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Prasad S, Verma A, Kumar S, Gupta S. An Evaluation of the Changing Trends in Substance Use Behavior Among Patients in the Tertiary Care Setting After the Implementation of Liquor Prohibition in Bihar, India: A Cross-Sectional Study. Cureus 2024; 16:e63692. [PMID: 39092379 PMCID: PMC11293793 DOI: 10.7759/cureus.63692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/29/2024] [Indexed: 08/04/2024] Open
Abstract
Background and objective Substance use disorders pose significant global public health challenges, with India being no exception. Bihar, one of India's most populous states, implemented alcohol prohibition in April 2016 to address the adverse effects of alcohol abuse. However, the impact of this policy on overall substance use behavior among patients in healthcare settings remains to be explored. This cross-sectional study aimed to evaluate the changing trends in substance use behavior among patients in the tertiary care setting following the prohibition of alcohol use in Bihar. Methods A total of 372 patients diagnosed with substance use disorders were recruited from tertiary care facilities in Bihar. Data on demographic characteristics, types of substances used, frequency and quantity of use, reasons for use, and awareness of prohibition laws were collected through structured interviews and reviews of medical records. Descriptive and inferential statistics were used for data analysis. Results The majority of the participants were male (n = 346, 93.01%), with a mean age of 38.5 years. While tobacco use remains stable, there are significant increases in opioid and cannabis consumption post-prohibition, highlighting unintended consequences (p-values - opioids: 0.008, cannabis: 0.021). Additionally, heightened daily and weekly substance use after prohibition is evident (p-values: daily: 0.008, weekly: 0.021), emphasizing the necessity for nuanced policy considerations. Reasons for substance use, including coping with stress and peer pressure, showed significant differences before and after the prohibition (p<0.05). Moreover, awareness of alcohol prohibition laws increased significantly after the implementation of the prohibition (p = 0.003). Conclusions Our findings suggest that while alcohol prohibition in Bihar did not significantly lead to any changes in terms of the types of substances used among patients in tertiary care settings, it did influence the frequency and quantity of tobacco and cannabis consumption. Increased awareness of prohibition laws underscores the importance of policy enforcement and public education initiatives in addressing substance use behavior.
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Affiliation(s)
- Sambhu Prasad
- Department of Psychiatry, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Anant Verma
- Department of Psychiatry, Vardhaman Medical College and Hospital, Nalanda, IND
| | - Santosh Kumar
- Psychiatry, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Sweta Gupta
- Orthodontics, Patna Dental College and Hospital, Patna, IND
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Karlsson P, Callinan S, Gmel G, Raninen J. How well do DSM-5 criteria measure alcohol use disorder in the general population of older Swedish adolescents? An item response theory analysis. Addict Behav 2024; 154:108007. [PMID: 38460492 DOI: 10.1016/j.addbeh.2024.108007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND This study assesses the psychometric properties of DSM-5 criteria of AUD in older Swedish adolescents using item response theory models, focusing specifically on the precision of the scale at the cut-offs for mild, moderate, and severe AUD. METHODS Data from the second wave of Futura01 was used. Futura01 is a nationally representative cohort study of Swedish people born 2001 and data for the second wave was collected when participants were 17/18 years old. This study included only participants who had consumed alcohol during the past 12 months (n = 2648). AUD was measured with 11 binary items. A 2-parameter logistic item response theory model (2PL) estimated the items' difficulty and discrimination parameters. RESULTS 31.8% of the participants met criteria for AUD. Among these, 75.6% had mild AUD, 18.3% had moderate, and 6.1% had severe AUD. A unidimensional AUD model had a good fit and 2PL models showed that the scale measured AUD over all three cut-offs for AUD severity. Although discrimination parameters ranged from moderate (1.24) to very high (2.38), the more commonly endorsed items discriminated less well than the more difficult items, as also reflected in less precision of the estimates at lower levels of AUD severity. The diagnostic uncertainty was pronounced at the cut-off for mild AUD. CONCLUSION DSM-5 criteria measure AUD with better precision at higher levels of AUD severity than at lower levels. As most older adolescents who fulfil an AUD diagnosis are in the mild category, notable uncertainties are involved when an AUD diagnosis is set in this group.
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Affiliation(s)
- Patrik Karlsson
- Department of Social Work, Stockholm University, Stockholm, Sweden.
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 23A, 1011 Lausanne, Switzerland; Research Department, Addiction Switzerland, Avenue Louis-Ruchonnet 14, 1003 Lausanne, Switzerland; Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 250 College Street, Toronto, ON M5T 1R8, Canada; Alcohol and Research Unit, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Jonas Raninen
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
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Schiestl ET, Gearhardt AN, Wolfson J. The qualitative evaluation of food addiction across the lifespan. Appetite 2024; 194:107170. [PMID: 38147964 DOI: 10.1016/j.appet.2023.107170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/14/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Although it remains controversial, food addiction (FA) research has expanded substantially and empirical evidence for FA is growing. While quantitative studies have explored the prevalence and correlates of FA during childhood and adolescence, little is known about the perceived lived experience of FA across the lifespan, nor how experiences and perceptions of FA may change over time. For this study, 16 participants who met symptom threshold criteria for FA on the Yale Food Addiction Scale 2.0 completed in-depth, semi-structured qualitative interviews focused on their perceptions of the development of FA overtime, and perceived risk and protective factors. Thematic analysis was used to develop themes about the lived experience of FA in childhood, adolescence, and adulthood. Overall, highly palatable foods were viewed as the most problematic, while minimally processed foods were less associated with impairment and distress. Themes in childhood included a strong desire for highly processed foods and the perception that parental control over food choices could be either protective or risky for the later development of FA depending on which foods were available at home. In adolescence and young adulthood, increasing autonomy over food choices and the high availability of highly processed foods in the college environment were viewed as risk factors. Additionally, weight gain was a prominent theme. Finally, adulthood was characterized by more severe manifestations of FA, and the stress of adult responsibilities (e.g., work, parenting) contributed to this perception. This research sets the stage for future quantitative studies to explore these novel findings at the population level.
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Campbell AG, Naz S, Gharbi S, Chambers J, Denne S, Litzelman DK, Wiehe SE. The Concordance of Electronic Health Record Diagnoses and Substance use Self-Reports Among Reproductive Aged Women Enrolled in a Community-Based Addiction Reduction Program. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241237051. [PMID: 38528783 DOI: 10.1177/00469580241237051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Substance use disorders among reproductive aged women are a major public health issue. There is little work investigating the validity and reliability of electronic health record (EHR) data for measuring substance use in this population. This study examined the concordance of self-reported substance use with clinical diagnoses of substance use, substance abuse and substance use disorder in EHR data. Reproductive age women enrolled in the Community-Based Addiction Reduction (CARE) program were interviewed by peer recovery coaches (PRC) at enrollment. That survey data was linked with EHR data (n = 102). Concordance between self-reported substance use and clinical diagnoses in the EHR was examined for opioids, cannabis/THC, and cocaine. Cohen's kappa, sensitivity, and specificity were calculated. The survey captured a higher number of women who use substances compared to the EHR. The concordance of self-report with EHR diagnosis varied by substance and was higher for opioids (17.6%) relative to cannabis/THC (8.8%), and cocaine (3.0%). Additionally, opioids had higher sensitivity (46.2%) and lower specificity (76.2%) relative to cannabis/THC and cocaine. Survey data collected by PRCs captured more substance use than EHRs, suggesting that EHRs underestimate substance use prevalence. The higher sensitivity and lower specificity of opioids was due to a larger number of women who had a diagnosis of opioid use in the EHR who did not self-report opioid use in the self-report survey relative to cannabis/THC and cocaine. Opioid self-report and diagnosis may be influenced by research setting, question wording, or receipt of medication for opioid use disorder.
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Affiliation(s)
| | - Saman Naz
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sami Gharbi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joanna Chambers
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
| | - Scott Denne
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
| | - Debra K Litzelman
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Sarah E Wiehe
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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5
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Boness CL, Carlos Gonzalez J, Sleep C, Venner KL, Witkiewitz K. Evidence-Based Assessment of Substance Use Disorder. Assessment 2024; 31:168-190. [PMID: 37322848 PMCID: PMC11059671 DOI: 10.1177/10731911231177252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.
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Affiliation(s)
- Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | | | - Chelsea Sleep
- Cincinnati VA Medical Center, OH, USA
- University of Cincinnati, OH, USA
| | - Kamilla L Venner
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | - Katie Witkiewitz
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
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Dwyer CL, Craft WH, Tomlinson DC, Tegge AN, Kim-Spoon J, Bickel WK. Latent profiles of regulatory flexibility in alcohol use disorder: Associations with delay discounting and symptoms of depression, anxiety, and stress. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:188-198. [PMID: 38206279 PMCID: PMC10786339 DOI: 10.1111/acer.15235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Regulatory flexibility (RF) involves three distinct components of self-regulation: context sensitivity, repertoire, and feedback responsiveness. Subgroups based on differences in RF have been identified in a general sample and are differentially associated with symptoms of anxiety and depression. However, potential RF profiles have not been examined in individuals with substance use disorders. This study examined RF subtypes in individuals with alcohol use disorder (AUD) and their associations with psychosocial outcomes (i.e., depression, anxiety, and stress) and delay discounting (a core feature of addiction). METHODS Individuals (n = 200) with an Alcohol Use Disorders Identification Test score of >16 (mean = 24.12 (±6.92)) were recruited from Amazon Mechanical Turk (mean = 37.26 years old (±11.41); 94 (47%) women). Participants completed the Context Sensitivity Index, the Flexible Regulation of Emotional Expression Scale, and the Coping Flexibility Scale to assess RF. Participants also completed an Adjusting Amount Delay Discounting Task and the Depression, Anxiety, and Stress Scale (DASS-21). Latent profile analyses (LPA) were used to identify patterns in RF deficits. Kruskal-Wallis and Dunn's tests were performed to examine differences in discounting rates and symptoms of depression, anxiety, and stress across RF profiles. RESULTS The LPA revealed a 2-profile characterization, including (1) context sensitive regulators (CSR; n = 39) and (2) moderate flexibility regulators (MFR; n = 161). CSR demonstrated significantly lower symptoms of depression (p = 0.004), anxiety (p < 0.001), and stress (p < 0.001) than MFR. CSR also displayed significantly lower AUDIT scores (p = 0.031). CONCLUSIONS Findings illustrate that among individuals with moderate-severe AUD, those high in context sensitivity coupled with moderate abilities in repertoire and feedback responsiveness have fewer symptoms of depression, anxiety, and stress. Together, context sensitivity may be an important and protective component of RF among individuals with AUD.
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Affiliation(s)
- Candice L. Dwyer
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - William H. Craft
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | - Devin C. Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | | | | | - Warren K. Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
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Keyser-Marcus L, Ramey T, Bjork JM, Martin CE, Sabo R, Moeller FG. Initial Validation of a Behavioral Phenotyping Model for Substance Use Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:14. [PMID: 38276802 PMCID: PMC10815773 DOI: 10.3390/ijerph21010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
Standard nosological systems, such as DSM-5 or ICD-10, are relied upon as the diagnostic basis when developing treatments for individuals with substance use disorder (SUD). Unfortunately, the vast heterogeneity of individuals within a given SUD diagnosis results in a variable treatment response and/or difficulties ascertaining the efficacy signal in clinical trials of drug development. Emerging precision medicine methods focusing on targeted treatments based on phenotypic subtypes rather than diagnosis are being explored as alternatives. The goal of the present study was to provide initial validation of emergent subtypes identified by an addiction-focused phenotyping battery. Secondary data collected as part of a feasibility study of the NIDA phenotyping battery were utilized. Participants completed self-report measures and behavioral tasks across six neurofunctional domains. Exploratory and confirmatory factor analysis (EFA/CFA) were conducted. A three-factor model consisting of negative emotionality, attention/concentration, and interoception and mindfulness, as well as a four-factor model adding a second negative emotion domain, emerged from the EFA as candidate models. The CFA of these models did not result in a good fit, possibly resulting from small sample sizes that hindered statistical power.
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Affiliation(s)
- Lori Keyser-Marcus
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Tatiana Ramey
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse (NIDA), Gaithersburg, MD 20877, USA
| | - James M. Bjork
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Caitlin E. Martin
- Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - Roy Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23219, USA;
| | - F. Gerard Moeller
- Department of Psychiatry, Division of Addictions, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA 23219, USA
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Sher KJ. The Heterogeneous Nature of Substance Use and Substance Use Disorders: Implications for Characterizing Substance-Related Stigma. Psychol Sci Public Interest 2023; 24:82-89. [PMID: 38095161 DOI: 10.1177/15291006231212385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Kenneth J Sher
- Department of Psychological Sciences, University of Missouri
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Abaatyo J, Favina A, Bulega SE, Kaggwa MM. Suicidal behavior among inpatients with severe mental conditions in a public mental health hospital in Uganda. BMC Psychiatry 2023; 23:346. [PMID: 37208631 PMCID: PMC10196297 DOI: 10.1186/s12888-023-04858-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda. METHOD This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018-2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals. RESULTS The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14-13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44-33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21-14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94-0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05-4.86; p = 0.036). CONCLUSION Suicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress.
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Affiliation(s)
- Joan Abaatyo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alain Favina
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Steven Elijah Bulega
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, McMaster, Canada.
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Sher KJ. A Clinical Psychologist Who Studies Alcohol. Annu Rev Clin Psychol 2023; 19:1-21. [PMID: 37159285 DOI: 10.1146/annurev-clinpsy-080621-045733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
In this article, I describe why I believe the study of alcohol use and its consequences is a rich and rewarding area of scholarly activity that touches on multiple disciplines in the life sciences, the behavioral sciences, and the humanities. I then detail the circuitous path I took to become an alcohol researcher and the various challenges I encountered when starting up my research program at the University of Missouri. A major theme of my journey has been my good fortune encountering generous, brilliant scholars who took an interest in me and my career and who helped guide and assist me over the course of my career. I also highlight selected, other professional activities I've been involved in, focusing on editorial work, quality assurance, and governance of professional societies. While the focus is on my training and work as a psychologist, the overarching theme is the interpersonal context that nurtures careers.
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Affiliation(s)
- Kenneth J Sher
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA;
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Watts AL, Latzman RD, Boness CL, Kotov R, Keyser-Marcus L, DeYoung CG, Krueger RF, Zald DH, Moeller FG, Ramey T. New approaches to deep phenotyping in addictions. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:361-375. [PMID: 36174150 PMCID: PMC10050231 DOI: 10.1037/adb0000878] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The causes of substance use disorders (SUDs) are largely unknown and the effectiveness of their treatments is limited. One crucial impediment to research and treatment progress surrounds how SUDs are classified and diagnosed. Given the substantial heterogeneity among individuals diagnosed with a given SUD (e.g., alcohol use disorder [AUD]), identifying novel research and treatment targets and developing new study designs is daunting. METHOD In this article, we review and integrate two recently developed frameworks, the National Institute on Drug Abuse's Phenotyping Assessment Battery (NIDA PhAB) and the Hierarchical Taxonomy of Psychopathology (HiTOP), that hope to accelerate progress in understanding the causes and consequences of psychopathology by means of deep phenotyping, or finer-grained analysis of phenotypes. RESULTS AND CONCLUSIONS NIDA PhAB focuses on addiction-related processes across multiple units of analysis, whereas HiTOP focuses on clinical phenotypes and covers a broader range of psychopathology. We highlight that NIDA PhAB and HiTOP together provide deep and broad characterizations of people diagnosed with SUDs and complement each other in their efforts to address widely known limitations of traditional classification systems and their diagnostic categories. Next, we show how NIDA PhAB and HiTOP can be integrated to facilitate optimal rich phenotyping of addiction-related phenomena. Finally, we argue that such deep phenotyping promises to advance our understanding of the neurobiology of SUD and addiction, which will guide the development of personalized medicine and interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ashley L Watts
- Department of Psychological Sciences, University of Missouri
| | | | - Cassandra L Boness
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University
| | | | | | | | - David H Zald
- Center for Advanced Human Brain Research, Department of Psychiatry, Rutgers University
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12
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Gauld C, Baillet E, Micoulaud-Franchi JA, Kervran C, Serre F, Auriacombe M. The centrality of craving in network analysis of five substance use disorders. Drug Alcohol Depend 2023; 245:109828. [PMID: 36868091 DOI: 10.1016/j.drugalcdep.2023.109828] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND AND AIMS Among the 11 current diagnostic criteria, craving is a potential central marker for understanding and for treatment of Substance Use Disorders (SUD). Our objective was to explore craving centrality across SUD based on the study of symptom interactions in cross-sectional network analyses of DSM-5 SUD diagnostic criteria. We hypothesized the centrality of "Craving" in SUD across substance types. DESIGN Participants from the ADDICTAQUI clinical cohort with regular use (2 times per week threshold for a substance) and at least one DSM-5 SUD. SETTING Outpatient substance use treatment services in Bordeaux, France. PARTICIPANTS The sample of 1359 participants, had a mean age of 39 years old and 67% were males. The prevalence of SUD over the time course of the study was: 93% for alcohol, 98% for opioids, 94% for cocaine, 94% for cannabis and 91% tobacco. MEASUREMENTS Construction of a Symptom Network Model conducted on the DSM-5 SUD criteria evaluated over the past 12 months for Alcohol-, Cocaine-, Tobacco-, Opioid- and Cannabis Use disorder. FINDINGS The only symptom that consistently remained in terms of centrality was "Craving" [3.96 - 6.17] (z-scores), indicating that it exhibits a high degree of connections in the entire symptom network regardless of the substance. CONCLUSION Identifying craving as central in SUD symptoms network confirms the role of craving as a marker of addiction. This constitutes a major avenue in the understanding of the mechanisms of addiction, with implications to ameliorate diagnostic validity and clarify treatment targets.
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Affiliation(s)
- Christophe Gauld
- Department of Child Psychiatry, CHU de Lyon, F-69000 Lyon, France; Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS & Université Claude Bernard Lyon 1, F-69000 Lyon, France
| | - Emmanuelle Baillet
- University of Bordeaux, F-33076 Bordeaux, France; SANPSY, CNRS, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France
| | - Jean-Arthur Micoulaud-Franchi
- University of Bordeaux, F-33076 Bordeaux, France; SANPSY, CNRS, UMR 6033, F-33076 Bordeaux, France; University Sleep Clinic, University Hospital of Bordeaux (CHU Bordeaux), Place Amélie Raba-Leon, F-33076 Bordeaux, France
| | - Charlotte Kervran
- University of Bordeaux, F-33076 Bordeaux, France; I-prev, MéRISP/PHARES, CIC 1401, Inserm U1219, Bordeaux Population Health Research Center (BPH), F-33076 Bordeaux, France
| | - Fuschia Serre
- University of Bordeaux, F-33076 Bordeaux, France; SANPSY, CNRS, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France
| | - Marc Auriacombe
- University of Bordeaux, F-33076 Bordeaux, France; SANPSY, CNRS, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France.
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13
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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Watts AL, Watson D, Heath AC, Sher KJ. Alcohol use disorder criteria exhibit different comorbidity patterns. Addiction 2023. [PMID: 36606740 DOI: 10.1111/add.16121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Alcohol use disorder is comorbid with numerous other forms of psychopathology, including externalizing disorders (e.g. conduct disorder) and, to a lesser extent, internalizing conditions (e.g. depression, anxiety). Much of the time, overlap among alcohol use disorder and other conditions is explored at the disorder level, assuming that criteria are co-equal indicators of other psychopathology, even though alcohol use disorder criteria span numerous varied domains. Emerging evidence suggests that there are symptom clusters within the construct of alcohol use disorder that relate differentially with important external criteria, including psychopathology and allied personality traits (e.g. impulsivity, novelty-seeking). The present study mapped individual alcohol use disorder criteria onto internalizing and externalizing dimensions. DESIGN AND PARTICIPANTS We used multivariate and factor analytical modeling and data from two large nationally representative samples of past year drinkers (n = 25 604; 19 454). SETTING United States. MEASUREMENTS Psychopathology was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, yielding alcohol use disorder criteria, internalizing diagnoses (i.e. major depressive disorder, dysthymia, social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia and panic disorder) and externalizing diagnoses and symptoms (i.e. antisocial personality disorder, conduct disorder and three impulsivity items drawn from borderline personality disorder criteria). Alcohol consumption was assessed in terms of past-year drinking frequency, usual amount of alcohol consumed on drinking days, binge drinking frequency, intoxication frequency, and maximum number of drinks in a 24-hour period. FINDINGS Four different patterns emerged. First, several alcohol use disorder criteria were relatively weakly associated with externalizing and internalizing. Secondly, withdrawal was associated with internalizing, but this association was not specific to distress. Thirdly, there was a general lack of specificity between alcohol use disorder criteria and narrower forms of internalizing, despite what might be predicted by modern models of addiction. Fourthly, recurrent use in hazardous situations reflected higher degrees of externalizing and lower internalizing liability. CONCLUSIONS Different symptom combinations appear to yield differential expressions of alcohol use disorder that are disorder-specific, or reflect broader tendencies toward externalizing, internalizing or both.
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Affiliation(s)
- Ashley L Watts
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Andrew C Heath
- School of Medicine, Department of Psychiatry, Washington University, St Louis, MI, USA
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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15
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O'Loughlin CM, Park Y, Ammerman BA. Suicide Ideation, Distress, and Peer Perceptions as Predictors of Substance Use. Subst Use Misuse 2023; 58:560-569. [PMID: 36762468 DOI: 10.1080/10826084.2023.2177964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Substance use and suicide ideation are common behaviors that often overlap among college students. However, clues about their temporal relationship, as well as moderating factors (e.g., distress, peer perceptions of substance use), are understudied. Indeed, those with a history of suicide ideation may use avoidance coping (including substance use) to manage distress, underscoring the possibility of substance use as a response to suicide ideation, an oft-stressful experience in and of itself. Further, as a low sense of belongingness confers risk for suicide ideation, distress may increase compliance with perceived cultural norms, thus increasing substance use behavior. This study examined the effect of the suicide ideation-distress-peer perception interaction on substance use. METHOD Participants were 3,608 undergraduate students across eleven college campuses. Measures of past month substance use frequency, general distress, peer perceptions of substance use, and past year suicide ideation were utilized. RESULTS Suicidal ideation was associated with e-cigarette, marijuana, and illicit drug use. There were main effects of suicide ideation (on e-cigarette and marijuana use) and peer perceptions of substance use (on tobacco, alcohol, e-cigarette, and marijuana use), but not distress, on past 30-day substance use. Further, the three-way interaction of suicide ideation, distress, and peer perceptions of substance use predicted frequency of past month tobacco and illicit drug use. CONCLUSIONS Suicide ideation may be temporally linked to use of specific substances. Peer perception and distress may strengthen the suicide ideation-substance use relationship. These factors should be carefully considered when treating individuals with substance use.
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Affiliation(s)
| | - Yeonsoo Park
- Department of Psychology, Notre Dame, University of Notre Dame, IN, USA
| | - Brooke A Ammerman
- Department of Psychology, Notre Dame, University of Notre Dame, IN, USA
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16
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Conceptualization of Alcohol Use Disorder (AUD): Can Theoretical or Data Driven Approaches Improve the Construct Validity of AUD? Res Child Adolesc Psychopathol 2022; 50:1605-1618. [DOI: 10.1007/s10802-022-00965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
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17
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Schiestl ET, Wolfson JA, Gearhardt AN. The qualitative evaluation of the Yale Food addiction scale 2.0. Appetite 2022; 175:106077. [PMID: 35537659 PMCID: PMC9663207 DOI: 10.1016/j.appet.2022.106077] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Yale Food Addiction Scale 2.0 (YFAS 2.0) operationalizes food addiction (FA) by applying the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) criteria for substance use disorder (SUD) to the overconsumption of highly processed foods. The YFAS 2.0 has been quantitatively validated across numerous populations, but has never undergone qualitative analysis. AIMS Using qualitative methods we aimed to determine if the interpretation YFAS 2.0 is aligned with the DSM 5 conceptualization of SUD, to determine if any items are perceived as irrelevant to the lived-experience of FA, and to determine if there are constructs central to the lived-experience of FA that are not captured by the scale. METHODS We interviewed 16 participants who met criteria for FA on the modified YFAS 2.0 using semi-structured interviews to understand each participants' interpretation of items on the scale and their perceptions of how the scale matched their lived-experience of FA. Reflexive thematic analysis was used to code responses and identify themes. RESULTS Most interpretations aligned with the DSM 5 conceptualization of SUDs. Withdrawal and tolerance-related items were subject to some misinterpretations. Participants viewed problem-focused symptoms (e.g., interpersonal problems) as the least relevant to their lived-experience. Novel themes not included on the YFAS 2.0 (e.g., emotional eating) emerged. SUMMARY Our study supports the validity of the YFAS 2.0 by showing consistency with the DSM 5 conceptualization of SUDs and consistency with the lived-experience of individuals who endorse FA. Future research should explore the novel themes that emerged in this study.
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Affiliation(s)
| | - Julia A Wolfson
- Department of International Health, Ann Arbor, USA; Department of Health Policy and Management, USA
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18
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Mattingley S, Youssef GJ, Manning V, Graeme L, Hall K. Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis. J Affect Disord 2022; 300:492-504. [PMID: 34986376 DOI: 10.1016/j.jad.2021.12.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/08/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distress tolerance (DT) has received increased attention in recent years due to its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology. METHODS A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, and BPD symptomatology. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender. RESULTS DT shared significant, negative, medium correlations with PSU (r = -.18,), DEB (r = -.20), and BPD symptomatology (r = -.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships. LIMITATIONS The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures. CONCLUSIONS The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.
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Affiliation(s)
| | - George J Youssef
- Deakin University, Geelong, Australia, School of Psychology; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Victoria Manning
- Monash Addiction Research Centre (MARC), Eastern Health Clinical School, Monash University, Australia; Turning Point, Eastern Health, Australia
| | - Liam Graeme
- Deakin University, Geelong, Australia, School of Psychology
| | - Kate Hall
- Deakin University, Geelong, Australia, School of Psychology; Centre for Drug Use, Addictive, and Anti-social Behaviour Research (CEDAAR), Deakin University, Australia.
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19
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Durand A, Girardeau P, Freese L, Ahmed SH. Increased responsiveness to punishment of cocaine self-administration after experience with high punishment. Neuropsychopharmacology 2022; 47:444-453. [PMID: 34429520 PMCID: PMC8674259 DOI: 10.1038/s41386-021-01159-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 02/07/2023]
Abstract
One behavioral feature of drug addiction is continued drug use despite awareness that this causes negative consequences. Attempts to model this feature in animals typically involve punishing drug self-administration with electrical footshock to identify individuals whose drug use is differently suppressed by punishment. Here we sought to further study individual responsiveness of drug use to punishment in rats self-administering intravenous cocaine. Rats were first trained during several weeks to self-administer cocaine under a fixed-ratio 3 schedule of reinforcement. Then, their self-administration behavior was punished with increasing intensity of footshock (i.e., from 0.1 mA to 0.9 mA, every 30 min). With increasing intensity of punishment, rats first continued to self-administer cocaine before eventually stopping near completely. When retested, however, drug use became more responsive to punishment and was suppressed by a low and initially ineffective footshock intensity (i.e., 0.1 mA). This increase in responsiveness to punishment was seen in all individuals tested, albeit with varying degrees, and was acquired after one single experience with an intensity of punishment that near completely suppressed drug self-administration. Mere passive, non-contingent exposure to the same intensity, however, had no such effect. Once acquired, increased responsiveness to punishment persisted during at least one month when rats were tested every week, but not every day. Finally, increased responsiveness to punishment was not observed after exposure to a non-painful form of punishment (i.e., histamine). Overall, this study reveals that initial responsiveness of drug use to punishment can change rapidly and persistently with experience. We discuss several possible mechanisms that may account for this change in punishment responsiveness and also draw some of the implications and future perspectives for research on animal models of compulsion-like behavior.
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Affiliation(s)
| | - Paul Girardeau
- grid.412041.20000 0001 2106 639XUniversité de Bordeaux, UFR des Sciences Odontologiques, Bordeaux, France
| | - Luana Freese
- grid.412344.40000 0004 0444 6202Laboratory of Neuropsychopharmacology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul Brazil
| | - Serge H. Ahmed
- grid.462010.1Université de Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
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20
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Pouliquen M, Auriacombe M. Psychotherapeutic interventions for cannabis use disorder. What do we know and what should we do? Encephale 2021; 48:70-77. [PMID: 34625215 DOI: 10.1016/j.encep.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cannabis use disorder is the most commonly reported illegal substance use disorder and demand for treatment is growing worldwide. OBJECTIVES Our aim was to compare the two last Cochrane systematic reviews of the literature concerning psychotherapeutic and psychosocial interventions for cannabis use disorder to determine what new evidence emerged and how craving was considered as a treatment mediator. METHOD We extracted raw data from both reviews regarding their titles, objectives, methods and results. This information was analyzed by face validity to distinguish apparent differences from real differences. It enabled us to describe similarities and differences between reviews. We also screened both reviews looking for craving or related words. RESULTS The objective and methods of both reviews were mostly similar. Although the second review covered a wider range of psychotherapies, including drug counseling and mindfulness-based meditation as an intervention group and minimal treatment as a control group. Five of the six studies included in the first review were also included in the second review. One study excluded from the first review was included in the last review that included an additional 17 studies published after the first review. The 2016 review performed a meta-analysis whereas the first review was descriptive. Both reviews supported the efficacy of motivational enhancement therapy and cognitive and behavioral therapy interventions with adjunction of contingency management for abstinence when possible. There was no relevant mention of craving in the 2006 review and very few in the 2016 review. CONCLUSION The methods and results of the last two Cochrane reviews on psychosocial interventions for cannabis use disorder were mostly similar. Consistent with other reviews on the same subject and reviews of psychotherapies for other substance use disorders, the 2016 review confirmed evidence already available in the 2006 review. Instead of confirming already confirmed evidence, future research is needed to determine if craving focused treatment would increase efficiency and how to maintain initial treatment outcomes long-term.
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Affiliation(s)
- M Pouliquen
- University of Bordeaux, 33000 Bordeaux, France; Équipe phénoménologie et déterminants des comportements appétitifs, Sanpsy CNRS USR 3413, University of Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France
| | - M Auriacombe
- University of Bordeaux, 33000 Bordeaux, France; Équipe phénoménologie et déterminants des comportements appétitifs, Sanpsy CNRS USR 3413, University of Bordeaux, 33076 Bordeaux, France; Pôle interétablissement d'Addictologie, CH Charles Perrens and CHU de Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France.
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21
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Wang FL, Pedersen SL, Kennedy TM, Gnagy EM, Pelham WE, Molina BSG. Persistent attention-deficit/hyperactivity disorder predicts socially oriented, but not physical/physiologically oriented, alcohol problems in early adulthood. Alcohol Clin Exp Res 2021; 45:1693-1706. [PMID: 34245175 PMCID: PMC8429135 DOI: 10.1111/acer.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/05/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although individuals with histories of childhood attention-deficit/hyperactivity disorder (ADHD) report more alcohol-related problems in adulthood than those without ADHD, it is unknown whether there are group differences in certain types of alcohol problems. We tested whether the nature of alcohol problems differed for individuals with and without childhood ADHD, as well as adulthood-persistent ADHD, to facilitate a personalized medicine approach for alcohol problems in this high-risk group. METHODS Data were drawn from a prospective, observational study. Children diagnosed with ADHD and demographically similar individuals without childhood ADHD were followed prospectively through young adulthood (N = 453; 87.6% male). ADHD symptom persistence was assessed using self-reports and parent reports. Alcohol problems and heavy drinking were assessed repeatedly from 18-30 years old to construct lifetime measures. RESULTS Full-sample confirmatory factor analyses identified 5 alcohol problem "types:" interpersonal problems/risky behaviors, occupational/academic impairment, impaired control/treatment seeking, tolerance/withdrawal, and drinking to blackout. Latent class analyses of items within each type yielded the best fit for 3-class solutions for all sets of items except blackout drinking, for which 2 classes emerged. Children with ADHD were more likely than those without ADHD to belong to high-risk latent classes for interpersonal problems/risky behaviors, occupational/academic problems, and impaired control (the high-risk class that indexed treatment-seeking behavior). These effects were driven by individuals whose ADHD symptoms persisted into adulthood. Few group differences emerged for tolerance/withdrawal and blackout drinking, except that individuals with only childhood ADHD (no persistence) were more likely to belong to the low-risk groups than those with adulthood-persistent ADHD and without ADHD. CONCLUSIONS Individuals with ADHD histories whose symptoms persist into adulthood may be more likely to experience socially oriented alcohol problems and impaired control/treatment seeking than individuals without an ADHD history and those with childhood ADHD only. Tailored alcohol prevention and treatment programs may benefit this high-risk population.
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Affiliation(s)
- Frances L Wang
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah L Pedersen
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Traci M Kennedy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth M Gnagy
- Department of Psychology, Florida International University, Miami, FL, USA
| | - William E Pelham
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Brooke S G Molina
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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22
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Jiang H, Lange S, Tran A, Imtiaz S, Rehm J. Determining the sex-specific distributions of average daily alcohol consumption using cluster analysis: is there a separate distribution for people with alcohol dependence? Popul Health Metr 2021; 19:28. [PMID: 34098997 PMCID: PMC8186209 DOI: 10.1186/s12963-021-00261-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It remains unclear whether alcohol use disorders (AUDs) can be characterized by specific levels of average daily alcohol consumption. The aim of the current study was to model the distributions of average daily alcohol consumption among those who consume alcohol and those with alcohol dependence, the most severe AUD, using various clustering techniques. METHODS Data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used in the current analyses. Clustering algorithms were applied in order to group a set of data points that represent the average daily amount of alcohol consumed. Gaussian Mixture Models (GMMs) were then used to estimate the likelihood of a data point belonging to one of the mixture distributions. Individuals were assigned to the clusters which had the highest posterior probabilities from the GMMs, and their treatment utilization rate was examined for each of the clusters. RESULTS Modeling alcohol consumption via clustering techniques was feasible. The clusters identified did not point to alcohol dependence as a separate cluster characterized by a higher level of alcohol consumption. Among both females and males with alcohol dependence, daily alcohol consumption was relatively low. CONCLUSIONS Overall, we found little evidence for clusters of people with the same drinking distribution, which could be characterized as clinically relevant for people with alcohol use disorders as currently defined.
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Affiliation(s)
- Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, D-01187, Dresden, Germany
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, Moscow, Russian Federation, 119992
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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23
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Vergés A, Lee MR, Martin CS, Trull TJ, Martens MP, Wood PK, Sher KJ. Not all symptoms of alcohol dependence are developmentally equivalent: Implications for the false-positives problem. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:444-457. [PMID: 33956473 PMCID: PMC8184633 DOI: 10.1037/adb0000723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Recent studies have examined the extent to which alcohol dependence (AD) criteria prospectively predict the course of AD. Critically, these studies have lacked a developmental perspective. However, the differential performance of criteria by age might indicate overendorsement in younger individuals. The current study examined AD criteria in terms of persistence and prediction of AD course and alcohol use by age in order to identify criteria that are likely to be overly endorsed by younger individuals. METHOD The current study used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions to depict age differences in rates of new onset, recurrence, and persistence for each AD criterion, thereby showing how these three factors contribute to the overall age-prevalence curve of each criterion. Additionally, we tested age moderation of the predictive association between each criterion at baseline and new onset, recurrence, and persistence of syndromal AD. RESULTS Some criteria (particularly, persistent desire or unsuccessful efforts to cut down or control drinking, and drinking despite physical/psychological problems) are both less persistent and less predictive of AD course among younger adults compared to older adults. CONCLUSIONS These findings raise the possibility of elevated rates of false-positive AD among younger adults and suggest ways to improve the assessment of AD criteria. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Kervran C, Shmulewitz D, Serre F, Denis C, Roux P, Jauffret-Roustide M, Lalanne L, Hasin D, Auriacombe M. Do DSM-5 substance use disorder criteria differ by user care settings? An item response theory analysis approach. Addict Behav 2021; 116:106797. [PMID: 33450665 DOI: 10.1016/j.addbeh.2020.106797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 11/07/2020] [Accepted: 12/20/2020] [Indexed: 01/05/2023]
Abstract
AIM To examine differences in the psychometric characteristics of diagnostic criteria for Substance Use Disorders (SUD) between substance users in harm reduction settings (HR) and substance users seeking treatment (Tx). METHODS Differential Item and Test Functioning (DIF & DTF) analysis were performed to examine differences in the difficulty of endorsement and in discrimination of the 11 diagnostic criteria and to test if the criteria set as a whole (the "test") functioned differently by care settings (Tx vs. HR) for alcohol, cocaine, cannabis, opiates and tobacco. To test uniform and nonuniform DIF, multiple indicator multiple cause (MIMIC) structural equation models were used. RESULTS Regardless of the substance, the DSM-5 criteria "craving", "large amount", "time spent", "tolerance" and "activities given up" had similar functioning by care settings. Little evidence for DIF was found for other criteria. The criteria set as a whole did not function differently by care settings for alcohol, cocaine and tobacco. At the same trait severity, compared to HR, the Tx subgroup had a greater number of endorsed criteria for cannabis and a smaller number of endorsed criteria for opioids. CONCLUSION The unidimensionality of the 11 DSM-5 criteria and applicability of all criteria and diagnosis was confirmed in this large sample of problematic substance users. While the majority of the criteria related to loss of control of substance use, functioned well in both care settings, the criteria related to consequences of substance use had several differential functioning.
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Affiliation(s)
- C Kervran
- University of Bordeaux, Addiction Team, Sleep Addiction and Neuropsychiatry Laboratory (SANPSY), Bordeaux, France; USR CNRS 3413, Bordeaux, France; Pôle Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - D Shmulewitz
- New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - F Serre
- University of Bordeaux, Addiction Team, Sleep Addiction and Neuropsychiatry Laboratory (SANPSY), Bordeaux, France; USR CNRS 3413, Bordeaux, France; Pôle Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France
| | - C Denis
- University of Bordeaux, Addiction Team, Sleep Addiction and Neuropsychiatry Laboratory (SANPSY), Bordeaux, France; USR CNRS 3413, Bordeaux, France; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - P Roux
- Aix Marseille University, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de la Santé and Traitement de l'Information Médicale, Marseille, France
| | - M Jauffret-Roustide
- Cermes3, Inserm U988, CNRS UMR 8236, Université de Paris, EHESS, Paris, France; British Columbia Centre on Substance Use (BCCSU), Vancouver, Canada; Baldy Center for Law and Social Policy, Buffalo University of Social Sciences, Buffalo, NY, United States
| | - L Lalanne
- INSERM 1114, Department of Psychiatry and Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - D Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - M Auriacombe
- University of Bordeaux, Addiction Team, Sleep Addiction and Neuropsychiatry Laboratory (SANPSY), Bordeaux, France; USR CNRS 3413, Bordeaux, France; Pôle Addictologie, CH Ch. Perrens and CHU de Bordeaux, Bordeaux, France; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
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Vize CE, Lane SP. Reliability of Differential Item Functioning in Alcohol Use Disorder: Bayesian Meta-Analysis of Criteria Discrimination Estimates. Assessment 2021; 29:925-939. [PMID: 33615848 DOI: 10.1177/1073191120986613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Numerous studies leverage item response theory (IRT) methods to examine measurement characteristics of alcohol use disorder (AUD) diagnostic criteria. Less work has examined the consistency of AUD IRT parameter estimates, an essential step for establishing measurement invariance, making statements about symptom diagnosticity, and validating the theoretical construct. A Bayesian meta-analysis of IRT discrimination values for AUD criteria across 33 independent samples (Total N = 321,998) revealed that overall consistency of AUD criteria discriminations was low (generalized intraclass correlation range = .105-.249). However, specific study characteristics accounted for substantial variability, suggesting that the unreliability is partially systematic. We replicated evidence of differential item functioning (DIF) via established factors (e.g., age, gender), but the magnitudes were small compared with DIF associated with assessment instrument. These results offer practical recommendations regarding which instruments to use when specific AUD criteria are of interest and which criteria are most sensitive when comparing demographic groups.
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Loeffelman JE, Steinley D, Boness CL, Trull TJ, Wood PK, Brusco MJ, Sher KJ. Combinatorial Optimization of Clustering Decisions: An Approach to Refine Psychiatric Diagnoses. MULTIVARIATE BEHAVIORAL RESEARCH 2021; 56:57-69. [PMID: 32054331 PMCID: PMC8428183 DOI: 10.1080/00273171.2020.1717921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Using complete enumeration (e.g., generating all possible subsets of item combinations) to evaluate clustering problems has the benefit of locating globally optimal solutions automatically without the concern of sampling variability. The proposed method is meant to combine clustering variables in such a way as to create groups that are maximally different on a theoretically sound derivation variable(s). After the population of all unique sets is permuted, optimization on some predefined, user-specific function can occur. We apply this technique to optimizing the diagnosis of Alcohol Use Disorder. This is a unique application, from a clustering point of view, in that the decision rule for clustering observations into the "diagnosis" group relies on both the set of items being considered and a predefined threshold on the number of items required to be endorsed for the "diagnosis" to occur. In optimizing diagnostic rules, criteria set sizes can be reduced without a loss of significant information when compared to current and proposed, alternative, diagnostic schemes.
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Boness CL, Loeffelman JE, Steinley D, Trull T, Sher KJ. Using Complete Enumeration to Derive "One-Size-Fits-All" Versus "Subgroup-Specific" Diagnostic Rules for Substance Use Disorder. Assessment 2020; 27:1075-1088. [PMID: 32037845 PMCID: PMC7694888 DOI: 10.1177/1073191120903092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of fixed diagnostic rules, whereby the same diagnostic algorithms are applied across all individuals regardless of personal attributes, has been the tradition in the Diagnostic and Statistical Manual of Mental Disorders. This practice of "averaging" across individuals inevitably introduces diagnostic error. Furthermore, these average rules are typically derived through expert consensus rather than through data-driven approaches. Utilizing National Survey on Drug Use and Health 2013 (N = 23, 889), we examined whether subgroup-specific, "customized" alcohol use disorder diagnostic rules, derived using deterministic optimization, perform better than an average, "one-size-fits-all" diagnostic rule. The average solution for the full sample included a set size of six and diagnostic threshold of three. Subgroups had widely varying set sizes (M = 6.870; range = 5-10) with less varying thresholds (M = 2.70; range = 2-4). External validation verified that the customized algorithms performed as well, and sometimes better than, the average solution in the prediction of relevant correlates. However, the average solution still performed adequately with respect to external validators.
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Kervran C, Shmulewitz D, Serre F, Stohl M, Denis C, Hasin D, Auriacombe M. Item Response Theory analyses of DSM-5 substance use disorder criteria in French outpatient addiction clinic participants. How much is craving special? Drug Alcohol Depend 2020; 212:108036. [PMID: 32464467 DOI: 10.1016/j.drugalcdep.2020.108036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND To evaluate the dimensionality and psychometric validity of the 11 DSM-5 criteria for 5 substance use disorders, with a focus on craving, and taking into account age, gender and psychiatric comorbidities in a French sample of subjects seeking addiction treatment. METHODS This cross-sectional study, included participants with DSM-5 substance use disorders that sought treatment for at least one addiction from outpatient clinics. Diagnostic criteria were evaluated with the Mini international Neuropsychiatric Interview. In Current regular user (2 times per week), factor and 2-parameter IRT analysis was used to investigate the dimensionality and psychometric properties of the 11 DSM-5 SUD criteria. Differential Item and Test functioning (DIF and DTF) analysis were performed across sociodemographic characteristics and psychiatric disorders. RESULTS 1359 participants (alcohol n = 787, opiates n = 131, cocaine n = 141, tobacco n = 1014, cannabis n = 504), were included (68% male; mean age 38.7). One-factor dimensionality was confirmed, except for tobacco. Craving criterion had the strongest factor loadings, lower difficulty (range, -1.29 to -0.67) and higher discrimination (range, 2.11-3.05), and no DIF compared to other criteria. The tobacco criteria set functioned differently by mood and anxiety disorders. CONCLUSIONS We confirmed the unidimensionality of the 11 SUD DSM-5 criteria and furthermore that craving was the most selective criterion because of its psychometric properties and no DIF compared to other criteria, regardless of the substance in this adult clinical sample. Unidimensionality of tobacco criteria was not confirmed, suggesting DSM-IV abuse criteria limitations as indicators of the construct.
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Affiliation(s)
- Charlotte Kervran
- University of Bordeaux, Phenomenology and Determinants of Appetitive Behaviors (Addiction Team), Sleep, Addiction and Neuropsychiatry Laboratory (SANPSY), USR CNRS 3413, 146 Bis Rue Léo Saignat, 33076, Bordeaux, France; Pôle Addictologie, CH Ch. Perrens and CHU de Bordeaux, 121 Rue De La Béchade, 33076, Bordeaux, France
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Fuschia Serre
- University of Bordeaux, Phenomenology and Determinants of Appetitive Behaviors (Addiction Team), Sleep, Addiction and Neuropsychiatry Laboratory (SANPSY), USR CNRS 3413, 146 Bis Rue Léo Saignat, 33076, Bordeaux, France; Pôle Addictologie, CH Ch. Perrens and CHU de Bordeaux, 121 Rue De La Béchade, 33076, Bordeaux, France
| | - Malki Stohl
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Cécile Denis
- Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Suite 4000, Philadelphia, PA 19104, USA; University of Bordeaux, Phenomenology and Determinants of Appetitive Behaviors (Addiction Team), Sleep, Addiction and Neuropsychiatry Laboratory (SANPSY), USR CNRS 3413, 146 Bis Rue Léo Saignat, 33076, Bordeaux, France
| | - Deborah Hasin
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA; Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Marc Auriacombe
- University of Bordeaux, Phenomenology and Determinants of Appetitive Behaviors (Addiction Team), Sleep, Addiction and Neuropsychiatry Laboratory (SANPSY), USR CNRS 3413, 146 Bis Rue Léo Saignat, 33076, Bordeaux, France; Pôle Addictologie, CH Ch. Perrens and CHU de Bordeaux, 121 Rue De La Béchade, 33076, Bordeaux, France; Center for Studies of Addiction, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, Suite 4000, Philadelphia, PA 19104, USA.
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Bornstein AM, Pickard H. "Chasing the first high": memory sampling in drug choice. Neuropsychopharmacology 2020; 45:907-915. [PMID: 31896119 PMCID: PMC7162911 DOI: 10.1038/s41386-019-0594-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
Although vivid memories of drug experiences are prevalent within clinical contexts and addiction folklore ("chasing the first high"), little is known about the relevance of cognitive processes governing memory retrieval to substance use disorder. Drawing on recent work that identifies episodic memory's influence on decisions for reward, we propose a framework in which drug choices are biased by selective sampling of individual memories during two phases of addiction: (i) downward spiral into persistent use and (ii) relapse. Consideration of how memory retrieval influences the addiction process suggests novel treatment strategies. Rather than try to break learned associations between drug cues and drug rewards, treatment should aim to strengthen existing and/or create new associations between drug cues and drug-inconsistent rewards.
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Affiliation(s)
- Aaron M Bornstein
- Department of Cognitive Sciences, University of California, Irvine, CA, 92617, USA.
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, 92697, USA.
- Institute for Mathematical Behavioral Sciences, University of California, Irvine, CA, 92697, USA.
| | - Hanna Pickard
- Department of Philosophy, Johns Hopkins University, Baltimore, MD, 21218, USA.
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA.
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30
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Baggio S, Trächsel B, Rousson V, Rothen S, Studer J, Marmet S, Heller P, Sporkert F, Daeppen JB, Gmel G, Iglesias K. Identifying an accurate self-reported screening tool for alcohol use disorder: evidence from a Swiss, male population-based assessment. Addiction 2020; 115:426-436. [PMID: 31656049 DOI: 10.1111/add.14864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/21/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Short screenings for alcohol use disorder (AUD) are crucial for public health purposes, but current self-reported measures have several pitfalls and may be unreliable. The main aim of our study was to provide empirical evidence on the psychometric performance of self-reports currently used. Our research questions were: compared with a gold standard clinical interview, how accurate are (1) self-reported AUD, (2) self-reported alcohol use over time and (3) biomarkers of alcohol use among Swiss men? Finally, we aimed to identify an alternative screening tool. DESIGN A single-center study with a cross-sectional design and a stratified sample selection. SETTING Lausanne University Hospital (Switzerland) from October 2017 to June 2018. PARTICIPANTS We selected participants from the French-speaking participants of the ongoing Cohort Study on Substance Use and Risk Factors (n = 233). The sample included young men aged on average 27.0 years. MEASUREMENTS We used the Diagnostic Interview for Genetic Studies as the gold standard for DSM-5 AUD. The self-reported measures included 11 criteria for AUD, nine alcohol-related consequences, and previous 12 months' alcohol use. We also assessed biomarkers of chronic excessive drinking (ethyl glucuronide and phosphatidylethanol). FINDINGS None of the self-reported measures/biomarkers taken alone displayed both sensitivity and specificity close to 100% with respect to the gold standard (e.g. self-reported AUD: sensitivity = 92.3%, specificity = 45.8%). The best model combined eight self-reported criteria of AUD and four alcohol-related consequences. Using a cut-off of three, this screening tool yielded acceptable sensitivity (83.3%) and specificity (78.7%). CONCLUSIONS Neither self-reported alcohol use disorder nor heavy alcohol use appear to be adequate to screen for alcohol use disorder among young men from the Swiss population. The best screening alternative for alcohol use disorder among young Swiss men appears to be a combination of eight symptoms of alcohol use disorder and four alcohol-related consequences.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.,Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Bastien Trächsel
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stéphane Rothen
- Addiction Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Simon Marmet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.,Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals, Thônex, Switzerland
| | - Frank Sporkert
- Centre of Legal Medicine, Forensic Toxicology and Chemistry Unit, Lausanne and Geneva Universities, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto,, ON, Canada.,University of the West of England, Bristol, UK
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
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Sylvetsky AC, Parnarouskis L, Merkel PE, Gearhardt AN. Children's Sugar-Sweetened Beverage Consumption: Striking Parallels With Substance Use Disorder Symptoms. Front Pediatr 2020; 8:594513. [PMID: 33282802 PMCID: PMC7689136 DOI: 10.3389/fped.2020.594513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | | | - Patrick E Merkel
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
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32
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Helle AC, Watts AL, Trull TJ, Sher KJ. Alcohol Use Disorder and Antisocial and Borderline Personality Disorders. Alcohol Res 2019; 40:arcr.v40.1.05. [PMID: 31886107 PMCID: PMC6927749 DOI: 10.35946/arcr.v40.1.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Alcohol use disorder (AUD) frequently co-occurs with other psychiatric disorders, including personality disorders, which are pervasive, persistent, and impairing. Personality disorders are associated with myriad serious outcomes, have a high degree of co-occurrence with substance use disorders, including AUD, and incur significant health care costs. This literature review focuses on co-occurring AUD and personality disorders characterized by impulsivity and affective dysregulation, specifically antisocial personality disorders and borderline personality disorders. Prevalence rates, potential explanations and causal models of co-occurrence, prognoses, and the status of existing treatment research are summarized. Several important future research considerations are relevant to these complex, co-occurring conditions. Research assessing mechanisms responsible for co-occurring AUD and antisocial personality disorder or borderline personality disorder will further delineate the underlying developmental processes and improve understanding of onset and courses. In addition, increased focus on the efficacy and effectiveness of treatments targeting underlying traits or common factors in these disorders will inform future prevention and treatment efforts, as interventions targeting these co-occurring conditions have relatively little empirical support.
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Affiliation(s)
- Ashley C Helle
- Ashley C. Helle, Ph.D., is a Postdoctoral fellow in the Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Ashley L Watts
- Ashley L. Watts, Ph.D., is a Postdoctoral fellow in the Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Timothy J Trull
- Timothy J. Trull, Ph.D., is a Curators' Distinguished Professor and a Byler Distinguished Professor in the Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Kenneth J Sher
- Kenneth J. Sher, Ph.D., is a Curators' Distinguished Professor in the Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
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Rehm J, Shield KD. Global Burden of Alcohol Use Disorders and Alcohol Liver Disease. Biomedicines 2019; 7:E99. [PMID: 31847084 PMCID: PMC6966598 DOI: 10.3390/biomedicines7040099] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022] Open
Abstract
Alcohol use is a major risk factor for burden of mortality and morbidity. Alcoholic liver disease (ALD) and alcohol use disorders (AUDs) are important disease outcomes caused by alcohol use. We will describe the global mortality and burden of disease in disability-adjusted life years for ALD and AUDs, based on data from the comparative risk assessment of the World Health Organization for 2016. AUDs have a limited impact on mortality in this assessment, since alcohol poisonings are almost the only disease category directly attributable to AUDs; most other alcohol-related deaths are indirect, and the cause which directly led to the death, such as liver cirrhosis, is the one recorded on the death certificate. Burden of disease for AUDs is thus mainly due to disability resulting from alcohol use. In contrast to AUDs, ALD is one of the major lethal outcomes of alcohol use, and burden of disease is mainly due to (premature) years of life lost. Many of the negative outcomes attributable to both AUDs and ALD are due to their interactions with other factors, most notably economic wealth. To avoid alcohol-attributable morbidity and mortality, measures should be taken to reduce the AUDs and ALD burden globally, especially among the poor.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada;
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 1P8, Canada
- Institute of Medical Science, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5T 2S1, Canada
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, D-01187 Dresden, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, Moscow 119992, Russia
| | - Kevin D. Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada;
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 1P8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5T 2S1, Canada
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Rehm J, Heilig M, Gual A. ICD-11 for Alcohol Use Disorders: Not a Convincing Answer to the Challenges. Alcohol Clin Exp Res 2019; 43:2296-2300. [PMID: 31424579 PMCID: PMC6899584 DOI: 10.1111/acer.14182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
- Campbell Family Mental Health Research InstituteCAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
- Institute of Clinical Psychology and PsychotherapyCenter for Clinical Epidemiology and Longitudinal StudiesTechnische Universität DresdenDresdenGermany
- Department of International Health ProjectsInstitute for Leadership and Health ManagementI. M. Sechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Markus Heilig
- Center for Social and Affective NeuroscienceDepartment of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
| | - Antoni Gual
- Addictions UnitPsychiatry DepartmentNeurosciences Institute, Hospital ClínicBarcelonaSpain
- IDIBAPS (Institut per a la Recerca Biomèdica Agustí Pi i Sunyer)BarcelonaSpain
- Red de Trastornos AdictivosInstituto Carlos IIIMadridSpain
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Cheng HG, Parker MA, Anthony JC. Female-male differences in prescription pain reliever dependence levels: Evidence on newly incident adolescent and young adult users in the United States, 2002-2014. Drug Alcohol Depend 2019; 204:107466. [PMID: 31518887 PMCID: PMC6878123 DOI: 10.1016/j.drugalcdep.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND A comprehensive epidemiology of dependence on prescription opioid pain relievers requires evidence about age-specific female-male differences, possibly manifest during adolescent and early adult years. In this study, we identified newly incident extra-medical users of prescription pain relievers (EMPPR), all observed with onsets before the 22nd birthday. We then quantified female-male differences in clinical features or manifestations of opioid dependence (OD), devised a measurement-equivalent OD dimension, and estimated age-specific female-male differences in OD levels. METHOD The population under study included 12-to-21-year-old non-institutionalized civilian community residents of United States sampled for recent nation-scale surveys. Confidential computer-assisted self-interviews identified newly incident EMPPR users (n = 10,188). Analysis-weighted estimation procedures yielded cumulative incidence proportions for each OD feature, evaluated measurement non-equivalence across subgroups, and estimated female-male differences age-by-age. RESULTS (1) Tolerance and salience ('spending a lot of time') are most common OD features. (2) Measurement non-equivalence (bias) was found across sex- and onset-age groups. (3) With biasing features removed, we can see elevated OD levels for female new initiates, age-by-age. Subsidiary analyses suggested possibly accelerated progression toward higher OD levels when extra-medical PPR use starts before age 18. CONCLUSIONS Dimensional approaches to OD and other drug use disorders have gained popularity but can be fragile when differential measurement biases are left uncontrolled. This study's bias-corrected dimensional view of female-male differences shows elevated OD levels among newly incident female EMPPR users relative to new male initiates. Future studies can check for accelerated progression to higher OD levels when EM use starts before age 18 years.
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Affiliation(s)
- Hui G. Cheng
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, 48824, USA
| | - Maria A. Parker
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, 05401, USA
| | - James C. Anthony
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, 48824, USA
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36
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Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394:781-792. [PMID: 31478502 DOI: 10.1016/s0140-6736(19)31775-1] [Citation(s) in RCA: 345] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
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Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
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37
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Stevens JE, Steinley D, McDowell YE, Boness CL, Trull TJ, Martin CS, Sher KJ. Toward more efficient diagnostic criteria sets and rules: The use of optimization approaches in addiction science. Addict Behav 2019; 94:57-64. [PMID: 30777336 PMCID: PMC6544486 DOI: 10.1016/j.addbeh.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
Psychiatric diagnostic systems, such as The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), use expert consensus to determine diagnostic criteria sets and rules (DCSRs), rather than exploiting empirical techniques to arrive at optimal solutions (OS). Our project utilizes complete enumeration (i.e., generating all possible subsets of item combinations A and B with all possible thresholds, T) to evaluate all possible DCSRs given a set of relevant diagnostic data. This method yields the entire population distribution of diagnostic classifications (i.e., diagnosis of the disorder versus no diagnosis) produced by a set of dichotomous predictors (i.e., diagnostic criteria). Once unique sets are enumerated, optimization on some predefined correlate or predictor will maximally separate diagnostic groups on one or more, disorder-specific "outcome" criteria. We used this approach to illustrate how to create a common Substance Use Disorder (SUD) DCSR that is applicable to multiple substances. We demonstrate the utility of this approach with respect to alcohol use disorder and Cannabis Use Disorder (CUD) using DSM-5 criteria as input variables. The optimal SUD solution with a moderate or above severity grading included four criteria (i.e. 1) having a strong urge or craving for the substance (CR), 2) failure to fulfill major role obligations at work school or home (FF), 3) continued use of the substance despite social or interpersonal problems caused by the substance use (SI) and 4) physically hazardous use (HU)) with a diagnostic threshold of two. The derived DCSR was validated with known correlates of SUD and performed as well as DSM-5. Our findings illustrate the value of using an empirical approach to what is typically a subjective process of choosing criteria and algorithms that is prone to bias. The optimization of diagnostic criteria can reduce criteria set sizes, resulting in decreased research, clinician, and patient burden.
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Affiliation(s)
- Jordan E Stevens
- Department of Psychological Science, University of Missouri, United States.
| | - Douglas Steinley
- Department of Psychological Science, University of Missouri, United States
| | - Yoanna E McDowell
- Department of Psychological Science, University of Missouri, United States
| | - Cassandra L Boness
- Department of Psychological Science, University of Missouri, United States
| | - Timothy J Trull
- Department of Psychological Science, University of Missouri, United States
| | | | - Kenneth J Sher
- Department of Psychological Science, University of Missouri, United States
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Zapata JP, García J, Arroyave CA, Calderón JD, Gómez JM, Buitrago DJ, Aparicio A, Aguirre DC. Validation of the sixth version of the Addiction Severity Index (ASI-6) for patients in a clinical population of Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2019; 39:385-404. [PMID: 31529824 DOI: 10.7705/biomedica.v39i3.4536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 06/10/2023]
Abstract
Introduction: The Addiction Severity Index (ASI-6) is recommended for identifying the needs of addicted patients and assessing the effectiveness of a program. Objective: To develop a version of the ASI-6 suitable for Colombia and trans-linguistically and trans-culturally equivalent to the original. Additionally, this study also sought to assess the reliability and construct validity of the resulting version. Materials and methods: The study included Colombian adults with harmful substance use or dependence syndrome who were being treated at drug addiction centers. The original English version underwent a cultural adaptation process. The scale was translated and back-translated to assess its equivalence. Reliability was assessed in terms of internal consistency and interrater and test-retest reliability. The convergent aspect of the construct validity was assessed via the correlation of the instrument with other scales measuring similar underlying constructs. Results: We found an adequate internal consistency for the subscales of the ASI-6 for its Cronbach´s alpha coefficient was above 0.7 with the exception of the social problems subscale (α=0.66). In addition, interrater and test-retest reliability was high, since their intraclass correlation coefficient (ICC) was above 0.7 for all the subscales. Construct validity was demonstrated by a Spearman correlation coefficient ranging from 0.53 to 0.88 between the ASI-6 subscales and other similar scales. Conclusion: The version of the ASI-6 adapted to the Colombian context was found to have good reliability and validity, thus it can be introduced into clinical practice. However, additional studies are needed to evaluate its responsiveness and structural validity.
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Affiliation(s)
- Juan Pablo Zapata
- Grupo Académico de Epidemiología Clínica, GRAEPIC, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
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Boness CL, Stevens JE, Steinley D, Trull T, Sher KJ. Deriving alternative criteria sets for alcohol use disorders using statistical optimization: Results from the National Survey on Drug Use and Health. Exp Clin Psychopharmacol 2019; 27:283-296. [PMID: 30556734 PMCID: PMC6538450 DOI: 10.1037/pha0000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Much of the foundation of clinical practice, psychiatric epidemiology, and research into the etiology, course, prevention, and treatment of alcohol use disorder (AUD) rests on psychiatric diagnosis. However, existing research has failed to adequately exploit empirical techniques and existing databases to derive criteria considered optimal with respect to predicting external correlates. The current project adopts a novel approach to deriving new diagnostic criteria sets and rules for AUD. Utilizing the 2010 (N = 24,120) and 2013 (N = 23,627) National Survey on Drug Use and Health (NSDUH; Substance Abuse and Mental Health Services Administration [SAMHSA], 2011, 2014) data sets, we performed a statistical optimization procedure, using complete enumeration, on participants 21 or older who had consumed at least 1 alcoholic beverage in the past year. The goal was to maximize the distance (based on Cohen's d) between mean levels of the optimization criteria (i.e., consumption and functional impairment) in those with an AUD diagnosis versus those without. In contrast with current convention, AUD is derived transparently using a data-driven approach. The best solution included 9 criteria with a diagnostic threshold of 3, while the second-best solution comprised 5 criteria with a threshold of 2. External validation demonstrated both solutions perform similarly, suggesting it is appropriate to use either, depending on the goal of the diagnosis. Overall, statistical optimization approaches can yield highly efficient criteria sets and rules, although multiple, near equivalently performing solutions can be generated. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Guillem K, Ahmed SH. Preference for Cocaine is Represented in the Orbitofrontal Cortex by an Increased Proportion of Cocaine Use-Coding Neurons. Cereb Cortex 2019; 28:819-832. [PMID: 28057724 DOI: 10.1093/cercor/bhw398] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/13/2016] [Indexed: 11/13/2022] Open
Abstract
Cocaine addiction is a harmful preference for drug use over and at the expense of other nondrug-related activities. Here we identify in the rat orbitofrontal cortex (OFC) a mechanism that explains individual preferences between cocaine use and an alternative, nondrug action. OFC neuronal activity was recorded while rats performed each of these 2 actions separately or while they chose between them. First, we found that these actions are encoded by 2 nonoverlapping neuronal populations and that the relative size of the cocaine population represented individual preferences. A larger relative size was only observed in cocaine-preferring individuals. Second, OFC neurons encoding a given individual's preferred action progressively fired more than other action-coding neurons few seconds before the preferred action was actually chosen, suggesting a prechoice neuronal competition for action selection. In cocaine-preferring rats, this manifested by a prechoice ramping-up activity in favor of the cocaine population. Finally, pharmacological manipulation of prechoice activity in favor of the cocaine population caused nondrug-preferring rats to shift their choice to cocaine. Overall, this study suggests that an individual preference for cocaine is represented in the OFC by a population size bias that systematically advantages cocaine use-coding neurons during prechoice competition for action selection.
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Affiliation(s)
- Karine Guillem
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 146 rue Léo-Saignat, F-33000 Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 146 rue Léo-Saignat, F-33000 Bordeaux, France
| | - Serge H Ahmed
- Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 146 rue Léo-Saignat, F-33000 Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 146 rue Léo-Saignat, F-33000 Bordeaux, France
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Effect of transcranial direct current stimulation on decision making and cognitive flexibility in gambling disorder. Eur Arch Psychiatry Clin Neurosci 2019; 269:275-284. [PMID: 30367243 DOI: 10.1007/s00406-018-0948-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022]
Abstract
Decision making and cognitive flexibility are two components of cognitive control that play a critical role in the emergence, persistence, and relapse of gambling disorder. Transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been reported to enhance decision making and cognitive flexibility in healthy volunteers and individuals with addictive disorders. In this triple-blind randomized sham-controlled parallel study, we aimed to determine whether tDCS over DLPFC would modulate decision making and cognitive flexibility in individuals with gambling disorder. Twenty participants with gambling disorder were administered Iowa Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST). Subsequently, participants were administered three every other day sessions of active right anodal /left cathodal tDCS (20 min, 2 mA) or sham stimulation over bilateral DLPFC. WCST and IGT were readministered following the last session. Baseline clinical severity, depression, impulsivity levels, and cognitive performance were similar between groups. TDCS over the DLPFC resulted in more advantageous decision making (F1,16 = 8.128, p = 0.01, ɳp2 =0.33) and better cognitive flexibility (F1,16 =8.782, p = 0.009, ɳp2 = 0.35), representing large effect sizes. The results suggest for the first time that tDCS enhanced decision making and cognitive flexibility in gambling disorder. Therefore, tDCS may be a promising neuromodulation-based therapeutic approach in gambling disorder.Trial registration: Clinicaltrials.gov NCT03477799.
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Lima DR, Gonçalves PD, Ometto M, Malbergier A, Amaral RA, Dos Santos B, Cavallet M, Chaim-Avancini T, Serpa MH, Ferreira LRK, Duran FLDS, Zanetti MV, Nicastri S, Busatto GF, Andrade AG, Cunha PJ. The role of neurocognitive functioning, substance use variables and the DSM-5 severity scale in cocaine relapse: A prospective study. Drug Alcohol Depend 2019; 197:255-261. [PMID: 30875646 DOI: 10.1016/j.drugalcdep.2019.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/19/2018] [Accepted: 01/19/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The severity of substance use disorder (SUD) is currently defined by the sum of DSM-5 criteria. However, little is known about the validity of this framework or the role of additional severity indicators in relapse prediction. This study aimed to investigate the relationship between DSM-5 criteria, neurocognitive functioning, substance use variables and cocaine relapse among inpatients with cocaine use disorder (CUD). METHODS 128 adults aged between 18 and 45 years were evaluated; 68 (59 males, 9 females) had CUD and 60 (52 males, 8 females) were healthy controls. For the group with CUD, the use of other substances was not an exclusion criterion. Participants were tested using a battery of neurocognitive tests. Cocaine relapse was evaluated 3 months after discharge. RESULTS Scores for attention span and working memory were worse in patients compared to controls. Earlier onset and duration of cocaine use were related to poorer inhibitory control and global executive functioning, respectively; recent use was related to worse performance in inhibitory control, attention span and working memory. More DSM-5 criteria at baseline were significantly associated with relapse. CONCLUSIONS Recent cocaine use was the most predictive variable for neurocognitive impairments, while DSM-5 criteria predicted cocaine relapse at three months post treatment. The integration of neurocognitive measures, DSM-5 criteria and cocaine use variables in CUD diagnosis could improve severity differentiation. Longitudinal studies using additional biomarkers are needed to disentangle the different roles of severity indicators in relapse prediction and to achieve more individualized and effective treatment strategies for these patients.
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Affiliation(s)
- Danielle Ruiz Lima
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil.
| | - Priscila Dib Gonçalves
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Mariella Ometto
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Andre Malbergier
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Ricardo Abrantes Amaral
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Bernardo Dos Santos
- Escola de Enfermagem, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 419, Cerqueira César, 05403-000, Sao Paulo, SP, Brazil
| | - Mikael Cavallet
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Tiffany Chaim-Avancini
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Mauricio Henriques Serpa
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Luiz Roberto Kobuti Ferreira
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Fabio Luis de Souza Duran
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Marcus Vinicius Zanetti
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Sergio Nicastri
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Geraldo Filho Busatto
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
| | - Arthur Guerra Andrade
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Departmento de Neurociencias, Escola de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, 09060-870, Santo Andre, SP, Brazil
| | - Paulo Jannuzzi Cunha
- Grupo Interdisciplinar de Estudos de Álcool e Drogas GREA, Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil; Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria IPq, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 785, Cerqueira César, 01060-970, Sao Paulo, SP, Brazil
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McDowell YE, Vergés A, Sher KJ. Are Some Alcohol Use Disorder Criteria More (or Less) Externalizing than Others? Distinguishing Alcohol Use Symptomatology from General Externalizing Psychopathology. Alcohol Clin Exp Res 2019; 43:483-496. [PMID: 30620411 PMCID: PMC6397083 DOI: 10.1111/acer.13952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The externalizing spectrum contains a range of disinhibition-related conditions, such as conduct disorder, antisocial personality disorder, and substance use disorders. Comorbidity among externalizing disorders is commonly investigated at the syndromal and trait level precluding insight into the relationship of symptoms across externalizing disorders. It is unknown whether comorbidity across externalizing disorders holds constant across highly varied, individual alcohol use disorder (AUD) criteria. AUD criteria range from symptoms reflecting neuroadaptation (e.g., tolerance) to symptoms reflecting behavioral problems (e.g., social problems). The present study aimed to determine the degree to which individual AUD criteria are associated with symptomatology from other externalizing disorders. Characterization of the degree to which AUD criteria reflect neuroadaptation versus behavioral problems can be used to identify symptom profiles, which, in turn, can be used to inform diagnostic and treatment approaches. METHODS Data from 2 large nationally representative samples were used to examine associations between AUD criteria and externalizing behavior. Psychometric inquiries via multivariate and factor analytic approaches estimated relative associations of externalizing behavior and AUD criteria endorsement, as compared to alcohol consumption. RESULTS Our results indicate differential relations of externalizing behavior and AUD criteria endorsement. For example, social problems and role interference criteria were most strongly associated with externalizing behavior across analytic approaches, with general and unique associations with externalizing behavior. Additionally, tolerance was most weakly associated with externalizing behavior across approaches. CONCLUSIONS Results highlight potential etiological heterogeneity among AUD criteria that could guide future diagnostic refinements and aid in the identification of treatment targets.
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Affiliation(s)
- Yoanna E McDowell
- Department of Psychological Sciences , University of Missouri, Columbia, Missouri
| | - Alvaro Vergés
- Escuela de Psicología , Pontificia, Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Kenneth J Sher
- Department of Psychological Sciences , University of Missouri, Columbia, Missouri
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Boness CL, Lane SP, Sher KJ. Not all alcohol use disorder criteria are equally severe: Toward severity grading of individual criteria in college drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:35-49. [PMID: 30676037 DOI: 10.1037/adb0000443] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol use disorder (AUD) diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) contains a severity gradient based on number of criteria endorsed, implicitly assuming criteria are interchangeable. However, criteria vary widely in endorsement rates, implying differences in the latent severity associated with a symptom (e.g., Lane, Steinley, & Sher, 2016) and demonstrating criteria are not interchangeable (Lane & Sher, 2015). We evaluated whether variation in the severity of criteria could be resolved by employing multiple indicators of each criterion varying in item-level severity. We assessed 909 undergraduate students aged 18 years or older with at least 12 drinking occasions in the past year. Participants self-administered questions on alcohol consumption and past year AUD symptoms via an online survey. For each of the 11 AUD criteria, we selected three indicators based on the difficulty values of the one-parameter logistic item response theory model ranging from low to high. We first tested a higher order AUD factor defined by 11 lower order criterion factors, χ2(551) = 2,959.35, p < .0001; root mean square error of approximation = 0.09. The 33 items were used to create severity scores: a criterion count (0-11), symptom count (0-33), and factor scores derived from a bifactor model. Though our new scores resulted in incremental validity over DSM-5 across a range of external validators, when the standardized regression estimates were compared, the new scores did not consistently outperform the DSM-5 suggesting this approach is viable for developing more sensitive diagnostic instruments but needs further refinement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Sean P Lane
- Department of Psychological Sciences, Purdue University
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri
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Bickel WK, Crabbe JC, Sher KJ. What Is Addiction? How Can Animal and Human Research Be Used to Advance Research, Diagnosis, and Treatment of Alcohol and Other Substance Use Disorders? Alcohol Clin Exp Res 2019; 43:6-21. [PMID: 30371956 PMCID: PMC6445393 DOI: 10.1111/acer.13912] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 10/16/2018] [Indexed: 01/01/2023]
Abstract
The current article highlights key issues in defining, studying, and treating addiction, a concept related to but distinct from substance use disorders. The discussion is based upon a roundtable discussion at the 2017 annual meeting of the Research Society on Alcoholism where Warren K. Bickel and John C. Crabbe were charged with answering a range of questions posed by Kenneth J. Sher. All the presenters highlighted a number of central concerns for those interested in assessing and treating addiction as well as those seeking to conduct basic preclinical research that is amenable to meaningful translation to the human condition. In addition, the discussion illustrated both the power and limitations of using any single theory to explain multiple phenomena subsumed under the rubric of addiction. Among the major issues examined were the important differences between traditional diagnostic approaches and current concepts of addiction, the difficulty of modeling key aspects of human addiction in nonhuman animals, key aspects of addiction that have, to date, received little empirical attention, and the importance of thinking of recovery as a phenomenon that possibly involves processes distinct from those undergirding the development and maintenance of addiction.
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Affiliation(s)
- Warren K Bickel
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, Roanoke, Virginia
| | | | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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Kiluk BD, Fitzmaurice GM, Strain EC, Weiss RD. What defines a clinically meaningful outcome in the treatment of substance use disorders: reductions in direct consequences of drug use or improvement in overall functioning? Addiction 2019; 114:9-15. [PMID: 29900624 PMCID: PMC6289694 DOI: 10.1111/add.14289] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/10/2018] [Accepted: 06/07/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sustained abstinence is currently the only accepted end-point for pharmacotherapy trials for most substance use disorders (SUD), with the exception of alcohol. Despite recent efforts, the identification of a non-abstinence alternative as a clinically meaningful end-point for drug use trials has been elusive. ARGUMENT AND ANALYSIS The current standard for establishing a clinically meaningful outcome in SUD trials is to demonstrate that a reduction in drug use is associated with improvement in long-term functioning, but data indicate relatively weak associations between drug use and various psychosocial problem domains. This may be because assessments used most commonly to measure an individual's functioning do not specify whether aspects of functioning are a direct consequence of drug use. The acceptance of a non-abstinence-based end-point for alcohol use disorder trials was supported in part through associations with reductions in alcohol-related consequences, although measures designed to assess the direct consequences of drug use are rarely included in drug treatment efficacy trials. CONCLUSIONS The field of substance use disorders should include measures of negative psychosocial and health consequences of drug use, as opposed to overall functioning, in the effort to establish meaningful non-abstinence-based end-points.
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Affiliation(s)
- Brian D Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Garrett M Fitzmaurice
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roger D Weiss
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA, USA
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Iglesias K, Sporkert F, Daeppen JB, Gmel G, Baggio S. Comparison of self-reported measures of alcohol-related dependence among young Swiss men: a study protocol for a cross-sectional controlled sample. BMJ Open 2018; 8:e023632. [PMID: 30012797 PMCID: PMC6082486 DOI: 10.1136/bmjopen-2018-023632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Short screenings of alcohol-related dependence are needed for population-based assessments. A clinical interview constitutes a reliable diagnosis often seen as gold standard, but it is costly and time consuming and as such, not suitable for population-based assessments. Therefore, self-reported questionnaires are needed (eg, alcohol use disorder (AUD) as in the Diagnostic and Statistic Manual of Mental Disorders (DSM) 5), but their reliability is questionable. Recent studies called for more evidence-based measurements for population-based screening (eg, heavy alcohol use over time (HAU)). This study aims to test the reliability of different self-reported measures of alcohol use. METHODS AND ANALYSIS Based on stratified random selection, 280 participants will be recruited from the French-speaking subgroup of the Swiss National Science Foundation-supported Cohort Study on Substance Use and Risk Factors (C-SURF). This cohort is a population-based sample of young Swiss men in their mid-20s (n=2668). The sample size calculation is based on a proportion non-inferiority test (alpha=5%, power=80%, margin of equivalence=10%, difference in sensitivity between self-reported AUD and HAU=5%, correlation between AUD and HAU=0.35, and drop-outs=15%). Assessment will include a clinical interview as the gold standard of alcohol-related dependence, self-reported alcohol measures (HAU, AUD and drinking patterns), biomarkers as gold standards of chronic excessive drinking, and health outcomes. To assess the validity of the self-reported alcohol measures, sensitivity analyses will be run. The associations between alcohol-related measures and health outcomes will be tested. A non-response analysis will be run using the previous waves of the C-SURF study using logistic regressions. ETHICS AND DISSEMINATION The study protocol has been approved by the Human Research Ethics Committee of the Canton of Vaud, Switzerland (no. 2017-00776). The results will be submitted for publication in peer-reviewed journals and presented at national and international conferences.
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Affiliation(s)
- Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
- Center for the Understanding of Social Processes, University of Neuchâtel, Neuchâtel, Switzerland
| | - Frank Sporkert
- Forensic Toxicology and Chemistry Unit, Lausanne and Geneva Universities, Centre of Legal Medicine, Lausanne, Switzerland
| | | | - Gerhard Gmel
- Alcohol Treatment Centre, Lausanne University Hospital, Lausanne, Switzerland
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of the West of England, Bristol, UK
| | - Stephanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Life Course and Social Inequality Research Center, University of Lausanne, Lausanne, Switzerland
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Martin CS, Sher KJ. Drinkers' Harm to Others: A Commentary on Karriker-Jaffe et al. (2018). J Stud Alcohol Drugs 2018; 79:244-245. [PMID: 29553352 PMCID: PMC9798473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Christopher S. Martin
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania,
| | - Kenneth J. Sher
- Department of Psychological Sciences, University of Missouri–Columbia, Columbia, Missouri
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Martin CS, Sher KJ. Drinkers' Harm to Others: A Commentary on Karriker-Jaffe et al. (2018). J Stud Alcohol Drugs 2018; 79:244-245. [PMID: 29553352 PMCID: PMC9798473 DOI: 10.15288/jsad.2018.79.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Affiliation(s)
- Christopher S. Martin
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kenneth J. Sher
- Department of Psychological Sciences, University of Missouri–Columbia, Columbia, Missouri
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A narrative review of potential treatment strategies for food addiction. Eat Weight Disord 2017; 22:387-393. [PMID: 28589470 DOI: 10.1007/s40519-017-0400-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/10/2017] [Indexed: 02/07/2023] Open
Abstract
The concept of food addiction (FA) remains controversial with research being in the nascent stages; FA like any addiction can have a devastating impact on the lives of those afflicted. There exists a clinical need for treatment strategies for those affected. This article reviews potential treatment strategies for FA. The treatment strategies target four core behaviours of the addiction phenotype specifically craving through the opioid system, impulsivity as a personality trait, compulsivity through the serotonergic system and lastly motivation through the dopaminergic system. A range of pharmacological and psychological interventions are reviewed. Future research should seek to test and validate the proposed clinical treatment strategies.
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