Comparison between the WHO and NIAAA criteria for binge drinking on drinking features and alcohol-related aftermaths: Results from a cross-sectional study among eight emergency wards in France.

BACKGROUND: Binge drinking (BD) consists of heavy episodic alcohol use. Whereas the World Health Organization (WHO) defines BD as 60g of alcohol or more per occasion, the National Institute on Alcoholism and Alcohol Abuse (NIAAA) conceives BD as drinking 70g (men) or 56g (women) in less than two hours. We compared the subjects delineated by each definition. METHODS: Eight-center cross-sectional study among 11,695 subjects hospitalized in emergency wards. Participants completed the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C), CAGE and Rapid Alcohol Problem Screen 4 (RAPS4-QF) questionnaires. The WHO criteria were investigated using the RAPS4-QF. Independent questions assessed the NIAAA criteria. The main medical admission motive was noted. The characteristics of subjects meeting respectively: 1) the exclusive WHO criteria (BD1); 2) the NIAAA criteria (BD2); and 3) no BD criteria (noBD) were compared using multinomial regression analyses. Binary age- and gender-adjusted regression analyses directly compared BD1 and BD2. Subjects with at least four drinking occasions per week were excluded from the analyses, to withdrawn regular heavy drinking. RESULTS: Compared to BD1, BD2 subjects were more frequently males (OR=1.67 [1.39-2.0]), single (aOR=1.64 [1.36-1.98]) and unemployed (aOR=1.57 [1.27-1.90]). BD2 reported significantly more drinks per occasion, and higher heavy drinking frequencies. Previous alcohol-related remarks from family (aOR=3.00 [2.53-3.56]), ever drinking on waking-up (aOR=2.05 [1.37-2.72]), and admission for psychiatric motive (aOR=2.27 [1.68-3.07]) were more frequent among BD2 subjects. CONCLUSIONS: Compared to WHO criteria, NIAAA criteria for BD delineate subjects with more concerning drinking patterns and alcohol aftermaths.

Sex differences in college student adherence to NIAAA drinking guidelines.

BACKGROUND: Exceeding nationally recommended drinking limits puts individuals at increased risk of experiencing harmful effects due to alcohol consumption. Both weekly and daily limits exist to prevent harm due to toxicity and intoxication, respectively. It remains unclear how well college students adhere to recommended limits, and whether their drinking is sensitive to the wider sex difference in weekly versus daily drinking limits. METHODS: This study used a daily-level, academic-year-long, multisite sample to describe adherence to NIAAA daily (no more than 4 drinks per day for men, 3 drinks per day for women) and weekly (no more than 14 drinks per week for men, 7 drinks per week for women) drinking guidelines, and to test for sex differences and time effects. College students (n = 992; 58% female) reported daily drinking on a biweekly basis using web-based surveys throughout their first year of college. RESULTS: Women exceeded weekly limits more frequently (15% of weeks [14 to 17%]) than men (12% [10 to 14%]). Women and men exceeded daily drinking limits similarly often (25 and 27%, respectively). In a generalized estimating equations analysis across all 18 biweekly assessments, adjusted for covariates and a linear trend over time, women were more likely to exceed weekly guidelines compared to men. Sex differences in exceeding daily limits were not significant. Over time, rates of exceeding limits declined for daily limits but only for men for weekly limits. CONCLUSIONS: Female college students are more likely to exceed weekly alcohol intake limits than men. Furthermore, trends over time suggest that college students may be maturing out of heavy episodic drinking, but women may not mature out of harmful levels of weekly drinking. The observed disparity in risk for long-term health consequences may represent a missed opportunity for education and intervention.

Use of the screening suggested by the National Institute on Alcohol Abuse and Alcoholism and of a newly derived tool for the detection of unhealthy alcohol drinkers among surgical patients.

OBJECTIVE: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed a two-question tool for the detection of unhealthy drinking (NIAAA-2Q) that investigates excessive alcohol consumption per single occasion. NIAAA-2Q can be commuted into a four-question tool (NIAAA-4Q) by the addition of two questions aimed at investigating excessive weekly alcohol intake. NIAAA-2Q and NIAAA-4Q may prove useful in busy settings such as an anesthesiological environment. However, to date, no study has evaluated their efficacy in a surgical setting. The purpose of this study was to evaluate the accuracy of NIAAA-2Q and NIAAA-4Q in detecting unhealthy drinking among surgical patients using the more complex Alcohol Use Disorders Identification Test (AUDIT) comprising 10 questions as the criterion method. METHOD: NIAAA-4Q and AUDIT were administered to 200 surgical patients by three anesthetists. RESULTS: A total of 23.5%, 12.5%, and 28.5% surgical patients were unhealthy drinkers according to AUDIT, NIAAA-2Q, and NIAAA-4Q, respectively. NIAAA-2Q negative and positive predictive values were 0.78 and 0.36, respectively, and positive and negative likelihood ratios were 1.80 and 0.90, respectively. NIAAA-4Q negative and positive predictive values were 0.93 and 0.65, respectively, and positive and negative likelihood ratios were 6.00 and 0.24, respectively. CONCLUSIONS: NIAAA-4Q demonstrated a better satisfactory agreement than NIAAA-2Q with AUDIT in detecting unhealthy alcohol drinking among surgical patients. These results suggest that the detection of unhealthy alcohol drinking may be increased by the administration of questions aimed at assessing the weekly average of alcohol intake. The modest time required for NIAAA-4Q administration is a major advantage in clinical practice with respect to AUDIT. Further research will compare NIAAA-2Q and NIAAA-4Q with other brief alcohol screening tests.

Sources of biased inference in alcohol and drug services research: an instrumental variable approach.

OBJECTIVE: This study examined the potential for biased inference due to endogeneity when using standard approaches for modeling the utilization of alcohol and drug treatment. METHOD: Results from standard regression analysis were compared with those that controlled for endogeneity using instrumental variables estimation. Comparable models predicted the likelihood of receiving alcohol treatment based on the widely used Aday and Andersen medical care-seeking model. Data were from the National Epidemiologic Survey on Alcohol and Related Conditions and included a representative sample of adults in households and group quarters throughout the contiguous United States. RESULTS: Findings suggested that standard approaches for modeling treatment utilization are prone to bias because of uncontrolled reverse causation and omitted variables. Compared with instrumental variables estimation, standard regression analyses produced downwardly biased estimates of the impact of alcohol problem severity on the likelihood of receiving care. CONCLUSIONS: Standard approaches for modeling service utilization are prone to underestimating the true effects of problem severity on service use. Biased inference could lead to inaccurate policy recommendations, for example, by suggesting that people with milder forms of substance use disorder are more likely to receive care than is actually the case.