case study in alcoholism

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CASE STUDY Jeff (alcohol use disorder, mild/moderate)

Case study details.

Jeff is a 66-year-old Caucasian man whose wife has encouraged him to seek treatment. He has never been in therapy before, and has no history of depression or anxiety. However, his alcohol use has recently been getting in the way of his marriage, and interfering with his newly-retired life. He describes drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. He notes that this amount “doesn’t give me the same buzz as it used to.” He denies ever experiencing “the shakes” or any other withdrawal symptoms if he skips a day of drinking.

Jeff comments that his wife is his biggest motivation to decrease his alcohol use. She tells him that he gets argumentative and irritable when he drinks, though he does not always remember these incidents. He has also fallen while intoxicated twice, causing bruises both times and hitting his head on one of the occasions.

• Alcohol Use
• Irritability
• Substance Abuse

Diagnoses and Related Treatments

2. substance and alcohol use disorders.

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Robert’s story

Robert was living with an alcohol addiction and was homeless for over 25 years. He was well known in the local community and was identified as one of the top 100 A&E attendees at the Local General Hospital.

He drank all day every day until he would pass out and this was either in the town centre or just by the roadside. In addition, Robert was also incontinent and really struggled with any meaningful communication or positive decision making due to his alcohol usage. This often resulted in local services such as police, ambulance being called in to help. He had no independent living skills and was unable to function without alcohol.

In addition, and due to his lifestyle and presenting behaviours, Robert had a hostile relationship with his family and had become estranged from them for a long period of time.

Robert needed ongoing support and it was identified at the General Hospital that if he was to carry on “living” the way he currently was, then he wouldn’t survive another winter.

On the back of this, Robert was referred to Calico who organised a multi-disciplinary support package for him, which included support with housing as part of the Making Every Adult Matter programme.

After some initial challenges, Robert soon started to make some positive changes.

The intensive, multidisciplinary support package taught him new skills to support him to live independently, sustain his tenancy and make some positive lifestyle changes which in turn would improve his health and wellbeing.

This included providing daily visits in the morning to see Robert and to support him with some basic activities on a daily/weekly basis. This included getting up and dressed; support with shopping and taking to appointments; guidance to help make positive decisions around his associates; support about his benefits and managing his money. In addition, he was given critical support via accessing local groups such as RAMP (reduction and motivational programme) and Acorn (drugs and alcohol service), as well as 1 to 1 sessions with drugs workers and counsellors to address his alcohol addiction.

After six months Robert continued to do well and was leading a more positive lifestyle where he had greatly reduced his A&E attendance. He had significantly reduced his alcohol intake with long periods of abstinence and was now able to communicate and make positive decisions around his lifestyle.

Critically he had maintained his tenancy and continued to regularly attend local groups and other support for his alcohol addiction and had reconnected with some of his family members.

By being able to access these community resources and reduce his isolation he is now engaged in meaningful activities throughout the day and has been able to address some of his critical issues. A small but significant example is that Robert is now wearing his hearing aids which means that he can now interact and communicate more effectively.

Module 9: Substance-Related and Addictive Disorders

Case studies: substance-abuse disorders, learning objectives.

• Identify substance abuse disorders in case studies

Case Study: Benny

The following story comes from Benny, a 28-year-old living in the Metro Detroit area, USA. Read through the interview as he recounts his experiences dealing with addiction and recovery.

Q : How long have you been in recovery?

Benny : I have been in recovery for nine years. My sobriety date is April 21, 2010.

Q: What can you tell us about the last months/years of your drinking before you gave up?

Benny : To sum it up, it was a living hell. Every day I would wake up and promise myself I would not drink that day and by the evening I was intoxicated once again. I was a hardcore drug user and excessively taking ADHD medication such as Adderall, Vyvance, and Ritalin. I would abuse pills throughout the day and take sedatives at night, whether it was alcohol or a benzodiazepine. During the last month of my drinking, I was detached from reality, friends, and family, but also myself. I was isolated in my dark, cold, dorm room and suffered from extreme paranoia for weeks. I gave up going to school and the only person I was in contact with was my drug dealer.

Q : What was the final straw that led you to get sober?

Benny : I had been to drug rehab before and always relapsed afterwards. There were many situations that I can consider the final straw that led me to sobriety. However, the most notable was on an overcast, chilly October day. I was on an Adderall bender. I didn’t rest or sleep for five days. One morning I took a handful of Adderall in an effort to take the pain of addiction away. I knew it wouldn’t, but I was seeking any sort of relief. The damage this dosage caused to my brain led to a drug-induced psychosis. I was having small hallucinations here and there from the chemicals and a lack of sleep, but this time was different. I was in my own reality and my heart was racing. I had an awful reaction. The hallucinations got so real and my heart rate was beyond thumping. That day I ended up in the psych ward with very little recollection of how I ended up there. I had never been so afraid in my life. I could have died and that was enough for me to want to change.

Q : How was it for you in the early days? What was most difficult?

Benny : I had a different experience than most do in early sobriety. I was stuck in a drug-induced psychosis for the first four months of sobriety. My life was consumed by Alcoholics Anonymous meetings every day and sometimes two a day. I found guidance, friendship, and strength through these meetings. To say early sobriety was fun and easy would be a lie. However, I did learn it was possible to live a life without the use of drugs and alcohol. I also learned how to have fun once again. The most difficult part about early sobriety was dealing with my emotions. Since I started using drugs and alcohol that is what I used to deal with my emotions. If I was happy I used, if I was sad I used, if I was anxious I used, and if I couldn’t handle a situation I used. Now that the drinking and drugs were out of my life, I had to find new ways to cope with my emotions. It was also very hard leaving my old friends in the past.

Q : What reaction did you get from family and friends when you started getting sober?

Benny : My family and close friends were very supportive of me while getting sober. Everyone close to me knew I had a problem and were more than grateful when I started recovery. At first they were very skeptical because of my history of relapsing after treatment. But once they realized I was serious this time around, I received nothing but loving support from everyone close to me. My mother was especially helpful as she stopped enabling my behavior and sought help through Alcoholics Anonymous. I have amazing relationships with everyone close to me in my life today.

Q : Have you ever experienced a relapse?

Benny : I experienced many relapses before actually surrendering. I was constantly in trouble as a teenager and tried quitting many times on my own. This always resulted in me going back to the drugs or alcohol. My first experience with trying to become sober, I was 15 years old. I failed and did not get sober until I was 19. Each time I relapsed my addiction got worse and worse. Each time I gave away my sobriety, the alcohol refunded my misery.

Q : How long did it take for things to start to calm down for you emotionally and physically?

Benny : Getting over the physical pain was less of a challenge. It only lasted a few weeks. The emotional pain took a long time to heal from. It wasn’t until at least six months into my sobriety that my emotions calmed down. I was so used to being numb all the time that when I was confronted by my emotions, I often freaked out and didn’t know how to handle it. However, after working through the 12 steps of AA, I quickly learned how to deal with my emotions without the aid of drugs or alcohol.

Q : How hard was it getting used to socializing sober?

Benny : It was very hard in the beginning. I had very low self-esteem and had an extremely hard time looking anyone in the eyes. But after practice, building up my self-esteem and going to AA meetings, I quickly learned how to socialize. I have always been a social person, so after building some confidence I had no issue at all. I went back to school right after I left drug rehab and got a degree in communications. Upon taking many communication classes, I became very comfortable socializing in any situation.

Q : Was there anything surprising that you learned about yourself when you stopped drinking?

Benny : There are surprises all the time. At first it was simple things, such as the ability to make people smile. Simple gifts in life such as cracking a joke to make someone laugh when they are having a bad day. I was surprised at the fact that people actually liked me when I wasn’t intoxicated. I used to think people only liked being around me because I was the life of the party or someone they could go to and score drugs from. But after gaining experience in sobriety, I learned that people actually enjoyed my company and I wasn’t the “prick” I thought I was. The most surprising thing I learned about myself is that I can do anything as long as I am sober and I have sufficient reason to do it.

Q : How did your life change?

Benny : I could write a book to fully answer this question. My life is 100 times different than it was nine years ago. I went from being a lonely drug addict with virtually no goals, no aspirations, no friends, and no family to a productive member of society. When I was using drugs, I honestly didn’t think I would make it past the age of 21. Now, I am 28, working a dream job sharing my experience to inspire others, and constantly growing. Nine years ago I was a hopeless, miserable human being. Now, I consider myself an inspiration to others who are struggling with addiction.

Q : What are the main benefits that emerged for you from getting sober?

Benny : There are so many benefits of being sober. The most important one is the fact that no matter what happens, I am experiencing everything with a clear mind. I live every day to the fullest and understand that every day I am sober is a miracle. The benefits of sobriety are endless. People respect me today and can count on me today. I grew up in sobriety and learned a level of maturity that I would have never experienced while using. I don’t have to rely on anyone or anything to make me happy. One of the greatest benefits from sobriety is that I no longer live in fear.

Case Study: Lorrie

Figure 1. Lorrie.

Lorrie Wiley grew up in a neighborhood on the west side of Baltimore, surrounded by family and friends struggling with drug issues. She started using marijuana and “popping pills” at the age of 13, and within the following decade, someone introduced her to cocaine and heroin. She lived with family and occasional boyfriends, and as she puts it, “I had no real home or belongings of my own.”

Before the age of 30, she was trying to survive as a heroin addict. She roamed from job to job, using whatever money she made to buy drugs. She occasionally tried support groups, but they did not work for her. By the time she was in her mid-forties, she was severely depressed and felt trapped and hopeless. “I was really tired.” About that time, she fell in love with a man who also struggled with drugs.

They both knew they needed help, but weren’t sure what to do. Her boyfriend was a military veteran so he courageously sought help with the VA. It was a stroke of luck that then connected Lorrie to friends who showed her an ad in the city paper, highlighting a research study at the National Institute of Drug Abuse (NIDA), part of the National Institutes of Health (NIH.) Lorrie made the call, visited the treatment intake center adjacent to the Johns Hopkins Bayview Medical Center, and qualified for the study.

“On the first day, they gave me some medication. I went home and did what addicts do—I tried to find a bag of heroin. I took it, but felt no effect.” The medication had stopped her from feeling it. “I thought—well that was a waste of money.” Lorrie says she has never taken another drug since. Drug treatment, of course is not quite that simple, but for Lorrie, the medication helped her resist drugs during a nine-month treatment cycle that included weekly counseling as well as small cash incentives for clean urine samples.

To help with heroin cravings, every day Lorrie was given the medication buprenorphine in addition to a new drug. The experimental part of the study was to test if a medication called clonidine, sometimes prescribed to help withdrawal symptoms, would also help prevent stress-induced relapse. Half of the patients received daily buprenorphine plus daily clonidine, and half received daily buprenorphine plus a daily placebo. To this day, Lorrie does not know which one she received, but she is deeply grateful that her involvement in the study worked for her.

The study results? Clonidine worked as the NIDA investigators had hoped.

“Before I was clean, I was so uncertain of myself and I was always depressed about things. Now I am confident in life, I speak my opinion, and I am productive. I cry tears of joy, not tears of sadness,” she says. Lorrie is now eight years drug free. And her boyfriend? His treatment at the VA was also effective, and they are now married. “I now feel joy at little things, like spending time with my husband or my niece, or I look around and see that I have my own apartment, my own car, even my own pots and pans. Sounds silly, but I never thought that would be possible. I feel so happy and so blessed, thanks to the wonderful research team at NIDA.”

• Liquor store. Authored by : Fletcher6. Located at : https://commons.wikimedia.org/wiki/File:The_Bunghole_Liquor_Store.jpg . License : CC BY-SA: Attribution-ShareAlike
• Benny Story. Provided by : Living Sober. Located at : https://livingsober.org.nz/sober-story-benny/ . License : CC BY: Attribution
• One patientu2019s story: NIDA clinical trials bring a new life to a woman struggling with opioid addiction. Provided by : NIH. Located at : https://www.drugabuse.gov/drug-topics/treatment/one-patients-story-nida-clinical-trials-bring-new-life-to-woman-struggling-opioid-addiction . License : Public Domain: No Known Copyright

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A case study of alcohol dependence syndrome with poor motivation and coping skills: the psychosocial perspective

• January 2017
• Open Journal of Psychiatry & Allied Sciences 8(1):87
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• Amrita Vishwa Vidyapeetham

• Institute of Human Behaviour & Allied Sciences

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Interactive case report

An alcoholic patient who continues to drink: case presentation, stuart mcpherson.

1 Department of Gastroenterology, South Tyneside Healthcare NHS Foundation Trust, South Shields NE34 0PL

Colin John Rees

Mr Bond is a 42 year old man with alcoholic cirrhosis who was admitted to our unit with haematemesis. He had had three previous admissions with alcohol related problems and had twice bled from oesophageal varices. The varices had been treated by sclerotherapy and banding, and he was taking propranolol 40 mg twice daily as secondary prophylaxis. His most recent endoscopy had shown three, barely noticeable oesophageal varices.

Mr Bond has a history of excessive alcohol intake over five years, with no periods of abstinence. He was drinking 3-4 litres of strong cider a day up until the day of admission. A consultant psychiatrist had previously diagnosed depression and alcohol dependence syndrome. Although Mr Bond had been treated with paroxetine, he discontinued it as he thought it was unhelpful. He had also seen the drug and alcohol team several times. His attendance at appointments with the psychiatrist and drug and alcohol team was sporadic as he felt that these were of little benefit to him. He complied with medical drug treatment.

• What are the likely causes of Mr Bond's bleeding?
• How would you rate the severity of this bleed?
• What initial steps should be taken in his management?
• Given Mr Bond's continued alcohol consumption, how far should we go with treatment?

Please respond through bmj.com , remembering that Mr Bond is a real patient and that he and his carers will read your response

Mr Bond lives with a partner and has three children from a previous marriage, whom he rarely sees. He worked for the local council for 22 years but stopped working several years ago because of his alcohol dependence and depression. His marriage breakup a few years earlier had precipitated particularly heavy drinking. Mr Bond describes himself as a worrier and turns to alcohol when things go wrong. His mother died at the age of 60 from alcoholic liver disease.

On presentation with gastrointestinal bleeding he was jaundiced and showed signs of chronic liver disease ( table ). He was not encephalopathic. His pulse was 140/min and blood pressure 118/67 mm Hg with no appreciable postural drop. He had mild ascites but no hepatosplenomegaly. Per rectal examination showed melaena.

Results of investigations at presentation

Competing interests: None declared.

This is the first of a three part case report where we invite readers to take part in considering the diagnosis and ethical issues surrounding the management of a case using the rapid response feature on bmj.com . Next week we will report the case progression, and in four weeks' time we will report the outcome and summarise the responses

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Alcohol effects on family relations: a case study

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• 1 Minas Gerais Federal University, School of Nursing. [email protected]
• PMID: 18709271
• DOI: 10.1590/s0104-11692008000700005

Problems related to alcohol abuse have been associated to different factors, regardless of the causes attributed to this phenomenon. Alcohol consumption and dependence is considered a public health problem and deserve attention because of the social, work, family, physical, legal and violence-related risks it represents. This study aimed to identify the effects of alcoholism on family relations and, by means of case management, to encourage the recovery of these relationships. The results show that the problems caused by alcohol abuse impose profound suffering to family members, which contributes to high levels of interpersonal conflict, domestic violence, parental inadequacy, child abuse and negligence, financial and legal difficulties, in addition to clinical problems associated to it.

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Introduction to Social Work: An Advocacy-Based Profession

Student resources, case studies.

Case Study for Chapter 10: Substance Use and Addiction

Jennifer’s brother Emmett resorted to drugs and alcohol to drown his sorrow after their dad left their mother. The local inner city high school had its share of dealers and Emmett’s will power was nil. While weed (cannabis, marijuana, pot) was Emmett’s initial drug of choice, his substance use later led him to having a heroin addiction. Now out of the closet as a gay man, Emmett also was introduced to the club/party drugs of ecstasy and crystal meth. It breaks Jennifer’s and her mom’s heart to watch Emmett maintain his addiction despite some brief stints in drug rehab and attendance at local AA meetings. Emmett’s sponsor uses tough love—a mix of encouragement and challenge—to help Emmett stay on his path to and through recovery.

1) What local, state, and national policy and practice resources exist for social workers who work with people who abuse substances?

2) With the help of a social worker, how might family members intervene to help Emmett recover and maintain his sobriety? How might they benefit personally from social work services as well?

3) How much stigma encircles people who succumb to substance abuse or addiction?  

4) What specific challenges might need to be addressed in treatment in order for Emmett to truly achieve a high functioning level?

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Summary of the case Employee privacy and occupational safety especially in a dangerous workplace have always clashed in the past. Employers always feel the need to perform random drug tests at the workplace, which many argue violates employee privacy. The Supreme Court of Canada only recently released a ruling related to random alcohol and drug tests at the workplace in Canada. The case was between Communications, Energy and Paperworkers Union of Canada, Local 30 v. Irving Pulp & Paper, Limited and was published on June 14, 2013 (Naccaroto 2013).

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• Researchers Study Intersection of Alcohol, Anxiety and Sleep in Teens

UM researcher, students examine adolescent sleep patterns and alcohol use

OXFORD, Miss. – To help prevent alcohol use in adolescence, parents may want to pay attention to their teenager's sleep schedule, according to a recent study from University of Mississippi researchers.

Poor sleep quality is associated with a higher risk of anxiety and, subsequently, a higher likelihood of alcohol use in adolescence, concludes Sarah Bilsky, assistant professor of psychology , and a team of students. Their research was published in the journal Substance Use & Misuse .

"Most people can agree that sleep is important, but I don't think families always understand how important it really is," Bilsky said. "If you can get on good sleep schedules early, that can have the benefit of preventing these downstream problems.

"This (research) suggests in a very preliminary way that one way to reduce alcohol use in adolescents is to target some of these downstream factors. Getting kids engaged in healthier sleep habits and trying to target anxiety – doing those interventions early can may reduce the likelihood of these problematic outputs later."

Americans are sleeping less and stressing more , a recent study from Gallup found. Young women are the most likely to get poor sleep and experience anxiety.

The idea for the research grew from Gabrielle Armstrong's honors thesis, Bilsky said. Armstrong, a Tupelo native, graduated with a bachelor's degree in psychology in 2022 and is returning to Ole Miss this fall to work on a doctoral degree.

"I recognize in my community and in Mississippi, a lot of people do struggle with internalizing disorders and to cope with those symptoms, they often turn to alcohol," Armstrong said. "What led me to this topic, I think I wanted to better understand how those variables like anxiety and alcohol interact with each other and how they interact with sleep."

Armstrong, Bilsky and two other student researchers surveyed more than 140 adolescents between the ages of 13 and 18 about their relationship with alcohol, anxiety and sleep.

"We found a positive association between poor sleep and increased level of anxiety and alcohol use, and the more anxiety individuals had, the more they engaged in alcohol use and coping motives for alcohol use," Armstrong said.

This mirrors what research has shown in adults: that poor sleep increases the likelihood of anxiety , and many people self-medicate anxiety symptoms with alcohol. But alcohol also has been shown to be a disrupter of sleep patterns , adding to the cycle.

"Adults with anxiety tend to report more alcohol use, but in adolescence, the association is not quite as consistent or as clear," Bilsky said. "But it could create this sort of path: Once kids initiate alcohol use, they may begin using it to cope.

"Once that pattern begins, it can become a problem."

When she returns to complete her doctorate, Armstrong hopes to continue studying the intersection of mental health and addiction, she said. Understanding these complex relationships can help parents, mentors and health care providers better treat teens.

More research is needed to prove poor sleep patterns can increase the likelihood of alcohol misuse, but this work is a start, Bilsky said.

"Kids who have anxiety who are also using alcohol, if they start to use that alcohol to cope with negative feelings, that can set up a pretty negative path for them, and they are more likely to use alcohol problematically," Bilsky said. "We hypothesize that it starts with sleep, but we can't say it does definitively.

"This was a first stab at looking at these associations. Now, we have to look and see if this hypothesis replicates in future examinations."

Top: By helping their children develop good sleep habits, parents may be able to help ward off problems with anxiety and alcohol abuse down the road, a study by Ole Miss researchers suggests. Graphic by Jordan Thweatt/University Marketing and Communications

Clara Turnage

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July 24, 2024

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Zero-alcohol beverages appeal to teens and could encourage alcohol use, Australian study finds

A world-first Australian study involving 15 to 17-year-olds has found more than half of teens surveyed are attracted to zero-alcohol-branded products.

Leon Booth from the George Institute for Global Health, who led the research, says the products could further normalise alcohol consumption among teens.

What's next?

The Cancer Council and the Alcohol and Drug Foundation are calling on the federal government to regulate how zero-alcohol products are marketed and sold.

There are calls for better regulation of zero-alcohol beverages following new research suggesting they condition teenagers into a "harmful" drinking culture. 

The Australian study, commissioned by the Cancer Council, echoes concerns raised by the World Health Organisation about a lack of policy and regulation on the sale of these drinks.

Leon Booth from the George Institute for Global Health led the research, which involved focus group discussions with 44 Australian teenagers aged between 15 and 17 years old, and a national survey of 679 Australian teenagers in the same age bracket. 

"More than a third had tried zero-alcohol products, and we found that they were really quite attractive to a large proportion of adolescents," Dr Booth said. 

"The males tended to like the look of the beers, whereas the female participants really liked some of the more colourful cocktail drinks.

Dr Booth said the research showed that zero-alcohol products and marketing were likely making young people more familiar with alcohol brands and further normalising alcohol consumption.

He said young people could buy these drinks easily and were purchasing them to consume in a variety of situations.

"Some of it just seems to be a curiosity, like they wanted to know what beer or wine or different spirits tasted like, and so they saw this as an opportunity to [try them]," he said."

The variety and availability of these drinks has increased in recent years, with more than 30 per cent of all consumers buying no-alcohol beer, cider, wines, spirits and ready-to-drinks in 2022.

The deputy chair of Cancer Council's Nutrition, Alcohol and Physical Activity Committee, Julia Stafford, said the organisation was calling on the federal government to better regulate zero-alcohol branded products.

"There are currently no standards limiting the ways they simulate alcoholic products, or restrictions on marketing or sales, meaning young people can purchase these products and are exposed to marketing in highly visible places such as supermarkets," she said. 

"This environment creates a public health risk to young Australians."

Energy drinks a bigger problem?

The focus groups and survey, while nationally representative, were weighted towards young people in the city.

So, what do young people in regional Australia think about these drinks?

Zelda Edwards has just turned 18 and lives in Berri in South Australia's Riverland, about three hours from Adelaide.

While they can now buy any drink they want, they have never really felt drawn to zero-alcohol products.

"There are some colourful ones, and ones with little animals like penguins on them that could be appealing," she said.

"But I think they're priced quite ridiculously … I'm not wasting my money on that when I'd rather buy Monster [energy drink] instead."

Zelda did feel sales of zero-alcohol drinks could be more regulated. 

"I don't want to see little kids walking around with fake alcohol trying to be hard," she said.

Li Ingle works at rural youth arts organisation Riverland Youth Theatre but has found little buzz for zero-alcohol products among the teenagers like Zelda that they work with.

"Their vice is energy drinks," they said, in reference to all the young people they interact with.

"If it's got guarana or caffeine, that's what they're going to go for."

The 28-year-old said many of their peers enjoyed zero-alcohol drinks and hoped they remained widely available. 

"I think having more options that are not alcoholic is actually a safer situation," they said.

Products 'mimic' the look of alcohol

Alcohol and Drug Foundation evidence manager Eleanor Costello said while zero-alcohol products had helped adults substitute alcoholic drinks, they should be sold in licensed bottle shops.

"We're concerned about how these products mimic alcohol in the way they look, taste and are marketed, and that behavioural conditioning of young people," she said.

"From the perspective of wanting to delay uptake of alcohol use because of the harms, we would really like to see access to these products limited."

A spokesperson for the federal Department of Health said in a statement the government was providing more than $870 million over four years, from July 2023, to support drug and alcohol treatment services, prevention, research and communication activities.

"The Alcohol Beverages Advertising Code Scheme applies to advertising of low and zero-alcohol beverage products that are alcohol brand extensions," the spokesperson said.

Editor's note: Eliza Berlage is a board member of the Riverland Youth Theatre. The contribution from members of RYT was independently approved prior to publication. 

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Prevalence of alcohol-impaired driving: a systematic review with a gender-driven approach and meta-analysis of gender differences

• Published: 26 July 2024

Cite this article

• Guido Pelletti 1   na1 ,
• Rafael Boscolo-Berto 2   na1 ,
• Laura Anniballi 1 ,
• Arianna Giorgetti 1 ,
• Filippo Pirani 1 ,
• Mara Cavallaro 1 ,
• Luca Giorgini 1 ,
• Paolo Fais   ORCID: orcid.org/0000-0002-2270-9956 1 ,
• Jennifer Paola Pascali 1 &
• Susi Pelotti 1  

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A growing number of studies investigated the factors that contribute to driving under the influence (DUI) of alcohol in relation to gender. However, a gendered approach of the scientific evidence is missing in the literature. To fill this gap, a gender-driven systematic review on real case studies of the last two decades was performed. In addition to the gender of the drivers involved, major independent variables such as the period of recruitment, the type of drivers recruited, and the geographical area where the study was conducted, were examined. Afterwards, a meta-analysis was performed comparing alcohol-positive rates (APR) between male and female drivers in three subgroups of drivers: those involved in road traffic accidents, those randomly tested on the road, and volunteers.

Three databases were searched for eligible studies in October 2023. Real-case studies reporting APR in man and women convicted for DUI of alcohol worldwide were included. Univariate analysis by ANOVA with post-hoc tests identified the independent variables with a significant impact on the dependent variable APR, according to a relationship subsequently investigated by standard multiple linear regression. The meta-analysis of random effects estimates was performed to investigate the change in overall effect size (measured by Cohen’s d standardized mean difference test) and 95% confidence interval (CI).

Among papers addressing driver gender, univariate analysis of independent variables revealed a higher Alcohol Positive Rate (APR) in men, particularly in drivers involved in crashes, with a noticeable decrease over time. Analyzing the gender of drivers involved in crashes, the meta-analysis showed that men had a significantly higher APR (30.7%; 95%CI 26.8–35.0) compared to women (13.2%; 95%CI 10.7–16.1). However, in drivers randomly tested, there was no significant difference in APR between genders (2.1% for men and 1.4% for women), while in volunteers, there was a statistically significant difference in APR with 3.4% (95%CI 1.5–7.6) for men and 1.1% (95%CI 0.5–2.7) for women.

Despite a progressive decrease in the epidemiological prevalence of alcohol-related DUI over time, this phenomenon remains at worryingly high levels among drivers involved in road traffic accidents in both genders, with a higher prevalence in men. It’s important for policymakers, professionals, and scientists to consider gender when planning research, analysis, interventions, and policies related to psychoactive substances, such as alcohol or other licit drugs. Forensic sciences can play a vital role in this regard, enabling a thorough analysis of gender gaps in different populations.

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Guido Pelletti and Rafael Boscolo-Berto equally contributed to this paper.

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Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, Bologna, 40126, Italy

Guido Pelletti, Laura Anniballi, Arianna Giorgetti, Filippo Pirani, Mara Cavallaro, Luca Giorgini, Paolo Fais, Jennifer Paola Pascali & Susi Pelotti

Institute of Human Anatomy, Department of Neurosciences, University of Padova, Via A. Gabelli 65, Padua, 35127, Italy

Rafael Boscolo-Berto

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GP: conceptualization; writing-original draft; RBB: methodology; formal analysis; LA: data curation; visualization; AG: data curation; formal analysis; FP: data curation; formal analysis; MC data curation; visualization;: LG data curation; visualization;: PF data curation; visualization;: JPP: SP: conceptualization; supervision. All authors have read and approved the final version of the manuscript.

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Pelletti, G., Boscolo-Berto, R., Anniballi, L. et al. Prevalence of alcohol-impaired driving: a systematic review with a gender-driven approach and meta-analysis of gender differences. Int J Legal Med (2024). https://doi.org/10.1007/s00414-024-03291-3

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DOI : https://doi.org/10.1007/s00414-024-03291-3

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Low Alcohol Use Offers No Clear Health Benefits

July 25, 2024 – Do people who drink alcohol in moderation have a greater risk of early death than people who abstain? For years, a drink or two a day appeared to be linked to health benefits. But recently, scientists pointed out flaws in some of the studies that led to those conclusions, and public health warnings have escalated recently that there may be no safe level of alcohol consumption.

Now, yet another research analysis points toward that newer conclusion – that people who drink moderately do not necessarily live longer than people who abstain. The latest results are important because the researchers delved deep into data about people who previously drank but later quit, possibly due to health problems.

“That makes people who continue to drink look much healthier by comparison,” said Tim Stockwell, PhD, lead author of this latest analysis and a scientist with the Canadian Institute for Substance Use Research at the University of Victoria, in a  statement .

The findings were published this month in the  Journal of Studies on Alcohol and Drugs .

The key to their conclusion that drinking isn’t linked to longer life is based yet again on who moderate drinkers are compared to, Stockwell and his colleagues wrote.

For the study, researchers defined “low volume drinking” as having between one drink per week and up to two drinks per day. When researchers carefully excluded people who were former drinkers and only included data for people who were younger than 55 when they joined research studies, the abstainers and low-volume drinkers had similar risks of early death. But when the former drinkers were included in the abstainer group, the low-volume drinkers appeared to have a reduced risk of death.

When researchers define which people are included in a research analysis based on criteria that don’t reflect subtle but important population characteristics, the problem is called “selection bias.” 

“Studies with life-time selection biases may create misleading positive health associations. These biases pervade the field of alcohol epidemiology and can confuse communications about health risks,” the authors concluded.

They called for improvements in future research studies to better evaluate drinking levels that may influence health outcomes, and also noted one of their exploratory analyses suggested a need to delve deeper into the effects of other outside variables such as smoking and socioeconomic status. 

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Acute cardiovascular effects of simultaneous energy drink and alcohol consumption in young adults: a review of case reports.

1. Introduction

2. materials and methods, 2.1. eligibility criteria, 2.1.1. inclusion criteria, 2.1.2. exclusion criteria, 2.2. information sources, 2.3. search strategy, 2.4. selection process, 2.5. record selection, summary of included cases, 4. discussion, 4.1. effects of eds on the cardiovascular system, 4.2. effects of alcohol on the cardiovascular system, 4.3. effects of eds and alcohol on the cardiovascular system, 4.4. prevention of adverse health events associated with simultaneous ed and alcohol consumption, 4.5. limitations, 5. conclusions, author contributions, data availability statement, conflicts of interest.

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• Foodwatch. Energydrinks: Altersgrenze Auch in Deutschland! Available online: https://www.foodwatch.org/de/energy-drinks-altersgrenze-auch-in-deutschland (accessed on 12 January 2024).

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Azarm, V.; Link, J.-P.; Mandilaras, G.; Li, P.; Dalla-Pozza, R.; Jakob, A.; Haas, N.A.; Oberhoffer, F.S.; Schrader, M. Acute Cardiovascular Effects of Simultaneous Energy Drink and Alcohol Consumption in Young Adults: A Review of Case Reports. Pediatr. Rep. 2024 , 16 , 618-630. https://doi.org/10.3390/pediatric16030052

Azarm V, Link J-P, Mandilaras G, Li P, Dalla-Pozza R, Jakob A, Haas NA, Oberhoffer FS, Schrader M. Acute Cardiovascular Effects of Simultaneous Energy Drink and Alcohol Consumption in Young Adults: A Review of Case Reports. Pediatric Reports . 2024; 16(3):618-630. https://doi.org/10.3390/pediatric16030052

Azarm, Victor, Jan-Philipp Link, Guido Mandilaras, Pengzhu Li, Robert Dalla-Pozza, André Jakob, Nikolaus Alexander Haas, Felix Sebastian Oberhoffer, and Meike Schrader. 2024. "Acute Cardiovascular Effects of Simultaneous Energy Drink and Alcohol Consumption in Young Adults: A Review of Case Reports" Pediatric Reports 16, no. 3: 618-630. https://doi.org/10.3390/pediatric16030052

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Alcohol, snack industries take hit as weight loss drugs drive healthier shopping trends: Study

Data from analytics firm grocery doppio indicates shoppers are buying less and swapping processed foods for healthier options.

Ozempic, Wegovy are great drugs for the right people: Dr. Marc Siegel

FOX News medical contributor Dr. Marc Siegel discusses how prepared hospital E.R.s are to treat kids and the side effects of weight loss drugs on 'The Big Money Show.'

Ninety-seven percent of shoppers reduced their grocery spending after taking GLP-1 (Glucagon-Like Peptide-1) medication, a recent study shows, and alcohol and processed foods are two of several areas taking a hit.

Data from analytics firm Grocery Doppio's "State of Digital Grocery Performance Scorecard" found that shoppers who used popular drugs like Ozempic, Wegovy, Mounjaro and Zepbound for weight loss not only purchased fewer food items, but they also swapped out bad foods for healthier alternatives, according to The New York Post .

On the winning end, lean proteins, meal replacements, healthy snack alteratives, whole fruits and vegetables and energy drinks comprised the top five, with lean meat seeing the most significant purchase increase at +27%, the Post reported.

OZEMPIC AND WEGOVY NEEDLES REQUIRE PROPER DISPOSAL, HEALTH OFFICIALS SAY – HERE'S HOW TO THROW THEM AWAY

Shoppers are buying less unhealthy foods and opting for healthier alternatives after taking GLP-1 injectables. (iStock)

On the contrary, data indicates shoppers opted less for starchy, sugary and processed goods, with snacks and confectionery makers taking the hardest hit at a -52% decline. 

Prepared baked goods (-47%), soda and sugary beverages (-28%), alcoholic beverages (-17%) and processed foods (-13%) also saw measurable declines.

GLP-1 users' grocery spending declined an overall total of 11%, a change presumably creditable to the drugs' appetite-suppressing effects and one that could lead major brands to look for ways to appeal to customers focused on weight loss goals.

Food giant Nestlé recently launched a line of products to appeal to GLP-1 users, with nutrient-dense and portion-controlled products, including frozen meals like frozen pastas, sandwich melts and pizzas.

OZEMPIC AND WEGOVY WEIGHT LOSS DRUGS COULD HELP REDUCE ALCOHOL USE DISORDER SYMPTOMS, STUDY SUGGESTS

This photograph taken on February 23, 2023, in Paris, shows the anti-diabetic medication "Ozempic" (semaglutide) made by Danish pharmaceutical company "Novo Nordisk."  (Photo by JOEL SAGET/AFP via Getty Images / Getty Images)

Other companies also homed in on opportunities to cash in on the GLP-1 craze, including Kellogg's, who recently released a duo of healthier plant-based cereals called "Eat Your Mouth Off" that are richer in protein and have no added sugar.

GLP-1 drugs, or glucagon-like peptide-1 receptor agonists, mimic the actions of the naturally-occurring GLP-1 hormone that controls hunger, manages blood sugar and insulin and helps manage metabolism. 

WEGOVY, THE WEIGHT-LOSS MEDICATION, GETS FDA APPROVAL FOR USE AS HEART DISEASE PREVENTION DRUG

Ro GLP-1 tracker helps people crowdsource supply and report shortages: Zach Reitano

 RO CEO Zach Reitano explains how his company tracks Ozempic and Wegovy supply on 'The Claman Countdown.'

Originally intended to treat type 2 diabetes, Novo Nordisk's Ozempic garnered attention and saw massive amounts of off-label use for its slimming side effect and to treat other endocrinological conditions such as polycystic ovarian syndrome, metabolic syndrome, insulin resistance and prediabetes. Its stronger counterpart, Wegovy, received FDA approval for obesity treatment in 2021.

Eli Lilly's Mounjaro, a first-in-class GLP-1/GIP (glucose-dependent Insulinotropic polypeptide) receptor agonist drug was also initially used to treat type 2 diabetes, but was FDA approved to be sold for obesity treatment under the name Zepbound in late 2023.

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Studies show Ozempic, Wegovy have a 'very positive' effect on the brain: Dr. Marc Siegel

Fox News medical contributor Dr. Marc Siegel discusses whether weight loss drugs like Ozempic can lower anxiety and depression on 'Varney & Co.'

Top 10 states with employees most likely to go to work hungover, according to new study

• Published: Jul. 28, 2024, 9:00 a.m.

‘Heavy’ drinking describes eight or more drinks (for women) or 15 or more drinks (for men) per week. Getty Images

• Dr. Gracelyn Santos | [email protected]

A new study reveals the states where workers are most likely to go to work hungover — and it’s bad news for North Dakota.

The study , collected by Origins Recovery Center, examined CDC and MHA data and ranked states based on binge drinking rates.

According to the report, North Dakota is the most likely to drink alcohol excessively and turn up to work the following day feeling sick, with the highest percentage of people who binge or heavy drink, as 23.9%.

This is significantly higher than the national average of 18.4%, with one in five of the state’s drinkers putting their health at risk when consuming alcohol.

Therefore, with such high binge drinking rates, residents of North Dakota are most likely to arrive at work hungover. ‘Binge’ drinking refers to consuming four or more drinks (for women) or five or more drinks (men) on one occasion in the past 30 days.

Meanwhile, ‘heavy’ drinking describes eight or more drinks (for women) or 15 or more drinks (for men) per week.

Read on for the complete list.

TOP 10 STATES WITH HIGHEST PERCENTAGE OF BINGE DRINKING:

• North Dakota has highest percentage of people who binge or heavy drinking, with 23.9% of the population reported excessive drinking – nearly a quarter of the population.
• Montana takes second place, with almost a quarter (23.4%) admitting to overconsuming alcohol weekly, and nearly one-fifth (19.2%) accepting that they have a substance abuse problem, which can also produce a hangover.
• Iowa takes third place, with 22.6% of state residents report binge or heavy drinking.
• Wisconsin is fourth, with 21.6%
• Minnesota is fifth, with 21.2%.
• Colorado is sixth, with 20%
• Vermont is seventh, with 20.5%
• Nebraska (tied), with 20.5%
• South Dakota is eighth, with 18.6%
• Missouri is tenth, with 20.2%

DATA COLLECTION

Data was taken from Mental Health America’s (MHA) Adults with Substance Use Disorder 2023 ranking (which uses data from the SAMHSA report) and from the CDC’s Behavioural Risk Factor Surveillance System (2022), with prevalence of alcohol issue scaled by population to create a ranking of the states which are most likely to binge drink.

In the raw data, linked here , a ranking of 1 suggests the state most likely to over-indulge or demonstrate a substance use disorder, whereas a ranking of 51 (as the study includes the District of Columbia) suggests that the state is least likely to overconsume alcohol. A median value was calculated for the national average.

THE HARMFUL EFFECTS OF DRINKING ALCOHOL

Drinking alcohol, even moderately, can have immediate effects on your brain and behavior. It directly impacts your central nervous system, leading to impaired judgment, and can cause blackouts or alcohol poisoning in extreme cases.

Dehydration, lactic acid over-production, and disrupted sleep are all consequences of alcohol, and these factors produce what we colloquially call ‘hangovers’, which can involve feeling nauseous, headaches, shaking, and sweats.

The study suggests for people who drink alcohol to be conscious of drinking habits and to avoid binge drinking and regular overconsumption, as turning up hungover to work will significantly impact performance and cause trouble with your employer.

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Tuesday, July 23, 2024

NIH findings shed light on risks and benefits of integrating AI into medical decision-making

AI model scored well on medical diagnostic quiz, but made mistakes explaining answers.

Researchers at the National Institutes of Health (NIH) found that an artificial intelligence (AI) model solved medical quiz questions—designed to test health professionals’ ability to diagnose patients based on clinical images and a brief text summary—with high accuracy. However, physician-graders found the AI model made mistakes when describing images and explaining how its decision-making led to the correct answer. The findings, which shed light on AI’s potential in the clinical setting, were published in npj Digital Medicine .   The study was led by researchers from NIH’s National Library of Medicine (NLM) and Weill Cornell Medicine, New York City.

“Integration of AI into health care holds great promise as a tool to help medical professionals diagnose patients faster, allowing them to start treatment sooner,” said NLM Acting Director, Stephen Sherry, Ph.D. “However, as this study shows, AI is not advanced enough yet to replace human experience, which is crucial for accurate diagnosis.”

The AI model and human physicians answered questions from the New England Journal of Medicine (NEJM)’s Image Challenge. The challenge is an online quiz that provides real clinical images and a short text description that includes details about the patient’s symptoms and presentation, then asks users to choose the correct diagnosis from multiple-choice answers.

The researchers tasked the AI model to answer 207 image challenge questions and provide a written rationale to justify each answer. The prompt specified that the rationale should include a description of the image, a summary of relevant medical knowledge, and provide step-by-step reasoning for how the model chose the answer.

Nine physicians from various institutions were recruited, each with a different medical specialty, and answered their assigned questions first in a “closed-book” setting, (without referring to any external materials such as online resources) and then in an “open-book” setting (using external resources). The researchers then provided the physicians with the correct answer, along with the AI model’s answer and corresponding rationale. Finally, the physicians were asked to score the AI model’s ability to describe the image, summarize relevant medical knowledge, and provide its step-by-step reasoning.

The researchers found that the AI model and physicians scored highly in selecting the correct diagnosis. Interestingly, the AI model selected the correct diagnosis more often than physicians in closed-book settings, while physicians with open-book tools performed better than the AI model, especially when answering the questions ranked most difficult.

Importantly, based on physician evaluations, the AI model often made mistakes when describing the medical image and explaining its reasoning behind the diagnosis — even in cases where it made the correct final choice. In one example, the AI model was provided with a photo of a patient’s arm with two lesions. A physician would easily recognize that both lesions were caused by the same condition. However, because the lesions were presented at different angles — causing the illusion of different colors and shapes — the AI model failed to recognize that both lesions could be related to the same diagnosis.

The researchers argue that these findings underpin the importance of evaluating multi-modal AI technology further before introducing it into the clinical setting.

“This technology has the potential to help clinicians augment their capabilities with data-driven insights that may lead to improved clinical decision-making,” said NLM Senior Investigator and corresponding author of the study, Zhiyong Lu, Ph.D. “Understanding the risks and limitations of this technology is essential to harnessing its potential in medicine.”

The study used an AI model known as GPT-4V (Generative Pre-trained Transformer 4 with Vision), which is a ‘multimodal AI model’ that can process combinations of multiple types of data, including text and images. The researchers note that while this is a small study, it sheds light on multi-modal AI’s potential to aid physicians’ medical decision-making. More research is needed to understand how such models compare to physicians’ ability to diagnose patients.

The study was co-authored by collaborators from NIH’s National Eye Institute and the NIH Clinical Center; the University of Pittsburgh; UT Southwestern Medical Center, Dallas; New York University Grossman School of Medicine, New York City; Harvard Medical School and Massachusetts General Hospital, Boston; Case Western Reserve University School of Medicine, Cleveland; University of California San Diego, La Jolla; and the University of Arkansas, Little Rock.

The National Library of Medicine (NLM) is a leader in research in biomedical informatics and data science and the world’s largest biomedical library. NLM conducts and supports research in methods for recording, storing, retrieving, preserving, and communicating health information. NLM creates resources and tools that are used billions of times each year by millions of people to access and analyze molecular biology, biotechnology, toxicology, environmental health, and health services information. Additional information is available at https://www.nlm.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

NIH…Turning Discovery Into Health ®

Qiao Jin, et al. Hidden Flaws Behind Expert-Level Accuracy of Multimodal GPT-4 Vision in Medicine. npj Digital Medicine. DOI: 10.1038/s41746-024-01185-7 (2024).

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More women are ending pregnancies on their own, a new study suggests. Some resort to unsafe methods

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A growing number of women said they’ve tried to end their pregnancies on their own by doing things like taking herbs, drinking alcohol or even hitting themselves in the belly, a new study suggests.

Researchers surveyed reproductive-age women in the U.S. before and after the Supreme Court overturned Roe v. Wade in June 2022. The proportion who reported trying to end pregnancies by themselves rose from 2.4% to 3.3%.

“A lot of people are taking things into their own hands,” said Dr. Grace Ferguson, a Pittsburgh OB-GYN and abortion provider who wasn’t involved in the research, which was published Tuesday in the journal JAMA Network Open.

Study authors acknowledged that the increase is small. But the data suggests that it could number in the hundreds of thousands of women.

Researchers surveyed about 7,000 women six months before the Supreme Court decision, and then another group of 7,100 a year after the decision. They asked whether participants had ever taken or done something on their own to end a pregnancy. Those who said yes were asked follow-up questions about their experiences.

“Our data show that making abortion more difficult to access is not going to mean that people want or need an abortion less frequently,” said Lauren Ralph, an epidemiologist at the University of California, San Francisco, and one of the study’s authors.

Women gave various reasons for handling their own abortions, such as wanting an extra measure of privacy, being concerned about the cost of clinic procedures and preferring to try to end their pregnancies by themselves first.

They reported using a range of methods. Some took medications — including emergency contraception and the abortion pills misoprostol and mifepristone obtained outside the medical system and without a prescription. Others drank alcohol or used drugs. Some resorted to potentially harmful physical methods such as hitting themselves in the abdomen, lifting heavy things or inserting objects into their bodies.

Some respondents said they suffered complications like bleeding and pain and had to seek medical care afterward. Some said they later had an abortion at a clinic. Some said their pregnancies ended after their attempts or from a later miscarriage, while others said they wound up continuing their pregnancies when the method didn’t work.

Ralph pointed to some caveats and limits to the research. Respondents may be under-reporting their abortions, she said, because researchers are asking them about “a sensitive and potentially criminalized behavior.”

She also cautioned that some women may have understood the question differently after the Dobbs decision, such as believing that getting medication abortion through telehealth is outside the formal health care system when it’s not. But Ralph said she and her colleagues tested how people were interpreting the question before each survey was conducted.

The bottom line, Ferguson said, is that the study’s findings “confirm the statement we’ve been saying forever: If you make it hard to get (an abortion) in a formal setting, people will just do it informally.”

The research was funded by the David and Lucile Packard Foundation, the William and Flora Hewlett Foundation and a third foundation that was listed as anonymous.

AP polling editor Amelia Thomson DeVeaux in Washington contributed to this report.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

LIVE: Simone Biles and Team USA aim for first gold of their ‘redemption tour’

Which artificial sweetener is the safest choice?

There’s mounting evidence that artificial sweeteners may be linked to heart disease and other possible health risks. Scientists say the findings are far from definitive, however, with some leading researchers calling for better-designed clinical trials investigating the long-term health effects of sugar substitutes.

That’s why, in separate trials, researchers are actively working to get a clearer understanding of how artificial sweeteners affect blood glucose levels, gut microbiome health and the cardiovascular system. Some studies are beginning to compare the alternatives against each other, while others hope to learn how they affect the body compared to sugar.

As it is, it’s difficult for consumers to determine which sugar alternative carries the fewest health risks. Most of the research is observational , meaning it doesn’t prove cause and effect. In some cases, researchers looked at people who ate nonsugar sweeteners, analyzed their incidence of certain health risks like heart attacks or diabetes, then noted associations between the two.

All the widely consumed alternatives such as saccharin, aspartame, sucralose, stevia, xylitol and erythritol are approved by the Food and Drug Administration. They’re found in countless products including sports drinks, energy bars, yogurts, cereals, beverages, candies, baked goods and syrups.

Even with FDA approval, Dr. Dariush Mozaffarian, a cardiologist and professor of nutrition science and policy at Tufts University, said “they’re all potentially worrisome and all understudied.”

In recent research, cardiologist Dr. Stanley Hazen at the Cleveland Clinic found that the high concentrations of the sugar alcohol sweeteners xylitol and erythritol may cause the platelets in the blood to become more sticky and prone to clotting, in turn raising the risk of heart attack and stroke. The phenomenon is similar to what happens with high cholesterol, Hazen said. If they get big enough, the clots can block blood flow through crucial veins and arteries.

Some experts say that instead of trying to pinpoint the safest nonsugar sweetener, better studies need to determine whether there’s a benefit to swapping out sugar in the first place.

After publishing research finding a connection between erythritol and increased risk of heart attack and stroke , Hazen and his colleagues conducted the first head-to-head human trial comparing the effects of consuming erythritol versus sugar on the blood platelets that control clotting. The results of that study are pending publication.

Vasanti Malik, an assistant professor of nutritional sciences at the University of Toronto, meanwhile, is conducting a study of more than 500 people directly comparing the health effects of drinking sugar-sweetened beverages, noncaloric sweeteners or water. Malik and her colleagues plan to measure obesity and heart health over time.

At Virginia Tech, registered dietitian Valisa Hedrick is working with the National Institutes of Health on another study comparing the effects of four different artificial sweeteners versus sugar on blood glucose levels and gut microbiome health. The study, which focuses on people with prediabetes, is a controlled feeding trial, meaning participants only eat the meals that NIH provides them, and nothing more.

This is important, Hedrick said, because one of the growing concerns with nonsugar sweeteners is that the products trick the brain in such a way that they increase sugar cravings. People may then end up eating more sugar throughout the day, spiking their blood glucose.

With a controlled study, the researchers can answer whether the sweeteners themselves raise blood glucose directly — not the sugar people could otherwise eat later.

The limits of sweetener studies

A research bias called reverse causation can make it difficult to draw decisive conclusions from prior studies, Malik said.

People often change their diets after they start developing diabetes or putting on weight, Malik said. These people, generally, are most likely to switch from sugar to nonsugar sweeteners. This is where the reverse causation comes into play.

“You get a spurious association between the intake of nonsugar sweeteners and the risk for diabetes,” she said. That is, the data ends up suggesting that these sweeteners are causing health problems that already existed.

Many studies also rely on people to report whether they’ve consumed nonsugar substitutes, which can be unreliable. Names like xylitol can be buried in a long list of ingredients.

Other studies, meanwhile — like Hazen’s erythritol and xylitol studies — may focus directly on what happens in the body after someone consumes one of these sweeteners, but they tend to enroll small numbers of people and track them only for a short time.

“A lot of these studies are really hard to interpret,” said Dr. Michelle Pearlman, a gastroenterologist and the CEO and co-founder of the Prime Institute in Miami. “And the problem is that there’s no head-to-head trials of people eating candy bars versus xylitol, so I can’t make any blanket statements recommending one or the other.”

Both Hedrick and Malik hope to share results from their respective studies in the next several years.

“We need experimental science alongside more rigorous observational research,” Malik said. “There are trials underway, and I think in the next five years we’ll have more clarity on the topic. We’re just not quite there.”

In a statement, the Calorie Control Council, an industry trade group representing more than two dozen sweetener manufacturers, said studies linking alternative sweeteners to health risks are based on flawed research and that the products are safe.

“It is irresponsible to amplify faulty research to those who look to alternative sweeteners to reduce overall sugar intake as well as the millions who use it as a tool to manage their health conditions, including obesity and diabetes,” Carla Saunders, the trade group’s president, said in the statement.

Why it’s important to know

Most low-calorie and sugar-free foods contain at least one sugar substitute, and many contain several. These products are growing more popular, especially in the U.S. By 2033, market research suggests sugar substitutes could be worth more than $28.57 billion.

“They’re ubiquitous,” Mozafarrian said. “And they’re proliferating because people have become so obsessed with avoiding sugar.”

Mozaffarian said these sweeteners soared in popularity following changes to U.S. nutrition labeling requirements in 2016 .

The change required manufacturers to list added sugars on a separate line beneath total sugars. The idea was to help consumers differentiate between foods with naturally occurring sugars, like fruit and plain Greek yogurt, and foods that had sugars mixed in.

“Now, the food industry has a big incentive to make that ‘added sugars’ number as small as possible,” he said. “So you’re seeing these compounds in everything, and we still don’t have enough information on them.”

Some products are labeled as “artificial sweeteners” or “natural sweeteners” based on whether they’re derived from natural sources or chemically engineered.

Even natural sweeteners go through heavy chemical processing, said Dr. Maria Carolina Delgado-Lelievre, a cardiologist at the University of Miami.

For example, stevia comes from processed stevia plant extract, monk fruit sweetener comes from processing a chemical in a gourdlike fruit grown in China, and sucralose is a chemically altered version of sugar about 600 times sweeter, according to the FDA .

Aspartame and saccharin are from human-made fusions of amino acids and chemicals.

Many of these sweeteners are so potent in tiny quantities that they’re mixed with xylitol or erythritol to bulk them up and fill a packet, said the Cleveland Clinic’s Hazen.

Given this label confusion, Hedrick said researchers are increasingly using the term “nonsugar sweeteners.”

Health risks of added sugars

Sugar, of course, is one of the country’s most pressing public health problems. Especially in soda and juice, excess sugar fuels the ongoing obesity epidemic , contributing to heart disease, liver disease, cancer and diabetes .

However, there’s a big difference between processed, concentrated sugars like high-fructose corn syrup and the natural sugars found in fruits, Pearlman, the Miami gastroenterologist, said. Processed sugars are highly addictive.

“Anything with high-fructose corn syrup stimulates the same reward centers in our brain as cocaine and heroin,” she said. “Natural sugars from fruit act differently in the body.”

Sugar’s bad rap has much more to do with the quantity people consume than any intrinsically bad property, experts agree.

“Added sugar is nuanced,” Mozaffarian said. “When you try to take that very real nuance and turn it into a simple message, you get the industry misleading consumers that foods are ‘not good.’”

A little bit of added sugar in otherwise healthy foods, he said — such as lightly sweetened whole-grain cereals — is usually OK.

“The harms of these different nonsugar sweeteners have been greatly underemphasized and the harms of small amounts of added sugar have been overemphasized,” he argued.

Sugar substitutes for children?

The U.S. government’s Dietary Guidelines for Americans recommend that anyone over the age of 2 consume less than 10% of their daily calories from added sugar, or the equivalent of roughly 12 teaspoons of added sugar. In reality, as of 2018, people in the U.S., including children, were consuming about 17 teaspoons of added sugar per day, on average.

Recently, the U.S. Department of Agriculture implemented a new rule limiting added sugars in public school lunches . Michael Goran, a professor of pediatrics at the University of Southern California’s Keck School of Medicine, said he worries that schools will replace sugary foods with artificially sweetened foods to comply with the new rules.

“There’s this general perception that these sweeteners are safe alternatives, but if they’re broadly applied to children, I unfortunately think that’s very risky,” he said.

Mozaffarian said that at their current levels of added sugar, most yogurts would no longer be allowed in school lunches once the new rule goes into effect.

“They’re just above the new limit, so it’s likely these yogurts are now going to be made with a series of sweeteners with uncertain health effects,” Mozaffarian said.

In the meantime, Pearlman said, it’s easy to see they haven’t helped the population become healthier on the whole.

“We have more chronic disease, more diabetes today than we’ve ever had before,” she said. “That shows that despite the diet industry being worth billions of dollars, we’re clearly missing the ball.”

A confusing body of limited research, coupled with the lack of clarity on food labels, puts consumers in a tough position when it comes to selecting the healthiest choices, the experts concluded.

All agreed on the best solution:

• Eat as many whole, unprocessed foods as you can.
• The less processed a food, the less likely it is to be loaded with added sugars or nonsugar sweeteners.

“If I had the choice of eating a store-bought cookie with a lot of sweeteners in it, a store-bought cookie with monk fruit, or a homemade cookie with sugar, I would choose the homemade cookie,” Goran said. “You can still enjoy the cookie, but maybe put a little less sugar in there.”

NBC News contributor Caroline Hopkins is a health and science journalist who covers cancer treatment for Precision Oncology News. She is a graduate of the Columbia University Graduate School of Journalism.