Methodological Challenges and Limitations of Research on Alcohol Consumption and Effect on Common Clinical Conditions: Evidence from Six Systematic Reviews
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Despite the high prevalence of alcohol consumption in the US, ‘mainstream’ physicians generally consider it to be peripheral to most patient care. This may be due in part to a dearth of rigorous research on alcohol’s effect on common diseases.
To evaluate this issue, we examined six systematic reviews, four of which were conducted as part of a research initiative supported by the Robert Wood Johnson Foundation, the Program of Research to Integrate Substance Use Information into Mainstream Healthcare (PRISM). PRISM aimed to assimilate and improve the evidence on the medical impact of alcohol (and other drugs of abuse) on common chronic conditions.
From these reviews, we summarize the methodological limitations of research on alcohol’s impact on development and/or clinical course of depression, hypertension, diabetes, bone disease, dementia, and sexually transmitted diseases. The studies included in these reviews were largely fair to good quality, and few were in primary care settings. Syntheses were hampered by the myriad of definitions of alcohol consumption from any/none to seven levels and a plethora of types of alcohol use disorders.
We recommend more high-quality observational and experimental studies in primary care settings as well as a more standard approach to quantifying alcohol use and to defining alcohol use disorders.
- Institute of Medicine Committee on Quality of Health in America. The quality of health care for mental and substance-use conditions. Washington, DC: National Academy Press; 2006.
- Centers for Disease Control and Prevention, National Center for Health Statistics Health, Health, United States. 2007. Chartbook on Trends in the Health of Americans, Hyattsville, MD: Library of Congress Catalog Number 76–641496
- Allen JP, Wilson VB. Assessing Alcohol Problems: A Guide for Clinicians and Researchers. 2003: 2nd ed. NIH Publication No. 03–3745.
- Spandorfer JM, Israel Y, Turner BJ. Primary care physicians’ views on screening and management of alcohol abuse: inconsistencies with national guidelines. J Fam Pract. 1999;48:899–902.
- Vinson DC, Elder NC, Werner JJ, Vorel LA, Nutting PA. Alcohol-related discussions in primary care: a report from ASPN. J Fam Pract. 2000;49:28–33.
- Rush BR, Urbanoski KA, Allen BA. Physicians’ enquiries into their patients’ alcohol use: public views and recalled experiences. Addiction. 2003;98:895–900. CrossRef
- Sullivan LE, Fiellin DA, O’Connor PG. The prevalence and impact of alcohol problems in major depression: a systematic review. Am J Med. 2005;118:330–341. CrossRef
- McFadden CB, Brensinger CM, Berlin JA, Townsend RR. Systematic review of the effect of daily alcohol intake on blood pressure. Am J Hyperten. 2005;18:276–286. CrossRef
- Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: A systematic review. Ann Intern Med. 2004;140:211–9.
- Berg KM, Kunins HV, Jackson JL, et al. Association between alcohol consumption and both osteoporotic fracture and bone density. Am J Med. 2008;121:406–18. CrossRef
- Peters R, Peters J, Warner J, Beckett N, Bulpitt C. Alcohol, dementia and cognitive decline in the elderly: a systematic review. Age Ageing. 2008;37(5):505–12. CrossRef
- Cook RL, Clark DB. Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis. 2005;32(3):156–64. CrossRef
- Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Comm Res. 1998;52:377–384. CrossRef
- Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145–55. CrossRef
- Brick J. Standardization of alcohol calculations in research. Alcohol Clin Exp Res. 2006;30(8):1276–87. CrossRef
- United States Department of Agriculture and United States Department of Health and Human Services. In: Dietary Guidelines for Americans. Chapter 9 – Alcoholic Beverages. Washington, DC: US Government Printing Office; 2005, p. 43–46. Available at http://www.health.gov/DIETARYGUIDELINES/dga2005/document/html/chapter9.htm Accessed June 4, 2009
- Australian Government Department of Health and Aging. The Australian Standard Drink. http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/standard, Accessed June 4, 2009
- National Institute on Alcohol Abuse and Alcoholism. 2005. A Pocket Guide for Alcohol Screening and Brief Intervention. http://pubs.niaaa.nih.gov/publications/Practitioner/PocketGuide/pocket.pdf. Accessed June 4, 2009.
- Stahre M, Naimi T, Brewer R, Holt J. Measuring average alcohol consumption: the impact of including binge drinks in quantity-frequency calculations. Addiction. 2006;101(12):1711–8. CrossRef
- http://Psychweb.com, http://psyweb.com/Mdisord/DSM_IV/jsp/dsmab.jsp accessed June 4, 2009
- Bradley KA, Bush KR, McDonell MB, Malone T, Fihn SD. The Ambulatory Care Quality Improvement Project (ACQUIP). Screening for problem drinking: Comparison of CAGE and AUDIT. J Gen Intern Med. 1998;13(6):379–88. CrossRef
- Fan AZ, Russell M, Stranges S, Dorn J, Trevisan M. Association of lifetime alcohol drinking trajectories with cardiometabolic risk. J Clin Endocrinol Metab. 2008;93(1):154–61. CrossRef
- Rehm J, Irving H, Ye Y, Kerr WC, Bond J, Greenfield TK. Are lifetime abstainers the best control group in alcohol epidemiology? On the stability and validity of reported lifetime abstention. Am J Epidemiol. 2008;168(8):866–71. CrossRef
- Klatsky AL, Gunderson EP, Kipp H, Udaltsova N, Friedman GD. Higher prevalence of systemic hypertension among moderate alcohol drinkers: an exploration of the role of underreporting. J Stud Alcohol. 2006;67(3):421–8.
- Anthony JC, Echeagaray-Wagner F. Epidemiologic analysis of alcohol and tobacco use. Alcohol Res Health. 2000;24(4):201–8.
- Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials. 1996;17:1–12. CrossRef
- Kmet LM, Lee RC, Cook LS. Standard quality assessment criteria for evaluating primary research papers from a variety of fields. Alberta Heritage Foundation for Medical Research 2004.
- Methodological Challenges and Limitations of Research on Alcohol Consumption and Effect on Common Clinical Conditions: Evidence from Six Systematic Reviews
Journal of General Internal Medicine
Volume 24, Issue 10 , pp 1156-1160
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- standardized measurement
- medical impacts
- research limitations
- alcohol drinking/adverse effects
- Industry Sectors
- Author Affiliations
- 1. Division of General Internal Medicine, University of Pennsylvania, 1123 Blockley Hall/6021 423 Guardian Drive, Philadelphia, PA, 19104, USA
- 2. Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- 3. Treatment Research Institute, Philadelphia, PA, USA