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â´Â Êع·ÃÕ ÈÃÕâ¡äÊÂ
Alcohol Consumption and Alcohol Dependent Among Women
¡Òà ×èÁÊØÃÒáÅÐ ¡ÒÃàʾ Ô´ÊØÃҢͧ Ê ÃÕ
ʹѺʹعâ´Â á¼¹§Ò¹¡ÒþѲ¹ÒÃкº ÃٻẺ áÅÐÇÔ Õ¡ÒúӺѴÃÑ¡ÉÒ ¼ÙŒÁÕ»˜ÞËÒ¡ÒúÃÔâÀ¤ÊØÃÒẺºÙóҡÒà (¼ÃÊ.)
¡Òà ×èÁÊØÃÒáÅСÒÃàʾ Ô´ÊØÃÒ¢Í§Ê ÃÕ Alcohol Consumption and Alcohol Dependent Among Women
., . ., APN, Ph. D Candidate
ISBN : 978-686-11-0012-4
( .)
( .)
( .) 2
131 50100 0-5328-0228 236, 525 0-5327-3201
www.i-mapthailand.org
1 : 2553 : 110
: 500 : ( .)
/ : 0-5311-0503-4, 08-1783-8569
: . . : ( .); 2553.
. 0-5328-0228 236, 525 05327-3201 www.i-mapthailand.org
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1 1 2 9
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30
31 31
35
36 36
40 41
43
43 44
46 47
47 48
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64 65
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92 92
92 93
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. . 1999-2008
(Joanna Briggs Institute) 30.2
1-2
1 7
(The Drinkers’ Pyramid)
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1 3
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2.
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2
ÇÔ¸Õ´Óà¹Ô¹¡ÒÃ
(1)
1. (review question) 2. (inclusion criteria) 3. (search strategy and
selection of studies) 4. (critical appraisal) 5. (data extraction) 6. (data synthesis) 7. (discussion and summary) 8. (report writing)
1. (review question)
1.1 1
1) 2)
2
1) 2)
3
( .)
3
1) 2)
4
1) 2)
5
1.2
1
1) 2)
3)
2
1)
4
2)
3
1)
2)
1.3
2.
(selection bias) peer review
2.1 (inclusion criteria)
1)
2) 3) . . 1999-2008
. . 2542-2551
:
5
( .)
2.2 (exclusion criteria) 1) 2) 3)
2.3
prevalence of women drinking, women drinking, behavior of women drinking, cause
of women drinking, impact of women drinking, alcohol use, alcohol dependent, alcohol consumption, women, gender gender and alcohol
prevention, women drinking, alcohol use, women, brief intervention, motivational enhancement therapy, psychosocial intervention, psychosocial care for women drinking,
alcohol treatment
guideline, guideline for psychosocial treatment guideline for helping women and alcohol
3. (search strategy
and selection of studies)
3.1 CINAHL, NIAAA, PUBMED,
3.2
6
3.3 1) CINAHL 400 2) NIAAA 18 3) PUBMED 39 4) Cochran Library 9 5) 40
4. (critical appraisal)
(Joanna Briggs Institute) (2) The Appraisal of Guidelines for Research & Evaluation (AGREE) (3)
4.1
Observational Critical Appraisal Form (FORM 4.2: The Joanna Briggs Institute) 5
1) 2) 3) 4) 5)
Decision = use, Summary Score = 5/5 4
7
( .)
4.2
Experimental Critical Appraisal Form (FORM 4.1: The Joanna Briggs Institute) 10
1) 2) 3) 4) 5) /
6) / 7) concealed (allocator) 8) 9) / 10) follow-up
Decision = use, Summary Score = 10/10 8
4.3
Appraisal of Guidelines for Research & Evaluation (3)
4.4
30.23
125
20 ( ) 9
88 8
8
( systematic review) 28
0 ( ) 0
28 0
0
5. (data extraction)
6. (data synthesis)
7. (discussion and summary)
8. (report writing)
9
( .)
àÍ¡ÊÒÃ͌ҧÍÔ§ 1. JBIEBNM. (2001). An introduction to systematic review. Changing practice. [Online] Available:
URL: http://www.joannabriggs.edu.au/CP2.pdf [2008, November 7]. 2. Joanna Briggs Institute. (nd). Systematic review protocol. [Online]. Available: Available:
www.joannabriggs.edu.au/pubs/approach.php [2008, November 7]. 3. The AGREE Collaboration. (2001). Appraisal of guidelines for research & Evaluation: AGREE
Instrument. [Online]. Available: www.agreecollabolation.org [2008, November 7].
10
¼Å¡Ò÷º·Ç¹
1-2
1
7
(The Drinkers’ Pyramid)
4 (abstainers) (low-risk drinkers) (high-risk drinkers) (probable alcohol dependence)
(88) 4 1
11
( .)
1
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ 1. /
15
12-65
13-21
2.
( )
(7 )
3. /
12
1 ( )
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ 4.
/
13
( .)
2
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ 1. /
15
25-74 “Cardiovascular Risk Factor Prevalence Study in Hong Kong”
18-70
18
2.
18
2
14
3 3
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ 1.
70
70-75
2.
MUSP (Mater-University of pregnancy and its outcomes)
4-5
15
( .)
4
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ
1. /
18-44
18-44
60
18-64 Winnipeg, Manitoba Canada 1990 1991
60 National Health and Nutrition Examination Survey I
( 18-24 ) National Epidemiologic
Survey on Alcohol and Related Conditions (NESARC)
3 drinks /
20
55-65
2. /
18-24
The Signs of Suicide (SOS) Program
,
16
4 ( )
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ
“The National Longitudinal Study of Adolescent Health”
1
1 1
3.
6-7
Maternal Health Practices and Child Development (MHPCD) Health Outcomes from Prenatal Education (HOPE), ,
1, 3
17
( .)
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ 4.
social drinkers
5.
6.
estradiol (E2) cyclic ovarian function
7.
14-18 opioid use disorder (OUD) cannabis/alcohol use disorders
opioid use disorder (OUD) cannabis/alcohol use disorders
8.
The National Birth Defects Prevention Study 1997-2002
10 The International research Group on Gender and Alcohol (IRGGA)
(tourists vacationing in the resort)
4 ( )
18
5
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ
1. /
15
alcohol use disorders
14
18-25
20-29 heavy drinking
30-64 hazardous
50-59
25-64 National FINRISK Study
heavy drinking heavy drinking
20 Copenhagen City Heart Study (CCHS-I)
20-49 “Longitudinal (prospective) Project on Women’s Drinking”
16-24 “The National Chlamydia Screening Programme”
Chlamydia trachomatis
2.
18-61
18-30
alcohol intoxicated
19
( .)
5 ( )
¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ 3.
(hazardous or harmful)
4.
lifetime /
lifetime 1
5.
“Women and Alcohol in Goteborg”
12
1 3 6
20
6
»ÃÐà·È ¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà ç¹·ÕèÈÖ¡ÉÒ
(N = 215 , 21.8%)
hazardous drinkers
alcohol use disorders (N = 232 , 50.3%)
12
(N = 40 , 23.0%)
(N = 40 , 100.0%)
(N = 29 , 48.3%) Motivational Interviewing (MI)
Information Package (PI)
5
18-75
(N = 32 , 14.8%)
self-efficacy
(N = 32 , 14.8%)
self-efficacy
(N = 3478 , 69.0%)
(website-based personalized feedback intervention)
18-64
(N = 147 , 35.1%)
(N = 5 , 41.6%)
21
( .)
»ÃÐà·È ¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà´ç¹·ÕèÈÖ¡ÉÒ
(N = 30.0%)
4-6
Intensive
out-patient program (N = 17.4%)
/ (N = 12 , 100.0%)
4 18-39
(N = 509 , 55.8%) 4
(N = 131 , 21.9%)
(N = 18 , 30.0%)
(N = 144 , 77.0%) (website-based intervention)
18 ( 68.0)
(N = 480 ,46.0% 205 , 25.0%)
(N = 71 , 54.2%)
6 ( )
22
»ÃÐà·È ¡ÅØ‹ÁÊ ÃÕ·Õè¶Ù¡ÈÖ¡ÉÒ »ÃÐà ç¹·ÕèÈÖ¡ÉÒ
(N = 44 , 100.0%)
(website-based, self-guided treatment program)
18
(N = 11 , 100%)
Cochrane
Review
( )
( ) 12
AA TSF programes
Systematic
Review
( )
( )
( )
hazardous drinkers
6 ( )
23
( .)
24
(Alcohol
consumption) 10 ( . . 2542-2551 . . 1999-2008)
. . 2539-2548
0.7
19.4–54.6 (2, 4, 24, 60, 80, 89)
3.0 (58)
19.4 (24)
binge drinking 3.6 60 (53)
Alcohol Use Disorders Identification Test (AUDIT) (alcohol use disorder) 2.5 (2)
¡Òà ×èÁÊØÃÒáÅСÒÃàʾ Ô´ÊØÃÒ¢Í§Ê ÃÕ
25
( .)
11.1 (97) 31.9 (91)
11.1-31.9 AUDIT
( 4-5 ) 4.1-28.5 (9, 6, 31) 1.6 (SD = 1.2)
(20) . . 2001-2002 18-20
16.8 21-24 18.2 (41) - (low-rates of heavy
drinking) 34.0-36.0 (5) - (problem drinking) CAGE
31.7 (61) Native American Composite International Diagnostic Interview (CIDI) (life-time prevalence)
28.2 (4) 55-65 38.0
7 16.0 14 51.0 1 (79)
( 60 ) . . 1971-1974 5 18.0 (37)
AUDIT 22.0 3.1 (89) 47,202
(purging) binge drinking (p < .001) (7)
. . 2001 Behavioral Risk Factor Surveillance System (BRFSS) 54.6 30 12.5 (frequent drinking) (80)
. . 2001-2003 binge drinking 13.0 (6)
26
30.3, 1 22.5, 3 7.9 2.7 (31)
. . 2001-2003 Behavioral Risk Factor Surveillance System (BRFSS) binge drinking 2.0 (6) National Longitudinal
Survey of Labor Market Experiences in Youth (NLSY) (p < 0.0001) 38.3 . .1982-1983
23.0 . .1994-1995 (52) 3.8
(low levels) (68) 13.0 (moderate/heavy use) (69)
( 3.3 2.7) T-ACE alcohol tolerance
( 83.3 52.3, p < 0.01) (104)
94.2 84.6 6 (22)
Miami Health Services Questionnaire Addiction Severity Index (ASI) (lifetime) 88.2 91.8
1 68.6 69.4 (48)
8.3-38.0 4 30
54.6
, CIDI, quantity-frequency questionnaire, AUDIT, CAGE, Miami Health Services Questionnaire, ASI
T-ACE
27
( .)
(hazardous) (harmful)l 17.0 6.0 binge drinking 46.0 binge drinking
18-24 (69) 30-64 (hazardous drinking) 3.1 (102)
15.6 (SD = 2.6) 16
50-59 1 39.4 binge drinking
1 56.6 (99) 10
(51)
6.0 (98)
30 (regular) (69)
binge drinking ( 6.0-56.6) 18-24 16
AUDIT, frequency-quantity questionnaire, CIDI
(co-morbidity) (Psychiatric disorders) 2.48
(2) 18-44 serious psychological distress 1.1 (9) Opioid Use Disorders Anorexia Nervosa Bulimia Nervosa
1 4 (57)
28
15
( 1-2 / 1-2 / )
15 8.1 . . 2538 10.3 . . 2547 9.8
. . 2549 8.8 . . 2550 2.5 . . 2539 3.6
. . 2549 3.1 . . 2550 (77, 78)
. . 2550 3.2 ,
2.0 1.3 25-44
12-24 45-65 25-44 45-65 12-24 (17)
2 . . 2549
(85) . . 2538,
2544 2547 25-59 10.5, 12.6 13.0 15-24
( 3.3, 4.6 5.3 ) (77) 30-39
(73) 2 ( 25.2 12.7 ) (85)
40.5 (5)
53.8 40.4 (76)
29
( .)
1 . . 2550 0.7
0.6 5 (15)
15
AUDIT
(lifetime) binge drinking
1.
2. AUDIT T-ACE TWEAK
30
3. (lifetime) (past year)
(past month) (binge drinking heavy drinking) 4.
5.
(Alcohol Dependence)
8.4 (86)
15.7 (1) New Mexico 14.0 (lifetime) 32.5 (4)
0.7 binge drinking 9.9 (53) (lifetime) 11,350
27,440 (63)
18.6 45-54 2 (1)
(53)
31
( .)
¾Ä Ô¡ÃÃÁ¡Òà ×èÁÊØÃÒ áÅСÒÃàʾ Ô´ÊØÃÒ¢Í§Ê ÃÕ
1. Behavioral Risk Factor Surveillance System (BRFSS) . . 2001-
2003 18-44 (6) • “Binge drinking” 5
30 • “Any use” 1
30 2. Nat ional Household Survey on Drug Abuse (NHSDA)
Substance Abuse and Mental Health Service Admininstration (SAMHSA) . . 2000 (26)
• “Current alcohol use” 1 1 12 4-5
1.5 • “Binge drinking” 5
1 • “Heavy drinker” 5
30
32
3. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) 3 (30)
• “Light” < 0.25 g/kg
• “Moderate” 0.25-0.50 g/kg 1-2
• “Heavy” > 0.50 g/kg 2
4. “ (alcohol
abuse)” (81) 1)
2) 3)
5. (concept analysis) (moderate drinking in women) “women’s
moderate drinking” (13) 1) 2) 3)
4) 5) 6) 1
6. . . 2006 60 (37)
• “ ” 3 4 4
33
( .)
• “ ” 3 4 1-2
7. 18 (66) • “ (light)” 1-2 • “ (moderate)” 3-4 • “ (heavy)” 5 8. (22) • “ (at risk levels)” 8
5
(binge drinking)
/ / / /
AUDIT AUDIT
6 (9, 14, 17)
heavy drinking binge drinking 5
30 women’s moderate drinking 1-2
0.25-0.50 g/kg (13) moderate
drinking
34
3 1
10 2 9 (36)
1. (71)
4 • “ ” 13-14
1
• “ ” 25-50
• “ ”
• “ ”
2. . .2550
( ) 8-15 58 , 16-19 68 20 180 (17)
35
( .)
/ /
(24)
71.1 (78) (
47.56) ( 47.56 41.46 ) ( 78.05 48.78 ) (76)
(23)
(84)
30-40 40-60 (47)
(71) (84) 60
(47)
36
1. 2. 3.
4. 5. moderate drinking 6. moderate drinking 7.
ÊÒàË Ø¡Òà ×èÁÊØÃÒ áÅСÒÃàʾ Ô´ÊØÃÒ¢Í§Ê ÃÕ
(hedonism) 96 g (4)
(54)
37
( .)
(12)
(84)
(1, 46, 71)
(73)
(87) 96 g (4)
(suffering women)
(double standard)
(18)
(71)
38
(self-identity) (16)
- (11)
(Odds) (misuse) (low self-assertiveness) (high emotionality)
(19)
(9) (62, 99) (62)
anorexia nervosa bulimia nervosa
(psychosocial functioning) anorexia nervosa 1)
2) 3) (59) (82)
3 (103)
1) (sexual victimization)
4 2 2)
6 2 3)
7 2 4) 10 2 (32)
39
( .)
-
(happy about pregnancy) (11)
16 (29)
(58)
(24) (drug used) - (11)
(p=0.03 p=0.05 ) (8)
(p=0.05) (24)
- (61) 1
(p< 0.05) (70)
(24, 38, 95, 97)
8 (45) (11, 97)
binge drinking
40
(31) - (11)
(27)
binge drinking
binge drinking
, (unintended pregnancy)
(97)
(72)
- (drinking norm of ethnic)
(5) (socio-cultural sanction) (1)
( ) (73)
(OR = 1.13, 95% CI = 1.03-1.25)- 21-49 (61)
41
( .)
(83)
13-15 (12)
(11)
(12)
(72)
85.4 (76) (84)
85.4 (76)
(87)
(85)
42
(87)
1.
2.
3.
4. 5.
5.1
5.2
5.3 /
43
( .)
Íѹ ÃÒ¨ҡ¡Òà ×èÁÊØÃÒ áÅСÒÃàʾ Ô´ÊØÃÒ¢Í§Ê ÃÕ
(49, 40, 30)
glucocorticoids (40, 30, 10)
binge drinking (Hazard ratio = 1.10, 95% CI = 1.02-1.18) (28)
. . 1954-1992 . . 1977-2001
(SIR = 2.44, 95% CI = 2.19-2.73) (hemorrhagic stroke) (SIR = 2.77, 95% CI = 2.18-3.48) (106)
1
9.0 10 g 23-30
(30)
estradiol (E2) ( )
(50)
44
(70-75 ) harmful drinking 3 6
(physical component score) (94)
(75)
(pre-menstrual phase of the cycle) (26)
(21)
8 (35)
45-64 2.2
(34) (unpleasant emotions and conflict)
(62)
( 69.2 30.0, P < 0.05) (104)
45
( .)
(43)
5 (26)
(physical violence)
(39) 45.3 (75) 15.96
(76)
(60)
8.55 (95%, CI = 1.75-41.90, p = 0.008) (55)
3.2
6 7 (68)
( 34.0 72.3) (85)
(1-5 ) (6-10 ) (10-14 ) 8
(45) 7 (40)
(alcohol use disorders) (eating disorders) bulimia nervosa, bulimic behavior, purging, binge eating disorder eating disorders not otherwise specified (65)
46
12.2 (76)
2 ( 19.1) ( 6.9)
( 14.0 1.4) ( 28.8
20.3) (85) (100)
60 ( . . 1971-1974 . . 1992)
(risk of death) 0.87 (95% CI=0.61-1.24) (37) 70
(moderate alcohol use) (Cambridge Cognitive Examination for Mental Disorders of the Elderly;
CAMCOG) 50.0 (OR = 2.0, 95% CI = 1.1-3.5 ) (64)
4 2
cytochrome P450, hepatic acid binding protein, Na, ATPase (86)
(sexual aggression) 4.7
72.0 (3)
(14) binge drinking (p < 0.05) (33)
Chlamydia (44) 1.2-2.2 (56)
18-25 (hazardous drinking) / (90)
47
( .)
(71)
17.07 (76)
(caseness) depression, hostility psychoticism (22)
(71) muta-analysis
(96, 101, 105)
4
hyperactivity inattention 47 81 (93)
(MI) (r = 0.21, 95% CI = 0.06-0.77) (25) crochren review moderate drinking
(40) 1 (light drinkers) (30)
70-75 moderate drinking 3 2 physical component score (PCS)
(94) moderate drinking Hodgkin lymphoma
renal cell carcinoma (P = 0.03, P = 0.005, P = 0.001) (92)
48
1.
2. 3.
4.
5. moderate drinking
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55
( .)
10 2
T-ACE TWEAK AUDIT
MAST-G AUDIT MAST-G
AUDIT (Alcohol Use Disorders Identification Test) AUDIT
(14) 10 ( 1-3) ( 4-6) ( 7-10)
3 ( 0-7) (hazardous) ( 8-15) (harmful drinker) ( 16-19) ( 20-40)
( 2 ) 1 (3) 12
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56
(14) (9, 15)
(17, 27) (11, 25) AUDIT (17) AUDIT
6 (14) 7 (17) ( 8 )
binge drinking 4 2 ( 5
) 7 3 (9)
AUDIT
AUDIT 6
1-2 (14)
MAST-G (Michigan Alcoholism Screening
Test-Geriatric Version) AUDIT AUDIT
MAST-G MAST-G AUDIT AUDIT (28)
AUDIT MAST-G (285 ) (215 ) AUDIT
MAST-G (0.96, 95% CI= 0.93-0.98 0.83, 95% CI= 0.75-0.92 )
CAGE (CAGE questionnaire) (lifetime prevalence of alcohol dependence)
4 (cut down)
57
( .)
(annoyed) (guilty) (eye-opener) (3, 23) CAGE
72.0-91.0 76.0 (23) CAGE 60.0-100.0
40.0-96.0 (3) CAGE
(guilty) CAGE
(tolerance question) “How many drinks does it take to make you feel high?” T-ACE (Tolerance - Annoyed - Cut down - Eye opener)
4 tolerance 2 annoyed, kut down eye openers 1
0-5 2 (3)
TWEAK (Tolerance–Worried–Eye openers–Amnesia–Kut down)
TWEAK (Tolerance - Worried - Eye openers - Amnesia - Kut down)
CAGE MAST 5 eye openers,
amnesia, kut down 1 tolerance worried 2 0-7 2
(3)
AUDIT MAST-G (45) AUDIT alpha coefficients =
0.93 adverse psychological reactions alpha coefficients = 0.81 AUDIT
58
(r = 0.31-0.51) (3) AUDIT UK Royal College of Psychiatrists’ guidelines on safe levels of alcohol consumption
optimal cut-point 3/4 92.3 88.6 optimal cut-point 5/6 95.0
94.0 27.9 99.6 63.3
99.5 (28) AUDIT, CAGE, MAST AUDIT (long-term alcohol dependence)
CAGE MAST 2 (heavy drinkers)
(3)
(quantity- frequency method)
“ ” “ ” “ ”
heavy episodic drinking “ ” (3)
AUDIT CAGE
0.80 T-ACE TWEAK quantity- frequency
59
( .)
(8) Delphi survey
79
-
(8)
1.
2. T-ACE TWEAK
3.
60
2004 7 (8)
1.
( )
2. “ ”
3.
-
4. (motivational interviewing principles)
5. ( )
6. ( )
7.
(screening and brief intervention; SBI)
SBI
61
( .)
“ ” “
” (8)
10 1) 2) 3) 4) 5) 6) 7) 8) 9) 2-3 10)
62
( 75.0-100.0)
( 25.0-50.0) 6.5 (95%, CI = 3.9-11.5)
( 50.0-75.0) 3.1 (95%, CI = 1.8-5.2)
(26)
13-21 (22)
(1) (2) (3) (4)
(5)
(16)
“ ”
63
( .)
“ ”
“ ” (44)
1.
2. 10
3.
4.
5.
64
(8, 35)
1. 2. 3. 4. 5.
6.
7.
8. 9. 10.
11.
12.
13. (Brief Intervention)
(Referral to Treatment) SBIRT SBIRT
SBIRT 97.3
( 88.6) SBIRT 10 (35)
65
( .)
1)
2) (Screening and Brief
Intervention; SBI) 3) 4) SBI
1.
2.
10
66
12
1. (Brief Intervention; BI) (BI)
(hazardous) (harmful)
AUDIT 6 1 3
(14)
(p = 0.02) 6 (15)
. . 1988-2007 14 9 5
3-4 1 1 FRAMES
(40)
1. 6 serum gammaglutamyl transpeptidase (GGT)
1 3 12 2.
5 3.
(heavy episodic drinking) 1
67
( .)
12
4.
18 31.0
NIAAA ( < 7 < 3 , < 14 < 4
) 28.0
18.0 (34)
3
stepped care
1-3 fixed care 4
34.0 stepped care fixed care
(36)
1 15 6 215 772 1)
2)
3) - 4)
68
1 10 5) / / 6) / /
AUDIT 12 3
( 35.6, 34.0, 37.0 , p = 0.71)
binge drinking AUDIT (9)
(hazardous) (harmful)
(hazardous, harmful, heavy high-risk)
5 (13) 1) . . 1997 RCTs 8
(motivational counseling)
Odds Ratio 2 (OR = 1.95; 95% CI = 1.66-2.30)
2 1 (OR = 2.12 OR = 1.83 )
2) . . 1999 RCTs 7 6 12 5 20
3) . . 2002
4) . . 2003 RCT
69
( .)
10-20 5 10.0
5) . . 2004 13 RCT 6
12 4 1) 2)
3-5 (minimal intervention) 3) 10-15
3-5 4) (extended BIs)
10-15
(minimal intervention)
minimal intervention (OR = 1.6) 3
(excessive drinkers) 1 (at-risk drinkers)
2 6 12
GGT ( 1.52 1.2, p < 0.05) 1.75 2.16
1 60 2 1 6 78.0
63.0-68.0 7.0
(harzadous drinkers) 6 (RCT) 1001 1980
2 1 3
70
12 ( 1 6) standardized effect sizes
( d = -0.25, 95% CI = -0.34-0.17 d = -0.26, 95% CI = -0.38-0.13)
( 4 OR = 2.32, 95% CI = 1.78-2.93 OR = 2.31, 95% CI = 1.60-3.17) (32)
5
3 ( 0.9 2.9) (37)
5-10 51.0 ( 34 ) 49.0 (
32 ) AUDIT 12 (baseline = 11.1, SD = 5.0
12 = 9.7, SD = 6.6, t = 2.04, p = 0.04) (17)
Cochrane review . . 1840-2006 RCTs 22
( 7,619 ) (19) 1.
1 (mean difference = -38 grams/week, 95% CI = -54 -23) 22 12 ( 57.0)
2. ( 8 2,307 )
mean difference = -57 grams/week, 95% CI = -89 -25 (mean difference = -10 grams/week, 95% CI = -48 -29)
(risky) (harmful drinkers) 15 (RCTs) . . 1994-2002 5
, , , 3
71
( .)
12 (12)
1. (7 )
2. (4 ) 13.0-34.0
(mean = 2.9-8.7)
3. (multi-contact interventions) (1 )
4. (1 )
5. (5 )
10.0-19.0 6. 2 4
binge drinking 7. binge drinking
49.0 binge drinking 31.0-69.0 8. 53 ( 34.0) 1
9.
(hazardous) Cochrane
Review (39) 1.
478 27 (BI) 5 10-15
15 60 1 (cognitive therapy)
72
2 1 45 20 (6 ) Cognitive Behavier Therapy (CBT)
6 3 3 3
2 1-6
2. 18 25 (RCTs) 18
1,614 6,198 25 6
1 7 (brief counseling)
(cognitive therapy) 6-9 1 2 GGT
GGT 1
3. 2
10-16 6
GGT 1
4.
148 50.0
12 22.0 49.0
73
( .)
272
299
(cognitive
Intervention)
5. RCTs
6. (specif ic treatment) (usual or standard treatment)
(supportive counseling)
motivation-enhancing treatment, cognitive behavioral therapy, 12-step treatment structured interactional therapy.
7. (Marital therapy)
RCTs 15
47.8, 55.0, 57.0, 51.0, 100.0, 56.3, 28.0, 00.0, 65.0, 54.0, 100.0, 60.0, 72.0, 40.0, 00.0 integrative analysis (18)
74
1. “ ”
2. convenience sampling
7 1 2 2 4 5
2 4 (self-regulation theory)
3. RCTs 5
1)
2) convenience sampling
(high-use) 3) (effect sizes)
(type II errors) 4) 2
5)
6) 2-3
75
( .)
7)
8) 3
9)
10)
4.
1)
/ 2)
3) 5.
/ /
Brief Motivational Interventions (BMIs) 1) 2)
76
3) 4) 5)
6. 1) convenience
sampling RCTs /
/
/
2)
3) / 1
30 1
14 5 ( ) 4
( 66 ) 40 ( 23.0) 60 ( 77.0)
3 12
(11)
77
( .)
2. (Motivational Interviewing; MI)
1 18-64
AUDIT 8 5 MI 29
31 (Information pact) ( 26 32 ) (24)
1. (to rst hospital event) MI (mean 583 SE 63, 392 , SE 52; log rank test
21 = 4.75, p = 0.029)
2. (to rst alcohol-related event approached) MI (mean 1261 , SE 70
1092 , SE 72; log rank test 22 = 3.8, p = 0.051)
3. 5 hazardous, harmful, dependent 75.0, 60.0, 35.0
(to rst alcohol-related event) (hazardous mean 1585 , SE 74; harmful mean 1230 SE 77; dependent mean 884 , SE 90; log rank test 2
1 = 23.95, p = 0.001)
4. (to rst mental health event) MI (mean 788 , SE 75 580 , SE 70;
log rank test 21 = 4.53, p = 0.033)
Cochrane review . . 1806-2007 RCTs
1) RCTs / fetal alcohol syndrome
(FAS) 2)
78
3)
4) /
/
5) 1 /
6)
7) placebo
8) FAS
FAS 9)
/
(2)
(hazardous) benzodiazepines A-FRAMES assessment, feedback,
responsibility, advice, menu, empathy self-efficacy benzodiazepine (29)
( 71.1
36.0, p = 0.017)
(excessive drinking)
79
( .)
88.0 (56 )
6-8
/ (21)
187 AUDIT CAGE /
81.0
( = 46.4, df = 2, p < 0.001 = 10.2, df = 2, p < 0.01 ) 8.0
(23)
69.0 (3,478 ) 31.0 (1,562 )
(mean = 10.22, SD =8.17 mean = 8.46, SD = 5.68) CAGE
CAGE
(33)
80
2-3 binge drinkers (30)
3. (Brief Advice) AUDIT
AUDIT
6 12 6 35.7 20.5 12
22.8 10.9 4. web-based (self-guided treatment program)
self-efficacy
self-efficacy
web-based
(31) 5.
40
132 66 11
4 14 5 30 1
12 (p = 0.193)
(p = 0.042)
81
( .)
(11)
1) 2) 3)
(27) (alcohol use disorders)
59 (41) 1) 72,052 ( 84.0)
1970s 7.0 1980s 17.0 21.0 1990s
2) 3.8
. . 1953-59 27.4 . . 1995 15.8
3)
4) opiate antagonists (naltrexone,
nalmefene) acamprosate
6. (Cognitive Behavior Therapy; CBT) 5 ( 18
42 ) 5 7 CBT
82
1) CBT
2)
3) 6 60.0
4) CBT (6) Brief CBT (4-6 sessions)
CBT
(4) 7. 12 (Twelve-Step Facilitation; TSF)
Cochrane reviews Alcoholics Anonymous (AA) TSF 18
8 (20) 1) AA 2) AA
3) 3 AA
4)
AA
5) AA remission (alcohol use
disorders) (229 ) (232 ) AA AA
AA AA (10)
83
( .)
(baseline = 94.4 = 94.8, 1- = 45.3 = 57.6, 8- = 31.9 = 45.4, 16- = 28.4 = 39.7)
( ) (baseline = 11.8 = 13.1, 1- = 3.5 = 4.7, 8- = 5.8 = 3.0, 16- = 1.5 = 2.6)
(baseline = 88.3 = 79.8, 1- = 39.8 = 50.0, 8- = 28.1 = 41.2, 16- = 29.4 = 35.5)
8. Intensive Out-Patient Treatment (STND)
/ STND 2 / (addiction counseling)
12 (12 step) (telephone
monitoring and brief counseling, TEL) STND, TEL (Relapse Prevention; RP) 1) 60.0-69.0
/ 1-3 2) 93.0 1-3 80.0-86.0 10-12
3) 45.0-50.0 10-12 (5) 9.
(Self-Efficacy)
(self efficacy) /
9 (preliminary
discussion) (acquiring and providing information) (self monitoring) (increasing awareness)
(situation - appraisal and appropriate coping stratrgies) (goal setting) (relapse)
84
(self evaluation and self reinforcement) (hazardous
or harmful alcohol consumption) 32 183 18-75 1 45 /
(25)
hazardous, harmful, risk, heavy, binge drinking (BI)
/ / /
1 5 60
1-4 4 (feedback), (advice),
(goal setting), / (self help manual) (follow up)
1 (extended BI)
85
( .)
1.
2.
3.
4. hazardous harmful drinkers RCT
5. RCT
6.
7.
8.
1
9. RCTs / FAS
10.
11. 1 /
86
147 272 2-3
6
(38)
12 6 90 6 5 “ ” “ ”
(connectedness and disconnectedness)
(7)
connectedness (7)
87
( .)
(process of reconnecting)
(AA) Narcotics Anonymous (NA) (sponsor)
(higher power) (7 )
/
(42)
‘ ’
(43)
12
88
Cochrane review RCTs 82 benzodiazepines antiepileptics, 2-agonists, -receptor antagonists, calcium antagonists, magnesium, antipsychotic drugs, and thiamine benzodiazepines
autonomous hyperactivity (perspiration, tremore, palpitation ) (39) 5
benzodiazepines delirium
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28. . : . : ; 2544.
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