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Aims: To examine the association between drinking levels and inpatient health service utilization in people with a lifetime diagnosis of alcohol dependence. Methods: A longitudinal prospective study was conducted in a cohort of patients with alcohol dependence who had undergone treatment in 1987. Current results refer to the association between drinking patterns at 20-year follow-up and subsequent inpatient health service utilization. At 20 years after baseline, 530 of 850 patients were alive with administrative data available. Follow-up interview was conducted on 378 patients. There were 88 refusals and 64 could not be traced. Three categories of alcohol consumption were established (abstainers, moderate drinkers and heavy drinkers) depending on the pattern of alcohol use during the last year prior to the evaluation. Health service utilization was based on official statistics, including admissions to general, rehabilitation and psychiatric hospitals. The time period analysed was 5 years after the assessment of drinking patterns. Results: Admission rates were lowest for abstainers compared to people with moderate and heavy drinking. With respect to hospital days, heavy drinking was associated with significantly higher adjusted rates than both abstainers and moderate drinkers. Alcohol-related diagnoses in hospital admissions were more frequent for both moderate and heavy drinkers. Conclusion: Abstinence and moderate alcohol consumption were both associated with lower hospitalization in people with a lifetime diagnosis of alcohol dependence. Thus, not only abstinence-oriented treatment strategies but also those to reduce alcohol intake would reduce inpatient hospitalizations. [ABSTRACT FROM AUTHOR]

Aims: To examine the association between drinking levels and inpatient health service utilization in people with a lifetime diagnosis of alcohol dependence. Methods: A longitudinal prospective study was conducted in a cohort of patients with alcohol dependence who had undergone treatment in 1987. Current results refer to the association between drinking patterns at 20-year follow-up and subsequent inpatient health service utilization. At 20 years after baseline, 530 of 850 patients were alive with administrative data available. Follow-up interview was conducted on 378 patients. There were 88 refusals and 64 could not be traced. Three categories of alcohol consumption were established (abstainers, moderate drinkers and heavy drinkers) depending on the pattern of alcohol use during the last year prior to the evaluation. Health service utilization was based on official statistics, including admissions to general, rehabilitation and psychiatric hospitals. The time period analysed was 5 years after the assessment of drinking patterns. Results: Admission rates were lowest for abstainers compared to people with moderate and heavy drinking. With respect to hospital days, heavy drinking was associated with significantly higher adjusted rates than both abstainers and moderate drinkers. Alcohol-related diagnoses in hospital admissions were more frequent for both moderate and heavy drinkers. Conclusion: Abstinence and moderate alcohol consumption were both associated with lower hos-pitalization in people with a lifetime diagnosis of alcohol dependence. Thus, not only abstinence-oriented treatment strategies but also those to reduce alcohol intake would reduce inpatient hospitalizations. Short Summary: Abstention and reduced drinking in lifetime alcohol-dependent patients were associated with lower health care utilization compared to heavy drinking. Alcohol treatment strategies for alcohol-dependent patients have a positive impact on the reduction in health care utilization. An increase in treatment rate for alcohol use disorders will consequently have marked population health improvements. [ABSTRACT FROM AUTHOR]

Issues: Patient-centered care (PCC) is increasingly accepted as an integral component of good health care, including addiction medicine. However, its implementation has been controversial in people with alcohol use disorders. Approach: A systematic search strategy was devised to find completed randomized controlled trials enrolling adults (>18 years) with alcohol use disorders. Studies had to use a PCC approach such that they should have been individualized, respectful to the patients' own goals, and empowering. Studies until September 2015 were searched using PubMed, Scopus, the Cochrane Library, PsychINFO, and Web of Knowledge. Key findings: In total, 40 studies enrolling 16,020 patients met the inclusion criteria. Assessment revealed two main categories of study: psychosocial (n=35 based on motivational interviewing) and pharmacological (n=5 based on an as needed dosing regimen). Psychosocial interventions were further classified according to the presence or absence of an active comparator. When no active comparator was present, studies were classified according to the number of sessions (≥1). Results from single sessions of motivational interviewing showed no clear benefit on alcohol consumption outcomes, with few studies indicating benefit of PCC versus control. Although the results for studies of multiple sessions of counseling were also mixed, many did show a significant benefit of the PCC intervention. By contrast, studies consistently demonstrated a benefit of pharmacologically supported PCC interventions, with most of the differences reaching statistical significance. Implications: PCC-based interventions may be beneficial for reducing alcohol consumption in people with alcohol use disorders. [ABSTRACT FROM AUTHOR]

Abstract: This study evaluated the efficacy of as-needed use of the opioid system modulator nalmefene in reducing alcohol consumption in patients with alcohol dependence. Seven hundred and eighteen patients (placebo=360; nalmefene=358), ≥18 years of age, with a diagnosis of alcohol dependence, ≥6 heavy drinking days and an average alcohol consumption ≥WHO medium drinking risk level in the 4 weeks preceding screening, were randomised (1:1) to 24 weeks of as-needed placebo or nalmefene 18mg/day. The co-primary efficacy analyses showed a significantly superior effect of nalmefene compared to placebo in the change from baseline to month 6 in heavy drinking days (group difference: −1.7 days/month [95% CI −3.1; −0.4]; p=0.012) and a better but not significant effect in reducing total alcohol consumption (group difference: −5.0g/day last month [95% CI −10.6; 0.7]; p=0.088). A subgroup analysis showed that patients who did not reduce their drinking prior to randomisation benefitted more from nalmefene. Improvements in Clinical Global Impression and reductions in liver enzymes were greater in the nalmefene group than in the placebo group. Adverse events were more common with nalmefene; the incidence of adverse events leading to dropout was similar in both groups. This study provides evidence for the efficacy of nalmefene, which constitutes a new pharmacological treatment paradigm in terms of treatment goal (reduced drinking) and dosing regimen (as-needed), in alcohol dependent patients unable to reduce alcohol consumption on their own. [Copyright &y& Elsevier]

Introduction and Aims Women are underrepresented in long-term studies of alcohol dependence. While gender differences in drinking behaviour have been observed when starting treatment, very few studies have investigated gender differences in long-term drinking outcomes. This paper evaluates gender differences in the long-term outcome of patients treated for alcohol dependence. Design and Methods A cohort of 850 outpatients (19% women, age 39 ± 9 years) treated for alcohol dependence in specialist centres of Catalonia ( Spain) were followed up prospectively for 20 years. Covariance analysis was used to assess gender differences at 1, 5, 10 and 20 years in drinking behaviour, psychosocial stress and social functioning ( Axes 4 and 5 of Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised). We evaluated gender differences in drinking trajectories using a multilevel model controlling for basal differences. Results Women started treatment earlier in their drinking career, with more symptoms of dependence. In the first year they remained in treatment longer and had more clinic visits. Women presented lower alcohol consumption than men at baseline, 5 and 10 years, and similar levels of stress and psychosocial functioning. When basal alcohol consumption, length of treatment and employment were controlled, female gender predicted less drinking at year 1 and a drinking trajectory closer to abstinence between 1 and 20 years. Discussion and Conclusions Increased severity of alcohol dependence in women starting treatment was not associated with a worse prognosis. Women did better while under treatment and achieved a better long-term drinking outcome. Gender differences were not relevant concerning psychosocial stress and social functioning. [Fabián Bravo, Antoni Gual, Anna Lligoña, Joan Colom. Gender differences in the long-term outcome of alcohol dependence treatments: An analysis of twenty-year prospective follow up. Drug Alcohol Rev 2013;32:381-388] [ABSTRACT FROM AUTHOR]

To consider, briefly, science's role in informing alcohol policy, and how science could help reframe the present governance of alcohol policy. Expression of the two project coordinators' reflections based on discussions during project meetings of the Alcohol Measures for Public Health Research Alliance (AMPHORA) project. Three endeavours are considered important for science's role in informing alcohol policy: modelling studies that help predict the outcomes of differing policy approaches; studying the impact of live policy changes as a powerful set of natural experiments; and, improved study of the impact of integrated, coordinated and joined up alcohol policies, as opposed to the impact of individual alcohol policy measures. Three areas where science can contribute to strengthened alcohol policy governance include: analysis of different governance architectures that might promote joined-up actions between different sectors; the design of better metrics that measure the impact of public and private sector actions on health; and, by identifying incentives that help consumers make choices on the use of alcohol that improve health. The impact of science on better alcohol policy governance can only happen if there is more and better dialogue between scientists and those who design alcohol policy. [ABSTRACT FROM AUTHOR]

A literature review of existing research on the prevalence of alcohol use disorders (AUDs) and availability of alcohol interventions in Europe was conducted. The review also explored what is known about the gap between need and provision of alcohol interventions in Europe. The review search strategy included: (i) descriptive studies of alcohol intervention systems in Europe; (ii) studies of alcohol service provision in Europe; and (iii) studies of prevalence of AUD and alcohol needs assessment in Europe. Europe has a relatively high level of alcohol consumption and the resulting disabilities are the highest in the world. Most research on implementation of alcohol interventions in Europe has been restricted to screening and brief interventions. Alcohol needs assessment methodology has been developed but has not been applied in comparative studies across countries in Europe. This review points to key gaps in knowledge related to alcohol interventions in Europe. There is a lack of comparative data on variations in alcohol treatment systems across European countries and there is also a lack of comparative data on the prevalence of alcohol use disorders across European countries and the relative gap between need and access to treatment. The forthcoming Alcohol Measures for Public Health Research Alliance (AMPHORA) research project work package on 'Early identification and treatment' aims to address these gaps. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to evaluate long-term outcomes in alcohol-dependent patients following outpatient treatment and gender differences in drinking outcome and mortality. Methods: A 20-year longitudinal prospective study was done with interim analyses at 1, 5 and 10 years. Of the original sample of 850 patients, 767 (90%) were located 20 years later and 393 of these were interviewed. 273 (32%) patients died during the intervening period and 101 (12%) no longer wished to participate in the study. Drinking status was assigned based on the 12 months prior to the follow-up interview. Results: At the 20-year follow-up, 277 (32.6%) of the 393 patients for whom drinking status could be assigned were abstinent (defined never drinking or drinking on less than occasion per month and never more than four drinks/drinking occasion.), 29(3.4%) were controlled drinkers and 87(10.2%) were heavy drinkers. Controlled drinking was the least stable category, with 23% continuing from years to year 10 in that category, and 10% continuing in that category from year 10 to year 20. Mortality was higher (39.1%) in those who had been categorized at years as heavy drinkers compared to those who had been categorized as controlled drinkers or abstinent. Abstinent patients reported fewer alcohol-related problems and better psychosocial functioning than heavy drinkers. Women achieved higher abstinence rates (47.2% versus 29.0%, P = 0.005) and had lower mortality (22.4% versus 34.5%, P = 0.03) than men. Conclusions: Over the long-term, abstinence is the most frequent and stable drinking outcome achieved and is associated with fewer problems and better psychosocial functioning. Controlled drinking is rarely achieved and sustained. Women appear to do better than men in the long term. [ABSTRACT FROM AUTHOR]

Background: Despite evidence of dual diagnosis (DD) in impaired physicians, few studies have investigated its prevalence and clinical characteristics. Aims: To assess the prevalence and clinical characteristics of DD in a sample of inpatient physicians and to compare physician patients with DD to other inpatient physicians. Methods: A chart review of clinical and demographic data was conducted on 290 consecutive admissions to the inpatient unit of the Integrated Care Programme for Physicians in Barcelona from January 1999 to August 2005. Results: 60 (20.6%) patients had DD, with the most common form of co-occurring disorders being alcohol dependence with mood disorder (46.4%). DD patients were more likely to be male. DD patients were more similar to patients with substance use disorders with regards to demographic variables and antisocial personality traits, but were more similar to patients with only a psychiatric disorder concerning severity and avoidant traits. Conclusions: DD is a major cause of impairment in physicians and is associated with particular clinical and demographic characteristics. DD in physicians deserves attention to improve early detection, prevention and treatment strategies. [ABSTRACT FROM AUTHOR]

To identify the possible risk factors and negative outcomes associated with parental alcoholism. A secondary aim was to determine the influence of the family density of alcoholism on children of alcoholics’ (COAs) psychological functioning. A multisite epidemiological study was conducted in 8 Spanish cities, recruiting a total sample of 371 COAs (whose parents were in contact with alcohol treatment centers and accepted to participate in this study) and 147 controls (from schools in the same localities as COAs). Both groups were 6–17 years old and received a comprehensive evaluation of mental disorders (no symptoms, subclinical symptoms or clinical diagnosis for each disorder; according to DSM-IV criteria); alcohol and other substance use (none, occasional, regular and risky consumption); school achievement (low, middle and high) and other academic performance indicators (WISC-R Information and Arithmetic subtests, school support activities and failed subjects and courses). Lastly, several cognitive functions were measured by the WISC-R Similarities, Block Design and Digit Symbol subtests, the Toulouse-Piéron test and the Stroop test. Logistic regression methods were used to compare both groups and a linear regression model was used to determine the influence of the family density of alcoholism. The following confounding variables were controlled for: age, gender, socio-economic status and family cohesion. Children of alcoholics’ were twice as likely as controls to present subclinical symptoms and four times more likely than controls to have a definite diagnosis of any mental disorder. More specifically, COAs had a significantly higher risk than controls of attention deficit disorder/hyperactivity, depression, phobias, enuresis and tics. COAs also tended to have more symptoms of generalized anxiety disorder. COAs had worse results on all the cognitive tests used and their risk of low school achievement was nine times higher than that of controls. Family density of alcoholism was significantly related to several psychiatric disorders and to low academic and cognitive performance in these children. Children of alcoholics’ whose parents are in contact with treatment centers in Spain constitute a target group for selective prevention, as they have a higher risk of different negative outcomes, which mainly include attention disorders and other cognitive deficits, depression and anxiety. [ABSTRACT FROM AUTHOR]

Our aim is to describe the current situation regarding the diagnosis and treatment of addiction in a variety of settings in Spain. Four-hundred and twenty-seven physicians known to treat addicted patients in non-private settings were recruited and agreed to participate. Each physician provided clinical and anonymous information on the first 6 consecutive patients who attended on a scheduled day. A total of 2361 patients were interviewed (92.1%) and data were obtained concerning gender, age, work, educational level, civil status, addiction diagnosis, type of treatment and psychiatric comorbidity. Seven-hundred and ninety-eight out of 2361 addicts (33.8%) presented with a dual diagnosis. Depression was the most prevalent disorder (21.6%), followed by anxiety disorders (11.7%). Comorbidity was found to be related to age, female gender, divorce and widowhood, and higher educational levels. Alcoholics who abused other drugs showed the highest rates of comorbidity (48.5%), while opiate addicts were at the lower end of the spectrum (27.4%). No differences were found related to the treatment setting, the doctor's medical specialty, or the geographical area. Finally, doctors tended to perceive that dual diagnosis was related to a worse psychiatric prognosis but not to higher relapse rates. Antidepressants were the most commonly prescribed drugs (62.4% of co-morbid patients) and anticraving agents were prescribed equally to comorbid and non-comorbid patients. Within the limitations of a descriptive study, our data show that comorbidity is a common clinical problem in patients who access addiction treatment. Affective and anxiety disorders are the most common comorbid diseases, and comorbidity rates seem to be unrelated to regional differences, medical settings or doctor's professional background. Dual diagnosis patients thus account for one third of the clinical workload of addiction specialists in Spain. [Gual A. Dual diagnosis in Spain. Drug Alcohol Rev 2007;26:65 - 71] [ABSTRACT FROM AUTHOR]

The article presents the alcohol consumption and drinking patterns in Spain. The twenty year period from 1975 to 1995 showed a decrease in alcohol consumption due to a difference in drinking habits where there is a shift from wine to beer. In terms of drinking pattern, traditional patterns are described by drinking daily and during meals in older and rural populations, but among the young urban people, drinking pattern is characterized by intermittent drinking during weekends that leads to intoxication.

— Aims: To identify suitable short versions of the Alcohol Use Disorders Identification Test (AUDIT) and to evaluate their effectiveness as screening tests for ‘risky drinking’ among men and women in primary health care (PHC) settings. Methods: A total of 255 patients attending five PHC centres in Catalonia (Spain) were interviewed by clinicians regarding health status and drinking pattern. Patients also completed the AUDIT. Clinicians’ diagnosis of risky drinking was used as a gold standard to evaluate the effectiveness of three forms of AUDIT. Results: AUDIT-3 and AUDIT-4 performed similarly to AUDIT-10 in detecting risky drinking and had equivalent receiver operating characteristics curves and their areas under the curve. Conclusions: Both short forms of AUDIT seem to be as effective as the full AUDIT for detecting risky drinking among men and women in PHC settings. [ABSTRACT FROM PUBLISHER]

Founded in 1969, SOCIDROGALCOHOL is a reference point for professionals interested in drug dependencies, both for Spaniards and for professionals belonging to Spanish-speaking areas. In its 32 years of existence SOCIDROGALCOHOL has spread to all the regions of Spain and most of the Latin-American countries. In the past 5 years SOCIDROGALCOHOL has undergone notable growth, increasing the number of members (from 460 to 816), as well as the number of scientific activities carried out. The National Conferences represent an annual meeting point for the members, where multiple scientific sessions take place, as well as the ordinary general assembly. They are usually held in the spring and last 3 days, with an attendance of around 400 professionals. Within the field of ongoing training, SOCIDROGALCOHOL also carries out other activities: the Autumn School, the Latin-American Virtual Congress of Drug Dependence, distance learning courses, etc. Special mention should be made to the official journal of the Society, Adicciones, founded in 1989. Adicciones is published quarterly in Spanish and its articles are subjected to peer review; 2000 copies of each issue are published. The abstracts can be accessed free on the website of the Society, www.SOCIDROGALCOHOL.org. In this paper the most relevant historical aspects of SOCIDROGALCOHOL will be summarized, along with its current activities and future perspectives. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the outcomes and pitfalls of the second European Alcohol Action Plan. Prevention of health risk and social problems resulting from alcohol use; Reduction of alcohol consumption throughout the continent; Improvement of the health of an individual as the primary objective of the plan.

Three hundred and twenty-nine alcohol dependent patients, diagnosed according to DSM. III-R criteria who had participated in one of five different psychotherapy groups over a 5-year period, were studied using survival analysis statistics. Patients were followed-up until their discharge or withdrawal from the group to determine their retention in therapy, and to examine the effect of gender, age and family situation on compliance. Retention rates at 6, 12 and 24 months were 61%, 49% and 37%, respectively. Median retention time was 46 weeks. Women remained longer in treatment than men (median period 98 vs. 34 weeks), and this was due mainly to lower dropout rates in the first 3 months. Dropout rates were also higher in patients aged 35 years or younger. The first 3 months seem to be crucial in the process of deciding whether or not to remain in therapy. [ABSTRACT FROM AUTHOR]

Introduction: Training in addiction medicine and addiction psychology is essential to ensure the quality of treatment for patients with substance use disorders. Some earlier research has shown varying training between countries, but no comprehensive study of addiction training across Europe has been performed. The present study by the European Federation for Addiction Societies (EUFAS) aimed to fill this gap. Methods: A Delphi process was used to develop a questionnaire on specialist training in addiction treatment in 24 European countries. The final questionnaire consisted of 14 questions on either addiction medicine or addiction psychology, covering the nature and content of the training and institutional approval, the number of academic professorial positions, and the estimated number of specialists in each country. Results: Information was not received from all countries, but six (Belgium, Denmark, Ireland, Italy, Poland, and Romania) reported no specialized addiction medicine training, while 17 countries did. Seven countries (Belgium, France, Ireland, Italy, Russia, Switzerland, and the Netherlands) reported no specialized addiction psychology training, while 14 countries did. Training content and evaluation methods varied. Approval was given either by governments, universities, or professional societies. Eighteen countries reported having professorships in addiction medicine and 12 in addiction psychology. The number of specialists in addiction medicine or psychology varied considerably across the countries. Discussion: The survey revealed a large heterogeneity in training in addiction medicine and addiction psychology across Europe. Several countries lacked formal training, and where formal training was present, there was a large variation in the length of the training. Harmonization of training, as is currently the case for other medical and psychology specializations, is warranted to ensure optimal treatment for this under-served patient group. [ABSTRACT FROM AUTHOR]

A prospective, multicentre study was designed to evaluate the impact of a treatment programme in alcohol-dependent patients (n = 850). Drinking status and measures related to quality of life such as morbidity, mortality, alcohol-related problems, and psychological and social functioning were assessed for 5 years from the initial contact with the patient. Five years after the initial visit, drinking status followed a bimodal distribution: 371 patients (43.6%) were found to be abstinent, 323 (38%) were heavy drinkers, and only 55 (6.5%) were controlled drinkers. A total of 65 (7.6%) patients died during the study, 33 (3.9%) patients were lost to follow-up and three (0.3%) patients were not collaborative. Differences in health-related issues were identified for each of the drinking status categories. Abstinent patients presented with significantly better outcomes than controlled and heavy drinkers on most medical, socio-economic and psychological measures. Heavy drinkers showed significantly worse outcomes than controlled drinkers. [ABSTRACT FROM PUBLISHER]

The use of standard drink units (SDUs) in the measurement of individual alcohol consumption has become widely popular in recent year. However, the ethanol content of drinks varies from country to country and is usually arrived at without scientific backing. The present study was designed to establish an SDU for a predominantly wine-drinking country (Spain). Two field studies were simultaneously conducted to gather data about home and public alcohol consumption in eight regions of the country with a total of 10 751 subjects. The average alcohol content of a drink was very similar for wine and beer, whereas in the case of spirits it was almost double. Relevant differences were found across regions, drinking settings and city sizes. A Spanish SDU was set at 10 g of ethanol for wine and beer, with a measure of spirits accounting for two SDUs. The use of SDUs should be encouraged in primary health care settings. However, dispersion of data suggests that, when SDU is used as a screening tool, additional information should always be obtained in borderline cases. [ABSTRACT FROM PUBLISHER]

Describes the evolution of alcohol consumption over the last 30 years in countries of southern Europe. Five countries included on analysis of alcohol consumption; The World Drink Trends as a standard source of data for anyone studying world alcohol consumption; Evidences of alcohol consumption decrease; Several factors responsible for the decrease in alcohol consumption; Consequences of alcohol-related morbidity and mortality; Conclusions.

Liver transplantation remains an essential procedure for many patients suffering from alcoholic liver disease. Alcohol use monitoring remains paramount all through the stages of this complex process. Direct alcohol biomarkers, with improved specificity and sensibility, should replace traditional indirect markers. Phosphatidylethanol (PEth) has been recently tested in alcoholic liver disease patients, but more evidence is needed, especially in comparison with other direct biomarkers. We conducted an observational study among patients awaiting liver transplantation. We analyzed Peth in blood, ethylglucuronide (EtG) in hair and urine and ethylsulphate (EtS) in urine, using mass spectrometry methods. In addition, transaminases, and self-reports were analyzed. A total of 50 patients were included (84% men, mean age 59 years (SD = 6)). 18 patients (36%) screened positive for any marker. Self-reports were positive in 3 patients. EtS was the biomarker with more positive screens. It also was the most frequently exclusive biomarker, screening positive in 7 patients who were negative for all other biomarkers. PEth was positive in 5 patients, being the only positive biomarker in 2 patients. It showed a false negative in a patient admitting alcohol use the previous week and screening positive for EtG and EtS. Hair EtG was positive in 3 patients who had negative Peth, EtG. EtG did not provide any exclusive positive result.A combination of biomarkers seems to be the best option to fully ascertain abstinence in this population. Our study suggest EtS might also play a significant role. [ABSTRACT FROM AUTHOR]

Tobacco use is more prevalent among alcohol liver disease (ALD) transplant patients and exerts harmful effects to the patient and to the graft. The aims of this study were to examine the impact of smoking status (nonsmoker, ex-smoker, active smoker) on patient survival and clinical outcomes, and to assess risk factors for active smoking before and after liver transplant (LT). An observational retrospective cohort study with 314 ALD patients undergoing LT from January 2004 to April 2016. Recipients were followed until April 2017 or death. Kaplan–Meier and Cox proportional hazards regression analyses were used to assess risk of mortality according to smoking status before LT. Smokers had a 79% higher risk of dying than those who had never smoked or quit smoking before LT. Ex-smokers had a greater survival probability (96.2%, 93.8%, 86.9%, and 83.1% at 1, 3, 5, and 10 years after LT) than active smokers until LT (96.0%, 85.6%, 80.0%, and 70.4%). Active smokers before LT with poor toxicity awareness had more than a twofold higher risk of mortality (Cox HR = 2.20, 95% CI: 1.05–4.58, p = 0.04) than ex-smokers. Younger age (OR = 94), higher Model for End-Stage Liver Disease (MELD) (OR = 1.06), and comorbid substance use disorder (OR = 2.35) were predictors of smoking until LT. Six months or less of alcohol abstinence (OR = 3.23), and comorbid substance use disorder (OR = 4.87) were predictors of active smoking after LT. Quitting smoking before transplantation improved survival. Evidence based smoking cessation interventions should be offered before and after LT. [ABSTRACT FROM AUTHOR]

Background: Primary care (PC) is crucial in the care of substance use disorder (SUD) patients. However, the relationship between PC and addiction settings is complex and collaboration issues stand out. Available evidence suggests that integration of SUD and PC services can improve physical and mental health of SUD patients and reduce health expenses.Objective: To explore the experiences, views and attitudes of PC professionals towards the interaction between PC and SUD services.Methods: Twenty-seven GPs took part in three focus groups. The focus group sessions were audio-taped, transcribed verbatim and analysed using reflexive thematic analysis. Recurrent themes were identified.Results: Four main themes were devised: (1) Differences and specificities of SUD patients, (2) Interaction between providers of PC and addiction services, (3) Patient management (4) Addiction stigma. These main themes reflect the consideration that SUD patients are a specific group with specific care needs that yield specific challenges to GPs themselves. Improved training, availability of a shared medical record system, increased feedback between GP and addiction specialists and the efficiency of the circuit are to be considered the main priority for the majority of the participants.Conclusions: An efficient and effective referral circuit, with increased feedback and shared medical records is considered key to GPs. Its implementation should keep in mind the specific features of both SUD patients and GPs. [ABSTRACT FROM AUTHOR]

The AMPHORA Project is a 4 years project funded by the 7th Framework Programme of the European Commission which aims to contribute with new evidence on scarcely explored or unexplored areas of alcohol consumption and alcohol-related harm in Europe. In this introductory article we describe the background of the Project and its main features. The research areas covered by AMPHORA are wide and diverse. Some of the most relevant are: an update on European epidemiological data; the definition of standard common indicators of alcohol consumption and harm; the measurement of the strength of alcohol policies; the study of contextual determinants of alcohol consumption, the analysis of the impact of marketing on youth; the availability of treatments at a European level; and two areas of harm reduction (contamination of illegal or surrogate alcohols and the reduction of harm in drinking venues). [ABSTRACT FROM AUTHOR]

Addressing substance use in psychiatric care encounters significant barriers, but the emergence of specialized services offers an opportunity to advance and scale up the integration of addiction services within psychiatric settings. However, research gaps still exist in this field, particularly in understanding the substance relapse rates of people with co-occurring disorders after a psychiatric hospitalization. This study aimed to investigate and compare the relapse rates of patients under inpatient care with exclusively addiction-related issues and those with co-occurring disorders after a hospitalization in a psychiatric ward and gain insights into differences in outcomes for these two patient groups. This retrospective analysis examined electronic medical records of patients admitted to the Acute Psychiatry Ward of the Hospital Clinic of Barcelona with a substance use disorder diagnosis between January 2019 and February 2021. Cox regression was used to identify variables independently associated with the first relapse episode. From a total of 318 admissions (79.2% with psychiatric comorbidity), 76.1% relapsed during the study follow-up, with a median survival time of 54 days. Younger age, female gender, voluntary admission, and outpatient follow-up were independently associated with relapse. The presence of a co-occurring disorder was not associated with relapse. This study highlights the need for interventions aimed at improving post-discharge abstinence rates for addiction-related hospitalizations. It also challenges the notion that co-occurring disorders automatically imply a worsened prognosis and emphasizes the importance of addressing addiction and psychiatric comorbidity in a comprehensive, integrated, and specialized manner. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsAddiction has historically been conceptualized and treated differently to other conditions. Studies suggest that healthcare staff perceive patients with substance use disorders (SUD) as a specific subgroup with distinct and challenging needs yet SUD patients frequently receive treatment in general psychiatry settings. Notwithstanding, knowledge of how SUD patients view themselves compared to other psychiatric patients and how they experience treatment in general psychiatry settings is lacking.We conducted semi-structured interviews with 22 SUD patients voluntarily hospitalized in the acute psychiatric unit of a general hospital to explore the lived experiences of SUD patients receiving detoxification in an acute psychiatry ward. Data were analyzed using Thematic Content Analysis.Two primary themes and five subthemes emerged: (A) Patient perceptions of the problem and its consequences’, which includes the subcategories (i) Patient views of addiction, (ii) Staff perception of the patients; and (B) Lived experiences within the specific setting with subthemes (i) Interaction with the specific setting, (ii) Interaction with fellow patients, and (iii) Perception of staff by patients.Overall, SUD patients had mixed perceptions; while many appreciated aspects of their hospitalization, others faced challenges in having all their needs met. Implementing policy-level interventions, like integrating SUD patient needs into psychiatry ward design and ensuring adequate resource allocation and staff training, could improve care quality for addiction patients in general psychiatry settings. [ABSTRACT FROM AUTHOR]

Introduction: Attentional bias (AB) is an implicit selective attention toward processing disorder-significant information while neglecting other environmental cues. Considerable empirical evidence highlights the clinical implication of AB in the onset and maintenance of substance use disorder. An innovative method to explore direct measures of AB relies on the eye-movement activity using technologies like eye-tracking (ET). Despite the growing interest regarding the clinical relevance of AB in the spectrum of alcohol consumption, more research is needed to fully determine the AB patterns and its transfer from experimental to clinical applications. The current study consisted of three consecutive experiments. The first experiment aimed to design an ad-hoc visual attention task (VAT) consisting of alcohol-related and neutral images using a nonclinical sample (n = 15). The objective of the second and third experiments was to analyze whether the effect of type of image (alcohol-related vs. neutral images) on AB toward alcohol content using the VAT developed in the first experiment was different for type of drinker (light vs. heavy drinker in the second experiment [n = 30], and occasional social drinkers versus alcohol use disorder (AUD) patients in the third experiment [n = 48]). Methods: Areas of interest (AOIs) within each type of image (neutral and alcohol-related) were designed and raw ET-based data were subsequently extracted through specific software analyses. For experiment 1, attention maps were created and processed for each image. For experiments 2 and 3, data on ET variables were gathered and subsequently analyzed through a two-way ANOVA with the aim of examining the effects of the type of image and drinker on eye-movement activity. Results: There was a statistically significant interaction effect between type of image and type of drinker (light vs. heavy drinker in experiment 2, F(1, 56) = 13.578, p < 0.001, partial η2 = 0.195, and occasional social drinker versus AUD patients in the experiment 3, F(1, 92) = 35.806, p < 0.001, partial η2 = 0.280) for "first fixation" with large effect sizes, but not for "number of fixations" and "dwell time." The simple main effect of type of image on mean "first fixation" score for AUD patients was not statistically significant. Conclusion: The data derived from the experiments indicated the importance of AB in sub-clinical populations: heavy drinkers displayed an implicit preference for alcohol-related images compared to light drinkers. Nevertheless, AB fluctuations in patients with AUD compared to the control group were found. AUD patients displayed an early interest in alcohol images, followed by an avoidance attentional processing of alcohol-related images. The results are discussed in light of recent literature in the field. [ABSTRACT FROM AUTHOR]

Commentary to: Reviewing and interpreting the effects of brief alcohol interventions: comment on a Cochrane review about motivational interviewing for young adults [ABSTRACT FROM AUTHOR]

Objective: Benzodiazepines have a good safety profile. Nevertheless, off-label use of these drugs may increase the risk of falls, dependence, and memory loss. Off-label prescription use is not highly prevalent. Studies have not researched the factors that influence off-label prescription use. We aim to identify the prevalence of off-label use of benzodiazepines in Barcelona and explore sociodemographic factors that may be involved for professionals and patients.Method: A cross-sectional study in Barcelona was carried out. Data from professionals were obtained from the Medical Official College of Barcelona. Patients' healthcare data were extracted from the electronic prescription system DataMart and from the Catalan Health System Observatory (catchment of 97% of the prescription system). Two multivariate analyses were performed to identify risk factors of off-label prescription use; one focused on the patients' characteristics and the other focused on professionals' characteristics.Results: In total, 9.7% of Barcelona's citizens used benzodiazepine prescriptions; 96.1% of them were off-label uses. The most common reason was long-term use (95.8%). Elderly patients were the most common demographic that was exposed to off-label use (OR 1.05, 95% CI 1.04-1.05). Family doctors (B = 38.87, 95% CI 25.25-35.50) and psychiatrists (B = 16.93; 95% CI 11.50-22.35) were the largest groups of off-label prescribers.Conclusions: The prevalence of benzodiazepine off-label prescriptions in our environment is very high, especially when the length of the treatment is considered. Implementation of evidenced-based strategies to facilitate more effective prescription practices is required. [ABSTRACT FROM AUTHOR]

The article focuses on revision of International Classification of Diseases (ICD-11) was published June 18, 2019 and includes a revised definition for alcohol use disorders (AUDs). Topics discussed include revised ICD-11 with respect to AUDs in light of the criticisms leveled at earlier versions of the ICD, diagnoses in mental health, are currently based mostly on behavioral symptoms, and use of consequences as criteria for substance use disorders.

Brief alcohol advice offered to patients was shown to be a clinically- and cost-effective intervention to prevent and manage alcohol-related health harm. However, this intervention is not yet optimally implemented in practice. A suggested strategy to improve the implementation of brief alcohol advice is through community actions which would enhance the environment in which primary healthcare providers must deliver the intervention. However, there has been scarce research conducted to date regarding which community actions have most influence on the adoption and implementation of brief alcohol advice. The current protocol presents the development of a package of community actions to be implemented in three Latin American municipalities, in Colombia, Mexico and Peru. The community actions were based on the Institute for Health Care Improvement's framework for going to full scale, and include: (i) involvement of a Community Advisory Board, (ii) involvement of a project champion, (iii) adoption mechanisms, (iv) support systems and (v) a communication campaign. By presenting a protocol for developing community actions with input from local stakeholders, this article contributes to advancing the public health field of alcohol prevention by potentially stimulating the sustainable adoption and implementation of brief alcohol advice in routine practice. [ABSTRACT FROM AUTHOR]

Aim: This study was aimed at investigating the availability and prescription of different medicinal variants of cannabis and their status in European countries.Methods: A -web-based survey was sent to all member societies of the -European Federation of Addiction Societies (EUFAS) in 2 waves during the summer of 2017. All 34 member societies in 19 different European countries were invited to participate.Results: We received 28 responses from 17 European countries. The cannabis extract nabiximol (Sativex®) is the most prevalent cannabis-based medicinal product marketed in Europe. Synthetic cannabinoids and standardized cannabis are less prevalent, and no country allows the growing of cannabis for personal medical use. The bringing of medical cannabis products from across borders to countries where the drug is not marketed is quite limited. The use of medical cannabis is restricted to some central medical conditions, but off-label use is prevalent in some countries.Conclusion: The use of medical cannabis in Europe seems to be restricted mostly to the use of the cannabis extract, nabiximol. There is only limited use of the cannabis plant as such for medical purposes, possibly indicating a different scenario in Europe as compared to the USA. Position Statement: EUFAS as an umbrella association of European addiction societies stresses the need for further studies on the efficacy of medical cannabis and warrants for possible dangers associated with the increasing popularity of medical cannabis. We need regulations at European level concerning registration and medical indications, development of uniform compounds and strength of products, and rules concerning sales and marketing. [ABSTRACT FROM AUTHOR]

In this article the author expresses his views on the researcher's approach in conducting a study on the alcohol industry and public interest science. He finds it hard to disagree at the proponents of the study since they made their points consistent, logical, clear and full of common sense. He wonders if it is essential to use the standards of the proponents to all types of research where ay kind of commercial interest can be foreseen.

In this article the author comments on the research paper "Does alcohol increase the risk of overdose death: the need for a translational approach," by G. Henderson in a previous issue of this journal. The author discusses the difficulties associated with attempting to replicate reality in the laboratory. The author suggests that the more difficult it is to reproduce a disease in the laboratory, the more helpful a translational approach would be. Agreement is made with the researchers over the number of hypotheses in the addictions field.

The author comments on the separation of alcohol from other illicit drugs in the proposed cross-cutting research agenda. He stresses the significance of integrating alcohol control policy with that of research, treatment, and policy of legal and illegal drugs to ensure better outcomes in reducing the risk of harms. He likewise argues on the estimated costs of alcohol over those of drug abuse costs.

Aims The estimated effect of sodium oxybate (SMO) in the treatment of alcohol dependence is heterogeneous. Population severity and treatment duration have been identified as potential effect modifiers. Population severity distinguishes heavy drinking patients with <14 days of abstinence before treatment initiation (high-severity population) from other patients (mild-severity population). Treatment duration reflects the planned treatment duration. This study aimed to systematically investigate the effect of these potential effect moderators on SMO efficacy in alcohol-dependent patients. Methods Network meta-regression allows for testing potential effect modifiers. It was selected to investigate the effect of the above factors on SMO efficacy defined as continuous abstinence (abstinence rate) and the percentage of days abstinent (PDA). Randomized controlled trials for alcohol dependence with at least one SMO group conducted in high-severity and mild-severity populations were assigned to a high-severity and mild-severity group of studies, respectively. Results Eight studies (1082 patients) were retained: four in the high-severity group and four in the mild-severity group. The high-severity group was associated with larger SMO effect sizes than the mild-severity group: abstinence rate risk ratio (RR) 3.16, P  = 0.004; PDA +26.9%, P  < 0.001. For PDA, longer treatment duration was associated with larger SMO effect size: +11.3% per extra month, P  < 0.001. In the high-severity group, SMO showed benefit: abstinence rate RR 2.91, P  = 0.03; PDA +16.9%, P  < 0.001. In the mild-severity group, SMO showed benefit only in PDA for longer treatment duration: +23.9%, P  < 0.001. Conclusions In the retained studies with alcohol-dependent patients, high-severity population and longer treatment duration were associated with larger SMO effect sizes. [ABSTRACT FROM AUTHOR]

Cannabis is one of the most commonly used substances in the world. However, its effects on human cognition are not yet fully understood. Although the cerebellum has the highest density of cannabinoid receptor type 1 (CB1R) in the human brain, literature on how cannabis use affects cerebellar-dependent learning is sparse. This study examined the effect of chronic cannabis use on sensorimotor adaptation, a cerebellar-mediated task, which has been suggested to depend on endocannabinoid signaling. Chronic cannabis users (n = 27) with no psychiatric comorbidities and healthy, cannabis-naïve controls (n = 25) were evaluated using a visuomotor rotation task. Cannabis users were re-tested after 1 month of abstinence (n = 13) to assess whether initial differences in performance would persist after cessation of use. Cannabis users showed lower adaptation rates compared to controls at the first time point. However, this difference in performance did not persist when participants were retested after one month of abstinence (n = 13). Healthy controls showed attenuated implicit learning in the late phase of the adaptation during re-exposure, which was not present in cannabis users. This explains the lack of between group differences in the second time point and suggests a potential alteration of synaptic plasticity required for cerebellar learning in cannabis users. Overall, our results suggest that chronic cannabis users show alterations in sensorimotor adaptation, likely due to a saturation of the endocannabinoid system after chronic cannabis use. [ABSTRACT FROM AUTHOR]

In this article the author discusses the issues surrounding the distinction between risky single drinking occasions and acute alcohol intoxications. It states that distinction can be made by defining a risky single drinking occasion (RSDO) as a drinking occasion, where blood alcohol concentration (BAC) is above 0.08%. It notes that RSDO and heavy episodic drinking must be seen as a continuum.

In this article the author discusses aspects of drinking among the elderly as a double exclusion phenomenon. The author notes that the formation of European guidelines to determine the alcohol problems in older people in the primary health care and other settings is a move forward from the double exclusion phenomenon. The author mentions the negative effects of economic recession to the social conditions of the elderly.

The author comments on an article by Munro concerning issues of responsibility in drinking alcoholic beverages on the part of the drinker and the industry. In reality, the alcohol industry places the responsibility on the drinker while the health industry tends to point the blame to the industry. There is evidence that the alcohol industry support all those preventive strategies that lack proven effectiveness and fight against those which do have a real effect on consumption levels. Munro's analysis focuses on the question of the scientist's responsibility in being objective and neutral in his or her studies and in defending scientific evidence when confronted by opinions biased by economic, cultural and religious factors.

Background: Sodium oxybate (SMO) has been shown to be effective in the maintenance of abstinence (MoA) in alcohol-dependent patients in a series of small randomized controlled trials (RCTs). These results needed to be confirmed by a large trial investigating the treatment effect and its sustainability after medication discontinuation.Aims: To confirm the SMO effect on (sustained) MoA in detoxified alcohol-dependent patients.Methods: Large double-blind, randomized, placebo-controlled trial in detoxified adult alcohol-dependent outpatients (80% men) from 11 sites in four European countries. Patients were randomized to 6 months SMO (3.3-3.9 g/day) or placebo followed by a 6-month medication-free period. Primary outcome was the cumulative abstinence duration (CAD) during the 6-month treatment period defined as the number of days with no alcohol use. Secondary outcomes included CAD during the 12-month study period.Results: Of the 314 alcohol-dependent patients randomized, 154 received SMO and 160 received placebo. Based on the pre-specified fixed-effect two-way analysis of variance including the treatment-by-site interaction, SMO showed efficacy in CAD during the 6-month treatment period: mean difference +43.1 days, 95% confidence interval (17.6-68.5; p = 0.001). Since significant heterogeneity of effect across sites and unequal sample sizes among sites (n = 3-66) were identified, a site-level random meta-analysis was performed with results supporting the pre-specified analysis: mean difference +32.4 days, p = 0.014. The SMO effect was sustained during the medication-free follow-up period. SMO was well-tolerated.Conclusions: Results of this large RCT in alcohol-dependent patients demonstrated a significant and clinically relevant sustained effect of SMO on CAD.Trial Registration: ClinicalTrials.gov Identifier: NCT04648423. [ABSTRACT FROM AUTHOR]

Aims Cognitive impairment in patients with alcohol use disorder (AUD) is highly prevalent, and it negatively impacts treatment outcome. However, this condition is neither systematically assessed nor treated. Thus, we aimed to explore the usability of a virtual reality-based protocol ('Rehabilitation Gaming System', RGS) for patients with AUD. Methods Twenty AUD patients (50% also cognitive impairment) underwent a single session of the RGS protocol (four cognitive training tasks, 10 minutes each). System Usability Scale (SUS) and Post-Study System Usability Questionnaire (PSSUQ) were applied to assess the RGS usability and patients' satisfaction with it. Also, the Perceived Competence Scale was administered to assess the patients' feelings of competence when using the training protocol. Comparisons of the responses to these questionnaires were performed between AUD patients with cognitive impairment and those without cognitive impairment. Results RGS usability was very positively rated (median SUS score = 80, Interquartile Range, IQR = 68.13–86-88). No significant differences were found in the median SUS scores for any of the sociodemographic or clinical variables, excepting for gender (women median score = 85; IQR = 80–94.38 vs. men median score = 71.25; IQR = 61.25–89.25; P -value = 0.035). The quality of the information provided by the RGS training scenarios and the usability were positively rated (PSSUQ), and patients experienced high feelings of competence. Conclusions The RGS has been found to be usable in the short term and patients with AUD stated to be satisfied with it. Future larger, randomized trials are needed to explore the effectiveness of this tool to help overcome the cognitive deficits in AUD patients. [ABSTRACT FROM AUTHOR]

Introduction Second-hand smoke (SHS) exposure has been associated with increased risks of respiratory and heart diseases. However, little is known about the potential effects of SHS on psychological distress. The aim of this study is to examine the association of SHS exposure at home with psychological distress in Spain. Methods A cross-sectional survey about SHS exposure, socio-demographic and health related variables, and psychological distress, measured with the 12-item version of the General Health Questionnaire (GHQ-12) with a cut-off score ≥ 3, was conducted from 2011–2012 among a representative sample of the adult population (aged ≥ 15 years) of Spain. From the total sample (n = 21,007), we used the subsample of never-smokers (n = 11,214). We computed the odds ratios (OR) and their 95% confidence intervals (95% CI) for scoring ≥ 3 on the GHQ by means of unconditional multiple logistic regression models adjusted for sex and age. Results In the subsample, 9.7% (n = 1,090) responded that they were exposed to SHS at home. The prevalence of subjects scoring ≥ 3 on the GHQ was higher for the sample exposed to SHS (22.7%) than for the non-exposed sample (18.9%; OR: 1.39; CI: 1.19–1.62). This association was also present when stratified for sex, age, marital status, socio-economic status, perceived general health, presence of any chronic disease, and alcohol intake. Conclusions Exposure to SHS at home is associated with psychological distress. Further investigation is necessary to determine if this association is causal. Avoiding SHS exposure at home could have beneficial effects on psychological distress. [ABSTRACT FROM AUTHOR]

Background: The lack of an agreed international minimum approach to measuring cannabis use hinders the integration of multidisciplinary evidence on the psychosocial, neurocognitive, clinical and public health consequences of cannabis use. Methods: A group of 25 international expert cannabis researchers convened to discuss a multidisciplinary framework for minimum standards to measure cannabis use globally in diverse settings. Results: The expert‐based consensus agreed upon a three‐layered hierarchical framework. Each layer—universal measures, detailed self‐report and biological measures—reflected different research priorities and minimum standards, costs and ease of implementation. Additional work is needed to develop valid and precise assessments. Conclusions: Consistent use of the proposed framework across research, public health, clinical practice and medical settings would facilitate harmonisation of international evidence on cannabis consumption, related harms and approaches to their mitigation. [ABSTRACT FROM AUTHOR]

Issues Numerous studies have examined the impact of the COVID‐19 pandemic on alcohol use changes in Europe, with concerns raised regarding increased use and related harms. Approach: We synthesised observational studies published between 1 January 2020 and 31 September 2021 on self‐reported changes in alcohol use associated with COVID‐19. Electronic databases were searched for studies evaluating individual data from European general and clinical populations. We identified 646 reports, of which 56 general population studies were suitable for random‐effects meta‐analyses of proportional differences in alcohol use changes. Variations by time, sub‐region and study quality were assessed in subsequent meta‐regressions. Additional 16 reports identified were summarised narratively. Key Findings: Compiling reports measuring changes in overall alcohol use, slightly more individuals indicated a decrease than an increase in their alcohol use during the pandemic [3.8%, 95% confidence interval (CI) 0.00–7.6%]. Decreases were also reported more often than increases in drinking frequency (8.0%, 95% CI 2.7–13.2%), quantity consumed (12.2%, 95% CI 8.3–16.2%) and heavy episodic drinking (17.7%, 95% CI 13.6–21.8%). Among people with pre‐existing high drinking levels/alcohol use disorder, high‐level drinking patterns appear to have solidified or intensified. Implications: Pandemic‐related changes in alcohol use may be associated with pre‐pandemic drinking levels. Increases among high‐risk alcohol users are concerning, suggesting a need for ongoing monitoring and support from relevant health‐care services. Conclusion: Our findings suggest that more people reduced their alcohol use in Europe than increased it since the onset of the pandemic. However high‐quality studies examining specific change mechanisms at the population level are lacking. [ABSTRACT FROM AUTHOR]

Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. To describe the process of development and cultural adaptation of the clinical intervention and training package. We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework. In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making. [ABSTRACT FROM AUTHOR]

Aims: To investigate changes in alcohol consumption during the first months of the COVID‐19 pandemic in Europe as well as its associations with income and experiences of distress related to the pandemic. Design Cross‐sectional on‐line survey conducted between 24 April and 22 July 2020. Setting: Twenty‐one European countries. Participants: A total of 31 964 adults reporting past‐year drinking. Measurements Changes in alcohol consumption were measured by asking respondents about changes over the previous month in their drinking frequency, the quantity they consumed and incidence of heavy episodic drinking events. Individual indicators were combined into an aggregated consumption‐change score and scaled to a possible range of −1 to +1. Using this score as the outcome, multi‐level linear regressions tested changes in overall drinking, taking into account sampling weights and baseline alcohol consumption [Alcohol Use Disorder Identification Test (AUDIT‐C)] and country of residence serving as random intercept. Similar models were conducted for each single consumption‐change indicator. Findings The aggregated consumption‐change score indicated an average decrease in alcohol consumption of −0.14 [95% confidence interval (CI) = −0.18, −0.10]. Statistically significant decreases in consumption were found in all countries, except Ireland (−0.08, 95% CI = −0.17, 0.01) and the United Kingdom (+0.10, 95% CI = 0.03, 0.17). Decreases in drinking were mainly driven by a reduced frequency of heavy episodic drinking events (−0.17, 95% CI = −0.20, −0.14). Declines in consumption were less marked among those with low‐ or average incomes and those experiencing distress. Conclusions: On average, alcohol consumption appears to have declined during the first months of the COVID‐19 pandemic in Europe. Both reduced availability of alcohol and increased distress may have affected consumption, although the former seems to have had a greater impact in terms of immediate effects. [ABSTRACT FROM AUTHOR]