[Vol. 1, No. 1, 2000]

With this edition of the Argonaut we inaugurate the Newsletter of the national alcohol research center at the Alcohol Research Group in Berkeley. The ARG Center is an exciting place to be working at this time and I hope this bulletin will convey the spirit of our group as a vigorous participant in the nation’s attack on the complex social and human problems arising from alcohol abuse and alcoholism. The National Alcohol Research Center is one of 15 in the U.S. funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Centers Program, which recognizes the synergy that comes of well-orchestrated, focused programs of research. Within our Center, the Year 2000 National Alcohol Survey (N10), a telephone survey of 10,000 adults in all 50 states and DC, is now in the field. Initial analyses begin later this year, but using our unique series of five-year interval national surveys, we continue our work to understand what underlies trends in drinking and alcohol-related problems. A number of Center studies articulate with its national surveys. One is a supplemental study, to be covered in a later newsletter, that brings to bear ethnography and survey methods to study bar-going and the risks of STD and other negative drinking outcomes. The Center’s multi-pronged epidemiological studies develop and test explanatory models with immediate relevance for prevention, treatment and policy reform. A number of our scientists are also engaged in an ongoing program of methodological studies, which, breaking new ground in measurement, is beginning to yield significant advances in self-report of drinking patterns and problems.

ARG and its Center’s ambitious health services studies are examining, with a multi-year perspective, the course of alcohol problems following treatment admissions. To answer service-related questions at a system level, we turn to multiple samples, drawn in one case from those entering treatment in the public, private indemnity, and HMO service sectors. Increasingly, these important studies look broadly at the social handling of important populations with substance abuse problems. The focus is on trajectories of alcohol consumption and problems, which are affected by the evolving interaction of individuals with their communities, including medical and social agencies of many types. For example, ARG’s welfare project is one of the only longitudinal studies available to conduct in-depth investigations of the dynamics of alcohol problems and welfare use. Other studies have been closely delving into California counties’ managed care for substance abusers, homelessness, drunk driving among Mexican American and white respondents. ARG’s multi-ethnic clinical studies also include some that involve primary care, ER, and pre-natal clinics and that compare social and medical model programs addressing alcohol problems. These and other exciting studies will be described in subsequent editions.

The Center brings together specialists with different disciplines, painstaking observational strategies, and state-of-the art analytic tools to pursue multi-method studies of general and specialized populations. The foment of ideas is catalyzed, too, by the presence of outstanding postdoctoral trainees from the epidemiological and health services training programs that ARG runs in conjunction with the UC Berkeley School of Public Health and the Prevention Research Center (a sister NIAAA-sponsored national center). Consultants and vising scientists inject their unqiue perspectives from the outside. My hope is that some of this spirit will be conveyed by the articles in this and future quarterly Argonauts. We are indeed adventurers on a quest—the scientific challenge to deepen our epidemiological grasp of conditions potentiating or protecting against alcohol problems, including their social handling through prevention programs, service provision, community interventions, and alcohol policies.

By Thomas K. Greenfield, Ph.D.

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[Vol.1, No. 1, 2000]

CADPAAC may seem to be one of those famously convoluted U.S. Navy acronyms, but it is short for the California County Alcohol and Drug Program Administrators Association. This California state adjunct organization of the 58 county administrators has the responsibility to reduce individual and community problems related to the abuse of alcohol, illegal drugs, and other hazardous substances. It is an advocate for policy and procedural change in alcohol and drug matters as they impact welfare reform, job training, pregnant and parenting services, and the criminal justice system. Among its goals are research on the effectiveness of prevention and treatment programs and how they can be better organized, staffed, and funded, in short, outcome evaluation and services research, and attaining support for a holistic approach to treating clients with both mental health and alcohol or drug problems.

On May 27, 1999, CADPAAC presented ARG with its Research Award for “outstanding work in the area of research.” Dr. Thomas K. Greenfield as the incoming Center Director accepted the award on behalf of ARG at the organization’s Annual Awards Banquet in Sacramento. This appreciative honor comes to ARG because over the last 20 years this National Alcohol Research Center has worked closely with numerous California counties in conducting varied epidemiological and health services investigations within the interests of the association. Although much of the support for this research came from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Center Grant, numerous investigator initiated grants, and at times other sources, have sponsored this research.

One major study is the ARG Center’s Community Epidemiology Laboratory based on multiple samples drawn from one large northern California County. Directed by Dr. Connie Weisner for more than 15 years, this novel approach to understanding specific treatment and prevention needs in a ethnically and socio-economically diverse community—and the effectiveness of public, private, and volunteer social and health agencies in fulfilling them—has provided a truly comprehensive analysis that serves as a model for services research in similar regions around the nation. For instance, of particular usefulness to reform-minded administrators who seek coordination and cooperation among county services was the information on the relationships between systems and how little influence treatment systems have in policy decisions affecting other services, namely, ones in the criminal justice system. County administrators have recognized the long experience of ARG in designing and carrying out closely coordinated studies with appropriate measures and methodology, thanks to the close interaction of its multi-disciplinary research staff, a hallmark of the institution.

The San Francisco Bay Area county selected for in depth study has a population of some 800,000. ARG has continued its ongoing relationship with the county in question over two decades, with general population surveys in the early and late 1980s and numerous studies of specific clientele and services, some of them continuing today, to trace effects of recent policy reforms. The second population survey was noteworthy because the region and the survey represented the United States in a World Health Organization-sponsored international investigation of drinking patterns. The demographic profile of this county was shown to be a reasonable microcosm of the United States as a whole. Other surveys of agencies and their clients in the CEL have focused on country residential alcohol detoxification and drinking-driving programs; emergency room studies of the relationship between alcohol and injury in county and private hospitals, including Kaiser Permanente facilities, a leading health maintenance organization; mental health outpatient and inpatient programs, especially alcohol-related admission policies and the problem of dependence on alcohol tangled with drug use or psychological distress; alcohol treatment, or its lack, in county jails; health care approaches to alcohol problems in primary care clinics; alcohol consumption and harms among welfare recipients; and county drug outpatient and residential detoxification programs. Together, these studies provide a picture of alcohol-associated problems faced by the county, of who does and does not receive care whether voluntary or coerced legally or socially, and of the interconnecting pathways an individual may travel among the relevant agencies and services. Drs. Laura Schmidt, Connie Weisner, Cheryl Cherpitel, Tammy Tam, Jim Wiley, Lee Kaskutas, and several others are among those involved in these studies. These CEL studies have provided an immensely rich picture of the county, and in turn have led directly to some of the current studies such as Drs. Lee Kaskutas, Laura Schmidt and Connie Weisner’s new NIAAA-sponsored study of factors affecting drinking trajectories among various types of problem drinker.

ARG’s long-term commitment to epidemiological research in California counties includes early studies conducted general population surveys in Marin and San Francisco Counties, among others. From the late 1980s the focus in San Francisco was the attitudes and behavior toward alcohol and sex in light of the AIDS epidemic and the prevalence of other sexually transmitted diseases, which have paved the way for Dr. Karen Trocki’s present NIAAA study of bargoing and STDs.

The southern zone of “Silicon Valley,” south of San Francisco, comprises Santa Clara County and its revitalized metropolitan hub, San Jose. Santa Clara County was the host to ARG investigations of driving-under-the-influence (DUI), with emphasis on white and Hispanic cultural distinctions, led by Drs. Raul Caetano and later Cheryl Cherpitel, who also has studied screening for alcohol-related problems in that county’s emergency rooms, with emphasis on Hispanics. Additionally, Dr. Cheryl Cherpitel has directed emergency room and primary care studies in several counties and other regions. Related Center studies have also investigated differences among men of three ethnic groups being treated for alcohol dependence. Headed by scientist Martha Beattie, ARG continues its work in Santa Clara County with Project Impact, which is a comparative evaluation of managed care centers for the treatment of substance abuse, with focus on admission policy, duration, costs, and principles of treatment. Project Impact also involves San Bernardino and Sacramento Counties.

Elsewhere, Center scientist Lee Kaskutas studied a large sample of social versus medical model alcoholism recovery programs. Tom Greenfield recently evaluated the innovative staffing arrangements and effectiveness of a self-help, social approach to care. He designed a randomized clinical trial of assignment to the innovative crisis residential mental health facility versus a professionally staffed, locked, in-patient psychiatric unit, both located in Sacramento County. This evidence supports the viability of employing consumers as service providers and program managers in programs catering to clients in crisis who include large numbers of people with dual diagnoses. Los Angeles County was the one of the host sites for the Center’s DEER [Determining Educational Effects and Resources] Project developed by Dr. Lee Ann Kaskutas. This project surveyed pregnant minority women for their awareness and understanding of the hazards of Fetal Alcohol Syndrome and any subsequent change in their drinking patterns. Importantly, it has also developed innovative tools to improve measurement of alcohol consumption in these special populations. Alcohol abuse and associated mental problems among the homeless of Alameda County was and remains the target of other ARG investigations, including a longitudinal study of homeless families, based on NIMH and NIAAA grants to ARG scientists Marjorie Robertson and Chery Zlotnick. Alameda County is also the location of ARG scientist Ruth Gassman’s study of predictors of screening and brief intervention among physicians and nurses practitioners, while Contra Costa County is the location of ARG scientist Nancy Piotrowski’s study of perceptions of moderate drinking among clinical populations, the general population and providers. Both of these studies are also funded by NIAAA.

This simple sketch indicates how much ARG has contributed toward the improvement of county services and county governments in their efforts to deal with the range of alcohol and drug problems and identify the most effective services configurations. With the recent expansion of the economy and rapid growth in the population of Bay Area counties, it remains to be seen whether or not these preventive and treatment systems can cope with such change and what new policies are warranted. The results of the 2000 census and new ARG surveys—including the Center’s Year 2000 National Alcohol Survey and its associated Bay Area Supplement, the latter closely examining the relationship of bar-going to risks of sexually transmitted diseases—are eagerly awaited.

By Debra Jan Bibel, Ph.D.

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Back to Back: Greenfield, Midanik, and Rogers Report 10-Year Trends

[Vol. 1, No. 1, 2000]

Part of the research program of ARG is epidemiological analysis of the National Alcohol Survey data sets, which the NIAAA-sponsored National Alcohol Research Center collects at five-year intervals. ARG has been involved in these efforts over three decades with each succeeding questionnaire, giving the Center a keen perspective in trends of alcohol consumption, social harms, and other aspects of alcohol problems within the United States. In the January 2000 issue of the American Journal of Public Health a team of Center scientists led by Drs. Thomas K. Greenfield and Lorraine T. Midanik have two back-to-back reports describing changes in such patterns between 1984 and 1995, a period encompassing the last three surveys. Dr. John D. Rogers is co-author of the first paper. The data sets from the 1984, 1990, and 1995 surveys cover information recorded each time from between 2,000 and 5,000 people, sampled within the 48 contiguous states and interviewed face-to-face in their home. These historical trend papers, which appropriately inaugurate the new century for the journal, also provide the anchor for forthcoming analyses of the Year 2000 National Alcohol Survey (NAS) now in progress and the future NAS survey proposed for 2005.

The first article, “A 10-year national trend study of alcohol consumption, 1984–1995: Is the period of declining drinking over?”, focused on three indicators of consumption: current drinking or abstention, weekly drinking, and weekly heavy drinking, defined as 5 or more drinks in a day. Since social preferences for the type of alcoholic beverage change over time—the steady drop in the consumption of spirits (“hard liquor”) since 1970 is indicative—these researchers also sought any trends in beverage choice. Finally, they checked for ethnic and other demographic correlations in both amount and kind of consumption. Many people have prejudicial opinions of the drinking behavior of other affinity groups. For targeting prevention efforts it is important to know if some subgroups do, in fact, have greater risks based on heavy consumption or alcohol-related problems.. The ARG team hence examined trends by sex, age, marital status, race or ethnicity, income level, employment status, religion, education level, urban or rural residency, and regional location within the country. The researchers found that, except for those having at least one episode of heavy drinking during the previous year, the percentage of people consuming alcohol had fallen between 1984 and 1990, continuing a recognized trend begun around 1980; however, by 1995 the falling percentage of respondents drinking alcohol leveled out. This flattening trend included weekly heavy drinkers. When the researchers considered the type of beverage, they found across-the-board reductions over the entire period in wine, beer, and spirits. A closer inspection revealed that preferences were virtually unchanged between 1990 and 1995 and that most of the observed declines took place in the late 1980’s rather than the early 1990’s.

When the researchers examined the total number of days in the year when alcohol was consumed, results paralleled these other analyses: people drank fewer times in 1990 compared to 1984, but they drank about as often in 1995 as in 1990. Since wine drinkers were consistent in their rate of consumption over the entire period (about 39 days per year), most of the reductions occurred among the beer drinkers between 1984 and 1990 (96 down to 75 days per year), with the drinking of spirits continuing a more modest decline in frequency between 1990 and 1995 (34 down to 26 days per year). Respondents who had consumed spirits about 34 days on average over the year preceding the 1984 survey had by 1990 reduced their frequency to 26 days. The number of days when heavy drinking occurred was significantly different only for beer drinkers between 1984 and 1990. Heavy drinking was rare for wine drinkers, occurring only 1 or 2 days on average during the previous year. Hard liquor drinkers indulged heavily some 2 to 4 days, which is appreciably less often than that reported by the beer-drinking population, who on average drank heavily 14 days in 1983–1984 and 10 days in 1994–1995.After inspecting the demographic breakdowns of the data, the research team was impressed with the reduction of drinking (versus abstaining) by Hispanic respondents in 1995 compared to those of the 1990 survey. In contrast, African Americans reported higher rates of heavy drinking in 1995 than those interviewed in 1990. Findings confirmed earlier trends that men and younger people in general were apt to drink alcohol heavily and often. The researchers found no remarkable distinctions among the respondents’ marital status, education, religion, residence location, and other independent variables. Although the form of religion had no statistically predictive capacity, it is interesting to note that the lighter drinkers and those who imbibed less heavily were apt to answer that religion was very important to them.

As these researchers observed, “The commodity of alcohol is always poised in a dynamic rather than a static equilibrium—promoted by commercial interests and held in check by social policy and mores.” These analyses indicate that the social movement toward moderate or restricted drinking may have reached its limit of effectiveness, that favorable economics and a host of other cultural factors may have counter-balanced these forces such that by 1995 the patterns of alcohol consumption have at least temporarily stabilized.

In the second report, “Trends in social consequences and dependence symptoms in the United States: The National Alcohol Surveys, 1984–1995,” Drs. Midanik and Greenfield go beyond amounts and frequency of drinking to the social and individual harms induced by alcohol. Have there been any changes here, or have they also leveled? An earlier analysis suggested that despite the decrease in national alcohol consumption, the self-reported prevalence of alcohol problems either remained steady or—for younger, unemployed, and never married respondents—even increased.

With sample sizes of 1,300 to 1,500 individuals who were current drinkers, the 15 questions about drinking problems covered the following categories: fights and arguments; accidents and legal problems; health problems; difficulties at work; and negative reactions. Alcohol Dependence symptoms were based on 13 items in the questionnaire, which included loss of control, blackouts, and other symptoms of withdrawal. The researchers noted no significant alterations over the entire period in social consequences except for two categories: accidents/legal problems and problems at work. A closer look showed that reductions occurred between 1984 and 1990, respectively from 4% to 1.7% and 2% to 0.6% of respondents. These trends did not continue; they found no appreciable change in any category between 1990 and 1995. The prevalence rate of given dependence symptoms was unchanged throughout.

Inspecting the influence of the previously mentioned demographic variables, the research team found little of interest. Women between age 40 and 49 years did report fewer social consequences in 1995 than in 1990, from about 6% down to 1% of the sampled group. Also, Hispanics reported significantly higher prevalence of social difficulties in 1995 when compared to 1984 figures, an increase from 6% to nearly 17% of participants. An approximate doubling in the prevalence rate of dependency symptoms (4.5% to 8.5%) took place between 1984 and 1995 among people who are affiliated with religions regarded moderate by the T. W. Smith classification, among which are Catholicism, Lutheranism, and Methodism.

Is this apparent paradox a result of self-reporting in a time when diminished alcohol consumption makes such untoward behavior relatively more unusual, hence, more likely to be identified and acknowledged? Drs. Midanik and Greenfield cite, among other evidence, how the measuring bar had been lowered in reporting drunkenness between 1979 and 1995—from an average of 8.2 drinks in 1979 to 6.3 drinks fifteen years later—increasing the frequency of reported drunkenness at a given level of drinking. Public toleration of overt alcohol-related social problems has diminished, especially in “drier” cultural environments. The abuser stands out and, in many instances, seems to know it. A clear caveat to the study, the researchers add, is the absence from the household sample of those known to have more chronic and serious social consequences of drinking, the homeless and institutional residents; hence, observed prevalence rates may be somewhat conservative.

The two ARG reports provide strong evidence that nationally the early 1990’s have been a period of dynamic balance in alcohol consumption and associated problems. It is interesting to reflect on the similar stability of the socio-economic and political situation during this period and the accompanying pubic attitudes toward adults drinking alcohol. Recently, the media have focused more on changes in the level and especially frequency of drinking by teenagers and college students than on adult drinking habits. Also, economic boom, minimal unemployment, and affluence suggest that the social forces that provide this stability are in flux: “The times they are a-changin’.” Whether the decline of alcohol abuse and its consequences has merely stalled, a resurgence is occurring, or a steady state will continue will be an important question for the next National Alcohol Survey now being fielded.

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RSA Honors Dr. Lee Ann Kaskutas

[Vol. 1, No. 1, 2000]

Lee Ann Kaskutas, Dr.P.H., the 1998 recipient of the Young Investigator Award of the Research Society on Alcoholism, spoke last year on “Understanding drinking during pregnancy among urban Native and African Americans: health messages, risk beliefs, and how we measure consumption” at the award-related Plenary Session of the 22nd Annual RSA Scientific Meeting held in Santa Barbara. This rare honor to a social scientist—biomedical laboratory researchers typically receive the award—reflects Dr. Kaskutas’s numerous significant contributions to the epidemiology of alcohol consumption over the years since her doctorate in 1992, particularly in her direction of the DEER [Determining Educational Effects and Resources] Project in Los Angeles and San Francisco Bay Area communities. This research investigated the effectiveness among pregnant minority women of health education campaigns to prevent Fetal Alcohol Syndrome. Among her other research interests is the self-help organization Alcoholic Anonymous; she has recently contributed the chapter on AA in the United States to a book presenting case studies within the World Health Organization’s International Collaborative Study of Alcoholics Anonymous (ICSAA). Two current projects involve randomized clinical trials comparing the medical and social models of substance abuse treatment. Dr. Kaskutas quips that she is one of the oldest RSA Young Investigator honorees! Before coming to ARG in 1990, she worked 17 years in marketing management within the telecommunications industry. In additional to her research, Dr. Kaskutas is in charge of training at ARG and is an adjunct assistant professor in the School of Public Health, University of California, Berkeley, where she teaches a course on survey research methods.

By Debra Jan Bibel, Ph.D.

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ARG Trainees at NIAAA-Sponsored Workshop

[Vol. 1, No. 1, 2000]

For a young researcher, the opportunity to present findings before a national body of experts is both an important challenge and a highly rewarding experience. Conferences provide the arena to hone one’s skills in defending a scientific position, to gain knowledge of related issues that expand the perspective of a research project, and to establish oneself in the field. Such interactions, which personalize the profession through formal and casual meetings with leading investigators, are key practical elements in the development of a scientist. Two Center NIAAA trainees at ARG, E. Anne Lown, Dr.P.H. and Michelle Scott, Ph.D., can attest to these principles having recently presented their research before a combined meeting of Center Directors and Training Program Directors of the various National Alcohol Research Centers.

The conference, “Alcoholism: What can research offer in the 21st century?”, took place in Indianapolis, Indiana, on December 8 and 9, 1999. It was organized and co-sponsored with NIAAA by Dr. Ting-Kai Li’s laboratory, an Alcohol Research Center, at the Indiana University School of Medicine. Dr. Scott, having an interest in the interrelationships of alcohol, treatment services, and the justice system, focused her talk on “Alcohol and juvenile justice contact: a comparison of fee-for-service and capitated Medicaid mental health services.” Capitation here refers to the fixed price paid for each enrolled client within given restrictions of time and types of service. She concluded from her statewide longitudinal study that while alcohol problems, determined by DSM-IV diagnosis or subjective symptomatic evaluation, increase the chance of the youth coming in contact with the juvenile justice system, subsequent contact may be reduced if mental health treatment is through a capitated approach.

Dr. Scott was enthusiastic about her selection as a speaker. “It was a great opportunity for social scientists to discuss alcohol problems with laboratory researchers,” she observed. “I learned a lot about research with mice and rats!” Since the National Alcohol Research Centers each specialize in aspects of alcoholism, the meeting was cross-disciplinary, with scientists in pathology and cell biology, treatment and pharmacology, prevention and psychology, health services sociology, public health, and social epidemiology sharing their latest results. NIAAA and the Indiana Alcohol Research Center had designed the conference to encourage bridge-building, if not integration, of the related social and basic sciences.

In addition, a working lunch with NIAAA staff gave the trainees a chance to broaden their outlook and learn about career opportunities. They received guidance in obtaining grants and other funding and in publishing their results. “I was especially impressed by Dr. Enoch Gordis [Director of NIAAA], who seemed to know everything about alcohol research from biochemistry to preventive social policies,” said Dr. Scott. “He was brilliant, and I found him accessible to young scientists.”

Already holding an M.S.W. from the School of Social Welfare of the University of California at Berkeley, awarded in 1995, Dr. Scott continued there to earn her Ph.D. in May 1999 while working at the Center for Mental Health Services Research, the Institute of Human Development, and the Family Welfare Research Group on campus. She has been a post-doctoral trainee with ARG since July 1999, explaining her choice by citing, in addition to the Center library and supportive infrastructure, how the ARG Center “permits and encourages independent research pursuits.” She has her eyes set on a career in research and hopes to participate in the training of the next generation of investigators.

Now a post-doctoral trainee, Dr. Lown was still a graduate student at the time of the conference; she received her Dr.P.H. from the School of Public Health, University of California, Berkeley, in January 2000. With an M.P.H. from Columbia University, she was previously employed by the Department of Epidemiology and Biostatistics, University of California, San Francisco. At ARG, she was among the small number of pre-doctoral NIAAA trainees nationwide. (Dr. Scott also began her association with ARG as a pre-doctoral trainee.) These fellowships are designed to expose entering graduate students to the alcohol field, which typically is not part of the core curriculum of any established academic discipline.

Her presentation at the conference was on “Alcohol abuse or dependence among Mexican American women reporting violence.” Alcohol-driven violence against women is scarcely a new topic, having, for instance, been an element of numerous movies and countless police reports over the decades. Prevalence studies, however, are relatively new, and Dr. Lown decided not only to focus on the minority population of Mexican Americans living in Fresno County, California, an agricultural region, but also to look at alcohol abuse by women victims, a little studied measure. Her source was a randomized household survey that provided data from some 1,500 women between ages 18 and 59. Calculating odds ratios, she found that women who reported physical or sexual assault by someone other than their partner were 8 times more likely to abuse alcohol or be alcohol dependent and about 3 times more likely to have alcohol disorders if the perpetrator was her current partner. Physical assault by nonpartners was especially associated with a woman’s alcohol use—a 9-fold increase in likelihood compared to a 5-fold increase with sexual assault. Although Dr. Lown’s study did not include any causative or temporal information, she warns that in such instances of dual problems, it would be germane to screen for alcohol abuse in women who seek services for current or chronic violence and, in turn, to screen for physical and sexual violence in women being treated for alcohol disorders.

Dr. Lown described the conference as “extremely warm and welcoming. The NIAAA staff supported and encouraged young professionals. Trainees were respected and repeatedly referred to as the cream of the crop.” She appreciated the high quality of the discussions and presented papers, which forced trainees to think critically; she further was pleased how “trainees were pushed forward to the next step” in their work. Dr. Lown also plans a career in research and hopes that her findings will help shape public policy.

Both ARG trainees valued the well-balanced meeting and their opportunity to network and perhaps someday collaborate with researchers from complementary fields. The personal approach of this dedicated meeting contrasted sharply with large meetings of professional societies, where a scientist could easily attend with little interaction. They hoped that NIAAA will continue to support such worthy conferences.

By Debra Jan Bibel, Ph.D.

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Screening for Alcohol Dependence in Primary Care

[Vol. 1, No. 2, 2000]

When a person with an underlying alcohol use disorder enters a primary care setting, such as a clinic or emergency room, how should the medical staff effectively proceed, particularly if the patient does not recognize the disorder or is not immediately forthcoming? What if that patient is a minor? What should be the alcohol abuse intervention and preventive policies of health care institutions? These concerns were addressed recently at a two-day conference on “The Expanding Role of Primary Care in the Prevention and Treatment of Alcohol Use Disorders: Issues for Research and Policy” co-sponsored by NIAAA and the Agency for Healthcare Research and Quality.

The conference, which took place in Rockville, Maryland, March 9–10, 2000, brought together researchers, practitioners, and private indemnity, HMO, and federal insurers for an insightful interdisciplinary exchange. Although the focus was on primary care and its role and practice of screening, treating, and preventing alcohol use disorders, discussions also covered primary intervention policies and procedures for the often related harms of cardiovascular disease, domestic violence, and depression, which served as more developed models. The goal of the meeting was to incorporate the presented research into the development of a research agenda for implementing quality improvement in the identification and management of alcohol use disorders by primary care personnel.

In addition to the participation of ARG-associated investigator Constance Weisner, Dr. P.H., who, representing work in substance abuse and primary care at Kaiser Permanente, chaired the session on managed care and reimbursements, was a feature talk in the overview session by ARG senior scientist Cheryl J. Cherpitel, Dr.P.H. She presented her findings on a novel screening instrument especially useful in emergency rooms. Dr. Cherpitel explained, “my interest was in identifying those instruments, or a small subset of screening items, that would perform optimally across gender and ethnic [white, Black, and Hispanic] subgroups of emergency room patients.” Many standard instruments were especially gender variable, providing poorer sensitivity for females. With funding from NIAAA to collect emergency room patient samples in Jackson, Mississippi; San Jose, California; and Pachuca, Mexico, she evaluated the CAGE, brief-MAST, AUDIT, and TWEAK, determining those questions that optimize sensitivity while maintaining reasonable specificity against two diagnostic standards, ICD-10 (International Classification of Disease, 10th edition) and DSM-IV (Diagnostic and Statistical Manual, 4th edition), used for assessing harmful drinking or alcohol abuse or its dependence.

Initially selecting five questions from among these and then paring it down to four, Dr. Cherpitel arrived at a successful recipe. Called RAPS4 for Rapid Alcohol Problems Screen and its four questions, her instrument in turn refers to the attributes detected by the items: Remorse—During the last year have you had a feeling of guilt or remorse after drinking?; Amnesia—During the last year has a friend or family member ever told you about things you said or did while you were drinking that you could not remember?; Perform—During the last year have you failed to do what was normally expected from you because of drinking?; and Starter—Do you sometime take a drink in the morning when you first get up? Dr. Cherpitel observed that the question on remorse alone identified 83% of those found to be alcohol dependent; a positive response to any one of the four items gave a sensitivity of 93% and a specificity of 87%. Indeed, with no need for weighting, a positive response on any one question signified a positive screen. “RAPS4,” Dr. Cherpitel concludes, “may hold promise in screening for alcohol dependence across a variety of clinical settings because of its consistently high sensitivity across gender and ethnic subgroups and its simplicity.” Dr. Cherpitel’s most recent report in this body of work, “A brief screening instrument for problem drinking in the emergency room: the RAPS4,” appeared in the May 2000 issue of Journal of Studies on Alcohol, 61, 447–449.

By Debra Jan Bibel, Ph.D.

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[Vol. 1, No.2, 2000]

On the Friday and Saturday before the opening of the annual meeting of the Research Society on Alcoholism in Denver this June occurred a series of free lectures on Alcohol Use and Alcohol Actions. ARG scientists were among the lecturers of these two workshops, one focusing on a broad overview of psychosocial issues, such as epidemiology, treatment, prevention, and health-related effects, and the other concentrating on biomedical issues like pharmacokinetics, animal models, genetics, and alcohol as a reinforcer. These series were designed to provide an overview of the alcohol field especially useful for students and young investigators.

Thomas K. Greenfield, Ph.D. reviewed the importance of alcohol policy studies, which can help reduce the social and medical harms of alcohol beverages. He noted the particular regulatory roles each jurisdictional level plays on alcohol use patterns, whether it be a workplace policy, a local ordinance, state and federal laws, or even an international treaty. The influence of policies may be as narrow as personal conduct to as wide as the commerce of alcohol from production to taxation, from sales and distribution to warning labels and advertising. Policies shift the research priorities of foundations and national agencies. Dr. Greenfield described how legislative policies develop and are shaped by public health advocates, alcohol industry lobbyists, trade groups, and professional organizations all churned and filtered by the broadcast and print media.

Lee A. Kaskutas, Dr.P.H. spoke on “Primary prevention and education.” Her presentation began with the Institute of Medicine’s delineation of three levels of prevention to provide a continuum of preventive measures: universal (informing the general or patient population about a potential risk), selective (targeting special populations that are apt to be at risk) and indicated (dealing with those who are symptomatic). While providing examples for selective and indicated approaches, Dr. Kaskutas focused on the goals, strategies, and effectiveness of universal education and promotional campaigns in numerous settings, including schools, health clinics, highways, bars, television broadcasts, sports events, and even hair salons and barber shops. Educational interventions include the DARE project, the warning label on alcohol beverage containers, and public service advertisements on television, while environmental measures target availability and promotions, such as reducing the hours alcohol may be sold or the number of sales outlets.

In addition to these lectures, there was a workshop on Grantsmanship co-chaired by ARG scientist Karen Trocki, Ph.D., a member of the RSA Education Committee. Held on Sunday, June 25, the workshop provided the opportunity for senior staff from NIAAA and CSR to provide much appreciated information about funding.

By Debra Jan Bibel, Ph.D.

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40th Anniversary Party, 1959 to 1999

[Vol. 1, No. 2, 2000]

The Alcohol Research Group celebrated its fortieth anniversary on February 11, 2000, with a gala reunion dinner at the Berkeley City Club emceed by Drs. Marjorie Robertson and Tom Greenfield. The fête included a series of informal historical talks covering each decade, which conveniently comprised an era, playfully dubbed “founding,” “developing and spawning,” “centering and recentering,” “expanding the base,” and anticipating, “the present and beyond.”

This seasoned institution has evolved at six different locations in Berkeley and under numerous administrative umbrellas. Its existence began in 1959 with Drs. Wendle Lipscomb and Genevieve Knupfer’s California Drinking Practices Study, an NIMH grant to the California State Department of Health, which soon resided in new quarters under the aegis of the Mental Research Institute of Palo Alto. In 1968, the enlarged organization transformed into the Social Research Group, led by Dr. Don Cahalan, and affiliated itself first as the West Coast Division of the Social Research Group of George Washington University and then as a unit within the School of Public Health of the University of California at Berkeley. The group at last asserted its alcohol focus in 1981 by becoming the Alcohol Research Group under Dr. Robin Room’s leadership and linked with the Medical Research Institute of San Francisco, which itself became the California Pacific Medical Center Research Institute. With the departure of Dr. Room to the Addiction Research Foundation in Toronto (and then to the University of Stockholm), ARG, under the direction of Dr. Raul Caetano, moved to the Western Consortium of Public Health and, since 1997, the Public Health Institute, Berkeley.

During the joyous celebration the 105 attendees, who arrived from New York, Idaho, and Pennsylvania to as far away as Sweden, reminisced about ARG’s NIAAA training grant program, begun in 1971, and its first NIAAA Center award in 1977; how Dr. Larry Wallack, attorney Jim Mosher, and Dr. Fried Wittmann budded off to form the Prevention Research Group, since 1984 another NIAAA National Alcohol Research Center; ARG’s hosting of the 1988 meeting of the Kettil Bruun Society for Social and Epidemiological Research; and the extraordinary growth of the Library (founded in 1959), which carried merely 6 AOD (Alcohol & Other Drug) journals in 1971 and now subscribes to 43 such publications in English alone. Also mentioned was ARG’s literary enterprise established to encourage worldwide communication and collaboration. Between 1970 and 1992, ARG published 24 issues of the Drinking and Drug Practices Surveyor, a journal of broad scope, whose changing cover display of alcohol-related international postage stamps brought much delight to its global readership.

Throughout the thick and thin of funding and the tribulations of launching multiple studies, one feature of ARG has sustained its enthusiasm and drive: its training program. Dr. Constance Weisner, who was the Training Program Director for the previous decade, welcomed among the festive gathering the former ARG predoctoral and postdoctoral fellows, many of whom went on to establish distinguished careers in alcohol research. “The training grant considerably broadened our horizons,” observed Dr. Room, the first director of the training program. “The start of the training grant largely marks the point where we shifted from being a single project or study into being a research group and eventually a research center.” ARG’s program has seen, to date, the completion of 52 doctoral dissertations and the award of 188 fellowships (81 predoctoral and 107 postdoctoral). Former ARG predoctoral and postdoctoral fellows may be found among universities, governmental agencies (including NIAAA and city, county, and state public health departments), research institutes, informational and service industries, and community and advocacy groups in the United States, Canada, and Europe. The majority have remained active in the alcohol field.

With ARG authors having already published over 880 articles and book chapters and presented a similar number of papers at conferences and society meetings, the research group continues to contribute significantly to the sociological, epidemiological, and methodological examination of alcohol beverage consumption and related problems. After yet another decade of such in-depth investigations and rigorous predoctoral and postdoctoral training, the 50-year reunion should be grand indeed.

By Debra Jan Bibel, Ph.D.

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[Vol. 1, No. 2, 2000]

We were proud to come together in March for ARG’s 40th Anniversary Reunion, with over 100 former staff and fellows gathering at the Berkeley City Club to help us celebrate. On Sunday following, an all-day seminar organized by Harry Levine explored the contributions of our predecessors and the climate of the times they worked in. We looked at the changing currents in alcohol research and how these both affected and, in turn, were affected by ARG and its Center. On September 30, 1977, ARG became one of the first five National Alcohol Research Centers funded by NIAAA. Robin Room traced ARG’s beginnings from 1959, when Wendell Lipscomb, a physician-epidemiologist from the California State Department of Public Health (who was able to join us at the Reunion), was PI of an NIMH grant to undertake community general population studies of drinking practices. We recapitulated our evolution through the overlapping eras involving the leadership of Genevieve Knupfer, Don Cahalan, Robin Room, and Raul Caetano, to the present. The article in this Newsletter provides a fuller picture, but I want to highlight the role played by the Post- and Pre-Doctoral Training Grant, which commenced in 1971, six years before the Center. Connie Weisner, who steered this crucial part of our program, gave the welcome to former and current fellows. It was warming that so many were able to join us at the reunion, and we feel privileged that so many Fellows have gone on to make major contributions to the field of alcohol studies. For those of you who were not able to come back, we hope this ARGonaut will reconnect you, and we welcome hearing from you and visiting when you come to the Bay Area.

A Work in Progress

[Vol. 1, No. 3, 2000]

Karen Trocki, Ph.D. is a master chef, so to speak. Her grant, the Epidemiology of Alcohol Problems: Risk of AIDS, can be compared to an elaborate feast, and it is her responsibility to conceive, develop, prepare, complete, and bring the components together and in proper sequence to provide a sumptuous repast worthy of praise by patrons. Such is the work of a principal investigator. With the support of five research associates and a corps of up to a dozen part-time aides, Dr. Trocki is using her social psychological skills to examine the sundry interrelationships of bars/pubs, sex, and sexually transmitted diseases. The role of alcohol consumption and environment in risky behavior, particularly risky sexual behavior, is far more complex than most people realize–encompassing the layers of individuals, groups, and, establishments. To gain a more complete picture of these complex phenomena, she is triangulating data from different sources using multiple methods. The cornucopia of ensuing information will take years to digest fully.

Her comprehensive four-year plan, now half-way achieved, consists of 5 different methodological approaches, several of which acquire both qualitative and quantitative data–unusual for such investigations. As the first step in the process, 8 focus groups each of 8 to 12 participants were led by a trained moderator Conducted in a room with a one-way mirror behind which researchers viewed and audiovisually recorded the proceedings, the group discussed bars and bar culture as a relaxed, open conversation. Three groups consisted of bartenders within particular geographic areas; the remaining groups were of bar patrons who were clustered on the basis of gender, ethnicity, and sexual orientation. Information gathered from these focus groups helped Dr. Trocki and her associates to develop questionnaire items used in later components and to target specific bars for visits by observation teams.

Another component consists of particular sections and questions in the San Francisco Bay Area regional supplement to the 2000 National Alcohol Survey (a scientific component of ARG’s NIAAA Center grant), which is conducted by telephone. This randomized inquiry of households provides an overview of drinking and bar-going patterns as well as sexual partner selection and risky behavior.

Perhaps the most interesting approach is the use of observation teams in bars, taverns, clubs, and similar “watering-holes” in San Francisco and the East Bay. Broad-based team members, who already had earned degrees in anthropology, psychology, or sociology, underwent further ethnographic training to be fair qualitative observers of the bar scene and, like anthropologists secretly examining a jungle tribe, how to ward off unwanted approaches. They are assisted with an extraordinarily detailed, 76-question checklist that covers the bar’s architectural design (including restrooms), decor, activities (type of music, TV, games, dance floor, etc.), ambience (theme, decoration, noise, energy, conduct, etc.), and people flow; types of alcohol beverages served; and a description of both bar workers and patrons (hair style, clothing style, gender/sexual orientation, ethnicity). Each team of two observers, who attempt to fit naturally into the particular scene, venturing into both exposed areas and dark nooks, record drug and sexual activities present in addition to apparent drunkenness and intoxication. This is true field work! The use of two members permits a check & balance of prejudices and views. Short-term observations cover approximately 100 bars, which vary by district, socio-economic level, and surroundings Ten sites are the target of extended observations.

In the fourth component, a sample of about 150 individuals will be interviewed on multiple occasions using more open-ended or qualitative methods. These participants will be recruited largely from respondents of the national telephone survey. Others will be selected from bars or from other subsamples, such as the focus groups. Such inquiries initially probe the volunteer subjects’ attendance of venues where alcohol is prominent; their drinking patterns; the activities present at such places and their personal activities, including socializing; and their purposes of going to the site. Part of the nearly 3-hour interview involves stress testing, such as a challenging arithmetical task and frustrating computer games, to determine sensitivity to pressure and degree of self-control so important in risky behavior–essentially the ability to say no to peer pressure, going beyond one’s normal moderate alcohol consumption, and sexual advances.

The final component will consist of team members going to the streets to capture quantitative information from patrons as they enter and exit bars. In this survey of some 1,600 people at 30 locales, the team member will ask patrons questions that psychologically profile the drinker’s risk-taking behavior, such as attitudes, personality, self-image, and mood states. This will provide information not only on typical patrons of each bar but also how bars link to one another, i.e., the networks of bars and people.

To accomplish this complex investigation, Dr. Trocki and staff have had to overcome myriad logistical hurdles: hiring of staff; recruitment of subjects by advertisement, word-of-mouth or “snowballing,” and lists of prior subjects; training of associates and aides; production of manuals and survey instruments; the placing in the field–the body politic–of the national survey; subject scheduling; standardizing special meeting rooms; obtaining and operating appropriate equipment; database development and the amassing and organizing of data and administrative documents; the preliminary analysis of information; and the repeated adjustment of procedures, for planning never covers every circumstance encountered in the field. The list is seemingly endless. The well-considered methodological details are duly written to ensure controlled situations and consistency. This sketch provides a mere taste of the diverse activities a principal investigator and team leader must administer.

Significant sociological research often comes from multiple approaches to a complex but narrow topic, and this investigation will certainly provide new insights into the epidemiology of sexually transmitted diseases. We look forward to the many presentations and publications that will be issued from this important research.

By Debra Jan Bibel, Ph.D.

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[Vol. 1, No. 3, 2000]

Anyone visiting the office of Jason C. Bond, Ph.D. immediately confronts the archetypical scrawl of mathematics on the white melamine board above his desk. As ARG’s new statistician, Dr. Bond consults on the design and analysis of surveys and other studies besides supervising the programming department. He earned his Ph.D. in statistics at UCLA with focus on linear and nonlinear multivariate analysis, nonparametric dimension reduction techniques for regression models, and the development of graphical and interactive statistical tools. Now at ARG, Dr. Bond has moved from the more theoretical to diverse practical studies, including a longitudinal alcohol consumption survey of managed care clients, an examination of the validity of respondents’ reports of alcohol consumption, and an analysis of service providers in various health sectors who refer or treat clients with alcohol problems. Reflecting on his new responsibilities, Dr. Bond observes, “I am bringing novel techniques and statistical ideas that have not been applied before to data analysis in the alcohol field. With the development and expansion of specific tools that go beyond the limitations of commercial software, we should be able to analyze data with more detail. These new perspectives may provide different interpretations.” Like an artist whose brush is statistical analysis, Dr. Bond hopes to change the way we look at quantitative and ethnographic information, understanding more about alcohol consumption patterns and the ways individuals, organizations, and communities deal with the consequences. ARG welcomes his expertise and looks forward to his contributions to alcohol research.

By Debra Jan Bibel, Ph.D.

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Center Director’s Note – Some Words on Our Library

[Vol. 1, No. 3, 2000]

As we enter the Center’s next five-year phase, one aspect of ARG infrastructure that is “mission critical” is our extraordinary library. It is fair to say that we cherish this unique and developing asset and feel privileged to have this amazing collection so close at hand whether we are researching the underpinnings of a new hypothesis, delving deeper into a research idea, challenging an established scientific approach, or researching the historical basis of a social movement or policy. Visiting social and epidemiological scientists from Aarhus to Zimbabwe, rubbing shoulders with our scientists and pre- and post-docs, frequently spend a large and productive portion of their Berkeley time in its recesses. One finds them engrossed at tables surrounded by hillocks of its books, reports, and papers. Our success and renewal is integrally tied to this resource, reminding us of how much we are committed to developing this modern and evolving facility.

We also take the opportunity to honor here Andrea Mitchell, a librarian recognized nationally and internationally for building librarianship tools, capacities, and organizations in the field of substance abuse. In keeping with the classical theme of our newsletter’s banner, we may say she is a worthy successor to the first librarians from Zenodotus of Alexandria to Aristophanes of Byzantium, though her labyrinthine office is evocative of the stories of author-librarian, Jorge Luis Borges! We are looking forward to developing ways to better link library services to scientist needs, tailor acquisitions in areas such as research methodology and statistics, and facilitate access to our holdings via the web for wider use of this national resource.

By Thomas K. Greenfield, Ph.D.

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A researcher today depends on the latest information, of course, but also on the wealth of earlier studies to provide perspective, to avoid pitfalls of the past, and perhaps to rediscover a forgotten insight. In short, the researcher needs a library—not the dark, cramped, unattended musty alcove of yore, but a bright, modern, service-oriented facility. ARG researchers are fortunate to have one of the best. Indeed, the ARG Library and Information Center, among the oldest and largest alcohol and other drug (AOD) libraries in the United States, has since 1959 supported the research efforts of the Alcohol Research Group and later its National Alcohol Research Center, one of 15 funded by NIAAA. The ARG Library, in addition to being the main AOD information and documentation center for the San Francisco Bay Area, has been designated by the Center for Substance Abuse Prevention as a “Specialty” Regional Alcohol and Drug Awareness Resource (RADAR) Information Center. Researchers, teachers, counselors, students, the press, physicians, and other librarians regularly contact the ARG library for information; in a typical year over 800 persons visit the library, and more than 1,200 phone and e-mail requests are answered.

Andrea Mitchell, M.L.S. 

Ms. Mitchell, a historical resource for ARG was part of the group from 1971 to 2008. Among her career honors were in 1996 serving as Manager of the NIAAA library in Washington, D.C., and later as consultant to NIAAA, the World Health Organization, and the Center for Substance Abuse Prevention (CSAP). Dear to her heart is SALIS, the association of Substance Abuse Librarians and Information Specialists (see http://salis.org), which she and other AOD librarians founded in 1978 to support AOD information systems and services. She is Executive Director of this organization and Editor of its newsletter, SALIS News. Ms. Mitchell was a member of the Alcohol and Other Drug Thesaurus Advisory Committee, formed by NIAAA on recommendation of SALIS to bring a fine focus to the field with a stable, consistent vocabulary so instrumental to the ETOH database. She remains co-chair of the Information and Dissemination Section of the International Council on Alcohol and the Addictions (ICAA).

Under her leadership, the ARG library expanded its holdings and increasingly emphasized information services. The collection, whose main focus is the social and cultural aspects of alcohol and other drug use, has major subject strengths in epidemiology, alcohol and other drug-related problems, control policies and legal aspects, special populations, treatment, prevention, evaluation, and social history. The book collection alone comprises over 6,000 volumes, and is augmented by some 60,000 other materials, including article reprints, conference papers, dissertations, unpublished working papers, government documents, and other fugitive materials. Currently the library receives over 300 journals and newsletter titles, including almost all of the English language alcohol and other drug specific journal titles and many of the AOD foreign language journal titles. Special collections include the history of the prohibition movement, the Classified Abstract Archive of the Alcohol Literature (CAAAL Archive) comprising approximately 20,000 abstracts of the scientific alcohol research literature dating between 1933 and 1976, and the unpublished papers and documents from the Tulapai to Tokay annotated bibliography (a collection of more than 900 books, articles, manuscripts, and dissertations on Native American drinking).

Besides assisting the institute’s researchers in obtaining required publications from other libraries and governmental sources, during her time here Ms. Mitchell and the ARG library staff search specialized bibliographic databases and Web resources to provide solutions to various informational problems. With the unrelenting deluge of information in all its forms arriving at the library day after day, our library staff strives to catalogue and maintain an objective, current, and reliable collection. The light of knowledge ably flows from this resource in support of ARG researchers and thence the community at large.

By Debra Jan Bibel, Ph.D.

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In the wake of her 1998 Young Investigator Award of the Research Society on Alcoholism [see our April 2000 issue], the National Institute on Alcohol Abuse and Alcoholism has honored Lee Ann Kaskutas, Dr.P.H. with a nomination for a Presidential Early Career Award for Scientists and Engineers (PECASE), given annually since 1996 to “outstanding researchers who show exceptional potential for leadership at the frontiers of scientific knowledge.” Presented at the White House, this Award, which is a special research grant lasting up to five years, is the highest honor bestowed by the U.S. government on scientists in the early stage of their career. Dr. Kaskutas is a social scientist whose work encompasses the prevention of Fetal Alcohol Syndrome, the evaluation of outcomes associated with the social model of recovery and self-help programs, and the implementation of innovative self-report metholodogies in measuring drink sizes. As coordinated by the National Science and Technology Council, the nine related federal agencies select candidates for this distinction; NIH named 17 of the 60 honorees last year.

By Debra Jan Bibel, Ph.D.

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Researchers at ARG have a variety of career backgrounds and training that complement each other and fit well into the social epidemiological investigations that characterize this institution. Some have degrees in social welfare or sociology, others come from nursing, epidemiology, or public health, one is an educator, and several are social or clinical psychologists. Most social scientists here had a traditional service and research track, though the career of one began in mathematics and business. Tom K. Greenfield, Ph.D., Director of the National Alcohol Research Center at ARG and also present Executive Director of ARG, administers and coordinates this mélange with a unique perspective. Eventually earning a doctorate in clinical psychology, he originally had his eyes on the heavens, for as an undergraduate in astronomy he worked at the Palomar Observatory, examining subdwarf stars in the halo of our Milky Way galaxy, and later earned a master’s degree in space science at MIT studying galactic dynamics!

A former scientist of so-called exact physical phenomena now working in the domain of ever fluctuating social trends, culturally influenced institutional systems, and the whims and vagaries of human behavior, Dr. Greenfield has specialized, to no surprise, in developing consistent survey methodology in addition to epidemiological analysis, policy formation, and consumer and community action—the more technical fields. Within the Center organization, he is mainly involved in general population surveys on drinking patterns and problems, including their associated methodology, and has a secondary interest in community responses to these alcohol-related problems, i.e., health and social services research. With the Center Management Group, Dr. Greenfield is involved in the planning, evaluation, and oversight of the various Center-related scientific projects; fiscal management; and coordination of such infrastructure as data processing, clerical support, and library/information services. He is the Center liaison with academic and professional organizations at local, state and federal levels. If this were not enough, Dr. Greenfield, as current Executive Director of ARG, focuses on the needs and operation of the institution at large. The light on the Captain’s table burns long into the night.

Dr. Greenfield is not merely an administrator. A particular research problem that occupies his mind at present is the methodological challenge of improving self-report measures. Compared to national alcohol beverage sales data, the body of survey respondents seem to be underreporting consumption by 50–65%. Here, the psychological gamut of individual differences, accuracy of memory, and the format and context of the questions are addressed. Diary measures of consumption reduce the burden of recall, yet they may affect the drinking pattern through self-judgment or impact later summaries because of self-reflection this approach provides the respondent. Still, summary scales may be calibrated against this record. Summary measures may prove satisfactory alternatives, depending on the way questions are designed. The Graduated Frequency summary measure, for instance, assists the calculation of volumes of alcohol drinks imbibed by asking participants how often they drink in each of several ranges: 12 or more; 8–11, 5–7; 3–4; and 1–2 drinks on any single day. With his colleague Dr. Lorraine Midanik, Dr. Greenfield has looked closely at the cognitive demands this series of choices places on interviewees and what typical errors or biases such questions may introduce.

To develop a more solid footing for such self-reporting, Dr. Greenfield and other ARG investigators have improved the questioning. Although 12-month reference periods have been standard, to avoid variation and interviewee and analyst confusion, a specific date anchor has been instituted, such as “in the 12 months since January 15. . .” (or other date exactly 12 months earlier). And instead of the basic beer, wine, and liquor classification, surveys now include subcategories, such as fortified wine and malt liquor, to provide better dose calculations. Another innovation is to place drining amounts in context by asking for the physical and social circumstances surrounding the drinking occasion. These memory cues may improve precision. For instance, when referring to the maximum number of drinks consumed within a given period, the participant may state five to seven, but when induced to associate drinking within the context of a festive celebration, the person may state a different, often higher, amount. Such a tactic may lead to better estimates of volume and heavy drinking. For the sake of trend analysis, original questions are phrased exactly as in prior surveys; follow-up questions typically have improved phrasing for increased accuracy. When questioned by this approach, some 15% of drinkers provided higher maximum consumption and 9% indicated larger volumes. Despite this tactic, cue-enhanced measurement has produced a mere 3.5% expansion in overall consumption figures and a 3–4% increase in in frequency of drinking and heavy drinking; these improvements fall far below the unaccounted amounts—which Dr. Greenfield fittingly calls “dark matter”—inferred by comparisons of survey results with annual alcohol sales data. Preliminary evidence to be reported at the Kettil Bruun Society indicates that drink size and strength adjustments may account for more of the discrepancy.

“Increased specificity of beverage type, container size, volume, duration, and context all help provide a more accurate profile of individual drinking patterns,” observed Dr. Greenfield. “ARG has pioneered measures that are now widely used in the field. We are now refining measures for subsequent use by others, fulfilling one of our roles as a National Alcohol Research Center.” He added that “improving survey measurement is critical for making sound, evidence-based policy recommendations.” With the Year 2000 National Alcohol Survey soon to enter the analysis stage, we can look forward to findings in trends of alcohol consumption and its associated harms and social problems as well as improved sensitivity and precision of respondent information. With each survey cycle, Dr. Thomas Greenfield and the Center team navigate the waters with new, enhanced charts.

Organization Chart

Spring, time of renewal and growth, also comes to ARG. For instance, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) has continued its support of the National Alcohol Research Center at ARG (there are 15 nationwide) with a new cycle of funding. Over the ensuing five years, Thomas K. Greenfield, Ph.D., Center Director and Principal Investigator, and the Component Directors & Area Coordinators Cheryl J. Cherpitel, Dr.P.H. (also Associate Director), Lee Ann Kaskustas, Dr.P.H., Laura Schmidt, Ph.D., Karen Trocki, Ph.D., and Constance Weisner, Dr.P.H. with the support of Lorraine Midanik, Ph.D., Tammy W. Tam, Ph.D. and statistician Jason Bond, Ph.D. will be engaged in five main investigations and several pilot studies.

The National Alcohol Surveys comprise two components, adding to ARG’s acknowledged treasure for trend analysis, a database begun in 1964 (NAS 1) and furthered in value with each succeeding survey (NAS 2, 1967; NAS 3, 1969; NAS 4, 1974; NAS 5, 1974; NAS 6, 1979; NAS 7, 1984; NAS 8, 1990; and NAS 9, 1995). The Year 2000 National Alcohol Survey (NAS 10), now in progress, is special—besides providing an epidemiological profile of alcohol-related behaviors at the cusp of the millennium—since for the first time it involves computer-assisted interviewing primarily by telephone (CATI) of random-digit dialed adults in all 50 states plus the District of Columbia. (A preliminary comparison of telephonic and face-to-face questioning demonstrated both the utility and validity of the more efficient remote survey method.) NAS 10, moreover, is an enlarged survey, reaching some 8,000 persons with an oversampling of African Americans and Hispanics, special populations from which ARG has developed estimates of alcohol consumption and problems since 1984.

Each new national survey builds upon the previous, keeping some core questions that support trend estimates and tailoring other questions to address current research issues and policy needs. NAS 10 examines alcohol consumption patterns and associated social problems and individual harms. These consequences include driving under the influence of alcohol (DUI), injuries, alcohol dependence symptoms, and changes in cognitive and social factors. Also studied are emergency room usage, participation in alcohol and substance abuse treatment and preventive programs, and the support of governmental alcohol policies. Once the raw data are collected, statistical analysis and the development of risk curves will help determine the relationships of particular styles of alcohol consumption with specific problems. Likewise, the examination of population data using age-period-cohort analyses will aid ARG researchers in learning which people—by age, ethnicity, gender, and so forth, and born at which period in our history—are apt to develop alcohol-related problems. This in turn will help establish the levels of need for various social services.

These national surveys chart changes in people’s consumption patterns, attitudes, and needs, and help construct policies that affect social and health-related services as well as personal habits and choices. Such diverse applications are the reasons behind the development of NAS 11, the 2004–2005 National Alcohol Survey, which extends the survey series. Results of NAS 10 will, of course, impact the framing of particular questions for this next survey; however, already plans are afoot for focusing on a variety of new relationships. Theses include studying the effect of state-level alcohol regulations and treatment capacity of a state’s services, testing theoretical models of the relationship between poverty and alcohol consumption and of the risk of injury, examining how certain adult alcohol problems may stem in part from childhood sexual abuse, and investigating the effect of individual and environmental influences on drinking and risky behavior in bars and similar public alcohol outlets. In short, NAS 11 continues, improves, and expands earlier efforts toward providing the epidemiological insights needed for evidence-based policy choices at federal and state levels.

The methodology component, directed by Dr. Greenfield in collaboration with Affiliate Scientist Dr. Lorraine Midanik, tackles the reliability and validity of alcohol consumption measures. Various strategies and tools exist to gauge a person’s alcohol consumption and each has its strengths and faults. The standard drink for particular alcoholic beverages, for instance, often does not correspond to the drinker’s customary container size and shape, hence beverage volume, and as Dr. Kaskutas has documented for urban Native American and African-American women, amounts consumed are typically underreported. Consider the variation among goblets, flutes, mugs, tumblers, and other glassware. People refer to “drinks,” not to so many milliliters or ounces. Thus, the first examination is how to encourage telephone interviewees to provide more accurate descriptions of their alcohol consumption. This is crucial in assigning risk (such as for drunk driving and injuries) to heavy drinking episodes or to long-term harmful volumes, known to lead to liver disease and alcohol- dependence. The second methodological element investigates the Interactive Voice Response approach that permits collection of answers by telephone to computer-driven questions. Would people be less reluctant to divulge personal details to an impersonal machine, which has no negative body language or judgmental vocal traits? If so, would the method provide higher prevalence rates than with face-to-face interview methods?>

The role of welfare reform in alcohol consumption and its demographic patterns is the target of Dr. Schmidt’s component. Applying both longitudinal and comparative studies, she will seek trends of socioeconomic correlates of low-income people entering two welfare programs in a large California county, the federally-funded Temporary Aid to Needy Families, TANF—formally Aid to Families with Dependent Children, AFDC—and General Assistance, GA. Policy reform in eligibility criteria seem to have an effect on alcohol consumption within each program, but such policy modifications also shift program clientele, with the chronic problem heavy drinkers moving to GA, increasing its burden. Here again evidence is required to guide policy makers in their improving welfare strategies.

Dr. Cherpitel directs the Center component on the relationships between alcohol consumption and injury presentation at emergency rooms. In the planned meta-analysis and multi-level modeling, she will compile, merge, and analyze a unique data set developed from 15 ER studies undertaken in 6 countries, comprising a total of 21,000 patients, 12,000 of whom were injured. She will focus on social and cultural factors that influence the drinking pattern of patients, organizational features, and the administrative policies that govern services and patient flow and individual and event level variables. Such a multinational study will demonstrate cultural similarities and differences in the use of measures, profiles of injury, and risk factors. Indeed, Dr. Cherpitel plans to refine and test models that determine risk of injury and the causal relationships of particular patterns of alcohol consumption to injury.

Two pilot, i.e., preliminary, studies are planned with several more anticipated within the current cycle. Both current probes, one investigating alcohol use and alcohol-related problems in Asian Americans, the other involving a mutual self-help group—a Twelve-Step Facilitation—test innovative techniques. If validated, the methods will be used in expanded research programs.

By Debra Jan Bibel, Ph.D.

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The Center’s new program of work, years 21 through 25, is launched. Funded again by NIAAA through its Alcohol Research Centers Program, the ARG Center specializes in the epidemiology of alcohol problems, complementing the work of other centers. We study ways in which social, community, and individual characteristics and choices interact to elevate risks or confer protection, examining policies and services designed to address alcohol abuse and dependence. ARG Center scientists are continuing an ambitious set of studies that together anchor their other work at ARG, currently funded by 12 independent research grants. The Center again includes a methodological studies component. Whether it be in developing improved screening measures (Cherpitel)