Alcohol, especially wine, may be the most commonly used anxiolytic. France is a country which has among the highest per capita use of wine and of benzodiazepines [1, 2]. It is not known whether these are used as a complement to one other, or as substitutes.
To explore this, we examined the relationship of current wine intake to benzodiazepine (BZD) use in a cohort of community residents, 65 years and older living in the area of Bordeaux, France, included in the Paquid program in 1989 (n = 3777) [3]. Usual daily intake of wine was estimated from a questionnaire on food habits. Daily wine consumption was divided into: (i) none, (ii) moderate: up to 0.25 l day−1 and (iii) heavy: more than 0.25 l day−1. Benzodiazepine use was recorded on adhoc questionnaires including visual control of patient pharmacies. Multivariate unconditional logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for BZD use and wine consumption, after adjustment for potential confounding variables (age, gender, living alone, depressive symptomatology evaluated by the Center for Epidemiological Studies-Depression (CES-D) scale, global cognitive decline defined as a Mini-Mental State Examination (MMSE) score lower than 24, education level and subjective health assessment).
Table 1 shows the baseline characteristics of the 3767 persons (99.7%) for whom wine consumption was available. Current use of benzodiazepines was inversely correlated to drinking patterns: 37.4% of non-drinkers used BZD, compared with 31.3% of moderate drinkers (unadjusted OR 0.76; 95% CI 0.66, 0.88; adjusted OR 0.99; 95% CI 0.85, 1.16), and 19.3% of heavy drinkers (unadjusted OR 0.40; 95% CI 0.32, 0.50; adjusted OR 0.70; 95% CI 0.52, 0.94) (Table 2). This relationship was essentially unchanged during subsequent follow-up of the same population.
Table 1.
Baseline characteristics of the cohort.
| Wine consumption at baseline | |||
|---|---|---|---|
| None n (%) | Moderate (≤ 0.25 l day−1) n (%) | Heavy (> 0.25 l day−1) n (%) | |
| Total | 1652 (43.7) | 1538 (40.7) | 577 (15.3) |
| Age (years, mean, s.d.) | 75.5 (6.9) | 76.0 (6.9) | 73.9 (6.4) |
| Gender (%) | |||
| Female | 1293 (78.3) | 833 (54.2) | 69 (12.0) |
| Male | 359 (21.7) | 705 (45.8) | 508 (88.0) |
| Living alone (%) | 865 (52.6) | 616 (40.1) | 132 (23.0) |
| Education (years) (%) | |||
| 0–4 | 607 (36.7) | 534 (34.7) | 197 (34.1) |
| 5 | 704 (42.6) | 669 (43.5) | 262 (45.4) |
| 5–12 | 273 (16.5) | 262 (17.0) | 82 (14.2) |
| ≥ 13 | 68 (4.1) | 73 (4.7) | 36 (6.2) |
| Subjective health assessment ‘Good health’ (%) | 1418 (86.5) | 1385 (90.6) | 541 (93.9) |
| Depressive symptomatology (CES-D) % | 252 (15.3) | 150 (9.7) | 49 (8.5) |
| Global cognitive decline (MMSE < 24) | 423 (26.3) | 361 (24.1) | 111 (19.4) |
| Benzodiazepine (% use)* | 615 (37.4) | 479 (31.3) | 111 (19.3) |
Data are based on BZD use among 1643 non drinkers, 1528 moderate drinkers and 575 heavy drinkers.
Table 2.
Unadjusted and adjusted odds ratios (ORs) for benzodiazepine use dependent on wine consumption.
| Wine consumption at baseline | |||
|---|---|---|---|
| None | Moderate (≤ 0.25 l day−1) | Heavy (> 0.25 l day−1) | |
| Unadjusted OR (95% CI) | 1 | 0.76 (0.66, 0.88) | 0.40 (0.32, 0.50) |
| Adjusted OR* (95% CI) | 1 | 0.99 (0.85, 1.16) | 0.70 (0.52, 0.94) |
Odds ratios (ORs) were ajdusted for age, gender, living alone, education level, subjective health assessment, depression symptomatology and global cognitive decline (MMSE < 24).
Heavy wine consumption (> 0.25 l day−1) is associated, in the 65 years old and above population, with a lower use of benzodiazepines, contrary to the finding of Finnish doctors [4]. The direction of a possible causality is uncertain, and the relative health benefits between wine and benzodiazepines to treat anxiety could be a matter of debate [5].
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