Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
Ann Pharmacother. 2011 Oct;45(10):1240-7. doi: 10.1345/aph.1Q375. Epub 2011 Sep 6.
Most studies on heavy drinking and sedative/anxiolytic drug use have been cross-sectional, and evidence for a possible temporal association is lacking.
To prospectively investigate whether heavy drinking predicts initiation, continuation, or discontinuation of sedative/anxiolytic drugs at 4 and 11 years and, conversely, whether sedative/anxiolytic drug use predicts heavy drinking.
This was a longitudinal population-based study conducted in Kuopio, Finland. An age-stratified random sample of 1516 men aged 42, 48, 54, and 60 years received a structured clinical examination at baseline (August 1986-December 1989). Follow-up clinical examinations were conducted at 4 (n = 1038) and 11 (n = 854) years. Multinomial logistic regression was used to compute odds ratios and 95% confidence intervals for the association between sedative/anxiolytic drug use and initiation, continuation, and discontinuation of heavy drinking (≥ 14 drinks/wk). The reverse association between heavy drinking and sedative/anxiolytic drug use was also investigated. Regression models were adjusted for age, working status, smoking, and depressive symptoms.
At baseline 12.9% (134/1038) of participants were heavy drinkers and 4.0% (41/1030) used sedative/anxiolytic drugs. In multivariate analyses, baseline heavy drinking predicted initiation of sedative/anxiolytic drug use at 4 years (OR 2.96; 95% CI 1.23 to 7.15). Conversely, baseline sedative/anxiolytic drug use predicted continuation of heavy drinking at 11 years in unadjusted analysis (OR 3.30; 95% CI 1.19 to 8.44). However, the association was not statistically significant in adjusted analyses (OR 2.69; 95% CI 0.86 to 8.44).
The main finding of this study was the association between heavy drinking and subsequent initiation of sedative/anxiolytic drugs that was not fully explained by baseline depressive symptoms. This may inform strategies to optimize the use of sedative/anxiolytic drugs, and assist in the early identification of patients at risk of heavy drinking. Clinicians should consider a patient's alcohol consumption prior to prescribing or dispensing sedative/anxiolytic drugs. Clinicians should also monitor patients prescribed sedative/anxiolytic drugs for subsequent heavy drinking.
大多数关于大量饮酒和镇静/抗焦虑药物使用的研究都是横断面的，缺乏关于两者之间可能存在的时间关联的证据。
前瞻性研究大量饮酒是否可预测 4 年和 11 年时镇静/抗焦虑药物的起始、持续或停药，反之，镇静/抗焦虑药物的使用是否可预测大量饮酒。
这是一项在芬兰于韦斯屈莱进行的基于人群的纵向研究。一项分层年龄的随机抽样，共纳入 1516 名年龄为 42、48、54 和 60 岁的男性，于基线（1986 年 8 月至 1989 年 12 月）接受了结构化临床检查。4 年（n=1038）和 11 年（n=854）时进行随访临床检查。使用多项逻辑回归计算饮酒量≥14 杯/周的起始、持续和停药时，镇静/抗焦虑药物使用与大量饮酒之间的关联的比值比（OR）和 95%置信区间（CI）。还研究了大量饮酒与镇静/抗焦虑药物使用之间的反向关联。回归模型调整了年龄、工作状态、吸烟和抑郁症状。
基线时，12.9%（134/1038）的参与者为大量饮酒者，4.0%（41/1030）使用镇静/抗焦虑药物。多变量分析显示，基线时的大量饮酒可预测 4 年时镇静/抗焦虑药物的起始使用（OR 2.96；95%CI 1.23 至 7.15）。相反，基线时使用镇静/抗焦虑药物可预测未经调整分析中 11 年时的持续大量饮酒（OR 3.30；95%CI 1.19 至 8.44）。然而，在调整分析中，该关联无统计学意义（OR 2.69；95%CI 0.86 至 8.44）。
本研究的主要发现是大量饮酒与随后使用镇静/抗焦虑药物之间的关联，而基线时的抑郁症状并未完全解释这种关联。这可能为优化镇静/抗焦虑药物的使用策略提供信息，并有助于早期识别有大量饮酒风险的患者。临床医生在开处方或配给镇静/抗焦虑药物之前，应考虑患者的饮酒量。临床医生还应监测开处方镇静/抗焦虑药物的患者，以防止随后发生大量饮酒。
