Transitions between lifetime alcohol use, regular use and remission: Results from the 2004 South African Stress and Health Survey

Burnhams, Nadine Harker; Bharat, Chrianna; Williams, David R.; Stein, Dan J.; Myers, Bronwyn

doi:10.7196/samj.2018.v109i1.13061

Cited by 10 publications

(11 citation statements)

References 31 publications

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“…Respondents with higher education had decreased odds of every transition (except opportunity, for which those with and SLC had increased odds for females but decreased odds for males). These findings for sex, cohort and education are similar to those from other settings, such as the United States [13], Brazil [12], South Africa [11,25], China [14], New Zealand [15,26] and Northern Ireland [27]; the new data from Nepal provide more evidence that these associations may be consistent across diverse settings.…”

Section: Discussionsupporting

confidence: 82%

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Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking

et al. 2020

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Aims To disaggregate associations with alcohol use disorder relative to those with early alcohol use stages in an adult population. We estimated prevalence rates and socio‐demographic correlates for the opportunity to drink and transitions into life‐time alcohol use, regular use and alcohol use disorder. Design A retrospective, cross‐sectional population survey within a family panel study. Setting Chitwan in Nepal, an ethnically diverse setting with heterogeneous ethnic restrictions regarding alcohol. Participants A total of 10 714 individuals aged 15–59 years (response rate = 93%). Measurements The Nepal‐specific Composite International Diagnostic Interview assessed life‐time alcohol use opportunity, any use, regular use, disorder and socio‐demographic characteristics. Findings Seventy per cent [95% confidence interval (CI) = 69.08–70.82%] of the population had the opportunity to drink, 38.06% (95% CI = 37.14–38.99%) had life‐time alcohol use, 32.37% (95% CI = 31.48–33.27%) had regular alcohol use and 6.04% (95% CI = 5.60–6.50%) developed an alcohol use disorder. Compared with high‐caste Hindus, all other ethnicities had greater odds of early stage transitions [odds ratios (OR) ranged from 1.31, 95% CI = 1.16–1.47 to 1.98, 95% CI = 1.81–2.18)], but not of development of disorder. Male sex was associated with greater odds of all transitions, from opportunity (OR = 5.71, 95% CI = 5.41–6.03) to development of disorder (OR = 1.95, 95% CI = 1.35–2.81). The youngest cohort had higher odds of all transitions, from opportunity (OR = 4.86, 95% CI = 4.47–5.29) to development of disorder (OR = 9.34, 95% CI = 6.88–12.70). Higher education was associated with lower odds of all transitions except opportunity [from use (OR = 0.77, 95% CI = 0.71–0.83) to the development of disorder (OR = 0.73, 95% CI = 0.59–0.89)]. Conclusions The prevalence of life‐time alcohol use among adults in Nepal appears to be low, but the overall prevalence of disorder is similar to other countries. Socio‐demographic correlates of early alcohol use transitions differ from those associated with later transitions; while sex and age cohort were associated with all transitions, ethnicity was associated with early transitions (opportunity, life‐time use, regular use), but not later transitions (use and regular use to disorder).

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Section: Discussionsupporting

confidence: 82%

“…All alcohol use indicators were coded as a dichotomous measure, 0 if the answer was 'never' and 1 if the respondent reported an age of onset for that outcome. 1 These questions to measure opportunity, first use and regular use are standard indicators used in multiple studies and settings [11][12][13][14][15][25][26][27].…”

Section: Alcohol Usementioning

confidence: 99%

Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking

et al. 2020

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“…Whilst the RAPS4 measurement which is a substance-related disorder-screening tool for dependency did not reach significance in this study, the lack of significance can be explained by the findings from a recent publication confirming that the median age of onset of use was around 20 years and that of regular use was at 21 years. The study further found that transitioning from regular alcohol use to alcohol abuse and from abuse to alcohol dependence occurs later in life, generally in the late 40s, and takes people an average of 5 years to transition from regular use to abuse and 7 years to transition from use to dependence [19]. Considering the length of time it takes people to transition to more harmful levels of alcohol use, there is an opportunity to identify regular users of alcohol via screening and to provide them with brief interventions to help them reduce their risk of progressing to abuse or dependence [19].…”

Section: Discussionmentioning

confidence: 75%

“…The study further found that transitioning from regular alcohol use to alcohol abuse and from abuse to alcohol dependence occurs later in life, generally in the late 40s, and takes people an average of 5 years to transition from regular use to abuse and 7 years to transition from use to dependence [19]. Considering the length of time it takes people to transition to more harmful levels of alcohol use, there is an opportunity to identify regular users of alcohol via screening and to provide them with brief interventions to help them reduce their risk of progressing to abuse or dependence [19]. However, careful consideration should be given to evidence for effectiveness of specific interventions [23].…”

Section: Discussionmentioning

confidence: 75%

“…The decision to use the RAPS4 measure was because it has been shown to be effective in detecting alcohol dependence in the past 12 months and would therefore be a measure of dependency whilst heavy episodic drinking may not necessarily indicate dependency but a pattern of drinking that could result in dependency or developing a substance-related disorder. In a recent publication, it was found that transition from use to abuse and dependency was longer for alcohol when compared to other drugs [19]. The RAPS4 has previously been used in one emergency room study in South Africa [20], but no previous studies on its psychometric properties among adolescents have been conducted.…”

Section: Raps4mentioning

confidence: 99%

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Characteristics and Predictors of Heavy Episodic Drinking (HED) among Young People Aged 16–25: The International Alcohol Control Study (IAC), Tshwane, South Africa

Harker

Londani

Morojele

et al. 2020

IJERPH

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In South Africa, little is known about alcohol consumption patterns, such as drinks consumed, container size, salience of alcohol price, affordability and availability, and perceptions of alcohol policies as potential predictors of heavy episodic alcohol (HED) use among young people. This paper examines predictors of HED among young people with specific consideration given to these alcohol consumption patterns. This study conducted in the Tshwane Metropole in 2014 employed multi-stage stratified cluster random sampling. Participants were between the ages 16–25 years. A structured questionnaire was used to collect data. Of the 287 (n = 678) participants who had used alcohol in the past six months and for whom we had complete consumption data, almost half were identified as heavy episodic drinkers (HEDs) and were significantly more likely to consume alcohol on a daily basis (p = 0.001). Having nightclub as the primary drinking location (p = 0.023) and drinking from a container size bigger than one standard drink (p = 0.014) were significant predictors for HED. HEDs were also more likely to have a perception that most people consume alcohol (p = 0.047). The results point to HED of alcohol among young people who drink in South Africa, highlighting the need for multicomponent interventions.

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The role of reward and reinforcement in understanding alcohol use among adults living with HIV in South Africa.

Belus¹,

Rose²,

Andersen³

et al. 2021

Psychology of Addictive Behaviors

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Objective: Most research investigating reinforcement in alcohol use is from high-income countries. The current study sought to understand the association of different reinforcement types (alcohol-specific reward, environmental reward, behavioral activation) with multiple measures of alcohol use and cravings among individuals living with HIV in South Africa. Method: Baseline data were obtained from a substance use clinical trial in Cape Town (N = 65). Unhealthy alcohol use was measured using the biomarker phosphatidylethanol (PEth), Alcohol Use Identification Test (AUDIT-C), average number of drinks from the timeline follow back (TLFB), and self-reported cravings. Reinforcement was measured using the proportion of income spent on alcohol (alcohol-specific reward), both subscales of the Reward Probability Index (environmental reward), and the Behavioral Activation Depression Scale (activation). Poisson and linear regression analyses were conducted. Results: Each percentage point increase in income spent on alcohol was significantly associated with PEth, RR = 1.004 [95% CI (1.001, 1.007)], which translates to a 13.6% increase in the relative risk of unhealthy alcohol use for the average person in the study. More alcohol-specific reward was significantly associated with higher scores on the AUDIT-C, higher average number of drinks on the TLFB, and more cravings. Higher activation was associated with lower scores on the AUDIT-C. Neither subscale of environmental reward was associated with model outcomes. Conclusion: Greater alcohol-specific reward and less behavioral activation were associated with more frequent and unhealthy alcohol use in this setting, but not environmental reward. Findings highlight how different reinforcement types potentially influence alcohol use in a low-resource global setting. Public Health Significance StatementMore money spent on alcohol and less goal-directed behavior were associated with more alcohol use in adult drinkers living with HIV in South Africa. Identifying readily available rewarding opportunities outside of alcohol is needed in a population with very few financial resources and comorbid HIV in South Africa.

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Transitions between lifetime alcohol use, regular use and remission: Results from the 2004 South African Stress and Health Survey

Abstract: This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Cited by 10 publications

References 31 publications

Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking

Predictors of transitions across stages of alcohol use and disorders in an adult population with heterogeneous ethnic restrictions regarding drinking

Characteristics and Predictors of Heavy Episodic Drinking (HED) among Young People Aged 16–25: The International Alcohol Control Study (IAC), Tshwane, South Africa

The role of reward and reinforcement in understanding alcohol use among adults living with HIV in South Africa.

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