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Sanader Vukadinovic B, Karch S, Paolini M, Reidler P, Rauchmann B, Koller G, Pogarell O, Keeser D. Neurofeedback for alcohol addiction: Changes in resting state network activity ✰. Psychiatry Res Neuroimaging 2024; 339:111786. [PMID: 38281353 DOI: 10.1016/j.pscychresns.2024.111786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
Alcohol dependence continues to be a major global burden despite significant research progress and treatment development. The aim of this study was to investigate whether neurofeedback training can alter resting state fMRI activity in brain regions that play a crucial role in addiction disorders in patients with alcohol dependence. For this purpose, a total of 52 patients were recruited for the present study, randomized, and divided into an active and a sham group. Patients in the active group received three sessions of neurofeedback training. We compared the resting state data in the active group as part of the NF training on six measurement days. When comparing the results of the active group from neurofeedback day 3 with baseline 1, a significant reduction in activated voxels in the ventral attention network area was seen. This suggests that reduced activity over the course of therapy in subjects may lead to greater independence from external stimuli. Overall, a global decrease in activated voxels within all three analysed networks compared to baseline was observed in the study. The use of resting-state data as potential biomarkers, as activity changes within these networks, may be to help restore cognitive processes and alcohol abuse-related craving and emotions.
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Affiliation(s)
- B Sanader Vukadinovic
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; University College London Hospitals NHS Foundation Trust (UCLH), London, United Kingdom.
| | - S Karch
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - M Paolini
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - P Reidler
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - B Rauchmann
- Department of Radiology, University Hospital LMU, Munich, Germany
| | - G Koller
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - O Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany
| | - D Keeser
- Department of Psychiatry and Psychotherapy, University Hospital LMU, Munich, Germany; NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany
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2
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Ingesson-Hammarberg S, Jayaram-Lindström N, Hammarberg A. Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking. Addict Sci Clin Pract 2024; 19:12. [PMID: 38388959 PMCID: PMC10882804 DOI: 10.1186/s13722-024-00443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Research is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD. METHODS This study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses. RESULTS BSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption. CONCLUSIONS BSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking. TRIAL REGISTRATION The original study was registered retrospectively at isrtcn.com (14539251).
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Affiliation(s)
- Stina Ingesson-Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
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Lai D, Kuo SIC, Wetherill L, Aliev F, Zhang M, Abreu M, Schwantes-An TH, Dick D, Francis MW, Johnson EC, Kamarajan C, Kinreich S, Kuperman S, Meyers J, Nurnberger JI, Liu Y, Edenberg HJ, Porjesz B, Agrawal A, Foroud T, Schuckit M, Plawecki MH, Bucholz KK, McCutcheon VV. Associations between alcohol use disorder polygenic score and remission in participants from high-risk families and the Indiana Biobank. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:283-294. [PMID: 38054532 PMCID: PMC10922306 DOI: 10.1111/acer.15239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND In the United States, ~50% of individuals who meet criteria for alcohol use disorder (AUD) during their lifetimes do not remit. We previously reported that a polygenic score for AUD (PGSAUD ) was positively associated with AUD severity as measured by DSM-5 lifetime criterion count, and AUD severity was negatively associated with remission. Thus, we hypothesized that PGSAUD would be negatively associated with remission. METHODS Individuals of European (EA) and African ancestry (AA) from the Collaborative Study on the Genetics of Alcoholism (COGA) who met lifetime criteria for AUD, and two EA cohorts ascertained for studies of liver diseases and substance use disorders from the Indiana Biobank were included. In COGA, 12-month remission was defined as any period of ≥12 consecutive months without meeting AUD criteria except craving and was further categorized as abstinent and non-abstinent. In the Indiana Biobank, remission was defined based on ICD codes and could not be further distinguished as abstinent or non-abstinent. Sex and age were included as covariates. COGA analyses included additional adjustment for AUD severity, family history of remission, and AUD treatment history. RESULTS In COGA EA, PGSAUD was negatively associated with 12-month and non-abstinent remission (p ≤ 0.013, βs between -0.15 and -0.10) after adjusting for all covariates. In contrast to the COGA findings, PGSAUD was positively associated with remission (p = 0.004, β = 0.28) in the Indiana Biobank liver diseases cohort but not in the Indiana Biobank substance use disorder cohort (p = 0.17, β = 0.15). CONCLUSIONS PGSAUD was negatively associated with 12-month and non-abstinent remission in COGA EA, independent of behavioral measures of AUD severity and family history of remission. The discrepant results in COGA and the Indiana Biobank could reflect different ascertainment strategies: the Indiana Biobank participants were older and had higher rates of liver disease, suggesting that these individuals remitted due to alcohol-related health conditions that manifested in later life.
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Affiliation(s)
- Dongbing Lai
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Sally I-Chun Kuo
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Fazil Aliev
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - Michael Zhang
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Marco Abreu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Tae-Hwi Schwantes-An
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Danielle Dick
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | | | - Emma C. Johnson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Chella Kamarajan
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Science University, NY
| | - Sivan Kinreich
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Science University, NY
| | - Samuel Kuperman
- Department of Psychiatry, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA
| | - Jacquelyn Meyers
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Science University, NY
| | - John I Nurnberger
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Yunlong Liu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Howard J Edenberg
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
| | - Bernice Porjesz
- Henri Begleiter Neurodynamics Lab, Department of Psychiatry, SUNY Downstate Health Science University, NY
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Marc Schuckit
- Department of Psychiatry, University of California, San Diego Medical School, San Diego, CA
| | - Martin H. Plawecki
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Kathleen K. Bucholz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Vivia V. McCutcheon
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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Watkins LE, Patton SC, Wilcox T, Drexler K, Rauch SAM, Rothbaum BO. Substance Use after Completion of an Intensive Treatment Program with Concurrent Treatment for Posttraumatic Stress Disorder and Substance Use among Veterans: Examining the Role of PTSD Symptoms. J Dual Diagn 2024; 20:16-28. [PMID: 38122816 DOI: 10.1080/15504263.2023.2290167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) are costly and highly co-occurring diagnoses, particularly among veterans, suggesting a need to understand this comorbidity and effectively treat both disorders among this population. METHODS The current study aimed to examine substance use outcomes among post-9/11 veterans and service members (N = 48) who completed a two-week intensive outpatient program with concurrent treatment for and PTSD using Prolonged Exposure and substance use. Substance use was assessed at two weeks and three months posttreatment. RESULTS The intensive program had high completion rates and demonstrated decreases in substance use at two weeks and three months posttreatment. Additionally, lower PTSD symptoms at treatment completion were related to less substance use posttreatment. CONCLUSIONS Concurrent intensive treatment of PTSD and SUDs can lead to symptom improvement in a short period of time. Findings support the self-medication model, such that PTSD symptoms at treatment completion were related to substance use at follow-up.
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Affiliation(s)
| | | | - Tiffany Wilcox
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karen Drexler
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sheila A M Rauch
- Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Robison CL, Cova N, Madore V, Allen T, Barrett S, Charntikov S. Assessment of ethanol and nicotine interactions using a reinforcer demand modeling with grouped and individual levels of analyses in a long-access self-administration model using male rats. Front Behav Neurosci 2023; 17:1291128. [PMID: 38098500 PMCID: PMC10720750 DOI: 10.3389/fnbeh.2023.1291128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
Previous reports have indicated the reciprocal effects of nicotine and ethanol on their rewarding and reinforcing properties, but studies using methodological approaches resembling substance use in vulnerable populations are lacking. In our study, rats first self-administered ethanol, and their sensitivity to ethanol's reinforcing effects was assessed using a reinforcer demand modeling approach. Subsequently, rats were equipped with intravenous catheters to self-administer nicotine, and their sensitivity to nicotine's reinforcing effects was evaluated using the same approach. In the final phase, rats were allowed to self-administer ethanol and nicotine concurrently, investigating the influence of one substance on the rate of responding for the other substance. Group analyses revealed notable differences in demand among sucrose, sweetened ethanol, and ethanol-alone, with sucrose demonstrating the highest demand and ethanol-alone exhibiting greater sensitivity to changes in cost. At the individual level, our study finds significant correlations between rats' demand for sucrose and sweetened ethanol, suggesting parallel efforts for both substances. Our individual data also suggest interconnections in the elasticity of demand for sweetened ethanol and ethanol-alone, as well as a potential relationship in price response patterns between ethanol and nicotine. Furthermore, concurrent self-administration of ethanol and nicotine at the group level displayed reciprocal effects, with reduced responding for nicotine in the presence of ethanol and increased responding for ethanol in the presence of nicotine. This study provides valuable insights into modeling the co-use of ethanol and nicotine and assessing their interaction effects using reinforcer demand modeling and concurrent self-administration or noncontingent administration tests. These findings contribute to our understanding of the complex interplay between ethanol and nicotine and have implications for elucidating the underlying mechanisms involved in polydrug use.
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Affiliation(s)
| | - Nicole Cova
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Victoria Madore
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Tyler Allen
- Department of Psychology, University of New Hampshire, Durham, NH, United States
| | - Scott Barrett
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Sergios Charntikov
- Department of Psychology, University of New Hampshire, Durham, NH, United States
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6
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Dick DM, Balcke E, McCutcheon V, Francis M, Kuo S, Salvatore J, Meyers J, Bierut LJ, Schuckit M, Hesselbrock V, Edenberg HJ, Porjesz B, Kuperman S, Kramer J, Bucholz K. The collaborative study on the genetics of alcoholism: Sample and clinical data. GENES, BRAIN, AND BEHAVIOR 2023; 22:e12860. [PMID: 37581339 PMCID: PMC10550787 DOI: 10.1111/gbb.12860] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/22/2023] [Accepted: 07/19/2023] [Indexed: 08/16/2023]
Abstract
The collaborative study on the genetics of alcoholism (COGA) is a multi-site, multidisciplinary project with the goal of identifying how genes are involved in alcohol use disorder and related outcomes, and characterizing how genetic risk unfolds across development and in conjunction with the environment and brain function. COGA is a multi-generational family-based study in which probands were recruited through alcohol treatment centers, along with a set of community comparison families. Nearly 18,000 individuals from >2200 families have been assessed over a period of over 30 years with a rich phenotypic battery that includes semi-structured psychiatric interviews and questionnaire measures, along with DNA collection and electrophysiological data on a large subset. Participants range in age from 7 to 97, with many having longitudinal assessments, providing a valuable opportunity to study alcohol use and problems across the lifespan. Here we provide an overview of data collection methods for the COGA sample, and details about sample characteristics and comorbidity. We also review key research findings that have emerged from analyses of the COGA data. COGA data are available broadly to researchers, and we hope this overview will encourage further collaboration and use of these data to advance the field.
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Affiliation(s)
- Danielle M. Dick
- Department of PsychiatryRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Emily Balcke
- Department of PsychiatryRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Vivia McCutcheon
- Department of PsychiatryWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
| | - Meredith Francis
- School of Social WorkVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Sally Kuo
- Department of PsychiatryRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Jessica Salvatore
- Department of PsychiatryRutgers Robert Wood Johnson Medical SchoolPiscatawayNew JerseyUSA
| | - Jacquelyn Meyers
- Department of Psychiatry and Behavioral SciencesSUNY Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Laura J. Bierut
- Department of PsychiatryWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
| | - Marc Schuckit
- Department of PsychiatryUniversity of California San Diego School of MedicineLa JollaCaliforniaUSA
| | - Victor Hesselbrock
- Department of PsychiatryUniversity of Connecticut School of MedicineFarmingtonConnecticutUSA
| | - Howard J. Edenberg
- Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Biochemistry and Molecular BiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Bernice Porjesz
- Department of Psychiatry and Behavioral SciencesSUNY Downstate Health Sciences UniversityBrooklynNew YorkUSA
| | - Samuel Kuperman
- Department of PsychiatryUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - John Kramer
- Department of PsychiatryUniversity of Iowa Carver College of MedicineIowa CityIowaUSA
| | - Kathleen Bucholz
- Department of PsychiatryWashington University School of Medicine in St. LouisSt. LouisMissouriUSA
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7
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Azagba S, Ebling T, Shan L. Is socioeconomic status related to youth e-cigarette use? Examining family affluence and sexual identity. Addict Behav 2023; 141:107636. [PMID: 36821881 DOI: 10.1016/j.addbeh.2023.107636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/08/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
There is limited evidence about the relationship between socioeconomic status (SES) and youth electronic cigarette use, particularly among sexual minorities. This study investigates whether family affluence is significantly associated with e-cigarette use among youth, including sexual minority youth. Data came from the 2021 National Youth Tobacco Survey (N = 10,515). The prevalence of e-cigarette use for all participants and sexual minority youth (N = 1376) by SES was calculated and ranked according to the Family Affluence Scale. A propensity score weighting method was used to address the imbalance in characteristics among SES groups. The associations of SES with current e-cigarette use and current flavored e-cigarette use were estimated using univariate survey logistic regression for all participants and self-identified sexual minority students. The prevalence of e-cigarette use was similar among socioeconomic groups for all participants and sexual minorities. The propensity score weighting analysis showed no significant association between SES and current e-cigarette use for all participants and sexual minority students. Equally, there was no significant association between SES and current flavored e-cigarette use. Findings suggest that other protective and risk factors might explain youth e-cigarette use more than SES (family affluence scale).
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Affiliation(s)
- Sunday Azagba
- College of Nursing, The Pennsylvania State University, University Park, PA, United States.
| | - Todd Ebling
- College of Nursing, The Pennsylvania State University, University Park, PA, United States
| | - Lingpeng Shan
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
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8
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Valyear MD, LeCocq MR, Brown A, Villaruel FR, Segal D, Chaudhri N. Learning processes in relapse to alcohol use: lessons from animal models. Psychopharmacology (Berl) 2023; 240:393-416. [PMID: 36264342 DOI: 10.1007/s00213-022-06254-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE Alcohol use is reliably preceded by discrete and contextual stimuli which, through diverse learning processes, acquire the capacity to promote alcohol use and relapse to alcohol use. OBJECTIVE We review contemporary extinction, renewal, reinstatement, occasion setting, and sex differences research within a conditioning framework of relapse to alcohol use to inform the development of behavioural and pharmacological therapies. KEY FINDINGS Diverse learning processes and corresponding neurobiological substrates contribute to relapse to alcohol use. Results from animal models indicate that cortical, thalamic, accumbal, hypothalamic, mesolimbic, glutamatergic, opioidergic, and dopaminergic circuitries contribute to alcohol relapse through separable learning processes. Behavioural therapies could be improved by increasing the endurance and generalizability of extinction learning and should incorporate whether discrete cues and contexts influence behaviour through direct excitatory conditioning or occasion setting mechanisms. The types of learning processes that most effectively influence responding for alcohol differ in female and male rats. CONCLUSION Sophisticated conditioning experiments suggest that diverse learning processes are mediated by distinct neural circuits and contribute to relapse to alcohol use. These experiments also suggest that gender-specific behavioural and pharmacological interventions are a way towards efficacious therapies to prevent relapse to alcohol use.
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Affiliation(s)
- Milan D Valyear
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada. .,Department of Psychology, McGill University, 1205 Ave. Dr. Penfield, Room N8/5, Montréal, QC, H3A 1B1, Canada.
| | - Mandy R LeCocq
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Alexa Brown
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Franz R Villaruel
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Diana Segal
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Nadia Chaudhri
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
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9
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Lubman DI, Grigg J, Reynolds J, Hall K, Baker AL, Staiger PK, Tyler J, Volpe I, Stragalinos P, Harris A, Best D, Manning V. Effectiveness of a Stand-alone Telephone-Delivered Intervention for Reducing Problem Alcohol Use: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:1055-1064. [PMID: 36129698 PMCID: PMC9494267 DOI: 10.1001/jamapsychiatry.2022.2779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022]
Abstract
Importance Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established. Objective To examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample. Design, Setting, and Participants This double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020. Interventions The telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets. Main Outcomes and Measures The primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument. Results This study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis). Conclusions and Relevance Based on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment. Trial Registration ANZCTR Identifier: ACTRN12618000828224.
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Affiliation(s)
- Dan I. Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Tyler
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - David Best
- Department of Criminology, University of Derby, Derby, United Kingdom
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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10
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Jensen ME, Stenbæk DS, Juul TS, Fisher PM, Ekstrøm CT, Knudsen GM, Fink-Jensen A. Psilocybin-assisted therapy for reducing alcohol intake in patients with alcohol use disorder: protocol for a randomised, double-blinded, placebo-controlled 12-week clinical trial (The QUANTUM Trip Trial). BMJ Open 2022; 12:e066019. [PMID: 36241352 PMCID: PMC9577917 DOI: 10.1136/bmjopen-2022-066019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/30/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Alcohol use disorder is a difficult-to-treat psychiatric disorder and a major burden on public health. Existing treatment efficacy is moderate, and relapse rates are high. Preliminary findings suggest that psilocybin, a psychedelic compound, can safely and reliably occasion highly meaningful experiences that may spur a positive change in drinking behaviour when administered in a therapeutic context. However, the efficacy of a single psilocybin administration and its potential neurobiological underpinnings still remain unknown. METHODS AND ANALYSIS To establish efficacy, we will investigate the effects of psilocybin-assisted therapy versus placebo in a randomised, double-blinded, placebo-controlled 12-week clinical trial. Ninety treatment-seeking patients, aged 20-70 years, diagnosed with alcohol use disorder will be recruited from the community via advertisement and referrals from general practitioners or specialised treatment units. The psilocybin or placebo will be administered in accordance with a protocol for psychological support before, during and after the dosing. Outcome assessments will be carried out 1, 4, 8 and 12 weeks postdosing. The primary outcome is reduction in the percentage of heavy drinking days from baseline to follow-up at 12 weeks. Key secondary outcomes are as follows: (1) total alcohol consumption, (2) phosphatidyl-ethanol, an objective biomarker for alcohol, (3) plasma psilocin, the active metabolite, to establish a possible therapeutic range, (4) the acute subjective drug experience as a possible predictor of treatment outcome and (5) neuronal response to alcohol cues and cognitive flexibility within corticostriatal pathways by use of functional MR brain imaging 1-week postdosing. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Committee on Health Research Ethics of the Capital Region of Denmark (H-20043832). All patients will be provided oral and written information about the trial before screening. The study results will be disseminated by peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER EudraCT 2020-000829-55 and NCT05416229.
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Affiliation(s)
| | - Dea Siggaard Stenbæk
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Søgaard Juul
- Psychiatry Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Patrick MacDonald Fisher
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Fink-Jensen
- Psychiatry Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Nagy NES, Ella EIA, Shorab EM, Moneam MHEDA, Tohamy AA. Assessment of addiction management program and predictors of relapse among inpatients of the Psychiatric Institute at Ain Shams University Hospital. MIDDLE EAST CURRENT PSYCHIATRY, AIN SHAMS UNIVERSITY 2022; 29:80. [PMCID: PMC9579533 DOI: 10.1186/s43045-022-00246-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Rehabilitation programs targeted to patients with substance use disorder (SUD) following successful detoxification constitute a global public health concern. This study aimed to examine the effectiveness of a combined pharmacotherapy/cognitive behavior therapy (CBT) model through assessing abstinence/relapse rate and quality of life (QOL) in a sample of patients with SUD. Indeed, we aimed to identify the relapse predictors. Results The relapse rate in the inpatient group was 45.33%, compared to 56% in the outpatient group. Multivariate analysis revealed that patients with educational levels less than secondary school, rural residency, being single or divorced, having cravings lasting for 6 weeks from detoxification, legal history, presence of borderline, antisocial and multiple personality disorder could predict relapse in patients with SUD. Moreover, there was a statistically significant difference between the legal, substance, and social domains of ASI (X2= 12.525, p=0.014; X2= 12.525, p=0.023; and X2= 6.335, p=0.042 respectively) and the majority of QOL domains and relapse. Conclusions Socio-demographic data, legal history, craving, and presence of co-morbid personality disorders along with, legal, substance, and social domains of ASI might be implicated in relapse, suggesting that addiction rehabilitation programs targeting these topics would reduce the risk of relapse.
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Affiliation(s)
- Nahla El Sayed Nagy
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
| | - Eman Ibrahim Abo Ella
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
| | - Eman Mohamed Shorab
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
| | - Mohamed Hossam El-Din Abdel Moneam
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
| | - Arwa Ahmed Tohamy
- grid.7269.a0000 0004 0621 1570Okasha Institute of Psychiatry, Ain Shams University, Abassia, Ramses street extension, P.O. Box 11657, Dair AL-Malak, Cairo Egypt
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12
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Szczypiński J, Jakubczyk A, Kopera M, Trucco E, Wojnar M. Impulsivity Scale-12 and its utilization in alcohol use disorder. Drug Alcohol Depend 2021; 225:108809. [PMID: 34175785 PMCID: PMC8311392 DOI: 10.1016/j.drugalcdep.2021.108809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION One of the core symptoms of alcohol use disorder (AUD) is impulsivity. The recently published study on the Impulsivity Scale 12 (IS-12) offers a promising tool to use in clinics working with clients with AUD due to its simplicity. IS-12 includes subscales related tocognitive impulsivity and behavioral impulsivity, which are related to different aspects of AUD symptomatology. The aim of the study was to adapt IS-12 to polish and test its utility in a sample of patients diagnosed with AUD. METHODS Using a Confirmatory Factor Analysis, we compared the two-factor model of the Polish adaptation of the BIS-11 and the IS-12 on a sample of 615 patients diagnosed with AUD. Additionally, we explored the association between the IS-12's cognitive impulsivity and behavioral impulsivity subscales and depressive symptoms, AUD severity, and suicidal ideation using Structural Equation Modeling on a subsample of 450 patients with AUD. RESULTS The IS-12 demonstrated a better model fit and good reliability compared to the BIS-11. Moreover, cognitive impulsivity predicted suicidal ideation, but not AUD severity, while behavioral impulsivity predicted AUD severity, but not suicidal ideation. Both subscales of IS-12 predicted depressive symptoms. CONCLUSION Consistent with prior work, findings indicate that the second-order factor model of the BIS-11 had reliability issues and evidenced poor model fit. In contrast, the IS-12 demonstrated a satisfactory model fit and was predictive of clinical symptomatology. Thus, utilizing an easy tool, such as IS-12, might be beneficial for researchers and clinicians working with patients with AUD.
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Affiliation(s)
- Jan Szczypiński
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw, Poland; Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Elisa Trucco
- Department of Psychology and the Center for Children and Families, Florida International University, Miami, FL, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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The Prognostic Role of DSM-5 Alcohol Use Disorder Severity and Age of Onset in Treatment Outcome Among Adults Aged 60. J Addict Med 2021; 16:303-309. [PMID: 34282079 DOI: 10.1097/adm.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS To investigate among older adults with DSM-5 alcohol use disorder (AUD) the relevance of (1) baseline DSM-5 AUD severity, (2) age of DSM-5 AUD onset, and (3) the interactions of DSM-5 AUD severity*treatment condition and age of DSM-5 AUD onset*treatment condition for the prediction of AUD treatment outcomes. METHODS The international multicenter RCT "ELDERLY-Study" compared outpatient motivational enhancement therapy (4 sessions) with outpatient motivational enhancement therapy followed by community reinforcement approach for seniors (8 sessions) in adults aged 60+ with DSM-5 AUD. Baseline and 1-, 3-, and 6-month follow-up data from the German and Danish ELDERLY-sites (n = 544) were used (6-month participation rate: 75.9%). DSM-5 AUD diagnoses were obtained using the Mini International Neuropsychiatric Interview and alcohol use using Form 90. Associations between DSM-5 AUD severity and age of onset and AUD treatment outcomes were investigated using multiple logistic regression and generalized linear models. RESULTS The sample was diverse in AUD severity (severe: 54.9%, moderate: 28.2%, mild: 16.9%) and age of onset (median: 50 years; 12-78 years). Overall, with few exceptions, neither AUD severity, nor age of onset, nor their respective interactions with treatment condition significantly predicted drinking outcomes at the different follow-ups (P ≥ 0.05). CONCLUSIONS No indication was found for the need to tailor treatment content according to DSM-5 AUD severity and earlier onset in older adults.
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Koskela M, Piepponen TP, Andressoo JO, Võikar V, Airavaara M. Female C57BL/6J Mice Show Alcohol-Seeking Behaviour after Withdrawal from Prolonged Alcohol Consumption in the Social Environment. Alcohol Alcohol 2021; 57:405-412. [PMID: 33893472 PMCID: PMC9270993 DOI: 10.1093/alcalc/agab032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Aims Recently we developed a model to study alcohol-seeking behaviour after withdrawal in a social context in female mice. The model raised several questions that we were eager to address to improve methodology. Methods In our model, female mice were group-housed in automated cages with three conditioned (CS+) corners and water in both sides of one separate non-conditioned corner. Water was available with opened doors at all the time of training. We established conditioning by pairing alcohol drinking with light cues. Here, we introduced prolonged access to increasing concentrations of alcohol instead of intermittent access. To study motivation to drink alcohol, we carried out the extinction tests on withdrawal days 1 (WD1) and 10 (WD10). During tests, the light cues were present in conditioned corners, but there was no liquid in the bottles. Results We found that the number of visits and nosepokes in the CS+ corner in the alcohol group was much higher than in the water group. Also, during training, the consumption of alcohol was increasing. In the extinction tests, we found that the number of nosepokes in the CS+ corner increased in the alcohol group on both WD1 and WD10. Conclusions Our study supports that alcohol-seeking behaviour after withdrawal can be modelled and studied in group-housed animals and environments without social isolation.
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Affiliation(s)
- Maryna Koskela
- Institute of Biotechnology, HiLIFE, University of Helsinki, PO Box 56, Viikinkaari 5, 00014, Helsinki, Finland.,Neuroscience Center, HiLIFE, University of Helsinki, PO Box 56, Biomedicum, Haartmaninkatu 8, 00014, Helsinki, Finland
| | - T Petteri Piepponen
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, PO Box 56, Viikinkaari 5, 00014, Helsinki, Finland
| | - Jaan-Olle Andressoo
- Department of Translational Neuroscience, Faculty of Medicine, University of Helsinki, PO Box 56, Biomedicum, Haartmaninkatu 8, 00014, Helsinki, Finland
| | - Vootele Võikar
- Neuroscience Center, HiLIFE, University of Helsinki, PO Box 56, Biomedicum, Haartmaninkatu 8, 00014, Helsinki, Finland
| | - Mikko Airavaara
- Institute of Biotechnology, HiLIFE, University of Helsinki, PO Box 56, Viikinkaari 5, 00014, Helsinki, Finland.,Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, PO Box 56, Viikinkaari 5, 00014, Helsinki, Finland.,Neuroscience Center, HiLIFE, University of Helsinki, PO Box 56, Biomedicum, Haartmaninkatu 8, 00014, Helsinki, Finland
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Marlow S, Stahl D, Gilchrist G. Factors associated with women achieving and maintaining abstinence from alcohol: a rapid evidence assessment. ADVANCES IN DUAL DIAGNOSIS 2019. [DOI: 10.1108/add-12-2018-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose
The purpose of this paper is to review the literature on the factors related to women’s ability to achieve and maintain abstinence from alcohol.
Design/methodology/approach
A rapid evidence assessment was carried out in four stages: definitions and research questions were agreed, search and selection were completed, data were extracted, quality of studies was assessed, and findings were synthesised and presented.
Findings
Medline, PsycINFO, CINAHL and ASSIA were searched for cohort studies published in English during January 2000–February 2015. Expanded search terms for Women, Alcohol and Abstinence, and Cohort were used to identify relevant studies for inclusion, resulting in 1,040 records. Of these, 32 manuscripts from 31 studies were eligible for inclusion in the review. Alcohol-related factors such as increased quantity and frequency of alcohol consumption were related to lower likelihood of achieving and maintaining abstinence; treatment factors such as type of treatment and number of treatment episodes were related to higher and lower likelihood; demographic factors such as financial problems and poor housing status were related to lower likelihood; and psychological factors such as craving, other drug use and comorbid health problems were linked to lower likelihood.
Originality/value
To the authors’ knowledge, this is the first time the factors related to the specific outcome of abstinence in women have been synthesised. Many of the factors found are also known to contribute to vulnerability for developing alcohol problems. The review revealed the paucity of studies with female only samples, or where results for women were reported separately.
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Martino F, Caselli G, Fiabane E, Felicetti F, Trevisani C, Menchetti M, Mezzaluna C, Sassaroli S, Albery IP, Spada MM. Desire thinking as a predictor of drinking status following treatment for alcohol use disorder: A prospective study. Addict Behav 2019; 95:70-76. [PMID: 30856546 DOI: 10.1016/j.addbeh.2019.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 10/27/2022]
Abstract
Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk.
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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Tanaree A, Assanangkornchai S, McNeil E. Patient predictors of individual cost of integrated treatment program for alcohol problems at community hospitals in southern Thailand. Asian J Psychiatr 2019; 43:132-136. [PMID: 31136909 DOI: 10.1016/j.ajp.2019.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/08/2019] [Accepted: 05/15/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the average cost of an integrated alcohol intervention program at community hospitals of Thailand and identify patient predictors and sources of variation of the program cost. METHODS Activity-based costing was conducted under a societal perspective among 113 outpatient alcohol users (29 low-risk, 43 high-risk and 41 dependent drinkers), aged 15 years and older, at four community hospitals in southern Thailand. Multivariate regression models were performed to identify individual-level determinants of cost components. RESULTS The average cost per low-risk, high-risk, and dependent drinkers were 516 (16 USD), 2,961 (94 USD), and 5,325 baht (168 USD), respectively, of which labor and patient costs were the major components. Regardless of drinking risk level, past-year functional disturbance lasting more than 20 days (β = 0.215, p = 0.035) and increasing number of previous treatment episodes (β = 0.035, p = 0.046) independently increased overall program cost. Variation in the program cost was mainly caused by length of hospital stay followed by staff time for screening and delivering interventions. CONCLUSION The study underlines the important role of pretreatment alcohol-related problems and human resources in alcohol intervention programs. Efforts should be focused on adequacy of treatment for the very first episode of alcohol problems to reduce the high healthcare costs.
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Affiliation(s)
- Athip Tanaree
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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Frequency and Predictors of Alcohol-Related Outcomes Following Alcohol Residential Rehabilitation Programs: A 12-Month Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050722. [PMID: 30823386 PMCID: PMC6427603 DOI: 10.3390/ijerph16050722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 01/12/2023]
Abstract
Excessive use of alcohol has been identified as a major risk factor for diseases, injury conditions and increased mortality. The aims of this study were to estimate the frequency of success (abstinence and no alcohol related hospitalization) at 6- and 12-month follow-up after hospital discharge, and to identify the predictors of success. In 2009, a total of 1040 patients at their first admission in one of the 12 Residential Alcohol Abuse Rehabilitation Units (RAARUs) participating in the CORRAL (COordinamento of Residenzialità Riabilitative ALcologiche) project were included in the study. Several socio-demographic and clinical variables, and the number of treatments' strategies during the rehabilitation were collected. Information on alcohol abstinence and no alcohol related hospitalization was assessed through a phone interview using a health worker-administered structured questionnaire at six and 12 months after discharge. An inverse probability weighted, repeated measures Poisson regression model with robust variance was applied to estimate the association between patients' characteristics and the study's outcomes, accounting for non-responders status. The frequencies of abstinence and non-alcohol related hospitalization were 68.38% and 90.73% at six months, respectively, and 68.65% and 87.6% at 12 months, respectively. Patients that were already abstainers in the month before RAARUs' admission have an increased probability of being abstainers after discharge (relative risk: RR 1.20, 95% confidence interval: 95%CI 1.08⁻1.33) and of having an alcohol related hospitalization at 12 months. Subjects undergoing more than four treatment strategies (RR 1.19; 95% CI 1.01⁻1.40) had a higher abstinence probability and lower probability of no alcohol related hospitalizations after 12 months. Finally, patients with dual diagnosis (co-occurrence of alcohol abuse/dependence and psychiatric disorders) have a decreased probability of not being hospitalized for alcohol-related problems (RR 0.95; 95% CI 0.91⁻0.99). The results of this study suggest that specific attention should be paid to the intensity of treatment, with particular regard to a multidisciplinary rehabilitation in order to respond to the complexity of alcohol dependent patients.
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Effectiveness of a national 'Minnesota Model' based residential treatment programme for alcohol dependence in Ireland: outcomes and predictors of outcome. Ir J Psychol Med 2018; 35:33-41. [PMID: 30115205 DOI: 10.1017/ipm.2017.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aims of this study were (a) to examine the effectiveness of an inpatient treatment programme for alcohol dependence based on the 'Minnesota Model' and (b) to examine potential predictors of outcomes from such treatment. METHODS Demographics and data relating to psychosocial functioning of a group of individuals who commenced treatment for alcohol dependence were gathered at the point of treatment entry. These individuals were then followed up 6 months after they were to complete their inpatient treatment to establish their alcohol-related outcomes. Outcomes from treatment were identified as an index of treatment effectiveness and the outcome data were analysed to determine whether any of the baseline variables could be used to predict outcomes from treatment. RESULTS Of those who were contacted at 6-month follow-up, 81.5% had a 'good outcome'. This represented 66.7% of the total group who participated in the study. The only variable that was found to predict outcomes at 6-month follow-up was severity of alcohol dependence at treatment entry, with more severe alcohol problems associated with poorer outcomes. CONCLUSIONS This study provides evidence of the potential for a Minnesota-based treatment programme to be effective in helping people with alcohol dependence to reduce the amount of alcohol they consume and sustain this reduction beyond the treatment period.
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Kadam M, Sinha A, Nimkar S, Matcheswalla Y, De Sousa A. A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence. Indian J Psychol Med 2017; 39:627-633. [PMID: 29200559 PMCID: PMC5688890 DOI: 10.4103/ijpsym.ijpsym_356_17] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Alcohol and opiates are among the most addictive substances posing significant public health problems due to the biopsychosocial impact that they have on individuals. Research shows that majority of abstinent alcohol and/or opioid dependence subjects relapse within 1 year. It has also been estimated that 26-36 million people worldwide abuse opiates, with exceptionally high-relapse rates. The purpose of this study was to compare the sociodemographic factors and correlates relapse in alcohol dependence and opioid dependence. METHODOLOGY This research uses a cross-sectional comparative study design with a sample size of 60 drawn from a population of clinically diagnosed patients of alcohol dependence (n = 30) or opioid dependence (n = 30) and seeking treatment for relapse. In addition to collecting sociodemographic data, other factors such as craving, affect, self-efficacy, and expressed emotions were measured using standardized instruments including brief substance craving scale, Bradburn affect balance scale, drug avoidance and self-efficacy scale and family emotional involvement, and conflict scale. The data were statistically analyzed. RESULTS Disparity in sociodemographic factors was seen in both the groups with opioid group being more likely to be single, unemployed, belonging to lower socioeconomic status, and having a criminal record (P = 0.025). Among factors associated with relapse, the opioid group scored significantly higher on craving, perceived criticism (P = 0.0001), and lower on self-efficacy (P = 0.016). Most common reason cited for relapse in both the groups was desire for positive mood. CONCLUSION This study highlights the role of social determinants in drug dependence and relapse. Relapse was found to be a complex multifactorial phenomenon. Despite differences in presentation, somewhat similar relapse mechanisms were seen in both groups.
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Affiliation(s)
- Maithili Kadam
- Department of Psychiatry, Grant Government Medical College, J.J. Hospital, Mumbai, Maharashtra, India
| | - Ankita Sinha
- Department of Psychiatry, Grant Government Medical College, J.J. Hospital, Mumbai, Maharashtra, India
| | - Swateja Nimkar
- Department of Health Services, University of Southern Indiana, Evansville, USA
| | - Yusuf Matcheswalla
- Department of Psychiatry, Grant Government Medical College, J.J. Hospital, Mumbai, Maharashtra, India
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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Bazargan-Hejazi S, De Lucia V, Pan D, Mojtahedzadeh M, Rahmani E, Jabori S, Zahmatkesh G, Bazargan M. Gender Comparison in Referrals and Treatment Completion to Residential and Outpatient Alcohol Treatment. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:109-116. [PMID: 28008266 PMCID: PMC5170882 DOI: 10.4137/sart.s39943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/04/2016] [Accepted: 07/11/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Residential treatment for alcoholism is associated with high completion rates for clients, yet there appear to be gender disparities in patient referrals and treatment completion rates. We studied whether (A) gender is associated with differential patient placement to outpatient vs. residential treatment facilities and (B) completion rates differ by gender. METHODS In this cross-sectional study, we analyzed the admission and discharge data from 185 publicly funded substance abuse treatment facilities across Los Angeles County between 2005 and 2010. RESULTS Among the 33,745 studied cases, women were referred to residential treatment facilities less frequently than men (75% vs. 66%). The adjusted results derived from logistic regression models confirmed that females were more likely to be referred to outpatient treatment than to residential treatment facilities (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.05–1.26). In addition, we observed that compared to White/Caucasian patients, all other races were associated with more referral to outpatient facilities (ie, less referral to residential facilities), indicating a racial disparity on the top of the observed gender disparity. However, there was no significant link between gender and treatment completion rates (OR: 0.93, 95% CI: 0.86–1.00). CONCLUSIONS Women seem to have treatment completion rates comparable to men, yet they are less likely to be referred to residential treatment facilities. Hence, there still remains a gender disparity in alcoholic patient referrals. Further studies should delineate which specific therapeutic aspects and programmatic components of women-focused treatments are essential to augment positive treatment outcomes.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles CA, USA.; Department of Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Valory De Lucia
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Deyu Pan
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Mona Mojtahedzadeh
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Elham Rahmani
- School of Public Health, Boston University, Boston, MA, USA
| | - Sinan Jabori
- University of California at Los Angeles, Los Angeles, CA, USA
| | - Golara Zahmatkesh
- School of Medicine, University of California at Irvine, Irvine, CA, USA
| | - Mohsen Bazargan
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Haug S, Schaub MP. Treatment outcome, treatment retention, and their predictors among clients of five outpatient alcohol treatment centres in Switzerland. BMC Public Health 2016; 16:581. [PMID: 27422382 PMCID: PMC4947295 DOI: 10.1186/s12889-016-3294-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/12/2016] [Indexed: 11/11/2022] Open
Abstract
Background Few studies have reported on the outcomes of outpatient alcohol treatment or the factors associated with effective treatment. We investigated treatment outcome, treatment retention, and their predictors in clients receiving outpatient treatment for alcohol misuse. Methods Naturalistic, longitudinal multi-centre study in Switzerland that included 858 clients receiving outpatient treatment for alcohol misuse. Assessments were conducted at treatment admission, discharge, and 6- and 12-month follow-ups. Non-problem drinking was used as an indicator of positive treatment outcome. Results Clients admitted to outpatient alcohol treatment were highly heterogeneous in terms of pre-treatment alcohol use and drinking goals. 45 % of clients exhibiting problem drinking at the beginning of treatment showed non-problem drinking at discharge, and 41 % and 43 % showed non-problem drinking at the 6- and 12-month follow-up, respectively; 51 % were discharged regularly and 43 % were discharged irregularly. Non-problem drinking at the 12-month follow-up was more likely in clients with a higher life satisfaction, those with lower alcohol use, those aiming for alcohol abstinence, and those who had been admitted for the first time to a treatment institution, whereas it was less likely in clients with a higher educational level. Treatment retention was higher among older clients, clients with a higher life satisfaction, and clients who subsisted on their own income. Conclusion Irregular discharge is high in outpatient alcohol treatment; nevertheless, a substantial portion of clients can achieve and maintain non-problem drinking by a 12-month follow-up.
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Affiliation(s)
- Severin Haug
- Swiss Research Institute for Public Health and Addiction, Zurich University, Konradstrasse 32, CH- 8031, Zurich, Switzerland.
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, Zurich University, Konradstrasse 32, CH- 8031, Zurich, Switzerland
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Jakubczyk A, Ilgen MA, Kopera M, Krasowska A, Klimkiewicz A, Bohnert A, Blow FC, Brower KJ, Wojnar M. Reductions in physical pain predict lower risk of relapse following alcohol treatment. Drug Alcohol Depend 2016; 158:167-71. [PMID: 26653340 PMCID: PMC4698033 DOI: 10.1016/j.drugalcdep.2015.11.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/08/2015] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Physical pain is considered a potential predictor of relapse in alcohol-dependent individuals after treatment. The aim of this study was to evaluate whether reductions in pain level during the follow-up period after treatment were associated with lower relapse risk. METHOD A sample of 366 participants was recruited from alcohol treatment centers in Warsaw, Poland. At baseline, information was obtained about pain level, demographics, childhood abuse, impulsivity, depressive symptoms, severity of alcohol and sleep problems. After finishing the alcohol treatment program, patients were followed for 12 months and alcohol drinking (relapse) as well as pain severity were evaluated. RESULTS In the followed-up group, 29.5% of patients confirmed that they drank any alcohol during past 4 weeks. Comparing follow-up to baseline pain, 48.6% of subjects reported an increased severity of pain, 28.8% reported the same level of pain, 22.6% reported decreased level of pain. There was a significant association between the decrease in level of pain and the lower risk of relapse. Other factors associated with relapse during 4 weeks prior to the follow-up were baseline severity of depressive symptoms, low baseline social support and number of drinking days during 4 weeks prior to entering treatment. In multivariate analysis, a decrease in pain level was associated with a lower likelihood of relapse (OR=0.159; 95%CI:0.04-0.62; p=0.008) even when controlled for other factors associated with relapse. CONCLUSIONS Decreases in pain level following treatment for alcohol dependence are associated with, and may contribute to, a lower risk of alcohol relapse.
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Affiliation(s)
- A Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665 Warsaw, Poland.
| | - MA Ilgen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System
| | - M Kopera
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665 Warsaw, Poland.
| | - A Krasowska
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665 Warsaw, Poland.
| | - A Klimkiewicz
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665 Warsaw, Poland.
| | - A Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, USA.
| | - FC Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System
| | - KJ Brower
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - M Wojnar
- Department of Psychiatry, Medical University of Warsaw, 27 Nowowiejska St., 00-665 Warsaw, Poland; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
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Jakubczyk A, Ilgen MA, Bohnert ASB, Kopera M, Krasowska A, Klimkiewicz A, Blow FC, Brower KJ, Wojnar M. Physical Pain in Alcohol-Dependent Patients Entering Treatment in Poland—Prevalence and Correlates. J Stud Alcohol Drugs 2015; 76:607-14. [PMID: 26098037 DOI: 10.15288/jsad.2015.76.607] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Chronic pain and problematic alcohol use commonly co-exist, as the use of alcohol is commonly considered a useful pain self-management strategy. The purpose of this study was to characterize pain and pain-related problems in a group of primary alcohol-dependent individuals entering treatment facilities. METHOD A sample of 366 (73.5% men and 26.5% women) alcohol-dependent (according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria) subjects was recruited in alcohol treatment centers in Warsaw, Poland. Information was obtained about demographics, social functioning, sexual and physical abuse during childhood, and severity of alcohol and sleep problems as well as level of impulsivity and general psychopathology. The study group was divided into a "mild or no pain" group and a "moderate or greater pain" group. RESULTS Among the study group, 34.4% of individuals reported moderate or greater physical pain during the last 4 weeks. The statistical analysis revealed that the experience of physical pain was significantly associated with lower level of education, unemployment, experience of sexual abuse before 18 years of age, and severity of alcohol dependence as well as other potential predictors of relapse (impulsivity, sleep problems, general psychopathology). When entered into logistic regression analysis with other dependent variables, the level of general psychopathology, severity of sleep problems, age, and education were all significantly associated with pain severity. CONCLUSIONS Physical pain is a prevalent and potentially impairing experience in adults seeking treatment for alcohol dependence. Therapeutic interventions aimed at reducing pain in alcohol-dependent individuals should be studied to evaluate their impact on improving overall treatment outcomes.
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Affiliation(s)
- Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Mark A Ilgen
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Amy S B Bohnert
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | | | - Anna Klimkiewicz
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Frederic C Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Kirk J Brower
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Steffen D, Steffen L, Steffen S. Sozialmedizinische Prognose der Entzugsbehandlung Suchtkranker. DER NERVENARZT 2015; 86:1383-92. [DOI: 10.1007/s00115-015-4300-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stuyt EB. Enforced abstinence from tobacco during in-patient dual-diagnosis treatment improves substance abuse treatment outcomes in smokers. Am J Addict 2015; 24:252-257. [PMID: 25907814 DOI: 10.1111/ajad.12179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although the prevalence of tobacco use in those in substance abuse treatment is known to be quite high, most treatment programs do not address tobacco. The purpose of this study was to determine substance abuse recovery rates a year after treatment in a fully integrated, 90-day inpatient, dual diagnosis treatment program where patients are required to quit tobacco use in addition to drug and alcohol use for the duration of their 3 month stay. Tobacco is treated in the same way as other drugs and alcohol. METHODS One hundred fifty-four patients enrolled in a yearlong follow-up after treatment study consisting of monthly phone contact to assess recovery from substance abuse. RESULTS One hundred forty (n=140) patients completed the year follow-up. At the time of entry into the program 120 (86%) were using tobacco daily. At the end of the year this decreased to 102 (73%). Patients who were using tobacco were more likely to relapse to other drugs or alcohol (p = .01). Patients who actively attempted to abstain from tobacco after treatment were significantly more likely to remain continuously abstinent throughout the year (p = .03). CONCLUSIONS This study demonstrates that tobacco use is correlated with relapse and addressing tobacco in treatment as seriously as and in the same fashion as other drugs, improves outcomes. SCIENTIFIC SIGNIFICANCE When provided with a tobacco free treatment environment for 90 days, patients with substance abuse and mental illness can and do make the decision to quit tobacco and stay quit, aiding their ability to remain sober.
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Affiliation(s)
- Elizabeth B Stuyt
- Department of Psychiatry, University of Colorado, Denver, Colorado
- Circle Program, Colorado Mental Health Institute at Pueblo, Pueblo, Colorado
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Haug S, Lucht MJ, John U, Meyer C, Schaub MP. A Pilot Study on the Feasibility and Acceptability of a Text Message-Based Aftercare Treatment Programme Among Alcohol Outpatients. Alcohol Alcohol 2015; 50:188-94. [DOI: 10.1093/alcalc/agu107] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Flórez G, Saiz PA, García-Portilla P, De Cos FJ, Dapía S, Alvarez S, Nogueiras L, Bobes J. Predictors of posttreatment drinking outcomes in patients with alcohol dependence. Eur Addict Res 2015; 21:19-30. [PMID: 25358471 DOI: 10.1159/000358194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 12/23/2013] [Indexed: 11/19/2022]
Abstract
AIM This cohort study examined how predictors of alcohol dependence treatment outcomes work together over time by comparing pretreatment and posttreatment predictors. METHODS A sample of 274 alcohol-dependent patients was recruited and assessed at baseline, 6 months after treatment initiation (end of the active intervention phase), and 18 months after treatment initiation (end of the 12-month research follow-up phase). At each assessment point, the participants completed a battery of standardized tests [European Addiction Severity Index (EuropASI), Obsessive Compulsive Drinking Scale (OCDS), Alcohol Timeline Followback (TLFB), Fagerström, and International Personality Disorder Examination (IPDE)] that measured symptom severity and consequences; biological markers of alcohol consumption were also tested at each assessment point. A sequential strategy with univariate and multivariate analyses was used to identify how pretreatment and posttreatment predictors influence outcomes up to 1 year after treatment. RESULTS Pretreatment variables had less predictive power than posttreatment ones. OCDS scores and biological markers of alcohol consumption were the most significant variables for the prediction of posttreatment outcomes. Prior pharmacotherapy treatment and relapse prevention interventions were also associated with posttreatment outcomes. CONCLUSIONS The findings highlight the positive impact of pharmacotherapy during the first 6 months after treatment initiation and of relapse prevention during the first year after treatment and how posttreatment predictors are more important than pretreatment predictors.
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Affiliation(s)
- Gerardo Flórez
- Addiction Treatment Unit, Department of Psychiatry CHUO, Galician Health System, Ourense, Spain
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Quality of life, alcohol detoxification and relapse: is quality of life a predictor of relapse or only a secondary outcome measure? Qual Life Res 2014; 23:2757-67. [PMID: 24929832 DOI: 10.1007/s11136-014-0735-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To estimate variations in Overall Quality Of Life (OQOL) within 12 months following alcohol detoxification and to evaluate the predictive value of OQOL for relapse and alcohol use severity. METHODS Alcohol use disorders and four OQOL domains (physical health, psychological health, social relationships and environment) were assessed in 199 patients entering in-patient alcohol detoxification. Follow-up assessments were performed at 6 and 12 months after discharge. Cross-sectional and longitudinal analyses explored the relationship between OQOL and alcohol use severity, examining differences between abstinent and relapsed patients. The predictive value of OQOL was analyzed by logistic and linear regression. RESULTS Correlation between OQOL and Alcohol Use Disorders Identification Test scores was confirmed at all stages of observation. Abstinent patients showed a significant improvement in all OQOL domains at 6 months after discharge, whereas OQOL domains did not undergo any significant change in relapsed patients. Baseline OQOL did not prove to be predictive of either relapse or alcohol use severity. CONCLUSIONS Overall quality of life changed in parallel with alcohol use severity throughout the duration of the study, confirming it to be a useful and sensitive measure of secondary outcome for alcohol detoxification. Conversely, none of the OQOL baseline scores functioned as predictors of relapse within 12 months following discharge or alcohol use severity in relapsed patients.
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Sugarman DE, Kaufman JS, Trucco EM, Brown JC, Greenfield SF. Predictors of drinking and functional outcomes for men and women following inpatient alcohol treatment. Am J Addict 2014; 23:226-33. [PMID: 24724879 PMCID: PMC3986726 DOI: 10.1111/j.1521-0391.2014.12098.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This prospective study uses path analytic models to examine baseline characteristics associated with both functioning and drinking outcomes 12 months after inpatient alcohol treatment. METHODS Alcohol-dependent participants (N = 101) were recruited during inpatient alcohol treatment and assessed monthly 1 year after discharge. RESULTS Alcohol severity was negatively associated with education and self-efficacy; marital status was positively associated with self-efficacy; and education and self-efficacy were negatively associated with drinking outcomes. Low alcohol severity, not having a depression diagnosis, and being married were associated with less social support impairment, which was in turn associated with better drinking outcomes. Having a history of sexual abuse did not influence drinking outcomes. However, having a history of sexual abuse was negatively associated with global functioning. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Drinking outcomes were associated with education, self-efficacy, social support, and diagnosis of depression at baseline; however, global functioning 1 year following treatment was primarily and negatively associated with sexual abuse history. Future treatment research should include measures of both functioning and drinking behavior outcomes.
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Affiliation(s)
- Dawn E. Sugarman
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, 115 Mill Street, Belmont, MA
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA
| | - Julia S. Kaufman
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, 115 Mill Street, Belmont, MA
- Department of Psychology, Miami University, 100 Psychology Building, Oxford, OH
| | - Elisa M. Trucco
- Department of Psychiatry, Addiction Research Center, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI
| | - Jodi C. Brown
- Department of Social Work, College of Social and Behavioral Sciences, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA
| | - Shelly F. Greenfield
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, 115 Mill Street, Belmont, MA
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA
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Schellekens AFA, de Jong CAJ, Buitelaar JK, Verkes RJ. Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment. Eur Psychiatry 2014; 30:128-36. [PMID: 24630346 DOI: 10.1016/j.eurpsy.2013.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Alcohol dependence and anxiety disorders often co-occur. Yet, the effect of co-morbid anxiety disorders on the alcohol relapse-risk after treatment is under debate. This study investigated the effect of co-morbid anxiety disorders on relapse rates in alcohol dependence. We hypothesized that co-morbid anxiety disorders would be particularly predictive for early relapse, but not late relapse. SUBJECTS AND METHODS In a prospective design, male alcohol dependent patients (n=189) were recruited from an inpatient detoxification clinic. Psychiatric diagnoses and personality traits were assessed using the Mini International Neuropsychiatric Interview for psychiatric disorders and the Temperament and Character Inventory. The addiction severity index was used to assess addiction severity and follow-up. RESULTS One year after detoxification, 81 patients (53%) relapsed and nine patients (7%) were deceased, due to alcohol related causes. Co-morbid anxiety disorder, marital status, addiction severity, in particular legal problems, and harm avoidance predicted relapse. Anxiety disorders specifically predicted early relapse. CONCLUSION Alcohol dependence is a severe mental disorder, with high relapse rates and high mortality. Alcohol dependent patients with co-morbid anxiety disorders are particularly prone to relapse during the first three months of treatment. These patients may therefore require additional medical and psychological attention.
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Affiliation(s)
- A F A Schellekens
- Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands; Nijmegen Institute for Science Practitioners in Addiction (NISPA).
| | - C A J de Jong
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)
| | - J K Buitelaar
- Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands
| | - R J Verkes
- Department of Cognitive Neuroscience, University Medical Centre
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Wilden JA, Qing KY, Hauser SR, McBride WJ, Irazoqui PP, Rodd ZA. Reduced ethanol consumption by alcohol-preferring (P) rats following pharmacological silencing and deep brain stimulation of the nucleus accumbens shell. J Neurosurg 2014; 120:997-1005. [PMID: 24460492 DOI: 10.3171/2013.12.jns13205] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECT There is increasing interest in deep brain stimulation (DBS) for the treatment of addiction. Initial testing must be conducted in animals, and the alcohol-preferring (P) rat meets the criteria for an animal model of alcoholism. This study is composed of 2 experiments designed to examine the effects of 1) pharmacological inactivation and 2) DBS of the nucleus accumbens shell (AcbSh) on the consumption of alcohol by P rats. METHODS In the first experiment, the effects of reversible inactivation of the AcbSh were investigated by administering intracranial injections of γ-aminobutyric acid (GABA) agonists. Bilateral microinjections of drug were administered to the AcbSh in P rats (8-10 rats/group), after which the animals were placed in operant chambers containing 2 levers--one used to administer water and the other to administer 15% EtOH--to examine the acquisition and maintenance of oral EtOH self-administration. In the second experiment, a DBS electrode was placed in each P rat's left AcbSh. The animals then received 100 or 200 μA (3-4 rats/group) of DBS to examine the effect on daily consumption of oral EtOH in a free-access paradigm. RESULTS In the first experiment, pharmacological silencing of the AcbSh with GABA agonists did not decrease the acquisition of EtOH drinking behavior but did reduce EtOH consumption by 55% in chronically drinking rats. Similarly, in the second experiment, 200 μA of DBS consistently reduced EtOH intake by 47% in chronically drinking rats. The amount of EtOH consumption returned to baseline levels following termination of therapy in both experiments. CONCLUSIONS Pharmacological silencing and DBS of the AcbSh reduced EtOH intake after chronic EtOH use had been established in rodents. The AcbSh is a neuroanatomical substrate for the reinforcing effects of alcohol and may be a target for surgical intervention in cases of alcoholism.
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Affiliation(s)
- Jessica A Wilden
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Farren CK, Murphy P, McElroy S. A 5-Year Follow-Up of Depressed and Bipolar Patients with Alcohol Use Disorder in an Irish Population. Alcohol Clin Exp Res 2014; 38:1049-58. [DOI: 10.1111/acer.12330] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Conor K. Farren
- Trinity College Dublin; St Patrick's University Hospital; Dublin Ireland
| | - Philip Murphy
- Trinity College Dublin; St Patrick's University Hospital; Dublin Ireland
| | - Sharon McElroy
- Trinity College Dublin; St Patrick's University Hospital; Dublin Ireland
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Klimkiewicz A, Jakubczyk A, Wnorowska A, Klimkiewicz J, Bohnert A, Ilgen MA, Brower KJ, Wojnar M. Violent behavior and driving under the influence of alcohol: prevalence and association with impulsivity among individuals in treatment for alcohol dependence in Poland. Eur Addict Res 2014; 20:151-8. [PMID: 24356779 DOI: 10.1159/000356192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Driving while intoxicated or under the influence (DUI; for the purposes of this paper, we use the following terms synonymously: driving under the influence, driving while intoxicated, and drunk driving) and engaging in interpersonal violence are two injury-related problems of high public health importance that have both been linked to alcohol consumption. This study sought to estimate the prevalence of DUI and violence in a sample of individuals in treatment for alcohol dependence in Poland. Patient characteristics associated with DUI and violence involvement, with a particular focus on impulsivity, were examined. METHODS Three hundred and sixty-four patients consecutively admitted to four alcohol treatment programs in Warsaw, Poland participated in this study. Questions concerning history of interpersonal violence as well as those about DUI were derived from the Michigan Alcoholism Screening Test. Impulsivity level was measured using the Barratt Impulsiveness Scale 11, the Revised NEO Personality Inventory, and the stop-signal task. RESULTS Among all participants in the study, 148 (40.1%) had been arrested in the past for DUI, and 196 (55%) reported involvement in a fight under the influence of alcohol (FUI). The DUI group had a significantly earlier onset of alcohol problems, a longer period of heavy alcohol use, and fewer women in comparison to participants without a DUI history. FUI patients were significantly younger, with a younger average age of onset of drinking problems, longer period of heavy drinking, and lower percentage of women than the non-FUI group. CONCLUSION Both of the self-reported measures of impulsivity indicated a higher level of impulsivity among participants from the FUI group than those from the non-FUI group.
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Affiliation(s)
- Anna Klimkiewicz
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
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van Amsterdam J, van den Brink W. Reduced-risk drinking as a viable treatment goal in problematic alcohol use and alcohol dependence. J Psychopharmacol 2013; 27:987-97. [PMID: 23824247 DOI: 10.1177/0269881113495320] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review describes and discusses studies related to reduced-risk drinking as an additional treatment option for patients with problematic alcohol use and alcohol dependence. The review provides some empirical support for the following statements: (a) reduced-risk drinking is a viable option for at least some problem and dependent drinkers; (b) abstinence and non-abstinence-based treatments appear to be equally effective; (c) allowing patients to choose their treatment goal increases the success rate. The relatively short follow-up period (1-2 years) of the studies hampers a proper evaluation of the added value of the reduced-risk drinking approach.
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Affiliation(s)
- Jan van Amsterdam
- 1Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
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Yoshimura A, Kimura M, Nakayama H, Matsui T, Okudaira F, Akazawa S, Ohkawara M, Cho T, Kono Y, Hashimoto K, Kumagai M, Sahashi Y, Roh S, Higuchi S. Efficacy of disulfiram for the treatment of alcohol dependence assessed with a multicenter randomized controlled trial. Alcohol Clin Exp Res 2013; 38:572-8. [PMID: 24117666 DOI: 10.1111/acer.12278] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The efficacy of disulfiram in preventing an alcoholic relapse has been controversial. The aim of our study was to assess the efficacy of supervised disulfiram for the treatment of alcohol dependence with a multi-institutional study in Japan. METHODS In a single-blinded, randomized placebo-controlled study, we recruited 109 patients diagnosed with alcohol dependence under ICD-10 criteria. The patients were randomly allocated to 4 treatment groups, depending on whether they took disulfiram (200 mg daily) or a placebo or whether they received adjunctive therapy consisting of mailed letters which delineated and emphasized the harmful effect of alcohol and the management of alcohol craving. The proportion of abstinence among the 4 groups at 26 weeks after discharge was the primary outcome measure. The proportion of abstinence was compared with the severity of alcohol dependence and craving. Furthermore, we examined the proportion of abstinence in patients with inactive aldehyde dehydrogenase-2 (ALDH2). RESULTS There were no significant differences among the 4 groups in terms of abstinent patients or study dropouts. The ratio of abstinence was not related to the severity of alcohol dependence or the degree of alcohol craving. Patients with inactive ALDH2 significantly sustained abstinence with the use of disulfiram (p = 0.044). CONCLUSIONS Supervised oral disulfiram use followed by intervention via letters seems to be ineffective for increasing abstinence. Further studies are necessary to prove the efficacy of disulfiram for the pharmacological treatment of alcohol dependence. We indicated the effectiveness of disulfiram for the maintenance of abstinence in patients with inactive ALDH2.
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Affiliation(s)
- Atsushi Yoshimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
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Levola J, Kaskela T, Holopainen A, Sabariego C, Tourunen J, Cieza A, Pitkänen T. Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions. Disabil Rehabil 2013; 36:1227-39. [DOI: 10.3109/09638288.2013.837104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Timko C, Bonn-Miller MO, McKellar J, Ilgen M. Detoxification History and 2-Year Outcomes of Substance Use Disorder Treatment and Mutual-Help Group Participation. JOURNAL OF DRUG ISSUES 2013. [DOI: 10.1177/0022042613491102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about detoxification (detox) history as a risk factor for poor treatment outcomes among dually diagnosed (substance use and other mental health disorders) patients. We compared patients with a detox history with those who had never received detox on baseline characteristics, subsequent treatment and mutual-help group participation, and substance use and related outcomes at 6-month, 1-year, and 2-year follow-ups. Having a detox history was associated with poorer status at treatment intake, but detoxed patients were functioning as well as never-detoxed patients on alcohol and drug use severity 2 years later. However, having a detox history at baseline was associated with poorer psychological and legal functioning at follow-ups. Assessing detox history in mental health programs would be feasible to implement routinely. Targeting more comprehensive mental health, case management, and 12-step facilitation services to dually diagnosed patients with a history of detox may improve mental health and criminal involvement status.
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Affiliation(s)
- Christine Timko
- Department of Veterans Affairs Health Care System, Palo Alto, CA, USA
- Stanford University Medical Center, Palo Alto, CA
| | - Marcel O. Bonn-Miller
- Department of Veterans Affairs Health Care System, Palo Alto, CA, USA
- Stanford University Medical Center, Palo Alto, CA
- Department of Veterans Affairs Center of Excellence in Substance Abuse Treatment and Education, Philadelphia, PA, USA
| | - John McKellar
- Department of Veterans Affairs Health Care System, Palo Alto, CA, USA
- Stanford University Medical Center, Palo Alto, CA
- Department of Veterans Affairs Central Office, Washington, DC, USA
| | - Mark Ilgen
- Department of Veterans Affairs Health Care System, Ann Arbor, MI, USA
- University of Michigan, Ann Arbor, MI, USA
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Jakubczyk A, Klimkiewicz A, Kopera M, Krasowska A, Wrzosek M, Matsumoto H, Burmeister M, Brower KJ, Wojnar M. The CC genotype in the T102C HTR2A polymorphism predicts relapse in individuals after alcohol treatment. J Psychiatr Res 2013; 47:527-33. [PMID: 23321485 PMCID: PMC3581721 DOI: 10.1016/j.jpsychires.2012.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/09/2012] [Accepted: 12/14/2012] [Indexed: 12/14/2022]
Abstract
The serotonin system is hypothesized to contribute to predisposition and course of alcohol dependence. However, the potential association between the T102C polymorphism (rs6313) in the type 2A serotonin receptor (HTR2A) gene and treatment outcomes in alcohol dependence has not been investigated. The aim of the study was to assess the contribution of this genetic polymorphism as a predictor of relapse in relation to other previously identified predictors. A sample of 254 alcohol dependent subjects, were recruited in alcohol treatment centers in Warsaw, Poland and prospectively assessed at baseline and follow-up after 12 months. At baseline, information about demographics, psychopathological symptoms and alcohol problems was obtained. The stop-signal task was performed and blood samples for genetic analysis of HTR2A T102C (rs6313) were collected. Relapse was defined as any drinking during the follow-up period. The statistical analysis showed that the CC genotype was significantly associated with increased relapse. Other significant factors were baseline depressive symptoms, number of drinking days during the 3 months prior to the baseline assessment, severity of alcohol-related problems, and a lifetime history of impulsive suicide attempts. Logistic regression analysis with and without the genetic factor revealed that adding the genetic factor increased the R square value by about 4%, with the CC genotype in the T102C polymorphism being the strongest predictor of relapse (OR = 2.32). The significant influence on relapse of the CC genotype, which is associated with fewer 5-HT2A receptors in the central nervous system, suggests the possibility that this genetic polymorphism could influence response to serotonergic medications.
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Affiliation(s)
- Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Anna Klimkiewicz
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kopera
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | | | - Małgorzata Wrzosek
- Department of Pharmacogenomics, Medical University of Warsaw, Warsaw, Poland
| | - Halina Matsumoto
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Margit Burmeister
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kirk J. Brower
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Krenek M, Maisto SA. Life events and treatment outcomes among individuals with substance use disorders: a narrative review. Clin Psychol Rev 2013; 33:470-83. [PMID: 23454221 DOI: 10.1016/j.cpr.2013.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 11/30/2022]
Abstract
Substance use disorders are characterized by a variable course, in which multiple treatment attempts and relapses are typical. Consistent with conceptualizations of substance use and relapse, life events have been implicated in contributing to poor substance use disorders treatment outcomes. However, inconsistencies in empirical findings regarding the life events-substance use disorders outcome literature have been previously observed. This review provides an updated critique of the literature since the previous review published in 1987 (O'Doherty & Davies, 1987), examining the relationship between life events and substance use disorders treatment outcome among clinical samples of individuals. Review of 18 peer-reviewed articles suggested that data on the life events-outcome relationship continue to be inconclusive. Inconsistencies across studies in the operationalization of life events and substance use treatment outcomes and lack of theoretically driven designs may be contributing to differences in findings. Recommendations for future research that will increase the clinical utility of the life events construct are provided.
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Affiliation(s)
- Marketa Krenek
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA.
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42
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Kuria MW. Factors associated with relapse and remission of alcohol dependent persons after community based treatment. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojpsych.2013.32025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pilowsky DJ, Keyes KM, Geier TJ, Grant BF, Hasin DS. Stressful Life Events and Relapse Among Formerly Alcohol Dependent Adults. SOCIAL WORK IN MENTAL HEALTH 2013; 11:10.1080/15332985.2012.711278. [PMID: 24167441 PMCID: PMC3808003 DOI: 10.1080/15332985.2012.711278] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We examined associations between stressful life events and relapse among adults in the United States with at least 1 year of remission from DSM-IV alcohol dependence. The sample consisted of individuals in remission from alcohol dependence at the Wave 1 interview (2001-2002) for the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who also participated in a Wave 2 interview (2004-2005; N 1,707). Associations between stressful life events, demographic variables, = and the binary outcome of alcohol dependence relapse were examined with multiple logistic regression models. After adjustment for potential confounders, respondents who were divorced or separated in the year preceding the baseline assessment (Wave 1) were over two times more likely (OR = 2.32; CI = 1.01-5.34) to have relapsed 3 years later (Wave 2), compared to those not experiencing a divorce/separation in the 12 months prior to Wave 1. No other stressful life event was associated with relapse. Findings suggest that formerly alcohol dependent adults are at increased risk for relapse following divorce/separation. These results highlight the need for social work practitioners to consider the possibility of relapse following a divorce when one or both partners have a history of alcohol dependence.
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Affiliation(s)
- Daniel J Pilowsky
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA; Department of Psychiatry, Columbia College of Physicians and Surgeons, Columbia University, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA
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McCutcheon VV, Grant JD, Heath AC, Bucholz KK, Sartor CE, Nelson EC, Madden PAF, Martin NG. Environmental influences predominate in remission from alcohol use disorder in young adult twins. Psychol Med 2012; 42:2421-2431. [PMID: 22423619 PMCID: PMC3752317 DOI: 10.1017/s003329171200044x] [Citation(s) in RCA: 10] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Familial influences on remission from alcohol use disorder (AUD) have been studied using family history of AUD rather than family history of remission. The current study used a remission phenotype in a twin sample to examine the relative contributions of genetic and environmental influences to remission. METHOD The sample comprised 6183 twins with an average age of 30 years from the Australian Twin Registry. Lifetime history of alcohol abuse and dependence symptoms and symptom recency were assessed with a structured telephone interview. AUD was defined broadly and narrowly as history of two or more or three or more abuse or dependence symptoms. Remission was defined as absence of symptoms at time of interview among individuals with lifetime AUD. Standard bivariate genetic analyses were conducted to derive estimates of genetic and environmental influences on AUD and remission. RESULTS Environmental influences alone accounted for remission in males and for 89% of influences on remission in females, with 11% due to genetic influences shared with AUD, which decreased the likelihood of remission. For women, more than 80% of influences on remission were distinct from influences on AUD, and environmental influences were from individual experiences only. For men, just over 50% of influences on remission were distinct from those on AUD, and the influence of environments shared with the co-twin were substantial. The results for the broad and narrow phenotypes were similar. CONCLUSIONS The current study establishes young adult remission as a phenotype distinct from AUD and highlights the importance of environmental influences on remission.
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Affiliation(s)
- V. V. McCutcheon
- Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - J. D. Grant
- Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - A. C. Heath
- Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - K. K. Bucholz
- Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - C. E. Sartor
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - E. C. Nelson
- Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - P. A. F. Madden
- Midwest Alcoholism Research Center, Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - N. G. Martin
- Department of Epidemiology and Public Health, Queensland Institute for Medical Research, Brisbane, Australia
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Farren CK, Snee L, Daly P, McElroy S. Prognostic Factors of 2-year Outcomes of Patients with Comorbid Bipolar Disorder or Depression with Alcohol Dependence: Importance of Early Abstinence. Alcohol Alcohol 2012; 48:93-8. [DOI: 10.1093/alcalc/ags112] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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46
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Aguiar P, Neto D, Lambaz R, Chick J, Ferrinho P. Prognostic Factors During Outpatient Treatment for Alcohol Dependence: Cohort Study with 6 months of Treatment Follow-up. Alcohol Alcohol 2012; 47:702-10. [DOI: 10.1093/alcalc/ags097] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Curzio O, Tilli A, Mezzasalma L, Scalese M, Fortunato L, Potente R, Guidoni G, Molinaro S. Characteristics of alcoholics attending 'clubs of alcoholics in treatment' in Italy: a national survey. Alcohol Alcohol 2012; 47:317-21. [PMID: 22366119 DOI: 10.1093/alcalc/ags018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS To provide an overview of alcoholics attending a socio-ecological treatment programme [Clubs of Alcoholics in Treatment (CATs)] and to identify factors associated with abstinence and self-perceived improvement in lifestyle. METHODS A national sample of 7522 subjects (76% males and 24% females, mean age 53.2 ± 11.3 years ± SD) attending CATs was evaluated using a self-administered questionnaire completed at a weekly meeting in 2006. RESULTS Of participants, >70% reported no alcohol use in the last year and around 90% indicated no use in the previous month, whereas 4% of them declared no alcohol use before club attendance. Abstinence and lifestyle improvement were related positively to the number of years of club attendance but negatively to the presence of other problems in addition to the alcohol-related one. Moreover, being older or female was associated with more likely achievement of abstinence as well as with the perception of a better lifestyle. Finally, attending the club with one or more family members was associated with achievement of better lifestyle. CONCLUSION These data provide an overview of alcoholics attending the CAT programme and are a first step toward developing a surveillance system. In addition, on the basis of this preliminary picture further research (notably longitudinal studies) can be planned considering this method and its effectiveness.
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Affiliation(s)
- Olivia Curzio
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
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Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors. Psychopharmacology (Berl) 2011; 218:1-17. [PMID: 21373787 PMCID: PMC3755727 DOI: 10.1007/s00213-011-2236-1] [Citation(s) in RCA: 280] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 02/16/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Exposure to stress is potentially important in the pathway to alcohol use and alcohol use disorders. Stressors occur at multiple time points across the life course, with varying degrees of chronicity and severity. METHOD We review evidence from epidemiologic studies on the relationship between four different stressors (fateful/catastrophic events, child maltreatment, common adult stressful life events in interpersonal, occupational, financial, and legal domains, and minority stress) and alcohol consumption and alcohol use disorders. RESULTS Studies generally demonstrate an increase in alcohol consumption in response to exposure to terrorism or other disasters. Research has demonstrated little increase in incident alcohol use disorders, but individuals with a history of alcohol use disorders are more likely to report drinking to cope with the traumatic event. Childhood maltreatment is a consistent risk factor for early onset of drinking in adolescence and adult alcohol use disorders, and accumulating evidence suggests that specific polymorphisms may interact with child maltreatment to increase risk for alcohol consumption and disorder. Stressful life events such as divorce and job loss increase the risk of alcohol disorders, but epidemiologic consensus on the specificity of these associations across gender has not been reached. Finally, both perceptions of discrimination and objective indicators of discrimination are associated with alcohol use and alcohol use disorders among racial/ethnic and sexual minorities. CONCLUSION Taken together, these literatures demonstrate that exposure to stress is an important component in individual differences in risk for alcohol consumption and alcohol use disorders. However, many areas of this research remain to be studied, including greater attention to the role of various stressors in the course of alcohol use disorders and potential risk moderators when individuals are exposed to stressors.
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Ahmedani BK, McBride O, Cheng HG. Factors related to recent alcohol abstinence among individuals who received previous treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 38:87-92. [PMID: 21851200 DOI: 10.3109/00952990.2011.600394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Alcohol problems are widespread throughout the United States. While treatment can be successful, many individuals continue to drink. One method to assess treatment results over time is by investigating abstinence as a measure of success. OBJECTIVES The main aim of this study is to investigate factors that may be associated with past-year (PY) abstinence among individuals who received prior-to-past-year (PPY) treatment for alcohol problems, while also assessing abstinence by treatment subtype. METHOD This study uses data from 1742 individuals who received PPY treatment for alcohol problems in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Logistic regression models were used to assess the strength of association between alcohol abstinence and key demographic and clinical factors. RESULTS The level of PY abstinence was 36.5% among those who previously sought treatment for alcohol problems. Younger age groups and those who were nicotine dependent or had a cannabis use disorder were less likely to be abstinent. There were no differences based on sex or PY major depression or generalized anxiety disorder. CONCLUSION While causal inferences cannot be made, these results suggest that the majority of people continue to drink, even after being treated for alcohol problems. Nonetheless, variation may exist depending on the form of treatment a person receives. More research is needed regarding long-term levels of abstinence after individuals receive treatment.
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Affiliation(s)
- Brian K Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA.
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Arbour S, Hambley J, Ho V. Predictors and outcome of aftercare participation of alcohol and drug users completing residential treatment. Subst Use Misuse 2011; 46:1275-87. [PMID: 21615214 DOI: 10.3109/10826084.2011.572941] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study attempts to identify factors associated with greater aftercare participation for 367 adults who completed abstinence-based residential addiction treatment between 2004 and 2007 at Bellwood Health Services in Toronto, Canada. Pre-treatment substance use, number of days spent in residential treatment, motivation, treatment satisfaction, and demographics were used to determine which characteristics predicted greater aftercare participation. The duration of residential treatment and treatment satisfaction emerged as significant predictors of aftercare attendance. Regular aftercare attendance was associated with lower levels of substance use at 6-month follow-up. Results suggest that a longer duration of residential treatment can influence continuing care engagement and highlight the importance of initial treatment retention for long-term recovery.
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