Patterns of alcohol use among men receiving treatment for heroin and/or cocaine use in England, Brazil and Spain. A cross-country analysis

Introduction: Although alcohol is widely used concurrently with illicit drugs, the role of alcohol in recovery from and relapse to drug use is under-researched. This study investigates drinking patterns and factors associated with harmful drinking among men receiving community treatment for heroin and/or cocaine use. Methods: Secondary analysis of 3 cross-sectional studies in England (n = 153), Brazil (n = 149) and Spain (n = 131) was conducted. Sociodemographic, alcohol consumption (AUDIT), substance use, treatment characteristics, and physical health were assessed. Logistic regression determined factors associated with harmful drinking. Results: 41% of men receiving heroin and/or cocaine treatment met criteria for harmful drinking. Of this, 28% were not receiving treatment for alcohol. Factors identified with harmful drinking among those who were not receiving treatment for alcohol use were as follows: homeless, unemployment/receiving benefits, poly drug use, history of injecting drug(s), hepatitis C seropositive, and receiving treatment for heroin use with/without treatment for cocaine use. Participants from England who met criteria for harmful drinking were more likely to report not receiving treatment for alcohol use than those from Brazil and Spain. Discussion: Findings show that harmful drinking is common among men in treatment for drug use and remains neglected by the services.