ≥14 unhealthy days in the past month. Increased risk was mainly due to having more mentally (vs. physically) unhealthy days. Increased risk was mainly due to having more mentally (vs. physically) unhealthy days. Infrequent binge drinking** was significantly associated with experiencing ≥14 unhealthy days among women and people ≥55. Infrequent binge drinking** was significantly associated with experiencing ≥14 unhealthy days among women and people ≥55. *had ≥3 episodes in the past month; **1–2 episodes in the past month

64. www.alcoholandhealth.org64 Conclusions/Comments Frequent, and sometimes infrequent, binge drinking is associated with worse HRQOL and mental distress. Frequent, and sometimes infrequent, binge drinking is associated with worse HRQOL and mental distress. It is not clear whether binge drinking led to worse HRQOL or vice versa. It is not clear whether binge drinking led to worse HRQOL or vice versa. Findings underscore the adverse consequences of binge drinking and support the need effective prevention efforts. Findings underscore the adverse consequences of binge drinking and support the need effective prevention efforts.

65. www.alcoholandhealth.org65 WHO Report Summarizes Biological Factors Related to Substance use Geneva, Switzerland: World Health Organization, 2004

66. www.alcoholandhealth.org66 Objectives/Methods To summarize 30 years of research on biological factors related to substance use To summarize 30 years of research on biological factors related to substance use

67. www.alcoholandhealth.org67 Results “…Substance dependence is a chronic, relapsing disorder with a biological and genetic basis, and is not simply due to lack of will or desire to quit.” “…Substance dependence is a chronic, relapsing disorder with a biological and genetic basis, and is not simply due to lack of will or desire to quit.” Tobacco, alcohol, and illicit drugs are responsible for 9%, 3%, and 0.4% of deaths worldwide, respectively. Tobacco, alcohol, and illicit drugs are responsible for 9%, 3%, and 0.4% of deaths worldwide, respectively. Tobacco and alcohol are among the top 10 leading risk factors of avoidable disease burden, with each responsible for approximately 4% of disability worldwide. Tobacco and alcohol are among the top 10 leading risk factors of avoidable disease burden, with each responsible for approximately 4% of disability worldwide.

68. www.alcoholandhealth.org68 Results (cont.) Effective treatments for substance dependence are available and can be integrated into health systems, including primary care. Effective treatments for substance dependence are available and can be integrated into health systems, including primary care. Neuroscience-based knowledge of substance dependence can reduce the strong and pervasive stigma associated with substance use. Neuroscience-based knowledge of substance dependence can reduce the strong and pervasive stigma associated with substance use. Proper treatment of either substance dependence or mental illness requires attention to the comorbidity of these conditions. Proper treatment of either substance dependence or mental illness requires attention to the comorbidity of these conditions.

69. www.alcoholandhealth.org69 Conclusions/Comments This report summarizes what researchers have known for some time—there is a scientific basis for the etiology and management of alcohol, tobacco, and other drug use disorders. This report summarizes what researchers have known for some time—there is a scientific basis for the etiology and management of alcohol, tobacco, and other drug use disorders. Its findings may help dispel long-standing myths about the addictions. Its findings may help dispel long-standing myths about the addictions.