New steps for treating alcohol use disorder: the emerging importance of physical exercise

A lifestyle physical activity intervention for women in alcohol treatment: A pilot randomized controlled trial

INTRODUCTION

Compared to men, women with alcohol use disorder (AUD) are more likely to drink to manage stress and negative affect. Given women's risk for poor drinking outcomes, it is critical to develop and test interventions that target these affective factors. Physical activity improves negative affect and has emerged as a promising adjunct to AUD treatment and, thus, may be especially valuable for women.

METHODS

Fifty women with AUD (49.9 ± 12.0 years of age) participated in either a 12-week telephone-delivered lifestyle physical activity plus Fitbit (LPA + Fitbit) or a health education contact (HEC) control intervention following a partial hospital addictions treatment program. The study examined changes in drinking behaviors, mental health outcomes, and physical activity engagement post-intervention using both conventional test statistics and standard effect sizes.

RESULTS

Higher rates of continuous abstinence during the 12-week period were observed in the LPA + Fitbit condition (55.6 %) than in the HEC condition (33.6 %); odds ratio = 2.97. However, among women who drank any alcohol during the 12-weeks, slightly higher rates of heavy drinking and drinks/day were observed among women in the LPA + Fitbit condition. Significant differences for improved mental health outcomes (including depression, anxiety, negative affect, positive affect, perceived stress, and behavioral activation) and increased self-reported physical activity were consistently observed among participants in the LPA + Fitbit condition, relative to HEC.

CONCLUSIONS

The LPA + Fitbit program had a positive impact on alcohol abstinence, mental health, and physical activity in adult women receiving treatment for AUD. Future research should continue to investigate the optimal implementation strategies, duration, and intensity of LPA interventions in the context of a fully-powered RCT.

Effects of a multimodal physical exercise program on physical and mental health indicators in males with substance use disorder

Introduction: Substance use disorder (SUD) is seen as a serious and growing public safety and health problem worldwide. Long-term sequelae may involve permanent damage to physical fitness, body balance, and coordination skills, with a severe motor, functional, and emotional consequences. Objective: To verify the effect of 16 sessions of a multimodal physical exercise program on physical fitness, body balance, and internalized stigma of inpatients for the treatment of Substance use disorder. Methods: Forty-three males with Substance use disorder (aged 33.9 ±12.4 years) were divided into an Intervention Group (IG, n=21) and Control Group (CG, n=22). The IG was submitted to eight weeks of training with physical exercises. Participants were submitted to the evaluation of internalized stigma, body balance, agility, and flexibility, before and after the intervention period. Results: Positive results were observed in physical fitness (agility, p=0.001) and body balance variables (center of pressure path with closed eyes, p=0.050, and ellipse area with closed eyes, p=0.031). The time of substance use correlated with lower performance in agility and body balance tests. Conclusion: The data seem to support the potential benefit of physical exercise as an adjunct in Substance use disorder rehabilitation process, particularly for physical fitness and body balance variables.

Test-retest reliability, concurrent validity and correlates of the two-minute walk test in outpatients with alcohol use disorder

We investigated the test-retest reliability of the 2-min walk test (2MWT) and its concurrent validity with the 6-min walk test (6MWT) in Ugandan outpatients with alcohol use disorder (AUD). We also explored practice effects, and assessed the minimal detectable change (MDC) and correlations with the 2MWT. Fifty outpatients [7 women; median age = 32.0 years] performed the 2MWT twice, the 6MWT once, and completed the Simple Physical Activity Questionnaire, Brief Symptoms Inventory-18 (BSI-18), and Alcohol Use Disorders Identification Test. The median (interquartile) 2MWT score on the first and second test were 162.0 (49.0) meters and 161.0 (58.0) meters, respectively, without significant difference between the two trials (p = 0.20). The intraclass correlation between the two 2MWTs was 0.96 (95% confidence interval = 0.94-0.98). The Spearman Rho correlation between the second 2MWT and the 6MWT was 0.91 (p < 0.001). The MDC for the 2MWT was 18 m. There was no evidence of a practice effect. Variance in BSI-18 depression and the presence of leg pain following the 2MWT explained 18.7% of 2MWT score variance. The 2MWT is a reliable and valid fitness test, which can be conducted without any special equipment or substantial time demands in outpatients with AUD.

Physical activity: A promising adjunctive treatment for severe alcohol use disorder

Substance use disorder develops from complex interactions between socio-environmental and neurobiological factors. A neurocognitive model of addiction, the triadic model, proposes that Alcohol Use Disorder (AUD) is the result of an imbalance between the reflective and the impulsive subcomponents along with a disruption of the regulatory subcomponent. Physical activity is considered as an emerging treatment for severe AUD (sAUD). This short review examines the efficacy and mechanisms of action of physical intervention as an adjunctive treatment in severe AUD (sAUD) within the theoretical framework of the triadic model. Physical activity is a feasible, safe, and less stigmatizing approach than classical treatments. It improves sAUD patients' mental and physical comorbidities. The key finding of this short review is that physical activity could contribute to a rebalancing of the triadic model in sAUD patients by 1) improving neuroplasticity and cognitive functioning, 2) reducing impulsivity and urgency, and improving emotional regulation, and 3) reducing craving. This rebalancing could eventually reduce the risk of relapse. However, due to methodological issues, it remains difficult to observe an effect of physical activity on drinking outcomes. At best, a trend towards a reduction in alcohol consumption was noted. The mechanisms that could explain the benefits of physical activity in sAUD patients involve multiple physiological processes such as dopaminergic or glutamatergic transmission and signaling or neuroplasticity. Future randomized controlled trials should include neuropsychological and impulsivity assessments, in more controlled environments. Physical activity could contribute to a personalization of sAUD treatment using each subcomponent of the triadic model as a therapeutic target. Physical exercise could be an adjunctive treatment for sAUD patients, favoring the benefit of more usual treatments such as cognitive behavioral therapies. It could also be a stand-alone intervention in less severe patients.

At risk alcohol consumption with smoking by national background: Results from the Hispanic community health study/study of Latinos

INTRODUCTION

Tobacco smoking and binge or excess drinking are unhealthy behaviors that frequently co-occur. Studies of Hispanics/Latinos have mostly been of Mexican Americans although there are substantial differences in smoking and drinking by heritage background. Associated with co-use by 5 subpopulations.

METHODS

Cross-sectional data of 16,412 Hispanics/Latinos from Miami, the Bronx, Chicago and San Diego collected between 2008 and 2011 as part of the HCHS/SOL were analyzed. Smoking and alcohol consumption and demographic data were measured by self-report. Prevalence of smoking and alcohol consumption and co-use were reported. Logistic regression models examined the odds of co-use of smoking and binge or excess alcohol use by Hispanic/Latino background group.

RESULTS

Men of Cuban (10.3%), Puerto Rican (8.9%), and Mexican (8.9%) background had the highest prevalence of co-use of smoking and binge drinking compared to men of Central American (6.1%) and Dominican (6.6%) background. Women of Dominican (16.4%) and Puerto Rican (19.7%) background had the highest prevalence of binge drinking compared to women of Central American (10%) and Cuban (8%) background and Puerto Rican (34.1%) and Cuban (21.8%) women were the most likely to report current smoking compared to women of Central American (8.3%) and Mexican (10.4%) background. Acculturation was not associated with co-use among men and women. Elevated depressive symptoms were positively associated with smoking and binge drinking among men, OR = 1.5 [1.2-2.0], and women, OR = 1.5 [1.1-2.2]. Puerto Rican women had increased odds of co-use of smoking and binge or excess drinking compared to Mexican American women, OR = 3.2 [1.5-6.6].

CONCLUSIONS

Puerto Rican and Dominican Latinas and Central American and South American men have a higher prevalence of co-use.

Test-retest reliability and clinical correlates of the Eurofit test battery in people with alcohol use disorders

People with alcohol use disorder (AUD) are at an increased risk for cardiovascular diseases (CVD). Physical fitness is a predictor of CVD and premature mortality. Currently, no existing measures of physical fitness used in the general population have been tested for validity and reliability in this vulnerable population. Therefore, we examined the reproducibility, feasibility and correlates of the Eurofit test battery in this population. From 32 men (age = 40.8 ± 13.8years; illness duration = 10.2 ± 10.3years; body mass index, BMI = 24.8 ± 3.8) and 13 women (age = 41.9 ± 12.1years; illness duration = 13.7 ± 13.1years; BMI = 26.3 ± 4.9) with AUD two trials of the Eurofit test, administered within one week, were analyzed. All patients also completed the International Physical Activity Questionnaire, the Positive Affect and Negative Affect Scale and Alcohol Use Disorders Identification Test. All Eurofit items showed good reproducibility with intraclass correlation coefficients ranging from 0.82 for the flamingo balance test to 0.97 for the standing broad jump and handgrip strength tests. Better performance on Eurofit test items was associated with younger age, a shorter illness duration, a lower BMI and higher physical activity levels. The current study demonstrates that the Eurofit test can be recommended as a reliable test for evaluating the physical fitness of inpatients with alcohol use disorder.