1
|
Wood E, Pan J, Cui Z, Bach P, Dennis B, Nolan S, Socias ME. Does This Patient Have Alcohol Use Disorder?: The Rational Clinical Examination Systematic Review. JAMA 2024; 331:1215-1224. [PMID: 38592385 DOI: 10.1001/jama.2024.3101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Importance The accuracy of screening tests for alcohol use disorder (defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress) requires reassessment to align with the latest definition in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5). Objective To assess the diagnostic accuracy of screening tools in identifying individuals with alcohol use disorder as defined in the DSM-5. Data Sources and Study Selection The databases of MEDLINE and Embase were searched (January 2013-February 2023) for original studies on the diagnostic accuracy of brief screening tools to identify alcohol use disorder according to the DSM-5 definition. Because diagnosis of alcohol use disorder does not include excessive alcohol use as a criterion, studies of screening tools that identify excessive or high-risk drinking among younger (aged 9-18 years), older (aged ≥65 years), and pregnant persons also were retained. Data Extraction and Synthesis Sensitivity, specificity, and likelihood ratios (LRs) were calculated. When appropriate, a meta-analysis was performed to calculate a summary LR. Results Of 4303 identified studies, 35 were retained (N = 79 633). There were 11 691 individuals with alcohol use disorder or a history of excessive drinking. Across all age categories, a score of 8 or greater on the Alcohol Use Disorders Identification Test (AUDIT) increased the likelihood of alcohol use disorder (LR, 6.5 [95% CI, 3.9-11]). A positive screening result using AUDIT identified alcohol use disorder better among females (LR, 6.9 [95% CI, 3.9-12]) than among males (LR, 3.8 [95% CI, 2.6-5.5]) (P = .003). An AUDIT score of less than 8 reduced the likelihood of alcohol use disorder similarly for both males and females (LR, 0.33 [95% CI, 0.20-0.52]). The abbreviated AUDIT-Consumption (AUDIT-C) has sex-specific cutoff scores of 4 or greater for males and 3 or greater for females, but was less useful for identifying alcohol use disorder (males: LR, 1.8 [95% CI, 1.5-2.2]; females: LR, 2.0 [95% CI, 1.8-2.3]). The AUDIT-C appeared useful for identifying measures of excessive alcohol use in younger people (aged 9-18 years) and in those older than 60 years of age. For those younger than 18 years of age, the National Institute on Alcohol Abuse and Alcoholism age-specific drinking thresholds were helpful for assessing the likelihood of alcohol use disorder at the lowest risk threshold (LR, 0.15 [95% CI, 0.11-0.21]), at the moderate risk threshold (LR, 3.4 [95% CI, 2.8-4.1]), and at the highest risk threshold (LR, 15 [95% CI, 12-19]). Among persons who were pregnant and screened within 48 hours after delivery, an AUDIT score of 4 or greater identified those more likely to have alcohol use disorder (LR, 6.4 [95% CI, 5.1-8.0]), whereas scores of less than 2 for the Tolerance, Worried, Eye-Opener, Amnesia and Cut-Down screening tool and the Tolerance, Annoyed, Cut-Down and Eye-Opener screening tool identified alcohol use disorder similarly (LR, 0.05 [95% CI, 0.01-0.20]). Conclusions and Relevance The AUDIT screening tool is useful to identify alcohol use disorder in adults and in individuals within 48 hours postpartum. The National Institute on Alcohol Abuse and Alcoholism youth screening tool is helpful to identify children and adolescents with alcohol use disorder. The AUDIT-C appears useful for identifying various measures of excessive alcohol use in young people and in older adults.
Collapse
Affiliation(s)
- Evan Wood
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jeffrey Pan
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Zishan Cui
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Brittany Dennis
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
2
|
Friesen EL, Mataruga A, Nickel N, Kurdyak P, Bolton JM. Outcomes in Clinical Subgroups of Patients With Alcohol-Related Hospitalizations. JAMA Netw Open 2024; 7:e2353971. [PMID: 38294814 PMCID: PMC10831574 DOI: 10.1001/jamanetworkopen.2023.53971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 02/01/2024] Open
Abstract
Importance Alcohol-related hospitalizations are common and associated with significant cost to the health care system. We have a limited understanding of the characteristics of individuals who experience alcohol-related hospitalizations, which limits our capacity to prioritize those at the highest risk of postdischarge harm. Objective To identify and characterize the clinical subgroups of individuals who are hospitalized for alcohol-related harms. Design, Setting, and Participants This cohort study used latent class analysis (LCA) to identify clinical subgroups of individuals experiencing alcohol-related hospitalizations in 2 provinces in Canada. All individuals between ages 10 and 105 years who were hospitalized for an alcohol-related harm between January 2017 and December 2018 (ie, the index hospitalization) were eligible. Data were analyzed between June 2023 and August 2023. Exposures The exposure of interest was the clinical subgroup that an individual belonged to. These subgroups were identified using an LCA based on (1) the characteristics of the index hospitalization and (2) the history of alcohol-related health service use. Main Outcomes and Measures In-hospital mortality, alcohol-related hospital readmission, and all-cause mortality in the year following discharge from the index hospitalization. The association between subgroup membership and the risk of in-hospital and postdischarge outcomes was evaluated using multivariable regression. Results A total of 34 043 individuals were included in analysis, 4753 from Manitoba (median [IQR] age, 49 [40-58] years; 1786 female [37.6%]) and 29 290 from Ontario (median [IQR] age, 57 [45-67] years; 8527 female [29.1%]). Seven subgroups were identified following a gradient from low-frequency service use for acute intoxication to high-frequency service use for severe alcohol use disorder and liver disease. In Ontario, there were 4431 individuals in the liver disease subgroup representing 15.5% of the cohort who were at the highest risk of 1-year mortality (1382 [31.2%]) relative to the acute intoxication subgroup (42 [4.0%]) (adjusted hazard ratio [aHR], 3.83; 95% CI, 2.80-5.24). There was also a small subgroup (10.6%) of individuals with high-frequency alcohol-related health service use who had a much higher hazard of readmission following the index hospitalization (1-year readmission: 703 of 1526 [46.1%] vs 104 of 1058 [9.8%] in the acute intoxication subgroup; aHR, 5.09; 95% CI, 4.11-6.31). Conclusions and Relevance In this population-based cohort study of individuals experiencing alcohol-related hospitalizations, we identified several small, clinically distinct subgroups that were at a disproportionately high risk of readmission and mortality. These groups could merit prioritization in strategies aimed at reducing the risk of adverse outcomes following alcohol-related hospitalizations.
Collapse
Affiliation(s)
- Erik L. Friesen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Andrea Mataruga
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
| | - Nathan Nickel
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Mental Health and Addictions Research Program, ICES Central, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James M. Bolton
- Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
3
|
Subramaniam M, Abdin E, Kong AMC, Vaingankar JA, Jeyagurunathan A, Shafie S, Sambasivam R, Fung DSS, Verma S, Chong SA. Differences in the Prevalence and Profile of DSM-IV and DSM-5 Alcohol Use Disorders-Results from the Singapore Mental Health Study 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:285. [PMID: 36612604 PMCID: PMC9819399 DOI: 10.3390/ijerph20010285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for alcohol use disorders (AUD) was a significant shift from the historical DSM-IV Text Revised version. Following this shift in diagnostic criteria, a difference in the prevalence of AUD was expected. The current study aimed to evaluate the consequences of the modification of the diagnostic criteria from DSM-IV to DSM-5 AUD using lifetime diagnosis in Singapore's multi-ethnic population using data from a nationwide epidemiological study. METHODS Respondents were assessed for lifetime mental disorders using the Composite International Diagnostic Interview (CIDI) administered through face-to-face interviews. Lifetime DSM-IV AUD diagnoses were compared with DSM-5 AUD diagnoses generated by modifying the criteria and the addition of the craving criterion. Sociodemographic correlates of lifetime DSM-IV/DSM-5 AUD were examined using multiple logistic regression analysis. Associations between DSM-IV/DSM-5 AUD, chronic conditions, and the HRQOL summary scores were examined using logistic and linear regression after controlling for significant sociodemographic factors. RESULTS The lifetime prevalence of DSM-IV AUD was 4.6% (0.5% for dependence and 4.1% for abuse) in the adult population, while the lifetime prevalence of DSM-5 AUD was 2.2%. Younger age, male gender, and lower education were associated with higher odds of both DSM-IV and DSM-5 AUD. However, those who were economically inactive (versus employed) (AOR, 0.4; 95% CI 0.2-0.9) and had a higher monthly household income (SGD 4000-5999 versus below SGD 2000) had lower odds of DSM-IV AUD (AOR, 0.4; 95% CI 0.2-0.7), but this was not observed among those with DSM-5 AUD. Both DSM-IV and DSM-5 AUD were associated with significant comorbidities in terms of other mental disorders; however, those diagnosed with lifetime GAD had significantly higher odds of having DSM-5 AUD (AOR, 5; 95% CI 1.9-13.2) but not DSM-IV AUD. CONCLUSIONS While using the DSM-5 criteria would result in a lower prevalence of AUD in Singapore, it remains a highly comorbid condition associated with a poor health-related quality of life that is largely untreated, which makes it a significant public health concern.
Collapse
Affiliation(s)
- Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | | | | | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| | | | | | - Swapna Verma
- Medical Board, Institute of Mental Health, Singapore 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore 539747, Singapore
| |
Collapse
|
4
|
Barbosa C, Dowd WN, Neuwahl SJ, Rehm J, Imtiaz S, Zarkin GA. Modeling the impact of COVID-19 pandemic-driven increases in alcohol consumption on health outcomes and hospitalization costs in the United States. Addiction 2022; 118:48-60. [PMID: 35915549 PMCID: PMC9539393 DOI: 10.1111/add.16018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Alcohol consumption increased in the early phases of the COVID-19 pandemic in the United States. Alcohol use disorder (AUD) and risky drinking are linked to harmful health effects. This paper aimed to project future health and cost impacts of shifts in alcohol consumption during the COVID-19 pandemic. DESIGN An individual-level simulation model of the long-term drinking patterns for people with life-time AUD was used to simulate 10 000 individuals and project model outcomes to the estimated 25.9 million current drinkers with life-time AUD in the United States. The model considered three scenarios: (1) no change (counterfactual for comparison); (2) increased drinking levels persist for 1 year ('increase-1') and (3) increased drinking levels persist for 5 years ('increase-5'). SETTING United States. PARTICIPANTS Current drinkers with life-time AUD. MEASUREMENTS Life expectancy [life-years (LYs)], quality-adjusted life-years (QALYs), alcohol-related hospitalizations and associated hospitalization costs and alcohol-related deaths, during a 5-year period. FINDINGS Short-term increases in alcohol consumption (increase-1 scenario) resulted in a loss of 79 000 [95% uncertainty interval (UI]) 26 000-201 000] LYs, a loss of 332 000 (104 000-604 000) QALYs and 295 000 (82 000-501 000) more alcohol-related hospitalizations, costing an additional $5.4 billion ($1.5-9.3 billion) over 5 years. Hospitalizations for cirrhosis of the liver accounted for approximately $3.0 billion ($0.9-4.8 billion) in hospitalization costs, more than half the increase across all alcohol-related conditions. Health and cost impacts were more pronounced for older age groups (51+), women and non-Hispanic black individuals. Increasing the duration of pandemic-driven increases in alcohol consumption in the increase-5 scenario resulted in larger impacts. CONCLUSIONS Simulations show that if the increase in alcohol consumption observed in the United States in the first year of the pandemic continues, alcohol-related mortality, morbidity and associated costs will increase substantially over the next 5 years.
Collapse
Affiliation(s)
| | - William N. Dowd
- Community Health Research DivisionRTI International, Research Triangle ParkNCUSA
| | | | - Jürgen Rehm
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research InstituteCentre for Addiction and Mental Health (CAMH)TorontoONCanada,Dalla Lana School of Public HealthTorontoONCanada,Institute of Health Policy, Management and Evaluation and Department of PsychiatryUniversity of Toronto (UofT)TorontoONCanada,PAHO/WHO Collaborating Centre for Addiction and Mental HealthTechnische Universität Dresden, Klinische Psychologie and PsychotherapieDresdenGermany
| | - Sameer Imtiaz
- PAHO/WHO Collaborating Centre for Addiction and Mental HealthTechnische Universität Dresden, Klinische Psychologie and PsychotherapieDresdenGermany
| | - Gary A. Zarkin
- Community Health Research DivisionRTI International, Research Triangle ParkNCUSA
| |
Collapse
|
5
|
Chang T, Yen T, Wei C, Hsiao T, Chen I. Impacts of ADH1B rs1229984 and ALDH2 rs671 polymorphisms on risks of alcohol-related disorder and cancer. Cancer Med 2022; 12:747-759. [PMID: 35670037 PMCID: PMC9844601 DOI: 10.1002/cam4.4920] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND ADH1B rs1229984 and ALDH2 rs671 are the specifically prevalent functional variants in the East Asians. These variants, which result in a dramatic change in enzyme activity, are highly associated with alcohol-related disorders and cancer. Previous studies focusing on the additive and synergic effects of the variants are few and inconsistent. The aim of the research was to evaluate the associations of ADH1B rs1229984 and ALDH2 rs671 with the risks of alcohol-related disorder and cancer. METHODS This cohort study enrolled 42,665 participants from the Taiwan Precision Medicine Initiative database, including 19,522 and 20,534, ADH1B and ALDH2 carriers, respectively. The associations between the two variants and cancer risk were analyzed by univariable and multivariable logistic regression. RESULTS Compared with the noncarriers, the ADH1B rs1229984 variant had a stronger effect on alcohol-related disorders and was related to an increased risk of alcohol-related cancers. The CC genotype of ADH1B rs1229984 was significantly associated with cancer of the larynx, pharynx, and nasal cavities [odds ratio (OR) = 1.56, p = 0.0009], cancer of the pancreas (OR = 1.66, p = 0.018), and cancer of the esophagus (OR = 4.10, p < 0.001). Participants who carried the rs1229984 TC/CC and rs671 GG genotypes were at higher risk of esophageal cancer (OR = 3.02, p < 0.001). The risk of esophageal cancer was increased by 381% (OR = 4.81, p < 0.001) in those carrying the rs1229984 TC/CC and rs671 GA/AA genotypes. CONCLUSION rs1229984 and rs671 are common and functionally important genetic variants in the Taiwanese population. Our findings provide strong evidence of additive and synergic risks of ADH1B and ALDH2 variants for alcohol-related disorders and cancer. The results suggested that are reduction in alcohol consumption should be advised as a preventive measure for high-risk patients carrying ADH1B rs1229984 C or the ALDH2 rs671 A allele.
Collapse
Affiliation(s)
- Ting‐Gang Chang
- Department of PsychiatryTaichung Veterans General HospitalTaichungTaiwan,School of PsychologyChung Shan Medical UniversityTaichungTaiwan
| | - Ting‐Ting Yen
- Department of OtorhinolaryngologyTaichung Veterans General HospitalTaichungTaiwan,School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Chia‐Yi Wei
- Department of Medical ResearchTaichung Veterans General HospitalTaichungTaiwan
| | - Tzu‐Hung Hsiao
- Department of Medical ResearchTaichung Veterans General HospitalTaichungTaiwan,Department of Public Health, College of MedicineFu Jen Catholic UniversityNew Taipei CityTaiwan,Institute of Genomics and BioinformaticsNational Chung Hsing UniversityTaichungTaiwan
| | - I‐Chieh Chen
- Department of Medical ResearchTaichung Veterans General HospitalTaichungTaiwan
| |
Collapse
|
6
|
Schneider BS, Arciniegas DB, Harenski C, Clarke GJB, Kiehl KA, Koenigs M. The prevalence, characteristics, and psychiatric correlates of traumatic brain injury in incarcerated individuals: an examination in two independent samples. Brain Inj 2021; 35:1690-1701. [PMID: 35067151 PMCID: PMC8884136 DOI: 10.1080/02699052.2021.2013534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PRIMARY OBJECTIVE Identify the prevalence, characteristics, and psychological correlates of traumatic brain injury (TBI) among incarcerated individuals. RESEARCH DESIGN Three aims: (1) Determine the prevalence and characteristics of TBI in 1469 adults incarcerated in Wisconsin state prisons (1064 men, 405 women); (2) Characterize the relationship between mild TBI and mental illness in a sub-sample of men and women; (3) Reproduce the findings from Aim 1 and Aim 2 in an independent sample of 1015 adults incarcerated in New Mexico state prisons (600 men, 415 women). METHODS AND PROCEDURES Standardized TBI assessment with structured clinical interviews and self-report questionnaires. MAIN OUTCOMES AND RESULTS Rates of TBI were approximately five times greater than the general population, with a substantially higher rate of TBI caused by assault. In the Wisconsin sample, mild TBI was associated with greater levels of post-traumatic stress disorder (PTSD) among women (but not among men). In the New Mexico sample, TBI of any severity was associated with greater levels of major depressive disorder (MDD) among women (but not among men). CONCLUSIONS This study thus provides novel data on TBI and its correlates among individuals incarcerated in state prisons, and highlights a specific treatment need within the prison population.
Collapse
Affiliation(s)
- Brett S. Schneider
- Department of Psychiatry, University of Wisconsin-Madison, 53719,Department of Psychology, University of Wisconsin-Madison 53706
| | - David B. Arciniegas
- Marcus Institute for Brain Health, University of Colorado-Anschutz Medical Campus, Aurora, Colorado 80045,Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuqerque, New Mexico 87106
| | - Carla Harenski
- The MIND Research Network, Albuquerque, New Mexico 87106
| | | | - Kent A. Kiehl
- The MIND Research Network, Albuquerque, New Mexico 87106,Departments of Psychology, Neuroscience and Law, University of New Mexico, Albuquerque, New Mexico 87106
| | - Michael Koenigs
- Department of Psychiatry, University of Wisconsin-Madison, 53719,Corresponding Author , Michael Koenigs, 6001 Research Park Boulevard, Madison, WI 53719
| |
Collapse
|
7
|
Descriptive Epidemiology of Alcohol Use in the Lagos State Mental Health Survey (LSMHS), Nigeria. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-020-00263-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
8
|
Livne O, Shmulewitz D, Stohl M, Mannes Z, Aharonovich E, Hasin D. Agreement between DSM-5 and DSM-IV measures of substance use disorders in a sample of adult substance users. Drug Alcohol Depend 2021; 227:108958. [PMID: 34450471 PMCID: PMC8977110 DOI: 10.1016/j.drugalcdep.2021.108958] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In DSM-5, definitions of substance use disorders (SUD) were changed considerably from DSM-IV, yet little is known about how well DSM-IV and DSM-5 SUD diagnoses agree among substance users. Because data from many studies are based on DSM-IV diagnostic criteria, understanding the agreement between DSM-5 and DSM-IV SUD diagnoses and reasons for discordance between these diagnoses is crucial for comparing results across studies. MEASUREMENTS Prevalences and chance-corrected agreement of DSM-5 SUD and DSM-IV substance dependence were evaluated in 588 substance users in a suburban inpatient addiction program and an urban medical center, using a semi-structured interview (PRISM-5). Alcohol, tobacco, cannabis, cocaine, heroin, opioid, sedative, and stimulant use disorders were examined. Cohen's kappa was used to assess agreement between DSM-5 and DSM-IV SUD (abuse or dependence), DSM-5 SUD and DSM-IV dependence, and DSM-5 moderate/severe SUD and DSM-IV dependence. RESULTS Agreement between DSM-5 and DSM-IV SUD was excellent for all substances (κ = 0.84-0.99), except for cannabis and tobacco (κ = 0.75; 0.80, respectively). The most common reason for diagnostic discrepancies was a positive DSM-5 SUD diagnosis but no DSM-IV diagnosis, due to the lowered DSM-5 SUD threshold. Agreement between DSM-5 SUD and DSM-IV dependence was excellent for all substances (κ = 0.88-0.94), except for alcohol, tobacco, and cannabis (κ = 0.63-0.75). Agreement between moderate/severe DSM-5 SUD and DSM-IV dependence was excellent across all substances. CONCLUSION While care should be used in interpreting results of studies using different methods, studies relying on DSM-IV or DSM-5 SUD diagnostic criteria offer similar information and thus can be compared when accumulating a body of evidence.
Collapse
Affiliation(s)
- Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY, United States, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Malka Stohl
- New York State Psychiatric Institute, New York, NY, United States
| | - Zachary Mannes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Efrat Aharonovich
- New York State Psychiatric Institute, New York, NY, United States, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States
| | - Deborah Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States.
| |
Collapse
|
9
|
Alcohol use patterns and disorders among individuals with personality disorders in the Sao Paulo Metropolitan Area. PLoS One 2021; 16:e0248403. [PMID: 33755679 PMCID: PMC7987194 DOI: 10.1371/journal.pone.0248403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/25/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Alcohol Use Disorders are frequently comorbid with personality disorders. However, the heterogeneity of the prevalence estimates is high, and most data come from high income countries. Our aim is to estimate the prevalence and association between alcohol use outcomes and the three DSM-5 clusters of personality disorders in a representative sample of the São Paulo Metropolitan Area. Materials and methods A representative household sample of 2,942 adults was interviewed using the WHO Composite International Diagnostic Interview and the International Personality Disorder Examination Screening Questionnaire. Lifetime PD diagnoses were multiply imputed, and AUD diagnoses were obtained using DSM-5 criteria. We conducted cross-tabulations and logistic regression to estimate the associations between AUDs and PDs. Results and discussion Our study did not find significant associations of PDs with heavy drinking patterns or mild AUD. Cluster B PD respondents tended to show the highest conditional prevalence estimates of most alcohol use patterns and AUD, including its severity subtypes. When alcohol outcomes were regressed on all PD Clusters simultaneously, with adjustment for sex and age, only cluster B was significantly associated with past-year alcohol use (OR 3.0), regular drinking (OR 3.2), and AUDs (OR 8.5), especially moderate and severe cases of alcohol use disorders (OR 9.7 and 16.6, respectively). These associations between Cluster B PDs and these alcohol outcomes were shown to be independent of other PD Clusters and individuals´ sex and age. Conclusion The main finding of our study is that AUDs are highly comorbid with PDs. The presence of Cluster B PDs significantly increases the odds of alcohol consumption and disorders and of more severe forms of AUDs. Considering the local context of poor treatment provision, more specific prevention and intervention strategies should be directed to this population.
Collapse
|
10
|
Onaemo VN, Fawehinmi TO, D'Arcy C. Alcohol Use Disorder and the Persistence/Recurrence of Major Depression: Le trouble de l'usage de l'alcool et la persistance/récurrence de la dépression majeure. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:652-663. [PMID: 32364768 PMCID: PMC7485041 DOI: 10.1177/0706743720923065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aims to determine the role of alcohol use disorder and other potential risk factors on persistence/recurrence of major depression in a Canadian population sample. METHODS Data were drawn from the National Population Health Survey (1994/1995 to 2010/2011), a prospective epidemiologic survey of individuals 12 years and older, living in 10 Canadian provinces (N = 17,276). Participants were reinterviewed every 2 years for 9 cycles. This study population was a cohort of individuals who at baseline met the diagnosis of a major depressive episode (MDE) in the previous 12 months (n = 908). After the 6-year (cycle 4) and 16-year (cycle 9) follow-up period, 124 of 718 participants and 79 of 461 participants met the criteria for MDE, respectively. Persistence or recurrence of major depression was defined as meeting a diagnosis of MDE after 6 years and 16 years. Modified Poisson regression models were used to assess the role of alcohol dependence and other risk factors on the persistence/recurrence of major depression using Stata 14. RESULTS Alcohol use disorder was significantly correlated with a 6-year (odds ratio [OR]: 3.03; 95% confidence interval [CI], 1.68 to 5.48; P < .0001) and 16-year (OR, 3.17; 95% CI, 1.15 to 8.77, P = 0.003) persistence/recurrence of major depression. Other factors associated with the persistence/recurrence of major depression include female sex, childhood traumatic events, chronic pain restricting activities, daily smoking, and low self-esteem. CONCLUSIONS Comorbid alcohol use disorder was found to be a strong risk factor for the persistence or recurrence of major depression.
Collapse
Affiliation(s)
- Vivian N Onaemo
- School of Public Health, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | | | - Carl D'Arcy
- School of Public Health, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Department of Psychiatry, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
11
|
Ghandour LA, Anouti S, Afifi RA. The impact of DSM classification changes on the prevalence of alcohol use disorder and 'diagnostic orphans' in Lebanese college youth: Implications for epidemiological research, health practice, and policy. PLoS One 2020; 15:e0233657. [PMID: 32502221 PMCID: PMC7274407 DOI: 10.1371/journal.pone.0233657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background Studies comparing prevalence of alcohol use disorder (AUD) using DSM-IV and DSM-5 diagnostic criteria in college students are limited. This study examines changes in AUD prevalence estimates using DSM-IV versus DSM-5 and characterizes the profile of DSM-5 “diagnostic orphans.” Methods and findings A college student sample (n = 1,155; mean age: 21 ±1.97) selected conveniently from six large private and public universities in Greater Beirut, Lebanon completed an anonymous survey in May 2016. The study response rate was 83.1%. Data on DSM-IV and DSM-5 AUD criteria were gathered from 582 past-year drinkers, of which 377 (65%) were screened to have DSM-IV abuse/dependence, and 203 (35%) to have any DSM-5 AUD (58% mild, 21% moderate, and 21% severe). Overall percent agreement between measures was 68% (kappa = 0.41). One hundred and ninety-one students met one DSM-5 AUD criterion only (i.e. “diagnostic orphans,” herein DOs), of which the majority (82%) endorsed “hazardous use.” Compared to past-year drinkers with zero-endorsed DSM-5 criteria, DOs were more likely to be aged 21 or above [OR = 1.57(1.21–2.03)], less likely to perceive their socioeconomic status (SES) as poorer vs. same as others [OR = 0.17(0.07–0.43)], more likely to drink 1–2 times/week vs. ≤3 times per month [OR = 2.24(1.44–3.49)], and more likely to report past-year cigarette smoking [OR = 2.16(1.10–4.24)]. When compared to past-year drinkers with DSM-5 AUD, DOs were more likely to be pursuing a graduate or medical degree (vs. undergraduate degree) [2.06 (1.09–3.89)], and to be living with parents most of the time vs. not [OR = 2.68(1.14–6.31)]. DOs (versus drinkers with AUD) were less likely to drink at a high frequency (3–4 times /week or more vs.≤3 times per month) [OR = 0.15(0.05–0.48)], and to report past-year waterpipe smoking [OR = 0.54(0.34–0.85)], but more likely to report past-year marijuana use [1.89(1.10–3.23)]. The findings are subject to recall bias and under-reporting and the study could not infer causality because temporality of associations cannot be established in a cross-sectional study design. Conclusions DSM-IV abuse/dependence prevalence rate was higher than DSM-5 AUD prevalence mainly due to the high percentage of students who engaged in “hazardous use”. The DO screen might capture a young person in transition between non-drinking/occasional drinking to drinking frequently/developing an AUD. The prevention, identification, and management of DOs may be critical components of a national alcohol harm-reduction policy.
Collapse
Affiliation(s)
- Lilian A. Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- * E-mail:
| | - Sirine Anouti
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima A. Afifi
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
12
|
Kim J, Hendershot CS. A review of performance indicators of single-item alcohol screening questions in clinical and population settings. J Subst Abuse Treat 2020; 111:73-85. [DOI: 10.1016/j.jsat.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
|
13
|
Baggio S, Trächsel B, Rousson V, Rothen S, Studer J, Marmet S, Heller P, Sporkert F, Daeppen JB, Gmel G, Iglesias K. Identifying an accurate self-reported screening tool for alcohol use disorder: evidence from a Swiss, male population-based assessment. Addiction 2020; 115:426-436. [PMID: 31656049 DOI: 10.1111/add.14864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/21/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Short screenings for alcohol use disorder (AUD) are crucial for public health purposes, but current self-reported measures have several pitfalls and may be unreliable. The main aim of our study was to provide empirical evidence on the psychometric performance of self-reports currently used. Our research questions were: compared with a gold standard clinical interview, how accurate are (1) self-reported AUD, (2) self-reported alcohol use over time and (3) biomarkers of alcohol use among Swiss men? Finally, we aimed to identify an alternative screening tool. DESIGN A single-center study with a cross-sectional design and a stratified sample selection. SETTING Lausanne University Hospital (Switzerland) from October 2017 to June 2018. PARTICIPANTS We selected participants from the French-speaking participants of the ongoing Cohort Study on Substance Use and Risk Factors (n = 233). The sample included young men aged on average 27.0 years. MEASUREMENTS We used the Diagnostic Interview for Genetic Studies as the gold standard for DSM-5 AUD. The self-reported measures included 11 criteria for AUD, nine alcohol-related consequences, and previous 12 months' alcohol use. We also assessed biomarkers of chronic excessive drinking (ethyl glucuronide and phosphatidylethanol). FINDINGS None of the self-reported measures/biomarkers taken alone displayed both sensitivity and specificity close to 100% with respect to the gold standard (e.g. self-reported AUD: sensitivity = 92.3%, specificity = 45.8%). The best model combined eight self-reported criteria of AUD and four alcohol-related consequences. Using a cut-off of three, this screening tool yielded acceptable sensitivity (83.3%) and specificity (78.7%). CONCLUSIONS Neither self-reported alcohol use disorder nor heavy alcohol use appear to be adequate to screen for alcohol use disorder among young men from the Swiss population. The best screening alternative for alcohol use disorder among young Swiss men appears to be a combination of eight symptoms of alcohol use disorder and four alcohol-related consequences.
Collapse
Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.,Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Bastien Trächsel
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stéphane Rothen
- Addiction Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Simon Marmet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.,Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals, Thônex, Switzerland
| | - Frank Sporkert
- Centre of Legal Medicine, Forensic Toxicology and Chemistry Unit, Lausanne and Geneva Universities, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto,, ON, Canada.,University of the West of England, Bristol, UK
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| |
Collapse
|
14
|
Jun HJ, Webb-Morgan M, Felner JK, Wisdom JP, Haley SJ, Austin SB, Katuska LM, Corliss HL. Sexual orientation and gender identity disparities in substance use disorders during young adulthood in a United States longitudinal cohort. Drug Alcohol Depend 2019; 205:107619. [PMID: 31678835 PMCID: PMC7437659 DOI: 10.1016/j.drugalcdep.2019.107619] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study examined associations of sexual orientation and gender identity with prevalence of substance use disorders (SUDs) and co-occurring multiple SUDs in the past 12-months during young adulthood in a United States longitudinal cohort. METHODS Questionnaires self-administered in 2010 and 2015 assessed probable past 12-month nicotine dependence, alcohol abuse and dependence, and drug abuse and dependence among 12,428 participants of an ongoing cohort study when they were ages 20-35 years. Binary or multinomial logistic regressions using generalized estimating equations were used to estimate differences by sexual orientation and gender identity in the odds of SUDs and multiple SUDs, stratified by sex assigned at birth. RESULTS Compared with completely heterosexuals (CH), sexual minority (SM; i.e., mostly heterosexual, bisexual, lesbian/gay) participants were generally more likely to have a SUD, including multiple SUDs. Among participants assigned female at birth, adjusted odds ratios (AORs) for SUDs comparing SMs to CHs ranged from 1.61 to 6.97 (ps<.05); among participants assigned male at birth, AORs ranged from 1.30 to 3.08, and were statistically significant for 62% of the estimates. Apart from elevated alcohol dependence among gender minority participants assigned male at birth compared with cisgender males (AOR: 2.30; p < .05), gender identity was not associated with prevalence of SUDs. CONCLUSIONS Sexual and gender minority (SGM) young adults disproportionately evidence SUDs, as well as co-occurring multiple SUDs. Findings related to gender identity and bisexuals assigned male at birth should be interpreted with caution due to small sample sizes. SUD prevention and treatment efforts should focus on SGM young adults.
Collapse
Affiliation(s)
- Hee-Jin Jun
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Megan Webb-Morgan
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Jennifer K. Felner
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | | | - Sean J. Haley
- Department of Health Policy and Management, School of Public Health, City University of New York, New York, NY, USA
| | - S. Bryn Austin
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Laura M. Katuska
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Heather L. Corliss
- School of Public Health, San Diego State University, San Diego, CA, USA,Institute for Behavioral and Community Health, San Diego State University, San Diego, CA,Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| |
Collapse
|
15
|
Cheslack-Postava K, Wall MM, Weinberger AH, Goodwin RD. Increasing Depression and Substance Use Among Former Smokers in the United States, 2002-2016. Am J Prev Med 2019; 57:429-437. [PMID: 31443956 DOI: 10.1016/j.amepre.2019.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Mental health and substance use problems are associated with smoking relapse among former smokers. Yet, little is known about the prevalence of mental health and substance use among former smokers in the U.S. In addition, it is unknown whether the prevalence of these conditions has changed over time as former U.S. smokers have grown to outnumber current U.S. smokers. This study, which was conducted in 2018 and 2019, examined the prevalence and trends over time in depression (2005-2016), marijuana use (2002-2016), and alcohol use problems (2002-2016) among former U.S. smokers. METHODS The National Survey on Drug Use and Health is an annual, nationally representative, cross-sectional study. Data from U.S. individuals who were aged ≥18 years in 2002-2016 were included. Former smokers were defined as having smoked ≥100 lifetime cigarettes and no past-year cigarettes. RESULTS From 2005 to 2016, the prevalence of major depression increased from 4.88% to 6.04% (AOR=1.01, 95% CI=1.00, 1.03, p=0.04). From 2002 to 2016, past-year marijuana use rose from 5.35% to 10.09% (AOR=1.08, 95% CI=1.07, 1.09, p<0.001) among former smokers. Past-month binge alcohol use also increased from 17.22% to 22.33% (AOR=1.03, 95% CI=1.02, 1.04, p<0.001), although the prevalence of past-year alcohol abuse or dependence did not change. CONCLUSIONS Depression and substance use, which are factors associated with increased risk for cigarette use relapse, appear to be increasing over time among former U.S. smokers. Increased awareness of these trends may be important for clinical and public health efforts to direct attention to conditions potentially threatening sustained abstinence among former smokers.
Collapse
Affiliation(s)
- Keely Cheslack-Postava
- Department of Psychiatry, Columbia University, New York, New York; Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, New York
| | - Melanie M Wall
- Department of Psychiatry, Columbia University, New York, New York; Research Foundation for Mental Hygiene, New York State Psychiatric Institute, New York, New York; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Renee D Goodwin
- Institute for Implementation Science in Population Health, City University of New York, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, New York.
| |
Collapse
|
16
|
Dacosta-Sánchez D, Fernández-Calderón F, González-Ponce B, Díaz-Batanero C, Lozano ÓM. Severity of Substance Use Disorder: Utility as an Outcome in Clinical Settings. Alcohol Clin Exp Res 2019; 43:869-876. [PMID: 30861142 DOI: 10.1111/acer.14020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/07/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Some authors have pointed out the usefulness of the levels of substance use disorder (SUD) as a treatment outcome. However, in order to use this variable as an outcome measure, its impact needs to be addressed within a clinical context. The aim of this study was to analyze the sensitivity of SUD levels as a measure for detecting reliable changes and to make a comparison between the changes in SUD levels detected when using the number of criteria fulfilled and when using the reliable change index (RCI). METHODS The sample consisted of 206 (106 in follow-up) patients diagnosed with abuse/dependence on alcohol and cocaine, according to DSM-IV criteria. The Substance Dependence Severity Scale for DSM-5 was used to determine current alcohol use disorder (AUD) and cocaine use disorder (CUD). Number of DSM-5 criteria fulfilled and RCI were used to determine the change in SUD levels. RESULTS No association was found between adherence to/abandonment of treatment and AUD severity levels (χ2 = 7.029, p = 0.071) or CUD severity levels (χ2 = 2.044, p = 0.413). Statistical significant differences for levels of AUD (z = -3.870, p = 0.000) and CUD (z = -5.382, p = 0.000) were found between baseline assessment and follow-up. According to the number of DSM-5 criteria and RCI, the Kappa coefficient for the change in patient status (improved, worsened, or no change) was k = 0.61 for alcohol patients and k = 0.64 for cocaine patients. The "mild" category showed the greatest inconsistency between both procedures. CONCLUSIONS Levels of SUD are sensitive to the impact of treatment as measured by the difference between the baseline assessment and 3-month follow-up. However, conclusions differ according to whether the DSM-5 criteria or the RCI is applied.
Collapse
Affiliation(s)
- Daniel Dacosta-Sánchez
- Department of Clinical and Experimental Psychology , University of Huelva, Huelva, Spain
| | - Fermín Fernández-Calderón
- Research Center for Natural Resources , Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - Bella González-Ponce
- Department of Clinical and Experimental Psychology , University of Huelva, Huelva, Spain
| | - Carmen Díaz-Batanero
- Research Center for Natural Resources , Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - Óscar M Lozano
- Research Center for Natural Resources , Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| |
Collapse
|
17
|
Qadeer RA, Georgiades K, Boyle MH, Ferro MA. An Epidemiological Study of Substance Use Disorders Among Emerging and Young Adults. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:313-322. [PMID: 30071752 PMCID: PMC6591883 DOI: 10.1177/0706743718792189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We investigated the prevalence of substance use disorders (SUDs) among emerging adults and quantified the extent to which emerging adults, compared with young adults, have increased odds for SUDs. METHODS Data were from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH). Respondents were 15 to 39 y of age ( n = 9228) and were categorized as: early emerging adults (15 to 22 y); late emerging adults (23 to 29 y); and, young adults (30 to 39 y). SUDs [alcohol or drug abuse/dependence (AAD or DAD)] were measured using the WHO Composite International Diagnostic Interview 3.0. The prevalence of SUDs was compared across age groups, and odds ratios (OR) and 95% confidence intervals (CI) were computed from logistic regression models adjusting for sociodemographic and health covariates. Analyses were weighted to maintain representativeness to the Canadian population. RESULTS The prevalence of AAD was 8.0%, 6.6%, and 2.7% for early emerging adults, late emerging adults, and young adults, respectively. For DAD, the prevalence was 6.4%, 3.6%, and 1.3%. After covariate adjustment, early and late emerging adults had greater odds of reporting AAD (OR = 3.2, 95% CI = 2.2 to 4.9 and OR = 2.4, 95% CI = 1.6 to 3.4, respectively) or DAD (OR = 4.2, 95% CI = 2.5 to 7.0 and OR = 2.5, 95% CI = 1.6 to 4.1, respectively) compared with young adults. Differences between early and late emerging adults were not significant. CONCLUSION Emerging adults are at increased odds for SUDs. Lack of differences between early and late emerging adults provide evidence of the extension of emerging adulthood into the late 20s. Findings have implications for the provision of screening and treatment of SUDs during this developmental period.
Collapse
Affiliation(s)
- Rana A Qadeer
- 1 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Georgiades
- 2 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael H Boyle
- 2 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mark A Ferro
- 3 School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
18
|
Udo T, Grilo CM. Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States. Int J Eat Disord 2019; 52:42-50. [PMID: 30756422 DOI: 10.1002/eat.23004] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine psychiatric and somatic correlates of DSM-5 eating disorders (EDs)-anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED)-in a nationally representative sample of adults in the United States. METHOD A national sample of 36,309 adult participants in the national epidemiologic survey on alcohol and related conditions III (NESARC-III) completed structured diagnostic interviews (AUDADIS-5) to determine psychiatric disorders, including EDs, and reported 12-month diagnosis of chronic somatic conditions. Prevalence of lifetime psychiatric disorders and somatic conditions were calculated across the AN, BN, and BED groups and a fourth group without specific ED; multiple logistic regression models compared the likelihood of psychiatric/somatic conditions with each specific ED relative to the no-specific ED group. RESULTS All three EDs were associated significantly with lifetime mood disorders, anxiety disorders, alcohol and drug use disorders, and personality disorders. In all three EDs, major depressive disorder was the most prevalent, followed by alcohol use disorder. AN was associated significantly with fibromyalgia, cancer, anemia, and osteoporosis, and BED with diabetes, hypertension, high cholesterol, and triglycerides. BN was not associated significantly with any somatic conditions. CONCLUSIONS This study examined lifetime psychiatric and somatic correlates of DSM-5 AN, BN, and BED in a large representative sample of U.S. adults. Our findings on significant associations with other psychiatric disorders and with current chronic somatic conditions indicate the serious burdens of EDs. Our findings suggest important differences across specific EDs and indicate some similarities and differences to previous smaller studies based on earlier diagnostic criteria.
Collapse
Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, New York
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
19
|
Kidorf M, Solazzo S, Yan H, Brooner RK. Psychiatric and Substance Use Comorbidity in Treatment-Seeking Injection Opioid Users Referred From Syringe Exchange. J Dual Diagn 2018; 14:193-200. [PMID: 30332349 DOI: 10.1080/15504263.2018.1510148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The present study evaluated rates of co-occurring current psychiatric and substance use disorders in a sample of opioid-dependent treatment-seeking injection drug users referred from syringe exchange. METHODS Participants (N = 208) completed the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-R to assess current (within the past year) psychiatric and substance use disorders and the two most commonly diagnosed personality disorders (antisocial and borderline personality disorders). RESULTS Forty-eight percent of the sample had a current Axis I psychiatric disorder, and 67% had a co-occurring current substance use disorder. Posttraumatic stress disorder (21%), major depression (17%), and bipolar I (12%) were the most prevalent Axis I psychiatric disorders, and cocaine use disorder (53%) was the most commonly co-occurring substance use disorder. Women were more likely to have diagnoses of most anxiety disorders and less likely to have diagnoses of alcohol use disorder or antisocial personality disorder. The presence of a personality disorder was associated with higher rates of cocaine and sedative use disorder. CONCLUSIONS Findings suggest the importance of evaluating and treating co-occurring psychiatric and substance use disorders in the treatment of injection drug users with opioid dependence.
Collapse
Affiliation(s)
- Michael Kidorf
- a Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Stephanie Solazzo
- a Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Haijuan Yan
- a Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Robert K Brooner
- a Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services-BBRC, Johns Hopkins Bayview Medical Center , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| |
Collapse
|
20
|
Peña S, Suvisaari J, Härkänen T, Markkula N, Saarni S, Härkönen J, Mäkelä P, Koskinen S. Changes in prevalence and correlates of alcohol-use disorders in Finland in an 11-year follow-up. Nord J Psychiatry 2018; 72:512-520. [PMID: 30383463 DOI: 10.1080/08039488.2018.1525427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIMS This study aimed to examine changes in prevalence and correlates of alcohol-use disorders (AUD) between 2000 and 2011. We also explored the impact of using multiple imputation on prevalence estimates, to address survey nonresponse. METHODS The study used a Finnish nationally representative survey of adults aged 30 years and older in 2000 and in 2011. The Munich Composite International Diagnostic Interview (M-CIDI) was used to diagnose AUD in 6005 persons in 2000 (response rate 75%) and 4381 in 2011 (response rate 55%). Multiple imputation using sociodemographic, health, and registry-linked data on mental health hospitalizations was compared with weights to account for nonresponse. RESULTS Prevalence of 12-month AUD in Finland decreased from 4.6% (95% CI 4.0-5.1) in 2000 to 2.0% in 2011 (95% CI 1.6-2.4). Lifetime AUD prevalence decreased from 10.8% (95% CI 9.9-11.6) to 7.5% (CI 95% 6.8-8.3) from 2000 to 2011. The reduction was observed for people aged 30-64 years. At both time points, AUD prevalence was higher among individuals aged 30-64, men and those unmarried, widowed or divorced. The observed prevalence changes can be partly attributed to reporting and selection bias. The latter was addressed by multiple imputation. CONCLUSIONS Alcohol use disorders appear to have decreased in Finland from 2000 to 2011, especially for the 30-64 years age group. Males, younger adults and those unmarried, widowed or divorced had a higher risk of AUD.
Collapse
Affiliation(s)
- Sebastián Peña
- a Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland.,b Faculty of Medicine , University Diego Portales , Santiago , Chile
| | - Jaana Suvisaari
- a Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland
| | - Tommi Härkänen
- a Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland
| | - Niina Markkula
- a Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland.,c Faculty of Medicine , Clínica Alemana Universidad del Desarrollo , Santiago , Chile
| | - Suoma Saarni
- a Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland
| | - Janne Härkönen
- a Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland
| | - Pia Mäkelä
- a Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland
| | - Seppo Koskinen
- a Department of Public Health Solutions , National Institute for Health and Welfare , Helsinki , Finland
| |
Collapse
|
21
|
Agabio R, Leggio L. Baclofen in the Treatment of Patients With Alcohol Use Disorder and Other Mental Health Disorders. Front Psychiatry 2018; 9:464. [PMID: 30323774 PMCID: PMC6172346 DOI: 10.3389/fpsyt.2018.00464] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/06/2018] [Indexed: 12/20/2022] Open
Abstract
A limited number of medications are approved to treat Alcohol Use Disorder (AUD). Furthermore, the magnitude of their therapeutic effect is relatively modest, suggesting the potential for subtypes of patients who respond to a specific medication. The use of these medications is also limited in clinical practice by a series of contraindications such as medical comorbidities and/or concurrent use of other medications. In recent years, animal and human studies have been conducted to evaluate the efficacy of baclofen, a GABAB receptor agonist approved for clinical use as a muscle relaxant, in the treatment of AUD. However, these studies have yielded contrasting results. Despite this discrepancy, baclofen is often used off-label to treat AUD, especially in some European countries and Australia. Recently, several factors have been considered to try to shed light on the potential reasons and mechanisms underlying the inconsistent results obtained until now. The presence of a psychiatric comorbidity may be amongst the abovementioned factors playing a role in explaining different responses to baclofen treatment in terms of alcohol drinking outcomes. Therefore, the aim here was to conduct a narrative review of the scientific literature related to the use of baclofen in AUD, both in patients with and without concomitant psychiatric disorders. All clinical studies (randomized and controlled, open-label, retrospective, human laboratory studies, and case reports) were analyzed and discussed, bearing in mind other potential factors that may have influenced baclofen response, including dose administered, severity of AUD, use of other psychosocial therapies, and the presence of physical disorders. This review indicates that the most frequent psychiatric comorbidities in patients affected by AUD undergoing baclofen treatment are anxiety and mood disorders. Unfortunately, no definitive conclusions can be drawn due to the lack of specific analyses on whether baclofen efficacy is different in AUD patients with comorbid psychiatric disorders vs. those without. Therefore, it will be critical that psychiatric comorbidities are considered in the planning of future studies and in the analysis of the data, with the ultimate goal of understanding whether subtypes of AUD patients may respond best to baclofen.
Collapse
Affiliation(s)
- Roberta Agabio
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Monserrato, Italy
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research and National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Bethesda, MD, United States
- Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, United States
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States
| |
Collapse
|
22
|
Hartwell EE, Ray LA. Craving as a DSM-5 Symptom of Alcohol Use Disorder in Non-Treatment Seekers. Alcohol Alcohol 2018; 53:235-240. [PMID: 29145640 DOI: 10.1093/alcalc/agx088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/25/2017] [Indexed: 12/13/2022] Open
Abstract
Aims DSM-5 has added craving as a new criterion and changed the diagnostic structure of alcohol use disorder (AUD). Though craving has long been a target of intervention, less is known about the impact this addition will have on prevalence and factor structure of AUD, particularly in non-treatment seeker with alcohol problems. Methods Non-treatment seeking individuals reporting alcohol-related problems (N = 296) completed a structured clinical interview and the Penn Alcohol Craving Scale (PACS). PACS scores greater than 20 were considered to meet diagnostic criteria for the alcohol craving symptom. This study examined DSM-IV to DSM-5 diagnostic conversion and conducted an exploratory factor analysis to test the factor structure of the DSM-5 symptoms, including craving. Results The mean PACS score was 13.1 and alcohol craving was strongly correlated with other measures of alcohol use. Using the proposed cut-off score of PACS > 20, 46 participants (16.2%) met criteria for alcohol craving. Craving loaded moderately (0.47) onto the retained DSM symptoms and produced a unidimensional factor structure. The majority of participants who met for a DSM-IV AUD also met for a DSM-5 AUD (98.8%). Conclusions Craving prevalence using the PACS was relatively low compared to the remaining 10 DSM-5 symptoms, possibly due to the non-treatment seeking nature of the sample. Conversion of DSM-IV to DSM-5 in this sample led to a small increase in overall AUD prevalence. Craving loaded well onto a single factor structure for AUD.
Collapse
Affiliation(s)
- Emily E Hartwell
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, CA 900951563, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, CA 900951563, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, 760 Westwood Plaza, Los Angeles, CA 90095, USA.,Brain Research Institute, University of California, 695 Charles Young Drive South, Los Angeles, CA 90095, USA
| |
Collapse
|
23
|
Abdul-Rahman AK, Card TR, Grainge MJ, Fleming KM. All-cause and cause-specific mortality rates of patients treated for alcohol use disorders: A meta-analysis. Subst Abus 2018; 39:509-517. [PMID: 29958085 DOI: 10.1080/08897077.2018.1475318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although alcohol use disorders (AUDs) are known to increase the relative risk of all-cause and some cause-specific mortality, the absolute mortality rates of the AUD population are unknown. Such knowledge would benefit planners of the provision of services for this population, including in prioritizing the identification and/or treatment of diseases likely to cause their death. METHODS We conducted a systematic review of studies in English, reporting the cause-specific mortality rates among people treated for AUDs. Number of deaths by cause and total person-years of follow-up were extracted. All-cause and cause-specific mortality rates per 1000 person-years were meta-analyzed assuming random effects. RESULTS Thirty-one studies were included. Participants were mainly middle-aged males. The quality of studies was generally good. A total of 6768 all-cause deaths in 276,990.7 person-years of follow-up (36,375 patients) were recorded, and the pooled all-cause mortality rate was 27.67/1000 person-years (py) (95% confidence interval [CI]: 23.9, 32.04). The most common cause of death in the AUD population was cardiovascular disease (CVD) (6.9/1000 py; 95% CI: 5.61, 8.49), followed by gastrointestinal deaths (5.63/1000 py; 95% CI: 4.1, 7.74), unnatural deaths (4.95/1000 py; 95% CI: 4.01, 6.09)), neoplasms, respiratory diseases, and substance use disorders. CONCLUSIONS Patients with AUDs have increased rates of all-cause and cause-specific mortality compared with the general population. Like the general population, they are most likely to die of CVD. In contrast to the general population, gastrointestinal and unnatural deaths are the next most common causes of death. We believe these facts should be considered when planning health care services for patients with AUDs.
Collapse
Affiliation(s)
- Abdul-Kareem Abdul-Rahman
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom.,b UK Centre for Tobacco and Alcohol Studies , Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom
| | - Timothy R Card
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom.,c Nottingham Digestive Diseases Biomedical Research Unit , Nottingham University Hospitals NHS Trust and the University of Nottingham, Queens Medical Centre , Nottingham , United Kingdom
| | - Matthew J Grainge
- a Division of Epidemiology and Public Health, School of Medicine , University of Nottingham, Clinical Sciences Building, Hucknall Road , Nottingham , United Kingdom
| | - Kate M Fleming
- d Department of Public Health and Policy , University of Liverpool , Liverpool , United Kingdom
| |
Collapse
|
24
|
Gilbert PA, Marzell M. Characterizing a Hidden Group of At-Risk Drinkers: Epidemiological Profiles of Alcohol-Use Disorder Diagnostic Orphans. Subst Use Misuse 2018; 53:1239-1251. [PMID: 29185842 DOI: 10.1080/10826084.2017.1402057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Drinkers who report some symptoms of alcohol-use disorder (AUD) but fail to meet full criteria are "diagnostic orphans." To improve risk-reduction efforts, we sought to develop better epidemiologic profiles of this underrecognized subgroup. METHODS This study estimated the population prevalence and described AUD symptoms of diagnostic orphans using the 2012-2013 National Epidemiological Survey of Alcohol and Related Conditions-III. Multivariate logistic regression was used to model odds of being a diagnostic orphan or meeting mild, moderate, and severe AUD criteria versus no AUD symptoms. Models were adjusted for the complex survey design using sampling weights and survey procedures (e.g., proc surveylogistic). RESULTS Among drinkers, 14% of men and 11% of women were classified as diagnostic orphans. The most common symptoms were drinking more or for longer periods than intended, wanting or trying unsuccessfully to quit or cut back, and drinking in ways that increased risk of injury. We noted broad similarities between diagnostic orphans and mild/moderate AUD groups. There were no differences in odds of diagnostic orphans status by race/ethnicity; however, female gender was associated with lower odds of diagnostic orphan status and all levels of AUD. Individual history of AUD, family history of problem drinking, concurrent smoking, and concurrent marijuana use were associated with greater odds of problem drinking, with stronger associations as AUD severity increased. CONCLUSIONS Diagnostic orphans remain a sizeable and overlooked population of problem drinkers. Clarifying the array of symptoms and cooccurring disorders can improve screening and facilitate alcohol risk-reduction intervention efforts.
Collapse
Affiliation(s)
- Paul A Gilbert
- a Department of Community and Behavioral Health , University of Iowa College of Public Health , Iowa City , Iowa , USA
| | - Miesha Marzell
- b Department of Social Work , College of Community & Public Affairs, Binghamton University , Binghamton , New York , USA
| |
Collapse
|
25
|
Saunders JB, Peacock A, Degenhardt L. Alcohol Use Disorders in the Draft ICD-11, and How They Compare with DSM-5. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0197-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
26
|
Just-Østergaard E, Mortensen EL, Flensborg-Madsen T. Major life events and risk of alcohol use disorders: a prospective cohort study. Addiction 2018; 113:25-33. [PMID: 28734057 DOI: 10.1111/add.13947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/12/2017] [Accepted: 07/14/2017] [Indexed: 12/14/2022]
Abstract
AIMS To estimate associations of individual major life events as well as accumulated major life events in childhood, adult private life and adult work life with risk of alcohol use disorders (AUD). DESIGN Prospective cohort study with baseline examination in 1991-93 and linkage to national registers to identify AUD at follow-up. SETTING Copenhagen, Denmark. PARTICIPANTS Individuals (aged 21-93 years) who participated in the Copenhagen City Heart Study in 1991-93 (n = 8758). MEASUREMENTS The primary outcome was first registration with AUD during follow-up (n = 249). AUD was identified in the Danish National Patient Register, in the Danish Psychiatric Central Register and in an outpatient treatment register. Major life events were assessed by a questionnaire in the Copenhagen City Heart study. Data were analysed by Cox proportional hazards models adjusted for age, sex, educational level, household income, cohabitation status and psychiatric comorbidity. FINDINGS Serious family conflicts in childhood [hazard ratio (HR) = 1.35; 95% confidence interval (CI) = 1.00, 1.83] and serious economic problems in adult life (HR = 2.22; 95% CI = 1.64, 3.01) were associated significantly with increased risk of AUD. Prospective analyses did not show consistent effects of accumulation of major life events in childhood or adult life, but an additional analysis based on all AUD registrations suggested an association between accumulated childhood events and risk of AUD. CONCLUSIONS Serious economic problems in adult life are associated strongly with risk of alcohol use disorders, and there may be an influence of accumulated childhood events on risk of alcohol use disorders.
Collapse
Affiliation(s)
- Emilie Just-Østergaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Erik L Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Trine Flensborg-Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
27
|
García-Marchena N, Silva-Peña D, Martín-Velasco AI, Villanúa MÁ, Araos P, Pedraz M, Maza-Quiroga R, Romero-Sanchiz P, Rubio G, Castilla-Ortega E, Suárez J, Rodríguez de Fonseca F, Serrano A, Pavón FJ. Decreased plasma concentrations of BDNF and IGF-1 in abstinent patients with alcohol use disorders. PLoS One 2017; 12:e0187634. [PMID: 29108028 PMCID: PMC5673472 DOI: 10.1371/journal.pone.0187634] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/23/2017] [Indexed: 12/27/2022] Open
Abstract
The identification of growth factors as potential biomarkers in alcohol addiction may help to understand underlying mechanisms associated with the pathogenesis of alcohol use disorders (AUDs). Previous studies have linked growth factors to neural plasticity in neurocognitive impairment and mental disorders. In order to further clarify the impact of chronic alcohol consumption on circulating growth factors, a cross-sectional study was performed in abstinent AUD patients (alcohol group, N = 91) and healthy control subjects (control group, N = 55) to examine plasma concentrations of brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1) and IGF-1 binding protein-3 (IGFBP-3). The association of these plasma peptides with relevant AUD-related variables and psychiatric comorbidity was explored. The alcohol group was diagnosed with severe AUD and showed an average of 13 years of problematic use and 10 months of abstinence at the moment of participating in the study. Regarding common medical conditions associated with AUD, we observed an elevated incidence of alcohol-induced liver and pancreas diseases (18.7%) and psychiatric comorbidity (76.9%). Thus, AUD patients displayed a high prevalence of dual diagnosis (39.3%) [mainly depression (19.9%)] and comorbid substance use disorders (40.7%). Plasma BDNF and IGF-1 concentrations were significantly lower in the alcohol group than in the control group (p<0.001). Remarkably, there was a negative association between IGF-1 concentrations and age in the control group (r = -0.52, p<0.001) that was not found in the alcohol group. Concerning AUD-related variables, AUD patients with liver and pancreas diseases showed even lower concentrations of BDNF (p<0.05). In contrast, the changes in plasma concentrations of these peptides were not associated with abstinence, problematic use, AUD severity or lifetime psychiatric comorbidity. These results suggest that further research is necessary to elucidate the role of BDNF in alcohol-induced toxicity and the biological significance of the lack of correlation between age and plasma IGF-1 levels in abstinent AUD patients.
Collapse
Affiliation(s)
- Nuria García-Marchena
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Daniel Silva-Peña
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | | | - María Ángeles Villanúa
- Departamento de Fisiología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro Araos
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - María Pedraz
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Rosa Maza-Quiroga
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Pablo Romero-Sanchiz
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Gabriel Rubio
- Instituto i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Estela Castilla-Ortega
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Juan Suárez
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Fernando Rodríguez de Fonseca
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
- * E-mail: (FRF); (AS); (FJP)
| | - Antonia Serrano
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
- * E-mail: (FRF); (AS); (FJP)
| | - Francisco Javier Pavón
- Unidad Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
- * E-mail: (FRF); (AS); (FJP)
| |
Collapse
|
28
|
Chung T, Cornelius J, Clark D, Martin C. Greater Prevalence of Proposed ICD-11 Alcohol and Cannabis Dependence Compared to ICD-10, DSM-IV, and DSM-5 in Treated Adolescents. Alcohol Clin Exp Res 2017; 41:1584-1592. [PMID: 28667763 DOI: 10.1111/acer.13441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/25/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Proposed International Classification of Diseases, 11th edition (ICD-11), criteria for substance use disorder (SUD) radically simplify the algorithm used to diagnose substance dependence. Major differences in case identification across DSM and ICD impact determinations of treatment need and conceptualizations of substance dependence. This study compared the draft algorithm for ICD-11 SUD against DSM-IV, DSM-5, and ICD-10, for alcohol and cannabis. METHODS Adolescents (n = 339, ages 14 to 18) admitted to intensive outpatient addictions treatment completed, as part of a research study, a Structured Clinical Interview for DSM SUDs adapted for use with adolescents and which has been used to assess DSM and ICD SUD diagnoses. Analyses examined prevalence across classification systems, diagnostic concordance, and sources of diagnostic disagreement. RESULTS Prevalence of any past-year proposed ICD-11 alcohol or cannabis use disorder was significantly lower compared to DSM-IV and DSM-5 (ps < 0.01). However, prevalence of proposed ICD-11 alcohol and cannabis dependence diagnoses was significantly higher compared to DSM-IV, DSM-5, and ICD-10 (ps < 0.01). ICD-11 and DSM-5 SUD diagnoses showed only moderate concordance. For both alcohol and cannabis, youth typically met criteria for an ICD-11 dependence diagnosis by reporting tolerance and much time spent using or recovering from the substance, rather than symptoms indicating impaired control over use. CONCLUSIONS The proposed ICD-11 dependence algorithm appears to "overdiagnose" dependence on alcohol and cannabis relative to DSM-IV and ICD-10 dependence, and DSM-5 moderate/severe use disorder, generating potential "false-positive" cases of dependence. Among youth who met criteria for proposed ICD-11 dependence, few reported impaired control over substance use, highlighting ongoing issues in the conceptualization and diagnosis of SUD.
Collapse
Affiliation(s)
- Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jack Cornelius
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Duncan Clark
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Christopher Martin
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
29
|
Takahashi T, Lapham G, Chavez LJ, Lee AK, Williams EC, Richards JE, Greenberg D, Rubinsky A, Berger D, Hawkins EJ, Merrill JO, Bradley KA. Comparison of DSM-IV and DSM-5 criteria for alcohol use disorders in VA primary care patients with frequent heavy drinking enrolled in a trial. Addict Sci Clin Pract 2017; 12:17. [PMID: 28716049 PMCID: PMC5514480 DOI: 10.1186/s13722-017-0082-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 05/25/2017] [Indexed: 12/04/2022] Open
Abstract
Background Criteria for alcohol use disorders (AUD) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) were intended to result in a similar prevalence of AUD as DSM-IV. We evaluated the prevalence of AUD using DSM-5 and DSM-IV criteria, and compared characteristics of patients who met criteria for: neither DSM-5 nor DSM-IV AUD, DSM-5 alone, DSM-IV alone, or both, among Veterans Administration (VA) outpatients in the Considering Healthier drinking Options In primary CarE (CHOICE) trial. Methods VA primary care patients who reported frequent heavy drinking and enrolled in the CHOICE trial were interviewed at baseline using the DSM-IV Mini International Neuropsychiatric Interview for AUD, as well as questions about socio-demographics, mental health, alcohol craving, and substance use. We compared characteristics across 4 mutually exclusive groups based on DSM-5 and DSM-IV criteria. Results Of 304 participants, 13.8% met criteria for neither DSM-5 nor DSM-IV AUD; 12.8% met criteria for DSM-5 alone, and 73.0% met criteria for both DSM-IV and DSM-5. Only 1 patient (0.3%) met criteria for DSM-IV AUD alone. Patients meeting both DSM-5 and DSM-IV criteria had more negative drinking consequences, mental health symptoms and self-reported readiness to change compared with those meeting DSM-5 criteria alone or neither DSM-5 nor DSM-IV criteria. Conclusions In this sample of primary care patients with frequent heavy drinking, DSM-5 identified 13% more patients with AUD than DSM-IV. This group had a lower mental health symptom burden and less self-reported readiness to change compared to those meeting criteria for both DSM-IV and DSM-5 AUD. Trial Registration ClinicalTrials.gov NCT01400581. 2011 February 17 Electronic supplementary material The online version of this article (doi:10.1186/s13722-017-0082-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Traci Takahashi
- Department of Veterans Affairs Puget Sound Health Care System, General Medicine Services, 1660 South Columbian Way (S-152), Seattle, WA, 98108, USA. .,Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Gwen Lapham
- Health Services Research and Development (HSR&D), Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste. 1600, Seattle, WA, 98101, USA
| | - Laura J Chavez
- Health Services Research and Development (HSR&D), Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA.,Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy K Lee
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste. 1600, Seattle, WA, 98101, USA
| | - Emily C Williams
- Health Services Research and Development (HSR&D), Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Department of Health Services, University of Washington, 1959 Pacific Street, Seattle, WA, 98195, USA
| | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste. 1600, Seattle, WA, 98101, USA.,Department of Health Services, University of Washington, 1959 Pacific Street, Seattle, WA, 98195, USA
| | - Diane Greenberg
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Department of Veterans Affairs Puget Sound Health Care System, Mental Health Service, 1660 South Columbian Way (S-152), Seattle, WA, 98108, USA
| | - Anna Rubinsky
- Health Services Research and Development (HSR&D), Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, S-123-PCC, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,The Kidney Health Research Collaborative, San Francisco and San Francisco VA Medical Center, University of California, 4150 Clement Street (111A1), San Francisco, CA, 94121, USA
| | - Douglas Berger
- Department of Veterans Affairs Puget Sound Health Care System, General Medicine Services, 1660 South Columbian Way (S-152), Seattle, WA, 98108, USA.,Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Eric J Hawkins
- Health Services Research and Development (HSR&D), Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, S-123-PCC, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Joseph O Merrill
- Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Katharine A Bradley
- Health Services Research and Development (HSR&D), Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, S-123-PCC, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste. 1600, Seattle, WA, 98101, USA.,Department of Health Services, University of Washington, 1959 Pacific Street, Seattle, WA, 98195, USA.,Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| |
Collapse
|
30
|
Bartoli F, Carrà G, Biagi E, Crocamo C, Dakanalis A, Di Carlo F, Parma F, Perin AP, Di Giacomo E, Zappa L, Madeddu F, Colmegna F, Clerici M. Agreement between DSM-IV and DSM-5 criteria for alcohol use disorder among outpatients suffering from depressive and anxiety disorders. Am J Addict 2016; 26:53-56. [PMID: 27973696 DOI: 10.1111/ajad.12482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/18/2016] [Accepted: 12/04/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Since significant differences have been reported, we estimated agreement between DSM-5 and DSM-IV criteria for alcohol use disorder (AUD). METHODS We assessed 327 outpatients (mean age: 45.2 ± 13.4) with depressive or anxiety disorders. RESULTS Absolute differences in prevalence rates between DSM-5 and DSM-IV AUD ranged from -1.1% (subjects with anxiety disorders) to +1.8% (tobacco smokers). The agreement was excellent (k = 0.88), also accounting for specific subgroups (relevant k coefficients >0.80). DISCUSSION AND CONCLUSIONS DSM-5 criteria did not inflate AUD rates. SCIENTIFIC SIGNIFICANCE Our results have epidemiological significance since, unlike previous reports, we found diagnostic stability between new and old AUD criteria in this clinical population. (Am J Addict 2017;26:53-56).
Collapse
Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,Department of Mental Health, San Gerardo Hospital, Monza, Italy.,Division of Psychiatry, University College London, London, UK
| | - Enrico Biagi
- Department of Mental Health, San Gerardo Hospital, Monza, Italy
| | | | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Francesco Di Carlo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Francesca Parma
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | | | - Ester Di Giacomo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,Department of Mental Health, San Gerardo Hospital, Monza, Italy
| | - Luigi Zappa
- Department of Mental Health, San Gerardo Hospital, Monza, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | | | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,Department of Mental Health, San Gerardo Hospital, Monza, Italy
| |
Collapse
|
31
|
Chang JW, Kim JS, Jung JG, Kim SS, Yoon SJ, Jang HS. Validity of Alcohol Use Disorder Identification Test-Korean Revised Version for Screening Alcohol Use Disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria. Korean J Fam Med 2016; 37:323-328. [PMID: 27900069 PMCID: PMC5122663 DOI: 10.4082/kjfm.2016.37.6.323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 11/20/2022] Open
Abstract
Background The Alcohol Use Disorder Identification Test (AUDIT) has been widely used to identify alcohol use disorder (AUD). This study evaluated the validity of the AUDIT-Korean revised version (AUDIT-KR) for screening AUD according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria. Methods This research was conducted with 443 subjects who visited the Chungnam National University Hospital for a comprehensive medical examination. All subjects completed the demographic questionnaire and AUDIT-KR without assistance. Subjects were divided into two groups according to DSM-5 criteria: an AUD group, which included patients that fit the criteria for AUD (120 males and 21 females), and a non-AUD group, which included 146 males and 156 females that did not meet AUD criteria. The appropriate cut-off values, sensitivity, specificity, and positive and negative predictive values of the AUDIT-KR were evaluated. Results The mean±standard deviation AUDIT-KR scores were 10.32±7.48 points in males and 3.23±4.42 points in females. The area under the receiver operating characteristic curve (95% confidence interval, CI) of the AUDIT-KR for identifying AUD was 0.884 (0.840–0.920) in males and 0.962 (0.923–0.985) in females. The optimal cut-off value of the AUDIT-KR was 10 points for males (sensitivity, 81.90%; specificity, 81.33%; positive predictive value, 77.2%; negative predictive value, 85.3%) and 5 points for females (sensitivity, 100.00%; specificity, 88.54%; positive predictive value, 52.6%; negative predictive value, 100.0%). Conclusion The AUDIT-KR has high reliability and validity for identifying AUD according to DSM-5 criteria.
Collapse
Affiliation(s)
- Jung Wei Chang
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jong Sung Kim
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jin Gyu Jung
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sung Soo Kim
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seok Joon Yoon
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Hak Sun Jang
- Department of Family Medicine, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| |
Collapse
|
32
|
Yoshimura A, Komoto Y, Higuchi S. Exploration of Core Symptoms for the Diagnosis of Alcohol Dependence in the ICD-10. Alcohol Clin Exp Res 2016; 40:2409-2417. [PMID: 27716976 PMCID: PMC5108416 DOI: 10.1111/acer.13225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 08/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The classification of alcohol use disorder has changed over the past century. Now, the conceptualization of alcohol dependence is still controversial. Accumulating evidence has shown the reliability and validity for the diagnosis of alcohol dependence in the ICD-10 and DSM-IV. However, the meaning and association of the respective diagnostic items, which are descriptive of representative symptoms, have hardly been examined. The core symptom of substance use disorder has been debated in various situations, but has never been elucidated logically. METHODS We consecutively registered 192 patients with alcohol-related problems who visited our hospital for the first time during a certain period. The relations and principal components among the checked items of the ICD-10 diagnostic criteria were examined statistically. RESULTS Three diagnostic items in the ICD-10 were strongly correlated with each other and were thought to form the core symptoms of alcohol dependence: "strong desire," "difficulties in controlling," and "neglect of pleasures." One major physical phenomenon, "withdrawal," seemed to complement the core symptoms in the diagnosis of alcohol dependence. Another physical phenomenon, "tolerance," was demonstrated to be a relatively independent item. The principal component analysis also demonstrated that the diagnostic item "difficulties in controlling" had the maximum component loading value, followed by 2 items, "neglect of pleasures" and "strong desire." CONCLUSIONS The core symptomatic elements in the diagnosis of alcohol dependence were statistically suggested in this study. Knowledge of the relations and components among the diagnostic items of alcohol dependence might also be applicable to other forms of substance use dependence and behavioral addiction.
Collapse
Affiliation(s)
- Atsushi Yoshimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan. .,Department of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Yasunobu Komoto
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Susumu Higuchi
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| |
Collapse
|
33
|
Bartoli F, Crocamo C, Biagi E, Di Carlo F, Parma F, Madeddu F, Capuzzi E, Colmegna F, Clerici M, Carrà G. Clinical utility of a single-item test for DSM-5 alcohol use disorder among outpatients with anxiety and depressive disorders. Drug Alcohol Depend 2016; 165:283-7. [PMID: 27318372 DOI: 10.1016/j.drugalcdep.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a lack of studies testing accuracy of fast screening methods for alcohol use disorder in mental health settings. We aimed at estimating clinical utility of a standard single-item test for case finding and screening of DSM-5 alcohol use disorder among individuals suffering from anxiety and mood disorders. METHODS We recruited adults consecutively referred, in a 12-month period, to an outpatient clinic for anxiety and depressive disorders. We assessed the National Institute on Alcohol Abuse and Alcoholism (NIAAA) single-item test, using the Mini- International Neuropsychiatric Interview (MINI), plus an additional item of Composite International Diagnostic Interview (CIDI) for craving, as reference standard to diagnose a current DSM-5 alcohol use disorder. We estimated sensitivity and specificity of the single-item test, as well as positive and negative Clinical Utility Indexes (CUIs). RESULTS 242 subjects with anxiety and mood disorders were included. The NIAAA single-item test showed high sensitivity (91.9%) and specificity (91.2%) for DSM-5 alcohol use disorder. The positive CUI was 0.601, whereas the negative one was 0.898, with excellent values also accounting for main individual characteristics (age, gender, diagnosis, psychological distress levels, smoking status). DISCUSSION Testing for relevant indexes, we found an excellent clinical utility of the NIAAA single-item test for screening true negative cases. Our findings support a routine use of reliable methods for rapid screening in similar mental health settings.
Collapse
Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.
| | | | - Enrico Biagi
- Department of Mental Health, San Gerardo Hospital, Monza, Italy
| | - Francesco Di Carlo
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - Francesca Parma
- Department of Psychology, University of Milano Bicocca, Milano, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milano Bicocca, Milano, Italy
| | - Enrico Capuzzi
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy; Department of Mental Health, San Gerardo Hospital, Monza, Italy
| | | | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy; Department of Mental Health, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy; Department of Mental Health, San Gerardo Hospital, Monza, Italy; Division of Psychiatry, University College London, London, UK
| |
Collapse
|
34
|
Carrà G, Johnson S, Crocamo C, Angermeyer MC, Brugha T, Azorin JM, Toumi M, Bebbington PE. Psychosocial functioning, quality of life and clinical correlates of comorbid alcohol and drug dependence syndromes in people with schizophrenia across Europe. Psychiatry Res 2016; 239:301-7. [PMID: 27046394 DOI: 10.1016/j.psychres.2016.03.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 01/27/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
Little is known about the correlates of comorbid drug and alcohol dependence in people with schizophrenia outside the USA. We tested hypotheses that dependence on alcohol/drugs would be associated with more severe symptoms, and poorer psychosocial functioning and quality of life. The EuroSC Cohort study (N=1204), based in France, Germany and the UK, used semi-structured clinical interviews for diagnoses, and standardized tools to assess correlates. We used mixed models to compare outcomes between past-year comorbid dependence on alcohol/drugs, controlling for covariates and modelling both subject and country-level effects. Participants dependent on alcohol or drugs had fewer negative symptoms on PANSS than their non-dependent counterparts. However, those dependent on alcohol scored higher on PANSS general psychopathology than those who were not, or dependent only on drugs. People with schizophrenia dependent on drugs had poorer quality of life, more extrapyramidal side effects, and scored worse on Global Assessment of Functioning (GAF) than those without dependence. People with alcohol dependence reported more reasons for non-compliance with medication, and poorer functioning on GAF, though not on Global Assessment of Relational Functioning. In people with schizophrenia, comorbid dependence on alcohol or drugs is associated with impaired clinical and psychosocial adjustment, and poorer quality of life.
Collapse
Affiliation(s)
- Giuseppe Carrà
- Division of Psychiatry (Formerly Mental Health Sciences), University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Sonia Johnson
- Division of Psychiatry (Formerly Mental Health Sciences), University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Cristina Crocamo
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy.
| | - Matthias C Angermeyer
- Department of Psychiatry, University of Leipzig, Johannisallee 20, 04137 Leipzig, Germany.
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK.
| | - Jean-Michel Azorin
- SHU Psychiatrie Adultes, Hôpital Sainte Marguerite, 13274 Marseille Cedex 9, France.
| | - Mondher Toumi
- Chair of Market Access, University Claude Bernard Lyon I, UFR d'Odontologie 11, Rue Guillaume Paradin, 69008 Lyon, France.
| | - Paul E Bebbington
- Division of Psychiatry (Formerly Mental Health Sciences), University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| |
Collapse
|
35
|
Isenberg-Grzeda E, Shen MJ, Alici Y, Wills J, Nelson C, Breitbart W. High rate of thiamine deficiency among inpatients with cancer referred for psychiatric consultation: results of a single site prevalence study. Psychooncology 2016; 26:1384-1389. [PMID: 27228202 DOI: 10.1002/pon.4155] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/03/2016] [Accepted: 04/17/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Thiamine deficiency (TD) is increasingly recognized in medically ill patients. The prevalence of TD among cancer patients is unknown. This study aims to characterize the prevalence of TD among inpatients with cancer. METHODS Retrospective chart review of patients admitted to a large cancer center who were referred for psychiatric consultation and whose serum thiamine concentration was measured. Patients with alcohol use were excluded. RESULTS Among 217 patients with various cancer types, TD was found in 55.3%. Risk factors included fluorouracil-based chemotherapy, significant weight loss, and undergoing active cancer treatment. Almost all patients were normal weight, overweight, or obese, and few had concomitant vitamin B12 or folate deficiency. A total of 17.5% were receiving multivitamin supplementation. Nearly half (49.8%) did not receive empiric treatment with thiamine and among those who did, treatment delay occurred in the majority of cases (59.6%). Measurement of serum thiamine concentration preceded psychiatric consultation in only 10.6% of cases. CONCLUSIONS Our findings suggest that TD is highly prevalent among inpatients with cancer, even among normal and overweight individuals, in the absence of other vitamin deficiencies, and while receiving multivitamin supplements. Several potential risk factors were identified, including active cancer treatment. Evaluation of TD was most commonly not initiated by oncologists. Failure to treat and treatment delay were common. Given these findings, oncologists must be vigilant about detecting TD among inpatients with cancer. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Elie Isenberg-Grzeda
- Department of Psychiatry, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | | | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Wills
- Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
36
|
Abstract
Our distant forebears wrestled with concepts of alcohol addiction not unlike those of today: Is addiction a sin or a disease? Is addiction caused by the gods, the substance, the individual's vulnerability, or psychological or social factors? Luther, Calvin, and Catholic Church leaders viewed moderate alcohol use as God's gift; used intemperately, it was a moral transgression. The founders of modern scientific psychiatry rejected moral explanations for addiction in favor of an early biological model. The first two versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I and DSM-II) stigmatized addiction by listing it with other societally disapproved disorders stemming from personality disorder. DSM-III espoused atheoretical, descriptive diagnoses but required tolerance or withdrawal to diagnose dependence. Substance dependence in DSM-III-R included physiological and behavioral symptoms and reflected the substance dependence syndrome. DSM-IV's emphasis on biology in its concept of dependence was unchanged from its immediate predecessors. DSM-5 declared that all drugs taken in excess have in common the direct activation of the brain reward system. This article examines evolving concepts of alcohol addiction through 12,000 years of recorded human history, from the first mention of alcohol consumption in China more than 12,000 years ago to alcohol use and abuse in the DSM era, 1952 to the present.
Collapse
Affiliation(s)
| | - Mandy Conrad
- National American Indian/Alaska Native ATTC (N-AIAN ATTC), College of Public Health, University of Iowa, Iowa City, Iowa 52242;, ,
| | - Anne Helene Skinstad
- National American Indian/Alaska Native ATTC (N-AIAN ATTC), College of Public Health, University of Iowa, Iowa City, Iowa 52242;, ,
| |
Collapse
|
37
|
Lipsky S, Kernic MA, Qiu Q, Hasin DS. Posttraumatic stress disorder and alcohol misuse among women: effects of ethnic minority stressors. Soc Psychiatry Psychiatr Epidemiol 2016; 51:407-19. [PMID: 26266627 PMCID: PMC4752921 DOI: 10.1007/s00127-015-1109-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The aims of this study were to examine the relationship between adult-onset posttraumatic stress disorder (PTSD) and subsequent alcohol use outcomes (frequent heavy drinking, alcohol abuse, and alcohol dependence) in non-Hispanic white, non-Hispanic black, and Hispanic US women, and whether this relationship was moderated by ethnic minority stressors (discrimination and acculturation). METHODS The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions, employing time-dependent data to conduct multiple extended Cox regression. RESULTS Women with PTSD were over 50 % more likely than those without PTSD to develop alcohol dependence [adjusted hazards ratio (aHR) 1.55; 95 % confidence interval (CI) 1.15, 2.08]. Hispanic and black women were at lower risk of most alcohol outcomes than white women. In race-/ethnic-specific analyses, however, PTSD only predicted alcohol abuse among Hispanic women (aHR 3.02; CI 1.33, 6.84). Higher acculturation was positively associated with all alcohol outcomes among Hispanic women and discrimination was associated with AUD among Hispanic and black women. Acculturation and discrimination modified the effect of PTSD on AUD among Hispanic women: PTSD predicted alcohol dependence among those with low acculturation (aHR 10.2; CI 1.27, 81.80) and alcohol abuse among those without reported discrimination (aHR 6.39; CI 2.76, 16.49). CONCLUSIONS PTSD may influence the development of hazardous drinking, especially among Hispanic women. The influence of PTSD on alcohol outcomes is most apparent, however, when ethnic minority stressors are not present.
Collapse
Affiliation(s)
- Sherry Lipsky
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA.
| | - Mary A Kernic
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Qian Qiu
- Department of Psychiatry and Behavioral Sciences, University of Washington at Harborview Medical Center, Seattle, WA, USA
| | - Deborah S Hasin
- Columbia University/New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
38
|
Castellano F, Bartoli F, Crocamo C, Gamba G, Tremolada M, Santambrogio J, Clerici M, Carrà G. Facial emotion recognition in alcohol and substance use disorders: A meta-analysis. Neurosci Biobehav Rev 2015; 59:147-54. [DOI: 10.1016/j.neubiorev.2015.11.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/02/2015] [Accepted: 11/02/2015] [Indexed: 12/23/2022]
|
39
|
Hsu TY, He GY, Wang YC, Chen CY, Wang SH, Chen WK, Kao CH. Alcohol Use Disorder Increases the Risk of Irritable Bowel Disease: A Nationwide Retrospective Cohort Study. Medicine (Baltimore) 2015; 94:e2334. [PMID: 26705226 PMCID: PMC4697992 DOI: 10.1097/md.0000000000002334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Alcohol use disorder (AUD) is considered a possible risk factor for irritable bowel syndrome (IBS); however, previous studies investigating the association between AUD and IBS have yielded inconsistent results. The study investigated whether AUD increases the risk of IBS by using a population-based database in Taiwan.This retrospective matched-cohort study included the health insurance claims data of 56,355 AUD inpatients and 225,420 randomly selected controls by frequency-matched for sex, age, and index year. Cox proportional hazards regression analysis was performed to measure the risk of IBS among AUD patients compared with non-AUD patients.During the follow-up period, the incidence rate ratio (IRR) of IBS had 12.3-fold (95% CI: 11.9-12.7) in the AUD patients than non-AUD patients and the adjusted hazard ratio (aHR) for IBS in the AUD patients was 5.51 (95% CI: 4.36-6.96). For several comorbidities, the risk of IBS was significantly higher in the AUD patients than in non-AUD patients, with aHRs of 2.14 (95% confidence interval [CI]: 1.19-3.84), 2.05 (95% CI: 1.06-3.96), and 2.91 (95% CI: 1.26-6.72) for sleep disorders, acute pancreatitis, and hepatitis B, respectively. When we stratified the severity of AUD according to the length of hospital stay, the aHRs exhibited a significant correlation (P < 0.001) with severity, yielding aHRs of 3.24 (95% CI: 2.49-4.22), 11.9 (95% CI: 8.96-15.9), and 26.1 (95% CI: 19.4-35.2) for mild, moderate, and severe AUD, respectively.The risk of IBS was higher among AUD patients, and increased with the length of hospital stay.
Collapse
Affiliation(s)
- Tai-Yi Hsu
- From the Department of Emergency Medicine, China Medical University Hospital (T-YH, C-YC, W-KC), School of Medicine, College of Medicine, China Medical University, Taichung (T-YH, C-YC, W-KC), Department of Dermatology, National Taiwan University Hospital, Yunlin Branch, Douliou (G-YH), Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei (G-YH), Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (Y-CW), Altitude Research Center, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA (S-HW), Taiwan Wilderness Medical Association, Taipei (S-HW), Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
| | | | | | | | | | | | | |
Collapse
|
40
|
Hoffmann NG, Kopak AM. How Well Do the DSM-5 Alcohol Use Disorder Designations Map to the ICD-10 Disorders? Alcohol Clin Exp Res 2015; 39:697-701. [DOI: 10.1111/acer.12685] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Norman G. Hoffmann
- Department of Psychology; Western Carolina University; Cullowhee North Carolina
| | - Albert M. Kopak
- Department of Criminology & Criminal Justice; Western Carolina University; Cullowhee North Carolina
| |
Collapse
|