Executive functioning and alcohol binge drinking in university students

The combination of donepezil and cognitive training for improving treatment outcomes for alcohol use disorder: Design of a randomized controlled trial

BACKGROUND

The development of alcohol use disorder (AUD) is a major concern in public health, and cognitive impairments caused by alcohol are involved in this process. Emerging neurobiological evidence suggests that donepezil, an anticholinesterase agent, may improve AUD treatment outcomes by enhancing neurocognitive functioning. Previous research has also suggested that cognitive remediation therapy (CRT) could potentially improve cognitive function and AUD treatment outcomes. We present the rationale and design of a trial to evaluate the combination of donepezil and cognitive remediation therapy (donepezil + CRT) as an intervention for AUD.

METHODS

We propose a 13-week, randomized, double-blind, placebo-controlled, between-subjects trial comparing 4 groups (donepezil + CRT vs. donepezil alone vs. CRT alone vs. placebos) as an intervention for AUD. The main goal of the study is to evaluate if donepezil + CRT is superior to placebo in reducing heavy drinking days and improving neurocognitive functioning. A total of 160 patients (4 groups, 40 per each group) with AUD between the ages of 18-80 years will be recruited at Yale University and the VA Connecticut Healthcare System. Primary outcome measures include 1) heavy drinking by Timeline Follow Back (TLFB) over 13 weeks and 2) global neurocognitive functioning by a global index of neurocognitive function score at 7 and 13 weeks.

DISCUSSION

This protocol paper describes the rationale and proposed methods for the randomized controlled trial for improving AUD treatment outcomes. This project has significant clinical potential to help patients suffering from AUD by improving their cognition and reducing alcohol consumption.

TRIAL REGISTRATION

NCT05042102.

Factors underlying the neurofunctional domains of the Addictions Neuroclinical Assessment assessed by a standardized neurocognitive battery

The Addictions Neuroclinical Assessment (ANA) is a neurobiologically-informed framework designed to understand the etiology and heterogeneity of Alcohol Use Disorder (AUD). Previous studies validated the three neurofunctional domains of ANA: Incentive Salience (IS), Negative Emotionality (NE) and Executive Function (EF) using secondary data. The present cross-sectional observational study assessed these domains in an independent, prospective clinical sample. Adults across the drinking spectrum (N = 300) completed the ANA battery, a standardized collection of behavioral tasks and self-report assessments. Factor analyses were used to identify latent factors underlying each domain. Associations between identified domain factors were evaluated using structural equation models. Receiver operating characteristics analyses were used to determine factors with the strongest ability to classify individuals with problematic drinking and AUD. We found (1) two factors underlie the IS domain: alcohol motivation and alcohol insensitivity. (2) Three factors were identified for the NE domain: internalizing, externalizing, and psychological strength. (3) Five factors were found for the EF domain: inhibitory control, working memory, rumination, interoception, and impulsivity. (4) These ten factors showed varying degrees of cross-correlations, with alcohol motivation, internalizing, and impulsivity exhibiting the strongest correlations. (5) Alcohol motivation, alcohol insensitivity, and impulsivity showed the greatest ability in classifying individuals with problematic drinking and AUD. Thus, the present study identified unique factors underlying each ANA domain assessed using a standardized assessment battery. These results revealed additional dimensionality to the ANA domains, bringing together different constructs from the field into a single cohesive framework and advancing the field of addiction phenotyping. Future work will focus on identifying neurobiological correlates and identifying AUD subtypes based on these factors.

Executive and memory dysfunction related to binge drinking in stroke survivors during a 9-year follow-up

Background

Ischemic stroke and heavy alcohol consumption are both known risk factors for cognitive impairment. The issue gains importance because the prevalence of stroke and binge drinking have both increased among working-aged adults. Alarmingly, a recent cross-sectional study suggests the additive negative effects of binge drinking and comorbid brain disease on cognition. However, the long-term cognitive prognosis of the additive effects of stroke and binge drinking on adults remains unknown.

Methods

In this prospective, two-center cohort study, we recruited consecutive 18-65-year-old patients with first-ever ischemic stroke along with demographically matched stroke-free controls. Patients participated in neuropsychological assessment at 6 months, 2 years, and 9 years after stroke, and in neurological assessment at acute care and at 9-year follow-up. Controls participated in a similar follow-up procedure. We examined the association between binge drinking, follow-up time, and long-term cognitive outcomes using repeated-measures analysis of variance.

Results

We included 85 patients who had had their first-ever and only ischemic stroke (mean age 53 years at the incident stroke). Patients were divided into binge-drinking (n = 22) and non-binge-drinking groups (n = 63) based on the shortened version of the Alcohol Use Disorders Identification Test. Follow-up data in healthy controls (n = 31) was used to normalize the patients' test scores for effects of age, sex, and education. We compared cognitive changes between binge-drinking and non-binge-drinking patients over a 9-year follow-up. Non-binge-drinking patients outperformed binge-drinking patients across all follow-up points on most of the executive function tests and in one memory test: binge drinking had a significant main effect both on executive function (the phonemic fluency task, p = 0.002; the Trail Making Test, p = 0.013) and memory (the list learning task, p = 0.002).

Conclusion

Binge drinking was associated with executive and memory dysfunction at three time points over a decade after a first-ever ischemic stroke. Subdiagnostic binge drinking might increase the adverse effects of a first-ever ischemic stroke on executive function and memory, evident over a decade poststroke.

Alcohol and stress exposure across the lifespan are key risk factors for Alzheimer's Disease and cognitive decline

Alzheimer's Disease and related dementias (ADRD) are an increasing threat to global health initiatives. Efforts to prevent the development of ADRD require understanding behaviors that increase and decrease risk of neurodegeneration and cognitive decline, in addition to uncovering the underlying biological mechanisms behind these effects. Stress exposure and alcohol consumption have both been associated with increased risk for ADRD in human populations. However, our ability to understand causal mechanisms of ADRD requires substantial preclinical research. In this review, we summarize existing human and animal research investigating the connections between lifetime stress and alcohol exposures and ADRD.

Comparing self-affirmation manipulations to reduce alcohol consumption in university students

Objective: Self-affirmation theory proposes that defensive processing prevents people from accepting health-risk messages, which may explain university students' dismissal of risk-information about binge drinking. SA-interventions may encourage non-biased processing of such information through impacting on interpersonal feelings and self-esteem. This study compared two self-affirmation manipulations on interpersonal feelings, self-esteem, message processing, message acceptance and subsequent alcohol consumption.Participants: UK university students (N = 454).Methods: Participants were randomly allocated to one of three conditions (Self-affirmation Implementation Intention, Kindness Questionnaire, Control) before reading health-risk information about binge drinking. This was followed by measures of interpersonal feelings, self-esteem, message processing, acceptance and behavioral intentions. Alcohol consumption was assessed one week later.Results: The self-affirmation manipulations had non-significant effects on all outcome variables.Conclusion: Consistent with previous research, the results indicate that self-affirmation interventions are not effective for reducing alcohol consumption in university students.

Verbal memory and executive components of recall in adolescent binge drinkers

Introduction

Binge drinking (BD) is a common health-risk behavior among young people. Due to the incomplete maturation of the adolescent brain, BD can lead to structural and functional changes that impact neurocognitive processes, particularly executive functioning and verbal memory. This study aimed to investigate the influence of executive components, such as mnemonic strategies and error avoidance, on performance in a verbal memory test and the potential effects of BD on this performance.

Methods

A sample of 160 college students (51.55% female) with a mean age of 18.12 ± 0.32 years completed assessments for alcohol use disorders using the Alcohol Use Disorder Identification Test (AUDIT), as well as psychopathological (Symptom Checklist-90-R) and neuropsychological evaluations (Verbal Learning Test Spain-Complutense and WMS-III Logical Memory). The Intensive Drinking Evaluation Instrument (IECI) was utilized to gather detailed information about binge drinking habits, including the calculation of the highest blood alcohol concentration (BAC) during an episode of intake.

Results

Correlation and clustering analyses revealed a negative association between BAC values and verbal memory performance, as well as the use of memory strategies. The high BAC group (BD) exhibited negative values in verbal memory variables, higher accuracy errors, and less efficient strategy usage, while the low BAC group (No BD) demonstrated better memory test performance, fewer precision errors, and superior use of memory strategies.

Discussion

These findings support the hypothesis that, when solving tests requiring verbal memory, adolescents reporting a BD consumption pattern show fewer executive skills in their resolution and, therefore, achieved poorer performance than non-binge drinkers. Addressing excessive alcohol consumption in young individuals is crucial for safeguarding their cognitive development and overall well-being.

The Effect of Very-Long-Chain n-3 Polyunsaturated Fatty Acids in the Central Nervous System and Their Potential Benefits for Treating Alcohol Use Disorder: Reviewing Pre-Clinical and Clinical Data

Alcohol use poses a significant global health concern, leading to serious physical and socioeconomic issues worldwide. The current treatment options for problematic alcohol consumption are limited, leading to the exploration of alternative approaches, such as nutraceuticals. One promising target is very-long-chain n-3 polyunsaturated fatty acids (VLC n-3 PUFAs). This review aims to compile the most relevant pre-clinical and clinical evidence on the effect of VLC n-3 PUFAs on alcohol use disorders and related outcomes. The findings suggest that VLC n-3 PUFAs may alleviate the physiological changes induced by alcohol consumption, including neuroinflammation and neurotransmitter dysregulation. Additionally, they can reduce withdrawal symptoms, improve mood, and reduce stress level, all of which are closely associated with problematic alcohol consumption. However, more research is required to fully understand the precise mechanisms by which VLC n-3 PUFAs exert their function. Furthermore, PUFAs should not be considered a standalone solution, but as a complement to other therapeutic approaches. Although preliminary evidence supports the potential therapeutic effect of VLC n-3 PUFAs on problematic alcohol consumption, additional research is needed to validate these findings and determine the optimal use of PUFAs as part of a comprehensive approach to the treatment of alcohol use disorders.

Adolescent brain maturation and the neuropathological effects of binge drinking: A critical review

Adolescence is a transitional stage marked by continued brain development. This period is accompanied by physical and neurochemical modifications in the shape and function of the hippocampus, prefrontal cortex, and other limbic system structures. Brain maturation during adolescence, which is typically governed by intrinsic factors, can be dramatically altered by environmental influences such as drugs and alcohol. Unlike many other addictive substances, binge drinking is very common and normative among teenagers and young adults. This repeated pattern of excessive alcohol consumption in adolescents has been shown to cause behavioral changes and neurocognitive impairments that include increased anxiety, risky decision-making, and learning deficits, which could lead to the development of alcohol use disorder (AUD). This manuscript highlights factors that lead to adolescent binge drinking, discusses maturational changes that occur in an adolescent's brain, and then evaluates the effect of adolescent alcohol consumption on brain structure, function, and neurocognitive abilities in both human studies and animal models. The impact of gender/sex and COVID-19 are briefly discussed. Understanding the factors that promote the onset of adolescent binge drinking and its undesirable consequences could serve as a catalyst for developing therapeutic agents that would decrease or eradicate the damaging effects of alcohol on an adolescent brain.

Sex-specific decision-making impairments and striatal dopaminergic changes after binge drinking history in rats

Binge drinking (BD) is a harmful behavior for health and is a predictive factor for the development of alcohol addiction. Weak decision-making (DM) capacities could play a role in the vulnerability to BD which in turn would lead to DM impairments, thus perpetuating BD. Longitudinal preclinical studies are however lacking and necessary to understand this complex relationship. Both DM and BD are influenced by sex and involve dopamine release in the core of the nucleus accumbens, a central mechanism regulated by dopamine D2/3 autoreceptors. In this context, we used an operant self-administration procedure of BD in male and female rats, and longitudinally assessed DM capacity, memory and anxiety-like behavior. To better understand the mechanisms potentially involved in the relationship between DM and BD, ex vivo dopamine transmission was assessed short term after the end of the binge exposure in the core of the nucleus accumbens (NAc) using the fast-scan cyclic voltammetry (FSCV) technique and the D2/3 agonist quinpirole. We found important basal sex differences in DM, with female rats showing better performances at baseline. Choice processes were impaired exclusively in males after BD history, associated with a decrease in impulse control in both sexes, while memory and anxiety-like behavior were not affected. Our neurobiological results demonstrate that BD did not affect basal dopamine signaling in the NAc core, regardless of the sex, but reveal changes in the sensitivity to the inhibitory effects of quinpirole in females. DM impairments were neither associated with changes in basal dopamine signaling nor pre-synaptic D2 activity. Overall, our findings show that BD affects both DM processes and dopamine transmission in the core of the NAc in a sex-related manner, further suggesting that these effects may play a role in the vicious cycle leading to BD perpetuation and the early onset of AUD. Our results may inform novel strategies for therapeutic and prevention interventions.

Adolescent alcohol use is linked to disruptions in age-appropriate cortical thinning: an unsupervised machine learning approach

Cortical thickness changes dramatically during development and is associated with adolescent drinking. However, previous findings have been inconsistent and limited by region-of-interest approaches that are underpowered because they do not conform to the underlying spatially heterogeneous effects of alcohol. In this study, adolescents (n = 657; 12-22 years at baseline) from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study who endorsed little to no alcohol use at baseline were assessed with structural magnetic resonance imaging and followed longitudinally at four yearly intervals. Seven unique spatial patterns of covarying cortical thickness were obtained from the baseline scans by applying an unsupervised machine learning method called non-negative matrix factorization (NMF). The cortical thickness maps of all participants' longitudinal scans were projected onto vertex-level cortical patterns to obtain participant-specific coefficients for each pattern. Linear mixed-effects models were fit to each pattern to investigate longitudinal effects of alcohol consumption on cortical thickness. We found in six NMF-derived cortical thickness patterns, the longitudinal rate of decline in no/low drinkers was similar for all age cohorts. Among moderate drinkers the decline was faster in the younger adolescent cohort and slower in the older cohort. Among heavy drinkers the decline was fastest in the younger cohort and slowest in the older cohort. The findings suggested that unsupervised machine learning successfully delineated spatially coordinated patterns of vertex-level cortical thickness variation that are unconstrained by neuroanatomical features. Age-appropriate cortical thinning is more rapid in younger adolescent drinkers and slower in older adolescent drinkers, an effect that is strongest among heavy drinkers.

Associations between Adolescent Alcohol Use and Neurocognitive Functioning in Young Adulthood

This study examined the associations between excessive alcohol intake during adolescence and neurocognitive functioning in young adulthood and whether these relations varied by sex. Participants were working-class Chilean adolescents (N = 692; Mage 16.0 years; 54.5% female) who provided frequency of past 30-day bingeing and past-year intoxication. Neurocognitive measures were completed in young adulthood (Mage 21.2 years). Illicit substance users were excluded a priori and other substance use was controlled. When males and females were considered simultaneously, no main effects of intoxication or bingeing were found. However, several sex-specific effects emerged for intoxication, such that more frequent intoxication was associated with poorer visual memory, attention, processing speed, response inhibition, and cognitive flexibility in females, while frequent intoxication related to better attention and processing speed in males. In general, effect sizes were small. No relations emerged for verbal memory, working memory, or spatial learning. Possible factors that contribute to divergent sex effects are discussed.

Early developmental alcohol exposure alters behavioral outcomes following adolescent re-exposure in a rat model

BACKGROUND

Prenatal alcohol exposure alters brain development, affecting cognitive, motor, and emotional domains, and potentially leading to greater alcohol intake during adolescence. The present study investigated whether early alcohol exposure modifies vulnerability to behavioral alterations associated with adolescent alcohol exposure in a rodent model.

METHODS

Sprague-Dawley rats received ethanol or sham intubations during two developmental periods: (1) the third trimester equivalent of brain development in humans (postnatal days [PD] 4-9) and (2) adolescence (PD 28-42). Both exposures resulted in blood alcohol concentrations around 200 mg/dl. Subjects were tested in the open field (PD 45-48) and on hippocampal and prefrontal cortical (PFC) dependent tasks: the Morris water maze (PD 52-58) and trace fear conditioning (PD 63-64).

RESULTS

Neonatal alcohol exposure reduced forebrain and cerebellar weight, increased open-field activity, and slowed acquisition of trace fear conditioning. Adolescent alcohol exposure did not disrupt learning or significantly induce gross brain pathology, suggesting that 200 mg/dl/day of ethanol disrupts cognitive development during the 3rd trimester equivalent, but not during adolescence. Interestingly, females exposed to alcohol only during adolescence exhibited an increased conditioned fear response and more rapid habituation of locomotor activity in the open field, suggesting alterations in emotional responding. Moreover, subjects exposed to a combination of neonatal and adolescent alcohol exposure spent significantly more time in the center of the open field chamber than other groups. Similarly, males exposed to the combination exhibited less thigmotaxis in the Morris water maze.

CONCLUSIONS

These results indicate that combined exposure to alcohol during these two critical periods reduces anxiety-related behaviors and/or increases risk taking in a sex-dependent manner, suggesting that prenatal alcohol exposure may affect risk for emotional consequences of adolescent alcohol exposure.

Validation of the executive function strategy awareness and use questionnaire (SAUQ) in a university student population

Objective: The aim of the study is to design and evaluate the Strategy Awareness and Use Questionnaire to estimate students' awareness and use of strategies that optimize control of attention and/or compensate for stress on an executive system due to environmental and/or neurobiological influences. Participants: One hundred and forty-eight undergraduate and graduate students from various disciplines at an urban Canadian university campus participated in the Spring 2019 semester. Methods: An item analysis was conducted that included an assessment of dimensionality and item trimming. Results: Findings from an exploratory factor analysis suggest a seven-factor solution is optimal; Comprehension Monitoring, Planning/Organization, Self-Reward, Self-Regulation, Organization with Mobile Phone Technology, Regulating Technology, and Organization of Materials. Conclusion: This measure is likely to benefit students, as well as counselors and coaches interested in improving EF strategy use among students in a university population.

Protective behavioral strategies are more helpful for avoiding alcohol-related problems for college drinkers who drink less

Objective: To examine race, gender, and alcohol use level as moderators of the association between protective behavioral strategies (PBS) and alcohol-related problems. Participants: A sample of 12,011 participants who reported recent drinking (87.7% White, 61% Women) from Project INTEGRATE, a study that combined individual participant data (IPD) from 24 brief motivational intervention trials for college students. Methods: Hierarchical regressions were conducted to determine whether there was a moderated effect of PBS on alcohol problems across alcohol use levels, and whether the moderated protective effect of PBS by alcohol use differed by gender and race. Results: The protective association between PBS and alcohol-related problems was greater for those who drank less. This moderated effect did not differ across men and women or across racial groups. Conclusions: College drinking prevention programs should ensure that students are aware of the limits of PBS as a mitigator of alcohol problems.

Adolescent Binge Drinking Is Associated With Accelerated Decline of Gray Matter Volume

The age- and time-dependent effects of binge drinking on adolescent brain development have not been well characterized even though binge drinking is a health crisis among adolescents. The impact of binge drinking on gray matter volume (GMV) development was examined using 5 waves of longitudinal data from the National Consortium on Alcohol and NeuroDevelopment in Adolescence study. Binge drinkers (n = 166) were compared with non-binge drinkers (n = 82 after matching on potential confounders). Number of binge drinking episodes in the past year was linked to decreased GMVs in bilateral Desikan-Killiany cortical parcellations (26 of 34 with P < 0.05/34) with the strongest effects observed in frontal regions. Interactions of binge drinking episodes and baseline age demonstrated stronger effects in younger participants. Statistical models sensitive to number of binge episodes and their temporal proximity to brain volumes provided the best fits. Consistent with prior research, results of this study highlight the negative effects of binge drinking on the developing brain. Our results present novel findings that cortical GMV decreases were greater in closer proximity to binge drinking episodes in a dose-response manner. This relation suggests a causal effect and raises the possibility that normal growth trajectories may be reinstated with alcohol abstinence.

The effects of peri-adolescent alcohol use on the developing hippocampus

Adolescence is a period of continued brain development. Regions of the brain, such as the hippocampus, continue to undergo refinement and maturation throughout adolescence and into early adulthood. Adolescence is also a time of heightened sensitivity to novelty and reward, which contribute to an increase in risk-taking behaviors including the use of drugs and alcohol. Importantly, binge drinking is highly prevalent among adolescents and emerging adults. The hippocampus which is important for the integration of emotion, reward, homeostasis, and memory is particularly vulnerable to the neurotoxic effects of alcohol. In this chapter, we cover the fundamentals of hippocampal neuroanatomy and the current state of knowledge of the acute and chronic effects of ethanol in adolescent humans and adolescent rodent models. We focus on the hippocampal-dependent behavioral, structural, and neurochemical changes and identify knowledge gaps in our understanding of age-dependent neurobiological effects of alcohol use.

Reaction Time and Visual Memory in Connection to Alcohol Use in Persons with Bipolar Disorder

The purpose of this study was to explore the association of cognition with hazardous drinking and alcohol-related disorder in persons with bipolar disorder (BD). The study population included 1268 persons from Finland with bipolar disorder. Alcohol use was assessed through hazardous drinking and alcohol-related disorder including alcohol use disorder (AUD). Hazardous drinking was screened with the Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) screening tool. Alcohol-related disorder diagnoses were obtained from the national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on A tablet computer: the 5-choice serial reaction time task, or reaction time (RT) test and the Paired Associative Learning (PAL) test. Depressive symptoms were assessed with the Mental Health Inventory with five items (MHI-5). However, no assessment of current manic symptoms was available. Association between RT-test and alcohol use was analyzed with log-linear regression, and eβ with 95% confidence intervals (CI) are reported. PAL first trial memory score was analyzed with linear regression, and β with 95% CI are reported. PAL total errors adjusted was analyzed with logistic regression and odds ratios (OR) with 95% CI are reported. After adjustment of age, education, housing status and depression, hazardous drinking was associated with lower median and less variable RT in females while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores in females. Our findings of positive associations between alcohol use and cognition in persons with bipolar disorder are difficult to explain because of the methodological flaw of not being able to separately assess only participants in euthymic phase.

Chronic alcohol exposure during critical developmental periods differentially impacts persistence of deficits in cognitive flexibility and related circuitry

Cognitive flexibility in decision making depends on prefrontal cortical function and is used by individuals to adapt to environmental changes in circumstances. Cognitive flexibility can be measured in the laboratory using a variety of discrete, translational tasks, including those that involve reversal learning and/or set-shifting ability. Distinct components of flexible behavior rely upon overlapping brain circuits, including different prefrontal substructures that have separable impacts on decision making. Cognitive flexibility is impaired after chronic alcohol exposure, particularly during development when the brain undergoes rapid maturation. This review examines how cognitive flexibility, as indexed by reversal and set-shifting tasks, is impacted by chronic alcohol exposure in adulthood, adolescent, and prenatal periods in humans and animal models. We also discuss areas for future study, including mechanisms that may contribute to the persistence of cognitive deficits after developmental alcohol exposure and the compacting consequences from exposure across multiple critical periods.

Alcohol Consumption and Behavioral Consequences in Romanian Medical University Students

Alcohol consumption is a major public health problem facing universities. The objectives of the present study were to investigate alcohol consumption and the behaviors associated with it among Romanian university medical students, with particular reference to sex differences, behavioral consequences, and lifestyle patterns. We performed a cross-sectional study on 722 medical students (60.4% females; 39.6% males); the participants filled out a validated questionnaire containing the following items co-occurring with alcohol consumption: smoking, illicit drug use, energy drink consumption, and other behavioral drinking consequences. Physical activity was estimated using the IPAQ questionnaire. We statistically analyzed the interrelation between alcohol consumption and target factors. The present study showed a high percentage of at-risk drinkers among male (15.0%) and female medical students (14.9%) in the studied group. Male students reported higher illicit drug use and physical activity than female students, but the at-risk female drinkers' group consumed more drugs than the low-risk female drinkers. Both male and female drinkers engaged in other risky behaviors correlated with drinking (e.g., smoking, low academic performance, and driving a car after drinking). Public health policies, strategies, and interventions should be initiated to reduce alcohol consumption and associated behaviors in medical students.

Baseline executive functions and receiving cognitive rehabilitation can predict treatment response in people with opioid use disorder

BACKGROUND

Impaired cognitive functions, particularly executive function, predicts poor treatment success in people with substance use disorders. The current study investigated the effect of receiving adjunct cognitive rehabilitation and baseline executive function (EF) measures on treatment response among people with opioid use disorder (OUD).

METHOD

The analysis sample consisted of 113 participants with OUD who were discharged from a compulsory court-mandated methadone maintenance treatment (MMT) and followed for 3 months. We used the Backward digit span/Auditory verbal learning, Stroop, and Trail making tests to assess the three measures of EF, including working memory, inhibition, and shifting, respectively. Treatment response was operationalized as (1) treatment retention and (2) the number of positive urine tests for morphine during 3-month follow-up periods. The study used Cox's proportional hazards model and linear mixed model to identify predictive factors.

RESULTS

Lower Stroop interference scores predicted increased length of stay in treatment (χ² = 33.15, P < 0.001). The linear mixed model showed that scores on auditory verbal learning test and group intervention predicted the number of positive urine tests during a 3-month follow-up.

CONCLUSION

Working memory and inhibitory control, as well as receiving cognitive rehabilitation, could be potentially considered as predictors of treatment response for newly MMT admitted patients with OUD. Assessment of EF before treatment initiation may inform treatment providers about patient's cognitive deficits that may interfere with therapeutic interventions.

Why should we ask binge drinkers if they smoke cannabis? Additive effect of alcohol and cannabis use on college students' neuropsychological performance

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This study focused on combined binge drinking and cannabis use in college students.

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Cannabis use and binge drinking had an additive effect on cognition.

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This consumption pattern contributed to memory and executive impairments.

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Binge drinkers had a heterogeneous cognitive profile regardless of cannabis use.

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Cannabis use should be assessed in binge drinkers to adapt prevention strategies.

Introduction

Binge drinking (BD) and cannabis use are prevalent in European adolescents and students. BD has been shown to have a negative impact on neuropsychological functioning, but little is known about the additive effect when it is combined with cannabis consumption. We therefore investigated the neuropsychological profiles of students who engage in combined BD and cannabis use, in order to explore the potentially harmful additive effects of cannabis use and BD on cognition.

Material and methods

A sample of college students (N = 298) completed questionnaires on alcohol and cannabis use, and were screened for neuropsychological impairments using the Brief Evaluation of Alcohol-Related Neuropsychological Impairments (BEARNI). First, after dividing students into three groups according to their alcohol and cannabis use (i.e., light drinkers, binge drinkers, and binge drinkers consuming cannabis), we ran a linear mixed model based on the BEARNI z scores to test the performances of the three groups. Information yielded by the mixed model was supplemented by individual analyses. Second, to explore the heterogeneity of binge drinkers’ profiles, we ran a cluster analysis to characterize the alcohol users at higher risk of more severe neuropsychological impairment.

Results

Overall, poorer neuropsychological performances were observed among binge drinkers compared with light drinkers, whether they used cannabis or not. However, flexibility, episodic memory and working memory were particularly affected among binge drinkers who used cannabis.

Conclusions

Results emphasize the importance of asking binge drinkers if they smoke cannabis, in order to adapt care and prevention strategies to their consumption and neuropsychological profile.

What We Talk About When We Talk About Binge Drinking: Towards an Integrated Conceptualization and Evaluation

RATIONALE

Binge drinking (BD), characterized by recurring alternations between intense intoxication episodes and abstinence periods, is the most frequent alcohol consumption pattern in youth and is growing in prevalence among older adults. Many studies have underlined the specific harmful impact of this habit by showing impaired abilities in a wide range of cognitive functions among binge drinkers, as well as modifications of brain structure and function.

AIMS

Several controversies and inconsistencies currently hamper the harmonious development of the field and the recognition of BD as a specific alcohol consumption pattern. The main concern is the absence of consensual BD conceptualization, leading to variability in experimental group selection and alcohol consumption evaluation. The present paper aims at overcoming this key issue through a two-step approach.

METHODS AND CONCLUSIONS

First, a literature review allows proposing an integrated BD conceptualization, distinguishing it from other subclinical alcohol consumption patterns. Six specific characteristics of BD are identified, namely, (1) the presence of physiological symptoms related to BD episodes, (2) the presence of psychological symptoms related to BD episodes, (3) the ratio of BD episodes compared to all alcohol drinking occasions, (4) the frequency of BD episodes, (5) the consumption speed and (6) the alternation between BD episodes and soberness periods. Second, capitalizing on this conceptual clarification, we propose an evaluation protocol jointly measuring these six BD characteristics. Finally, several research perspectives are presented to refine the proposed conceptualization.

The role of executive functioning deficits in the association between substance-use-related stigma and substance use problems among trauma-exposed individuals

Background: Previous research has linked the internalization of shame and negative stereotypes associated with substance use to increased severity of substance use problems (i.e., negative consequences associated with alcohol and drug use, including occupational or relational difficulties and illegal behavior). However, little work has examined how other aspects of substance-use-related stigma (e.g., encounters with and anticipation of discrimination) might be related to the severity of substance use problems. Further, the psychological mechanisms through which stigma drives substance use problems remain poorly understood. Addressing these key limitations, the current study examined the role of executive functioning (EF) deficits in the relation between substance-use-related stigma and severity of substance use problems. Methods: In fall 2019, adults exposed to trauma who use substances were recruited via Amazon's Mechanical Turk (N = 320, 46.9% women) and completed self-report measures of substance-use-related stigma, EF deficits, and substance use problems. Results: Substance-use-related stigma was positively associated with EF deficits, which in turn related to substance use problems. Substance-use-related stigma was also indirectly associated with substance use problems through EF deficits, suggesting that EF deficits accounted for the significant association between substance-use-related stigma and substance use problems. Conclusions: These findings provide initial support for the role of EF deficits as a mechanism through which stigma drives substance use problems among individuals exposed to trauma. Results underscore the potential utility of addressing stigma coping and EF deficits in interventions aimed at preventing and treating substance use disorders.

Alcohol use and cognitive functioning in young adults: improving causal inference

BACKGROUND AND AIMS

There have been few longitudinal studies of association between alcohol use and cognitive functioning in young people. We aimed to examine whether alcohol use is a causal risk factor for deficient cognitive functioning in young adults.

DESIGN

Linear regression was used to examine the relationship between longitudinal latent class patterns of binge drinking and subsequent cognitive functioning. Two-sample Mendelian randomization (MR) tested evidence for the causal relationship between alcohol use and cognitive functioning.

SETTING

South West England.

PARTICIPANTS

The observational study included 3155 adolescents and their parents (fully adjusted models) from the Avon Longitudinal Study of Parents and Children (ALSPAC). Genetic instruments for alcohol use were based on almost 1 000 000 individuals from the genome-wide association studies (GWAS) and Sequencing Consortium of Alcohol and Nicotine use (GSCAN). Genome-wide association studies for cognitive outcomes were based on 2500 individuals from ALSPAC.

MEASUREMENTS

Binge drinking was assessed at approximately 16, 17, 18, 21 and 23 years. Cognitive functioning comprised working memory, response inhibition and emotion recognition assessed at 24 years of age. Ninety-nine independent genome-wide significant single nucleotide polymorphisms (SNPs) associated with 'number of drinks per week' were used as the genetic instrument for alcohol consumption. Potential confounders were included in the observational analyses.

FINDINGS

Four binge drinking classes were identified: 'low-risk' (41.3%), 'early-onset monthly' (19.1%), 'adult frequent' (22.5%) and 'early-onset frequent' (17.0%). The association between early-onset frequent binge drinking and cognitive functioning: working memory (b = -0.42, 95% confidence interval (CI) = -1.24 to 0.41), response inhibition (b = 31.9, 95% CI = -25.3 to 89.2), and emotion recognition (b = 0.02, 95% CI = -0.07 to 0.10) in comparison to low-risk drinkers were inconclusive as to whether a difference was present. Two-sample MR analyses similarly provided little evidence that alcohol use is associated with deficits in working memory using the inverse variance weight (b = 0.29, 95% CI = -0.42 to 0.99), response inhibition (b = -0.32, 95% CI = -1.04 to 0.39) and emotion recognition (b = 0.03, 95% CI = -0.55 to 0.61).

CONCLUSIONS

Binge drinking in adolescence and early adulthood may not be causally related to deficiencies in working memory, response inhibition or emotion recognition in youths.

The Interaction Between Genetic Variant ZNF804A rs1344706 and Alcohol Withdrawal on Impulsivity: Evidence for the Diathesis-Stress Model

Objective: Alcohol use disorder (AUD) is the most common substance use disorder, which may relate to increased impulsivity. A more detailed understanding of the potential moderating factor on association between AUD and impulsivity is likely to have far-reaching effects. This study aims to examine whether the interaction between a genetic variant ZNF804A rs1344706 and alcohol use is related to impulsivity in Chinese Han adult males diagnosed with AUD. Methods: A total of 455 Chinese Han adult males diagnosed with AUD were included in this study. Impulsivity was assessed using Barratt Impulsiveness Scale. Alcohol dependence was measured by Michigan Alcoholism Screening Test. Genomic DNA was extracted from peripheral blood of participants and genotyped. Results: Hierarchical multiple regression yielded a significant interaction between ZNF804A rs1344706 and alcohol use (β = 0.20, p = 0.0237). Then, A region of significance (RoS) test was performed to interpret the interaction effect. Re-parameterized regression models revealed that the interaction between ZNF804A rs1344706 and alcohol problem severity fit to the weak diathesis-stress model (R ² = 0.15, p < 0.0010), indicating that the T allele carriers are more susceptible to alcohol problem severity, jointly contributing to impulsivity. Conclusions: This study, which analyzed a specific gene-environment interaction, demonstrated that carriers of the T allele of ZNF804A rs1344706 may be more susceptible to alcohol problem severity, correlated with higher levels of impulsivity during withdrawal.

Component process analysis of verbal memory in a sample of students with a binge drinking pattern

Background

Many studies have emphasized the harmful impact of binge drinking on several cognitive functions, including memory. However, the exact nature of the memory processes involved is still unknown. The present study was designed to assess verbal working memory and verbal episodic memory, especially its encoding, storage and retrieval processes, in binge drinking to identify the processes impacted by this behavior.

Methods

Participants were 48 community-recruited college students aged 18-25 years and categorized as either binge drinkers (BDs) or social drinkers (SDs). They were assessed with (a) subtests of the Wechsler scale (digit span, letter-number sequencing) measuring verbal working memory, and (b) a modified version of the Free and Cued Selective Reminding Test (FCSRT), which measures verbal episodic memory functioning in various conditions of encoding (controlled) and recollection (free recall, cued recall, and recognition).

Results

Verbal working memory was unaffected by binge drinking, whereas verbal episodic memory performances were reduced. In particular, analysis of the modified FCSRT scores suggested that BDs had less proficient storage and retrieval processes. Furthermore, correlational analyses indicated that the proficiency of these memory components was negatively correlated with several indicators of binge drinking behavior.

Conclusions

Results suggest that binge drinking behavior affects the storage and recollection processes of verbal episodic memory. The academic failure described in binge drinkers could be partly related to this harmful effect. Our results on the negative impact of binge drinking on memory should be used to develop information campaigns targeting students.

Sex and Age Effects on Neurobehavioral Toxicity Induced by Binge Alcohol

Historically, most alcohol neurotoxicity studies were conducted in young adult males and focused on chronic intake. There has been a shift towards studying the effects of alcohol on the adolescent brain, due to alcohol consumption during this formative period disrupting the brain's developmental trajectory. Because the most typical pattern of adolescent alcohol intake is heavy episodic (binge) drinking, there has also been a shift towards the study of binge alcohol-induced neurobehavioral toxicity. It has thus become apparent that binge alcohol damages the adolescent brain and there is increasing attention to sex-dependent effects. Significant knowledge gaps remain in our understanding of the effects of binge alcohol on the female brain, however. Moreover, it is unsettling that population-level studies indicate that the prevalence of binge drinking is increasing among American women, particularly those in older age groups. Although study of adolescents has made it apparent that binge alcohol disrupts ongoing brain maturational processes, we know almost nothing about how it impacts the aging brain, as studies of its effects on the aged brain are relatively scarce, and the study of sex-dependent effects is just beginning. Given the rapidly increasing population of older Americans, it is crucial that studies address age-dependent effects of binge alcohol, and given the increase in binge drinking in older women who are at higher risk for cognitive decline relative to men, studies must encompass both sexes. Because adolescence and older age are both characterized by age-typical brain changes, and because binge drinking is the most common pattern of alcohol intake in both age groups, the knowledge that we have amassed on binge alcohol effects on the adolescent brain can inform our study of its effects on the aging brain. In this review, we therefore cover the current state of knowledge of sex and age-dependent effects of binge alcohol, as well as statistical and methodological considerations for studies aimed at addressing them.

Adolescent Substance Use and the Brain: Behavioral, Cognitive and Neuroimaging Correlates

Adolescence is an important ontogenetic period that is characterized by behaviors such as enhanced novelty-seeking, impulsivity, and reward preference, which can give rise to an increased risk for substance use. While substance use rates in adolescence are generally on a decline, the current rates combined with emerging trends, such as increases in e-cigarette use, remain a significant public health concern. In this review, we focus on the neurobiological divergences associated with adolescent substance use, derived from a cross-sectional, retrospective, and longitudinal studies, and highlight how the use of these substances during adolescence may relate to behavioral and neuroimaging-based outcomes. Identifying and understanding the associations between adolescent substance use and changes in cognition, mental health, and future substance use risk may assist our understanding of the consequences of drug exposure during this critical window.

Neuropsychological Trajectories Associated with Adolescent Alcohol and Cannabis Use: A Prospective 14-Year Study

OBJECTIVES

Alcohol and cannabis remain the substances most widely used by adolescents. Better understanding of the dynamic relationship between trajectories of substance use in relation to neuropsychological functioning is needed. The aim of this study was to examine the different impacts of within- and between-person changes in alcohol and cannabis use on neuropsychological functioning over multiple time points.

METHODS

Hierarchical linear modeling examined the effects of alcohol and cannabis use on neuropsychological functioning over the course of 14 years in a sample of 175 adolescents (aged 12-15 years at baseline).

RESULTS

Time-specific fluctuations in alcohol use (within-person effect) predicted worse performance across time on the Wechsler Abbreviated Scale of Intelligence Block Design subtest (B = -.05, SE = .02, p = .01). Greater mean levels of percent days of cannabis use across time (between-person effect) were associated with an increased contrast score between Delis-Kaplan Executive Function System Color Word Inhibition and Color Naming conditions (B = .52, SE = .14, p < .0001) and poorer performance over time on Block Design (B = -.08, SE = .04, p = .03). Neither alcohol and/nor cannabis use over time was associated with performance in the verbal memory and processing speed domains.

CONCLUSIONS

Greater cumulative cannabis use over adolescence may be linked to poorer inhibitory control and visuospatial functioning performance, whereas more proximal increases in alcohol consumption during adolescence may drive alcohol-related performance decrements in visuospatial functioning. Results from this prospective study add to the growing body of literature on the impact of alcohol and cannabis use on cognition from adolescent to young adulthood.

Individual and Environmental Factors Associated with Tobacco Smoking, Alcohol Abuse and Illegal Drug Consumption in University Students: A Mediating Analysis

Substance abuse is a major and prevalent public health concern among university students. Tobacco smoking, risky alcohol behavior, and illegal drug consumption may lead to health problems and behavioral and academic issues. Several individual and environmental factors associate with substance abuse in this population, and the mediating effect of alcohol abuse in the relationship between tobacco smoking and drug consumption is yet to be explored. The purposes of this study were to evaluate the association of individual and environmental factors and substance use, and to analyze the relationship between tobacco smoking, alcohol abuse, and drug consumption, considering alcohol abuse as a possible mediator. A total of 550 Spanish undergraduate and postgraduate students completed several questionnaires regarding their smoking status, alcohol use, and drug consumption during the last six months. Bivariate and multivariate analyses were conducted to explore associations between factors. Direct, indirect and mediating effects were tested using a partial least squares approach (PLS-SEM). The results indicated that substance abuse is associated with being male, living with other students, and combined substance consumption. PLS-SEM showed a significant effect of tobacco smoking and alcohol abuse on drug consumption. Alcohol abuse plays a mediating role in the relationship between tobacco smoking and drug use.

We Need to Delay the Age of Onset of Alcohol Consumption

In recent years, new consumption patterns, such as binge drinking, have increased among young people and have not always been recognized as problematic either by health personnel or by society in general, as they are intensive episodes, interspersed with no consumption periods. Although the prevalence of alcohol use disorders in the adult population continues to be higher in men than in women, these gender differences in relation to alcohol consumption are barely observed in adolescents between 14 and 18. Therefore, we are witnessing a change in the pattern of consumption, from regular to episodic, and an attenuation of gender differences. New patterns of alcohol consumption have not only been associated with an increased risk of alcohol use disorders in adult life, but also with neurocognitive involvement in youth. Understanding the risk and resilience factors of alcoholism or problematic drinking patterns will not only allow us to identify the most vulnerable group, but also to guide prevention programs towards protective factors; the skills that contribute to the natural abandonment of the pattern. Knowing the variables involved in the trajectories of abandonment and dependency would contribute to personalizing the interventions and increasing their efficacy and success—a lower relapse rate—, reducing the economic and socio-sanitary costs associated with alcohol dependency, as well as improving the health and well-being, family relations, work and social status of alcohol-dependent people.

Executive Dysfunction Related to Binge Drinking in Ischemic Stroke

BACKGROUND

Recent evidence has shown that cognitive dysfunction is associated with a history of binge drinking in adolescents who do not have an alcohol use disorder. Most previous studies with adults, however, have failed to show a link between cognitive dysfunction and subdiagnostic binge drinking, nor have any studies investigated the additive cognitive effect of binge drinking to ischemic stroke.

OBJECTIVE

To examine whether a pattern of cognitive dysfunction, especially executive and memory dysfunction, in patients with a first-ever ischemic stroke is associated with a history of subdiagnostic binge drinking.

METHODS

We studied 206 first-ever ischemic stroke patients (18-65 years) and 50 healthy, demographically comparable adults-both groups with no alcohol use disorder. After exclusion by matching, 189 patients and 39 healthy participants were included in our study (228 participants). The binge-drinking group included 76 participants; the non-binge-drinking group included 152. A multivariate analysis of covariance was used to compare nine cognitive functions between the two groups, with age, education, and stroke severity used as covariates.

RESULTS

Binge drinking had a significant negative effect on executive functions (P<0.001). The non-binge-drinking group outperformed the binge-drinking group on the Stroop Test (P=0.001), Trail Making Test (P=0.002), and a phonemic fluency test (P=0.005). The Binge×Stroke Severity interaction (P=0.037) indicated that a history of binge drinking increased the negative effect of stroke on executive functions.

CONCLUSIONS

Subdiagnostic binge drinking may exacerbate the adverse effects of ischemic stroke on executive dysfunction.

A dual-process exploration of binge drinking: Evidence through behavioral and electrophysiological findings

The dual-process model, describing addictive disorders as resulting from an imbalance between increased automatic approach behaviors towards the substance and reduced abilities to control these behaviors, constitutes a sound theoretical framework to understand alcohol-use disorders. The present study aimed at exploring this imbalance at behavioral and cerebral levels in binge drinking, a pattern of excessive alcohol consumption frequently observed in youth, by assessing both reflective control abilities and automatic processing of alcohol-related stimuli. For this purpose, 25 binge drinkers and 25 comparison participants performed a Go/No-Go task during electrophysiological recording. Inhibition abilities were investigated during explicit (ie, distinguishing alcoholic versus nonalcoholic drinks) and implicit (ie, distinguishing sparkling versus nonsparkling drinks, independently of their alcohol content) processing of beverage cues. Binge drinkers presented poorer inhibition for the explicit processing of beverage cues, as well as reduced N200 amplitude for the specific processing of alcohol-related stimuli. As a whole, these findings indicated inhibition impairments in binge drinkers, particularly for alcohol cues processing and at the attentional stage of the cognitive stream. In line with the dual-process model, these results support that binge drinking is already characterized by an underactivation of the reflective system combined with an overactivation of the automatic system. Results also underlined the influence of explicit processing compared with implicit ones. At the clinical level, our findings reinforce the need to develop intervention methods focusing on the inhibition of approach behaviors towards alcohol-related stimuli.

Alcohol Consumption, Drinking Patterns, and Cognitive Performance in Young Adults: A Cross-Sectional and Longitudinal Analysis

Long-term alcohol abuse is associated with poorer cognitive performance. However, the associations between light and moderate drinking and cognitive performance are less clear. We assessed this association via cross-sectional and longitudinal analyses in a sample of 702 Dutch students. At baseline, alcohol consumption was assessed using questionnaires and ecological momentary assessment (EMA) across four weeks (‘Wave 1’). Subsequently, cognitive performance, including memory, planning, and reasoning, was assessed at home using six standard cognition tests presented through an online platform. A year later, 436 students completed the four weeks of EMA and online cognitive testing (‘Wave 2’). In both waves, there was no association between alcohol consumption and cognitive performance. Further, alcohol consumption during Wave 1 was not related to cognitive performance at Wave 2. In addition, EMA-data-based drinking patterns, which varied widely between persons but were relatively consistent over time within persons, were also not associated with cognitive performance. Post-hoc analyses of cognitive performance revealed higher within-person variance scores (from Wave 1 to Wave 2) than between-person variance scores (both Wave 1 and Wave 2). In conclusion, no association was observed between alcohol consumption and cognitive performance in a large Dutch student sample. However, the online cognitive tests performed at home may not have been sensitive enough to pick up differences in cognitive performance associated with alcohol consumption.

Early Signs of Emotional Recognition Deficits in Adolescent High-Binge Drinkers

Background: Emotional dysregulation, measured with face recognition tasks, is prevalent in alcohol use disorders (AUD), constituting a risk factor for alcohol use and relapse. It is not clear however whether emotional dysregulation is a by-product of alcohol consumption, or if it can act as a predisposing factor for AUD. Objective: Our aim was to examine early signs of emotional dysregulation in adolescent drinkers. Method: Twenty-four high-school students and 24 university students completed two tasks. On the first one, participants had to gradually increment the emotional content of different faces until they could perceive an emotional expression (emotion perception threshold task). We also examined the propensity to perceive fearful expressions in an emotion identification task. Participants were semantically primed with emotion words (i.e., "fear"), and they then had to indicate whether a neutral-fearful facial composite matched the prime. Results: Using repeated-measures ANOVAS, in the emotion perception threshold task, "happy" faces were the easiest to detect and "sad" ones the hardest. For high school students there was a differential response pattern depending on binge scores, such that High-binge drinkers found it easier to detect a sad face but harder to detect a happy one compared to Low-binge drinkers. In the facial emotion identification task, Low-binge drinkers observed more fearful expressions compared to High-binge drinkers. Conclusions: Differences in emotional processing in young adolescents depending on drinking habits point towards the relevance of emotional dysregulation as an early sign of AUD. These findings could help develop novel diagnostic and treatment tools for young populations.

An Event-Related Potential Study of Decision-Making and Feedback Utilization in Female College Students Who Binge Drink

This study investigated the ability to use feedback for decision-making in female college students who binge drink (BD) using the iowa gambling task (IGT) and event-related potentials (ERPs). Twenty-seven binge drinkers and 23 non-binge drinkers (non-BD) were identified based on scores on the Korean version of the Alcohol Use Disorder Test and the Alcohol Use Questionnaire. The IGT consists of four cards, including two cards that result in a net loss, with large immediate gains but greater losses in the long term, and two cards that result in a net gain, with small immediate gains but reduced losses in the long term. Participants were required to choose one card at a time to maximize profit until the end of the task while avoiding losses. The BD group showed a significantly lower total net score than the non-BD group, indicating that the BD group chose more disadvantageous cards. The BD group showed significantly smaller ΔFRN amplitudes [difference in amplitudes of feedback-related negativity (FRN) between gain and loss feedback] but not in P3 amplitudes. Additionally, ΔFRN amplitudes in the fronto-central area were positively correlated with the total net score and net scores for sectors 4 and 5. Thus, total net scores and later performance on the IGT increased as ΔFRN amplitudes from the fronto-central area increased. FRN is known to reflect early feedback evaluation employing a bottom-up mechanism, whereas P3 is known to reflect late feedback processing and allocation of attentional resources using a top-down mechanism. These results indicate that college students who binge drink have deficits in early evaluation of positive or negative feedback and that this deficit may be related to decision-making deficits.

Exercise-driven restoration of the alcohol-damaged brain

There are vast literatures on the neural effects of alcohol and the neural effects of exercise. Simply put, exercise is associated with brain health, alcohol is not, and the mechanisms by which exercise benefits the brain directly counteract the mechanisms by which alcohol damages it. Although a degree of brain recovery naturally occurs upon cessation of alcohol consumption, effective treatments for alcohol-induced brain damage are badly needed, and exercise is an excellent candidate from a mechanistic standpoint. In this chapter, we cover the small but growing literature on the interactive neural effects of alcohol and exercise, and the capacity of exercise to repair alcohol-induced brain damage. Increasingly, exercise is being used as a component of treatment for alcohol use disorders (AUD), not because it reverses alcohol-induced brain damage, but because it represents a rewarding, alcohol-free activity that could reduce alcohol cravings and improve comorbid conditions such as anxiety and depression. It is important to bear in mind, however, that multiple studies attest to a counterintuitive positive relationship between alcohol intake and exercise. We therefore conclude with cautionary notes regarding the use of exercise to repair the brain after alcohol damage.

Electrophysiological correlates of emotional crossmodal processing in binge drinking

Emotional crossmodal integration (i.e., multisensorial decoding of emotions) is a crucial process that ensures adaptive social behaviors and responses to the environment. Recent evidence suggests that in binge drinking-an excessive alcohol consumption pattern associated with psychological and cerebral deficits-crossmodal integration is preserved at the behavioral level. Although some studies have suggested brain modifications during affective processing in binge drinking, nothing is known about the cerebral correlates of crossmodal integration. In the current study, we asked 53 university students (17 binge drinkers, 17 moderate drinkers, 19 nondrinkers) to perform an emotional crossmodal task while their behavioral and neurophysiological responses were recorded. Participants had to identify happiness and anger in three conditions (unimodal, crossmodal congruent, crossmodal incongruent) and two modalities (face and/or voice). Binge drinkers did not significantly differ from moderate drinkers and nondrinkers at the behavioral level. However, widespread cerebral modifications were found at perceptual (N100) and mainly at decisional (P3b) stages in binge drinkers, indexed by slower brain processing and stronger activity. These cerebral modifications were mostly related to anger processing and crossmodal integration. This study highlights higher electrophysiological activity in the absence of behavioral deficits, which could index a potential compensation process in binge drinkers. In line with results found in severe alcohol-use disorders, these electrophysiological findings show modified anger processing, which might have a deleterious impact on social functioning. Moreover, this study suggests impaired crossmodal integration at early stages of alcohol-related disorders.

Neurobiological and Cognitive Profile of Young Binge Drinkers: a Systematic Review and Meta-Analysis

This review provides the first systematic and quantitative synthesis of the literature examining the relationship between binge drinking, cognition, brain structure and function in youth aged 10 to 24 years. PubMed, EMBASE, Medline, PsychINFO and ProQuest were searched for neuroimaging, neurophysiological, and neuropsychological studies. A total of 58 studies (21 neuroimaging, 16 neurophysiological, 21 neuropsychological) met the eligibility criteria and were included in the review. Overall, abnormal or delayed development of key frontal executive-control regions may predispose youth to binge drink. These abnormalities appear to be further exacerbated by the uptake of binge drinking, in addition to alcohol-related neural aberrations in reward-seeking and incentive salience regions, indexed by cognitive deficits and maladaptive alcohol associations. A meta-analysis of neuropsychological correlates identified that binge drinking in youth was associated with a small overall neurocognitive deficit (g = -0.26) and specific deficits in decision-making (g = -1.70), and inhibition (g = -0.39). Using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Evidence Profile, the certainty in outcomes ranged from very low to low. Future prospective longitudinal studies should address concomitant factors, exposure thresholds, and age-related vulnerabilities of binge drinking, as well as the degree of recovery following discontinuation of use.

Polygenic liability for schizophrenia predicts shifting-specific executive function deficits and tobacco use in a moderate drinking community sample

Individuals with schizophrenia have higher lifetime rates of substance use disorders than the general population, and research suggests high comorbidity rates may be partially explained by shared genetic influences related to common underlying etiology. Moreover, deficits in executive functions are thought to be central to the diagnosis of schizophrenia and are likewise associated with alcohol and tobacco use. The current study examined the associations between schizophrenia polygenic risk scores and tobacco and alcohol use and the mediation of these associations by executive function sub-domains. Results from the Psychiatric Genomics Consortium's meta-analysis of genome-wide association studies of schizophrenia were used to calculate polygenic risk scores in a sample of moderate drinkers. Schizophrenia risk scores were significantly associated with shifting-specific executive function deficits and tobacco use phenotypes. However, risk scores were not significantly associated with alcohol use and executive functions were not significantly associated with either tobacco or alcohol use. These findings extend previous research by suggesting that genetic risk for schizophrenia may be associated with specific sub-domains of executive function as well as smoking. The lack of a relation with alcohol use suggests genetic factors related to schizophrenia and executive functioning may not influence drinking in a non-disordered, social-drinking sample.

Role of Patient Sex in Early Recovery from Alcohol-Related Cognitive Impairment: Women Penalized

BACKGROUND

The objective was to explore the role of patient sex in cognitive recovery and to identify predictive factors for non-recovery in alcohol use disorder (AUD).

METHODS

All patients with AUD admitted to a residential addictions treatment center were systematically assessed at admission and after 6 weeks of abstinence in a controlled environment. The inclusion criteria were that patients were admitted for AUD with baseline alcohol-related cognitive impairment (baseline total Montreal Cognitive Assessment (MoCA) score < 26) and reassessed at 6 weeks (n = 395). A logistic regression model was built to determine the influence of sex on recovery status (MoCA < or ≥ 26) taking into account the interaction effect of sex with alcohol consumption on cognitive function.

RESULTS

The mean age was 50.10 years (SD = 9.79), and 27.41% were women. At baseline, the mean MoCA scores were 21.36 (SD = 3.04). Participants who did not achieve recovery (59.3% of women vs 53.8% of men) had lower total MoCA scores at baseline. The 2 factors that was significantly and independently associated with non-recovery and with a non-zero coefficient was being a woman and initial MoCA score (respective adjusted odds ratios (AOR) = 1.5 and 0.96, p-values < 0.05).

CONCLUSIONS

These results could influence the time required in a controlled environment to maintain abstinence and the duration of in-care for women.

Associations among sleep problems, executive dysfunctions, and attention-deficit/hyperactivity disorder symptom domains in college students

Objective: The present study examined whether executive functions (EFs) and sleep problems operate together to predict four attention-deficit/hyperactivity disorder (ADHD) symptom domains. Methods: A sample of 306 college students completed ratings of sleep quality, EFs, and ADHD symptoms from January to December 2014. Simultaneous multiple regressions were used to examine (a) the unique contribution of EFs and sleep problems to ADHD symptoms, (b) the relations among EFs, sleep problems, and GPA, and (c) the relations between specific EF facets (i.e., time management, emotion regulation, problem solving, self-restraint, and self-motivation) and ADHD symptoms. Results: While approximately 52.8% of participants were categorized as poor-quality sleepers, 10.6% of the sample reported an ADHD diagnosis. EF ratings were associated uniquely with ADHD symptoms after controlling for sleep quality. All EF facets were related to ADHD symptoms. Conclusion: ADHD symptoms are associated with all EF facets even after controlling for sleep quality.

Behavioral and Cerebral Impairments Associated with Binge Drinking in Youth: A Critical Review

Binge drinking is a widespread alcohol consumption pattern in youth that is linked to important behavioral and cerebral impairments, in both the short and the long term. From a critical review of the current literature on this topic, we conclude that binge drinkers display executive impairments, cerebral modifications, and problems with emotion-related processes. Five key empirical and theoretical topics are discussed to pave the way for future research in the field: (1) the specificity of the brain modifications observed in binge drinkers that may index a compensatory mechanism or result from multiple withdrawals; (2) the nature of the relationship between binge drinking and impairments, suggesting reciprocal influences between excessive alcohol consumption and executive deficits; (3) the possible recovery of brain and cognitive functioning after the cessation of binge drinking; (4) the validity of the continuum hypothesis, suggesting links between binge drinking and severe alcohol use disorders; and (5) the existing strategies to reduce binge drinking habits or rehabilitate the associated cognitive deficits. Future perspectives are described in relation to the questions raised to identify the crucial variables to be addressed in research and clinical practice.

An Event-related Potential Study of Error-monitoring Deficits in Female College Students Who Participate in Binge Drinking

Objective

This study investigated error-monitoring deficits in female college students with binge drinking (BD) using event-related potentials (ERPs) and the modified Flanker task.

Methods

Participants were categorized into BD (n=25) and non-BD (n=25) groups based on the scores of the Korean-version of the Alcohol Use Disorder Identification Test (AUDIT-K) and the Alcohol Use Questionnaire (AUQ). The modified Flanker task, consisting of congruent (target and flanker stimuli are the same) and incongruent (target and flanker stimuli are different) conditions, was used to evaluate error-monitoring abilities.

Results

The BD group exhibited significantly shorter response times and more error rates on the Flanker task, as well as reduced error-related negativity (ERN) amplitudes compared with the non-BD group. Additionally, ERN amplitudes measured at FCz and Cz were significantly correlated with scores on the AUDIT-K and AUQ in the whole participants. The BD and non-BD groups did not show any significant differences in error positivity amplitudes.

Conclusion

The present results indicate that college students with BD have deficits in error-monitoring, and that reduced ERN amplitudes may serve as a biological marker or risk factor of alcohol use disorder.

An event-related potential study of spatial working memory in binge drinking college students

This study used event-related potentials (ERPs) and a modified spatial 2-back task to investigate spatial working memory in binge drinking (BD) college students. Based on the Korean version of the Alcohol Use Disorder Identification Test (AUDIT-K) and Alcohol Use Questionnaire (AUQ) scores, participants were assigned into BD (n = 25) and non-BD (n = 25) groups. The modified spatial 2-back task includes congruent, incongruent, and lure conditions and participants are required to respond as rapidly and accurately as possible to the congruent stimuli but not to the incongruent and lure stimuli. The BD and non-BD groups exhibited comparable performances on the spatial 2-back task but the BD group showed significantly larger P3 amplitudes than the non-BD group. Additionally, the non-BD group showed larger P3 amplitudes in response to the congruent stimuli compared to the incongruent and lure stimuli whereas the P3 amplitudes in the BD group did not differ significantly among the three conditions. These results indicate that the BD individuals exerted greater effort to maintain performance levels comparable to non-BD individuals and that they were less efficient in differentiating or allocating attentional resources between relevant and irrelevant information.

The dual-process model in young adults with a consistent binge drinking trajectory into adulthood

BACKGROUND

Binge Drinking (BD) generally declines once students have left university. However, many individuals continue to partake in BD into adulthood, constituting a scarcely investigated high-risk group towards whom interventions should be prioritized. Following the dual-process model, we examined the relationship between BD and both the reflective system (executive functions) and the affective system (alcohol bias) in young adults with a consistent BD trajectory. We considered impulsivity as a moderator in the relationship between BD and alcohol bias.

METHODS

A cohort of 63 (31♀) young adults were followed for eleven years (18-29 years old). In the last assessment, participants, with high and low drinking trajectories underwent neuropsychological assessment of executive functions (working memory [SOPT], cognitive flexibility [TMT -Verbal Fluency], inhibition [Stroop]) and alcohol bias (Addiction Stroop). The Barratt Impulsivity Scale measured impulsivity. Generalized linear mixed models and regression-based moderation models were applied.

RESULTS

BD was associated with weak inhibitory control, poor working memory and greater alcohol bias moderated by non-planning impulsivity. At moderate levels of non-planning impulsivity, BD was associated with greater alcohol bias. This association was not found at high levels of impulsivity. These deficits were related to loss of control over drinking and severity of alcohol use.

CONCLUSIONS

The imbalance between poor cognitive control and greater alcohol bias may contribute to the persistence of BD into adulthood. The findings highlight the complexities of the dual-process model, with intervention implications.

Changes and specificities in health behaviors among healthcare students over an 8-year period

BACKGROUND

Healthcare students are future health care providers and serve as role models and coaches to enhance behaviors for healthy lifestyles. However healthcare students face multiple stressors that could lead to adopting risk behaviors.

OBJECTIVES

To assess the changes in health risk factors among healthcare students between 2007 and 2015, and to identify specific health behaviors based on the curriculum in a population of healthcare students.

METHODS

Two cross sectionnal studies were conducted in 2007 and 2015 among nursing, medical, pharmacy, and physiotherapy students (Rouen, France). During compulsory courses and examination sessions students filled self-administered questionnaires on socio-demographic characteristics and behavior as: tobacco smoking, alcohol consumption, cannabis consumption, eating disorders, regular practice of sport, perceived health, stress and use of psychotropic drugs.

RESULTS

2,605 healthcare students were included (1,326 in 2007 and 1,279 in 2015), comprising 1,225 medical students (47.0%), 738 nursing students (28.3%), 362 pharmacy students (13.9%), and 280 physiotherapy students (10.8%). Between 2007 and 2015, occasional binge drinking and regular practice of sport increased significantly among healthcare students, respectively AOR = 1.48 CI95% (1.20-1.83) and AOR = 1.33 CI95% (1.11-1.60), regular cannabis consumption decreased significantly, AOR = 0.32 CI95% (0.19-0.54). There was no change in smoking or overweight/obese. There was a higher risk of frequent binge drinking and a lower risk of tobacco smoking in all curricula than in nursing students. Medical students practiced sport on a more regular basis, were less overweight/obese, had fewer eating disorders than nursing students.

CONCLUSION

Our findings demonstrate a stable frequency of classic behaviors as smoking but a worsening of emerging behaviors as binge drinking among healthcare students between 2007 and 2015. Health behaviors differed according to healthcare curricula and nursing students demonstrated higher risks. As health behaviors are positively related to favorable attitudes towards preventive counseling, therefore healthcare students should receive training in preventive counseling and develop healthy lifestyles targeted according to the health curriculum.

Effects of adolescent alcohol consumption on the brain and behaviour

Per occasion, alcohol consumption is higher in adolescents than in adults in both humans and laboratory animals, with changes in the adolescent brain probably contributing to this elevated drinking. This Review examines the contributors to and consequences of the use of alcohol in adolescents. Human adolescents with a history of alcohol use differ neurally and cognitively from other adolescents; some of these differences predate the commencement of alcohol consumption and serve as potential risk factors for later alcohol use, whereas others emerge from its use. The consequences of alcohol use in human adolescents include alterations in attention, verbal learning, visuospatial processing and memory, along with altered development of grey and white matter volumes and disrupted white matter integrity. The functional consequences of adolescent alcohol use emerging from studies of rodent models of adolescence include decreased cognitive flexibility, behavioural inefficiencies and elevations in anxiety, disinhibition, impulsivity and risk-taking. Rodent studies have also showed that adolescent alcohol use can impair neurogenesis, induce neuroinflammation and epigenetic alterations, and lead to the persistence of adolescent-like neurobehavioural phenotypes into adulthood. Although only a limited number of studies have examined comparable measures in humans and laboratory animals, the available data provide evidence for notable across-species similarities in the neural consequences of adolescent alcohol exposure, providing support for further translational efforts in this context.

Behavioral and Brain Activity Indices of Cognitive Control Deficits in Binge Drinkers

Heavy episodic drinking is prevalent among young adults and is a public issue of increasing importance. Its initiation and maintenance are associated with deficits in the capacity to inhibit automatic processing in favor of non-habitual responses. This study used functional magnetic resonance imaging (fMRI) to examine behavioral and brain activity indices of cognitive control during the Stroop task as a function of binge drinking. Heavy episodic drinkers (HED) reported consuming 5+/6+ drinks in two hours at least five times in the past six months and were compared to light drinkers (LED) who reported two or fewer binge episodes but were matched on demographics, intelligence and family history of alcoholism. Greater conflict-induced activity in the ventrolateral prefrontal cortex (VLPFC) and thalamus was observed in HED participants and it was positively correlated with alcohol intake and alcohol-related harmful consequences. HEDs maintained intact accuracy but at a cost of prolonged reaction times to high-conflict trials and increased ratings of task difficulty. Greater activation of the areas implicated in cognitive control is consistent with compensatory network expansion to meet higher cognitive demands. These results provide further insight into degradation of cognitive control in HEDs which may benefit development of detection and prevention strategies.