Pattern of alcohol use among problem

alcohol users in a community-based

setting in India: A cross-sectional study
Journal: Journal of Substance Use
Authors: Snehil Gupta, Rakesh Lal, Ravindra Rao, Ashwani Kumar Mishra & Atul Ambekar
Published online: 22 Sep 2017
DOI: 10.1080/14659891.2017.1366557
Outline
• About the journal
• Reasons for choosing the paper
• Background
• Paper Summary
• Summary of Methods
• Results
• Discussion
• Conclusion
• Critical Appraisal
• Significance and relevance of findings
• Strengths
• Weaknesses
• Overall critique
About the Journal:
• Title: Journal of Substance Use
• Publishing House:
• Frequency: bimonthly
• Aim and Scope: wide spectrum of issues relating to the use of legal
and illegal substances.
• Impact Factor: 0.895 (2021)
• Indexing: Cambridge Scientific Abstracts, CINAHL, EMBASE
Reasons for choosing the paper:
• Easy to understand study design and statistics
• A naïve researcher’s perspective
• Well-written – can serve as a template
Background
• Impact of an average volume of alcohol consumption on mortality or
morbidity is partly moderated by the way alcohol is consumed.
• Patterns of alcohol drinking:
• heavy episodic drinking (HED) or binge drinking
• associated with two fold mortality than their non-HED counterparts.
• Poor prognosis of myocardial infarction than their non-HED counterparts.
• type of alcoholic beverage consumed (beer, CML, IMFL)
• the time of drinking
• place of drinking
• Community setting – ‘raw data’
Background
• Few studies have focused on assessing the pattern of alcohol
consumption among alcohol users in India - restricted to the south
and eastern regions.
• This study was conducted with an aim to assess the pattern of
drinking among problem alcohol users in a community setting in
North India.
Paper Summary
Summary of Methods:
• Study design: cross-sectional, observational – in an urban slum of a
metropolitan city of India.
• How were participants recruited?
• Snowballing method
Summary of Methods:
• Who were the study participants?
• Males aged 18 years or more, not received treatment for alcohol-related
problem in the past three months, problem alcohol use (defined as those with
scores greater than 11 as assessed by WHO-ASSIST) and residing in the
community.
• Mode of Conduction of study?
• By interview style – Each interview lasted for about 60 minutes by psychiatry
trained personnel.
Summary of Methods:
• Assessment tools used:
• Alcohol, smoking, and substance involvement screening test (WHO-ASSIST)
• screening tool to identify those with substance use problems for referral to treatment.
• Validated Hindi version used for the current study.
• Was used to identify and include alcohol users in the moderate- to high-risk category as well as to
exclude those who reported consuming any other substances (except nicotine) in the past three
months.
• Semi-structured questionnaire
• to collect socio-demographic data, alcohol-use details.
• Quantity-Frequency (QF) approach
• To estimate the quantity of alcohol consumed by the subject in the past three months.
• Asks the overall frequency of drinking during a reference period and the usual number of drinks
consumed on days when drinking took place.
• Each subject was asked whether he had any episode of HED in the past three months.
Summary of Methods:
• Statistical analysis:
• For continuous data: (alcohol intake duration)
• mean (for variables that were less or moderately skewed)
• Median with Interquartile Range (IQR) (for characteristics that were more skewed)
• For categorical data: (sociodemographic, alcohol-related clinical details, and
drinking contexts)
• frequency distribution
• Average quantity of alcohol (in gram) consumed by an individual subject per
day:
• By converting the amount of alcohol consumed into number of standard drinks (one
standard drink = 10 g of absolute alcohol)
• Frequency distribution of HED
Results:
• Participant screening and reasons for exclusion given
• Subheadings for different types of findings
• Succinctly presented demographic details
• Only key findings presented in text to minimise repetition
 Discussion:
• Summarizes key results in relation to study objectives
• Emphasized the need to expand treatment services for problem alcohol
users
• Have compared their results with other studies in India - highlight the
importance of regional studies to understand diverse patterns of drinking.
• Emphasised need of pattern specific interventions
• Discussed limitations - convenience sampling and referral bias.
Conclusion:
• Among men drinking in a moderate- or high-risk pattern, a sizeable
proportion has high rates of HED and yet they are nonrecipient of
treatment.
• demonstrate some distinct pattern of alcohol consumption, which is
likely to place them at risk of various adverse acute and long-term
consequences of alcohol use.
Critical Appraisal
Significance and Relevance of Findings:
• Urgent need to expand treatment services for people suffering from
substance-use disorders, including problem alcohol users – as
addiction treatment services are woefully short.
• Increases importance of conducting awareness drives in such areas.
• Pattern specific interventions can be implemented.
• Brings to notice the importance of conducting similar research in
other parts of the country – would further allow comparison of
patterns and help carry out region specific interventions.
According to STROBE guidelines –
Strengths:
• Follows majority of the STROBE guidelines.
According to STROBE guidelines -
Weaknesses
• Study Variables – potential confounders
• Bias – social desirability bias, recall bias, selection bias
• Lack of Sample size calculation
• Limited generalizability
• Lack of a comparison group
• Missing data not addressed
• Funding and acknowledgement not mentioned
Weaknesses of the Study:
• Sampling method may introduce selection bias
• Lack of sample size calculation
• Limited generalizability
• Lack of a comparison group
• Reliance on self-reported data – recall bias and social desirability bias
Overall critique:
• Valuable insights into alcohol consumption patterns
• Credible data collection methods
• Consideration of study limitations is necessary
Thank You!