Craving and the social context: a new interaction model for enhancing recovery from alcoholism

Friends and social contexts as unshared environments: a discordant sibling analysis of obesity- and health-related behaviors in young adolescents

OBJECTIVE

This study examines the contribution of best friends' weight and the peer social context (time spent alone versus with friends) as sources of unshared environment associated with variability in weight and health behaviors among weight-discordant siblings.

METHODS

Pairs of same-sex biologic siblings (N=40 pairs; ages 13-17) were originally recruited as part of a study evaluating putative factors contributing to differences in adiposity among weight-discordant siblings. Siblings were asked to bring their best friends to the laboratory and siblings and friends' height and weight were objectively measured. Siblings also completed multi-pass dietary recalls to assess energy intake and sugar sweetened beverage (SSB) consumption. Siblings' physical activity was measured using accelerometry. Experience sampling methodology was used to assess sedentary behaviors/screen time and the number of occasions siblings spent alone and in the presence of friends. Multilevel models were used to estimate the relationships between predictors (best friends' zBMI, time spent alone or with friends) and outcomes (siblings' zBMI and obesity-related health behaviors).

RESULTS

Best friends' zBMI was the best predictor of participants' zBMI, even when controlling for child's birth weight. Best friends' weight (zBMI) further predicted participants' SSB intake and time engaged in sedentary behaviors. Being active with friends was positively associated with participants' overall physical activity, whereas spending time alone was negatively associated with accelerometer counts regardless of siblings' adiposity.

CONCLUSIONS

A friends' weight and the social context are unshared environmental factors associated with variability in adiposity among biologically-related weight-discordant siblings.

Effects of ALANON attendance on family perception of inner-city indigents

This study investigated the perception of family functioning of rehabilitating inner-city substance abusers and one of their family members. Subjects were 39 residents of a treatment center and 39 family members. The design was compromised experimental, comparing the group who had family members in ALANON (n = 36) with a nonrandomized control group whose family members had no help (n = 42). Data were collected three times: at the beginning of the abuser's treatment, at the end, and one month after treatment. Subjects completed two family functioning instruments: Assessment of Strategies in Families (ASF) and Family APGAR. Repeated-measure MANOVAs yielded significant differences in all family scores between the ALANON and the control groups. An increase in the perception of family effectiveness was most pronounced between time 2 and time 3, after the substance abuse program was completed. Family members changed their perceptions more than the abusers and maintained their favorable family perception, even though five of the abusers had relapsed shortly after discharge. At 3 months after treatment, the relapse rate for addicts in the ALANON group (n = 15) was 39% compared with 61% for addicts in the control group (n = 18). The difference was not of statistical significance due to the small group sizes, however. Evidence suggests the usefulness of ALANON in empowering families and assisting them in reevaluating the family system more positively.

Low doses of morphine reduce voluntary alcohol consumption in rhesus monkeys

Experimental opioid modulation has been found to influence the consumption of alcohol in animals. Whereas it has generally been agreed upon that opiate antagonists reduce alcohol consumption, the results with opiate agonists are less consistent. The present study reports on the effect of low doses of morphine in 8 adult male rhesus monkeys that had a free choice in drinking water, a 16% and a 32% ethanol/water solution, (a) during continuous ad libitum access (Experiment I), and (b) after 2 days of alcohol abstinence (Experiment II). In both experiments each monkey received a single morphine injection (i.m.) in 5 different doses (0.03, 0.06, 0.17, 0.50, 1.50 mg.kg-1); each morphine injection (i.m.) was placebo-controlled in a cross-over design. Consumption was measured from 16.00 h in the afternoon (30 min after injection) to 08.30 h the next morning. In Experiment I after 0.50 and 1.50 mg.kg-1 of morphine ethanol intake and water consumption were both reduced during the first hours after injection; only ethanol intake remained reduced during the subsequent night. Effects lasted not longer than 24 h. In Experiment II, morphine administered 30 min before reintroduction of ethanol solutions reduced ethanol intake at doses of 0.17, 0.50 and 1.50 mg.kg-1; water consumption was unaffected. The reduction lasted for the subsequent night after the 2 highest doses. Records obtained of various spontaneous behavioural activities made it unlikely that the used dose range had induced some aspecific sedation; monkeys remained alert and active. The results are contradictory with studies in which low doses of morphine stimulated alcohol drinking in rats. The present results seem to support the hypothesis that at least in monkeys morphine can compensate for some effects of alcohol.

Social and clinical features as predictors of outcome in outpatient alcohol withdrawal

OBJECTIVE

To identify patient features--both social and clinical--that may be associated with treatment failure in outpatient alcohol withdrawal.

DESIGN

A prospective observational cohort study of patients who underwent outpatient management of the alcohol withdrawal syndrome.

SETTING

Community hospital-based outpatient alcohol treatment program.

PATIENTS

The 179 patients who were eligible for and participated in a clinical trial of drug therapy for outpatient management of the alcohol withdrawal syndrome.

MAIN RESULTS

Treatment failure occurred for 45% (80/179) of the patients. Failure rating did not vary according to diverse sociodemographic features such as age, level of education, income, medical insurance status, and marital status. Persons who were homeless did as well as those who were not. In contrast, two clinical features of withdrawal were associated with significantly higher rates of treatment failure: craving and withdrawal symptom severity. High cravers had a treatment failure rate of 56% (22/39), compared with 36% (41/115) for those with lower scores (p less than 0.03). Among those with moderate-to-high withdrawal symptom severity, 49% (74/151) represented treatment failures, compared with 22% (6/27) of those in the low-symptom group (p less than 0.01).

CONCLUSIONS

While these data do not confirm that socially disadvantaged persons are at increased risk for withdrawal treatment failure, two clinical features--craving and withdrawal symptom severity--may help identify high-risk patients.

Effect of naltrexone on alcohol consumption during chronic alcohol drinking and after a period of imposed abstinence in free-choice drinking rhesus monkeys

Relapse into problematic alcohol drinking is a serious problem in the treatment of alcoholism. Free-choice drinking rhesus monkeys show relapse-like behaviour after imposed abstinence of alcohol, by immediately reinitiating ethanol intake at an increased level. The relapse-like behaviour of the monkeys seems not induced by physical withdrawal, but rather argues for a resistance to extinction of ethanol-reinforced behaviour. It has been suggested that endogenous opioids play a role in the positive reinforcing effect of ethanol. In this study, the effect of the opiate antagonist naltrexone was investigated in eight adult male rhesus monkeys (Macaca mulatta) who had about 1 year experience with alcohol drinking, under two conditions: 1) (expt 1) during continuous and concurrent supply of drinking water and two ethanol/water solutions (16% and 32% (v/v], and 2) (expt 2) after 2 days of alcohol abstinence. In both experiments, each monkey received six doses of naltrexone (0.02, 0.06, 0.17, 0.5, 1.0, 1.5 mg.kg-1); each dose was paired with a placebo injection (im) in a cross-over design. Consumption was measured from 16.00 hours in the afternoon (30 min after injection) to 9.00 hours the next morning. In experiment 1 naltrexone reduced total net ethanol intake in a graded dose-dependent manner. The effect of naltrexone was apparent shortly after injection, and lasted until the following day. Consumption of drinking water was reduced only shortly after injection. In expt 2, reduction of net ethanol intake was largely restricted to the first few hours of reinitiation of alcohol drinking, i.e. the period in which the abstinence-induced increase was manifest. Consumption of drinking water was not affected by naltrexone. Naltrexone hardly influenced consumption of the non-preferred ethanol solution of 32%. It is postulated that the opioid modulation specifically interacted with positively reinforced behaviour. In expt 2 naltrexone reduced ethanol intake at a lower dose (0.17 mg.kg-1) compared to expt 1 (0.50 mg.kg-1), but net ethanol intakes however remained higher. It might be that alcohol abstinence resulted in altered opioid activity, leading to increased ethanol-seeking behaviour. The renewed presentation of ethanol solutions (also) might have stimulated reinitiation of alcohol drinking, representing conditioned incentive stimuli. The reported monkey model of relapse in alcohol drinking could be a useful tool to evaluate new hypotheses and experimental treatments with respect to human alcoholism.