Identification of alcohol use disorders among women in the Republic of Khakassia

The article presents results of a regional project to prevent and reduce the prevalence of alcohol consumption among women in the Republic of Khakassia (Eastern Siberia, Russian Federation). In addition to the main preventive goal of reducing alcohol consumption among groups of women covered by the project, there was an objective to conduct screening using the AUDIT test and provide motivational counseling in case of identifying alcohol-related problems. 691 women took part in screening, among them 202 at enterprises of the Republic of Khakassia, and 489 when seeking social/psychological support to the Khakass Republican Branch of the Russian Red Cross, as well as to local branches of the Red Cross in other cities of the Republic of Khakassia. Levels of risk related to alcohol use were identified, based on the results of the screening the studied groups of women. Depending on the risk level, three types of socio-psychological interventions were carried out: informing about harmful consequences of alcohol use and the need to maintain a healthy lifestyle; motivational counseling; motivating women for treatment of dependency.Majority of women who were screened at workplaces were more likely to use alcohol with low risk (78.2%), much smaller proportion of women had risky alcohol consumption (14.4%), alcohol consumption with harmful consequences (2.5%) or signs of alcohol dependency (2.0%). Among women who applied for social and psychological support to branches of the Russian Red Cross, prevalence of low-risk use was lower (43.4%), and risky alcohol use (31.3%), alcohol use with harmful consequences (10.6%) or signs of alcohol dependency (14.5%) were significantly higher.

Exploring the Potential of Implementing Managed Alcohol Programmes to Reduce Risk of COVID-19 Infection and Transmission, and Wider Harms, for People Experiencing Alcohol Dependency and Homelessness in Scotland

People who experience homelessness and alcohol dependency are more vulnerable than the general population to risks/harms relating to COVID-19. This mixed methods study explored stakeholder perspectives concerning the impact of COVID-19 and the potential utility of introducing managed alcohol programmes (MAPs) in Scotland as part of a wider health/social care response for this group. Data sources included: 12 case record reviews; 40 semi-structured qualitative interviews; and meeting notes from a practitioner-researcher group exploring implementation of MAPs within a third sector/not-for-profit organisation. A series of paintings were curated as a novel part of the research process to support knowledge translation. The case note review highlighted the complexity of health problems experienced, in addition to alcohol dependency, including polysubstance use, challenges related to alcohol access/use during lockdown, and complying with stay-at-home rules. Qualitative analysis generated five subthemes under the theme of ‘MAPs as a response to COVID-19′: changes to alcohol supply/use including polysubstance use; COVID-19-related changes to substance use/homelessness services; negative changes to services for people with alcohol problems; the potential for MAPs in the context of COVID-19; and fears and concerns about providing MAPs as a COVID-19 response. We conclude that MAPs have the potential to reduce a range of harms for this group, including COVID-19-related harms.

ADHD and Mental Health Symptoms in the Identification of Young Adults with Increased Risk of Alcohol Dependency in the General Population—The HUNT4 Population Study

Symptoms of ADHD are strongly associated with alcohol use disorders, and mental health symptoms attenuate this relationship. There is limited knowledge about how specific symptoms of inattentiveness and hyperactivity/impulsivity can explain this association. We aimed to identify self-reported executive cognitive functioning and mental health and variables that may help identify subjects with an elevated risk of alcohol dependence in the general population. Data included 3917 subjects between 19 and 30 years old in the 4th Trøndelag Health Study. The Adult ADHD Self report Scale—Screener, the Hospital Anxiety and Depression Scale, and demographic variables were used as input variables. The alcohol screening instrument CAGE was used as the response variable for binary alcohol dependence risk. We used logistic regression and automated model selection to arrive at our final model that identified sex, age, inattentiveness, hyperactivity/impulsivity symptoms, and anxiety as predictors of having a CAGE score ≥2, achieving an area under the receiver operating characteristic curve of 0.692. A balanced accuracy approach indicated an optimal cut-off of 0.153 with sensitivity 0.55 and specificity 0.74. Despite attrition in the data, our findings may be important in the assessment of individual risk for alcohol dependency and when developing algorithms for risk triage in public health.

“Addiction is a strange bastard”: Alcohol(ism) in Irish Fiction

Although it is hard to challenge the claim that alcohol can be considered inherent in Irish culture, the common perception of the fact often feeds on clichés. What helps understand this question is Irish literature. On the one hand, it portrays jubilant festivity to be found in many literary works; on the other, it renders the drama behind alcohol dependency, shifting the focus from joviality towards the more murky aspects of drink consumption, mostly thematised in contemporary literature. This article takes a closer look at how Irish literature renders alcohol use and abuse, and how the literary representations offer a broader perspective, allowing to reconsider some of the stereotypical notions of the proverbial Irish propensity for drink.

Attachment, Rejection Sensitivity, Support, Psychological Capital and Alcohol Dependency in Students

Alcohol dependence evolves from problematic social relations hinged on attachment difficulties and fear of social rejection. This study sought to test an attachment-rejection-relationship model of the development of alcohol dependency. Emerging adults (N=762) of which 69.8%, were female, ranging in age from 18-63 years, took part in an online survey measuring adult attachment, rejection sensitivity, loneliness, social support, psychological capital, and alcohol consumption. Analysis supports the model and shows that individuals with insecure and anxious attachment, fear of social rejection, who experience loneliness and lack of social support, and whose psychological resources are less effective, are more likely to be at risk for alcohol dependency. The role of attachment, rejection and social relations in alcohol consumption point to social problem-solving interventions. Given the childhood origins of attachment problems and fear of social rejection there is a strong case for prevention using social problem-solving.

Occupational Lives in Sustained Recovery From Alcohol Dependency: An Interpretive Phenomenological Analysis

Alcohol use is a significant risk factor for ill health. Although many people complete treatment, only one third maintain their sobriety. Research has suggested that occupational engagement supports early recovery, but its role in sustained recovery is not known. This study aimed to explore the occupational lives of individuals in sustained recovery from alcohol dependency. An interpretive phenomenological analysis methodology was used, utilizing an occupational perspective. Participants were recruited from a substance use recovery center. Data were collected through interviews and analyzed thematically. This study had three participants. Four themes emerged: (a) shaping occupational lives, (b) shifting coping strategies, (c) finding a gateway to new social connections and a sense of belonging, and (d) establishing a new role in the context of recovery. Findings suggest that in sustained recovery, occupations develop new meanings and purposes that have the potential to support recovery.

Increased integrated testing for HIV, hepatitis C and sexually transmitted infections in health care facilities: results from the INTEGRATE Joint Action pilots in Lithuania, Romania and Spain

Background Indicator condition guided HIV testing is a proven effective strategy for increasing HIV diagnosis in health care facilities. As part of the INTEGRATE Joint Action, we conducted four pilot studies, aiming to increase integrated testing for HIV/HCV/HBV and sexually transmitted infections, by introducing and expanding existing indicator condition guided HIV testing methods. Methods Pilot interventions included combined HIV/HCV testing in a dermatovenerology clinic and a clinic for addictive disorders in Lithuania; Increasing HIV testing rates in a tuberculosis clinic in Romania by introducing a patient information leaflet and offering testing for HIV/HCV/sexually transmitted infections to chemsex-users in Barcelona. Methods for implementing indicator condition guided HIV testing were adapted to include integrated testing. Testing data were collected retrospectively and prospectively. Staff were trained in all settings, Plan-do-study-act cycles frequently performed and barriers to implementation reported. Results In established indicator conditions, HIV absolute testing rates increased from 10.6 to 71% in the dermatovenerology clinic over an 18 months period. HIV testing rates improved from 67.4% at baseline to 94% in the tuberculosis clinic. HCV testing was added to all individuals in the dermatovenerology clinic, eight patients of 1701 tested positive (0.47%). HBV testing was added to individuals with sexually transmitted infections with a 0.44% positivity rate (2/452 tested positive). The Indicator condition guided HIV testing strategy was expanded to offer HIV/HCV testing to people with alcohol dependency and chemsex-users. 52% of chemsex-users tested positive for ≥ 1 sexually transmitted infection and among people with alcohol dependency 0.3 and 3.7% tested positive for HIV and HCV respectively. Conclusions The four pilot studies successfully increased integrated testing in health care settings, by introducing testing for HBV/HCV and sexually transmitted infections along with HIV testing for established indicator conditions and expanding the strategy to include new indicators; alcohol dependency and chemsex. HCV testing of individuals with alcohol abuse showed high positivity rates and calls for further implementation studies. Methods used for implementing indicator condition guided HIV Testing have proven transferable to implementation of integrated testing.

The Mortality Crisis

Chapter 6 considers the roots of the mortality crisis that many postsocialist countries faced in the 1990s and the declining life expectancies that some countries continue to face, while others have increased dramatically. It shows how privatization dismantled socialist health care systems leading to significant deteriorations in health outcomes in some countries and how the privatization of previously state-run breweries and distilleries and deregulation of sales led to increased alcohol consumption. The chapter also evaluates rampant alcohol dependency and abuse as a significant factor in declining life expectancy and increasing mortality rates, and points to the psychosocial stress of transition as a major root cause for alcoholism, cardiovascular disease, and suicide.