BACKGROUND:To better quantify reasons for high levels of drinking observed among American Indians (AIs) who drink, we measured drinking behaviors in a sample of AI adults using the Alcohol Consumption Questionnaire (ACQ). METHODS:The sample consisted of 549 AI adults (54.8% female; average age = 31.7 years [standard deviation = 13.7]) living on reservations. Logistic regression models assessed associations of mean scale scores with lifetime alcohol use disorders (AUDs), adjusting for key demographics. RESULTS:Respondents were stratified by the amount of alcohol needed to feel they had "enough" (level of alcohol satiety). Approximately one quarter (23.3%) of respondents reported satiety at less than binge drinking (<4 drinks for women, <5 drinks for men), 30.9% by heavy binge drinking (4-7 women, 5-9 men), 30.9% by high-intensity binge drinking (8-15 women, 10-19 men), and 14.9% were only satiated by extreme binge drinking (16+ women, 20+ men). Respondents satiated by extreme binge drinking also reported that their satisfying level of alcohol use was associated with losing their ability to walk and talk and with experiencing blackouts. The overall ACQ score and the subscale indexing consumption were significantly associated with AUD, with odds ratios ranging from 5.53 for mild AUD to 33.37 for severe AUD (each versus no AUD; all P-values < .001). CONCLUSION:Extreme levels of binge drinking may be associated with extreme expectations about an individual's "satisfying" level of alcohol exposure. The ACQ measure effectively indexes consumptive behaviors and provides an additional diagnostic tool that may help target prevention and/or treatments for AUD.

Background: Harm reduction and recovery housing approaches are often thought to be in conflict, yet each share goals of reducing negative impacts of substance use.Objectives: Examining this, we surveyed substance use and medication policies and practices among a state-stratified, nationally representative sample of 838 residences (male = 479; female = 263; co-ed = 94; unknown = 2).Methods: Survey items assessed residence characteristics and practices as well as 12-step orientation and adherence to social model principles (valuing peer support, lived experience, and shared responsibility). We generated weighted estimates of policies and practices; logistic regression analyses tested differences by program orientation.Results: Nationally, nearly all (97%) residences require abstinence from alcohol and illegal drugs, implement drug testing (99%), evict residents who break substance use rules (94%), keep naloxone on site (98%), and have individuals trained to administer naloxone (94%). Fewer (56%) accept residents taking psychiatric medications. Primarily 12-step oriented residences (vs. not) were less likely to accept residents taking methadone (OR = 0.41, p = .003), psychiatric medications (OR = 0.52, p = .006), and medications for pain (OR = 0.37, p < .001) but more likely to keep naloxone on site (OR = 10.38, p = .010). Residences with greater social model adherence (vs. not) were more likely to accept residents taking medications for substance use (OR = 2.55, p = .015) and to provide naloxone training (OR = 2.55, p = .001).Conclusion: While largely abstinence-based, the majority of residences engage in harm reduction practices to safeguard against drug overdose. Efforts are needed to increase acceptance of residents on medications for substance use and other psychiatric conditions. Supporting social model principles may help in decreasing overdoses and increasing medication acceptance.

Purpose: Trends in heavy drinking among Hispanic young adults are shifting in the United States. Despite elevated risks for alcohol use disorder (AUD) and related problems among Hispanic populations, little work has examined cultural mechanisms to alcohol outcomes in the context of their neighborhood environments. This study examines how neighborhood environment factors (ethnic density and distance to the nearest border port of entry) and cultural factors (acculturative stress and ethnic identity) relate to AUD. Methods: The sample of 575 Mexican American men and women (aged 18 to 30) was recruited from San Diego County, California, USA. We assessed indirect effects of Mexican American ethnic density and distance to the nearest border port of entry on AUD through acculturative stress and ethnic identity. Multiple group path analysis was used to test sex differences. Results: While sex differences were not observed in the overall model, there were differential associations with focal variables for each group. For women, greater proportions of ethnic density and greater distance to the nearest port of entry both were negatively associated with AUD. For both women and men, acculturative stress was positively associated with AUD, and neighborhood environment indicators were not related to acculturative stress nor ethnic identity. Conclusions: These data may inform further studies to integrate social and cultural mechanisms in creation of place-based strategies for AUD prevention.

BACKGROUND:Individuals who consume alcohol often use other drugs as well. Little is known about the clustering of heavy and binge drinking with the use of other substances (tobacco, cannabis, illicit drugs, and nonmedical prescription drugs). Overweight/obesity, highly prevalent in the United States (US) and an established health risk factor, may also cluster with them. We aimed to identify patterns of clustering of these behavioral risk factors and demographic and chronic disease profiles of individuals who show each pattern of clustering. METHODS:Latent class analyses and multinomial and logistic regressions were conducted using a nationally representative sample of US adults (Analytic N = 214,505) from the 2015-2019 National Survey on Drug Use and Health. Demographic characteristics (age, race and ethnicity, education, and income) and chronic health conditions associated with each cluster of behavioral risk factors were examined, also adjusting for health insurance coverage and marital status. Analyses were stratified by gender. RESULTS:Four clusters with similar behavioral risk profiles were identified for both men and women: heavy-drinking-tobacco-some-cannabis-use-obese group, high-substance-use group, obese group, and relatively-healthy-lifestyle group. Additionally, heavy-drinking-tobacco-some-cannabis-use-overweight group and low-drinking-high-other-substance-use group for men and heavy-drinking-tobacco-some-cannabis-use group for women were identified. The high substance use group was more likely to be aged under 35. However, clusters featuring more commonly used substances (alcohol, tobacco, and, to a lesser degree, cannabis) were more likely to be midlife for men and to have higher income for both men and women. Clustered behavioral risk factors were positively associated with being White and having no college degree (with some exceptions) and negatively associated with self-rated health status and chronic conditions (except hypertension) for both sexes. CONCLUSIONS:Clustered multisubstance use and obesity is a problem affecting a significant segment of the US population. Tailored multibehavior interventions are warranted.

Background:Family burden has not been studied in relation to alcohol and other drug harms from others. We adapted a family burden scale from studies of caring for those with mental health conditions for use in the US Alcohol and Drug Harm to Others Survey (ADHTOS). We investigated associations between a seven-item summative burden scale and different types of harms attributed to someone else's use of alcohol, cannabis, or another drug: (a) being assaulted/physically harmed; (b) having family/partner problems; (c) feeling threatened or afraid; and (d) being emotionally hurt/neglected due to others' substance use. Methods:A survey of adults aged 18 years and over conducted between October 2023 and July 2024 (n = 8,311), involved address-based sampling (n = 3,931 including 193 mail-backs) and web panels (n = 4,380), oversampling Black (n = 951), Latinx (n = 790) and sexual or gender minority (SGM) respondents (n = 309). Data from seven items on types of burdens experienced from other people's alcohol or drug use were provided by those harmed by someone else's alcohol or drug use and were used to create a burden scale. Analyses used negative binomial regression on burden sum adjusting for covariates, such as age, gender, race and ethnicity, marital status and years of education. Results:The single factor burden scale showed good internal consistency (α = .91). Components assessing being emotionally drained/exhausted and family friction/arguments were endorsed by 38-39% of participants; finding stigma of the other's substance use upsetting was affirmed by 33%. Fewer endorsed feeling trapped in caregiving roles (22%), problems outside the family (26%), neglect of other family members' needs (16%), and having to change plans (14%). In adjusted regression models, seven of eight harm exposures were significantly associated with burden scores. Discussion:People reported substantial burden from others' use of alcohol, cannabis, and other drugs. Family support interventions and policy remedies to mitigate these burdens are needed.

[This corrects the article DOI: 10.1371/journal.pgph.0001219.].

Purpose: Trends in heavy drinking among Mexican American young adults are shifting in the United States. Despite elevated risks for alcohol use disorder (AUD) and related problems among Mexican American populations, little work has examined mechanisms contributing to alcohol outcomes in the context of their neighborhood environments. This study examines how neighborhood environment factors (ethnic density and distance to the nearest border port of entry) and cultural factors (acculturative stress and ethnic identity) relate to AUD. Method: The sample of 575 Mexican American men and women (aged 18 to 30) was recruited from San Diego County, California, USA. We assessed the indirect effects of Mexican American ethnic density and distance to the nearest border port of entry, on AUD through acculturative stress and ethnic identity. Multiple group path analysis was used to test sex differences. Results: While sex differences were not observed in the overall model, there were differential associations with focal variables for each group. For women, greater proportions of ethnic density and greater distance to the nearest port of entry were both negatively associated with AUD. For both women and men, acculturative stress was positively associated with AUD, and neighborhood environment indicators were not related to acculturative stress nor ethnic identity. Conclusions: These data may inform further studies to integrate social and cultural mechanisms in creation of placebased strategies for AUD prevention.

INTRODUCTION:High-intensity drinking (HID) poses significant health risks, yet research on its prevalence and contextual factors, among general adult populations, remains limited. To identify intervention points among heavy drinkers, this study compared event-level factors that were associated with higher risk for HID compared to heavy episodic drinking (5+ drinks). METHODS:We surveyed 756 adults (ages 18-65) who engaged in past-year 5+ drinking, answering questions on recent past 12-month drinking events at HED 5-7 drinks and HID 8-11 and 12+ drinks. Bivariate analyses were conducted to compare within-person differences between HED and HID events. Weighted conditional logistic regression models estimated within-person associations between event-specific (e.g., beverage type, day of the week, total hours spent drinking, drug co-use, drinking motives) characteristics and HID drinking levels (8-11 drinks and 12+ drinks separately), versus the HED drinking level (5-7 drinks). RESULTS:Bivariate analyses revealed significant differences for several event-specific characteristics (beverage proportion, total hours, day of the week, group size, tobacco co-use, and drinking motives) between HED 5-7 and HID (8-11 and 12+ drinks). Conditional logistic regression models revealed longer drinking periods and the intention to drink a lot were associated with increased odds of a HID event (8-11 and 12+ drinks) versus a HED event. Drinking in small groups was also associated with increased odds of a HID event (8-11 drinks), while marginally significant for a HID event (12+ drinks). CONCLUSION:Understanding distinct characteristics of HID events compared to HED events provides opportunities to identify prevention and early intervention strategies to reduce HID.

BACKGROUND:Second-wave mutual-help groups (MHGs) for addiction (e.g., SMART Recovery) are prevalent and promising, but limited studies have examined their effectiveness. We examined 1) the comparative effectiveness of second-wave MHGs for supporting alcohol use disorder recovery and 2) correlates of MHG involvement. METHODS:Data were pooled from the Peer ALternatives for Addiction (PAL) Study 2015 and 2021 Cohorts (N = 1152), which recruited adults via collaboration with MHG directors and recovery-related organizations. Eligibility criteria included U.S. residence, lifetime alcohol use disorder, and past-30-day in-person/online attendance at Women for Sobriety, LifeRing, SMART, and/or a 12-step group. Surveys were administered at baseline, 6 months, and 12 months (response rates=81-88 %), and assessed MHG choice (defined using attendance), MHG involvement (5-item scale; e.g., regular/home group, volunteering/service) and alcohol outcomes (below). RESULTS:In lagged, multivariate generalized estimating equations, greater MHG involvement strongly predicted higher odds of alcohol abstinence (OR=2.62, p<.001), lower odds of alcohol problems (OR=0.39, p<.01), and fewer drinking days (IRR=0.12, p<.001) at follow-ups. MHG choice was unrelated to outcomes either alone or in interaction with MHG involvement, suggesting comparable effectiveness for all second-wave MHGs (vs. 12-step). Predictors of greater MHG involvement included older age, a total abstinence (vs. other) goal, and 2015 (vs. 2021) Cohort. CONCLUSIONS:Findings suggest comparable effectiveness for the targeted second-wave alternatives (vs. 12-step) among community members attending MHGs, indicating that alcohol service providers, courts, and policymakers should consider referring to and supporting these alternatives. Still, variation in SMART's program across time and geography suggests caution in interpreting the results for SMART.

Introduction: Multimorbidity, the presence of two or more long-term health conditions in the same individual, is an emerging epidemic associated with increased morbidity and mortality. Continued drinking concurrent with alcohol-related chronic conditions, particularly with multi- morbidity, is likely to further elevate health risk. This study aimed to examine the associations of multimorbidity among diabetes, hypertension, heart disease, and cancer with drinking, and moderation of these associations by age. Methods: Logistic regression modeling was performed in 2023 using a nationally representative sample of U.S. adults from the 2015-19 - 19 National Survey on Drug Use and Health. Multimorbidity was assessed using (1) a count of these conditions and (2) disease-specific fi c categories. The outcomes were past month heavy drinking (7+/14+ drinks weekly) and binge drinking (4+/5+ drinks per occasion) for women and men. Results: A pattern of reduced odds for drinking outcomes associated with a greater degree of multimorbidity was found. This pattern was more apparent in models using the continuous measure of multimorbidity than in those using the categorical measure, and more consistent for binge drinking than for heavy drinking and for women than for men. Significant fi cant age interactions were found: the log odds of heavy drinking and binge drinking for both men and women decreased as the number of conditions increased, and more steeply for those ages 50+ than the younger. The log odds of heavy drinking varied little among men under age 50 regardless of multimorbidity. Conclusions: Alcohol interventions to reduce drinking with multimorbidity, particularly among heavy-drinking men under age 50, are warranted. Am J Prev Med 2024;67(3):407-416. - 416. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Aims High-intensity drinking (HID), extreme drinking considerably above the level of heavy episodic drinking (HED), is associated with long-term health and social consequences. There is limited understanding of HID beyond young adulthood. This study aims to identify concurrent risk factors for HID, comparing age differences among all adults.Methods Multinomial logistic and linear regression modeling was performed using a nationally-representative sample of adults (analytic n = 7956) from the 2015 and 2020 National Alcohol Surveys. The outcomes were any HID of 8-11 drinks and 12+ drinks for men, and 8+ drinks for women, and corresponding frequencies. Concurrent risk factors included coping motive, sensation seeking, simultaneous use of alcohol and cannabis (SAC), and drinking at a bar or party. Analyses were stratified by age (18-29 vs. older) and sex.Results For younger men, sensation-seeking was significantly associated with HID (vs. no HED) at both levels and frequency of HID 8-11 drinks, while drinking to cope was only significant for 12+ drinks. For older men, drinking to cope was a consistent predictor for both HID level and its frequency, but sensation-seeking was not significant. Both coping and sensation-seeking were significantly associated with any HID for all women, while coping was significant for HID frequency for younger women. Frequent drinking at bars and parties were associated with greater odds of HID for all adults. With HED as referent, similar patterns of (though fewer significant) associations were observed.Conclusions Younger and older adults share similar risk factors for HID, with coping more consistent for older men. Short Summary: A coping motive, simultaneous use of cannabis, and frequent drinking at bars and parties were associated with greater odds of high-intensity drinking (HID), both for young adults ages 18-29 and adults >= 30. Sensation seeking was not significant for HID for older men.

Ethnic enclave residence is associated with decreased risk for drinking and related problems, but less is known about the mechanisms that explain this association. Informed by theories of social control, we used a multilevel framework to examine whether negative attitudes toward drinking mediated associations between ethnic enclave residence (i.e., neighborhood linguistic isolation) and alcohol outcomes among Mexican American young adults (N = 628) in Southern California. Model 1 assessed mediation effects in the pathways from linguistic isolation to current drinking and alcohol use disorder (AUD). Model 2 adjusted for parental drinking attitudes and neighborhood alcohol availability. There were differential associations by gender in direct effects of linguistic isolation and negative drinking attitudes on both drinking and AUD. Among women only, linguistic isolation was related to greater abstinence and decreased AUD after accounting for social control proxies of parent attitudes and alcohol availability. Young adults' own drinking attitudes did not mediate relationships between linguistic isolation and alcohol outcomes. This study offers evidence on the importance of disaggregating Hispanic national groups by gender to uncover social mechanisms within ethnic enclave settings for tailored supports in reducing risk of drinking and alcohol-related harms.

BackgroundDespite substantial declines in underage drinking and binge drinking, alcohol consumption has increased in the past 30 years. This study examined how beverage-specific drinking patterns varied by sex, age, and race and ethnicity from 1979 to 2020.MethodsSecondary data analysis was conducted on pooled data from the National Alcohol Survey series from 1979 to 2020 of a sample of U.S. adults ages 18 years or older. Total and beverage-specific volume were calculated from graduated frequency questions on reported beverage type, which included beer, wine, and spirits. Sex-stratified analyses focused on descriptive trends of each alcohol measure over time and by age and race and ethnicity. Time-varying effect models were also conducted to identify subgroups at higher risk for increased consumption over time.ResultsWomen's drinking increased, with alcohol volume rising substantially from 2000 to 2020; the largest increase was among women 30 and older. Men's alcohol volume also rose over this period but remained below the levels of 1979 and 1984, with older adults increasing their consumption those 18-29 decreased their drinking. Beverage-specific trends showed some similarities by gender: in 2020, wine volume was at its highest level for both women and men, while spirits volume also was at its highest level for men and in women was tied with the 1979 peak in spirits consumption. Increases were also found among Black men and women and Latina women from 2000 to 2020.ConclusionsGiven the increases in alcohol volume, particularly among women and older age groups, alcohol policy, interventions, and education should consider ways to reduce harms associated with alcohol use among these groups. Continued monitoring of beverage-specific drinking patterns is needed to track policy-relevant changes.

BACKGROUND:Drinking patterns among young adult men and women in the United States have been understudied, especially among racial and ethnic groups such as Asian Americans and Hispanics. Because alcohol-related racial and ethnic health disparities persist or increase in midlife, identifying peak ages of hazardous drinking could help to reduce disparities.METHODS:We used the National Longitudinal Study of Adolescent to Adult Health to examine: (1) past 12-month heavy episodic drinking (HED) and total alcohol volume consumption among non-Hispanic White (NHW), Black, Hispanic, and Asian men and women from ages 12 through 41, and (2) age-varying associations of race and ethnicity with drinking. Hispanic and Asian ethnic groups were disaggregated by historical drinking patterns. Time-varying effect models accounted for major demographic confounders.RESULTS:NHW men and women experienced elevated drinking rates in their early 20s, with a second elevation in their 30s. Black men and women did not have elevated drinking until their 30s. Among Hispanic men and women, peak drinking periods varied by gender and subgroup drinking pattern. Peak HED and total consumption emerged in the early 30s for Asian men, while peak HED occurred in the early 20s for Asian women. Drinking at certain ages for some racial and ethnic minoritized men and women did not differ from that in their NHW counterparts.CONCLUSIONS:Age periods during which subgroups in the U.S. population experience elevated alcohol consumption vary by ethnicity and gender. Recognition of these group differences could enhance our understanding of intervention timing.