Do Racial and Ethnic Minority Drinkers Have More Alcohol Consequences than White Drinkers?

Researchers analyzed National Alcohol Survey data from 4080 current drinkers (69% white, 19% black, and 12% Hispanic) to assess racial differences in alcohol dependence symptoms and social consequences and to determine whether self-reported social disadvantages (e.g., poverty, unfair treatment, and racial/ethnic stigma) explained any observed racial differences. Heavy drinking* was stratified into the following categories: none/low (69%), moderate (21%), and high (10%).



  • More black (11%) and Hispanic (12%) than white (6%) participants had 2 or more alcohol dependence symptoms.

  • More black (13%) and Hispanic (15%) than white (9%) participants had 1 or more alcohol-related social consequences (accidents; arguments/fights; or health, legal, and workplace problems).

  • In separate adjusted analyses, black and Hispanic participants were significantly more likely than white participants to have 2 or more alcohol dependence symptoms (if they reported “none/low” or “moderate” heavy drinking), and to have 1 or more alcohol-related social consequences (the “none/low” category only).

  • Adding social disadvantages to the models did not change the results.

*In this study, a composite variable was used to define past-year heavy drinking based on 3 indicators: frequency of 5+ drinks in a single day, frequency of subjective drunkenness, and maximum number of standard drinks in a single day.


Comments by Tom Delaney, MSW, MPA
Those involved in program planning and clinical services for black and Hispanic populations will find this study a useful reference. The authors strongly suggest the need for additional investigations to support these results, but they are an important reminder of the need to factor in biological markers and sociologic and cultural factors in treatment.

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The Impact of Peer and Adult Modeling on Impaired Driving in Teenagers

Motor vehicle accidents are the leading cause of death for young people, and up to 40% involve substance-related impairment. To better understand the factors contributing to impaired driving in this age group, investigators administered anonymous questionnaires to 994 urban and 1600 rural 10th and 12th grade students on Vancouver Island, Canada. Of the sample, 1192 students had driving permits that required adult supervision and limitations on the number of nonrelatives in the car.



  • Just over half of students reported riding in a car with an adult who had been drinking, and one-fifth to one-third reported driving with an adult who had smoked cannabis.

  • One-fifth to one-third of students reported riding with a peer driver who had been drinking, and about one-third had ridden with a cannabis-impaired peer driver.

  • Of students with driving permits, up to one-fifth reported driving after drinking or after smoking cannabis. More favorable attitudes towards these substances were associated with increased driving after use.

  • Riding with impaired peers was independently associated with increased driving after substance use.

  • Driving after substance use was highest in youth who reported more frequent experiences of riding with adults who drank alcohol or used cannabis while driving.

Comments by Tom Delaney, MSW, MPA
Although this large study analyzes how drug use and drinking behavior by adults can influence the driving decisions of young people, it has important implications for the prevention and treatment of alcohol and drug addiction in other populations. Peers influence many decisions across the life span. This article reminds counselors of the importance of recognizing the role of peer influence in treatment and prevention.


Comments by Peter D. Friedmann, MD, MPH, Associate Editor, Alcohol, Other Drugs, and Health: Current Evidence
The influence of peers and parents on adolescent behavior is well-described, but this study suggests that peer and adult modeling of risky driving has synergistic effects on adolescents' likelihood of impaired driving. Although this study cannot discern whether the adults drove after drinking “under the limit,” children riding with them are unlikely to make such distinctions. In addition to counseling teens about the dangers of driving alone or with peers under the influence of drugs or alcohol, physicians are in a good position to counsel parents about driving after substance use and its risks to themselves and their children, regardless of amounts. 

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Referral to Mandated Alcohol Intervention with College Students Suggests Policy and Clinical Options

This article reports on the findings of a study of college students who were sanctioned for alcohol-related incidents and referred to a university-sponsored alcohol and drug assistance program. The aim of the study was to examine whether mandated assistance programs significantly reduced drinking in the time between the alcohol-related violation and the start of the assistance program.


Only those students with a 30 day or longer interval between the 2 events were included in the study. The sample consisted primarily of white students attending a large state college in the Northeast, 15% of whom were referred by police, emergency medical services, or hospital emergency services, and 85% of whom were referred by Resident Assistants (RAs).



  • Students referred to the treatment program significantly reduced their drinking after the violation and before the time of assessment in the program.

  • Students who had received a legal or medical referral reduced their alcohol consumption significantly more than those referred by RAs.

Comments by Tom Delaney, MSW, MPA
These findings suggest that referral to a student assistance program after an alcohol incident reduces drinking in college students. These findings may help college administrators better allocate resources to reduce student drinking that results in alcohol-related violations on college campuses. In addition, as the authors point out, knowing such students had already made significant changes in their drinking habits at intake provides counselors with a valuable opportunity to reinforce successful harm reduction strategies and adapt the type and intensity of intervention based on that knowledge.

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The Presence — or Absence — of mu-Opioid Receptor as a Predictor of Naltrexone Response in the Treatment of Alcohol Dependence

This article reports the results of a large scale study that analyzed the treatment of alcoholism with naltrexone for patients with and without the gene Asp40. The study followed subjects undergoing treatment at 11 academic medical sites. All participants received medical management and some received “combined behavioral intervention.” Half of the patients received naltrexone and the other half received placebo.


Patients treated with naltrexone for alcohol abuse who had at least one copy of the Asp40 allele showed an increasing trend in abstinence over time, while results of naltrexone treatment in those without the Asp40 allele was similar to placebo, showing fewer abstinent days over time. No significant differences were seen between outcomes for naltrexone patients with medical management regardless of whether or not they received behavioral counseling.


The study does not make a conclusion as to the impact of combined behavioral intervention but notes that such interventions “may obscure meaningful biological effects of genes on which a specific medication can act.”


In summary, the article reports that patients with the gene Asp40 responded positively to naltrexone with or without additional behavioral intervention.


Comments by Tom Delaney, MSW, MPA
Alcoholism counselors are seeing an increasing number of studies, reports, and marketing data indicating that naltrexone is an effective medication for the treatment of alcohol abuse. The question of which patients might be better served by this treatment has often not been raised. Alcoholism counselors should be encouraged that this question is being addressed in large, robust, and controlled studies. This study also provides a window to glance at the potential for gene studies to contribute to the treatment of alcohol abuse.

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Methadone Maintenance Plus Syringe Exchange Reduces HIV and HCV Incidence

Sharing syringe and other injection equipment places injection drug users (IDUs) at risk for bloodborne infections like HIV and HCV. Needle exchange plus methadone maintenance may lower the chance of these infections, although few studies have examined this possibility. Therefore, researchers in Amsterdam assessed the effects of the combination of these strategies among 714 injection drug users at risk for HIV or HCV.



  • Over 20 years of follow-up, neither methadone maintenance alone nor needle exchange alone was significantly associated with HIV or HCV seroincidence, 

  • However, daily methadone maintenance of ≥60 mg plus no drug injection or injection only with exchanged needles (all in the past 6 months) significantly reduced both HIV and HCV seroincidence (adjusted incidence rate ratios 0.43 and 0.36, respectively, when compared with no methadone maintenance and drug injection without exchanging needles).

Comments by Tom Delaney, MSW, MPA
This study supports HIV and HCV prevention strategies that include both methadone treatment and needle exchange. Counselors can use these findings as evidence-based advice to clients who may be otherwise inclined to use only methadone treatment or clean needles, but not both.


Comments by Peter D. Friedmann, MD, MPH, Associate Editor of Alcohol, Other Drugs, and Health: Current Evidence
This study provides prospective evidence that a long-term, comprehensive public strategy to reduce bloodborne infections among IDUs must include both syringe exchange and opioid agonist therapy at effective dose levels. Although most relevant to policy in countries with recent outbreaks of HIV and HCV among IDUs, these findings are also applicable to communities in the United States that lack adequate access to opioid treatment programs and/or syringe exchange. 

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Feasibility of a Smoking Cessation Intervention in Substance Abuse Treatment Programs

Many patients in treatment for substance use disorders smoke. However, treatment for nicotine dependence in substance abuse treatment settings is uncommon.

Researchers in this study evaluated the feasibility of implementing a smoking cessation intervention in substance abuse treatment programs. They surveyed the program directors, research directors, and 1,442 patients from 13 different sites.


  • Smoking prevalence was 76%. It was higher at sites that provided methadone (87% versus 66% at sites without methadone) and at sites located in a setting with medical services (85% versus 63% at sites without medical services).
  • Most (78%) smokers were interested in quitting, and 64% were willing to enroll in smoking cessation treatment. Interest in quitting and willingness to enroll in smoking cessation treatment were both more common at the sites that provided methadone (e.g., 77% versus 48% willing to enroll) and at sites located in a setting with medical services (e.g., 73% versus 45% willing to enroll).
  • Obstacles to performing a smoking cessation intervention identified by the sites included the time commitment by staff, and scheduling conflicts and low motivation among patients.
Comments by Tom Delaney, MSW, MPA:
These findings are useful for alcohol and drug counselors looking to implement smoking cessation efforts in different treatment settings. Such counselors should be encouraged by the high proportion of patients who want to quit smoking and should be mindful of and address the potential obstacles identified in this study as they design cessation interventions.

Comments by Julia H. Arnsten, MD, MPH, Associate Editor of Alcohol, Other Drugs, and Health: Current Evidence:
Smoking is highly prevalent among patients in substance abuse treatment. Although barriers to implementing smoking cessation interventions may exist, these patients, particularly those receiving methadone, are very interested in quitting smoking. Methadone maintenance programs may offer a unique means of integrating nicotine dependence treatment with substance abuse treatment.

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Health Plans' Requirements for Mental Health and Substance Use Screening

Most health plans cover some treatment for mental health and substance use disorders, but too few people who need these services receive them. Limited requirements for screening and identification of these disorders partially explain this gap in treatment.


Researchers in this study assessed how many health plans required mental health and substance use screening in primary care. They looked at data from a survey of 434 health plans in 1999 and 368 health plans in 2003.



  • The proportion of health plans that required screening for mental health or substance use disorders did not substantially change from 1999 (32%) to 2003 (34%).
  • Of plans with a screening requirement, there was an increase in the proportion that required alcohol screening (from 33% in 1999 to 78% in 2003) and drug screening (from 8% to 78%).

Comments by Tom Delaney, MSW, MPA:
According to this article, only a minority of healthcare plans mandate screening, although the proportion of these plans requiring alcohol and drug screening is increasing. As screening in primary care becomes more common (partly because of increases in health plan requirements), counselors may find patients more willing to discuss their mental health and substance use. Given the stigma and denial associated with alcohol and drug use diseases, patients may disclose a history of their use more readily if the subject had already been broached by their primary care physician. A counselor, therefore, may be able to facilitate her discussions with patients by first asking if they have been screened by their physicians.


Comments by Peter D. Friedmann, MD, MPH, Associate Editor of Alcohol, Other Drugs, and Health: Current Evidence:
Health plan mandates and reimbursement for substance use screening would encourage primary care physicians to take a greater role in identifying, managing, and referring patients with substance use disorders. The finding that only one-third of health insurance products in 1999 and 2003 required screening for mental health or substance use disorders highlights missed opportunities to improve detection and intervention. Although tracking adherence to such a requirement might be challenging to insurers, the recent addition of procedure codes for substance use screening and brief intervention promises to provide a mechanism for reimbursement and monitoring in the future.

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