Alcohol and drug use among clients receiving internet-delivered cognitive behavior therapy for anxiety and depression in a routine care clinic - Demographics, use patterns, and prediction of treatment completion and outcomes

Changes in patterns of alcohol consumption in young psychiatric outpatients: two comparable samples assessed with 10 years apart

AIMS

Over the past 20 years, a trend towards non-drinking and less use of alcohol has been reported among young adults. This study aimed to investigate if a similar trend in alcohol consumption can be seen among young adult psychiatric outpatients.

METHODS

This was a cross-sectional study based on two comparable samples of young adult (18-25 years) psychiatric outpatients recruited approximately 10 years apart in 2002-2003 (N = 197) and 2012-2016 (N = 380). The Swedish version of the Alcohol Use Disorders Identification Test (AUDIT) was used to assess alcohol consumption. Psychiatric diagnoses were based on diagnostic interviews. Differences between the two samples in alcohol consumption and a number of alcohol-use disorder diagnoses were analysed. Cramer's V was chosen as the effect size measure.

RESULTS

Mean AUDIT scores and prevalence of diagnosed alcohol-use disorder in the two samples did not differ significantly. The number of non-drinkers was larger among patients in the mid-2010s (15.8% vs. 8.1%; χ2 = 6.76, p < 0.01, Φ = 0.11), but when non-drinkers were excluded, the alcohol consumption was higher among females in the later sample.

CONCLUSION

The mean level of alcohol consumption seems not to have changed to the same extent among young psychiatric patients as in the general population. However, some young psychiatric patients have followed the trend of non-drinking, while others consume more alcohol. Further studies on both non-drinking and high alcohol consumption in psychiatric patients are needed to understand their mechanisms.

The Impacts of a Psychoeducational Alcohol Resource During Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety: Observational Study

BACKGROUND

Problematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown.

OBJECTIVE

This observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety.

METHODS

All patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients' use and perceptions of the resource; client characteristics associated with reviewing the resource; and whether reviewing the resource was associated with decreases in clients' alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into low-risk and hazardous drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores.

RESULTS

During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older (P=.004) and separated, divorced, or widowed (P<.001). Reviewers also consumed more weekly drinks (P<.001), scored higher on the AUDIT (P<.001), and were more likely to exhibit hazardous drinking (P<.001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores (P=.004), depression (P<.001), and anxiety (P<.001) over time; in contrast, there was no change in clients' drinks per week over time (P=.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week.

CONCLUSIONS

Overall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource.

Paternal alcohol exposure has task- and sex-dependent behavioral effect in offspring

BACKGROUND

Endophenotypes for alcohol use disorder are well known and may reflect paternal exposure effects passed down to offspring via epigenetic mechanisms. Previously, we showed that paternal alcohol exposure prior to conception attenuates the acquisition of operant alcohol self-administration. We now test whether paternal alcohol exposure alters their offsprings' behavioral responses to alcohol (endophenotypes) and global DNA methylation levels in reward-related brain regions.

METHODS

Adult male rats were exposed to alcohol vapors or air for 6 weeks and mated with alcohol-naïve females 8 weeks later. Adult male and female offspring of the alcohol- and control-sired litters were tested on three behaviors 30 m after gavage with water or alcohol (1.5 g/kg): open field, elevated plus maze, and accelerating rotarod. Global DNA methylation levels in sperm, nucleus accumbens, and prefrontal cortex were examined in male sires and in another group of offspring.

RESULTS

Alcohol-sired males showed less anxiety-like behavior in the elevated plus maze that was not affected by alcohol administration. By contrast, alcohol had anxiolytic effects in the open field in male offspring only with no paternal alcohol effect. Neither paternal alcohol exposure nor alcohol administration altered locomotor activity in either sex. Sex-specific effects of paternal alcohol exposure were seen in the rotarod test. Alcohol-sired male offspring showed blunted sensitivity to the alcohol's motor-impairing effects, whereas alcohol-sired female offspring showed enhanced sensitivity. Global DNA methylation was altered in the sperm of alcohol-exposed males, but no changes were seen in their offspring.

CONCLUSIONS

Paternal alcohol exposure prior to conception has sex- and task-dependent effects on unconditioned behaviors in their offspring.