Diagnostic Usefulness of Korean Standard on Heavy Drinking for the DSM-5 Alcohol Use Disorder

BACKGROUND: This research investigated the usefulness of heavy drinking standards of ‘guidelines for moderate alcohol drinking amount for Koreans’ for diagnosis of Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) alcohol use disorder. METHODS: This retrospective study was conducted with 976 adults who visited an health screening center in Daejeon for health check-up in 2015. Daily drinking amount, drinking frequency per week, and weekly drinking amount were investigated. Using the heavy drinking criteria of Korean guideline, participants were grouped by age and gender and classified as normal or heavy drinkers. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Positive likelihood ratio (LR+), Negative likelihood ratio (LR-), odds ratio (OR) and Youden's Index of heavy drinking according to Korean guideline for diagnosis of DSM-5 alcohol use disorder were calculated. RESULTS: The Area under the receiver operating characteristic (ROC) curve of a model screening DSM-5 alcohol use disorder by weekly drinking amount were 0.812 in males up to age 65 years and 0.931 in males over age 65 years and females respectively. The sensitivity, specificity, PPV and NPV of Korean guideline heavy drinking group for diagnosis of DSM-5 alcohol use disorder were 61.0%, 89.7%, 67.0%, and 87.05% respectively. The LR+, LR-, OR and Youden's Index of those were 5.917 (4.704-7.435), 0.434 (0.379-0.497), 13.623 (9.607-19.317), and 0.507 respectively. CONCLUSIONS: This research shows the Korean heavy drinking standard is useful for diagnosis of DSM-5 alcohol use disorder in Korean people.

Usefulness of Heavy Drinking and Binge Drinking for the Diagnosis of Alcohol Use Disorder / 가정의학회지

BACKGROUND: This research investigated the sensitivity and specificity of heavy and binge drinking for screening of alcohol use disorder. METHODS: This retrospective study was conducted with 976 adults who visited the Sun Health Screening Center for health screenings in 2015. Daily drinking amount, drinking frequency per week, and weekly drinking amount were investigated. Using criteria from the National Institute on Alcohol Abuse and Alcoholism, participants were classified as normal drinkers, heavy drinkers, or binge drinkers, and grouped by age and sex. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of heavy and binge drinking were compared for the diagnosis of alcohol abuse and alcohol dependence using the Diagnostic and Statistical Manual of Mental Disorders (DSM) 4th edition-text revision and alcohol use disorder using the DSM 5th edition. RESULTS: The sensitivity of heavy and binge drinking for the diagnosis of alcohol abuse, alcohol dependence, and alcohol use disorder were 51.7%, 43.8%, and 35.3%, and 69.0%, 62.5%, and 48.2%, respectively. The specificity of these were 90.1%, 91.7%, and 95.5%, and 84.3%, 86.8%, and 91.2%, respectively. The PPV of these were 24.8%, 40.5%, and 72.7%, and 21.7%, 38.0%, and 65.2%, respectively. The NPV of these were 96.7%, 92.6%, and 81.2%, and 97.8%, 94.7%, and 83.7%, respectively. CONCLUSION: Heavy and binge drinking did not show enough diagnostic power to screen DSM alcohol use disorder although they did show high specificity and NPV.

The Stress of Traditional Biggest Holidays among Korean Married Women / 가정의학회지

BACKGROUND: The Korean traditional national holidays commonly produce several physical symptoms related to stress. This study was performed to evaluate the degree of the stress from the married women during their Korean traditional biggest holidays. METHODS: The subjects were 99 married women who had visited the Health Promotion Center at a university hospital. For evaluating the stress of the Korean traditional biggest holidays, subjects were allowed to write in subjective stress score based on the Social Readjustment Rating Scale. The factors associated with the stress were investigated. RESULTS: The mean (+/- SD) score of the married women's stress of the Korean traditional biggest holidays was 38.7 (+/- 21.9). The score was widely distributed from the 0 to 100. The cases with hobbies to cope with stress showed significantly (P < 0.05) lower stress score than those without hobby. The stress score was inversely correlated with family APGAR score (r = -0.346, P < 0.01). In stepwise multiple regression model, the stress score was related to family APGAR score and hobby to cope with stress (overall R2 = 0.171, P < 0.001). CONCLUSION: The stress score of the Korean traditional biggest holidays was widely distributed from 0 to 100 in Korean married women. These results suggest that traditional biggest holidays act as a stressor for individual with a range of variable extent.

Carbohydrate-deficient Transferrin as a Marker of Heavy Drinking in Korean Males

This study was performed to evaluate the usefulness of carbohydrate-deficient transferrin (CDT) as a marker of heavy drinking in Korean males. The subjects (143 Korean males) were classified into 2 groups according to the amount of drinking, moderate drinkers (72 individuals) who drank 14 drinks or less per week and heavy drinkers (71 individuals) who drank more than 14 drinks per week. Using %CDT, gamma glutamyl transferase (GGT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) as clinical markers for heavy drinking, sensitivity, specificity, positive and negative predictive values were investigated. Sensitivities of %CDT, GGT, AST, and ALT were 83.1%, 67.6%, 52.1% and 46.5%, respectively. Specificities were 63.9%, 45.8%, 72.2%, and 54.2%, respectively. Positive predictive values were 69.4%, 55.2%, 64.9%, and 50.0% respectively. Negative predictive values were 79.3%, 58.9%, 60.5%, and 50.6% respectively. The areas under the receiver operating characteristic curve (95% confidence interval) for %CDT, GGT, AST, and ALT were 0.823 (0.755-0.891), 0.578 (0.484-0.673), 0.622 (0.528-0.717), and 0.516 (0.420-0.613), respectively. CDT is considered as the most reliable marker for detecting heavy drinking in Korean males.

The Readiness to Change and Insight in Alcohol dependent Patients

This study was performed to investigate the effect of insight on the readiness to change in alcoholism. The subjects were 131 Korean male patients with alcohol dependence who were being hospitalized in a community-based alcohol treatment center. The patients' readiness to change was classified into precontemplation, contemplation, and action stage through the readiness to change questionnaire. The state of the patients' insight was measured through the Hanil alcohol insight scale. Fourteen patients (10.7%) were in the stage of precontemplation, 65 (49.6%) in contemplation and 52 (39.7%) in action stage. The insight score of the patients in precontemplation stage was significantly lower (p<0.001) than that of others. On the basis of the precontemplation stage, multinomial logistic regression analysis for the control of the differences in the patients' characteristics among each stage of the readiness to change showed that the possibility of contemplation and action stage went up 1.231 (p<0.01) and 1.249 (p<0.01) times higher as the insight score increased.

Nicotine Dependence and Internal Response to Stress in Male Smokers

BACKGROUND: This study investigated the relationship between stress and nicotine dependence, dividing stress into external stress and internal response. METHODS: The subjects were 263 male adults who had visited the General Health Promotion Center at Chungnam National University Hospital in Korea between April and June 2005. Nicotine dependence, external stress and internal response were measured by the Fagerstrom test for nicotine dependence, life change unit of the social readjustment rating scale and the brief encounter psychosocial instrument. RESULTS: The mean (+/-SD) score of external stress in smokers (n=107) was 150.79 (+/-109.02), which was significantly (P<0.001) higher than 92.96 (+/-126.27) in non- smokers, and the mean (+/-SD) score of internal response in smokers was 10.30 (+/-3.16), which was also significantly (P<0.001) higher than 8.71 (+/-3.33) in non-smokers. The smokers' nicotine dependence showed positive correlation with the score of external stress (r=0.436, P<0.001) and the score of internal response (r=0.579, P<0.001). The stepwise multiple regression analysis showed that nicotine dependence was related to the score of internal response, the score of external stress, the duration of education, the age of first smoking (overall R2=0.433, P=0.040), and most closely to the score of internal response (partial R2=0.335, P<0.001). CONCLUSION: In order to develop an effective strategy for quitting smoking, the internal response to stress needs to be considered as one of evaluation items.