谈“酒精滥用”的诊断意义和伦理学问题

随着经济的发展,酒精使用障碍已经成为一个重大的公共卫生问题,对我国居民酒精使用现状的调查迫在眉睫。在流行病学调查中,因我国文化的差异,DSM-IV酒精滥用诊断标准在实际应用时产生分歧,本文举例说明分歧所在,并阐明文化因素在不同诊断系统中的重要影响以及伦理学问题。     

Cycling under the influence of alcohol in Germany

Cyclists have a relatively high risk of being injured in traffic accidents. In Germany, statistics have shown that cyclists injured in police-reported traffic accidents are often found to have cycled with high blood alcohol levels. Relevant research has discussed the ability of the Theory of Planned Behavior (TPB; Ajzen, 1991), deterrence factors, and habitual behavior to predict unsafe and rule-violating behavior in traffic. To promote safer cycling, the relative contributions of these predictors must be determined to design efficient countermeasures. In an online survey, N = 353 participants reported cycling and drinking behaviors for 1 week and answered questions on the TPB, deterrence, and additional predictors. Perceived social norms were quite permissive and perceived behavioral control when cycling under the influence (CUI) of alcohol was quite high. Furthermore, a third of the cyclists reported CUI. Participants with experience of CUI reported having consumed large amounts of alcohol before cycling. High levels of cycling, a permissive attitude, and greater alcohol consumption per drinking episode predicted the number of CUI trips. The amount of alcohol consumed before one CUI trip was predicted by high perceived behavioral control when CUI, a high level of need for stimulation, and higher habitual alcohol consumption per drinking episode. Deterrence factors were found to have no influence on reported CUI. Overall, the findings suggested that Germans who habitually drink a large amount of alcohol are not deterred from CUI in the same manner that they would be from driving under the influence (DUI). The generally permissive perceived social norms did not differentiate between CUI and non-CUI cyclists, which indicated that a societal effort is required to balance the mismatch between CUI and DUI. In addition, changing the general drinking behaviors of highly educated Germans who cycle, would be beneficial for their health.     

Alcohol and aggression without consumption. Alcohol cues, aggressive thoughts, and hostile perception bias

Researchers and the lay public have long known of a link between alcohol and aggression. However, whether this link results from alcohol's pharmacological effects or is merely an artifact of the belief that alcohol has been consumed (i.e., placebo effect) has been debated. The current experiments examined the propensity for alcohol-related cues to elicit aggressive thoughts and hostile perceptions in the absence of alcohol or placebo consumption. In Experiment 1, participants made faster lexical decisions concerning aggression-related words following alcohol-related primes compared with neutral primes. In Experiment 2, participants who first were exposed to alcohol advertisements subsequently rated the behavior of a target person as more hostile than participants who initially viewed control advertisements. Furthermore, this effect was largest among participants who most strongly associated alcohol and aggression. Findings are discussed in terms of semantic network theory and links in memory between alcohol and its anticipated effects.     

DAILY WORK STRESS AND ALCOHOL USE: TESTING THE CROSS-LEVEL MODERATION EFFECTS OF NEUROTICISM AND JOB INVOLVEMENT

Employee alcohol use has been shown to be prevalent and have potential detrimental effects for both employees' health and work outcomes. In this study, we used a daily telephone interview to investigate the relationships between work stress and alcohol use in a sample of Chinese workers. The results from multilevel modeling showed that daily work stress was significantly related to daily alcohol use and desire to drink. Further, there were significant interindividual variations in the work stress–alcohol use/desire to drink relationships that were predicted by neuroticism and job involvement. Both theoretical and practical implications of this study are discussed.     

Impact of the hormonal milieu on the neurobiology of alcohol dependence and withdrawal

Alcoholism, or alcohol dependence, is a complex disorder with withdrawal symptoms that are often problematic for those trying to recover from their dependence. As researchers attempt to elucidate the neurobiological underpinnings of alcohol dependence and withdrawal, it is becoming clear that numerous factors, including the hormonal environment, impact the manifestations of this disorder. Of particular interest is the observation that women have fewer and less severe withdrawal symptoms than do men even though they tend to suffer greater physiological harm from excessive alcohol consumption. In this article, the authors present an overview of their understanding of how gonadal and stress hormones interact with alcohol, which results in differential neurobiological responses between males and females. Thus far, data generated from representative animal models have shown significant differences between the sexes in behavioral responses and neuroadaptations to chronic alcohol consumption and withdrawal. Accumulating evidence suggests that treatment of alcoholism, including withdrawal, should be tailored to the patient's gender and hormonal status.     

湖北省保健干部健康状况主要影响因素分析

为了解保健干部健康状况的主要影响因素,对2003年～2005年湖北省830名保健干部健康体检结果和其主要影响因素进行分析研究,发现性别、年龄、BMI、吸烟、饮酒是影响该人群体检指标的主要因素。为了健康,控制体重、戒烟、限酒,养成好的生活习惯很有必要,这给该人群的健康促进工作指明了重点。     

Web-Based Intervention for Returning Veterans with Symptoms of Posttraumatic Stress Disorder and Risky Alcohol Use

A substantial number of military personnel who have served in Iraq (Operation Iraqi Freedom; OIF) and Afghanistan (Operating Enduring Freedom; OEF) develop symptoms of posttraumatic stress disorder (PTSD) in response to their military experiences and many of these same individuals will drink in a risky or problematic manner following deployment. If left untreated, PTSD symptoms and alcohol problems can become chronic and have a significant, negative impact on the lives of veterans, their families and communities. Further, OIF and OEF service members are often reluctant to seek treatment for mental health symptoms or alcohol problems secondary to stigma. In order to reach this population it is essential that new strategies and venues for delivering evidence-based care are explored. Web-based interventions are uniquely suited to this cohort of veterans in that they have the potential to reach a significant number of veterans who commonly use the Web and who might not otherwise receive care. This article will review the prevalence of PTSD and alcohol problems among OIF and OEF veterans, common barriers they experience with accessing care in traditional mental health settings, and what is known about the effectiveness of Web-based approaches for PTSD and alcohol problems. It also describes the components of a new Web-based intervention, developed by the authors, that uses motivational enhancement and cognitive-behavioral strategies to intervene with returning veterans who report PTSD symptoms and problem drinking. Recommendations for future directions in working with returning veterans with PTSD and alcohol problems will be offered.     

Contingent reinforcement of lowered blood-alcohol levels in an outpatient chronic alcoholic

Recently. the proposition that alcohol abuse is an operant behavior and thus functionally related to its consequences has been investigated under experimental conditions. In controlled laboratory settings, in which inpatient chronic alcoholics are allowed access to alcoholic beverages, alcohol consumption has been markedly altered via operant strategies. Monetary rewards (Cohen et al., 1971), the opportunity to participate in an enriched environment (Cohen et al., 1971). and visits to a girlfriend (Bigelow et al., 1973) have been used as reinforcers for decreased drinking.Other investigators (Sulzer, 1965; Miller, 1972: Hunt and Azrin, 1973) have successfully applied similar contingency management techniques to alcoholics in the natural environment. However, failure to control for the influence of extraneous therapeutic variables (e.g., attention-placebo factors, job counseling) together with reliance on self-report measures of drinking behavior seriously limit the conclusiveness of these results. Objective assessment is particularly essential with operant techniques since consequent events must be systematically scheduled upon the occurrence or non-occurrence of drinking. Documentation of drinking in the natural environment is a difficult task since the alcoholic frequently consumes alcohol when he is alone. In lieu of direct observation, blood alcohol concentrations are an obvious means of objective assessment. Such data are most conveniently obtained via breath tests similar to the ones that law enforcement officers utilize to identify intoxicated motorists.The purpose of the present study was to investigate the influence of reinforcement contingencies on lowering blood alcohol concentrations obtained in an alcoholic's natural environment.     

Implicit and Explicit Attitudes to Alcohol in Alcohol Dependent and Non-Alcohol Dependent Samples

Measures of implicit and explicit attitudes to alcohol have been used to predict drinking behavior. Early studies with the bipolar Implicit Association Test (IAT) indicated that heavy drinkers hold negative implicit attitudes to alcohol. More recent studies using the unipolar IAT have found that positive implicit attitudes to alcohol are associated with drinking behavior in samples of university students. The present study is the first to use a unipolar single target IAT to assess positive alcohol-related attitudes in two samples with alcohol dependency compared to a non-alcohol dependent control group. A group of recently detoxed alcohol dependent adults entering a treatment program (n?=?22), a group of alcohol dependent adults who had been in treatment for 3 months (n?=?22), and a group of age matched adults who had no history of alcohol dependence (n?=?22) were compared on a positive unipolar single target IAT and an explicit attitude measure. Results indicated that alcohol dependent participants showed stronger positive implicit attitudes, and stronger negative explicit associations compared to non-alcohol dependent participants, but there were no differences between the two groups with alcohol dependency. The findings are discussed in terms of the role of the IAT as an assessment tool for those undertaking treatment for alcohol problems and the implications for targeting unconscious attitudes to alcohol in a clinical setting.     

Why do people behave immorally when drunk?

Alcohol intoxication is a major source of antisocial behavior in our society, strongly implicated in various forms of interpersonal aggression. Yet, moral philosophers have paid surprisingly little attention to the literature on alcohol and its effects. In part, this is because philosophers who have adopted a more empirically informed approach to moral psychology have gravitated toward moral sentimentalism, while the literature on alcohol intoxication fits very poorly with the sentimentalist account. Most contemporary research on the psychological effects of alcohol is focused upon variants of the “disinhibition” theory, which suggests that alcohol does not provoke any specific affect, it merely weakens executive control. This research, we argue, lends support to a deontic moral psychology, which identifies our ability to suppress behavioral impulses as a central feature of moral agency.     

The Multiple, Distinct Ways that Personality Contributes to Alcohol Use Disorders

There is little question of whether personality is associated with problematic alcohol involvement (such as alcohol use disorders; AUDs); it clearly is. However, the question remains: how or why is personality related to risky drinking and AUDs? To address this question, theoretical models have been posited regarding the causal effects of personality on alcohol use and related problems. In this article, several of these models are summarized and reviewed. Future research directions are discussed, including possible frameworks that serve to integrate various models of the personality–AUD relation.     

Possible contributors to the gender differences in alcohol use and problems

Research on alcohol use and problems has demonstrated a much higher rate of alcohol use disorders (AUDs) among men compared with women. The authors review the most frequently researched biological and psychosocial factors that may play a role in the gender differences in alcohol use and problems. Among the biological factors, women might carry a lower genetic risk for AUDs and tend to suffer more negative biological consequences from drinking as compared with men. Regarding psychosocial factors, men appear to be more likely than women to manifest certain risk factors for alcohol use and problems (e.g., fewer perceived social sanctions for drinking, positive expectancies for alcohol use, personality traits such as impulsivity) and have fewer protective factors. Although these findings have helped to explain some of the gender differences in alcohol use and problems, there are inconsistencies in the literature. Additionally, many studie may not have enough statistical power to detect gender differences. The authors suggest that the biological and social consequences of alcohol abuse for women may be especially potent protective factors against AUDs and discuss the possibility of public health campaigns developed on the basis of this idea.     

Expectancies About the Effects of Alcohol on the Self and on Others as Determinants of Alcohol Policy Attitudes1

The present study brings together 2 separate lines of research in the alcohol field: alcohol expectancies and policy attitudes. Expectancies concerning the short- and long-term effects of drinking (e.g., aggression), were predicted to be stronger determinants of support for alcohol availability control when the target person was another, compared to when discussing effects of one's own drinking. In a population-based survey conducted in 1992, 804 current drinkers were asked about self and other alcohol expectancies, as well as attitudes toward various alcohol policies. Results showed a distinct self-other discrepancy, with people more likely to expect alcohol to have a greater effect over others than over themselves. Further, it was found that these other-expectancies were among the strongest predictors of favoring tighter alcohol controls. These findings lend support to findings of a self-other bias in social psychology, and provide insight as to the structure of public opinion on alcohol policy.     

Influence of Holy Month Ramadan on Alcohol Consumption in Turkey

This study utilizes a balanced panel data set covering 50 monthly observations regarding the brewery products to examine the impact of holy month Ramadan on alcohol consumption in Turkey. In addition to the Ramadan, temperature, prices of the products and disposable income are other demand factors which are taken into account in this study. As expected, the Ramadan has been found to be associated with lower alcohol usage. As price of alcoholic drinks increases, the alcohol consumption decreases significantly. In addition, alcohol consumption rises with the enhancements in the disposable income. However, surprisingly, the temperature has not any significant effect on alcohol consumption in Turkey.     

A Review of REBT Research in Alcohol Abuse Treatment

Clinical outcome studies have shown that cognitive-behavioral approaches to alcohol abuse are efficacious. As the research continues to be refined, practitioners can work with clients based on better science. REBT practitioners have developed a number of theoretical and treatment manuals to promote better practice. The empirical literature on REBT treatment for alcohol abuse does not provide strong evidence of its effectiveness. The present article comprehensively reviews the REBT outcome literature and identified six studies. Of these, three met the inclusionary criteria. The findings demonstrated change in endorsement of irrational thinking, with limited behavioral change. Limitations of the present research base for alcohol abuse are discussed and suggestions offered for conducting and reporting REBT research on alcohol abuse.     

Substance abuse and panic-related anxiety: a critical review

The relationship between substance abuse and panic-related anxiety can be divided into two broad areas: the incidence of anxiety disorders in substance abuse patients and the incidence of substance abuse in patients with panic-related anxiety disorders. Studies indicate that approx. 10-40% of alcoholics have a panic-related anxiety disorder, and about 10-20% of anxiety disorder patients abuse alcohol or other drugs. The majority of patients with both an anxiety and alcohol disorder report that anxiety problems preceded alcohol problems. In some cases substance abuse (e.g. cocaine) triggers the onset of panic attacks. Most patients believe that self-medication is efficacious despite the fact that they appear to have a more serious clinical condition (e.g. higher rates of depression). Directions for future research are outlined, including the proposal for a study to examine the effects of an anxiety intervention procedure for anxious alcoholics to reduce relapse rates.     

Alcohol consumption by college women following exposure to unsolvable problems: Learned helplessness or stress induced drinking?

Three experiments were intended to examine the relationship between alcohol, depression and learned helplessness. In Study I, more female undergraduate heavy drinkers than light drinkers were found to have critically elevated scores on a depression index. A sex difference in the relationship between drinking and depression is suggested since male depressives were equally distributed among drinking categories. In Studies II and III, female undergraduates were given unsolvable problems in a learned helplessness paradigm. Relative to controls these subjects reported increased depressive and hostile affect and drank more beer in a taste rating task. However, we failed to find deficits in anagram solution with those subjects given the learned helplessness manipulation. Specific questions are raised regarding the boundary conditions of learned helplessness while implications bearing on stress-related alcohol consumption are discussed.     

Drinking practices among black and white alcoholics and alcoholics of different personality types

In order to examine the effects that race and personality type have on self-reported drinking practices, samples of 49 White and 49 Black male alcoholics were matched on age and education, and classified into two personality types according to MMPI scores. The results of multivariate and univariate analyses of variance yielded significant main effects. White alcoholics reported a greater: (a) use of alcohol for symptomatic relief of psychological distress, (b) loss of motor control and tendency to engage in destructive acts, and (c) daily consumption of beverage alcohol than Black alcoholics. Alcoholics with psychiatric-appearing MMPI profiles reported greater: (a) social benefits of alcohol use, (b) alcohol use for symptomatic relief of psychological distress, and (c) perceptual distortions associated with alcohol withdrawal than alcoholics with characterlogical-appearing MMPIs. Results were discussed in terms of need to control confounding effects of biosocial variables in cross-cultural research and implications that these effects may have on the generalizability of alcoholic personality typologies.     

Drinking Practices Among Black and White Alcoholics and Alcoholics of Different Personality Types

In order to examine the effects that race and personality type have on self-reported drinking practices, samples of 49 White and 49 Black male alcoholics were matched on age and education, and classified into two personality types according to MMPI scores. The results of multivariate and univariate analyses of variance yielded significant main effects. White alcoholics reported a greater: (a) use of alcohol for symptomatic relief of psychological distress, (b) loss of motor control and tendency to engage in destructive acts, and (c) daily consumption of beverage alcohol than Black alcoholics. Alcoholics with psychiatric-appearing MMPI profiles reported greater: (a) social benefits of alcohol use, (b) alcohol use for symptomatic relief of psychological distress, and (c) perceptual distortions associated with alcohol withdrawal than alcoholics with characterlogical-appearing MMPIs. Results were discussed in terms of need to control confounding effects of biosocial variables in cross-cultural research and implications that these effects may have on the generalizability of alcoholic personality typologies.     

Traits that define the different alcohol intensive consume type during the practice of "botellon"

There is a phenomenon contributing to the current pattern of alcohol consumption among youngsters in Spain known as "botellon". From research financed by the National Plan on Drugs (2004-2007), data of 6009 youngsters (14-25 years old) were collected from three Spanish cities. Only individuals who engage in intensive consumption of alcohol (n = 2807) have been included. The purpose of this work has been to identify the different types of consumers at risk through a cluster analysis and to establish a profile for each particular group. Four groups were differentiated by age, gender, alcohol consumption and years of consumption. It was observed that adolescent students and university students of the same sex consume similar quantities of alcohol, and justify their consumption alluding to personal factors, whereas university students refer to issues related to control of leisure. The consumption by males is the highest, and they are the most likely to seek drunkenness. They associate to a lesser degree their consumption with the possibility of developing an addictive process. In general, all youngsters consider that their consumption will have no negative consequences. These results indicate the need to come up with different alternatives, addressing the particularities of each group.