Measuring Alcohol Consumption: Psychosocial and Biochemical Methods

231 Pages·1992·5.78 MB·English

by  Thomas F. Babor

Measuring Alcohol Consumption
Measuring
Alcohol Consumption
Psychosocial and Biochemical Methods
edited by
Raye Z. Litten and John P. Allen
National Institute on Alcohol Abuse and Alcoholism,
Rockville, Maryland
Springer Science+Business Media, LLC
This book is based on a workshop sponsored by the National Institute on Alcohol Abuse and
Aleoholism (NIAAA)
© 1992 The Springer Science+Business Media New York
Originally published by Humana Press Inc. in 1992
Softcover reprint of the hardcover 1s t edition 1992
All rights reserved.
No part of thuis book may be reproduced, stored in a retrieval system, or transmitted in any
form or by any means, electronic, mechanical, photocopying, microfilming, recording, or
otherwise without written permission from the Publisher.
Library of Congreaa Cataloging-in-Publication Oata
Main entry under title:
Measuring aleohol consumption : psychosocial and biochemical methods 1
edited by Raye Z. Litten and John P. Allen.
p. cm.
'Based on a workshop sponsored by the National Institute on
Aleohol Abuse and Alcoholism (NIAAA)'--T.p. verso.
Includes index.
ISBN 978-1-4612-6723-2 ISBN 978-1-4612-0357-5 (eBook)
DOI 10.1007/978-1-4612-0357-5
1. Aleoholism-Diagnosis--Research-Methodology-Congresses.
2. Drinking of alcoholic beverages-Research-Methodology-
Congress. 3. Alcoholism-Physiological aspects-Congresses.
I. Litten, Raye Z. 11. Allen, John P. 111. National Institute on
Aleohol Abuse and Alcoholism (U.S.)
[DNLM: 1. Alcohol Drinking-congresses. 2. Data Collection
methods--congresses. WM 274 M484]
RC565.M3458 1992
616.86'1-dc20
DNLM/DLC
for Library of Congress 92-1536
CIP
Preface
The Importance of Measuring Alcohol Consumption
To date, alcohol studies have attended far more to issues of alco
hol dependence and the harmful consequences of drinking than to the
level of alcohol consumption itself. This is, perhaps, not surprising
since dependence on alcohol is believed to constitute a meaningful
and distinct medical syndrome, regardless of the level of alcohol
consumption associated with it (Edwards and Gross, 1976). Also,
society is generally more concerned with the adverse consequences of
drinking (e.g., traffic fatalities, homelessness, health care and legal
expenses, and academiclbehavioral problems in young drinkers), than
with the quantity of alcohol actually consumed.
Nevertheless, accurate assessment of alcohol usage is important
in its own right in at least four contexts:
1. Evaluating the effectiveness of alcoholism and alcohol abuse
treatment and prevention efforts. Such efforts include both applied
evaluations of existing programs and formal, well-controlled efficacy
studies on experimental interventions. These investigations require
rigorous methodologies to assess outcomes precisely and contrast what
may be quite subtle differences between programs and between pre
treatment and posttreatment outcomes. Although these studies are
usually characterized by the employment of multiple measures of
success-including general improvements in social and physical
functioning, reduction in degree of dependence, and resolution of
problems directly resultant from drinking-it is by their assessment
of changes in drinking behavior that they are potentially able to achieve
the highest level of objectivity and exactitude. The stated goal of
most alcoholism treatment programs in the US is total abstinence, a
condition that can only be validated by exact quantification of alcohol
consumption. For those programs that aim at moderated consumption,
v
vi Preface
it is even more important precisely to measure both pretreatment
drinking and posttreatment levels of consumptuion over time so that
the actual impact of the intervention in achieving its stated goal can be
demonstrated. Though the evaluation of prevention and treatment
programs must include more than assessment of subsequent con
sumption, other outcome variables, such as changes in attitudes, health
status, dependence, and problems ascribed to drinking, are by their
very nature more susceptible to measurement error in that they rely
more heavily on a subject's interpretation and expression of internal
states than does level of consumption. So too, changes in alcohol con
sumption likely correlate with these other outcomes and may predict them.
2. Assessment of the level of alcohol consumption is probably the
single most important component of screening for future alcohol-related
behavioral and medical problems. Other screening indices, be they levels
of hepatic enzymes or verbal admission of alcohol-related difficulties, can
be accurately interpreted only if one knows the subject's level of drinking.
To date, biochemical screening markers, in particular, have tended to be
nonspecific to alcoholism since they are influenced by a variety of other
medical and lifestyle conditions. Commonly used self-report screening
instruments, such as the Michigan Alcoholism Screening Test, focus
primarily on the consequences of alcohol use and on the symptoms of
alcoholism. Since they rarely impose a time frame for the questions,
recovering alcoholics even with years of unintemIpted sobriety or indi
viduals with distant histories of problematic drinking may be expected to
continue to score well within the clinical range. Thus, it is important to
appreciate the significance of other biological and self-report screening
items that will allow the examiner to ascertain the respondent's current
level of alcohol consumption. Interestingly, carefully worded questions
about the level of consumption might also prove less threatening and more
specific and, hence, be more likely to be answered accurately than typical
verbal screening items dealing with others' reactions to one's drinking,
embarrassment, and guilt over drinking.
3. Alcohol consumption, with or without collateral alcoholism, is
itself an important risk factor for a mUltiplicity of serious medical prob
lems (Babor, Kranzler, and Lauerman, 1987) from fetal alcohol effects,
which seem primarily precipitated by acute peak maternal blood alcohol
levels during critical periods of prenatal development (Clarren, Bowden,
and Astley, 1987) to conditions such as coronary artery disease (Altura,
Preface vii
1986), pancreatitis (Van Thiel et al., 1981), and various liver pathologies
(Grant, Dufour, and Harford, 1988), the risks for all of which seem to be
exacerbated with increasing levels of consumption. A quick, inexpensive,
and accurate means of assessing alcohol consumption would greatly assist
primary care physicians in diagnosing medical problems caused or ag
gravated by heavy alcohol use and in advising patients on how their drinking
may be associated with future physical problems.
4. Finally, monitoring alcohol use itself is important in assuring
public safety. Society maintains an interest in total abstinence by airline
pilots, air traffic controllers, railway engineers, and medical personnel on
duty. Similarly, individuals charged with alcohol-related traffic offenses
may be ordered by the Court to refrain completely from drinking for
some period of time as a condition of probation or maintenance of a
restricted driving license. Assurance of abstinence obviously requires an
accurate means of measuring consumption.
To focus attention on methods for measuring alcohol consumption,
the National Institute on Alcohol Abuse and Alcoholism (NIAAA) con
vened a working conference of leading experts. The meeting was held
April 4 and 5, 1991 in Bethesda, MD. The techniques discussed encom
passed a broad range of approaches from direct verbal and collateral
accounts of drinking to complex and innovative biochemical indicators;
from techniques that summate drinking over an extended period of time
to procedures that yield a measure of relatively recent consumption. Not
included in the discussion were methods such as the analysis of blood,
breath, or urine that provide only brief and immediate measures of drink
ing. Each speaker reviewed the status of a particular technique, described
its application in both clinical and research settings, and specified what
research remains still necessary to refine the procedure or make it more
practicable. Those presentations, appropriately enhanced by the fruits of
the discussion, comprise the body of this text.
The second day of the Conference allowed deliberation on compari
sons and contrasts of techniques, broad methodological issues surround
ing applications of the procedures, and strategies for incorporating the
techniques into a range of settings. Salient aspects of their discussion
serve as the foundation for the summary chapter of this text.
Beyond providing investigators a forum in which to discuss their
research and its implications with each other, the Conference was valu
able for NIAAA staff. It allowed proponents of the various techniques to
viii Preface
recommend directions that the Institute might pursue in recommending
methodologies for assessing alcohol consumption in treatment and re
search contexts. This book represents the first formal effort to integrate
and disseminate this information to the broader range of clinical practi
tioners and alcohol researchers.
John P. Allen
Raye Z. Litten
References
B. M. Altura (1986) Introduction to the symposium and overview. Alcoholism
(NY) 10,557-559.
T. F. Babor, H. R. Kranzler, and R. J. Lauerman (1987) Social drinking as ahealth
and psychosocial risk factor: Anstie's limit revisited. Recent Developments in
Alcoholism (M. Galanter, ed.), Plenum, NY,S, 373-402.
S. K. Ciarren, D. M. Bowden, and S. L. Astley (1987) Pregnancy outcomes after
weekly oral administration of ethanol during gestation in the pig-tailed macaque
(Macaca nemestrina). Teratology 35, 345-354.
G.EdwardsandM.M. Gross (1976) Alcohol dependence: Provisionaldescription
of a clinical syndrome. Br. Med. J. 1, 1058-1061.
B. F. Grant, M. C. Dufour, and T. C. Hartford (1988) EpidemiOlogy of alcoholic
liver disease. SemiTUlrs in Liver Disease 8, 12-25.
D. H. Van Thiel, H. D. Lipshitz, L. E. Porter, R. R. Shade, G. P. Gottlieb, and T.
O. Graham (1981) Gastrointestinal and hepatic manifestations of chronic alcoholism.
Gastroenterology 81,594-615.
Contents
v Preface
xi Contributors
PSYCHOSOCIAL MEASURES OF ALCOHOL CONSUMPTION
3 Just the Facts: Enhancing Measurement
of Akohol Consumption Using Self-Report Methods
Thomas F. Babor and Frances K. Del Boca
21 Computerized Approaches to Alcohol Assessment
Douglas R. Gavin, Harvey A. Skinner, and Margo S. George
41 Timeline Follow-Back: A Technique for Assessing
Self-Reported Akohol Consumption
Linda C. Sobell and Mark B. Sobell
73 Using Subject and Collateral Reports
to Measure Alcohol Consumption
Stephen A. Maisto and Gerard I. Connors
BIOCHEMICAL MEASURES OF ALCOHOL CONSUMPTION
99 An Overview
of Current and Emerging Markers of Alcoholism
Alan S. Rosman and Charles S. Lieber
135 Blood and Liver Markers
in the Estimation of Alcohol Consumption
Paul Cushman, Ir.
ix
x Contents
149 Carbohydrate-Deficient Transferrin
and S-Hydroxytryptophol:
Two New Markers of High Akohol Consumption
Stefan Borg, Olof Beck, Anders Helander, Annette Voltaire,
and Helena Stibler
161 Protein-Acetaldehyde Adducts
as Biochemical Markers of Alcohol Consumption
Lawrence Lumeng and Renee C. Lin
183 Measuring Alcohol Consumption
by Transdermal Dosimetry
Michael Phillips
189 Assessment of Ethanol Consumption
with a Wearable, Electronic Ethanol SensorlRecorder
Robert M. Swift and Larry Swette
SUMMARY
205 Measures of Alcohol Consumption in Perspective
John P. Allen, Raye Z. Litten, and Raymond Anton
227 Index
Contributors
John P. Allen • National Institute on Alcohol Abuse and Alcoholism,
Rockville, MD
Raymond F. Anton • Medical University of South Carolina,
Charleston, SC
Thomas F. Babor • University of Connecticut School ofM edicine,
Farmington, cr
Olof Beck • Karolinska Hospital, Stockholm, Sweden
Stefan Borg • St. Gorans's Hospital, Stockholm, Sweden
Gerald J. Connors • Research Institute on Alcoholism,
Buffalo, NY
Paul Cushman, Jr. • Northport Veterans Administration Hospital
Center, Northport, NY
Frances K. Del Boca • University of Connecticut School of Medicine,
Farmington, cr
Douglas R. Gavin • Addiction Research Foundation of Ontario,
Toronto, Ontario, Canada
Margo S. George • University of Ottawa, Ottawa, Canada
Anters Helander • St. Gorans's Hospital, Stockholm, Sweden
Charles S. Lieber • Veterans Affairs Medical Center, Bronx, NY
Renee C. Lin • Indiana University, School of Medicine,
Indianapolis, IN
Raye Z. Litten • National Institute on Alcohol Abuse and Alcoholism,
Rockville, MD
Lawrence Lumeng • Indiana University, School of Medicine,
Indianapolis, IN
Stephen A. Maisto • Brown University Medical School,
Providence, RI
Michael Phillips • St. Vincent's Medical Center ofR ichmond,
Staten Island, NY
xi