Skip to main content

Advertisement

SpringerLink
Log in

Methodological Challenges and Limitations of Research on Alcohol Consumption and Effect on Common Clinical Conditions: Evidence from Six Systematic Reviews

  • Perspectives
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

Background

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.

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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.

    Google Scholar 

  2. 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

  3. Allen JP, Wilson VB. Assessing Alcohol Problems: A Guide for Clinicians and Researchers. 2003: 2nd ed. NIH Publication No. 03–3745.

  4. 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.

    CAS  PubMed  Google Scholar 

  5. 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.

    CAS  PubMed  Google Scholar 

  6. Rush BR, Urbanoski KA, Allen BA. Physicians’ enquiries into their patients’ alcohol use: public views and recalled experiences. Addiction. 2003;98:895–900.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  CAS  Google Scholar 

  9. Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: A systematic review. Ann Intern Med. 2004;140:211–9.

    PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  CAS  Google Scholar 

  14. 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.

    Article  CAS  PubMed  Google Scholar 

  15. Brick J. Standardization of alcohol calculations in research. Alcohol Clin Exp Res. 2006;30(8):1276–87.

    Article  CAS  PubMed  Google Scholar 

  16. 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

  17. 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

  18. 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.

  19. 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.

    Article  PubMed  Google Scholar 

  20. http://Psychweb.com, http://psyweb.com/Mdisord/DSM_IV/jsp/dsmab.jsp accessed June 4, 2009

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    PubMed  Google Scholar 

  25. Anthony JC, Echeagaray-Wagner F. Epidemiologic analysis of alcohol and tobacco use. Alcohol Res Health. 2000;24(4):201–8.

    CAS  PubMed  Google Scholar 

  26. 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.

    Article  CAS  PubMed  Google Scholar 

  27. 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.

Download references

Acknowledgements and Conflict of Interest

Both authors gratefully acknowledge the support of the Robert Wood Johnson Foundation for PRISM and the support of the Betty Ford Foundation for the development of this paper. Dr. Turner receives support from Pfizer, Inc., through a grant to the University of Pennsylvania for unrelated research. Dr. McLellan reports no sources of other support or conflicts of interest.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, University of Pennsylvania, 1123 Blockley Hall/6021 423 Guardian Drive, Philadelphia, PA, 19104, USA

    Barbara J. Turner MD, MSEd

  2. Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    A. Thomas McLellan PhD

  3. Treatment Research Institute, Philadelphia, PA, USA

    A. Thomas McLellan PhD

Authors
  1. Barbara J. Turner MD, MSEd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Thomas McLellan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara J. Turner MD, MSEd.

Additional information

Supported by the Robert Wood Johnson Foundation and the Betty Ford Foundation

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turner, B.J., McLellan, A.T. Methodological Challenges and Limitations of Research on Alcohol Consumption and Effect on Common Clinical Conditions: Evidence from Six Systematic Reviews. J GEN INTERN MED 24, 1156–1160 (2009). https://doi.org/10.1007/s11606-009-1072-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-009-1072-z

KEY WORDS

Search

Navigation