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Background Research has consistently shown that early onset of drinking (EOD) is associated with alcohol-related problems in adulthood. However, recent reviews have identified several limitations in the early onset literature, including the use of retrospective reports, insufficient control for potential confounders, ambiguous definitions of the concept, and an assumption that early onset is independent of cultural norms and national alcohol policies. This study addresses these limitations by examining whether EOD, independent of early onset of excessive drinking (EOE), prospectively predicts hazardous drinking in late adolescence/young adulthood in Norway and Australia, two countries with different drinking cultures. Methods Data were drawn from two population-based longitudinal studies; the Norwegian Tracking Opportunities and Problems Study ( n  = 329) and the Australian International Youth Development Study ( n  = 786). Data were collected prospectively from mid adolescence (14–16 years) to late adolescence/young adulthood (18–25 years) and a modified Poisson regression approach was used to estimate prevalence ratios. Adolescent self-reports included measures of EOD and EOE. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT). The results were adjusted for adolescent factors; age, gender, impulsivity, hyperactivity, conduct problems, smoking, early sexual intercourse and friends’ substance use, and family factors; alcohol and drug use in the family, maternal education, family management and monitoring. Results Hazardous drinking was identified in 46.8 and 38.9% of young adults in Norway and Australia, respectively. Both EOD and EOE in adolescence were significantly related to an increased risk of alcohol-related problems in late adolescence/young adulthood in both studies, even when adjusting for possible confounders. Conclusion Our findings indicate that adolescent drinking behaviour is an indicator of alcohol-related problems in late adolescence/young adulthood, even when controlling for a variety of covariates. This finding is in contrast to previous research on older adults, where no association between adolescent drinking and later alcohol-related problems were found when controlling for covariates. The divergence in findings may suggest that the impact of EOD/EOE is limited to the late adolescent and young adult period. Preventing drinking in early adolescence may thus have some impact on the drinking patterns in late adolescence/young adulthood.

Purpose We explored factors predicting repeated or hazardous alcohol use among autistic and non-autistic U.S. youth ages 16 to 20 years. Methods Autistic (n = 94) and non-autistic (n = 92) youth completed an online survey. By design, half of each group reported past-year alcohol use. We compared drinking patterns for autistic and non-autistic youth, and within each group between abstinent or infrequent drinkers (0–1 drinking episodes in past year) versus those who drank 2 + times in past year. Results Autistic (vs. non-autistic) youth who drank did so less frequently and consumed fewer drinks per occasion. However, 15% of autistic youth who drank in the past year reported heavy episodic drinking and 9.3% screened positive for AUDIT-C hazardous drinking. For autistic youth only, a diagnosis of depression, bullying or exclusion histories were positively associated with drinking 2 + times in the past year. Autistic youth who put more effort into masking autistic traits were less likely to report drinking 2 + times in the past year. As compared to non-autistic youth, autistic participants were less likely to drink for social reasons, to conform, or to enhance experiences, but drank to cope at similar rates. Conclusion Repeated and hazardous underage alcohol occur among autistic youth. Targeted prevention programs designed to address the specific drinking profiles of autistic youth are needed.

Background Hazardous drinking is a big problem in China, but there are no effective intervention measures to solve this issue. This study aimed to evaluate the effectiveness of the WeChat-based mini-program “Sober Time ACT” in the hazardous drinking population. Methods A prospective two-arm randomized controlled trial (RCT) was conducted via WeChat between March and November 2023. A total of 186 participants with hazardous drinking were included and randomized in a 1:1 ratio. The intervention group ( n  = 93) received the “Sober Time ACT” program, and the control group ( n  = 93) received alcohol abstinence brochures for 4 weeks. The primary outcome measure was the change in craving before and after the intervention. Secondary outcomes included changes in average weekly alcohol consumption and average number of risky drinking days per month, as well as psychological indicators (depression, anxiety, sleep status, and perceived stress). Intention-to-treat (ITT) analyses were applied. Sensitivity analysis was conducted using the expectation–maximization (EM) and the multiple imputation (MI) methods to handle missing data. Repeated measures ANOVA and linear regression models were used to evaluate all outcome indicators. Results The analysis revealed statistically significant time-by-group interaction effects for alcohol craving ( P  = 0.01), average weekly alcohol consumption ( P  = 0.03), anxiety levels ( P  = 0.03) and perceived stress ( P  < 0.05). The intervention group showed a significantly greater reduction in cravings from baseline to the end of follow-up compared to the control group with a group difference ( P  = 0.02 for EM and P  = 0.01 for MI). Conclusions These findings provide preliminary prospective evidence that, despite the limitation of high dropout rate, the “Sober Time ACT” mini-program not only effectively reduces alcohol craving and consumption but also improves related psychological indicators to a certain extent, providing an innovative and effective intervention tool for addressing hazardous drinking in China. Trial registration The study was registered on ClinicalTrials.gov (NCT05827822) in March 2023.

Rationale Emerging evidence suggests that the α4β2 form of the nicotinic acetylcholine receptor (nAChR) modulates the rewarding effects of alcohol. The nAChR α4β2 subunit partial agonist varenicline (Chantix™), which is approved by the Food and Drug Administration for smoking cessation, also decreases ethanol consumption in rodents (Steensland et al., Proc Natl Acad Sci U S A 104:12518–12523, 2007 ) and in human laboratory and open-label studies (Fucito et al., Psychopharmacology (Berl) 215:655–663, 2011 ; McKee et al., Biol Psychiatry 66:185–190 2009 ). Objectives We present a randomized, double-blind, 16-week study in heavy-drinking smokers ( n  = 64 randomized to treatment) who were seeking treatment for their smoking. The study was designed to determine the effects of varenicline on alcohol craving and consumption. Outcome measures included number of alcoholic drinks per week, cigarettes per week, amount of alcohol craving per week, cumulative cigarettes and alcoholic drinks consumed during the treatment period, number of abstinent days, and weekly percentage of positive ethyl glucuronide and cotinine screens. Results Varenicline significantly decreases alcohol consumption ( χ 2  = 35.32, p  < 0.0001) in smokers. Although varenicline has previously been associated with suicidality and depression, side effects were low in this study and declined over time in the varenicline treatment group. Conclusions Varenicline can produce a sustained decrease in alcohol consumption in individuals who also smoke. Further studies are warranted to assess varenicline efficacy in treatment-seeking alcohol abusers who do not smoke and to ascertain the relationship between varenicline effects on smoking and drinking.

Background: One of the best-known tools in screening for hazardous drinking is the Alcohol Use Disorders Identification Test (AUDIT) and its abbreviated form, the AUDIT-C. The aim of the present study is to determine the cut-offs of both instruments in identifying hazardous drinking in older adults. Method: A sample of 1577 older adults completed a questionnaire regarding alcohol behavior. Hazardous drinking was defined as drinking >10 units/week. Receiver operating characteristics (ROC) curves of AUDIT and AUDIT-C were calculated and cut-off scores were derived. Results: Respectively 27.3% and 12.3% of older men and women drank >10 units/week. For the AUDIT the best trade-off between sensitivity and specificity was using a cut-off of ≥5 for men and ≥4 for women, which yielded in men sensitivity and specificity values respectively of 80.7% and 81.3% and in women 100% and 71.7%, respectively. We found the AUDIT-C to perform well with an optimal cut-off of ≥5 for men and ≥4 for women, which generated in men sensitivity and specificity values respectively of 76.5% and 85.3% and in women 100% and 74.1%, respectively. Conclusion: The AUDIT-C is accurate and sufficient in screening for hazardous drinking in community-dwelling older adults if the cut-offs are tailored by gender.

Background The alcohol harm paradox (APH) posits that alcohol harms are more prevalent in low socioeconomic position (SEP) groups compared to high SEP groups, when adjusted for alcohol consumption volume. Aim We explored whether APH is valid for self-reported alcohol harms and whether SEP differences in hazardous drinking patterns may explain SEP differences in alcohol harms, accounting for consumption volume. Data and methods We applied cross-sectional data from national population surveys in Norway, restricted to a subsample of past month drinkers aged 25–79 years ( n  = 8 171). Two binary outcome measures of self-reported alcohol-related harms were constructed from the AUDIT-10 items 4 through 10; alcohol dependence symptoms and alcohol related consequences. We separated two SEP groups based on education level: low versus high. Employing logistic regression models, we examined the extent to which SEP differences in alcohol-related harms were attributable to a more hazardous drinking pattern in terms of: (i) heavy episodic drinking and (ii) proportion of consumption volume by spirits, adjusting for consumption volume and demographic characteristics. Results In the low SEP group, alcohol-related harms were significantly more prevalent as compared to the high SEP group when adjusted for gender and age, and more so after adjustment for consumption volume. Measures of hazardous drinking pattern and having a spouse could only to a minor extent account for the elevated risk of alcohol-related harm in the low SEP group. The findings were robust across various sensitivity analyses. Conclusion Low SEP was associated with alcohol-related harm and a more hazardous drinking pattern but also with lower consumption volume. The findings support the validity of the alcohol harm paradox for self-reported alcohol harms.

Addiction is a multifaceted disorder driven by complex neurobiological and psychological mechanisms. The Addictions Neuroclinical Assessment (ANA) framework offers a dimensional mechanistic approach, focusing on three core domains: incentive salience, negative emotionality, and executive function. This study aimed to validate the ANA framework in relation to hazardous drinking using a machine learning approach, with the hypothesis that incentive salience and negative emotionality would be most strongly associated with drinking severity. We analysed two independent datasets: a cohort of 1260 nonclinical community-based adults ascertained in 2016-2018 and a cohort of 655 young adults reporting regular binge drinking ascertained in 2017-2018. The three ANA domains were operationalized using behavioural and self-report measures. Four machine learning models (elastic net, support vector machines, random forest, and gradient boosting machines) with nested five-fold cross-validation were used to assess relations between ANA domains and hazardous drinking as measured via the Alcohol Use Disorder Identification Test (AUDIT), a validated screening instrument. Across both datasets, elastic net consistently outperformed other models. Incentive salience, largely reflecting alcohol's reinforcing value, was most robustly related to AUDIT score ( = 0.389-0.419), followed by negative emotionality ( = 0.293-0.317), largely reflecting drinking to cope. Executive function, reflecting impulsivity and inhibitory control, accounted for less variance ( = 0.098-0.109). Optimizing elastic net models via meta-learner further improved performance, explaining more than half of the variance ( = 0.539-0.549). These findings may not generalize to individuals who are older or have severe AUD. Cross-sectional data limits longitudinal causal inferences. These results provide robust computational validation for the ANA framework, emphasizing incentive salience and negative emotionality as key domains linked to AUDIT score. Future research should explore diagnostic and longitudinal applications.

Background Alcohol consumption is a significant public health concern among young people worldwide. While alcohol use is culturally embedded in many Nepalese communities, evidence regarding the prevalence of problematic drinking and its associated factors remains scarce among youths. This study aims to assess the prevalence of alcohol consumption and problematic drinking and their associated factors among management undergraduate students of Bhaktapur, Nepal. Method A cross-sectional study was conducted among 304 undergraduate students in Bhaktapur, Nepal. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess problematic drinking. Pearson’s chi-square test and multivariable logistic regression analysis were performed to determine factors associated with alcohol consumption and problematic drinking, at the 5% level of significance. Results The prevalence of alcohol consumption was 58.2% (95% CI:52.0-63.6%), with 26.6% (95% CI: 19.2–33.1%) exhibiting problematic drinking. Being male (aOR: 2.05, 95% CI:1.11–3.76), dissatisfaction with academic performance (aOR: 2.43, 95% CI:1.35–4.38), and alcohol preparation at home (aOR: 2.54, 95% CI: 1.20–5.40) were associated with alcohol consumption. Problematic drinking was linked to male gender (aOR: 4.03, 95% CI: 1.71–9.46), living in a joint family (aOR: 2.40, 95% CI: 1.09–5.29), poor perceived emotional support from family (aOR: 4.94, 95% CI: 1.50-16.26), and traumatic experience (aOR: 2.68, 95% CI: 1.19–6.02). Conclusion This study revealed the concerning prevalence of alcohol consumption and dependency among Nepali undergraduate students. These findings highlight the need for comprehensive interventions targeting gender, the family environment, and academic factors to address alcohol misuse among Nepali youth.

College student drinking is prevalent and costly to public and personal health, leading to calls to identify and target novel mechanisms of behavior change. We aimed to manipulate drinking identity (a cognitive risk factor for hazardous drinking) via three sessions of narrative writing about a future self. We tested whether writing could shift drinking identity and would be accompanied by changes in alcohol consumption and problems. Participants were college students meeting hazardous drinking criteria (N = 328; Mage = 20.15; 59% women, 40% men, 1% gender-diverse; 60% white; 23% Asian; 12% multiple races; 2% other racial groups; 8% identified as Hispanic/Latino/a/x). The study had a 2 [narrative writing topic: low-risk drinker vs. reduced smartphone use] × 2 [writing perspective: first person vs. non-first-person] × 2 [social network instruction: instructed to include vs. not] factorial design. Outcomes were drinking identity, drinking refusal self-efficacy, alcohol consumption, alcohol-related problems, and craving. Participants completed three writing sessions and online follow-up assessments at 2, 4, and 12 weeks. The study is a registered clinical trial; hypotheses and analyses were preregistered (https://osf.io/vy2ep/). Contrary to predictions, narrative writing about a future self as a low-risk drinker did not significantly impact outcomes. Null results extended to expected interactions with writing perspective and social network instructions. The narrative writing task did not shift drinking or alcohol-related outcomes. Future experimental work may benefit from greater flexibility in conceptualizing a future self, recruiting individuals interested in behavior change, and more sensitive measures of drinking identity. •Drinking identity is a robust predictor of hazardous drinking among college students.•We aimed to shift drinking identity via three writing sessions about a future self.•We also tested whether writing would change alcohol consumption and problems.•Results were null.•Future tasks should allow more flexibility for conceptualizing a future self.

Hazardous drinking, defined as the consumption of homemade, unofficially made alcohol and non-beverages, is prevalent and accounts for a high proportion of alcohol-related deaths in Russia. Individual-level characteristics are important explanations of hazardous drinking, but they are unlikely to explain spatial variation in this type of alcohol consumption. Areas that attracted insufficient attention in the research of hazardous drinking are the legacy of industrialization and the speed of economic reforms, mainly through the privatization policy of major enterprises in the 1990s. Applying mixed-effects logistic regressions to a unique dataset from 30 industrial towns in the European part of Russia, we find that in addition to individual-level characteristics such as gender, age, marital status, education, social isolation, labor market status, and material deprivation, the types of towns where informants’ relatives resided such as industrial structure and speed of privatization also accounted for the variance in hazardous alcohol consumption among both male and female populations of the analyzed towns.