Factors Associated With Alcohol Use

Published on March 2017 | Categories: Documents | Downloads: 29 | Comments: 0 | Views: 270
of 14
Download PDF   Embed   Report

Comments

Content

 

 Journal of Addictions Nursing, 21:194–206, 2010 Copyright © International Nurses Society on Addictions ISSN: 1088-4602 print / 1548-7148 online DOI: 10.3109/10884602.2010.515692 10.3109/10884602.2010.515692

Factors Associated with Alcohol Use and its Consequences Marshall Dean Alameida, PhD San Francisco State University, Nursing, San Francisco, CA, USA

Charlene Harrington, PhD University of California San Francisco, San Francisco, CA, USA

Mitchell LaPlante, PhD University of California San Francisco, Social & Behavioral Sciences, San Francisco, CA, USA

Taewoon Kang, PhD University of California San Francisco, San Francisco, CA, USA

The aim of this this study study was to exa examin minee the selfself-re repor ported ted experience perien cess of an adult adult popula populatio tion n livin living g in the commun community ity,, as they relate to alcohol use and potential negative outcomes (emotional/ph tiona l/physica ysicall prob problems, lems, role role func function tion problems problems,, drink drinking ing and driving, risk behaviors, and alcohol abuse/dependence). Analyses focused on 37,026 individuals that are weighted to the population of 212,686,651 drawn from a large representative cross-sectional survey of the US. population—the 2003 National Survey on Drug Use and health (NSDUH). Alcohol use of 1–9 drinks in the past month showed a significant increase in the odds ratios for most of the study outcomes compared to those who did not drink alcohol. As alcohol use increased, the odds ratios for all of the study outcomes linearly increased. Mental health symptoms and illicit drug use in the past year also significantly increased the odds ratios for all of the study outcomes. Hispanic and other race reflected an increased odds ratio for alcohol caused role function problems, when compared to Caucasians. Higher income and education levels increased the odds ratios for drinking and driving. Negative consequences occur at low levels of self-reported monthly alcohol use, use, whe when n binge binge and hea heavy vy drinki drinking ng ar aree not prese present. nt. An incre increase ase in alcohol consumption reflects a linear increase in the odds ratios for alcohol related problems. Nursing professionals need to be aware of the importance in educating clients about the risks associated with alcohol consumption. Keywords  Alcohol, Community, Co-occurring Disorders, Policy

INTRODUCTION Alcohol abuse is one of the most important social and health problems prob lems in the US and worldwide worldwide.. Negativ Negativee conse consequenc quences es from alcohol use have been reported on emotional and physAddres Add resss corres correspond pondenc encee to Dr Mar Marsha shall ll Dean Dean Alam Alameida eida,, San Francisco State Univ Francisco University ersity,, Nursing, Nursing, 1600 Hollo Holloway way Avenue venue,, San Francisco, CA, 94132. E-mail: [email protected]

ical wellbeing, and role functions, as well as in risk behaviors, and driving while under the influence of alcohol. This study involved the examination of secondary data from the National Survey on Drug Use and Health (NSDUH, 2003; US Department of Health and Human Services, 2003) based on a national probability sample. The purpose of this study was to examine the self-reported experiences of an adult population, that is a sample of the civilian civilian,, non-institutionalized US population who are 18 years of age and older, as they relate to alcohol use (quantity and frequency measures) and its consequences (exacerbated emotional/physical problems, role function problems, risk behaviors and). Previous studies of alcohol use have utilized differing quantity and frequency measures. For instance, Dawson, Grant, and Hartford (1995) examined two dimensions of alcohol consumption (average daily alcohol intake and the frequency in which individuals drank 5 or more drinks on one occasion) in relation to five problem domains Their analysis of selected levels of consumption showed a greater odds ratio for the “domains of impaired control, continued drinking despite problems, and hazardous drinking” when compared to the physiological domains of tolerance and withdrawal. Midanik, Tam, Greenfield and Caetano (1996) found that those individuals with lower alcohol consumption patterns (average of less than or equal to one drink/day) exhibited risks for drunk driving although they had less risk for work-related problems or meeting the criteria for alcohol dependence than heavy drinkers. Additionally, they found that alcohol consumption patterns that include drinking 5 or more drinks on a single occasion increased the risk for drunken driving, work problems and alcohol dependence. Finally, Russell, Light and Gruenwald (2004) utilized the National Health Interview Survey of 1988 to examine levels

194

 

FA FACTORS CTORS ASSOCIATED ASSOCIATED WITH ALCOHOL USE AND ITS CONSEQUENCES CONSEQUENCES

 

195

of alcohol use (drinks/drinking day, drinking days/year, heavy drinking drin king rate rates) s) and their their rela relation tionship ship to 41 alco alcohol hol outc outcome ome measures within five cohorts based on gender and age. They found that those persons reporting severe problems drank on average more times per week than those reporting minor problems (3.5 vs. 2.6), averaged more drinks on each drinking occasion (4.7 vs. 2.6), and were more frequent heavy drinkers (58 days/year vs. 12–13 days/year). Previous studies also have provided evidence of alcohol’s relationship to emotional and physical problems as well as role function problems, drinking and driving, and risk behaviors. In regard to emotional problems, affective disorders (major depression pres sion,, mood disorders) disorders),, a leadi leading ng cause of ment mental al health health disability, were associated with co-morbid alcohol dependence (LaPlante, 2002) in approximately 30% of bipolar I and 20% of bipolar II patients (Reiger et al., 1990). Grant and Harford (1995) also reported that 13.3% of those individuals 65 years of age and older with a major depressive disorder had an alcohol use disorder compared to 4.5% without a major depressive disorder. It has also been found that schizophrenia, another leading cause of mental health disability (LaPlante, 2002), has a comorbid prevalence for substance abuse or dependence (Reiger

has reported a sibling pair concordance to CAD with regular alcoho alcoholl con consum sumpti ption on (Ha (Hause userr et al. al.,, 2003). 2003). In a stu study dy com compar paring ing matched controls, the prevalence of congestive heart failure was higher in the alcohol dependence population than in the control group (Mertens, Lu, Parthasarathy, Moore, & Weisner, 2003). Also, Saremi and Arora (2008) reported an association between cardiomyopathy, cardiomyopat hy, hypertension, hypertriglyc hypertriglyceridemia eridemia and stroke with alcohol consumption of three or more drinks each day. These studies suggest a hypothesis that alcohol is a direct or covariate determinant of numerous etiologies, or an antecedent consequence of a debilitating, chronic disorder. Rolee fun Rol functi ction on pro proble blems ms were were in inves vestig tigate ated d by Lipsk Lipsky y, Caetano, Caet ano, Field and Larkin (2005), who foun found d a rela relations tionship hip between alcohol use and intimate partner violence (IPV) with the risk increasing 22% with each weekly, incremental increase of five drin drinks ks by the vict victim’ im’ss partner partner.. Chermack Chermack and Blo Blow w (2002) reported that increased alcohol use and the interaction of cocaine, along with other demographic variables, predicted the severity of violence. Additionally, Jennison (2004) found that binge drinkers in college experienced more alcohol related problems and that this pattern of alcohol use was predictive of al alcoh cohol ol ab abuse use and dep depend endenc encee in both both gen gender derss 10 yea years rs later.

et al., 1990) at a higher level than in the general population (47% vs. 16%), with alcohol the most frequently abused or dependent drug. Furthermore, research has identified a relationshipbetween subs substanc tancee abus abusee or depen dependenceand denceand Post Tr Trauma aumatic tic Stress Disorder (PTSD) in adolescents that had been physically or sexually assaulted, witnessed violence, or had family members with alcohol or drug abuse and dependence (Kilpatrick, Acierno, Saunders, Resnick, & Best, 2000). Impor Importan tantly tly,, it hasbeen rep report orted ed (Kess (Kessle lerr et al., al., 1997) 1997) that that cooccurring alcohol disorders initiate at a later point in time than at least one other DSM-III-R disorder and that earlier disorders generally more strongly predict alcohol dependence versus alcohol abuse. The National Co-morbidity Study data suggestion that alcohol disorders typically follow another non-substance abuse, mental disorder (Kessler et al., 1994); supports the fact

Risk behavior identifies those respondents that drank alcohol and committed acts that placed them in physical danger. Sexual risk behavior such as having multiple sexual partners, not using a condom, and HIV infection has been found to be more frequent with individuals who drink (Castilla, Barrio, Belza, & Fuente, 1999). Wines, Saitz, Horton, Lloyd-Travaglini, and Samet Sam et (2004) (2004) rep report orted ed tha thatt the odds odds rat ratio io fora histor history y of suicid suicidal al ideation was 2.66 for individuals with an alcohol problem when compared to those without an alcohol problem. Importantly, an alcohol use disorder was found to increase the risk for completed suicide even when controlling for co-morbid, psychiatric disorders (Flensborg-Madsen, Knop, Mortensen, Becker, Sher, & Groenbaek, 2009). Driving Dri ving under the influ influence ence of alco alcohol hol was stro strongly ngly evidence idenced d in the NSDUH 2003. 2003. Butter Butters, s, Smart, Smart, Mann, Mann, and

that alcohol use serves as a self-medicating behavior with some individuals who have mental health disorders. Physic Phy sical al proble problems ms rel relate ated d to alcoho alcoholl wer weree ide identi ntified fied by Campbell and associates (2006), who reported that alcohol accelerates the progression of liver disease in hepatitis C virus (HCV) infected individuals and negatively affects treatment. In fact, alcohol related liver disease is recognized as a cause for liver transplants (Day et al., 2008), with those that use some alcohol estimated as high as 50% of the population receiving liver transplants and those that drink alcohol in an addictive manner estimated as approximately 10% of this same population. In this regard, there is an expectation that individuals abstain from alcohol use for 6 months prior to receiving a liver transplant (Lucey & Weinrieb, 2009). In terms of coronary artery disease (CAD), a leading cause of disability in developed countries, research on sibling pairs

Asbridge (2005) found that in the most serious forms of road rage, illicit drugs and alcohol were involved. Dawson (1999) reported that those individuals that met three criteria for heavy dri drinki nking ng com compri prised sed onl only y 3.8% 3.8% of cur curren rentt dri drinke nkers rs but but acc accoun ounted ted for 36.4% of all impaired driving incidents. This study extends the prior research on quantity and frequenc que ncy y of alcoho alcoholl use and its con conseq sequen uences ces.. Fir First, st, it used used secondary data from a national survey on alcohol use (2003) for those living in the community in the US to examine the quantity and frequency of self-reported health consequences. The dat dataa wer weree based based on sel self-r f-repo eporte rted d alcoho alcoholl use and ex ex-perience peri encess related related to four pote potentia ntiall neg negati ative ve outcomes outcomes (emo (emo-tional/physical problems, role function problems, drinking and driving, risk behaviors). Second, it investigated the relationship of other drug use and mental health symptoms on the study outcomes.

 

196

 

M. D. ALAMEIDA ALAMEIDA ET AL.

METHODS This stu This study dy con conduc ductedsecon tedsecondar dary y data data ana analys lysis is on theNatio theNational nal Survey on Drug Use and Health (NSDUH, 2003) survey data. The purpose of this study was to examine the self-reported experiences of an adult population living in the community in the US, as the they y rel relate ate to alcoho alcoholl ab abuse use (qu (quant antity ity and fre freque quenc ncy y mea mea-sures) and its consequences (exacerbat (exacerbated ed emotional/physical problems prob lems,, role function problem problems, s, drin drinking king and driving driving,, and risk behaviors). This article used the Alcohol Dependency Syndrome Model (Edwards & Gross, 1976) as a conceptual framework where alcohol use begins with alcohol intake, with the potential progression to varying levels of disablement.

Design Th Thee samp sample le de desi sign gn in invo volv lves es a 5-ye 5-year ar desi design gn proc proces esss (1999–2003) with the objective of providing estimates of drug use use at th thee na nati tion onal al and and stat statee le leve vels ls.. Th Thee st stud udy y samp sample le is a “mul “multi ti-stage area probability sample for each of the 50 states and the District of Columbia,” and has been described in detail elsewhere (U.S. Department of Health and Human Services, 2004).

Sample The study popula populatio tion n is a sam sample ple of the civi civilia lian, n, nonnoninstitutionalized US population who are 12 years of age and older. The sample includes civilian inhabitants of military installations, and those individuals residing in rooming houses, college coll ege dorm dormitor itories, ies, shelters, shelters, and group homes. The coll collecection methods included computer-assis computer-assisted ted personal intervie interviews ws as well as audio computer-assisted, self-interviews (U.S. Dept. of Health and Human Services, 2004). In brief, the original NSDUH 2003 sample included 67,784 persons which were reduced to 55,230 with the public use data file due to a sub sampling step that protected respondent’s confidential data. Cases were evaluated for meeting minimum response spon se requi requireme rements. nts. The final weighted weighted scre screenin ening g resp response onse rate was 91% with a 77% Computer Assisted Interview (CAI)

dents that drank alcohol and committed acts that placed them in physical danger (Table 1). Driving under the influence of  alcohol was strongly evidenced in the NSDUH 2003 (Table 1).

Selected Variables: Alcohol Use Independent Variables Variables Two quantity and frequency measures of alcohol use were developed develop ed as independent variables variables and compared to no alcohol use.. They use They wer weree (1) past past mon month th alc alcoho oholl le leve vels, ls, and (2) past past month month average alcohol use. Past Month Alcohol Levels (T (Table able 2): In the National Survey on Drug Use and Health (2003), the alcohol levels were defined as: no use, past month use without binge or heavy use, past month binge use (5 or more drinks on at least one occasion in the past month), and past month heavy use (5 or more drinks on at least 5 or more occasions in the past month). The comparison groups for this those populations that reported alcohol use was those respondents that did not drink alcohol in the past month. Past Month Average Alcohol Use (Table 2): This measure was based on the product of: the number of days an individual drank dra nk alc alcoho oholl tim times es the avera average ge num number ber of dri drinks nks on eac each h dri drinknking day. The coding created six levels of categories of alcohol use (0,   <10,   >10-20,   >20-30,   >30-60 and   >60). The comparison groups for those that reported alcohol use was those respondents who did not drink alcohol in the past month.

Selected Variables: Non-Alcohol Independent Va Variables riables The non-alcohol use independent variables in the analyses included age (18–25, 26–34, 35–49, 50–64 compared to those 65 and older), males (comparison group  females), race and ethnicity (non-Hispanic Black, Hispanic and other compared with those who are White), education (high school, some college, college or graduate school compared to those with no high school graduation), employment (comparison group not employed), incomes by category (comparison group incomes of  less than   $10,000 ), health insurance (Medicare or Medicaid, private, both: comparison group none), mental health symptoms (comparison group none) and illicit drug use in the past year (comparison group  none). These variables were based on respondent’ respondent’ss self-reports.   =

=

=

=

=

weighted interview response rate (U.S. Dept. of Health and Human Services, 2004). In this study, respondents 12–17 years of  age were excluded. Therefore, the study population was comprised pris ed of 37,026individual 37,026individualss thatwere weighted weighted to the popul populatio ation n of 212,686,651.

Selected Variables: Variables: Alcohol Use Dependent Variables Four potentially negative consequences of alcohol use were examined as dependent variables: (1) emotional/physical problems; (2) role function problems; (3) risk behavior; and (4) drinking and driving. Self-reported emotional/physical emotional/physical problems were defined as an exacerbation to existing problems with emotional or physical function caused by alcohol use (Table 1). Role function problems are defined as problems with work, school, social interaction, or activity functions that are caused by alcohol use (Table 1). Risk behavior identifies those respon-

  =

Statistical Analysis The regression regression analyses analyses in this study were cond conducted ucted on the weighted sample, defined as the “final sampling weight.” The results are intended to provide an unbiased estimate for the entire study population due to the fact that the estimated results from the NSDUH 2003 are based on sample survey data rat ratherthan herthan com comple plete te data data forthe pop popula ulatio tion n thestudyis int intend ended ed to represent (U.S. DHHS, 2003). The stat statisti istical cal softwar softwaree used to gener generate ate and anal analyze yze the study data was SUDAAN. SUDAAN procedures are capable of  analyzing data from “complex sample surveys” and “its ability to compute compute stand standard ard errors errors of ratio ratio esti estimate mates, s, mean means, s, tota totals, ls,

 

 

FA FACTORS CTORS ASSOCIATED ASSOCIATED WITH ALCOHOL USE AND ITS CONSEQUENCES CONSEQUENCES

197

TABLE 1 Dependent variables descriptive descriptive statistics Dependent Variables Response Variables (Symptoms)

Estimated Weighted Sample # [212,686,651] (Thousands)

Estimated Weighted Sample %

, 67 20 11 0,5 572

. 95 4.02 98

201,189 10,936

94.84 5.16

201,326 10,701

94.95 5.05

138,704 30,711

81.87 18.13

Alcohol Caused Problems With Emotions/Nerves or Physical Problems Past 12 Months --N YeosA AllccoohhoollEEm moottiioonnaalloorrPPhhyyssiiccaallPPrroobblleem mss Alcohol Caused Problems With Social Role Functions [home/work/school, [home/work/s chool, family/fr family/friends, iends, less activities] activities] -No Alcohol Role problems -Yes Alcohol Role Problems Alcohol and Risk Behaviors -No Alcohol and Dangerous Activities -Yes Alcohol and Dangerous Activities Drinking and Driving -No Alcohol and Driving -Yes Alcohol and Driving

regression coefficients, and other statistics in accordance with

exacerba exac erbated ted emotional emotional or phys physical ical problem problemss in the past 12

the sample design”. The unit of analysis of this study was at the individual level. The weighted sample (212,686,651) was used for all statistical analysis. Logistic regression was used as the analytical method. The odds ratios and the upper and lower bounds of the 95% confidence intervals for the odds ratio were reported. The data were reported if they were si significant gnificant at probabilities of equal to or less than 0.01. The Goodness of Fit for the logistic regression models were reported as the Cox and Snell R-Squares.

months caused by alcohol. Role functions problems were reported by 10,936,360 individuals in the past 12 months. Many individuals who used alcohol reported engaging in risky behaviors. Of the total sample, 10,701,870 reported engaging in dangerous dange rous activiti activities es after after drinking drinking alcoh alcohol ol while alco alcohol hol use and driving was reported by 30,711,740 individuals. The alcohol independent variable descriptive statistics are found on Table 2. In the study 97,257,000 individuals (45.73%) di did d no nott us usee al alco coho holl in the the past past mo mont nth. h. Of thos thosee that that us used ed al alco coho hol, l, 35,331,304 (16.61 %) reported binge drinking and 15,527,966 (7.30 %) reported heavy alcohol use in the past month. Table 2 shows that 25% of respondents drank less than 10 drinks in the past month; 8.9% drank 10–19 drinks in the past month; 5.8%

RESULTS The dependent variables descriptive statistics are found in Table 1. Of the sample, 10,572,060 respondents report having

TABLE 2 Alcohol independent variable descriptiv descriptivee statistics Independent Variables Need Variables (Quantity)

Estimated Weighted Sample # [212,686,651]

Estimated Weighted Sample %

-No Alcohol Use Past Month -Alcohol Use Past Month (No Binge or heavy) -Binge Alcohol Use Past Month -Heavy Alcohol Use Past Month

97,257 64,569

45.73 30.36

35,331 15,527

16.61 7.30

-0 Alcohol Drinks Past Month -<10 Alcohol Drinks Past Month ->10 to 20 Alcohol Drinks Past Month ->20 to 30 Alcohol Drinks past month ->30 to 60 Alcohol Drinks past Month

97,257 52,173 18,460 11,898 15,509

47.08 25.26 8.94 5.76 7.51

->60 Alcohol Drinks past Month

11,267

5.45

 

198

 

M. D. ALAMEIDA ALAMEIDA ET AL.

TABLE 3 Study comparison groups for tables 4 and 5 Variable

Comparison Group

Alcohol Levels

No alcohol use in the past month.

-Use: No Binge/Heavy -Past Month Binge -Past Month Heavy Average Number Drinks Past Month: -Less than 10 ->10 to 20 ->20 to 30 ->30 to 60 ->60

No alcohol use in the past month.

Age -18 to 25 -26 to 34 -35 to 49 -50 to 64

Age 65 and older.

Male Gender

Female gender.

Race -Black/African American -Hispanic -Other Education -High School -Some College -College/Grad School

Non-Hispanic White.

Employment

Not employed.

Income -$10,000 to  $ 19,999 -$20,000 to  $ 29,999 -$30,000 to  $ 39,999 -$40,000 to  $ 49,999 -$50,000 to  $ 75,000 -$75,000 and Above Insurance -Medicare & Medicaid -Private -Both

Income less than  $ 10,000.

Mental Health Symptoms Drug Use in Past Year

Less than high school.

No insurance.

No mental health symptoms. No drug use in the past year.

drank 20–29 drinks in the past month; 7.5% drank 30–59 drinks in the past month and 5.5% drank more than 60 drinks in the past month. In terms of the dependent variable alcohol use and emotional or physical problems, this study found that alcohol levels (use but no binge or heavy, binge, heavy compared to no drinking) did progressively increase the odds ratios for exacerbation of  emotional/physical problems (Table 4: Model 1). In addition, past month alcohol use of less that 10 drinks/past month (compared to no drinking) increased the odds ratios for exacerbation of emotional/physical problems (Table 4: Model 2), with a linear increase in the odds ratios related to an increase in alcohol consumption. Individuals with public insurance (Medicare and Medicaid) had higher odds of alcohol caused or exacerbated emotiona emot ionall or physical physical problem problemss while those with priva private te insurance had lower odds, compared to those with no insurance, controlling for income (Table 4, Model 1 and Model 2). Having mental health symptoms and drug use in the past year increased the odds of having alcohol related emotional or physical problems. No other factors were significant in the models. In terms of the dependent variable alcohol and role function proble pro blems,Tab ms,Table le 4 (Mo (Model1 del1 and2) sho shows ws that that theodds of alc alcoho oholl caused role function problems increased linearly with alcohol used. Individuals that binged in the past month or had heavy alcohol use were 5 to 8 times more likely to have role function problems. Compared to those who did not drink, those who drank less than 10 drinks in the past month were 1.5 times more likely to have role function problems, which increased up to 19 times higher odds for those with 60 or more drinks. Individuals in the age groups of 18–25 and 26–34 reported significant role function problems. As expected, male gender increased the odds ratios for role function problems. Although Hispanics had lower alcohol use when compared to Whites in thisstudy (no tabl tablee sho shown), wn), surprisi surprisingly ngly,, theyhad incr increase eased d odds ratios of reporting role function problems. Those individuals with private insurance were less likely to have role function problems. Having mental health symptoms increased the odds of having alcohol related role function problems. Finally, illicit drug use in the past year was a predictor that increased the odds ratios for the outcomes of role function problems. As relates to the dependent variable alcohol and dangerous activities, Table 5 (Model 3 and 4) showed a similar pattern as with other problems. Alcohol use (including any use with no binge or heavy use, binge, and heavy use) was associated with an increase in dangerous activities. The odds of dangerous activities increased with each increase in the number of drinks in the past month. Age 18 to 25 was the group most associated with wit h dan danger gerous ous act activ iviti ities. es. Menta Mentall hea health lth sympto symptoms ms and dru drug g use in the past year also increased the odds of dangerous activities. As relates to the dependent variable alcohol and driving, any alcohol use was associated with driving under the influence of  alcohol and the number of drinks increased the odds of driving while drinking (Table 5 Model 3 and 4). As expected, younger age groups increased the odds ratios for alcohol risk behaviors,

 

    1     0  .     0     t    a     t    n    a    c     fi    n    g     i     S    e    u     l    a    v     P     ∗     ∗    :    s    m    e     l     b    o    r    p    n    o     i     t    c    n    u     f    e     l    o    r    r    o     l     i    c    a    s    y     h     4    /    p     E    l     L   a    n     B    i    o     A    t     T   o    m    e     d    e     t    a     b    r    e    c    a    x    e     d    n    a    e    s    u     l    o     h    o     l    a    c    r    o     f    s     t     l    u    s    e    r    n    o     i    s    s    e    r    g    e    r    c     i     t    s     i    g    o     L

    2     l    e     d    o     M

   n    o    s     i     t     h    c    t    n    n    u    o    ]     F    M    e    2    5     2     l    o    1    1     2     R    t     1    s     d    a    2    e    s     P    :    =    u    a    s     S     C   m    e    W     [     l     l    o    b     h    o    r     l    c    o    P     A     d    e     t    s    a     h     b     l     t    r    a    e    c    n    o    ]     i    c    a    s    y    M    0    x    h     4     E    P    2     1     1    r    r     t     2    o    o    s     1    a    2     d    e    l    a    P    =    s    n    :    u    o    s     S    a    i    m     C    t    e    W     [     l     l    o    o    m    b     h    E   o    r    o    c     P     l     A    n    o     h    s     i     t    c    t    n    n    u    o    ]     F    M    6    e     6     l    o    2     1    1     6     R    t     0    s     2     d    a    e    s     P    :    =    u    a    s     S     C   m    e    W     [     l     l    o    b     h    o    r    o    c    P     l     A

    1     l    e     d    o     d    e     M     t    s    a     h     b     l     t    r    a    e    c    n    o    ]     i    c    a    s    y    M    0    x    h     1     E     2    2     t     0     2    r    o    r     P    s    o    1    a    2     d     l    e     P    a    s    n    :    =    u    o    s     S    a    i    m     C    t    e    W     [     l     l    o    o    m    b     h    E   o    r    o    c     P     l     A    s    n    r    e     t     t    a     P    e    s     U     l    o     h    o    c     l     A

    )     )     7     )     )     )     4    5     9    0    3    9    1  .     2    5    8    1  .     5     0  .     0  .     0  .     2    2     2    5    7    1   –   –   –   –   –    2     8    0    2    7    2     7    8    9    7    7  .     1  .     7  .     0  .     4  .     8     1     (     (     2     (     4     (     1     (     6     6    7    3    7    5     4    4    8    5    4     5  .  .     7  .     3  .     2  .     1

    ∗     ∗     )     )     )     )     7    6    3    2     9    0    8    3     7  .  .     8  .     0  .     3     4    5    4    2   –   –   –   –     0    1    4    5     6    2    9    0     2  .  .     7  .     0  .     4     1     1     1     (     (     (     (     0     8    5    3    3     5    4    1    1     4  .  .     4  .     1  .     7

    ∗     )     6     9     6  .     1   –     6     2     2  .     1     (     2     4     4  .

    )     1     5     4  .     1   –     0     5     8  .     0     (     1     1     1  .

    ∗     ∗     )     )     1    4     1    6     9  .     8  .     1    1   –   –     3    2     6    9     2  .     0  .     1     (     1     (     4    6     5    2     5  .     4  .

    )    e    g    a    p     )     )     )    t     0    5    5    x     6    7    0    e    n     0  .     1  .     0  .     1    1    1    n   –   –   –    o     8    1    6    d     7    5    7    e    u     6  .     7  .     5  .    n     i     0     0     0     (     (     (    t     7    9    1    n    o     4    3    6    C     8     9     7     (  .  .  .

    1     1    3    5    9    9

    2    2    2    1     1

    1

    1    1

    0    0    0

    )     )     )     )     4    5    2    8     7    5    1    9     1  .  .     2  .     3  .     8     3    3    3    2   –   –   –   –     7    5    6    4     1    7    6    7     8  .  .     5  .     8  .     9     0     (     (     0     (     0     (     0     0    8    4    8     1    3    9    4     6  .  .     1  .     6  .     9     1    1    1    1

    )     0     4     1  .     1   –     8     8     7  .     0     (     8     4     9  .     0

    )     4     4     3  .     1   –     8     2     7  .     0     (     9     8     9  .     0

    )     )     9    1     3    8     1  .     2  .     1    1   –   –     4    4     3    7     7  .     6  .     0     (     0     (     4    9     1    2     9  .     9  .     0    0

    )     )     )     8    6    6     0    8    4     1  .     1  .     3  .     1    1    1   –   –   –     3    6    3     0    5    0     7  .     7  .     8  .     0     (     0     (     0     (     2    7    0     8    4    4     8  .     9  .     0  .     0    0    1

    )     )     )     )     0    4    5    5     8    8    1    4     7  .  .     6  .     5  .     2     3    4    3    2   –   –   –   –     1    3    6    6     0    5    4    6     0  .  .     6  .     9  .     1     1     (     (     0     (     0     (     1     5    2    3    7     4    2    2    2     9  .  .     3  .     8  .     2     1    2    1    1

    ∗     )     7     2     9  .     1   –     5     8     3  .     1     (     4     3     6  .     1

    )     9     3     4  .     1   –     3     5     8  .     0     (     8     0     1  .     1

    ∗     )     )     7    7     3    6     8  .     8  .     1    1   –   –     0    7     2    7     2  .     0  .     1     (     1     (     7    8     9    1     4  .     4  .     1    1

    )     )     )     6    7    0     8    3    3     0  .     2  .     1  .     1    1    1   –   –   –     2    8    3     9    8    4     6  .     7  .     6  .     0     (     0     (     0     (     7    7    3     8  .     8    5     0    9  .     8  .     0    0

    )     )     )     )     7    2    8    3     3    4    3    4     6  .  .     1  .     9  .     2     2   –     2   –    1     3   –    2     2   –    4     5     1    6    0    6     7  .  .     5  .     8  .     8     0     (     (     0     (     0     (     0     4    3    5    6     7    7    3    9     3  .  .     0  .     5  .     6     1    1    1    1

    )     4     9     2  .     1   –     4     9     8  .     0     (     5     7     0  .     1

    )     1     1     3  .     1   –     7     1     7  .     0     (     0     7     9  .     0

    )     )     3    2     0    5     1  .     2  .     1   –    7     1   –     7     0    5     7  .     6  .     0     (     0     (     3    7     8    0     8  .     9  .     0    0

    )     )     )     7    3    2     1    3    7     1  .     2  .     4  .     1   –    3     1   –    4     1   –     0     1    8    8     7  .     7  .     8  .     0     (     0     (     0     (     1    2    1     9    8    4     8  .     9  .     1  .     0    0    1

    ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗

    ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗

    )     )     9     )     )     )     9    7     7    9    2    2    9  .     9    1    4    8  .     5     1  .     7  .     5  .     4    2     3    8    9    1   –   –   –   –   –    9     7    5    4    9    2     6    0    4    1    0  .     7  .     7  .     4  .     2  .     9     1     1     7     4     5     (     (     (     (     (     7    5    4    7    1     7    0    7    3    9     3  .  .     4  .     0  .     0  .     8     2    6    7    0    9     1    1

    ∗     ∗     ∗     ∗

    )     3     5     8  .     1   –     1     2     0  .     1     (     5     7     3  .     1

    )     )     7     1    2     1    8  .     6  .     0     6    1   –   –     0    4     7    9     0  .     8  .     4     (     5     (     7    9     8    8     1  .     9  .     5    7

    ∗     ∗

    ∗     ∗     ∗     ∗

    )     6     1     7  .     3   –     5     8     0  .     2     (     4     8     7  .     2

    )     )     6     9    1     8    1  .     3  .     2     8   –    1   –     1     8     2    8     9  .     0  .     4     (     6     (     5    8     2    8     4  .     5  .     6    8

    ∗     ∗

   s     k    n    e    y    r    v    i    g    a    n    y    i    e    D    v     B    H   r    e     0    a    s    :     l    e    h     t     h     t     b     h    1    e     H     0    0     t    m    n    0    n    n    v     2    3    6    a    o    o    u    n     5    4    9    4    e    o    /    e    o    o    t    o    t    o     2    3    4    6     L    N   g    M    M    N     h     t     t     l    :     i    n    t     t    e    M   s     0    0    0    0     t    o    o    t    o    o    t    o    e    s     t    g    s     1    2    3    6     8    t    s    e     h    s     B   s    a    a    a     0     5     6    r    a    o     -     5   -     3   -     2   -     >   -    e    1   -     >   -     >   -     >    c    U   -     P   -     P   -    e    P    L     A    g     A    v     l     A

    ∗

    ∗

    ∗     ∗

    ∗

    l    o    o     h    c     S    e    n     l    g    d    a    r    c    e    a    o    l    e    r     i    o     l    r     d     G     f     h    o    n    c     /     i    c    e    e     A     /    n    n    n    S    C    g     G    r    a     k    o    h    e    l    e    a    e    t     i    c    p    e    c     l    s     h     l    g    m    a    i     i     i     t    a    o    r    a    e    l    o    e     O   c   -     H   -   -    u    H     M    c    B   -     S   -     C      m     R    a     A     d     E 199

 

    )     d    e    u    n     i     t    n    o     C     (     1     0  .     0     t     t    a    n    a    c     fi    n    g     i     S    e    u     l    a    v     P     ∗     ∗    :    s    m    e     l     b    o    r    p    n    o     i     t    c    n    u     f    e     l    r    o    o     4    l    a    c     E    i     L   s    y     B    h    p     A    /     T    l    a    n    o     i     t    o    m    e     d    e     t    a     b    r    e    c    a    x    e     d    n    a    e    s     l    u    o     h    o    c     l    a    r    o     f    s     t     l    u    s    e    r    n    o     i    s    s    e    r    g    e    r    c     i     t    s     i    g    o     L

200

   n    o    s     i     t     h    c    t    n    n    u    o    ]     )     5     F    M    e     5     2     4     4     l     2     1  .    o    1    2     1     R    t     1   –    s     d    a    2     9     7    e    s     P    =     9  .    :    u    s    a     S     0     (     C   m     W     9    e    [     l     l     8    o    b     1     h    o  .     1    o    c    P    r     l     A

    2     l    e     d    o     d    e     M     t    s    a     h     b     l     t    r    a    e    c    n    o    ]     )     i    c     8    a    s    y    M    0    x    h     4     4     2     E    P    2     1  .     1    2     1    r    r     t    o    o    s     1   –    a    2     6     d     l     P     5    e    =     8    s    a    n    :  .    u    s     S    o     0    a    i     (     t    m     C    e    [     l     W     3     l    o     3    o    m    b     0  .     h    E   o    r     1    o     P    c     l     A    n    o     h    s     i     t    c    t    n    n    u    o    ]     )     F    M    6     0    e     6     1     l     4  .    o    2     1    1     6     1     R    t     0   –    s     d    a    2     4    e     5    s     P    =     9    :  .    u    s    a     S     0     (     C   m     W     0    e    [     l     l     6    o    b     1     h    o  .    r    o     1    c    P     l     A

    1     l    e     d    o     d    e     M     t    s    a     h     b     l     t    r    a    e    c    n    o    ]     )     i    c     3    a    s    y    M    0    x    h     1     2     E     2    2     2  .   –     t     2     0     1    r    o    r     P    s    o    1    a    2     0     d     l     4    e     P    a    s    n    :    =     8  .    u    o    s     S     0    a    i     (     t    m     C    e    [     l     W     4     l    o     1    o    m    b     0  .     h    E   o    r     1    o     P    c     l     A    s    n    r    e     t     t    a     P    e    s     U     l    o     h    o    c     l     A

    t    n    e    m    y    o     l    p     E    m

    ∗

    ∗

    ∗

    ∗

    ∗

    ∗

    ∗

    ∗

    ∗

    ∗     )     )     )     )     )     )     7    0    6    1    2    0     6    2    3    1    3    3     1  .     9  .     8  .  .     0  .     0  .     1     1    1    1    1    0    0   –   –   –   –   –   –     9    2    8    1    1    2     7    9    7    8    9    1     7  .     4  .     3  .  .     4  .     5  .     6     0     (     0     (     0     (     (     0     (     0     (     0     3    0    4    7    1    9     5    8    7    9    7    1     9  .     6  .     5  .  .     6  .     7  .     8     0    0    0    0    0    0

    )     5     0     6  .     1   –     2     9     9  .     0     (     2     6     2  .     1

    )     )     )     )     )     )     1    9    9    5    8    2     3    0    8    7    6    0     2  .     3  .     1  .  .     0  .     0  .     2     1    1    1    1    1    1   –   –   –   –   –   –     6    3    1    8    0    9     9    3    2    8    5    0     7  .     6  .     5  .  .     4  .     6  .     7     0     (     0     (     0     (     (     0     (     0     (     0     0    1    2    4    1    0     9    4    2    2    0    9     9  .     8  .     8  .  .     7  .     8  .     9     0    0    0    0    0    0

    ∗     )     9     9     8  .     1   –     4     7     1  .     1     (     3     9     4  .     1

    ∗     ∗     )     )     )     2    5    7     1    0    1     9  .     5  .  .     3     0    1    3   –   –   –     0    1    3     1    6    0     6  .     4  .  .     2     0     (     0     (     (     2     6    3    3     4    3    0     7  .     8  .  .     7     0    0    2

    )     )     )     )     )     )     9    1    7    1    4    5     4    0    3    7    0    0     1  .     1  .     9  .  .     0  .     0  .     1     1    1    1    1    0    1   –   –   –   –   –   –     1    1    4    2    4    9     6    8    8    0    2    4     7  .     4  .     4  .  .     5  .     5  .     6     0     (     0     (     0     (     (     0     (     0     (     0     5    6    8    3    9    5     3    6    7    3    1    7     9  .     6  .     6  .  .     7  .     7  .     8     0    0    0    0    0    0

    )     9     1     5  .     1   –     7     3     9  .     0     (     3     9     1  .     1

    ∗     ∗     )     )     )     4    9    1     1    8    9     9  .     3  .  .     8     0    1    2   –   –   –     4    2    1     3    6    9     6  .     4  .  .     9     0     (     0     (     (     1     1    1    9     6    0    9     7  .     8  .  .     3     0    0    2

    )     )     )     )     )     )     3    8    0    0    8    8     1    9    0    1    4    9     2  .     3  .     2  .  .     1  .     1  .     1   –    1   –    1   –   –    1   –    1     1   –    1     8     5     2     6     4     7     8    2    2    0    8    5     7  .     6  .     5  .  .     5  .     6  .     7     0     (     0     (     0     (     (     0     (     0     (     0     7    1    0    9    7    5     7    3    3    4    5    5     9  .     9  .     8  .  .     7  .     8  .     9     0    0    0    0    0    0

    ∗     )     7     3     8  .     1   –     2     3     1  .     1     (     2     4     4  .     1

    ∗

    ∗

    ∗     ∗     )     )     )     9    0    6     1    1    0     9  .     4  .  .     9     0    1    2   –   –   –     6    8    0     3    6    1     6  .     4  .  .     0     0     (     0     (     (     2     4    2    7     6    1    1     7  .     8  .  .     4     0    0    2

    ∗     ∗     )     )     )     5    4    5     1    6    1     9  .     4  .  .     3     0   –    4     3   –     1   –    9     3     1    5    8     6  .     4  .  .     1     0     (     0     (     (     2     9    6    4     4    1    9     7  .     8  .  .     6     0    0    2

    ∗

    ∗     )     1     2     2  .     2    9   –    3     4    5     5    9     8     6  .     0     1  .     (     6     1     9  .     1

    ∗

    ∗     )     7     2     0  .     2    6   –    8     2    9     8    9     6     4  .     0  .     1     (     3     3     7  .     1

    ∗

    ∗     )     8     2     1  .     2    9   –    2     9    4     8    2     9     5  .     0  .     1     (     9     3     8  .     1

    ∗

    ∗     )     5     9     9  .     1   –    6     8     5     5    9     6     4  .     0  .     1     (     4     0     7  .     1

   r    a    e     9    9    9    9    0    e     9    9    9    9    0    v     Y    o     0     9     9     9     9     t  ,  ,  ,  ,  ,    s     9    9    9    9    5    b    a    R     l     1    2    3    4    7    A     h     P     l     t    s           $          $          $          $          $    d     l    e    n     &    n     d    a    n    o    a    e    i    o    t    o    t    m    o    t     i    o    t     t    e    o     S    a    e    r     t    c    e     H   p    s     d    e     0    0    0    0    0    0    a    i    r     0    0    0    0    0    0    e    i     l    a    c     t    n     d     U    a     0     0     0     0     0     0    m    u    c    a    a    e     t  ,  ,  ,  ,  ,  ,    n    d    v    h    y    g    e    0     t    n    u    x    q     0    0    0    0    5    a    e    M    i     S    o     S    r    e     2    3    4    5    7    r    m    1          $    r    o    o          $   -           $   -           $   -     B   -    u    M   -           $   -     P   -     M     D    C   -   -           $     I    s    n     I    c    n

 ,  ,     l     l    a    a     H    c    c    T    c    e     i     i    a    s     R    s     N    y    y  ,     h     h    r     P    e     P    O     M    r     d    r     T    o    o    n    e     S     l    a    A    a    G     l    n    P    n  ,    o    o     i     t     S     t    e    g     i    o    K    o    A    m    N    m  ,     I     E    S     E    R     L     D     d     d    e    R    e    E     t     t    a    a    V     b    E     b    E    r     B    e    r     L    e     M    c    a    U    a    O    c    x    N    x     E    H     E    r     O    r     E    o    C    o    G     L     d    A     d    e    R    e    A    s     [    s     E    u    u     S    a    V    a     C    E     C    A     l     L     l     [    o    S    o     h    E     h    B     A    o    o    c     L    c     I     l     l     B     R     A     A     [     A     [     A     I     S    V     S    R  .     E    T     E    A    ]     L    N     L    V   r    a     B    E     B    T   e     Y     D     A     A     t     I     N     I     N    s     R    E     R    E    a     D     A    P     A    N   p    n     V    E     V     i     E   e     T    D     T    P   s     N    E     N    N     E    I     E    D    U     D    h    g  .     D    e    ]     I    u     t    r     N    N     N    r    e    D    a     E    h     E    h     t    e     i     P     Y    P    t     d    n     E   w    t     E    h    a     i    s    s     D    t     D    ]    s    a    w    :    :     t    p    g    ]    m    g    h    o    s     t    n    n    h    n    n     i    o    i     i    p    e    w    t    w    M   s    n    o    o    m    o     l     l    y     l     2    U    l     S    o    M    o    1    g    f     f     h    u     t    r    e    2    s    e    t     1    l    a    D     h     h    a     t     t     t     P    s    e    a    H    :     d    e    P    e    s    n     d    a    d    :     l    u    a    u    m   s     l     l    e    c    s     t    c    l    n    m    n    m    n     i     b    e    e    o    i     l    o     t     t     t    r     M     b    a    P    p    a    o  ,     h    r    e     h     t    n    m    c    y    t    s     P    s     i    o    S    n    n    n    n    t    a    o    r    o    o     h    c     i     i     i    u     t    n    t     t     t     l    s    c    a    a    u    a    n    u    F    e    u    n     I    u  ,    q    q     H    e    e    l     l    e    F    e    e    n    l    a    o    o    t    o    n    R    o    o    m    n     i    e    i    s    s     R   c     d    n    s    s    e    M   e    d    I    e  ,    r    s    r    s    e  ,     t    u    g    g    n    a    e    u    e    e    c    r     C   n    r    a    e    e    C   m    e    l    a    y    o    r     h    u    h     t     l     t     h    o    o    l    s     f     f    o     h    n    o    o    p    c    I    o    l    c    m  ,    s     l    s     t     l     A    E     l     A   e    t  ,    u    m    u     d    s     d    n    n    o    s    e    e    o    n     i    r    r    a    c    n    a    t    s     I    e    s    a    e    h  ,     h     t     h     t     t     h     t    n    n     t    c    u     d    s    o    e    s    n    o     E    w    w  ,    o    M   e    o    M   m    y    h     h    o    c     2    s     l    s     2     1    p     1    a     t     R     3    t    s    m    4    s  ,    a    E    a    r     L    P     L    P    e  ,     E   :     d     E   :    n    n     D   s     i    o    D   s    e    m     t     O     O   m     G    e    e    a     l     l    c     M  ,     M   –    b    u   –    b    e    g    r    o    A    r    o    d     E     P     P

 

FA FACTORS CTORS ASSOCIATED ASSOCIATED WITH ALCOHOL USE AND ITS CONSEQUENCES CONSEQUENCES

and drinking and driving. Overall, the odds ratios for alcohol risk declined with age. Males had increased odds ratios for alcohol use and driving. An increase in education led to increased odds ratios for drinking and driving. Mental health symptoms increased the odds of dangerous activities, and driving while drinking. Illicit drug use in the past year also predicted an incre crease ase in the odds odds rat ratios ios for alcoho alcoholl an and d risk risk facto factors, rs, and aalco lcohol hol and driving.

 

201

The most important finding of this study relates to the low lev levels els of alco alcohol hol use (1–9 drinks per mont month) h) that increa increased sed the odds ratios for adverse outcomes associated with alcohol consumption. These reported levels of alcohol use were lower, when evaluated on a monthly average basis, than those levels recommended by the National Institute on Alcohol Abuse and Alcoholism of up to one drink per day for women and adults 65 years of age and older and two drinks per day for men below the age of 65 (National Institute on Alcohol Abuse and Alcoholism, 2004), and the Dietary Guidelines for Americans of up to one drink per day for women and two drinks per day for men (U.S Department of Health and Human Services, 2005).

lated emotional or physical problems or role function problems. It also increased the odds of dangerous activities, and driving while whi le dri drinki nking, ng, con contro trolli lling ng for the amount amount of alcoho alcoholl use used. d. Ind Indiividual vid ualss wit with h mental mental hea health lth sympto symptoms ms may lack lack aw aware arenes nesss abo about ut the synergistic effect of mental health symptoms and alcohol. In addition, it was not a surprise that illicit drug use in the past year also increased the odds ratios for all of the study negative outcomes (Kessler et al., 1994). Herd (1993) identified the predictors of alcohol related problems as the frequency of getting drunk, drinking to enhance the effects of drugs, or drinking to offset symptoms of sickness associated with drug use and heavy drinking (Herd, 1993). Male gender increased the odds ratios for role function problems, alcohol risk, and driving under the influence of alcohol. Studies on drug abuse and dependence have mostly involved men and have lacked a gender focus. Animal studies show that females are more susceptible to developing drug addictions yet therate of substa substanceabus nceabusee anddepen anddependen dence ce is hig higheramong heramong me men n than women in human research (Biener, 1987; Fattore, Altea & Fratta, 2008; Hilton, 1987; Kessler et al., 1994; Robbins, 1989). An explanation could reside in role development factors such as social and cultural expectations (Fattore et al., 2008), though it also has been found that the gender gap may be narrowing

It is understood that these self-reported levels of past month alcohol consumption (1–9) do not depict the number of drinks consumed in a specific day due to limitations in the NSDUH 2003, and as recommended by the various agencies. This study also acknowledges that the self reports associated with the alcohol consequences dependent variables were based on a timeframe of the past 12 months and that the alcohol consumption independent variables were based on alcohol consumption reported in the past month. Respondent’s self-reports, however, in the NSDUH 2003 indicate that alcohol use in the past month without having indulged in either binge or heavy drinking was sti still ll a sig signifi nifican cantt finding finding in the stu study dy tha thatt sho showed wed increa increased sed odd oddss ratios for alcohol caused or exacerbated emotional or physical problems prob lems,, dange dangerous rous activiti activities es and driving driving whil whilee under the influ influ-ence of alcohol. In addition, binge drinking or heavy drinking in

with younger aged cohorts in measures of alcohol consumption (Keye (Keyes, s, Grant, Grant, & Hasin, Hasin, 2008), 2008), and que questi stions ons ari arise se as to whethe whetherr gender neutral evaluative scales are specific enough to identify female alcohol symptoms (Nichol, Kreuger, & Iacono, 2007). Importantly,, research on psychiatric co-morbiditie Importantly co-morbidities, s, neurobiology, etiology and epidemiology has identified differences in genderr (Fat gende (Fattore tore et al., 2008)though addi additiona tionall rese research arch is neede needed d that is more specific to evaluating areas such as brain dimorphism, hormones, pharmacokinet pharmacokinetics ics and pharmacodynam pharmacodynamics. ics. An inc increa rease se in incom incomee and edu educat cation ional al le leve vels ls led to inc increa reased sed odds ratios for drink drinking ing and dri driving ving.. Altho Although ugh the NSDUH 2003 did not ask whether the amount of alcohol they consumed before driving was in excess of the legal limits or posed safety concerns, even small amounts of alcohol can impair driving. This suggests the need for greater educational efforts targeted

the past month were associated with a significant increase in the odds ratios for each of the study outcomes: emotional/physical problems, role function problems, risk behaviors, and drinking and driving compared to those that report no alcohol use in the past month. The findings from this study show the strong relationship between actual levels of alcohol and adverse consequences at a point in time. It is conceivabl conceivablee that individuals who experienced adverse outcomes associated with alcohol use prior to the past month have since reduced their alcohol intake and would not self report these same problems as occurring within the past month. Longitudinal research should be undertaken to understand how individuals who had adverse consequences respond to the negative consequences. Anothe Ano therr impor importan tantt find finding ing in the stu study dy is that that alcoho alcoholl use and menta mentall healthsymp healthsymptom tomss inc increa reasedthe sedthe odd oddss of havin having g alcoho alcoholl re-

to this population. It is imp import ortant ant tha thatt pol polic icy y contin continue ue to ev evalu aluate ate alcoho alcoholl rel relate ated d mortal mor talit ity y rat rates es due to the report reported ed 24, 24,108 108 dea deaths ths associ associate ated d wit with h heavy episodic drinking (5 drinks on one occasion in the past 30 days) in 2000 (Rivara, Garrison, Ebel, McCarty, & Christakis, 2004), and because the economic cost of alcohol related morbidit bid ity y and mor mortal talit ity y has bee been n estim estimate ated d at $55 bill billion ion (Har (Harwood wood,, Fountain, & Livermore, 1998). This figure does not, however, address addr ess the addit additiona ionall $129 bill billion ion for spec specialt ialty y alco alcohol hol serv services ices,, lost productivity due to morbidity, lost earnings due to crime, criminal justice and property damage costs, social welfare administration costs and fire damage costs that can be defined as alcohol’s contribution to social consequences net of mortality cost and the medical cost of morbidity (Harwood et al., 1998). Furtherm Furt hermore, ore, the findin findings gs of Fill Fillmore more,, Ker Kerr, r, Stockwell, Stockwell, Chikritzhs, and Bostrom (2006) raise serious questions about

Discussion and Policy Policy Implications

 

   e     ∗     ∗     l     ∗     ∗     ∗     )    c     )     ∗     ∗     ∗     ∗     i     ∗     ∗     )     9     7     ∗     ∗     ∗     ∗     ∗     h     3     )     1     )     0     )     )     )     )    e    ]     3     3     8     3     7    0    5    5  .     8  .     V    6     6     3     0     2    3    8    8     1  .     6     3     1     1    e     4  .     1    1    2  .     5  .  .     0  .     2  .     6    v     i     9     3    8    1   –   –     5    4    3    2    r     6   –   –     0   –   –     3   –   –   –     1     2    0    9    1    2     7    4    5    3     D    1     0  .     2    5    8    3     0    9    1    1  .     7     d    =  .     0     1     0  .     1    5  .     3  .     7  .    n  .     8  .     3  .     7     t    a    S     7     5     1     2     0     1     1     1     2    a     (     (     (     (     (     (     (     (     (     l     t    o    W     6    5    1    2    7     8    2    8    2    n     h    [     6    0    7    9    4     0    8    7    0    a    o    c     5     2  .     7  .     2  .     3  .     0  .  .  .     3  .     0  .     8    c     fi     l     2    7    9    3    9     3    2    2    1     i     4     A     1    1    g    n     l     i    e     S     d    e    o    u     M    s     l    r     ∗    a    o     ∗     ∗     ∗     )     i    v     ∗     ∗     ∗     ∗     )     ∗     ∗    v     )     6     ∗     ∗     ∗     ∗     P    a    ]     )     )     6    6    1     )     )     )     )     ∗     h     7     7     1     0     9     9    2    7     2     ∗     8    e    2  .     2     9     3     4     7    4    7     8  .  .  .     8     B    0     4    e     0     6  .  .     0    6    2  .  .     5  .     3  .     2    c     2     k     2    6    1    1   –     9    7    4    2    n    s     1   –   –   –   –    0   –   –   –   –     i     2    e     1    0    7    3    9     3    6    3    0     d     R     3    4    5    0    9     4    8    0    8    n  .    =     d     1     9    e  .     5  .     6  .     5  .     4  .  .     4  .     9  .     4    n    p     S     5     3     9     1     1     0     0     1     1    a    e     (     (     (     (     (     (     (     (     (     l     W     d     /     9    7    4    2    3     7    9    0    2    o    e     1    2    2    5    0     3    8    8    1     h    [    s     5     3    o    u  .     4  .     6  .     7  .  .     1  .     9  .     2  .     5  .    c     b     7     4     2     1     1     1     1     3     4     l    a     1     2     A     l    o     h    o    c     l     ∗    e    a     l     ∗     ∗     )    r    c     ∗     ∗     ∗     ∗     ∗     i     h     4    g    o     7     )     )    e    ]     8     2    6     3     )     1     8    )     7    )     9    )    n  .     V    6     i     1     7     4    9     2     5     7  .     3     4    v     5     2     5    e     0    1  .     5    i  .  .  .  .     7    r    v    4   –     1     3     3     i     3    2    1     3     d    r     6     E   r   –    8   –   –   –   –   –     8     4    7     L   o     1    8    4    2     D    1     8     6    9     4    9    5    2     B   s  .     d    =     0     3     4     0  .  .    n  .  .     7  .     0  .     2     A    i    e     1     7     2    a    S     0     1     1     1     T    t     (     (     (     (     (     (     (     i     l    v    o    W     0     8    7     5    7    9    7     i     t     8     5    9     h    [     6    4    3    3    c     9     4     8    o     2  .  .  .    a  .  .     1  .     6  .     0    c     l     3     8     2     1     1     2     2    s     1    u     3     A    o     l    r    e    e     d    g    o    n    s    a    r     d     M     i     ∗    o     ∗     ∗     )     ∗     ∗     d    v     ∗     ∗     ∗     9     )     )     )     )     )     )    n    a     ]    a     6     0     5     4    0    2     8     h     2    e     2     8     9     9    0    2     8    e  .     7     0     7     1     9    s     B     6  .  .  .     2  .  .     4  .     0    u     6    5    3    2     1     9    1     6     k     l   –   –   –   –   –   –   –    s     0     i     2    o     3    2    0    4     3     4    7     h     R     0    8    2    2     0     7    2  .  .     6  .  .     4  .     0  .     7  .    =     d     l    c    o     2     4     1    n     8     5     0     0     1     1     1     S    a     (     (     (     (     (     (     (    a    r     l     W     1     0    7     7    1    5    1    o    o    [     8    7    6    7     8     2    4     f     h     8     9     0     4    s  .  .  .  .     9  .     3  .     5  .    o     t     l     1     6     0     1     3     2     1    c     l    u     1    s     A    e    r    n    o     t     i    s    s    s    e    a    s     l    e     P     b    r    a    s     i    g     k    e     &   r    r    a    n    y    s     V    e    v    i    c    n    g    a    r     i     t    r     t    n    e    D    s    n    e     i    y     i     t    e     t    v     H   r     B    g    e     d    a    a    n     l    s    o     b     0     h     h     1    e     P     t     t     L    e    e     0    0    m   :    n    0     H    n    n    e    v    p     /    s    e    e    o    e    o    o    u    h    a    2    3    6     5    4    9    4     t     h    o    t    o    o     2    3    4    6     U    d     L    N   g    M    M    N   n    t     t     t    n     l     I     l    :     i    n    t     t    e    o    s     0    0    0    0     t    o    o    t    o    t    o    t    o    t    o    e    s    g    s    s     M   e    1    2    3    6     8    6    5    0     h    c     h    s     B   a    a    r    a    o    e    o    c    l   -     >   -     >   -     >   -     >   -    e    1     -     5   -     2   -     3   -    e     L   -     P    c    U   -     P     l     A    S    e     l     A    g     A    v     A 202

    ∗

    ∗

    ∗     ∗     ∗

    ∗     )     )     )     8    0    8     1    4    2     0  .     1  .  .     9     1    0    1   –   –   –     1    2    4     8    4    0     6  .     7  .  .     6     0     (     0     (     (     0     2    7    1     3    7    9     8  .     8  .  .     7     0    0    0

    ∗     ∗     ∗     )     )     )     5    2    4     9    9    0     8  .  .     2  .     0     1    2    2   –   –   –     6    0    1     1    4    5     3  .  .     4  .     4     1     (     (     1     (     1     9    6    8     7    3    8     5  .  .     7  .     7     1    1    1

    ∗     )     7     4     9  .     1   –     1     0     4  .     1     (     2     5     6  .     1

    )     )     )     0    4    5     2    5    1     4  .     4  .  .     3     1    1    1   –   –   –     5    0    9     9    5    8     7  .     6  .  .     8     0     0     (     (     (     0     3    3    8     6    7    8     0  .     9  .  .     0     1    1    0

    )     )     )     9    1    5     5    1    3     2  .  .     2  .     4     1    1    1   –   –   –     0    3    0     0    9    5     8  .  .     7  .     8     0     0     (     (     (     0     4    2    2     0    2    6     0  .  .     9  .     1     1    1    0

    ∗     )     4     0     6  .     1   –     4     8     2  .     1     (     5     3     4  .     1

    ∗     )     0    )     0     7    )     7    7    9     8     9  .  .  .     0     0    0    1   –   –   –     4    5    8     5    9    7     6  .     6  .  .     5     0     (     0     (     (     0     9    9    0     9    1    6     7  .     8  .  .     7     0    0    0

    ∗     ∗     ∗     )     9     3    )     7    )     4    4    3     2     9  .  .  .     5     1    2    2   –   –   –     6    6    8     6    6    8     3  .  .     6  .     5     1     (     (     1     (     1     1    4    0     3    7    7     6  .  .     0  .     8     1    1    2

    )     )     )     5    2    3     0    9    1     4  .     4  .  .     2     1    1    1   –   –   –     5    5    7     9    2    7  .     6  .  .     8     7     0     (     0     (     (     0     7    2    8     5    3    7     0  .     9  .  .     0     1    1    0

    )     )     )     1    9    4     9    9    0     2  .  .     4  .     4     1    1    1   –   –   –     9    6    2     1    4    5  .  .     8  .     9     8     0     (     (     0     (     0     8    1    4     2    9    9     0  .  .     0  .     1     1    1    1

    ∗     )     6     2     5  .     1   –     6     2     2  .     1     (     8     6     3  .     1

    ∗

    ∗

    ∗     )     9     3     1  .     2   –     9     5  .     5     1     (     6     2     8  .     1

   n    a    c     i     l    r    o    e    o    m     h    c     A     S    e    n     l    g    d    a    c    e    a    o    l    r     i    o    l     G    r    r     f     h    o    e    c     /     i    c    e     d     A     /    n    n    S    C    g    n    a    r     k    e    o    e    e    i     h    e     l    p    c     l     t    m    g     h    s     G    a    i     t    a    i    o    o     l    e    e    B    H    O   c    H    S    C     l    c   -   -   -    u   -   -       d     E    a     M    a     R

 

    )     9     2     4  .     1   –     0     1     0  .     1     (     1     0     2  .     1

    )     8     6     3  .     1   –     1     5     9  .     0     (     0     4     1  .     1

    )     2     7     3  .     1   –     4     7     9  .     0     (     6     5     1  .     1

    )     2     2     3  .     1   –     7  .     1     9     0     (     1     0     1  .     1

    t    n    e    m    y    o     l    p    m     E

 .     h    s     h     t     t    r     i     ]     i    m    a    o    w   e    w    t     ]     Y    ]    p     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗    g    g     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     )     )     )     )     )     )     )     )     )     )     )    s     i    n    t    n    m    y     3    5    0    2    4    2     5    8    1    8    1     i    v    a    v    S    p     2    5    4    4    4    8     9    1    5    3    2     i    r    n    i    r     h     6     0     9     0     8     0     1     3     2     8     9  .  .  .  .  .  .  .  .  .  .  .     D    i     D    t     1    2    1    2    1    2     1    1    1    1    2    1    e    d    l    a     d   –   –   –   –   –   –   –   –   –   –   –    2    s    e    n    n     2    8    9    5    1    8     3    6    8    7    4    5     U    a    a     5     H     7    3    8    2    8    4     1    8    6    7    1    1     l    g    l     l     1     8    o    u    o    t  .     4  .     2  .     3  .     1  .     2  .  .     9  .     5  .     4  .     3  .     2  .     h    r     h    a     1     1     1     1     1     1     0     0     0     1    n    o    o     (     (     (     (     (     (     (     (     (     (     2     (     D    c     l    c    e     9    9    1    5    5    2     6    0    3    7    0     l     d     M     A  ,     7    1    8    4    7    1     8    4    4    4    0     A   n    a    d     3     9     d    s    e  .     7  .     5  .     6  .     4  .     6  .  .     1  .     8  .     6  .     6  .    a    n    a    n    m    n    c    a     1    1    1    1    1    1     0    1    0    1    2    s    o    s    r     t    r    r    u    p    o    o     i    m    i    s    n    v    a    y    v    a    I  ,     h     h     S    e    e    e     B    h     B     t    m     l     k    o     ∗     ∗     k     ∗     ∗    s    a    s    c    e    i     i     )     )     )     )     )     )     )     )     )     )     )    n     I     6    2    8    1    0    4     5    5    1    8    2     R    H     R     l     3    5    0    1    9    5     4    1    2    1    6     d    a    d    t ,     3     6     t    n    n    n  .     3  .     2  .     6  .     1  .     0  .  .     2  .     0  .     7  .     3  .    a    n    a    e     1    1    1    1    1    1     1    1    2    2    2    7    e    l     3   –   –   –   –   –   –   –   –   –   –   –    8     l    o    o    m    y     M     5    0    4    0    9    4     0    9    3    4    8    3     h  ,     h    o     9    4    1    4    1    1     8    4    9    5    4    0    o    e    o    l     8     9    c    c    l    c    p  .     8  .     7  .     8  .     6  .     4  .  .     8  .     5  .     9  .     7  .     1     l  .    n    A   m     0     A     (     0     (     0     (     0     (     0     (     0     (     0     (     0     (     0     (     1     (     1     (     [    a    r     [     E  ,    u    n     4    6    9    3    8    0     0    6    5    5    2     S    s     9    6    2    6    5    6     7    1    9    0    3     E   n    S     E    o     I     i     0     2  .     0  .     9  .     1  .     8  .     6  .  .     0  .     0  .     3  .     0  .  ,     L    t     1    1    0    1    0    0     1    1    1    2    2     L     B   e     B   a    c    u     A   m     A    d     I     I    o     E     R   c     R    n    A  ,     A    I  ,     V   e     V    t    c    a     T   n    e     T    R     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     ∗     N   m     N   r  ,    y    E     E    e     )     )     )     )     )     )     )     )     )     )     )    o    D    d     8    1    5    0    6    4     7    4    4    2    6     D    l    n     1    5    7    0    9    8     1    2    0    3    7     N   p    N   e     6     1     E   m    E    G  .     0  .     9  .     2  .     9  .     2  .  .     3  .     2  .     8  .     8  .     1    2    1    2    1    2     1    1    1    1    2    6     P    E  ,  ,     P   –   –   –   –   –   –   –   –   –   –   –    6     E   n     E   e    g     9    2    6    9    1    1     3    7    8    1    1    7     3    o    D    A     6    3    0    0    8    7     6    8    5    7    6    1     D    :     i    :  ,     1     7    a    g    t    g  .     4  .     3  .     4  .     2  .     3  .  .     9  .     5  .     4  .     2  .     2  .    c    n    n    H     1     1     1     1     1     1     0     0     0     1     2     i    u    i     (     (     (     (     (     (     (     (     (     (     (     T     d    w    w     5    4    6    0    9    9     3    3    9    1    0     l    o    E    l    o    N     7    1    0    6    9    6     2    4    1    4    5     l  ,     l     3     9    o    e    o    O  .     7  .     6  .     7  .     5  .     7  .  .     1  .     8  .     6  .     5  .     f     f    c     1    1    1    1    1    1     0    1    0    1    2    a    e    M    e    R     T     h     t    r     t     S  ,     h    e    e    e    A     d    d     d    P    u    n    l    u    S     l    c    e    c    K    n    G    i    n     i     I  ,     t     N     t     ∗     ∗    e     ∗     ∗    a    a    R     )     )     )     )     )     )     )     )     )     )     )    g     h     h     t     D     8    1    7    9    5    5     2    8    9    4    0     t    s     A    s     R     2    4    2    4    1    0     3    0    8    0    7  ,    n     3     5     S    n  .     3  .     2  .     7  .     3  .     2  .  .     2  .     9  .     7  .     2  .    o    o    E     L     i     i     B     1    1    1    1    1    1     1    1    1    2    2    1     t     E    t    a    a   –   –   –   –   –   –   –   –   –   –   –    1    u    V   u    M     6    2    7    6    8    2     2    8    2    2    1    9     5    q    q     E   e     N  .     3  .     2  .     0  .     8  .     6  .  .     4  .     9  .     9  .     6  .     0     8     8     7     9     6     4     2     9     8     5     5     8     1    n    L    n    U  .    e     0    o    L    o    E     (     0     (     0     (     0     (     0     (     0     (     0     (     0     (     0     (     1     (     1     (     i     i     O     G    s    s    s     5    7    4    9    1    6     9    2    6    7    3     H   s     A    e    e     8    5    4    5    5    4     8    1    8    9    5    r     O   r     R     0     0     9     2     9     7     1     0     0     2     9    g    g  .  .  .  .  .  .  .  .  .  .  .     C     E    e     1    1    0    1    0    0     1    1    1    2    1    r     L    e    r     V    e    A    e    A     [     [     h     t     S    h     t     S     f     E    f     E    o    o    L    s     L    t    s     t     l     B    l     B    s    u    u    A     A    s     I  .    m    e     I    s    e    e    r     d    o    r    r     R    ]    r     R     i    a     t    a    a    e     A   e     A   r    a    p    e    u     9    9    9    9    0    e    e    c     h    q     t     t     V    Y     V    h    v     i     9    9    9    9    0    o     d    m     Y     S    s    s     9     9     9     9     0    y     t     t     T     T   w    s  ,  ,  ,  ,  ,    e    w     S    s     9    9    9    9    5    b     N   o    N   a    a    R    o    E     l     1    2    3    4    7    A     M     h     h     h    E   p     P     l     t           $          $          $          $          $    d     l    e    s     D   s     D    i    n    n     &    n    a    o    t    o    t    o    t    o    t    o    a    e     i    n     3    N    4    N   e     t    e     S    e     L    E    L    E   s     0    0    0    0    0    0    r    s    a     d     E    P    E    P    U    e     H     0    0    0    0    0    0    e    i     l    c     t     U    a    n     0     D    E   g    c    d    a    h    t    a     D    E  ,     0  ,     0  ,     0  ,     0  ,     0  ,    n    e    0    g    v    t     O    D    O    D   u    r     0    0    0    0    5    a    e    i    n    x    u    o    r    e     N    m    1    2    3    4    5    7    r     M    P     I     D     M    N     I     B    r    o     M    o          $          $          $          $          $          $    u   –   –    e     h    e    d    n     t     t    a    c    n   -   -   -   -   -   -     I    s    n   -   -   -     M    D    C     h     I

203

 

204

 

M. D. ALAMEIDA ALAMEIDA ET AL.

previous research conclusions regarding alcohol’ alcohol’ss protective influence, when used in moderation. These researchers point out that a “systematic misclassification error was committed by inclu cludin ding g as ‘absta ‘abstaine iners’ rs’ ma many ny people people who had red reduce uced d or st stopp opped ed drinking, a phenomenon associated with aging and ill health.” As a result result,, the lived lived ex exper perien iences ces rep report orted ed by respon responden dents ts in thi thiss study must be taken into account when developing guidelines for alcohol use. Therefore, policy may be well advised to include additional criteria, such as self reported outcomes related to alcohol use, when whe n deve develop loping ing rec recomm ommend endati ations ons.. As an ex examp ample, le, the Dietar Dietary y Guidelines for Americans 2005 are predicated on alcohol’s relationship to mortality, and profiles associated with macronutrients and micronutrients, thereby dispelling the importance of  evaluating eval uating alcohol’ alcohol’ss social consequences.

This study strongly underscores the importance for the nursing profession to become aware of the consequences associated with alcohol use at low levels of consumption, especially since there are an estimated 1.8 million hospital admissions each year that fit DSM-IV criteria for an alcohol use disorder (Smothers,

The expectation that the nursing profession will receive standardized protocols and organizational support from all health care environments they practice in, as relates to alcohol assessment, is an unrealistic expectation in the foreseeable future. Therefore, it is suggested that the individual nurse assume responsibility for self-directed education in the area of alcohol assessment and incorporate this knowledge into their practice, as they also assume a leadership role in the development of  standardized alcohol assessment protocols in their respective practice settings. Alcohol Alcoh ol withd withdraw rawal al instrume instruments nts such as the Clini Clinical cal Institute Institute Withdrawal Withdr awal Assessment-Alcohol (CIWA-A) (CIWA-A) and Clinical Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar), (CIWA-Ar), etc. can be found in the literature. Likewise, the alcohol assessment instruments such as the Cut down, Annoyed by critics, Guilt about drinking, Eye opener in the morning (CAGE), Alcohol Use Disorders Identification Test (AUDIT), and Michigan Alcohol Screening Test (MAST), etc., along with variations of  these instruments and others also can be found in the literature. It is incumbent upon the nurse to identify an instrument that has been researched for their client population and care environment, and that has credible psychometric values for instrument validity and reliability. reliability. Furthermore, the instrument’s instrument’s rationale,

Harwood, & Yahr 2003). Unfortunately, it has been reported that documented evidence of an alcohol related disorder was present in only 40%–42% of clients who had screened positive for a DSM-IV alcohol related disorder in a separate interview. Furthermore, intervention was provided for only 24% of  thesee clients thes clients while refe referral rral to treatmen treatmentt occur occurred red with 50%– 50%–53% 53% (Smothers, Harwood, & Yahr 2003). Given this evidence, the hospital environment must be utilized to evaluate clients for alcohol coh ol rel relate ated d pro proble blems ms (Smoth (Smothers ers,, Har Harwoo wood, d, & Yahr ahr,, 200 2004) 4) and nursing must lead. The literatu literature re describes describes the need for alcoh alcohol ol assessme assessment nt in all practice practice settings settings where nursi nursing ng is prese present, nt, yet points out the lack of attention to developing protocols and support for nur nurses ses to perfor perform m in thi thiss capaci capacity ty in em emer ergen gency cy roo rooms ms (Cherpitel, 2006). In fact, studies associated with nurses performing form ing alcohol alcohol assessme assessment nt and/or and/or inte interve rventio ntion n are spars sparsee (Hyman, 2006) although brief intervention for alcohol is recognized as a nursing role and fits within nursing’s accountability toward health screening and promotion. In this regard, Lock, Kaner, Lamont, and Bond (2002) reported on primary care nurses engaging in alcohol assessment, yet stating that they are given little preparation to facilitate this process in terms of formal training as well as in being taught client interaction skills when discussing this sensitive topic. Additionally, a lack  of self-ef self-efficac ficacy y, a fear of losing losing the nurs nurse-cl e-client ient relation relationship ship (Jo (Johns hnsson son,, Akerli Akerlind, nd, & Ben Bendst dsten, en, 2005) 2005) and the tim timee requiremen quir ementt asso associat ciated ed with alcoh alcohol ol asses assessmen smentt and inte interve rvenntion (Holmqvist et al., 2008; Johansson, Akerlind, & Bendsten, 2005)) were cited as reas 2005 reasons ons for nurses ambi ambival valence ence toward alcohol alco hol screening screening even thou though gh they concede its impo importan rtance ce (Holmqvist et al., 2008).

strengths and limitations, as well as the methodology for conducting the assessment must be part of the nurse’s learning. The nurse also should be aware that specific demographic variables play a contributory role in alcohol use and that knowledge of these variables is important in guiding the assessment. For instance, in many cases of alcohol abuse the client may also have a history of a co-morbid psychiatric and/or illicit drug use. Problems related to alcohol may be associated with the client’s self-medicating self-medica ting behaviors. In addition, clients take medications that should not be taken with alcohol, or may be older adults whose physiological changes and medication interactions are cause cau se for great great ala alarm rm when when mi mixed xed wit with h alcoho alcohol. l. In the these se circum circum-stances it is important to understand that any amount of alcohol could have adverse consequences for the client. Teaching can also be provided by the nurse in regard to the fact that higher education and income increases the odds ratio for drinking and driving and that male gender presents as a higher likelihood for alcohol related use and problems. The role of the nurse in the process of alcohol assessment involves the nurse-client relationship, requisite knowledge, and interdisciplinary collaboration. As it relates to the nurse-client relationship, the nurse must trust that the therapeutic relationship will survive the alcohol assessment. Requisite knowledge refers to the application of the assessment instrument and the interpretation of results. Interdisciplinary collaboration refers to the dissemination of the assessment findings and referral of  clinical clin ical responsi responsibili bilities ties to appr appropri opriate ate team members. members. As an example, this would mean that the Nurse Practitioner, Clinical Nurse Specialist or MD is responsible for the history and physical, detoxification protocols, and diagnostic evaluations such as laboratory tests. The psychiatrist would be responsible for

Nursing Role and Conclusion

 

FA FACTORS CTORS ASSOCIATED ASSOCIATED WITH ALCOHOL USE AND ITS CONSEQUENCES CONSEQUENCES

psychiatric evaluations and psychotropic medication management and the social worker would be tasked with treatment referrals. The nurse would generate the referrals to the team members mem bers whilealso moni monitori toring ng the clie client nt for alco alcohol hol with withdraw drawal al sympto sym ptoms ms with with the CIWA-A or CIWA-A A-Arr. In this this man manner ner,, the issues of self-efficacy self-efficacy,, fear of losing the nurse-client relationsh relationship, ip, lack of organizational protocols and time constraints associated with wit h alcoho alcoholl assess assessmen mentt can be mi mitig tigate ated, d, and the nur nursin sing g rol rolee is maxim maximiz ized ed by allow allowing ing for the immedi immediateasses ateassessme sment nt of alcoho alcoholl abuse within more nursing practice settings.

 

205

Harwood, H., Fountain, D., & Livermore, G. (1998). Economic costs of alcohol abuse and alcoholism.   Recent Developments in Alcoholism,  14 , 307– 330. Hauser, E., Mooser, V., Crossman, D., Haines, J., Jones, C., Winkelman, B., Schmidt, S., Scott, W., Roses, A., Pericak-V Pericak-Vance, ance, M., Granger, M., & Kraus, W. (200 (2003). 3). Design of the genetics genetics of early onset cardiova cardiovascul scular ar disease disease (GENECARD) study.  American Heart Journal ,  145, 602–613. Herd, D. (1993). Correlates of heavy drinking and alcohol related problems among men and women in drug treatment programs.  Drug and Alcohol De pendence,  32, 25–35.

Archer, L., Dawson, D., Grant, B. (1995). What if Americans drank less? The potentialeffect poten tialeffect on the preval prevalence ence of alcoh alcohol ol abuse abuse and dependenc dependence. e. American  Journal of Public Health, 85, 61–66. Biener, L. (1987). Gender differences in the use of substances for coping. In: Barnett, Barne tt, R.C. R.C.,, Bien Biener, er, L., and Baruch, Baruch, G.K. (Eds) (Eds) Gend Gender er and stre stress. ss. pp. 330– 349. New York: Free Press. Butters, J., Smart, R., Mann, R., & Asbridge, M. (2005). Illicit drug use, alcohol use and problem drinking among infrequent and frequent road ragers.  Drug and Alcohol Dependence,  80, 169–175. Campbell, J., Hagan, H., Latka, M. et al. (2006). High prevalence prevalence of alcohol use among hepatitis C virus antibody positive injection drug users in three U.S. cities. Drug and Alcohol Dependence,  81, 259–265. Castilla Cast illa,, J., Barrio, G., Belza, M., & Fuent Fuente, e, L. (199 (1999). 9). Drug and alcoh alcohol ol consumption and sexual risk behavior among young adults: results from a national survey.  Drug and Alcohol Dependence, 56 , 47–53. Chermack, S., & Blow, F. (2002). Violence among individuals in substance abuse treatment: the role of alcohol and cocaine consumption.   Drug and   Alcohol Dependence,  66 , 29–37. Cherpitel, C. (2006). Screening and brief intervention for alcohol problems in the emergency room: is there a role for nursing?   Journal of Addictions  Nursing,  17 , 79–82. Dawson, D. (1999). Alternative definitions of high risk for impaired driving: the overlap of high volume, frequent heavy drinking and alcohol dependence.  Drug and Alcohol Dependence, 54, 219–228.

Hilton, M.E. (1987). Drinking patterns and drinking problems in 1984: Results from a general population survey.  Alcoholism,  11, 167–175. Holmqvist, M., Bendtsen, P., Spak, F. et al. (2008). Asking patients about their drinking: A national survey among primary health care physicians and nurses in Sweden.  Addictive Behaviors,  33, 301–314. Hyman, Hyma n, Z. (200 (2005). 5). Briefinterventio Briefinterventions ns for high-ris high-risk k drinkers drinkers.. Journal of Clinical  Nursing,  15, 1383–1396 1383–1396.. Jennison, K. (2004). The short-term effects and unintended long-term consequences quen ces of bing bingee drin drinkingin kingin college:a college:a 10-y 10-year ear followfollow-up up study. study. TheAmerican  Journal of Drug and Alcohol Abuse,  30, 659–684. Johnsson John sson,, K., Aker Akerlind lind,, I., & Bend Bendtsen tsen,, P. (200 (2005). 5). Under Under whatcircumstancesare whatcircumstancesare nurses willing to engage in brief alcohol interventions? A qualitative study from primary care in Sweden.  Addictive Behaviors,  30, 1049–1053 1049–1053.. Kessler, R., Crum, R., Warner, L., Nelson, C., Schulenberg, J., & Anthony, J. (1997). Lifetime co-occurrence of DSM-III-R alcohol abuse and dependence with other psychiatric disorders in the national co morbidity survey. Archives of General Psychiatry, 54, 313–321. Kessler, R., McGonagle, K., Zhao, S. et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey.  Archives of General Psychiatry ,  51, 8–19. Keyes, K., Grant, B., & Hasin, D. (2008). Evidence for closing gender gap in alcohol use, abuse, and dependence in the United States population.  Drug and Alcohol Dependence,  93, 21–29. Kilpatrick, D., Acierno, R., Saunders, B., Resnick, H., & Best, C. (2000). Risk  factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology,  68(1), 19–30. LaPlante, M. (2002). The prevalence of mental health disability in adults. Disability Statistics Center, Institute for Health and Aging, University of California, San Francisco. Lipsky, Lips ky, S., Caet Caetano, ano, R., Field, Field, C., & Larki Larkin, n, G. (2005). (2005). Psychosocial Psychosocial and substance-use risk factors for intimate partner violence.   Drug and Alcohol  Dependence,  78, 39–47. Locke, C., Kaner, E., Lamont, S., & Bond, S. (2002). A qualitative study of  nurses’ attitudes and practice regarding brief alcohol intervention in primary

Dawson, D., Grant, B., & Hartford, T. (1995). Variation in the association of  alcohol consumption with five DSM-IV alcohol problem domains.  Alcohol Clinical Experimental Research,  19(1), 66–74. Day,, E.,Best Day E.,Best,, D.,Sweetin D.,Sweeting, g, R.,Russell R.,Russell,, R.et al.(2008).Dete al.(2008).Detecti ctinglifet nglifetimealco imealco-hol problems in individuals individuals referred for liver transplantati transplantation on for nonalcoholi nonalcoholicc liver failure.  Liver Transplantation 1609–1613.. Transplantation, 14, 1609–1613 Edwards, G., & Gross, M. (1976). Alcohol dependence: provisional description of a clinical syndrome.  British Medical Journal,  8(2), 171–183. Flensborg-Madsen, FlensborgMadsen, T., Knop, J., Mortensen, E. et al. (2009). Alcohol use disorders increase the risk of completed suicide—Irrespective suicide—Irrespective of other psychiatric disorders, A longitudinal cohort study.  Psychiatry Research, 50(4), 307–14. Fattore, L., Altea, S., & Fratta, W. (2008). Sex differences in drug addiction: a review of animal and human studies.  Women’s Health,  4(1), 51–65. Fill Fillmore,K., more,K., Kerr, Kerr, W., Stoc Stockwel kwell, l, T., Chikritzh Chikritzhs, s, T., & Bostrom,A Bostrom,A (200 (2006).Mod6).Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies. Addiction Research and Theory ,  14(2), 101–132. Grant, B., & Hartford, T. (1995). Comorbidity between DSM-IV alcohol use disordersand diso rdersand majo majorr depre depressio ssion: n: resul results ts of a nationalsurvey nationalsurvey.. Drug and Alcohol

health care. Journal of Advanced Nursing,  39(4), 333–342. Lucey, M., & Weinrieb, R. (2009). Alcohol and substance abuse.  Semin Liver   Dis.,  29(1), 66–73. Martens, J., Lu, Y., Parthasarathy, S., Moore, C., & Weisner, C. (2003). Medical and psychiatric conditions of alcohol and drug treatment patients in an HMO.  Archives of Internal Medicine , 163, 2511–2517. Midanik, L., Tam, T., Greenfield, T., & Caetano, R. (1996). Risk functions for alcohol-related problems in a 1988 U.S. national sample.  Addiction,  94, 649–663. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Division of  Biometry and Epidemiology. Alcohol Epidemiologic Data Directory (2001). CSR Incorporated Washington, Washington, DC. Contract No. NO1-AA-8-2 NO1-AA-8-2014. 014. Nichol, P., Krueger, R., & Iacono, W. (2007). Investigating gender differences in alcohol problems: a latent trait modeling approach.   Alcoholism Clinical and Experimental Research,  31(5), 783–794. Reiger, D., Farmer, M., Rae, D. et al. (1990). Co morbidity of mental disorders withalcohol and otherdrug abuse: abuse: Resul Results ts from the epid epidemiol emiologic ogic catch catchment ment area(ECA) study. study. The Journal Journal of the American American Medical Medical Association Association, 264(19),

DECLARATION OF INTEREST The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.

REFERENCES

 Dependence, 39, 197–206.

2511–2518.

 

206

 

M. D. ALAMEIDA ALAMEIDA ET AL.

Rivara, F., Garrison, M., Ebel, B., McCarty, C., & Christakis, D. (2004). Mortality attributable to harmful drinking in the United States, 2000.  Journal of  Studies on Alcohol,  65(4), 530–6. Robbins, C. (1989). Sex differences and psychosocial consequences of alcohol and drug abuse.  Journal of Health and Social Behavior ,  30, 117–130. Russell, M., Light, J., & Gruenewald, P. (2004). Alcohol consumption and problems: the relevance of drinking patterns.   Alcoholism: Clinical and Ex perimental Research,  28(6), 921–930. Saremi, A., & Arora, R. (2008). The ca rdiovascular rdiovascular implications of alcohol and red wine.  American Journal of Ther.,  15(3), 265–277.

sions, Unit sions, United ed States, States, 1994 1994..   Ar Archive chivess of Internal Internal Medicine Medicine,   163, 71 713– 3– 719. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th Edition, Washington, DC: U.S. Government Printing Office, January 2005. U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. NATIONAL SURVEY ON DRUG USE AND HEALTH, 2003 [Computer File]. ICPSR version. Research Triangle Park, NC: Research Triangle Institute [producer], 2004. Ann Arbo Arbor, r, MI: Inter-uni Inter-univers versity ity Cons Consorti ortium um for Politicaland Politicaland Soci Social al Resea Research rch

Smothers, B., Yahr, H., & Ruhl, C. (2004). Detection of alcohol use disorders in general general hosp hospital ital admissi admissions ons in the United Stat States. es.  Archiv  Archives es of Internal Internal  Medicine,  164, 749–756. Smothe Smo thers, rs, B., Yahr ahr,, H., & Sin Sincla clair ir,, M. (20 (2003 03). ). Pre Preva valen lence ce of cur curren rentt DSM-IV DSMIV alcoh alcohol ol use disorders disorders in shor short-st t-stay ay,, gener general al hosp hospital ital admi admiss-

[distributor], 2004. Wi Wines, nes, J., Saitz, Saitz, R., Horton, N., Lloyd-T Lloyd-Trav ravagli aglini, ni, C., & Samet, Samet, J. (200 (2004). 4). Suicidal Suic idal behavior, behavior, drug use and depressi depressive ve sympt symptoms oms after detoxifi detoxificacation: tion: a 2-ye 2-year ar prospecti prospective ve stud study. y.   Drug and Alcoh Alcohol ol Dependence Dependence,   76S , S21–S29.

 

Copyright of Journal of Addictions Nursing is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Sponsor Documents

Or use your account on DocShare.tips

Hide

Forgot your password?

Or register your new account on DocShare.tips

Hide

Lost your password? Please enter your email address. You will receive a link to create a new password.

Back to log-in

Close