Alcohol use, abuse and dependence among elderly in outpatient treatment through the application of AUDIT

SUMMARY OBJECTIVE To identify or use alcohol abuse and abuse in the IAMSPE elderly, through the application of AUDIT, socioeconomic characterization of the elderly, and problems associated with drinking and weight, if there is a relationship between depression and alcohol abuse. METHODS This is a cross-sectional, exploratory, and descriptive study with a quantitative approach. One hundred elderly patients were interviewed to apply a socioeconomic form and to assess alcohol consumption from AUDIT. RESULTS correlation between alcohol consumption and female gender (p = 0.021). Most of the participants were between 60 and 79 years old, were female, had a partner, had completed elementary school, had income and selected house, were retired and unemployed. CONCLUSION In the present study, we found no correlation between alcohol abuse and depression; Only one correlation was found between male gender and higher alcohol abuse. However, a significant prevalence of moderate use of high alcohol was found (3.9% in women and 21.7% in men), i.e., it poses a risk to the health of the elderly.

RESUMO OBJETIVO Identificar o uso, abuso e dependência de álcool em idosos do ambulatório do Iamspe, por meio da aplicação do Audit, através da caracterização socioeconômica dos idosos e dos problemas associados pelo consumo e pesar se há relação entre depressão e uso abusivo ou dependência de álcool. MÉTODOS Trata-se de um estudo de corte transversal, exploratório e descritivo de abordagem quantitativa. Foram entrevistados cem pacientes idosos para aplicação de um formulário socioeconômico e de avaliação do consumo de álcool, a partir da Audit. RESULTADOS Verificou-se correlação entre o consumo de álcool e sexo feminino (p=0,021). A maioria dos participantes estava na faixa etária entre 60 e 79 anos, era do sexo feminino, tinha companheiro(a), com ensino fundamental completo, renda e casa próprias, era aposentada e desocupada. CONCLUSÃO No presente estudo não verificamos correlação entre abuso de álcool e depressão; somente foi encontrada a correlação entre sexo masculino e maior uso abusivo de álcool. No entanto, encontrou-se prevalência significativa de uso moderado a alto de álcool (3,9% em mulheres e 21,7% em homens), o que, por si, traz risco para a saúde de idosos.

Validação brasileira do Alcohol Craving Questionnaire ­ Short Form Revised (ACQ-SFR) / Brazilian validation of Alcohol Craving Questionnaire ­ Short Form Revised (ACQ-SFR)

Introdução: A avaliação do craving é importante para o tratamento de pacientes com Transtornos por uso de substâncias psicoativas. O objetivo deste estudo foi realizar a validação do Alcohol Craving Questionnaire-Short Form Revised- Versão Brasileira (ACQ-SFR ­ Versão Brasileira). Métodos: Foi um estudo observacional transversal, com uma amostra não aleatória de 121 participantes alcoolistas, do sexo masculino, internados para desintoxicação em unidade especializada. Os instrumentos utilizados foram: entrevista clínica com dados sociodemográficos e de padrão de uso de substâncias, MMSE, ACQ-SFR ­ Versão Brasileira, EAV do craving, BDI, BAI, estímulo visual indutor de craving. Resultados: Na análise fatorial, foram encontrados dois fatores: o fator 1 representa o craving pelo reforço positivo e negativo do álcool, e o fator 2, o propósito de consumir o álcool associado ao prazer. O alfa de Cronbach total foi de 0,91 (12 itens), o do Fator 1 foi 0,92 (8 itens) e o do Fator 2 foi 0,70 (3 itens). O total de pontos da escala foi correlacionado com a Escala Analógico-Visual (r=0,658; p<0,01). Conclusão: Conclui-se que o ACQ-SFR ­ Versão Brasileira demonstrou ter propriedades psicométricas satisfatórias. (AU)

Introduction: The assessment of craving is important in the treatment of patients with psychoactive substance use disorders. The purpose of this study was to validate the Brazilian version of the Alcohol Craving Questionnaire ­ Short Form Revised (ACQ­SFR ­ Brazilian Version). Methods: A cross-sectional observational study was conducted, with a non-random sample of 121 male alcoholic participants admitted for detoxification in a specialized unit. The instruments used to collect data were clinical interview with sociodemographic data and substance use pattern, MMSE, ACQ-SFR ­ Brazilian version, VAS of craving, BDI, BAI, and visual inducer of craving. Results: In a factorial analysis, two factors were found: factor 1 represents craving due to positive and negative reinforcement of alcohol use, and factor 2, the purpose of consuming alcohol associated with pleasure. Overall Cronbach's alpha was 0.91 (12 items), while factor 1 was 0.92 (8 items) and factor 2 was 0.70 (3 items). Total scale score correlated with VAS score (r = 0.658; p < 0.01). Conclusions: AACQ-SFR ­ Brazilian version presented satisfactory psychometric properties. (AU)

Intervención en persona con adicción y que habita en calle / Overtreatment in person with adiction living in the streets

Se presenta el caso de un hombre de 37 años, con consumo dependiente de alcohol, sin redes familiares significativas. Desde hace nueve años, habita en calle. Durante este tiempo ha ingresado a once programas de las redes de apoyo e instituciones y, a pesar de las intervenciones terapéuticas, su cuadro ha empeorado progresivamente. Esta situación ha provocado que el paciente transite por diferentes tratamientos, estableciendo dinámicas de sobre intervención y vínculos de dependencia a los programas donde asiste.

This paper exposes the case of 37 years old man, alcohol dependent, without significant family networks. For 9 years he has been living in the streets, and during this time he has entered in 11 institutions and networks support programs. However, and despite therapeutic interventions, he is progressively worse. Because of this, the person goes through different treatments, leading to overtreatment and dependency bonds with programs he attends.

Factors Affecting the Downward Mobility of Psychiatric Patients: A Korean Study of National Health Insurance Beneficiaries / 예방의학회지

OBJECTIVES: The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients. METHODS: This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients. RESULTS: About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients. CONCLUSIONS: This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients.

Consumo de alcohol en el adulto mayor chileno que viaja / Alcohol consumption among traveling Chilean older people

Background: Problems associated with alcohol consumption are prevalent in Chile, but little is known about the situation in the elderly. Aim: To perform a screening to detect alcohol-related problems and risks in the Chilean older people who travel. Material and Methods: The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was answered by 1,076 travelers aged 60 to 93 years (66% females), who participated in trips organized by the Chilean National Tourism Service (SERNATUR). Results: Seventy six percent of respondents acknowledged to have ingested an alcoholic drink during the last month. The average AUDIT score was of 2.2 ± 2.6. Only 3.7% of the sample had a score equal or higher than eight, considered as risky use. Within this last group, 60% had symptoms of alcohol dependence. A higher alcohol consumption was associated with male gender (p < 0.01), being younger than 75 years of age (p < 0.01), having a medium-low economic income (p < 0.01) and having a higher education level (p = 0.03). There was no significant association with the respondents´ occupation. Conclusions: In this sample of Chilean traveling older people, there was a high prevalence of alcohol consumption, and nearly 4% of respondents had alcohol related problems.

Predictors of Hospitalization for Alcohol Use Disorder in Korean Men

PURPOSE: This study was done to identify the patterns and significant predictors influencing hospitalization of Korean men for alcohol use disorder. METHODS: A descriptive study design was utilized. Data were collected using self-report questionnaires from 143 inpatients who met the DSM-5 alcohol use disorder criteria and were receiving treatment and 157 social drinkers living in the community. The questionnaires included Alcohol Use Disorders Identification Test (AUDIT), Alcohol Problems, Alcohol Expectancy Questionnaire (AEQ), Life Position, and The Korean version of the Children of Alcoholics Screening Test (CAST-K). Data were analyzed using descriptive statistics, t-test, chi2-test, F-test, Pearson correlation coefficients, and logistic regression with forward stepwise. RESULTS: AUDIT had significant correlations with alcohol problems, alcohol expectancy, and parents' alcoholism. In logistic regression, factors significantly affecting hospitalization were divorced (OR=4.18, 95% CI: 1.28-13.71), graduation from elementary school (OR=28.50, 95% CI: 8.07-100.69), middle school (OR=6.66, 95% CI: 2.21-20.09), high school (OR=6.31, 95% CI: 2.59-15.36), drinking alone (OR=9.07, 95% CI: 1.78-46.17), family history of alcoholism (OR=2.41, 95% CI: 1.11-5.25), interpersonal relationship problems (OR=1.28, 95% CI:1.17-1.41), and sexual enhancement of alcohol expectancy (OR=0.83, 95% CI: 0.72-0.94), which accounted for 53% of the variance. CONCLUSION: Results suggest that interpersonal relationship programs and customized cognitive programs for social drinkers in the community are needed to decreased alcohol related hospitalization in Korean men.

Validez y confiabilidad del test de identificación de los trastornos debidos al consumo de alcohol (AUDIT) en estudiantes de una universidad chilena / Validity and reliability of the alcohol use disorders identification test (AUDIT) in a Chilean university students

Objetivo: analizar la confiabilidad y validez del test de Identificación de los Trastornos Debidos al Consumo de Alcohol en una población de estudiantes que ingresan por primera vez a la Universidad. Material y método: aplicación del instrumento a 845 estudiantes, previo consentimiento informado, seleccionados mediante muestreo aleatorio estratificado por facultad. 789 alumnos lo completaron satisfactoriamente, se aplicaron pruebas paramétricas para obtener resultados de consumo de alcohol basados en los puntajes de corte y zonas sugeridas por la Organización Mundial de la Salud. Se aplicó alfa de Cronbach para determinar la fiabilidad y análisis factorial para la validez. Resultados: La confiabilidad del instrumento fue apropiada (alfa = 0,83), y se detectaron dos componentes referidos al consumo de alcohol y las consecuencias. Conclusión: este test es un instrumento confiable y válido para diagnóstico en el consumo de alcohol tanto riesgoso como dependiente en estudiantes universitarios.

Objective: to analyze the reliability and validity of the Alcohol Use Disorders Identification Test in a population of students who are entering the university for their first time. Material and method: application of the instrument to 845 students, previous informed consent, selected through faculty stratified random sampling. 789 students completed it successfully, parametric tests for alcohol consumption were applied to obtain results based on cut scores and areas suggested by the World Health Organization. Cronbach's alpha was applied to determine the reliability and factor analysis for validity. Results: Te reliability of the instrument was appropriate (alpha = 0.83), and detected two components relating to alcohol consumption and consequences. Conclusion: This test is a reliable and valid diagnosis tool in both hazardous alcohol consumption and dependency in college students.

Questões relacionadas ao gênero no diagnóstico e classificação de transtornos por uso de álcool entre pacientes mexicanos que buscam serviços especializados / Gender-related issues in the diagnosis and classification of alcohol use disorders among Mexican patients seeking specialized services

OBJETIVO: O objetivo do estudo foi examinar o papel do gênero no endosso dos sintomas incluídos tanto na Classificação Internacional de Doenças-10ª Edição quanto no Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição. MÉTODO: Seiscentos pacientes tratados por problemas ligados ao álcool em serviços ambulatórios de saúde no México foram avaliados com o Módulo sobre Abuso de Substâncias da Composite International Diagnostic Interview. RESULTADOS: A análise fatorial confirmatória com a Classificação Internacional de Doenças-10ª Edição e o Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição produziu dois fatores, que incluíram uma combinação de abuso/uso nocivo de álcool e sintomas de dependência, que explicaram 40 por cento e 49,2 por cento da variância total, respectivamente. No grupo de pacientes abuso/uso nocivo, os sintomas e as consequências sociais diferiram entre os gêneros: síndrome de abstinência, falta de controle e problemas jurídicos foram mais frequentes nos homens, enquanto as mulheres apresentaram maiores taxas de tentativas de abandonar o álcool e dificuldades para realizar atividades diárias. Fatores específicos de gênero diferenciaram abuso/uso nocivo da dependência, como a perda de controle e o tempo gasto para beber, no caso dos homens, e do desejo de beber entre as mulheres, de acordo com os critérios de dependência do Manual Diagnóstico e Estatístico de Transtornos Mentais-4ª Edição, e presença de sintomas físicos em homens, problemas sociais/família, e desejo e esforço fútil de parar de beber em mulheres, segundo o critério de dependência da Classificação Internacional de Doenças-10ª Edição. CONCLUSÃO: Futuros sistemas de classificação da toxicomania devem levar em conta as diferenças entre os sexos, a fim de ajudar a suprimir a lacuna de tratamento para as mulheres.

OBJECTIVE: The objective of the study was to examine the role of gender in the endorsement of symptoms included in both the International Classification of Diseases-10th Edition and the Diagnostic and Statistical Manual of Mental Disorders-4th Edition. METHOD: Six hundred patients treated for alcohol-related problems in outpatient services in Mexico were evaluated with the Substance Abuse Module of the Composite International Diagnostic Interview. RESULTS: Confirmatory factor analyses using the International Classification of Diseases-10th Edition and Diagnostic and Statistical Manual of Mental Disorders-4th Edition criteria produced two factors that included a combination of abuse/harmful alcohol use and dependence symptoms, which explained 40 percent and 49.2 percent of the total variance, respectively. In the abuse/harmful use groups of patients, symptoms and social consequences differed according to gender: withdrawal syndrome, lack of control and legal problems were more frequent in men, while women exhibited higher rates of attempts to give up alcohol and difficulties to accomplish daily activities. Specific gender-related factors differentiated abuse/harmful use from dependence, such as loss of control and time spent to drink in the case of men and desire to drink among women, according to the Diagnostic and Statistical Manual of Mental Disorders-4th Edition dependence criteria; and presence of physical symptoms in men and family/social problems, craving, and futile effort to stop drinking in women, according to the International Classification of Diseases-10th Edition dependence criteria. CONCLUSION: Future classification systems of substance abuse disorders should take into account differences between genders in order to help closing the treatment gap for women.

Relationships of Mental Disorders and Weight Status in the Korean Adult Population

The purpose of this study was to evaluate the associations between weight status and mental disorders, including depressive disorder, anxiety disorder and alcohol use disorder. A total of nationally representative 6,510 subjects aged 18-64 yr was interviewed in face-to-face household survey. Response rate was 81.7%. Mental disorders were diagnosed using the Korean version of the Composite International Diagnostic Interview (K-CIDI). The subjects reported their heights and weights. After adjusting for age and gender, the lifetime diagnosis of depressive disorder had a significant association with only the underweight group (odds ratio [OR], 1.68, 95% confidence interval [CI], 1.19-2.38). The association between underweight and depressive disorder was the strongest for subjects with a high education level (OR, 1.75, 95% CI, 1.2-2.56), subjects with a married/cohabiting status (OR, 1.94, 95% CI, 1.17-3.22) and smokers (OR, 2.58, 95% CI, 1.33-4.98). There was no significant association between obesity and depressive disorder in Korea. But there was a significant association between the underweight group and depressive disorder. The relationship between obesity and mental disorder in a Korean population was different from that in a Western population. These results suggest that the differences of traditional cultures and races might have an important effect on the associations between the weight status and mental disorders.

The influence of the comorbidity between depression and alcohol use disorder on suicidal behaviors in the São Paulo Epidemiologic Catchment Area Study, Brazil / Influência da comorbidade entre depressão e transtornos por uso de álcool nos comportamentos suicidas no Estudo de Área de Captação de São Paulo, Brasil

OBJECTIVE: To investigate in a community sample the association of suicide-related cognitions and behaviors ("thoughts of death", "desire for death", "suicidal thoughts", and "suicidal attempts") with the comorbidity of depressive disorders (major depressive episode or dysthymia) and alcohol or substance use disorders. METHOD: The sample was 1464 subjects interviewed in their homes using the Composite International Diagnostic Interview to generate DSM-III-R diagnosis. Descriptive statistics depicted the prevalence of suicide-related cognitions and behaviors by socio-demographic variables and diagnoses considered (major depressive episode, dysthymia, alcohol or substance use disorders). We performed a multivariate logistic regression analysis to estimate the effect of comorbid major depressive episode/dysthymia and alcohol or substance use disorders on each of the suicide-related cognitions and behaviors. RESULTS: The presence of major depressive episode and dysthymia was significantly associated with suicide-related cognitions and behaviors. In the regression models, suicide-related cognitions and behaviors were predicted by major depressive episode (OR = range 2.3-9.2) and dysthymia (OR = range 5.1-32.6), even in the presence of alcohol use disorders (OR = range 2.3-4.0) or alcohol or substance use disorders (OR = range 2.7-2.8). The interaction effect was observed between major depressive episode and alcohol use disorders, as well as between dysthymia and gender. Substance use disorders were excluded from most of the models. CONCLUSION: Presence of major depressive episode and dysthymia influences suicide-related cognitions and behaviors, independently of the presence of alcohol or substance use disorders. However, alcohol use disorders and gender interact with depressive disorders, displaying a differential effect on suicide-related cognitions and behaviors.

OBJETIVO: Investigar, numa amostra comunitária, a associação entre cognições e comportamentos relacionados ao suicídio ("pensamentos de morte", "desejo de morte", "pensamentos suicidas", e "tentativas de suicídio") e a comorbidade entre transtornos depressivos (episódio depressivo maior ou distimia) e transtornos por uso de álcool ou substâncias. MÉTODO: 1.464 sujeitos foram entrevistados em seus domicílios com o CIDI para gerar diagnósticos DSM-III-R. Estatística descritiva demonstrou a prevalência de cognições e comportamentos relacionados ao suicídio pelas variáveis sociodemográficas e diagnósticos considerados (episódio depressivo maior, distimia, transtornos por uso de álcool ou substâncias). Realizamos também análises de regressão logística multivariada para estimar o efeito da comorbidade entre episódio depressivo maior/distimia e transtornos por uso de álcool ou substâncias em cognições e comportamentos relacionados ao suicídio. RESULTADOS: A presença de episódio depressivo maior e distimia foi significativamente associada a cognições e comportamentos relacionados ao suicídio. Em modelos de regressão multivariada, os preditores de cognições e comportamentos relacionados ao suicídio foram episódio depressivo maior (OR range = 2,3-9,2) e distimia (OR range = 5,1-32,6) mesmo na presença de transtornos por uso de álcool (OR range = 2,3-4,0) ou transtornos por uso de substâncias (OR range = 2,7-2,8). O efeito de interação foi observado entre episódio depressivo maior e transtornos por uso de álcool, bem como entre gênero e distimia. Transtornos por uso de álcool foi excluído da maioria dos modelos. CONCLUSÃO: A presença de episódio depressivo maior e distimia influencia os CCS, independentemente da presença de transtornos por uso de álcool ou substâncias. Contudo, transtornos por uso de álcool e gênero interagem com os transtornos depressivos, demonstrando um efeito diferencial em cognições e comportamentos relacionados ao suicídio.

Validez y confiabilidad de la versión chilena del Alcohol Use Disorders Identification Test (AUDIT) / Assessment of the alcohol use disorders identification test (AUDIT) to detect problem drinkers

Background: AUDIT is a self-reported questionnaire used to detect problem drinkers. It must be translated into Spanish and validated in order to be used in Chile. Aim: To assess the validity of a Chilean version of the AUDIT questionnaire. Material and methods: The English version of the questionnaire was translated into Spanish and adapted to the Chilean cultural environment. Using the Delphi method, an expert group examined the text and then decided on which would be the definitive version. This test was translated to English again and was approved by one of the original authors. It was then applied to 93 subjects aged 37 ± 12 years (60 percent males) consulting at a primary health care center These subjects also answered the Composite International Diagnostic Interview (CIDI), version 2.1 that was used as the gold standard for the diagnosis of hazardous drinking and alcohol dependence. Cronbach alpha and test-retest validity were analyzed. Sensitivity and specificity were determined using receiver operating (ROC) curves. Results: The internal consistency of AUDIT was 0.93, its test re-tests reliability was 0.97 (95 percent confidence intervals 0.96-0.98). Using a cutoff point of 6 for hazardous consumption, its sensitivity and specificity were 83 percent and 88 percent, respectively. The figures for dependence and harmful consumption, using a cutoff point of 9, were 87 percent and 85 percent, respectively. Conclusions: AUDIT is a valid questionnaire to detect problem drinkers.

Álcool e suas conseqüencias: uma abordagem multiconceitual / Alcohol and its consequences: an approach multiconceitual

A publicação, que apresenta diversas informações e resultados das mais recentes pesquisas sobre o consumo de álcool ao redor do mundo, foi organizada em nove capítulos, abordando temas como: dados epidemiológicos mundiais sobre o consumo nocivo de álcool; as principais consequências em longo prazo relacionadas ao consumo moderado de álcool; dependência do álcool; consumo nocivo de álcool entre estudantes; padrões de consumo do álcool e problemas decorrentes do beber pesado episódico no Brasil; álcool e HIV/AIDS; álcool e violência; álcool e trânsito; e consumo nocivo de álcool durante a gravidez.

Consumo de alcohol en la consulta de una sala de emergencia / Alcohol consumption in the emergency room

Se examinaron patrones de consumo de alcohol y alcoholemia en sala de emergencia del hospital público de referencia para traumatismos en la provincia de Jujuy aplicando el Instrumento de Evaluación para los Trastornos Debidos al Consumo de Alcohol, versión corta (AUDIT-C). Se entrevistaron pacientes durante las 24 horas de 4 días (N=500) y se obtuvieron muestras para prueba de alcoholemia en el 84%. El 37% presentaba consumo de riesgo (hombres 50% vs. mujeres 23%) y el 29% tenía síntomas de dependencia (hombres 48% vs. mujeres 11%). El 17% de los hombres y el 3% de las mujeres tenían un nivel de alcoholemia igual o mayor a 50 mg/dl. En modelos de regresión logística multivariados la razón de posibilidades para los hombres de ser consumidores de riesgo (OR ajustado 3.2; IC 95% 2.1-5.0), tener síntomas de dependencia (OR ajustado 7.5; IC 95% 4.4-12.7) o niveles elevados de alcoholemia (OR ajustado 8.0; IC 95% 2.2-28.8), fue mayor que para las mujeres. Para ingresos por accidentes, situaciones de violencia o uso de drogas, la razón de posibilidades de ser consumidores de riesgo (OR ajustado 2.4; IC 95% 1.5-3.9), presentar síntomas de dependencia (OR ajustado 2.0; IC 95% 1.2-3.3), o alcoholemia (OR ajustado 7.7; IC 95% 3.0-19.8) fue mayor comparados con ingresos por otras causas. El alcoholismo tiene un impacto significativo en la ocurrencia de lesiones e influye sobre la demanda de atención médica. La implementación de programas de prevención podría ser una herramienta efectiva para reducir el impacto negativo del alcoholismo.

We examined patterns of alcohol consumption and blood alcohol levels in emergency room patients. The study was conducted in a public hospital of the province of Jujuy, Argentina. A survey was conducted among all patients during the 24 hours of 4 consecutive days (N=500) using the Alcohol Use Disorders Identification Test, short version (AUDIT-C). Blood samples were collected in 84% of participants. Results showed that 37% were hazardous drinkers (men 50% vs. women 23%), 29% had symptoms of dependence (men 48% vs. women 11%); 17% of men and 3% of women had high blood alcohol levels, equal or greater than 50 mg/dl. In multivariate logistic regression models men had increased likelihood of hazardous drinking (Adjusted OR 3.2; 95% CI 2.1-5.0), symptoms of dependence (Adjusted OR 7.5; 95% CI 4.4-12.7) and increased blood alcohol levels (Adjusted OR 8.0; 95% CI 2.2-28.8), compared with women. Patients admitted due to accidents, violence, or drug use, had increased likelihood of hazardous drinking (Adjusted OR 2.4; 95% CI 1.5-3.9), dependence symptoms (Adjusted OR 2.0; 95% CI 1.2-3.3) and increased blood alcohol levels (Adjusted OR 7.7; 95% CI 3.0-19.8), compared with those admitted for other reasons. Alcoholism has a significant impact on the occurrence of injuries and on the demand imposed on health services. Prevention programs can potentially reduce the negative health and social impact of alcoholism.

Alcohol Consumption and the CAGE Questionnaire in Korean Adults: Results from the Second Korea National Health and Nutrition Examination Survey

We evaluated alcohol consumption and alcohol-related problems in Korean adults by evaluating alcohol consumption and responses to the CAGE questionnaire obtained from the second Korea National Health and Nutrition Examination Survey. The age-adjusted prevalence of males who consumed 0, 0.1-20, 20.1-40, or >40 g/day of alcohol were 28.0, 51.5, 12.5, and 8.0%, respectively; 26.9% of male drinkers were CAGE-positive (> or =2 affirmative responses to the CAGE). The age-adjusted prevalence of females who consumed 0, 0.1-10, 10.1-20, or >20 g/day of alcohol were 67.7, 26.6, 3.9, and 1.8%; 11.9% of female drinkers were CAGE-positive. The risk factors for high alcohol consumption were old age, low education level, smoking, and drinking onset at young ages in male drinkers, whereas low education level and smoking in female drinkers. The risk factors for a positive CAGE were young age, marriage, low education level, smoking, high amount of alcohol consumed on a single occasion, and high drinking frequency in male drinkers, whereas high household income, ex-smoking, high amount of alcohol consumed on a single occasion, and high drinking frequency in female drinkers. Our results suggest that high alcohol consumption and alcohol-related problems in Korean adults are not negligible and require intervention.

Fatores associados ao consumo de bebidas alcoólicas pelos adolescentes de uma Escola Pública da cidade de Maringá, Estadodo Paraná / Factors associated with the consumption of alcoholic beverages by adolescents from a Public School in Maringá, Paraná State

Atualmente, há tendência no aumento do consumo de bebidas alcoólicas,principalmente pelos adolescentes. Neste trabalho, os fatores associados ao consumo de bebidas alcoólicas pelos adolescentes de uma escola pública foram identificados. As informações foram coletadas pela aplicação de questionários. No grupo dos adolescentes que consomem bebidas alcoólicas, verificou-se que muitos pais ou responsáveis estão cientes desse consumo, e 32,30% dos adolescentes admitiram que iniciaram o hábito debeber com membros da família, enquanto os demais relataram que foi por influência de amigos. O vinho e a cerveja foram as bebidas alcoólicas mais consumidas pelos adolescentes.Estes resultados demonstram que a sociedade é permissiva quanto ao hábito dos adolescentes consumirem bebidas alcoólicas. Este consumo pode ter como objetivo contornar dificuldades de convívio social, mas também aumenta a chance do jovem ter comportamento de risco, levando ao envolvimento com acidentes automobilísticos. Por isso, o estabelecimento de programas educacionais destinados aos adolescentes e também aos pais ou responsáveis é necessário para que haja maior conscientização sobre os efeitosnocivos do consumo exagerado de bebidas alcoólicas.

Nowadays, there is a trend towards the increase in alcoholic beverage consumption, mainly by adolescents. Inthis study, factors associated with the consumption of alcoholic beverage by adolescents from a Public sSchool were identified. The data were collected by means for individual interviews conducted by questionnaire. In the group of adolescents who consume alcoholic beverages, it was verified that often guardians or parents are aware of this consumption, and 32.30% of adolescents admitted they began the habit of drinking with family members,while the remainder declared it was the influence of friends. Wine and beer were the most consumed alcoholic beverages by adolescents. These results demonstrate that society is permissive towards the habit of teenage drinking. This consumption might be an attempt toavoid the difficulties of social settings, but it must be emphasized that the consumption of these substances increases the possibility of young people displaying risk behaviors, leadingto involvement with car accidents. For this reason, the establishment of educational programs aimed at adolescents as well as their parents or guardians are necessary, in order toraise awareness of the harmful effects of the excess alcohol consumption.

O processo de alcoolização em populações indígenas do Alto Rio Negro e as limitações do CAGE como instrumento de screening para dependência ao álcool / The process of alcoholization among the indian population of the Upper Rio Negro river and CAGE's limitations as a screening instrument for alcohol dependence

CONTEXTO: Por meio de investigação qualitativa e interdisciplinar da validade teórica do CAGE como instrumento de screening para dependência ao álcool em populações indígenas do Alto Rio Negro, aborda-se a temática do uso de álcool em grupos culturalmente diferenciados, estudando a atribuição de significados do beber e as respostas dadas ao CAGE pelos indígenas entrevistados. MÉTODOS: As contribuições de Geertz (1989) e Menendez (1982) viabilizaram a distinção entre o conceito biomédico de dependência ao álcool e a noção de problemas relacionados ao uso do álcool, correlata ao plano da transgressão da norma social pelos bebedores. Ambas as noções foram subsumidas ao conceito de processo de alcoolização que remete às relações ambíguas e conflitivas travadas entre bebedores e não-bebedores em momentos históricos e situações sociais específicas. RESULTADOS: A análise das respostas ao CAGE mostrou incongruência entre seus objetivos e pressupostos e o entendimento indígena sobre o instrumento, invalidando um uso produtivo. CONCLUSÃO: Apesar da pretensão universalista do CAGE, a singularidade cultural indígena produziu novos e inesperados sentidos às perguntas-teste e gerou respostas infrutíferas para efetuar triagem de suspeitos de dependência ao álcool, na realidade estudada.

BACKGROUND: Through a qualitative and interdisciplinary investigation as to the theoretical validity of CAGE as a screening instrument for alcohol dependence among the Upper Rio Negro Indian population, the use of alcohol as a theme among culturally diverse groups is approached by studying the assignment of meanings to drinking and the answers given to CAGE by the interviewed Indians. METHODS: Geertz (1989) and Menendez's (1982) contributions have allowed the distinction between the biomedical concept of alcohol dependence and the social notion by the drinkers. Both notions were submitted to the alcoholization process concept which refers back to the ambiguous and conflicting relationships established between drinkers and non-drinkers in historical moments and specific social situations. RESULTS: The analysis of the answers to CAGE made evident the incongruence between its objectives and assumptions and the indigenous understanding of the instrument, invalidating a productive use. CONCLUSION: Despite CAGE's universalist intentions, the indigenous cultural singularity produced new and unexpected meanings to the test-questions and generated useless answers to carry out the screening of suspects of alcohol dependence, in the studied situation.

Emergencias en adicciones y abusos de psicofármacos / Substance-related disorders abuse and adictions emergency

El abuso y dependencia de sustancias psicoactivas es una causa frecuentemente oculta de consultas en servicios de urgencias. Si bien, ciertos consumos de drogas se han estabilizado en la última década, ha habido un aumento sostenido del consumo de todas las drogas, tabaco y alcohol. El abuso de psicofármacos se ha mantenido estable en los últimos años, pero irrumpe una nueva droga en el panorama nacional que es el éxtasis. En los servicios de urgencia hasta un 27 por ciento de los consultantes declaran haber usado alguna droga y/o alcohol. Además, un 7 por ciento de los consultantes mostró una muestra positiva para cocaína. Los pacientes no consultan por problemas adictivos sino por causas traumatológicas, intoxicaciones y otros. Se discute en el presente artículo la necesidad de evaluación práctica y clínica evaluando correspondientemente la existencia o no de problemas adictivos. Se analizan aspectos relacionados con el consumo, intoxicación y desintoxicación del paciente de acuerdo a cada paso. Se analiza además el manejo farmacológico y/o psicológico para cada una de las sustancias y situaciones clínicas y criterios para el manejo de estas emergencias.

Avaliação de instrumento de detecção de problemas relacionados ao uso do álcool (CAGE) entre trabalhadores da prefeitura do campus da Universidade de São Paulo (USP) - campus capital / Evaluation of a screening test for alcohol-related problems (CAGE) among employees of the Campus of the University of São Paulo

O uso do álcool pode ser responsável por acidentes, atrasos e faltas no trabalho. Sua detecção é limitada pelas dificuldades de pacientes e médicos quanto ao assunto. O questionário CAGE pode ser uma alternativa fácil, rápida e pouco intimidativa na detecção dos problemas relacionados ao uso de álcool (PRA). OBJETIVOS: Avaliar os indicadores de validade do CAGE - sensibilidade (S), especificidade (E), valor preditivo positivo, VPP e a área sob a curva ROC, ASC - entre funcionários da Prefeitura da Cidade Universitária, utilizando a Entrevista Clínica Estruturada para o DSM-IV, a SCID 2.0. MÉTODOS: Foram selecionados aleatoriamente 203 funcionários para entrevista com um questionário sociodemográfico seguido do CAGE e da SCID 2.0 Os indicadores de validade do CAGE foram analisados através dos resultados da SCID 2.0 para abuso e dependência do álcool e os dados sociodemográficos pelo cálculo do qui-quadrado. RESULTADOS: Entre os 192 funcionários entrevistados, a prevalência do CAGE positivo foi 19,8 por cento, com os seguintes indicadores de validade para a detecção de PRA: S=84,4 por cento, E=93,1 por cento, VPP=71,1 por cento e ASC=0,88 (p<0,01) e para dependência do álcool: S=91,3 por cento, E=89,9 por cento, VPP=55,3 por cento e ASC=0,90 (p<0,01). Houve associações significativas entre o CAGE positivo e as seguintes características: 1) faixa etária de 61 anos ou mais (p=0,04); 2) sexo masculino (p=0,01); e 3) função operacional (p=0,02). CONCLUSÕES: O CAGE teve menos falsos positivos na detecção de PRA (abuso e dependência) que na detecção de dependência do álcool isoladamente. Os resultados para faixa etária e sexo podem refletir limitações do CAGE. Funções operacionais podem indicar um risco para PRA. O CAGE foi considerado válido na detecção de PRA no local de trabalho.