Background Cannabis is the most commonly used drug among those who drink, yet no study has directly compared those who use cannabis and alcohol simultaneously vs. concurrently (i.e., separately) in the adult general population. Here we assess differences in demographics, alcohol-related social consequences, harms to self, and drunk driving across simultaneous, concurrent, and alcohol-only using groups. Methods Secondary analyses of the 2005 and 2010 National Alcohol Survey (N=8,626; 4,522 female, 4,104 male), a Computer Assisted Telephone Interview survey of individuals aged 18 and older from all 50 states and DC. Blacks and Hispanics are over-sampled. Data were collected using list-assisted Random Digit Dialing (RDD). Multinomial and multivariable logistic regressions were used for analyses. Results The prevalence of simultaneous use was almost twice as high as concurrent use, implying that individuals who use both cannabis and alcohol tend to use them at the same time. Furthermore, simultaneous use was associated with increased frequency and quantity of alcohol use. Simultaneous use was also the most detrimental: compared to alcohol only, simultaneous use approximately doubled the odds of drunk driving, social consequences, and harms to self. The magnitudes of differences in problems remained when comparing drunk driving among simultaneous users to concurrent users. Conclusion The overall set of results is particularly important to bear in mind when studying and/or treating problems among alcohol/cannabis co-users because they demonstrate that in the general population, co-users are a heterogeneous group who experience different likelihoods of problems relative to co-use patterns.

Aim To review and discuss measurement issues in survey assessment of alcohol consumption for epidemiological studies. Methods The following areas are considered: implications of cognitive studies of question answering such as self-referenced schemata of drinking, reference period and retrospective recall, as well as the assets and liabilities of types of current (e.g. food frequency, quantity-frequency, graduated frequencies and heavy drinking indicators) and life-time drinking measures. Finally we consider units of measurement and improving measurement by detailing the ethanol content of drinks in natural settings. Results and conclusions Cognitive studies suggest inherent limitations in the measurement enterprise, yet diary studies show promise of broadly validating methods that assess a range of drinking amounts per occasion; improvements in survey measures of drinking in the life course are indicated; attending in detail to on-and off-premise drink pour sizes and ethanol concentrations of various beverages shows promise of narrowing the coverage gap plaguing survey alcohol measurement.

The majority of prospective studies on alcohol use and mortality risk indicates that abstainers are at increased risk of mortality from both all causes and coronary heart disease (CHD). This meta-analysis of 54 published studies tested the extent to which a systematic misclassification error was committed by including as 'abstainers' many people who had reduced or stopped drinking, a phenomenon associated with ageing and ill health. The studies judged to be error free found no significant all-cause or cardiac protection, suggesting that the cardiac protection afforded by alcohol may have been over-estimated. Estimates of mortality from heavier drinking may also be higher than previously estimated.

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Significant increases in the prevalence of alcohol use and of binge drinking over the past 10 to 15 years were observed, but not for all demographic groups. However, the increase in binge drinking among middle-aged and older adults is substantial and may be driving increasing rates of alcohol-related morbidity and mortality.

Lifetime abstainers have often been recommended as the comparison group in alcohol epidemiology. The objective of this study was to provide insight into the validity and stability of lifetime abstention by using data derived from the National Alcohol Survey, a national probability survey of US households conducted in 1984, and its 2 follow-up surveys conducted in 1990 and 1992. Results indicated that more than half (52.9%; all proportions were weighted to represent the US population) of those who reported never having a drink of any alcoholic beverage in the 1992 survey reported drinking in previous surveys. Depending on assumptions, this difference may result in an underestimation of alcohol-attributable mortality of 2%−15% in men and 2%−22% in women. Sociodemographic factors differentiated those who consistently reported lifetime abstention across surveys from the rest of the study population. Results suggest that using reported lifetime abstainers as a sole comparison group is problematic, especially if reporting is based on 1 measurement only. Establishing multiple measurement points and including irregular lifetime light drinkers with lifetime abstainers as the comparison group are recommended for future epidemiologic studies.

Aims-The decomposition of trends in alcohol volume and heavy drinking days into age, period, cohort and demographic effects offers an important perspective on the dynamics of change in alcohol use patterns in the US.Design-The present study utilizes data from six National Alcohol Surveys conducted over the 26 year period between 1979 and 2005. Setting-United States.Measurements-Alcohol volume and the number of days when 5 or more and 8 or more drinks were consumed were derived from overall and beverage-specific graduated frequency questions.Results-Trend analyses show that while mean values of drinking measures have continued to decline for those aged 26 and older, there has been a substantial increase in both alcohol volume and 5+ days among those aged 18 to 25. Age-period-cohort models indicate a potential positive cohort effect among those born after 1975. However, an alternative interpretation of an age-cohort interaction where drinking falls off more steeply in the late twenties than was the case in the oldest surveys cannot be ruled out. For women only, the 1956-60 birth cohort appears to drink more heavily than those born just before or after. Models also indicate the importance of income, ethnicity, education and marital status in determining these alcohol measures.Conclusions-Increased heavy drinking among young adults in recent surveys presents a significant challenge for alcohol policy and may indicate a sustained increase in future US alcohol consumption.

Alcohol remains a major contributor to cancer mortality and YPLL. Higher consumption increases risk but there is no safe threshold for alcohol and cancer risk. Reducing alcohol consumption is an important and underemphasized cancer prevention strategy.