Substance Abuse News

The U.S. Joint Commission recently approved new hospital accreditation measures related to alcohol screening, brief intervention, and referral to treatment (SBIRT) for all hospitalized patients. Yet little is known about the effectiveness of brief interventions (BIs) or inpatient acceptability of SBIRT when performed by healthcare professionals other than physicians. A new study has found high hospital-patient acceptability of and comfort with nurse-delivered SBIRT.

Results will be published in the April 2012 issue of Alcoholism: Clinical & Experimental Research.

Identifying Unhealthy Alcohol Use

“SBIRT is widely endorsed for identifying and managing unhealthy alcohol use that ranges from hazardous or ‘risky’ drinking to the more serious alcohol abuse and dependence,” explained Lauren M. Broyles, a research health scientist at the VA Pittsburgh Healthcare System, assistant professor of medicine at the University of Pittsburgh, and corresponding author for the study.

“A more recent focus has extended to identification of hazardous drinking – consumption that exceeds guidelines established by the National Institute on Alcohol Abuse and Alcoholism – as more than 14 standard drinks/week or more than four/occasion for men, and more than seven standard drinks/week or more than three/occasion for women and healthy individuals age 65 or older,” she said. “Despite [supporting] evidence, recommendations and mandates concerning SBIRT implementation, uptake by healthcare providers in real-world clinical settings is still relatively limited.”

“SBIRT is a brief conversation, about 10 to 15 minutes, about hazardous alcohol consumption,” added Deborah S. Finnell, a research nurse scientist at the VA Western New York Healthcare System and associate professor of nursing at the University at Buffalo. “Healthcare team members could easily deliver SBIRT, assuming they are qualified. Since nurses provide 24-hour care in hospitals, nurses are most likely to have contact with patients compared with other healthcare team members, such as physicians and social workers.”

High Rate of Acceptability

Broyles and her colleagues conducted a cross-sectional survey of 355 (342 males, 13 females) hospitalized medical-surgical patients at a large university-affiliated medical center that is part of the U.S. Department of Veterans Affairs.

Results indicated acceptability for nurse-delivered SBIRT was high. Patient acceptability for eight out of 10 individual nurse-delivered SBIRT tasks was greater than 84 percent. Roughly 20 percent of the patients reported some degree of personal discomfort with the discussions; in general these individuals had a lower belief in their ability to reduce their drinking risk, were older than 60 years of age, had a positive alcohol screening, and were of non-black race.

“We found, in general, that acceptability for nurse-delivered SBIRT tasks was associated with how people perceived their own alcohol-related risks,” explained Broyles. “Patients had higher acceptability if they felt that they were able to determine and reduce their own alcohol-related health risks, and if they had expressed concern about their own alcohol use. Conversely, roughly 20 percent of the patients expressed annoyance or embarrassment with the questions while also showing high levels of acceptability. While this might seem contradictory, patients might feel embarrassed or uncomfortable with the topic or discussion even though they see the discussions as a legitimate, necessary, and acceptable part of the nurse’s role.”

Alcohol and Health Risks

“This study also highlights the importance of being patient-centered,” said Finnell. “Patients are accepting of receiving information from nurses about changing their alcohol use and about self-help groups. Specifically, when patients can make the connection between their alcohol use and health risks, they may be more accepting of having the conversation with the nurse and continuing that conversation about decreasing the amount of alcohol they consume. Additionally, nurses providing patient-centered care will be sensitive to signs that the patient is uncomfortable during the conversation.”

Broyles agreed. “For hazardous drinkers, nurses and other healthcare providers can normalize alcohol screening and BI by drawing analogies, for themselves and their patients, to screening and structured health behavior advice for other health conditions,” she said. “Normalizing talk about unhealthy alcohol use and alcohol use disorders in general medical settings, by general medical providers, in general medical encounters in this way may help both providers and patients feel more comfortable.”

Finnell said she was not surprised that patients were comfortable with nurse-delivered SBIRT. “I have been amazed at what patients share with me during my interactions with them,” she said. “Americans consistently rank nurses ‘very high’ or ‘high’ on honesty and ethical standards. The concept of trust is an important element in the nurse-patient relationship.”

Appropriate Training Needed

Both Broyles and Finnell emphasized the need for appropriate training, practice, support, and pragmatic strategies for incorporating alcohol SBIRT into existing clinical practices and routines. “Our findings suggest that once trained in SBIRT and motivational interviewing techniques, providers can proceed with greater confidence in alcohol-related risk assessment and risk-reduction conversations with patients,” said Broyles.

“While this study focused on nurse-delivered SBIRT, the take-home points are highly relevant to other clinicians,” added Finnell. “Clinicians who have been asked about barriers to delivering SBIRT report concern about jeopardizing their relationship with the patient. This study shows that patients are accepting of alcohol-related discussions, particularly brief counseling about alcohol, educational materials about changing alcohol use, and information about alcohol self-help groups. The findings from this study should alert nurses, physicians, and other health care providers to be prepared to meet the needs of these patients.”

Excessive drinking and an unbalanced diet are two preventable contributors to health problems in the developed world. Different studies have found varying linkages between amounts of alcohol consumed and quality of diet. A new study of adults in Spain has found that heavy drinking, binge drinking, a preference for spirits, and drinking alcohol at mealtimes were associated with a poor adherence to major food consumption guidelines.

Results will be published in the November 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Drinking alcohol may reduce maintaining a healthy diet, leading to adverse metabolic effects which in turn add to those directly produced by alcohol,” said José Lorenzo Valencia-Martín, a doctor at the Universidad Autónoma de Madrid and corresponding author for the study. “The specific influence of alcohol on diet may depend upon the overall quantity of alcohol ingested, frequency of consumption, beverage preference, and whether alcohol intake takes place during the meals. Alcohol may indirectly contribute to several chronic diseases such as obesity, diabetes mellitus, cardiovascular disease, or cancer.”

Careless Dietary Habits

“Unhealthy lifestyles tend to cluster together, but this is not a ‘necessary’ association,” added Miguel A. Martínez-González, chair of the department of preventive medicine and Public Health at the University of Navarra. “On average, people who drink excessive alcohol are more likely to be careless in their dietary habits. A high alcohol intake is especially unhealthy with respect to liver disease. A high-energy food pattern rich in trans fats – such as ‘fast-foods’ or items from a commercial bakery – is also likely to be related to liver disease. In this sense, if both unhealthy lifestyles cluster together, they can act synergistically to produce very adverse effects.”

“In Spain, alcohol is frequently drunk during meals, particularly lunch and dinner,” said Valencia-Martín. “Because of this, and the lower prevalence of abstainers, our findings apply to most adults in Spain and in other Mediterranean countries in Europe. Our results are of relevance because they show that drinking at mealtimes is associated with insufficient intake of healthy foods, such as fruits and vegetables, and with excessive intake of animal protein.”

Unintended Consequences

From 2000 to 2005, the researchers carried out a telephone survey of 12,037 adults (5850 men, 6187 women) considered representative of 18-to-64-year-olds in the region of Madrid. Binge drinking was defined as equal to or more than 80 grams of alcohol for men and equal to or more than 60 grams for women during one drinking session; the threshold between moderate and heavy drinking was 40 grams of alcohol per day for men and 24 grams per day for women. Food consumption was measured using a 24-hour recall.

“Excessive drinkers, either with or without binge drinking, showed a poor adherence to dietary recommendations,” said Valencia-Martín. “Although drinking at mealtimes has traditionally been considered a safe or even a healthy behavior, our results point to some unintended consequences that the general populations should be aware of. In particular, drinking at mealtimes is associated with poor adherence to most of the food consumption guidelines. Also, not all types of alcoholic beverages are equal with regard to their dietary effects; our results suggest that a preference for spirits is associated with a poorer diet. Lastly, the above implications apply to both men and women.”

“I believe the key finding of this study is the suggestion of a harmful effect of binge drinking on healthy eating habits,” said Martínez González. “Binge drinking prevalence was found to be relatively high – greater than 10 percent – in a representative sample of Spanish population. This is very bad news. Alcohol misuse has become a priority public-health problem in Spain, especially because of rising rates of binge drinking and especially because of the abandonment of the traditional Mediterranean pattern of moderate alcohol drinking, in little amounts, generally red wine during meals. Recent changes, especially among young Spanish people, include a pattern of high amounts of spirits during weekends. This excellent study adds another unfortunate consequence of this change: the impairment of eating habits.”

Alcohol Replaces Healthy Calories

Martínez González added that both alcohol researchers and clinicians need to pay more attention to the dietary pattern of binge drinkers, and also consider that some of the detrimental effects attributed to alcohol might in fact be consequences of a poor diet.

“Don’t forget that alcohol is addictive, that it replaces healthy calories from other foods by empty calories, meaning these calories are devoid of minerals and vitamins,” said Martínez González. “Keep also in mind that the drinking pattern might be more important than the total amount consumed. The unhealthiest pattern is to consume high amounts – three to four drinks per day – of spirits or beer exclusively during the weekends. Conversely, the healthiest use of alcohol may be red wine, no more than one glass per day for women and two per day for men, and consumed during meals in a regular daily pattern.”

In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence, Inc. (NCADD) and the American Society of Addiction Medicine (ASAM) published this definition for alcoholism:

“Alcoholism is a primary chronic disease with genetic, psychosocial and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic.”

A new report shows that alcohol dependence is four times more likely to occur among adults with mental illness than among adults with no mental illness (9.6-percent versus 2.2-percent).

Based on a nationwide survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) the report also shows that the rate of alcohol dependency increases as the severity of the mental illness increases. For example, while 7.9-percent of those with mild mental illness were alcohol dependent, 10-percent of those with moderate mental illness and 13.2-percent of those with serious mental illness were alcohol dependent.

“Mental and substance use disorders often go hand in hand. This SAMHSA study adds to the evidence of this connection,” said SAMHSA Administrator Pamela S. Hyde, J.D. “Co-occurring mental illness and substance use disorders are to be expected not considered the exception. Unfortunately, signs and symptoms of these behavioral health conditions are often missed by individuals, their friends and family members and unnoticed by health professionals. The results can be devastating and costly to our society.”

Behavioral Health Issues

The SAMHSA Spotlight report, “Alcohol Dependence is More Likely among Adults with Mental Illness than Adults without Mental Illness” was developed as part of SAMHSA’s strategic initiative on data, outcomes, and quality – an effort to inform policy makers and service providers on the nature and scope of behavioral health issues. The report is based on data from the 2009 National Survey of Drug Use and Health – a state-of-the-art scientific survey of a large representative sample of people throughout the United States.

The full report is available on the web.

Researchers know that there is a strong link between parental alcohol use disorders and the risk for developing an alcohol use disorders among their offspring. This study looked at the risk of alcohol use disorders in the offspring of a large population-based sample of Danish parents. Findings confirmed that parental alcohol use disorders were associated with an increased risk of alcohol use disorders among the offspring.

“Few studies have used a broad population-based approach to examine associations between a parental history of alcohol use disorders and risk of an alcohol use disorders in offspring,” said Erik Lykke Mortensen, associate professor in medical psychology at the University of Copenhagen and corresponding author for the study. “Longitudinal population studies are both expensive and take a long time to complete. In some countries it may also be a problem to follow several generations through decades. But in Denmark we have personal identification numbers and national health registries.”

Population Based Study

Mortensen and his colleagues gathered data on 7,177 individuals (3,627 men, 3,550 women) born in Copenhagen between October 1959 and December 1961: information on alcohol use disorders was gathered from three Danish health registers, and information on other psychiatric disorders (OPDs) was gathered from the Danish Psychiatric Central Register. Offspring registration with an alcohol use disorders was analyzed in relation to parental registration with an alcohol use disorders and/or OPD. The gender of the offspring and parental social status were also noted.

Results showed that parental alcohol use disorders were associated with an increased risk of alcohol use disorders among the offspring, independent of other significant predictors such as gender, parental social status, and parental psychiatric hospitalization with other diagnoses.

“Furthermore, this association appeared to be stronger among female than male offspring, which suggests that inherited factors related to alcohol use disorders are at least as important among daughters as among sons,” said Mortensen. “This finding is important because some early studies suggested that a genetic load played a stronger role in males than in females.”

Increased Risk for Alcoholism

One of the important aspects of this study, added Mortensen, is that contrary to a number of previous adoption and twin studies – often based on relatively small and selected samples – these findings represent risk estimates from a population-based study.

“The key message for the general public is that there is an increased risk associated with parental alcoholism,” said Mortensen, “but obviously many other factors determine whether an individual develops an alcohol use disorder.”

Results will be published in Alcoholism: Clinical & Experimental Research.

Addiction researchers at Washington University School of Medicine in St. Louis have found that a risk for alcoholism also may put individuals at risk for obesity.

The researchers noted that the association between a family history of alcoholism and obesity risk has become more pronounced in recent years. Both men and women with such a family history were more likely to be obese in 2002 than members of that same high-risk group had been in 1992.

“In addiction research, we often look at what we call cross-heritability, which addresses the question of whether the predisposition to one condition also might contribute to other conditions,” says first author Richard A. Grucza, PhD. “For example, alcoholism and drug abuse are cross-heritable. This new study demonstrates a cross-heritability between alcoholism and obesity, but it also says — and this is very important — that some of the risks must be a function of the environment. The environment is what changed between the 1990s and the 2000s. It wasn’t people’s genes.”

Obesity Rates Have Doubled

Obesity in the United States has doubled in recent decades from 15 percent of the population in the late 1970s to 33 percent in 2004. Obese people – those with a body mass index (BMI) of 30 or more – have an elevated risk for high blood pressure, diabetes, heart disease, stroke and certain cancers.

Reporting in the Archives of General Psychiatry, Grucza and his team say individuals with a family history of alcoholism, particularly women, have an elevated obesity risk. In addition, that risk seems to be growing. He speculates that may result from changes in the food we eat and the availability of more foods that interact with the same brain areas as addictive drugs.

“Much of what we eat nowadays contains more calories than the food we ate in the 1970s and 1980s, but it also contains the sorts of calories — particularly a combination of sugar, salt and fat — that appeal to what are commonly called the reward centers in the brain,” says Grucza, an assistant professor of psychiatry. “Alcohol and drugs affect those same parts of the brain, and our thinking was that because the same brain structures are being stimulated, overconsumption of those foods might be greater in people with a predisposition to addiction.”

Grucza hypothesized that as Americans consumed more high-calorie, hyper-palatable foods, those with a genetic risk for addiction would face an elevated risk because of the effects of those foods on the reward centers in the brain. His team analyzed data from two large alcoholism surveys from the last two decades.

Family History of Alcoholism

The National Longitudinal Alcohol Epidemiologic Survey was conducted in 1991 and 1992. The National Epidemiologic Survey on Alcohol and Related Conditions was conducted in 2001 and 2002. Almost 80,000 people took part in the two surveys.

“We looked particularly at family history of alcoholism as a marker of risk,” Grucza explains. “And we found that in 2001 and 2002, women with that history were 49 percent more likely to be obese than those without a family history of alcoholism. We also noticed a relationship in men, but it was not as striking in men as in women.”

Grucza says a possible explanation for obesity in those with a family history of alcoholism is that some individuals may substitute one addiction for another. After seeing a close relative deal with alcohol problems, a person may shy away from drinking, but high-calorie, hyper-palatable foods also can stimulate the reward centers in their brains and give them effects similar to what they might experience from alcohol.

“Ironically, people with alcoholism tend not to be obese,” Grucza says. “They tend to be malnourished, or at least under-nourished because many replace their food intake with alcohol. One might think that the excess calories associated with alcohol consumption could, in theory, contribute to obesity, but that’s not what we saw in these individuals.”

Change in the Food Environment

Grucza says other variables, from smoking, to alcohol intake, to demographic factors like age and education levels don’t seem to explain the association between alcoholism risk and obesity.

“It really does appear to be a change in the environment,” he says. “I would speculate, although I can’t really prove this, that a change in the food environment brought this association about. There is a whole slew of literature out there suggesting these hyper-palatable foods appeal to people with addictive tendencies, and I would guess that’s what we’re seeing in our study.”

The results, he says, suggest there should be more cross-talk between alcohol and addiction researchers and those who study obesity. He says there may be some people for whom treating one of those disorders also might aid the other.

Addictions, whether it is to drugs or alcohol, are a very difficult hurdle for individuals to overcome. But, there are ways to help people with their recovery through 12-step programs like Alcoholics Anonymous (AA). Many of these organizations, including AA, highlight spirituality as a very important factor, but the data surrounding its effectiveness have often been contested.

However, new research shows that as attendance of AA meetings increase, so do the participants spiritual beliefs, especially in those individuals who had low spirituality at the beginning of the study.

Important Aspect of Recovery

John F. Kelly, lead author of the study, Associate Professor in Psychiatry at Harvard Medical School and the Associate Director of the Center for Addiction Medicine at Massachusetts General Hospital, said that while spirituality is an important aspect of AA recovery, it is not the only way they can help individuals.

“I’ve heard it said that AA is too spiritual, and I’ve also heard it said that AA is not spiritual enough for some people. Although this is not the only way that AA helps individuals recover, I think these findings support the notion that AA works in part by enhancing spiritual practices,” Kelly said.

The researchers assessed more than 1,500 adults throughout their recovery process, with data being gathered at three, six, nine, 12, and 15 months. The study utilized data on their attendance to AA meetings, their individual spirituality/religiosity practices and overall alcohol-use outcomes to determine if spirituality is indeed a mechanism of behavior change.

Decrease in Alcohol Use

The results indicated that there was a robust association between an increase in attendance to AA meetings with increased spirituality and a decrease in the frequency and intensity of alcohol use over time. One of the most interesting aspects of the research was that the same amount of recovery was seen in both agnostics and atheists, which indicates that while spirituality is an important mechanism of behavioral change for AA, it is not the only method used.

“Many people will be surprised that alcoholic patients with little or no interest in spirituality attended AA and seemed to change even more than did those who had a pre-existing, strong sense of spirituality,” said Keith Humphreys, a Career Research Scientist with the Veterans Health Administration and Professor of Psychiatry at Stanford University. “AA is thus much more broad in its appeal than is commonly recognized.”

The researchers also noted that while spirituality is an important aspect of recovery, it is still not known how these beliefs work in complement or competition with other recovery methods, as there are multiple.

Changing Social Networks

“We have also found that AA participation leads to recovery by helping members change their social network and by enhancing individuals’ recovery coping skills, motivation for continued abstinence, and by reducing depression and increasing psychological well-being,” said Kelly.

“Down the road it will be important to conduct more qualitative research as well as further quantitative replication of our findings in order to understand more about how exactly spiritual practices and beliefs influence coping and behavioral change in recovery from addiction”

Despite the existence of effective programs for treating alcohol dependencies and disorders, less than a quarter of people who are diagnosed actually seek treatment. In a recent study by Columbia University’s Mailman School of Public Health researchers report that people diagnosed with alcoholism at some point in their lifetime were more than 60% less likely to seek treatment if they believed they would be stigmatized once their status is known.

This is the first study to address the underuse of alcohol services specifically with regard to alcohol-related stigma. Findings are published in the November issue of the American Journal of Epidemiology.

Perceived Negative Stigma

Based on a survey of 34,653 individuals in the general population (6,309 of whom had an alcohol use disorder) drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), researchers found that individuals with an alcohol use disorder who perceived negative stigma were 0.37 times less likely to seek treatment for their disorder compared to individuals with similarly serious alcohol disorders who did not perceive stigma.

In the general population, younger individuals perceived less stigma, and also were less likely to seek treatment for an alcohol disorder. Men perceived more stigma compared to women (38.1%vs. 37.7%). Non-Hispanic blacks and Hispanic adults overall reported a higher mean stigma compared to Whites (39 % vs. 37%) and were less likely to utilize alcohol services. However, the data also suggest that individuals with more severe alcohol disorders had a greater likelihood to seek treatment. Overall, perceived stigma was significantly higher for those with lower personal income, lower education, and individuals previously married compared to those who had never married.

A Barrier to Treatment

“People with alcohol disorders who perceive high levels of alcohol stigma may avoid entering treatment because it confirms their membership in a stigmatized group,” said Katherine Keyes, PhD, in the Mailman School of Public Health Department Epidemiology. “Given that alcohol use disorders are one of the most prevalent psychiatric disorders in the United States, the empirical documentation of stigma as a barrier to treatment is an important public health finding. Greater attention to reducing the stigma of having an alcohol disorder is urgently needed so that more individuals access the effective systems of care available to treat these disabling conditions.”

A hallmark of college life is staying up late to study for an exam the following morning, and many students stay awake by consuming an energy drink. Also increasing in popularity is the practice of mixing alcohol with energy drinks. But these drinks are highly caffeinated and can lead to other problems, in addition to losing sleep. Unfortunately, the contents of energy drinks are not regulated.

New research indicates that individuals who have a high frequency of energy drink consumption (52 or more times within a year) were at a statistically significant higher risk for alcohol dependence and episodes of heavy drinking.

The results will be published in the February 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

Energy Drinks Without Alcohol

Amelia M. Arria, the lead author of the study, Director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health, and a Senior Scientist at the Treatment Research Institute, said that prior research has highlighted the dangers of combining energy drinks with alcohol.

“We were able to examine if energy drink use was still associated with alcohol dependence, after controlling for risk-taking characteristics. The relationship persisted and the use of energy drinks was found to be associated with an increase in the risk of alcohol dependence.”

The study utilized data from more than 1,000 students enrolled at a public university who were asked about their consumption of energy drinks and their alcohol drinking behaviors within the past 12 months.

More Likely to Become Dependent

The researchers found that individuals who consumed energy drinks at a high frequency were more likely to get drunk at an earlier age, drink more per drinking session, and were more likely to develop alcohol dependence compared to both non-users of energy drinks and the low-frequency users.

The results of this study confirm and extend earlier research about the risks of energy drink consumption. A major concern is that mixing energy drinks with alcohol can lead to “wide-awake drunkenness,” where caffeine masks the feeling of drunkenness but does not decrease actual alcohol-related impairment. As a result, the individual feels less drunk than they really are, which could lead them to consume even more alcohol or engage in risky activities like drunk driving.

Caffeine Disguises Impairment

“Caffeine does not antagonize or cancel out the impairment associated with drunkenness—it merely disguises the more obvious markers of that impairment,” says Kathleen Miller, a research scientist from the Research Institute on Addictions at the University at Buffalo. According to her, the next steps in this research include identifying links between energy drinks and other forms of substance abuse, as well assessing the overall prevalence of energy drink use by adolescents and young adults.

“Also needed is research that directly assesses students’ reported reasons for mixing alcohol and energy drinks. Anecdotal reports suggest that part of this phenomenon may be driven by the perpetuation of myths (e.g., mixing alcohol and caffeine reduces drunkenness, prevents hangovers, or fools a breathalyzer test) that could be debunked through further education.”

Arria agrees, adding that further research and regulations are needed to curb this disturbing trend.

“The fact that there is no regulation on the amount of caffeine in energy drinks or no requirements related to the labeling of contents or possible health risks is concerning.”

Problem drinkers in the general population may reduce the amount of alcohol they consume over a period of years but not to the level of the average adult, according to a new study in the Journal of Studies on Alcohol and Drugs.

Given that heavy drinkers often don’t become “normal” drinkers on their own, the takeaway message for clinicians and family members is to help connect a problem drinker to a community social service agency or Alcoholics Anonymous. Simply telling someone that they had a drinking problem did not seem to be helpful in this study, but being specific about how to get help did.

Reduced, But Not Safe Consumption

Using a telephone screening program, researchers identified 672 problem and dependent drinkers who had not been in an alcohol treatment program for at least 12 months. Eleven years later, men in the study had reduced their average number of drinks per month by 51%, and women had reduced their average number of drinks by 57%. However, even after this reduction, male and female problem drinkers still consumed 160% and 223% more alcohol, respectively, than the average adult without a drinking problem.

The researchers point out that the greatest reductions in alcohol consumption occurred within one to two years after the initial screening and then slowed, suggesting that problem drinkers and heavy drinkers may never lower their consumption to the level of the general population.

Sustained Drinking Level

“Most heavy drinkers maintain a steady level of heavy alcohol consumption over time,” said lead researcher Kevin L. Delucchi, Ph.D., Professor of Biostatistics in Psychiatry at the University of California San Francisco. “It’s pretty toxic, but somehow they manage to keep drinking at a fairly sustained level. Our people were functional, for the most part. They had addresses, a lot of them had insurance at baseline, and they’re not at the ‘bottom of the barrel,’ which is interesting.”

The researchers say their study is one of the first to examine heavy alcohol use in the general population. Most studies have focused on the most severe drinkers — those who were already in a treatment program, said Delucchi.

Not Getting Treatment

“Not everyone who has an alcohol problem is in treatment or is in a program,” said Delucchi. “People are out there on their own.”

The researchers also examined which factors appeared to be linked with continued heavy drinking. Participants who received help from Alcoholics Anonymous or community social service agencies were likely to drink less. However, those who had heavy-drinking friends in their social network, received general suggestions that they do something about their drinking, and went to a formal treatment program were actually likely to drink more. Delucchi said they were unable to determine why formal treatment appeared to be linked with continued elevated drinking, although the researchers theorize that perhaps those who sought this type of treatment were likely to have experienced the greatest level of alcohol-related problems and, therefore, were more likely to have sought such treatment.