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PubMedDate not supplied

Drinking by alcoholic cirrhotic patients under medical care: a literature survey.

In order to gain a broader perspective on the natural course of drinking by alcoholic cirrhotic patients receiving medical care, the medical and surgical literature from 1963 through 1982 was surveyed for prospective studies of patients with alcoholic cirrhosis in which follow-up drinking data were reported. Eleven studies with 1,039 patients were summarized. The patients were mostly urban men, averaging about 50 years old, treated in municipal, Veterans Administration, and university hospitals for either decompensated cirrhosis or for portal hypertension and bleeding varices; follow-up periods ranged from less than 1 to 10 years. The clinical investigators in the studies used various means to assess drinking and to categorize drinking behaviors, and expressed caution regarding validity. Between series, from 20 to 53% of the patients were reported to be abstinent from alcohol during the clinical follow-up periods. In five studies (373 patients) where the extent of drinking was determined, from 21 to 35% of the patients were reported to be drinking in a reduced or moderate manner, and from 17 to 42% to have resumed heavier drinking. The rates of improvement in drinking reported for the cirrhotic patients under medical care compare favorably to those for middle-aged male clients after alcoholism treatment, but the variables that predict course and outcome cannot be fairly compared between "medical" and alcoholism treatment populations. The substantial reduction or cessation of drinking reported in these large series of alcoholic cirrhotic patients over long follow-up periods may simple represent the natural, terminal course of alcoholism in the presence of severe liver disease; concomitantly, improvement may reflect the favorable impact of an alcohol-related disease and continued medical care on changing drinking behaviors.

Alcohol Drinking↗
PubMed1995

Relationships between socioeconomic status and drinking problems among black and white men.

We sought to examine the relationships between socioeconomic status and drinking problems within the Black and White male populations. A two-way interactions of social class with race/ethnicity, and with drinking consequences and alcohol dependence symptoms was hypothesized among drinkers. Drinking problems were regressed on social class, race/ethnicity, age, alcohol consumption, and drinking settings. Social class was based on a composite of respondent's income, education, and main wage earner's occupation. Two types of drinking problems were analyzed: drinking consequences and alcohol dependence symptoms. Our hypothesis was partially confirmed. Interactions of social class with race/ethnicity and with drinking problems were observed. Less affluent Black men reported greater numbers of drinking consequences and total drinking problems than less affluent White men; the reverse was true for affluent Black and White men. Results suggest that the relationships between socioeconomic status and drinking problems may vary by race/ethnicity.

Adult↗
PubMed1995

Style, consumption, and problem drinking: a measurement model.

Yu and Williford (J. Drug Issues 22:75-90, 1992) report from a structural study that drinking style is the best predictor of problem drinking. This study further examines a measurement model on drinking style, alcohol consumption, and problem drinking. Four measures are specified for drinking style, three for alcohol consumption, and two for problem drinking. The maximum-likelihood procedure through the LISREL program is used to reproduce the observed correlations by allowing correlations among systematic measurement errors. Strong associations are noted among drinking style, alcohol consumption, and problem drinking. The analysis suggests that the style of drinking should be included in research on problem drinking. Implications of the findings and future research issues are discussed.

Adult↗
PubMed1978

Systemic angiotensin-induced drinking in the dog: a physiological phenomenon.

1. Intravenous infusion of the individual components of the renin-angiotensin system caused drinking in dogs in water balance. 2. Angiotensin II was the most potent and rapidly acting peptide inducing drinking. The minimum effective rate of infusion was between 8.3 and 16.6 X 10(-12) mole kg-1 min-1 which yield blood levels of angiotensin II that fell well within physiological limits for the dog and were mildly pressor. Angiotensin I and synthetic renin substrate caused less drinking than angiotensin II, and angiotensin III was the least effective dipsogen. 3. Renin caused significant drinking when infused I.V. at a rate of 0.5 u. min-1 for 15 min. Drinking was slower in onset and continued for longer than after other components of the renin-angiotensin system. 4. Within the dose range 1875-15,000 X 10(-12) mole of angiotensin II the amount of water drunk depended more on the rate of infusion than on the duration of the infusion. 5. During an I.V. infusion of angiotensin II lasting 2 hr, the rate of drinking was greatest during the first 15 min. After this declined progressively. 6. A delay of 1 hr after the start of an intravenous infusion of angiotensin II before access to water was allowed, did not significantly reduce the amount of water drunk. Nor did infusion of isotonic saline for 105 min reduce drinking in response to a subsequent infusion of angiotensin II. However, a preload of dilute milk approximately equal in volume to the amount of water normally drunk in response to I.V. angiotensin II significantly reduced drinking. Therefore the dog stopped drinking during long-term infusions of angiotensin II owing to the action of satiety mechanisms and not to tachyphylaxis or fatigue. 7. Intracarotid infusion of angiotensin II, angiotensin I, synthetic renin substrate and angiotensin III, at 40 X 10(-12) mole min-1 also caused drinking. Intakes of water were similar to the intakes after I.V. infusion at six times the arterial rate, except that angiotensin I was relatively less effective by intracarotid infusion than by I.V. infusion. 8. Renin, infused at 0.5 u. min-1 for 15 min, was much less effective by intracarotid infusion than by intravenous. 9. These results are compatible with a role for circulating angiotensin II in the thirst of hypovolaemia or moderate extracellular dehydration.

Angiotensin II↗
PubMed1981

Drinking and changes in blood pressure in response to angiotensin II in the pigeon Columba livia.

1. Angiotensin II is as potent a stimulus to drink in pigeons as it is in mammals. There are striking similarities in the action of this peptide in pigeons and mammals. 2. Angiotensin II injected intracranially, I.V. or I.P. consistently caused short-latency and vigorous drinking in pigeons but no other behaviour. Drinking was completed rapidly and intakes were very large, sometimes in excess of 10% of the bird's body weight. 3. The latency to drink and the amount drunk were dose dependent for all routes of injection. Angiotensin II was most effective when injected directly into the brain. As little as 10(-4) mol angiotensin II injected into the cerebral ventricles caused birds to drink. 4. The rapid cessation of drinking after intracranial injection of angiotensin II was not caused by rapid loss of activity of the peptide in the brain but by the actual ingestion of the water. 5. The brain sites most sensitive to the dipsogenic action of angiotensin II in the pigeon were the dorsal and ventral third ventricle, the tissue adjacent and anterior to these sites, and the lateral ventricles. The lateral hypothalamic area was only slightly less sensitive. Negative sites for drinking were found in the lateral forebrain and the hind brain. These findings are similar to those in mammals. 6. Pigeons drank during I.V. infusion of as little as 16 X 10(-12) mol angiotensin II kg-1 min-1. This was near the threshold for increasing arterial pressure in pigeons and is near the threshold for drinking in rats and dogs. 7. The Asn1, Asp1, Val5 and Ile5 analogues of angiotensin II were equipotent as stimuli to drink but a wide range of other peptides and drugs injected into the brain failed to increase water intake. An exception was eledoisin which was, comparing molecule with molecule, only 10-100 times less potent than angiotensin II in the pigeon. 8. Injections of angiotensin II into brain sites which caused drinking failed to alter heart rate or arterial pressure in pigeons. 9. This and other recent studies demonstrate the wide phylogenetic distribution of the dipsogenic action of angiotensin II and support the idea that the control of water intake is an important physiological function of the renin-angiotensin system in vertebrates.

Angiotensin II↗
PubMed1992

The location of the receptors involved in the human diuretic response to drinking an isotonic electrolyte solution.

1. This study aimed to shed light on the receptors involved in the diuretic response to drinking isotonic fluids in man by employing a polyethylene glycol-based bowel lavage solution (Golytely) which is reported to cause no net movement of fluid across the gut. 2. Drinking Golytely resulted in a transient hypotonic diuresis. Mean urine flow rose from control values of 0.9 ml min-1 to 10.1 ml min-1 70 min after the start of drinking. The increase in urine output was accompanied by a fall in urine osmolality from control values of 879 mosM kg-1 to 105 mosM kg-1. The diuresis is similar to that produced by ingestion of an equal volume of an absorbable electrolyte-based solution (Tyrode). 3. Neither solution produced changes in plasma osmolality or electrolytes, but Golytely provoked a 6.8% contraction of plasma volume, whereas drinking Tyrode resulted in plasma expansion. Copious diarrhoea was experienced by all subjects who drank Golytely solution and by none on drinking Tyrode solution. 4. The infusion of Golytely into the stomach resulted in a hypotonic diuresis similar in magnitude to that elicited by drinking. Drinking with simultaneous aspiration of gastric contents ('sham-drinking') did not produce a significant diuresis. 5. Plasma arginine vasopressin (AVP) levels did not fall following the drinking of Golytely. The assay used was sufficiently sensitive to measure changes of 0.6 pg AVP (ml plasma)-1. 6. The findings show that signals from the oropharynx do not mediate the diuretic response to drinking Golytely in man and that a mechanism other than inhibition of AVP release appears to be involved. The receptors mediating this response may lie in the stomach and/or small bowel since Golytely is not absorbed, as evidenced by the contraction of plasma volume and diarrhoea.

Adult↗
PubMed1990

Angiotensin II mediates drinking elicited by eating in the rat.

Captopril (CA) was used to block synthesis of endogenous angiotensin II (ANG II) in periphery and/or brain of adult male Sprague-Dawley rats in tests for drinking elicited by eating pelleted chow. Blockade of ANG II-converting enzyme (ACE) in periphery alone (using 0.5 mg/kg CA) increased drinking elicited by eating, whereas simultaneous blockade of ACE in periphery and brain (using subcutaneous 100 mg/kg CA or subcutaneous 0.5 mg/kg plus third ventricular 25 micrograms CA) decreased such drinking. The inhibitory effect of 100 mg/kg CA on water-to-food ratio was prevented by a dipsogenically subthreshold subcutaneous dose (5 micrograms/kg) of ANG II. Blockade of ACE in brain alone (third ventricular 25 micrograms CA) had no effect on food-related drinking. Pharmacological antagonism of ANG II (100 mg/kg CA) together with antagonism of histamine H1 and H2 receptors (using intraperitoneal dexbrompheniramine and cimetidine) were not additive in their inhibitory effects on drinking elicited by eating. Blockade of ACE (100 mg/kg CA) inhibited drinking elicited by subcutaneous histamine, but blockade of histamine receptors failed to inhibit drinking elicited by subcutaneous ANG II. These results support a role for endogenous ANG II under what appear to be physiological conditions for drinking behavior, i.e., when drinking is elicited by eating, and they suggest the working hypothesis of ANG II mediation of a histaminergic mechanism for food-related drinking in the rat.

Angiotensin II↗
PubMed1999

Effect of individual or combined ablation of the nuclear groups of the lamina terminalis on water drinking in sheep.

The subfornical organ (SFO), organum vasculosum of the lamina terminalis (OVLT), and median preoptic nucleus (MnPO) were ablated either individually or in various combinations, and the effects on drinking induced by either intravenous infusion of hypertonic 4 M NaCl (1.3 ml/min for 30 min) or water deprivation for 48 h were studied. Ablation of either the OVLT or SFO alone did not affect drinking in response to intravenous 4 M NaCl, although combined ablation of these two circumventricular organs substantially reduced but did not abolish such drinking. Ablation of the MnPO or MnPO and SFO together also substantially reduced, but did not abolish, drinking in response to intravenous hypertonic NaCl. Only near-total destruction of the lamina terminalis (OVLT, MnPO, and part or all of the SFO) abolished acute osmotically induced drinking. The large lesions also reduced drinking after water deprivation, whereas none of the other lesions significantly affected such drinking. None of these lesions altered feeding. The results show that all parts of the lamina terminalis play a role in the drinking induced by acute increases in plasma tonicity. The lamina terminalis appears to play a less crucial role in the drinking response after water deprivation than for the drinking response to acute intravenous infusion of hypertonic saline.

Animals↗
PubMed2003

The global distribution of average volume of alcohol consumption and patterns of drinking.

AIMS: To make quantitative estimates on a global basis of exposure of disease-relevant dimensions of alcohol consumption, i.e. average volume of alcohol consumption and patterns of drinking. DESIGN: Secondary data analysis. MEASUREMENTS: Level of average volume of drinking was estimated by a triangulation of data on per capita consumption and from general population surveys. Patterns of drinking were measured by an index composed of several indicators for heavy drinking occasions, an indicator of drinking with meals and an indicator of public drinking. Average volume of consumption was assessed by sex and age within each country, and patterns of drinking only by country; estimates for the global subregions were derived from the population-weighted average of the countries. For more than 90% of the world population, per capita consumption was known, and for more than 80% of the world population, survey data were available. FINDINGS: On the country level, average volume of alcohol consumption and patterns of drinking were independent. There was marked variation between WHO subregions on both dimensions. Average volume of drinking was highest in established market economies in Western Europe and the former Socialist economies in the Eastern part of Europe and in North America, and lowest in the Eastern Mediterranean region and parts of Southeast Asia including India. Patterns were most detrimental in the former Socialist economies in the Eastern part of Europe, in Middle and South America and parts of Africa. Patterns were least detrimental in Western Europe and in developed countries in the Western Pacific region (e.g., Japan). CONCLUSIONS: Although exposure to alcohol varies considerably between regions, the overall exposure by volume is quite high and patterns are relatively detrimental. The predictions for the future are not favorable, both with respect to average volume and to patterns of drinking.

Alcohol Drinking↗
PubMed2006

Water-induced thermogenesis reconsidered: the effects of osmolality and water temperature on energy expenditure after drinking.

CONTEXT: A recent study reported that drinking 500 ml of water causes a 30% increase in metabolic rate. If verified, this previously unrecognized thermogenic property of water would have important implications for weight-loss programs. However, the concept of a thermogenic effect of water is controversial because other studies have found that water drinking does not increase energy expenditure. OBJECTIVE: The objective of the study was to test whether water drinking has a thermogenic effect in humans and, furthermore, determine whether the response is influenced by osmolality or by water temperature. DESIGN: This was a randomized, crossover design. SETTING: The study was conducted at a university physiology laboratory. PARTICIPANTS: Participants included healthy young volunteer subjects. INTERVENTION: Intervention included drinking 7.5 ml/kg body weight (approximately 518 ml) of distilled water or 0.9% saline or 7% sucrose solution (positive control) on different days. In a subgroup of subjects, responses to cold water (3 C) were tested. MAIN OUTCOME MEASURE: Resting energy expenditure, assessed by indirect calorimetry for 30 min before and 90 min after the drinks, was measured. RESULTS: Energy expenditure did not increase after drinking either distilled water (P = 0.34) or 0.9% saline (P = 0.33). Drinking the 7% sucrose solution significantly increased energy expenditure (P < 0.0001). Drinking water that had been cooled to 3 C caused a small increase in energy expenditure of 4.5% over 60 min (P < 0.01). CONCLUSIONS: Drinking distilled water at room temperature did not increase energy expenditure. Cooling the water before drinking only stimulated a small thermogenic response, well below the theoretical energy cost of warming the water to body temperature. These results cast doubt on water as a thermogenic agent for the management of obesity.

Adult↗
PubMed1984

A "reverence for strong drink": the lost generation and the elevation of alcohol in American culture.

Over one-half of famous American authors with reputations for drunkenness were born between 1888 and 1900. Although college students of their generation seem to have been "drier" than earlier or later cohorts, many of the writers were already drinking heavily in college. Several reasons are suggested. After World War I, many fledgling authors spent time in Paris, becoming known as the "lost generation" and adding French and other drinking styles to their existing drinking patterns. Bohemian Americans during Prohibition found a resonance with the residual political symbolism of drinking in France as a statement of autonomy against the state. The community of expatriate writers provided a supportive environment for heavy drinking. In turn, the lost generation became a transmitter of new values concerning drinking to American culture in general. Their writings inadvertently promoted mass middle-class tourism to Paris in the late 1920s. Their lives and works strengthened the association between writing and drinking as a model for later literary generations. Both in written form and as films, their works conveyed an attractive image of drinking and often of drunkenness to the wider public. The decisive shift in drinking patterns among middle-class youth in the late 1920s ushered in a lasting change in the cultural position of drinking, as it became a cosmopolitan, progressive and eventually respectable behavior. At a minimum, the writers of the lost generation served as harbingers, carriers and catalysts of this change.

Alcohol Drinking↗
PubMed1986

Drinking patterns of inner-city black Americans and Puerto Ricans.

Alcoholic patients--183 Black Americans (62 women) and 132 Puerto Ricans (18 women)--at an inner-city alcoholism treatment program were surveyed using the Drinking History Questionnaire. Significantly more Puerto Rican men than Black men reported drinking distilled spirits, daily drinking, drinking in the morning to relieve a hangover, shakes when sobering up, blackouts when drinking, convulsions after a bout, psychoperceptual withdrawal symptoms and alcohol-related marital difficulties. Puerto Rican women were significantly older at the first time of drunkenness than the other groups. These women tended to drink at home daily and they reported a surprisingly high mean alcohol consumption. Significantly more Black women reported drinking to make friends. The tendency for Blacks to drink with their spouse, and to encourage their spouse to drink, was a major finding. This finding may have clinical implications for treatment and suggests that in lower class Black alcoholics a careful history of the drinking patterns of the spouse or living companion should be taken to determine the proper treatment approach.

Adaptation, Psychological↗
PubMed1987

Drinking at a southern university: its description and correlates.

A sample of 100 undergraduate students at a southern college campus were employed to answer computer-administered questions once a week for 20 weeks. This facility was used to collect both intensive and comprehensive data to describe respondents' drinking and its correlates. Although women were somewhat less likely to be abstainers than were men, women were disproportionately represented among moderate-only drinkers and men were overrepresented among heavy drinkers. The data indicate that the change in respondents' reported drinking was quite volatile in the transition from high school to college. Heavy-drinking college students reported that they drank in bars accompanied by friends. Different types of drinkers (e.g., moderate, infrequent, heavy) attributed different motives to drinking as well as to sometimes abstaining, but they held similar antialcohol beliefs. The drinking-related variables of friends explained more of the variance in respondents' drinking than did those of their parents. However, the variance explained by the parents' drinking-related variables was increased when statistical interactions involving family cohesion and control were included. The variance explained by the friends' drinking-related variables was also greater when interactions with respondents' spending money were included. There was a small positive correlation between socioeconomic status and drinking. The only variables to decrease this relationship when statistically controlled were the drinking-related variables of significant others.

Adolescent↗
PubMed1997

The relationship of drinking and hangovers to workplace problems: an empirical study.

OBJECTIVE: This article reports on the relationship between drinking patterns and workplace problems in a manufacturing facility operated by a Fortune 500 industry. METHOD: The data come from a survey of 832 hourly employees (88% male) and from ethnographic research in the plant. This study is distinctive because it examined a large random sample of workers, rather than an impaired subpopulation. Moreover, the study is among the few that has asked employees how much they drank prior to and during working hours and how frequently they had been hungover at work. Respondents were also asked about their overall alcohol consumption and their experience of various problems in the workplace. RESULTS: Bivariate analyses indicated that overall drinking, heavy drinking outside of work, drinking at or just before work and coming to work hungover were related to the overall number of work problems experienced by respondents, and to specific problems such as conflicts with supervisors and falling asleep on the job. Multivariate analyses revealed that workplace drinking and coming to work hungover predicted work-related problems even when usual drinking patterns, heavy drinking and significant job characteristics and background variables were controlled. Overall drinking and heavy drinking outside the workplace did not predict workplace problems in the multivariate analyses. The analyses show that workplace problems were also related to age, gender, ethnicity, work shift and departments. Survey results are explicated with findings from a plant ethnography. CONCLUSIONS: Although the relationships are modest, they support the hypothesis that work-related drinking and hangovers at work are related to problems within the workplace and may lead to lowered productivity and morale.

Adult↗
PubMed1999

Employee drinking practices and work performance.

OBJECTIVE: The purpose of this study was to examine the independent effects of a variety of drinking indicators on self-reported work performance. METHOD: Data from a cross-sectional mailed survey (response rate = 71%) of managers, supervisors and workers (N = 6,540) at 16 worksites were analyzed. Average daily volume was computed from frequency and usual quantity reports. Drinking on the job included drinking during any of six workday situations. The CAGE was used to indicate alcohol dependence. Employees were also asked how frequently they drank to get high or drunk. Work performance was measured through a series of questions about work problems during the prior year. The number of times respondents experienced work performance problems was regressed on the four drinking measures, and a variety of demographic characteristics, job characteristics and life circumstances that might also negatively affect work performance. RESULTS: The frequency of self-reported work performance problems increased, generally, with all four drinking measures. In a multivariate model that controlled for a number of demographics, job characteristics and life-situations, average daily volume was no longer significantly associated with work performance but the other three drinking measures were. Interestingly, although moderate-heavy and heavy drinkers reported more work performance problems than very light, light, or moderate drinkers, the lower-level-drinking employees, since they were more plentiful, accounted for a larger proportion of work performance problems than did the heavier drinking groups. CONCLUSIONS: Employers should develop clear policies limiting drinking on the job and, in addition to employee assistance programs for problem drinkers, should develop worksite educational interventions aimed at informing all employees about the relationship between drinking behaviors and work performance.

Absenteeism↗
PubMed2000

Understanding the relation between expectancies and drinking among DUI offenders using expectancy categories.

OBJECTIVE: In the context of several recent studies that have found negative expectancies to predict drinking-related variables, the present study was designed to examine the relationships among positive expectancies, negative expectancies and drinking, in a sample of DUI offenders. METHOD: Participants (N = 96; 75% male) recruited from a 3-day residential alcohol education program completed a demographic data sheet, the Negative Alcohol Expectancy Questionnaire (NAEQ), the Alcohol Expectancy Questionnaire (AEQ) and the Customary Drinking Record upon admission to treatment. At a 3-month follow-up assessment, these measures were re-administered to 49% of the sample. RESULTS: Hierarchical multiple regression revealed that both positive and negative expectancies were related to number of drinks in the previous 30 days. Stepwise multiple regression revealed that baseline drinking and negative expectancies were both related to number of drinking days at the 3-month follow-up assessment. To assess the interplay of positive and negative expectancies as they relate to drinking, participants were categorized as "low" or "high" on both the AEQ and the NAEQ. The low positive/low negative group drank more than the low positive/high negative group. There was no statistically significant difference in drinking between the high positive/low negative and the high positive/high negative group. CONCLUSIONS: This study provides additional evidence that negative alcohol expectancies are related to drinking. These findings suggest that the proposed restraining influence of negative expectancies on drinking may be reduced when a drinker has concurrent positive expectancies which are high.

Adolescent↗
PubMed2003

Drinking course in alcohol-dependent men from adolescence to midlife.

OBJECTIVE: Most studies of alcoholism course are based on clinical populations (characterized by severe and chronic alcohol-related problems) or community samples generally covering a short period of time. The current study assessed variations in drinking behaviors from adolescence to midlife in a community sample, describing age of "drinking firsts" (e.g., first alcoholic drink) as well as frequency and duration of periods of abstinence, alcohol dependence (AD) and nonproblem drinking. METHOD: Participants were 354 males with lifetime diagnoses of AD (mean age 50.35) from the Vietnam Era Twin Registry who were assessed regarding alcohol use, abuse and dependence histories (DSM-IV). Using a modified version of Skinner's Lifetime Drinking History, drinking history was reported in terms of distinct drinking periods (phases). RESULTS: Participants reported, on average, 4.18 phases, each lasting 8.22 years, and 12.78 years of AD. More than 60% experienced increases in AD symptoms at least once in successive phases, but only a third of those increases were extreme. In contrast, extreme decreases in AD symptoms were reported by more than 50% of participants. Further, half indicated that they had transitioned from both fewer to greater and from greater to fewer AD symptoms during their drinking years; 8.2% reported no changes in AD symptoms. CONCLUSIONS: Results reflect a wide variation in drinking behaviors among AD men as well as frequent fluctuations in course within individuals' drinking histories. Findings do not support a universal developmental model of alcoholism; notably, they provide counterevidence to the disease model concept of alcoholism course as progressive and chronic.

Adolescent↗
PubMed2004

Drinking restraint, alcohol consumption and alcohol dependence among children of alcoholics.

OBJECTIVE: Previous research has found drinking restraint to be a risk factor for alcohol use and alcohol-related problems in normative populations, but has not tested these relations in high-risk populations. The current study tested whether drinking restraint predicted alcohol-related outcomes in the same way for high-risk and low-risk individuals and tested whether there was a quadratic effect of drinking restraint on alcohol-related outcomes. METHOD: Data from an ongoing longitudinal study of children of alcoholics (COAs; n = 189) and controls (n = 192) were collected at two time points 5 years apart. RESULTS: The prospective findings extended previous cross-sectional literature by replicating the main effects of drinking restraint as a risk factor for subsequent drinking for controls. For COAs, however, higher levels of drinking restraint were associated with lower levels of later drinking. There was also a quadratic effect of drinking restraint in the prediction of alcohol dependence diagnoses, suggesting that those at the extreme levels of drinking restraint were least likely to develop alcohol dependence. CONCLUSIONS: The relation of drinking restraint to alcohol-related outcomes may be more complex than previously hypothesized because it may work in different directions for high- and low-risk individuals and may have a nonlinear relationship to diagnostic outcomes.

Adolescent↗