Nick Heather

The purpose of this study was to provide new knowledge about the temporal and contextual aspects of the alcohol–sport relationship. Eight U.K. student-athletes completed the Alcohol Use Disorders Identification Test in their final year at university, 18 months, and 30 months after graduation. They also completed semistructured interviews about their drinking motives, behaviors, and life circumstances. Results showed that participants reduced their alcohol consumption after leaving university, but despite the onset of some adult responsibilities, most were still drinking at hazardous levels. After university, drinking took place with old friends, new colleagues, and new sporting teammates. At all time points, social drinking motives were the most prevalent. Findings demonstrate a relationship between alcohol and sport that is cemented at university but continues beyond it. Targeted interventions to reduce the role of alcohol in the social experience of sport are needed to support long-term athlete health.

Aims: To examine whether World Health Organization (WHO) risk‐level reductions in drinking were achievable, associated with improved functioning and maintained over time among patients at varying initial alcohol dependence severity levels.Design and settingSecondary data analysis of multi‐site randomized clinical trials: the US Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study and the UK Alcohol Treatment Trial (UKATT).Participants: Individuals with alcohol dependence enrolled in COMBINE (n = 1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n = 742; 74.1% male).InterventionsNaltrexone, acamprosate or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT.Measurements: WHO risk‐level reductions were assessed via the calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol‐related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey) and liver enzyme tests.Findings: One‐ and two‐level reductions in WHO risk levels in the last month of treatment were maintained at the 1‐year follow‐up [adjusted odds ratio (OR), 95% confidence interval (CI) = one‐level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol‐related consequences [e.g. B, 95% CI = one‐level reduction COMBINE: –26.22 (–30.62, –21.82)], better mental health [e.g. B, 95% CI = one‐level reduction UKATT: 9.53 (7.36, 11.73)] and improvements in γ‐glutamyltransferase [e.g. B, 95% CI = one‐level reduction UKATT: –89.77 (–122.50, –57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded.ConclusionsReductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning and maintained over time in both the United States and the United Kingdom.

Outcomes used in alcohol brief intervention trials vary considerably. Achieving consensus about key outcomes can enhance evidence synthesis and improve healthcare guidelines. This international, e-Delphi study sought to prioritize outcomes for alcohol brief intervention trials as part of a larger program of work develop an alcohol brief intervention core outcome set. In total, 150 registrants from 19 countries, representing researchers, policymakers, and patients, participated in a two-round e-Delphi study. In Round 1, participants (n = 137) rated 86 outcomes, derived from a review of the literature and a patient and public involvement panel, by importance. In Round 2, participants (n = 114) received feedback on importance ratings for each outcome, and a reminder of their personal rating, before rating the outcomes for importance a second time. Seven additional outcomes suggested in Round 1 were added to the Round 2 questionnaire. We defined consensus a priori as 70% agreement across all stakeholder groups. Seven consumption outcomes met inclusion criteria: typical frequency, typical quantity, frequency of heavy drinking, alcohol-related problems, weekly drinks, at-risk drinking, and combined consumption measures. Others meeting the threshold were alcohol-related injury, quality of life, readiness to change, and intervention fidelity. This is the first international e-Delphi study to identify and prioritize outcomes for use in alcohol brief intervention trials. The use and reporting of outcomes in future alcohol brief intervention trials should improve evidence synthesis in systematic reviews and meta-analyses. Further work is required to refine these outcomes into a core outcome set that includes guidance for measurement of outcomes.

Borsboom et al.’s formulation provides an opportunity for a fundamental rethink about the “brain disease model” of addiction that dominates research, treatment, policy, and lay understanding of addiction. We also demonstrate how the American opioid crisis provides a contemporary example of how “brain disease” is not moderated by the environmental context but is instead crucially dependent upon it.