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Objective: The purpose of this study was to estimate the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person’s average lifetime weekly alcohol consumption to assess the impact of per-occasion alcohol consumption on health. Method: Lifetime risks were estimated using a cause-specific modeling approach that combined exposure data from national health surveys, relative risks, population data from the U.S. Census Bureau, mortality data from the Centers for Disease Control and Prevention, and morbidity data from the Institute for Health Metrics and Evaluation. A narrative review assessed the health impact of per-occasion alcohol consumption on health. Results: At low levels of consumption, no protective net effect of alcohol consumption on health was observed. Elevated mortality and morbidity risks were associated with alcohol consumption starting at relatively low levels. Males consuming >6.5 (95% CI [<1, 13.5]) and females consuming >7.0 (95% CI [<1, 11.5]) drinks per week had life-time alcohol-attributable mortality risks >1:1,000. At >8.5 (95% CI [2.5, 13]) drinks per week for both males and females, these risks increased to >1:100. At 14 drinks per week for males (the upper limit of the former Dietary Guidelines for males), the risk of an alcohol-caused death was 1:25 (4%). Drinking patterns also impacted risk. Above 1 drink per occasion, higher consumption was associated with progressively increased risks of breast cancer, cardiovascular disease, and injury. Conclusions: Alcohol consumption, including at what may be perceived as “moderate” levels, is associated with increased mortality and morbidity risks. These results support tightening alcohol use guidance in the United States, for both males and females, to no more than 1 drink per day. Public health significance statement: The Alcohol Intake and Health Study shows that for Americans, even what is socially considered “moderate drinking” increases the risk of dying or developing health problems, helping people better understand the net health impact of alcohol. Furthermore, by identifying the levels of alcohol use that raise the risk of cancer, cardiovascular disease, and injury, these findings can guide individuals, families, and communities in making safer choices about drinking patterns. The results also support changing the U.S. Dietary Guidelines on alcohol to recommend that current adult drinkers consume 1 drink or less in a day.

Objective: We investigated the risk for alcohol use disorder (AUD) and drug use disorder (DUD) in the offspring of parents with major depression (MDD) or bipolar disorder (BD), including how parent and offspring sex impact familial transmission. Method: Offspring born in Sweden during 1970–1990 in intact families with parental MDD or BD (n = 1,218,920) were examined using Swedish population registries. Hazard ratios (HRs) for AUD and DUD risk among offspring were calculated using Cox models. Results: Offspring of one parent with MDD or BD had higher risks of AUD (HR = 1.34; HR = 1.50, respectively) and DUD (HR = 1.32; HR = 1.43, respectively) than offspring of unaffected parents. Maternal MDD (HR = 1.38) had a stronger effect on offspring DUD than paternal MDD (HR = 1.26), and maternal BD (HR = 1.67) more strongly influenced offspring AUD than paternal BD (HR = 1.34). Parental MDD had stronger effects on daughters than sons for AUD (HR = 1.40 vs. HR = 1.32) and DUD (HR = 1.44 vs. HR = 1.27), whereas no sex differences were found for parental BD. Among daughters, maternal MDD had stronger effects than paternal MDD for AUD (HR = 1.48 vs. 1.32) and DUD (HR = 1.56 vs. 1.33); for sons, maternal MDD had a greater impact on DUD (HR = 1.31 vs. 1.23). Maternal BD had greater effects in daughters, both compared with sons for DUD (HR = 1.92 vs. HR = 1.37) and compared with paternal BD for AUD (HR = 1.82 vs. HR = 1.30) and DUD (HR = 1.92 vs. HR = 1.31). Conclusions: Findings demonstrate familial transmission of MDD and BD in parents to AUD and DUD in offspring. Affected mothers may be particularly influential. When sex-specific transmission occurred, it was consistently strongest from mother to daughter. Public health significance statement: This study found that offspring of parents with major depression or bipolar disorder are at increased risk for developing alcohol and drug use disorders compared with offspring of unaffected parents. Risk was especially elevated when the mother was affected, with the strongest patterns seen between mothers and daughters. These findings can inform prevention and intervention efforts, such as targeted support for mothers and daughters and family-focused strategies, to help mitigate the risk of alcohol and drug use disorders.

Objective: This pilot micro-randomized trial (MRT) evaluated the feasibility of the MRT design and compared the acceptability and preliminary impacts of drinking-focused and maternal-focused text messages to inform the development of a tailored, just-in-time adaptive text messaging intervention for postpartum at-risk alcohol use. Method: Postpartum mothers (N = 65) participated in a 28-day MRT. Participants completed ecological momentary assessment (EMA) surveys upon waking (morning survey) at two random times daily (hourly surveys), with an optional night survey (night survey). After each hourly and night survey, participants were randomized to receive either a maternal-focused message, a drinking-focused message, or no message. Check-in surveys assessed intermediate (motivation, maternal self-efficacy, drinking self-efficacy, self-regulation, and craving) and primary (alcohol use) outcomes 15 minutes later. Results: Compliance rates for all survey types exceeded 70%, except for optional night surveys. Participants reported a low burden associated with the MRT. Participants were more likely to rate maternal-focused messages as helpful and evoking positive feelings compared with drinking-focused messages. A significant effect of receiving an intervention message (vs. no message) was found for drinking self-efficacy (DSE), with those who received a message reporting higher DSE than those who received no message, and no difference between message types. Significant time-by-condition interactions revealed that the effect of maternal messages decreased over time, whereas DSE increased over time for the control condition. Conclusions: Findings support the feasibility and acceptability of the MRT design in postpartum mothers with at-risk drinking histories and inform the development of a tailored text messaging intervention for this population. Public health significance statement: Alcohol use during the early postpartum period is an important public health problem that can interfere with a mother’s ability to care for her baby and is associated with increased risk for child abuse and neglect and poor long-term child health and developmental outcomes. Postpartum mothers are often not connected to formal service systems and often do not receive needed help for alcohol use because of the stigma associated with substance use in mothers and fears of child protective services involvement if they disclose alcohol use to a professional. Digital interventions delivered via text messaging have the potential to provide confidential and convenient support to postpartum mothers to reduce risks associated with alcohol use.

Objective: Theories posit that acute alcohol responses predict the development of future heavy alcohol use and alcohol-related problems. The most prominent of these theories is the low-level response theory, which purports that less intense alcohol responses are associated with later development of alcohol use disorder. The counter-modified differentiator model posits that greater stimulant effects with lower sedative effects predict future heavy drinking. The present study provided a concurrent testing of these theories in a large-scale cohort of young adult Swiss men. Method: Data were derived from two waves of the Cohort Study on Substance Use Risk Factors in 2,749 French-speaking, current alcohol-consuming young adult men age 25.7 years at baseline and 28.5 years at follow-up. Participants completed the 6-item Anticipated Brief Biphasic Alcohol Effects Scale with the instructions of the anticipated effects they feel after consuming five standard drinks, and the stimulation and sedation subscales were used in analyses. Associations of these scores with volume of drinking and frequency of heavy episodic drinking were determined both at baseline and at 3-year follow-up. Models were adjusted for covariates, including disinhibited personality and family history of alcohol problems. Results: Results show that anticipated stimulation effects of alcohol predicted increasing alcohol consumption over time, and anticipated sedative alcohol effects predicted reductions in consumption (p values ≤ .001). Conclusions: The present study supported the modified differentiator model in that higher anticipated stimulation and lower sedation predicted future alcohol consumption patterns. This may be useful for preventing heavy drinking and informing pharmacological interventions intended to reduce the pleasurable effects. Public health significance statement: This is the first large general population study of young men showing that not only low-level responses to sedative effects of alcohol may increase future alcohol use, but also high-level responses to stimulating effects. This may be useful to identify high-risk individuals in large-scale surveys or integrated into primary health care screening programs for young adults to prevent the development of alcohol use disorder. It may be helpful to study the effects of pharmacological interventions like naltrexone or acamprosate, intended to reduce the motivation to drink and the pleasurable, positively reinforcing effects. Newer studies indicate that glucagon-like peptide-1 (GLP-1) receptor agonists may hold promise in the reduction of hazardous drinking, potentially by reducing alcohol’s stimulatory and rewarding effects.