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Before the COVID-19 pandemic, substance use health services to treat alcohol use disorder and problematic alcohol use (AUD/PAU) were fragmented and difficult for clients to access. The pandemic further elucidated system weaknesses, often leading to disruptions of treatment as alcohol use increased during the pandemic. When services for treatment were available, use was often low for several rationale. Virtual care was used to counteract the drop-off of in-person services, however accessibility to virtual care was not universal. Identification of the characteristics of treatment services for AUD/PAU that impact accessibility, as perceived by the individuals accessing or providing the services, will provide insights to enable improved access. We will conduct a scoping review of the literature to identify traits of services for treatment of clients with AUD/PAU that have been identified as barriers to or facilitators of service access from the perspectives of this population.

Background Depressive disorders and problematic drinking often co-occur, also among young adults. These co-occurring conditions are associated with various negative health outcomes compared to both conditions alone. Early intervention by addressing alcohol use and depressive symptoms simultaneously in the same treatment might improve both conditions. However, evidence on the (cost-) effectiveness of digital combined depression and alcohol interventions for young adults is currently insufficient. We therefore developed an add-on digital alcohol moderation adherence-focussed guided intervention to complement treatment as usual (TAU) for depressive disorders. The digital intervention is a web-app, including 6 modules based on motivational interviewing and cognitive behavioural therapy. This study aims to evaluate the (cost-)effectiveness of a digital alcohol moderation intervention + TAU compared to TAU on alcohol and depression outcomes among young adults with co-occurring depressive disorders and problematic alcohol use. Methods One hundred fifty-six participants, aged 18–35 years, with problematic alcohol use and a diagnosed depressive disorder will participate in a pragmatic multicentre two-arm randomized controlled trial. Problematic alcohol use is operationalised as scoring ≥5 for women and ≥ 8 for men on the Alcohol Use Disorder Identification Test (AUDIT). Participants will be randomized to either the experimental group (digital alcohol intervention + TAU) or control group (TAU only). Participants will be recruited at three Dutch mental health care centres and through social media. Assessments take place at baseline and after 3, 6 and 12 months post-randomization. The primary outcome is treatment response at 6-month follow-up, operationalized as a composite score that combines alcohol use and depression measures and indicates whether treatment has been successful or not. Secondary outcomes are depressive symptoms and alcohol use (i.e. number of weekly standard drinks and AUDIT score). An economic evaluation will be conducted alongside the trial. Discussion This study evaluates the (cost-) effectiveness of an add-on digital alcohol moderation intervention for young adults who are in treatment for depressive disorders. If proven effective, the digital intervention could be implemented in mental health care and improve treatment for people with co-occurring depressive disorders and problematic alcohol use. Trial registration Pre-registered on October 29, 2019 in The Netherlands Trial Register (NL8122).

This study investigated the individual and contextual correlates of problematic alcohol use among young adults during COVID-19 lockdown in Italy. Participants were 1533 young adults aged 18 to 26 (Mage =23.12, SDage =2.11; 73.2% women), who completed an online survey during national lockdown. Inclusion criteria for this study were the age-range (18–26 y. o.), and living in Italy during COVID-19 lockdown. Participants with low or very low socioeconomic levels (vs. higher levels) were more at risk for problematic alcohol use, as well as participants who lived alone or with roommates/friends during lockdown. Conversely, participants who spent the lockdown with their family or partner were less at risk for problematic alcohol use. Finally, participants who had their job suspended due to pandemic (vs. other job conditions) were more at risk for problematic alcohol use during lockdown. Implications for research and clinical practice are discussed.

Background: Several scholars hypothesize that one of the most negative impacts of the coronavirus disease 2019 (COVID-19) crisis would concern the increase of prevalence and severity of both substances and behavioral addiction. Despite the general concerns about the increase of prevalence and severity of addictions related to the COVID-19 emergency, few data are still available. Thus, the main aim of this study was to investigate the association between COVID-19 related distress and: (i) alcohol problems, (ii) social media addiction (SMA) symptoms, (iii) food addiction (FA) symptoms.Methods: A national online-survey was carried out during the Italian lockdown (i.e., 9 March 2020–4 May 2020). In the current study, 1,519 participants (365 men and 1,154 women, mean age: 28.49 ± 10.89 years) were included. The survey included socio-demographic related items (e.g., age, sex, residential regions, education level, civil status, tobacco use, etc.), as well as ad-hoc developed questions aimed to investigate COVID-19 related variables (e.g., isolation/quarantine, personal diagnosis to COVID-19, friends or relatives with COVID-19 diagnosis, etc.). Participants also completed the following self-report measures in order to investigate: the psychological impact of COVID-19, alcohol problems, SMA symptoms, FA symptoms, and impulsivity.Results: The psychological impact of COVID-19 was independently associated with alcohol problems (β = 0.058, p = 0.043), SMA symptoms (β = 0.259, p < 0.001), and FA symptoms (β = 0.150, p < 0.001).Conclusion: Taken together, our results seem to confirm the general concerns about the negative impacts of the COVID-19 emergency on addictive behaviors, suggesting that this issue should be carefully monitored.

Background: Alcohol is one of the most widely used drugs among adolescents and young people, and problematic alcohol use (PAU) is related to significant long-term biological, clinical, and psychosocial sequelae. Although preliminary reports have linked deficits in mentalization to increased vulnerability to addiction, no studies have specifically explored this phenomenon in relation to PAU. Methods: The association between mentalization impairment and PAU severity was investigated in a sample of 271 young adults (183 females, 65.9%, mean age: 23.20 &plusmn, 3.55 years, range: 18&ndash, 34). Self-report measures investigating PAU and mentalization were administered to all participants. Results: Individuals with PAU reported a more frequent use of tobacco and illicit drugs in the last 12 months. PAU severity was negatively associated with mentalization capacity (rho = &minus, 0.21, p &lt, 0.001), and also, when possible, confounding variables (i.e., gender, age, occupation, education, tobacco and illegal drugs use) were controlled for (rho = &minus, 0.17, p = 0.004). Conclusion: The present data showed that mentalization impairment is significantly associated with PAU among young adults, suggesting that it may have a role in the development and/or maintenance of alcohol use.

Background Recent studies revealed the role of the PAC1 (ADCYAP1R1) gene variability in vulnerability to posttraumatic stress disorder in women. Due to the relatively high comorbidity of posttraumatic stress disorder and substance use disorder, we hypothesized about possible associations between PAC1 gene and problematic alcohol use. Method The sample studied consisted of 491 women aged 18–28 years (mean age =21.76 years; SD =1.83) and the Alcohol Use Disorders Identification Test was used to assess drinking problems. We successfully genotyped 17 single-nucleotide polymorphisms in the PAC1 gene. Results Single locus analysis revealed a significant (after correction for multiple testing) association between intronic polymorphism rs2302475 and problematic alcohol use (P=0.00048; recessive model). This result was strengthened by the haplotype analysis (P=0.00379). Conclusion Our results suggest that the PACAP/PAC1 signaling system is implicated in the development of problematic alcohol use in women.

Wojciech Łukasz Dragan,1 Piotr M Czerski,2 Małgorzata Dragan3 1The Interdisciplinary Center for Behavior Genetic Research, Faculty of Psychology, University of Warsaw, Warsaw, 2Laboratory of Psychiatric Genetics, Poznan University of Medical Sciences, Poznan, 3Faculty of Psychology, University of Warsaw, Warsaw, Poland Background: Recent studies revealed the role of the PAC1 (ADCYAP1R1) gene variability in vulnerability to posttraumatic stress disorder in women. Due to the relatively high comorbidity of posttraumatic stress disorder and substance use disorder, we hypothesized about possible associations between PAC1 gene and problematic alcohol use. Method: The sample studied consisted of 491 women aged 18–28 years (mean age =21.76 years; SD=1.83) and the Alcohol Use Disorders Identification Test was used to assess drinking problems. We successfully genotyped 17 single-nucleotide polymorphisms in the PAC1 gene. Results: Single locus analysis revealed a significant (after correction for multiple testing) association between intronic polymorphism rs2302475 and problematic alcohol use (P=0.00048; recessive model). This result was strengthened by the haplotype analysis (P=0.00379). Conclusion: Our results suggest that the PACAP/PAC1 signaling system is implicated in the development of problematic alcohol use in women. Keywords: problematic alcohol use, PAC1 gene, AUDIT, HPA axis

Submitted by Boris Flegr (boris@uerj.br) on 2020-07-05T16:01:27Z No. of bitstreams: 1 Dissertacao Vitor Lobato.pdf: 1542658 bytes, checksum: edcc39fd23d1600f2ebbe83e1ac76c8e (MD5) Made available in DSpace on 2020-07-05T16:01:27Z (GMT). No. of bitstreams: 1 Dissertacao Vitor Lobato.pdf: 1542658 bytes, checksum: edcc39fd23d1600f2ebbe83e1ac76c8e (MD5) Previous issue date: 2019-04-29 In this work, I analyze the practices and speeches of health professionals from a unit of the Family Health Strategy of the municipality of Rio de Janeiro - RJ in relation to alcohol use. I carried out an ethnographic research in this health unit over a period of five months, from August to December 2018, which included participant observation in the unit, in the meeting rooms, in the consultations and in the assigned territory, as well as semi-structured interviews with nine health professionals of this unit. The use of alcohol is a very widespread and accepted social act in many contexts. By its social variability, we can refer in the plural to uses of alcohol. Certain patterns of these uses are considered as a health problem, characterizing the diagnosis of problematic alcohol use. This was chosen as a category to understand the moralities that cross the practices of the professionals of the unit where I carried out this research. The problematic alcohol use contemplates an amplification of the medical classification related to the use of alcohol considered deviant, which was previously defined, more restrictively, as alcoholism. Several publications in the health area indicate that, considering epidemiological estimates, the problematic alcohol use is poorly diagnosed and, consequently, a significant proportion of people that could be classified according to this diagnosis is not receiving the treatment that would be indicated. In this research, I tried to problematize the production of hegemonic knowledge in the field of health and to describe, from another perspective, practices that were familiar to me. The data produced refer to the specificity of the reality of the place where the research was carried out and were contextualized in relation to the Brazilian National Health System (SUS) and Family Health Strategy (FHS) policies, World Health Organization (WHO) publications and in the field of Global Mental Health (GMH). These data were analyzed on two thematic axes and their subdivisions. The first one refers to the interface of control and care at the following levels: individual, family and community. The second thematic axis contemplates an understanding of these moralities from the concepts of deviance (BECKER, 2008), accusation (VELHO, 2003), stigma (GOFFMAN, 2002) and medicalization (CONRAD, 2007). Neste trabalho, analiso as práticas e os discursos de profissionais de saúde de uma unidade da Estratégia Saúde da Família (ESF) do município do Rio de Janeiro - RJ em relação ao uso de álcool. Realizei uma pesquisa etnográfica nessa unidade de saúde ao longo de cinco meses, de agosto a dezembro de 2018, que incluiu observação-participante na unidade, nas salas de reuniões, nas consultas e no território adscrito, além de entrevistas semiestruturadas com nove profissionais de saúde dessa unidade. O uso de álcool é um ato social muito difundido e aceito em diversos contextos. Pela sua variabilidade social, podemos nos referir no plural a usos de álcool. Determinados padrões desses usos são considerados como problema de saúde, caracterizando o diagnóstico de uso problemático de álcool. Este foi escolhido como recorte para compreender as moralidades que atravessam as práticas dos profissionais da unidade onde realizei esta pesquisa. O uso problemático de álcool contempla uma ampliação da classificação médica relacionada ao uso de álcool considerado desviante, que foi definido anteriormente, de forma mais restrita, como alcoolismo. Diversas publicações na área da saúde assinalam que, considerando as estimativas epidemiológicas, o uso problemático de álcool é pouco diagnosticado e, consequentemente, uma proporção significativa de pessoas que poderiam ser classificadas de acordo com esse diagnóstico não estão recebendo o tratamento que seria indicado. Nesta pesquisa, busquei problematizar a produção de conhecimento hegemônica no campo da saúde e estranhar práticas que eram familiares para mim. Os dados produzidos referem-se às especificidades da realidade do local onde realizei a pesquisa e foram contextualizados em relação às políticas de saúde do SUS e da Estratégia Saúde da Família, as publicações da Organização Mundial de Saúde (OMS) e no campo da Saúde Mental Global (SMG). Esses dados foram analisados a partir de dois eixos temáticos e suas subdivisões. O primeiro dele refere-se à interface do controle e do cuidado nos seguintes níveis: individual, familiar e comunitário. O segundo eixo temático contempla uma compreensão dessas moralidades a partir dos conceitos de desvio (BECKER, 2008), acusação (VELHO, 2003), estigma (GOFFMAN, 2002) e medicalização (CONRAD, 2007).

Background Bhutan is a small landlocked country located between India and China that is largely rural and Buddhist. As the nation develops and adopts more Western practices, the nature of the relationship between its young people and alcohol is developing as well. Objectives The present study examines how problematic alcohol use relates to parenting styles and distress in a sample of predominantly tertiary students. Methods For this study, 245 young adults completed self-report measures of parenting style, distress, and alcohol-related problems. Results Strong correlations were found indicating that more dysfunctional parenting styles were associated with greater distress and problematic alcohol use. Further analyses to evaluate the relationship between parenting styles and alcohol use found no role for moderation but a significant mediation which indicated that more dysfunctional parenting styles were associated with greater distress which in turn was associated with greater problematic alcohol use. Conclusions These findings replicate those found in Western countries and imply that the same vulnerabilities to problematic alcohol use are also present in Bhutan.

Many service members and veterans seeking treatment for alcohol problems also have post-traumatic stress disorder (PTSD). This article considers the effectiveness of treating alcohol problems and PTSD simultaneously. The authors begin by summarizing the extent of excessive alcohol use among military service members and veterans. They then explore the relationship between combat exposure and subsequent alcohol use; identify and briefly describe evidence-based treatments for alcohol problems and PTSD, separately; and review research on the effects of single treatments for both PTSD symptoms and alcohol use.

International audience; Background: A minority of individuals with problematic alcohol use effectively seek help. Moreover, dropouts from care are not uncommon. It remains a major concern for health professionals, as adherence to treatment is significantly associated with better physical and psychological outcomes. Objectives: The main aim of this research was to assess what factors could distinguish patients with problematic alcohol use who dropped out from those who did not. Methods: The sample included 150 patients followed-up in an outpatient treatment center in France for a problematic alcohol use. Two measurement times were planned: at the first appointment and after six month of treatment. A large set of individual, environmental and institutional variables were considered to compare both subgroups.Results: Patients who dropped out mostly differ from patients who did not with a higher level of alcohol-related problems, ambivalence, inclinations to use the substance, number of missed appointments. Significant results were also observed regarding a lower time gap between the first contact with the center and the first appointment, as well as the season of the last appointment. Conclusions: Tailored motivational interventions could be offered to ambivalent patients, especially during the beginning of the treatment and some significant periods of the year. A particular focus should be brought on patients presenting such profiles in terms of level of alcohol problems, inclinations to drink and motivation to change. Overall, the study provides elements to better understand what may bring one patient to drop out of the treatment, and to improve the continuity of care.

Research on the use of mobile technologies for alcohol use problems is a developing field. Rapid technological advances in mobile health (or mHealth) research generate both opportunities and challenges, including how to create scalable systems capable of collecting unprecedented amounts of data and conducting interventions-some in real time-while at the same time protecting the privacy and safety of research participants. Although the research literature in this area is sparse, lessons can be borrowed from other communities, such as cybersecurity or Internet security, which offer many techniques to reduce the potential risk of data breaches or tampering in mHealth. More research into measures to minimize risk to privacy and security effectively in mHealth is needed. Even so, progress in mHealth research should not stop while the field waits for perfect solutions.

gam alkoholio vartojimui nustatyti. Tyrimuose žalingas alkoholio vartojimas nustatomas apsibrėžiant saikingo alkoholio vartojimo ribą ir įvardijamas kaip probleminis alkoholio vartojimas ar tiesiog piktnaudžiavimas alkoholiu. Apibendrinant AUDIT testo rezultatus, šiame tyrime analizuojamas probleminio alkoholio vartojimo paplitimo Lietuvoje reiškinys 2007 m. Metodai. Reprezentatyvus 15–74 m. amžiaus Lietuvos gyventojų tyrimas buvo atliktas 2007 m. spalio- gruodžio mėnesiais. Anketą iš viso užpildė 3302 asmenys. Žalingo alkoholio vartojimo paplitimui įvertinti buvo panaudotas AUDIT klausimynas. Respondentų buvo papildomai paprašyta nurodyti demografinius duomenis bei išlaidas alkoholiniams gėrimams. Rezultatai. Penktadalis 15–74 m. amžiaus Lietuvos gyventojų alkoholį vartoja žalingai. Didžiausias žalingo alkoholio vartojimo paplitimas nustatytas 35–44 m. amžiaus vyrų ir 25–34 m. amžiaus moterų grupėse. Vyrams pavojingas alkoholio vartojimas nustatytas beveik 3 kartus dažniau nei moterims. Taip pat didesnis probleminio alkoholio vartojimo paplitimas nustatytas žemesnį išsilavinimą turinčių, kaimiškose vietovėse gyvenančių, bedarbių bei vienišų asmenų grupėse, o probleminiu alkoholinių gėrimų vartojimu pasižymintys asmenys per mėnesį išleisdavo vidutiniškai 4 kartus didesnę sumą alkoholinių gėrimų įsigijimui. Šis tyrimas parodė, kad alkoholio vartojimo problemos yra aktualios pakankamai didelei daliai Lietuvos gyventojų, o ypatingą susirūpinimą turėtų kelti tai, kad jau pačiose jauniausiose tiriamųjų amžiaus grupėse nustatytas didelis alkoholio vartojimo rizikos lygis. AUDIT test is a traditional methodology to diagnose harmful use of alcohol. The study summarizes the AUDIT test results from the public survey data which was performed in 2007. Methods. The representative sample of Lithuanian adult (15-74 years old) population has been surveyed in October-December 2007. In total 3302 respondents filled in the questionnaire. The level of harmful use of alcohol was estimated with the AUDIT test. The respondents were also asked to provide additional demographic information as well as information about their expenditure on alcoholic beverages. Results. The harmful use of alcohol was observed in 1/5 of 15-74 years old Lithuanians. The highest prevalence of harmful use of alcohol was among 35-44 years old males, and 25-34 years old females. It was around three times more common among males then among females. The lower education, unemployment, living in rural areas, and living alone were the factors more closely associated with the higher prevalence of problematic alcohol use. Problematic alcohol users spend in average 4 times more money to purchase alcoholic beverages. According to the study results alcohol related problems are associated with significant proportion of Lithuanian population. Special concern must be attributed to a fact that the problematic use of alcohol is high among the people in youngest age groups.

Black Americans are at greater risk of initiating substance use during emerging adulthood in relation to other developmental periods. Previous research has identified perceived experiences of discrimination as a key contributing factor to substance use among Black emerging adults. Experiences of discrimination are particularly prevalent for Black Americans in majority White settings and previous research suggests that Black emerging adults may engage in problematic alcohol use to cope with discriminatory experiences which may, in turn, yield negative consequences for academic performance. Research has demonstrated that the presence of a natural mentor (a non-parental adult from a youth's pre-existing social network who provides support and guidance) is associated with positive psychosocial and academic outcomes among emerging adults. The proposed study employed a mixed methods design. Study participants were Black college students (n=118) completing their first year of study at a predominantly White Institution (PWI) in the mid-Atlantic region of the United States. Path analysis was used to determine if natural mentors may offset the potential negative effects of perceived discrimination on academic success via increased problematic drinking. Subsequently, semi-structured interviews were administered to a subset of students (n=12) and their natural mentors (n = 10) in an attempt to better understand potential causal associations between perceived discrimination, problematic drinking, and academic performance as well as to better explicate the mechanisms through in which natural mentors may help offset these associations. Contrary to study hypotheses, quantitative findings revealed that students who reported greater experiences of perceived discrimination had higher GPAs. Qualitative findings indicated that students perceived a range of discriminatory experiences and found many ways to cope including processing the event, talking about it with friends, and working harder academically. Students reported using perceived experiences as a motivator to excel academically. Natural mentors were also an important resource for students when they experienced discrimination. They imparted racial socialization messages unique to the academic context, as well as messages found in the racial socialization literature. The qualitative findings may help to explicate the lack of expected associations in the quantitative sample. The findings of the current study underscore the importance of access to supportive adults who can create a safe space for Black students at PWIs.

Although research has independently linked stress experienced by military personnel to both alcohol use and posttraumatic stress disorder, more recently researchers have noted that there also is a significant overlap between stress reactions and alcohol use in veterans and active-duty service members. This overlap seems to be most understood in individuals who have experienced combat or military sexual trauma. This article will provide a brief review of some potential causal mechanisms underlying this relationship, including self-medication and genetic vulnerability models. It also addresses the possible implications for assessment and treatment of military personnel with co-occurring disorders.

Impaired driving remains a significant public health problem in the United States. Although impressive reductions in alcohol-related fatalities occurred between 1982 and 1997, during which all 50 States enacted the basic impaired-driving laws, progress has stagnated over the last decade. Substantial changes in the laws and policies or funding for the enforcement of the criminal offense of driving while intoxicated (DWI) are needed for further substantial progress in reducing alcohol-related crash injuries. However, research indicates that evidence-based laws in the 50 States and current best practices in DWI enforcement are not being fully adopted or used. It seems, however, that effective operations, such as the low-staff check points that are routinely applied in many communities, could be extended to many more police departments. In addition, several enforcement methods have been proposed but never fully tested.

Adolescents with alcohol-related problems often also use cigarettes and marijuana. Furthermore, early childhood characteristics that increase the risk for adolescent alcohol use disorders also increase the risk for problematic drug use. Identifying these characteristics early in childhood can be important for the prevention of alcohol and other drug (AOD) use disorders. As a result, researchers are seeking to identify liability factors and observable characteristics (i.e., phenotypes) that can predict substance use disorders (SUDs) across drug categories. Other studies are focusing on endophenotypes--characteristics that cannot be openly observed but which link a person's genetic makeup, or genotype, and disease. Both predictive behavioral phenotypes and endophenotypes may reveal pathways connecting heritable predispositions and early environmental influences to later SUDs. One suggested predictive phenotype is psychological dysregulation, which is characterized by cognitive, behavioral, and emotional difficulties in childhood. An endophenotype that has been studied extensively is a particular brain wave called the P300 event-related potential. For people who are at high risk of AOD use based on these characteristics, adverse environmental conditions frequently lead to SUDs. Given the strong evidence that childhood psychological dysregulation predicts problematic AOD use, effective interventions for preventing adolescent SUDs may need to target the environmental features that put adolescents with this behavioral constellation at increased risk.

Alcohol consumption is prevalent among college students and can be associated with serious negative consequences. Several efficacious programs using one-on-one brief intervention techniques have been developed to target high-risk drinking by individual students, such as the Brief Alcohol Screening and Intervention for College Students (BASICS) (Dimeff et al. 1999). To reach a larger population (e.g., the incoming freshman class), researchers have adapted these interventions so that students can access them via the Internet or in some other electronic format. The purpose of this review is to discuss specific alcohol intervention programs that were (1) designed to be delivered remotely (e.g., via the Web or on an electronic device) without interaction with a provider and (2) were tested among college students using a randomized controlled trial design. Specific studies were drawn from earlier reviews as well as a comprehensive literature search. Although many programs have limited research support, and some findings are mixed, components that were directly translated from in-person BASICS to remote-delivery mediums (i.e., personalized feedback interventions [PFIs], personalized normative feedback [PNF] interventions), and broader programs that incorporate PFI/ PNF, show promise in reducing alcohol use and/or negative consequences. However, more research is needed and suggestions for how the field can move these interventions forward are discussed.

Background: Problematic alcohol consumption is associated with a high disease burden for affected individuals and has a detrimental impact on companies and society due to direct and indirect health costs. This protocol describes a study design to evaluate the (cost)-effectiveness of a guided and unguided Internet-based self-help intervention for employees called "GET.ON Clever weniger trinken" (be smart - drink less) compared to a waiting list control group. Methods: In a three-arm randomized controlled trial, 528 German adults who are currently members of the workforce will be recruited by occupational health departments of major health insurance companies. Employees aged 18 and older displaying problematic drinking patterns (>21/14 drinks per week and an AUDIT score∈>∈8/6 for men/women) will be randomly assigned to one of three following study conditions: 1. unguided web-based self-help for problematic drinking, 2. adherence-focused guided self-help, and 3. waiting list control. Self-report data will be collected at baseline (T1), 6 weeks (T2), and 6 months (T3) after randomization. The primary outcome will be the reduction of alcohol standard units during the 7 days prior to T2, using the Timeline Followback method. Cost-effectiveness analyses to determine direct and indirect costs will be conducted from the perspectives of employers and the society. Data will be analyzed on an intention-to-treat basis and per protocol. Discussion: There is a need to identify effective low-threshold solutions to improve ill-health and reduce the negative economic consequences due to problematic alcohol drinking in workforces. If the proposed web-based intervention proves both to be efficacious and cost-effective, it may be a useful tool to increase utilization rates of interventions for problematic drinking in occupational settings. Trial Registration: German Register of Clinical Studies (DRKS): DRKS00006105, date of registration: 2014-07-07.

The authors conducted a study of alcohol use biomarkers and cognitive performance among 85 veterans with problematic alcohol use and posttraumatic stress disorder (PTSD). All analyses were adjusted for demographics, depression, anxiety, and PTSD symptoms. Elevated levels of aspartate aminotransferase were associated with worse performance on the Trail Making Test Part A and Hopkins Verbal Learning Test. Two other biomarkers were not associated with any neurocognitive measures. Indirect alcohol use biomarkers (e.g., aspartate aminotransferase) may have a specific role in identifying veterans with problematic alcohol use and PTSD who show a change in psychomotor speed and immediate verbal memory performance.

Stress has long been suggested to be an important correlate of uncontrolled drinking and relapse. An important hormonal response system to stress—the hypothalamic–pituitary–adrenal (HPA) axis—may be involved in this process, particularly stress hormones known as glucocorticoids and primarily cortisol. The actions of this hormone system normally are tightly regulated to ensure that the body can respond quickly to stressful events and return to a normal state just as rapidly. The main determinants of HPA axis activity are genetic background, early-life environment, and current life stress. Alterations in HPA axis regulation are associated with problematic alcohol use and dependence; however, the nature of this dysregulation appears to vary with respect to stage of alcohol dependence. Much of this research has focused specifically on the role of cortisol in the risk for, development of, and relapse to chronic alcohol use. These studies found that cortisol can interact with the brain’s reward system, which may contribute to alcohol’s reinforcing effects. Cortisol also can influence a person’s cognitive processes, promoting habit-based learning, which may contribute to habit formation and risk of relapse. Finally, cortisol levels during abstinence may be useful clinical indicators of relapse vulnerability in alcohol-dependent people.

Alcohol consumption is prevalent among college students and can become problematic for some. Numerous randomized controlled trials have evaluated the efficacy of individual preventive interventions in reducing alcohol use and alcohol-related problems in college student populations. Consistent with earlier reviews, the balance of the evidence from studies conducted during the past 3 years strongly supports the efficacy of brief motivational interventions combined with personalized feedback interventions (PFIs) and personalized normative feedback (PNF), as well as of stand-alone PFI/PNF interventions. Recent analyses also continue to support the efficacy of alcohol expectancy challenge interventions, although the findings are less consistent. In addition, recent analyses offer mixed support for feedback-based interventions focused solely on blood alcohol concentration and for multicomponent, alcohol education–focused interventions that include elements of PFI/PNF. No evidence of efficacy was found for programs that only included alcohol education.

Regulations on the availability of alcohol have been used to moderate alcohol problems in communities throughout the world for thousands of years. In the latter half of the 20th century, quantitative studies of the effects of these regulations on drinking and related problems began in earnest as public health practitioners began to recognize the full extent of the harmful consequences related to drinking. This article briefly outlines the history of this work over four areas, focusing on the minimum legal drinking age, the privatization of alcohol control systems, outlet densities, and hours and days of sale. Some historical background is provided to emphasize the theoretical and empirical roots of this work and to highlight the substantial progress that has been made in each area. In general, this assessment suggests that higher minimum legal drinking ages, greater monopoly controls over alcohol sales, lower outlet numbers and reduced outlet densities, and limited hours and days of sale can effectively reduce alcohol sales, use, and problems. There are, however, substantial gaps in the research literature and a near absence of the quantitative theoretical work needed to direct alcohol-control efforts. Local community responses to alcohol policies are complex and heterogeneous, sometimes reinforcing and sometimes mitigating the effects of availability regulations. Quantitative models of policy effects are essential to accelerate progress toward the formulation and testing of optimal control strategies for the reduction of alcohol problems.