Search

In both the clinical and research settings, nurses assess patterns of alcohol consumption to screen for risk of adverse events or to determine the health consequences of drinking. The purposes of this critical review are to explore issues and controversies surrounding the measurement of alcohol consumption and to critique the existing literature relevant to the research and clinical arenas. An electronic literature search was completed to identify research articles addressing human studies from 1995 through 2004 related to alcohol consumption. Key words included alcohol drinking (subheadings blood, metabolism, psychology, and urine), standard drink, problem drinking, heavy drinking, and ethanol analysis (subheadings blood, urine, and chemistry). The results were in two primary content areas: self-reported alcohol consumption and assessment of consumption by using biological markers. Self-reported alcohol consumption can be quantified in a variety of ways, such as ounces of ethanol per day, standard drinks per day, drinking occurrences per month, heavy drinking occasions per month, and frequency of perceived drunkenness. The choice of measure depends on setting (clinical vs. research), the role of the variable under study, the capabilities and demographics of the study population, the study design, and the resources available to collect alcohol consumption data. A variety of biologic instruments are used to assess alcohol consumption, each with sensitivities and specificities that vary by age, gender, and possibly by ethnicity/race. Previous work has focused on the white, male, alcohol-dependent population and non-alcohol-dependent male controls. Some urgency exists to expand the biometrics of alcohol use to minority and older populations as well as to women across the life span.

A large proportion of Americans report binge or heavy drinking. The human and economic costs of alcohol misuse are extensive, with hundreds of thousands of lives lost or disrupted and billions of dollars spent due to impaired productivity, crime, and adverse health consequences. In an effort to reduce costs such as these, scientists and clinicians have developed brief interventions, characterized by their low intensity and short (5-60 minutes) duration, as well as by their intent to provide early intervention before drinkers develop alcohol abuse or dependence. The purpose of this review, therefore, is to analyze research studies related to brief intervention and critically analyze and critique their findings. In addition, both prospective randomized controlled trials and meta-analyses will be used to discuss the implications for clinical practice and make recommendations for future research.

This chapter reviews research on alcohol misuse, abuse, and addiction in young and middle adulthood. Young adulthood is defined as ages 21 to 35 and middle adulthood as ages 36 to 65. The authors searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and other databases for the years 1992 through 2004 using the terms alcohol abuse, alcoholism, and alcohol dependence, then hand-searched for the inclusion of age as a variable. The search was limited to research and English-language publications. Unpublished dissertation studies were excluded, as were topics that were reviewed in other chapters of this volume. When possible, articles for review were limited to alcohol only, as compared with other drugs of abuse. Research articles were selected for review if they contained the variables alcohol misuse, abuse, or alcohol addiction or dependence and age. The review included both nurse- and non-nurse-investigators and was comprised of 50 studies. The results are in four content areas across the global area of alcohol misuse, abuse, and dependence in young and middle adulthood: incidence and prevalence, developmental changes, the work setting, and the family setting. Few articles used a developmental framework, although in some studies, the framework was implicit. Nurse-investigators were more likely to produce qualitative studies, although the studies varied dramatically in size of sample, research design, and variables. Overall, there was greater breadth than depth. The use of adult developmental theory was limited despite its potential explanatory potential in this field. There is a need for more nurse-researchers to explore adult developmental theory and pay increased attention to age and developmental stage as explanatory variables.

Sixty percent of the U.S. population drinks alcohol. Although numerous investigators have shown that low-volume alcohol intake has positive influences on cardiovascular health, bone density, and cognition, there is a fine line between positive, neutral, and negative ramifications of alcohol consumption on health. Alcohol accounts for 7% of the global burden of disease and injury from all causes and for 10% to 11% of all illnesses and death each year worldwide. So alcohol use is a two-edged sword. Psychiatric nurses have a long history of involvement with alcoholic patients, and alcohol users, misusers, and abusers comprise a significant percentage of the patient load in every specialty and subspecialty of nursing. Yet nursing education has neglected this important area of content in general nursing curricula, staff development has not trained mainstream nurses to routinely assess for alcohol problems among hospital patients, and primary care providers have failed to do case finding. During the past 25 years, the federal government has funded curricular and faculty development programs to bring alcohol information into the core of health provider training. The process has been halting and minimally successful at best. One ramification of the inattention to alcohol-related education is the dearth of nurse-scientists engaged in programs of research in the field of alcohol abuse. A federally funded faculty development program in the 1990s focused attention on this issue, and a small cadre of nurses were trained to do related research. Several of the authors in this volume are members of that group. A brief overview of the focus of each of the remaining chapters in this volume is presented. A rationale is provided for the importance of this area of research for nursing knowledge and quality patient care in essentially all areas of nursing practice. Finally, several burning research questions are posed that would most appropriately be answered through nursing research.