Change in non-abstinent WHO drinking risk levels and alcohol dependence: a 3 year follow-up study in the US general population
Change in non-abstinent WHO drinking risk levels and alcohol dependence: a 3 year follow-up study in the US general population
复制标题
DOI：
10.1016/s2215-0366(17)30130-x
复制
发表时间：
2017-06-01
影响因子：
64.3
通讯作者：
Anton, Raymond
中科院分区：
文献类型：
--
作者：
Hasin, Deborah S.;Wall, Melanie;Anton, Raymond
酒精依赖通常未经治疗。虽然戒酒通常是治疗的目标，但许多饮酒者更喜欢减少饮酒的目标。因此，如果有证据支持，减少饮酒的目标可以扩大治疗的吸引力。监管机构正在考虑将非戒酒结果作为临床试验的疗效指标，包括降低世卫组织饮酒风险水平--根据每天平均乙醇消耗量（克）定义的非常高、高、中等和低。我们的目的是研究WHO饮酒风险水平的降低与随后酒精依赖风险降低之间的关系。方法在这项基于人群的队列研究中，我们纳入了2001-02年（第1波）和3年后再次访谈的22005名饮酒者的数据（2004-05;第2波）在美国全国流行病学调查酒精和相关条件。酒精消费（WHO饮酒风险水平）和酒精依赖（在过去12个月内至少有三个DSM-IV标准）在两个波进行了评估。我们使用逻辑回归来检验第一波和第二波之间WHO饮酒风险水平变化与第二波酒精依赖之间的关系。结果在第一波，2.5%（加权比例）的受访者是极高风险饮酒者，2.5%是高风险饮酒者，4.8%是中风险饮酒者，大多数（90.2%）是低风险饮酒者。世卫组织饮酒风险水平的降低预示着第2波酒精依赖的几率显著降低，特别是在极高风险饮酒者中（调整后的比值比为0。27 [95%CI 0.18-0.41]（降低一个水平）、0.17 [0.10-0.27]（降低两个水平）和0.07 [0.05-0.10]（降低三个水平））和高危饮酒者（一个水平为0.64 [0.54-0.75]，两个水平为0.12 [0.09-0.15]），在第1波酒精依赖者中（0.29 [0.15-0.57]对于一个水平，0.06 [0.04-0.10]对于两个水平，0.04 [0.03-0.06]对于三个水平的非常高风险饮酒者）。由于这些风险水平可以很容易地转化为不同国家每天的标准饮酒当量，因此世卫组织的风险水平也可以在国际上用于指导治疗目标和减少饮酒的临床建议。
Background Alcohol dependence is often untreated. Although abstinence is often the aim of treatment, many drinkers prefer drinking reduction goals. Therefore, if supported by evidence of benefit, drinking reduction goals could broaden the appeal of treatment. Regulatory agencies are considering non-abstinent outcomes as efficacy indicators in clinical trials, including reduction in WHO drinking risk levels-very high, high, moderate, and low-defined in terms of mean ethanol consumption (in grams) per day. We aimed to study the relationship between reductions in WHO drinking risk levels and subsequent reduction in the risk of alcohol dependence.Methods In this population-based cohort study, we included data from 22 005 drinkers who were interviewed in 2001-02 (Wave 1) and re-interviewed 3 years later (2004-05; Wave 2) in the US National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol consumption (WHO drinking risk levels) and alcohol dependence (at least three of seven DSM-IV criteria in the previous 12 months) were assessed at both waves. We used logistic regression to test the relationship between change in WHO drinking risk levels between Waves 1 and 2, and alcohol dependence at Wave 2.Findings At Wave 1, 2.5% (weighted proportion) of the respondents were very-high-risk drinkers, 2.5% were high-risk drinkers, 4.8% were moderate-risk drinkers, and most (90.2%) were low-risk drinkers. Reduction in WHO drinking risk level predicted significantly lower odds of alcohol dependence at Wave 2, particularly among very-high-risk drinkers (adjusted odds ratios 0 . 27 [95% CI 0.18-0.41] for reduction by one level, 0.17 [0.10-0.27] for two levels, and 0.07 [0.05-0.10] for three levels) and high-risk drinkers (0.64 [0.54-0.75] for one level and 0.12 [0.09-0.15] for two levels), and among those with alcohol dependence at Wave 1 (0.29 [0.15-0.57] for one level, 0.06 [0.04-0.10] for two levels, and 0.04 [0.03-0.06] for three levels in very-high-risk drinkers).Interpretation Our results support the use of reductions in WHO drinking risk levels as an efficacy outcome in clinical trials. Because these risk levels can be readily translated into standard drink equivalents per day of different countries, the WHO risk levels could also be used internationally to guide treatment goals and clinical recommendations on drinking reduction.