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This study aimed to identify alcohol use disorder (AUD) criteria that better characterized those who seek treatment and those who recover on their own. We gathered data from help-seeking (HS) patients in an alcohol unit and compared them with self-achieved remission (SAR) patients. The best criteria to predict HS were psychological problems due to use, physical problems due to use, repeated attempts or desire to stop using, and not being able to stop drinking. The best criteria to predict SAR were tolerance, craving, hazardous use, much time spent, larger/longer use than intended, and role impairment. We discuss the impact of these results in current efforts to improve the accuracy of AUD diagnosis.

Background  Considering the physical, mental and behavioral problems related to fetal alcohol exposure, prenatal clinical guides suggest a brief evaluation of alcohol consumption during pregnancy to detect alcohol intake and to adjust interventions, if required. Even if any alcohol use should be considered risky during pregnancy, identifying women with alcohol use disorders is important because they could need a more specific intervention than simple advice to abstain. Most screening tests have been developed and validated in male populations and focused on the long-term consequences of heavy alcohol use, so they might be inappropriate to assess consumption in pregnant women. Objective  To analyze the internal reliability and validity of the alcohol screening instruments Alcohol Use Disorders Identification Test (AUDIT), Alcohol Use Disorders Identification Test - Consumption (AUDIT-C), Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down (TWEAK), Rapid Alcohol Problems Screen - Quantity Frequency (RAPS-QF) and Tolerance, Annoyed, Cut-Down and Eye-Opener (T-ACE) to identify alcohol use disorders in pregnant women. Methods  A total of 641 puerperal women were personally interviewed during the 48 hours after delivery. The receiver operating characteristics (ROC) curves and the sensitivity and specificity of each instrument using different cut-off points were analyzed. Results  All instruments showed areas under the ROC curves above 0.80. Larger areas were found for the TWEAK and the AUDIT. The TWEAK, the T-ACE and the AUDIT-C showed higher sensitivity, while the AUDIT and the RAPS-QF showed higher specificity. Reliability (internal consistency) was low for all instruments, improving when optimal cut-off points were used, especially for the AUDIT, the AUDIT-C and the RAPS-QF. Conclusions  In other cultural contexts, studies have concluded that T-ACE and TWEAK are the best instruments to assess pregnant women. In contrast, our results evidenced the low reliability of those instruments and a better performance of the AUDIT in this population., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)

Background: Alcohol consumption and its related consequences are not equal for women and men, although related studies do not frequently include gender analysis., Objective: Our aim was to characterize differences in endorsement of ICD-10 and DSM 5 alcohol use disorder (AUD) criteria by gender in an Argentinean emergency department population., Methods: A probability sample of patients (N = 923) from the largest emergency department in the city of Mar del Plata, Argentina (44% were females, aged 16 to 86, M (SD) = 37.31(15.20) was collected. Using a structured questionnaire, diagnostic criteria for alcohol use disorders, alcohol consumption, and socio-demographic variables were obtained. Bivariate and multivariate analyses were used to assess differences in the endorsement of each diagnostic criterion by gender., Results: Women were less likely to endorse each of the criteria for each of the diagnostic schemes. Even after controlling alcohol consumption, socio-demographic variables, severity of alcohol use disorders and adjusting for multiple comparisons females had a lower probability than males of endorsing withdrawal and impaired control., Conclusions: gender differences in the endorsement of diagnostic criteria for both the DSM 5 and ICD-10 were found. Some differences in endorsement but not all, might be partially explained by alcohol consumption patterns and socio-demographic factors, and same remained after controlling severity of the AUD. Results also suggest a differential functioning of DSM 5 and ICD-10 AUD criteria for women and men., Competing Interests: Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Alcohol Use Disorder (AUD) is one of the most harmful conditions associated with consumption. Despite a high level of consumption and an elevated number of people living with an AUD, evidence from help-seeking processes in Latin America is scarce and absent in Argentina. This paper aims to describe reasons for delaying and starting help-seeking, the process of problem awareness, and the years elapsed between drinking initiation, problem awareness, and help-seeking, as perceived by a clinical, non-random sample of people with AUD (n = 51). The most frequent reason for delaying help-seeking was not believing there was a problem. The most frequent motivators for seeking help were having physical or psychological problems due to use and repeated attempts to reduce or stop use. The outcomes of this study can be useful for designing interventions to reduce help-seeking barriers and facilitate access to treatment. [ABSTRACT FROM AUTHOR]

Evidence regarding the association between early drinking (ED) and later dependence is controversial. It has been alternately hypothesized that ED either plays a causal role in the development of dependence or that it is an early marker of increased psychosocial vulnerabilities. Despite a clear rationale for delaying youth consumption, it is important to discern this relationship. However, most epidemiological evidence comes from individual studies and high-income countries. If there is a causal link between ED and dependence, an association at the aggregate level would be expected. Furthermore, if the link is due to biological mechanisms, the association should be rather invariable regardless of the drinking context, while if the association is due to psychosocial factors, a wider variability is to be expected. We explored whether the association between ED and dependence varied across countries clustered by their shared contextual drinking characteristics. We used data from 169 countries from the Global Information System on Alcohol and Health of the World Health Organization: ED, alcohol dependence, heavy episodic drinking (HED), actual drinkers, and alcohol policy. To cluster countries by their shared drinking characteristics (prevalences of HED and actual drinkers, and alcohol policy), we used, sequentially, two multivariate data reduction techniques: a multiple correspondence analysis (MCA) and a hierarchic classification. To estimate the association between ED and alcohol dependence, beta regressions were performed, and then adjusted by country income-level and repeated by gender. The results indicated four country clusters: primarily abstainers (class 1), low drinking countries (class 2), high drinking countries (class 3), and very high drinking countries (class 4). Positive relationships between ED and alcohol dependence were found for all the countries in the world and for those in classes 1 and 2. No significant relationships were found for class 3 or class 4. These results were similar for males, but not for females, where no significant relationships were found after adjusting for income level. The association between ED and dependence varies according to the drinking context. Our findings either suggest that the ED–dependence association may be due to individual or environmental vulnerabilities that promote consumption outside cultural norms or that, if there is a causal link between ED and dependence, it is strongly moderated by psychosocial characteristics. [ABSTRACT FROM AUTHOR]

Alcohol drinking during pregnancy might lead to detrimental consequences to the mother and fetus, being Fetal Alcohol Syndrome (FAS) the most severe. In many Latin-American countries, there is a paucity of information about prenatal exposure to alcohol. Aim. To estimate alcohol drinking in pregnant women and describe it concerning sociodemographic characteristics. Method. Data were collected from a random sample of women attending the public health care system (N=852) in 2016. Alcohol drinking, including binge drinking (BD), was evaluated before and after pregnancy recognition. Descriptive and bivariate analyses were performed. Results. While pregnant, two out of ten women reported drinking. Moreover, 2% engaged in BD and 3% presented indicators of alcohol dependence. BD before pregnancy was related to drinking during pregnancy and frequency, quantity, and BD before pregnancy with BD during pregnancy. Conclusions. Alcohol consumption in pregnant women was higher than the estimated for most Latin- American countries, and of the considered characteristics, was almost exclusively related to consumption patterns before pregnancy. [ABSTRACT FROM AUTHOR]

The prevalence of alcohol use disorders in university students is alarmingly high. Screening instruments are fundamental for both, epidemiological research and clinical practice. The aim of this article is to compare the performance of the most widely used screening instruments (AUDIT, AUDIT-C, TWEAK, RAPS-QF, and CAGE) in Argentinean university students. Screening tests, along with the Alcohol Section of the Composite International Diagnostic Interview that yields DSM 5 compatible diagnoses were administered to a probabilistic sample (N = 2,430) of university students from a national public university. The following characteristics were evaluated among others: optimal cut-off points, sensitivity, specificity, internal consistency, temporal stability, and item presence and discrimination capacity. The global appraisal of results suggests that the AUDIT and RAPS-QF would be preferable for evaluating AUD in this population. [ABSTRACT FROM AUTHOR]

A significant percentage of people with an alcohol-use disorder (AUD) recover on their own and differ substantially from those who do not. Those who do not seek assistance for AUD include a high proportion of university students. The aim of this study was to describe, in a cohort of Argentinean university students, the differences among drinkers who had never had an alcohol-related problem, those who recovered from an AUD on their own (natural recovery), and those who currently had an AUD. Participants were 1170 randomly selected students from the National University of Mar del Plata. They were assessed regarding the quantity and frequency of alcohol consumption, AUD severity, and sociodemographic variables. Descriptive and multivariate analyses (logistic regressions) were performed. Differences were found primarily in alcohol consumption variables, gender, and age. Natural recovery and current AUD groups drank higher quantities of alcohol and did so more frequently compared with drinkers who had never met any AUD criteria. Students with a current AUD drank higher quantities than did those who were in natural recovery. Students who recovered naturally had less severe AUDs, but many still had an alcohol-related problem. The implications of self-promoted changes in drinking behaviors are discussed. [ABSTRACT FROM AUTHOR]

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