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LaBarre C, Bradizza CM, Linn BK, Zhao J, Knapp KS, Wilding GE, Stasiewicz PR. Predictors of National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol Recovery among Individuals in Alcohol Treatment: Implications for Social Work. SOCIAL WORK RESEARCH 2024; 48:201-211. [PMID: 39234355 PMCID: PMC11371134 DOI: 10.1093/swr/svae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/29/2023] [Accepted: 01/30/2024] [Indexed: 09/06/2024]
Abstract
The National Institute on Alcohol Abuse and Alcoholism's (NIAAA) definition of alcohol use disorder (AUD) recovery stipulates two criteria: remission from DSM-5 AUD and cessation of heavy drinking. Importantly, these criteria allow for consideration of nonabstinent alcohol treatment outcomes. However, researchers have yet to assess potential predictors of the NIAAA recovery outcome. The current study examined associations between mental health and coping predictors of NIAAA recovery status in an AUD treatment sample. At baseline (BL) and end-of-treatment (EOT) research interviews in a clinical trial, participants (N = 118) completed questionnaires assessing alcohol dependence, mental health, and confidence levels in reducing heavy drinking, as well as alcohol use and DSM-5 AUD symptom endorsement. Logistic regression models tested the associations between chosen predictors and the odds of achieving NIAAA recovery. Twenty-four percent of individuals (n = 28) met both criteria for NIAAA recovery at EOT. Higher levels of BL state anxiety and anxiety sensitivity predicted lower odds of achieving NIAAA recovery, while greater confidence to reduce heavy drinking predicted increased odds of NIAAA recovery. Social workers are encouraged to continue assessing and addressing mental health in AUD treatment to help individuals with alcohol problems achieve their AUD recovery goals.
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Affiliation(s)
- Charles LaBarre
- LMSW, is a PhD candidate, School of Social Work, State University of New York at Buffalo, 1021 Main Street, Buffalo, NY 14203, USA
| | - Clara M Bradizza
- PhD, is professor, School of Social Work, State University of New York at Buffalo, Buffalo, NY, USA
| | - Braden K Linn
- PhD, LMSW, is assistant professor, Department of Family and Community Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Junru Zhao
- PhD, is a statistician, School of Social Work, State University of New York at Buffalo, Buffalo, NY, USA
| | - Kyler S Knapp
- PhD, is National Institute on Alcohol Abuse and Alcoholism (NIAAA) T32 postdoctoral fellow, Clinical and Research Institute on Addictions, School of Social Work, State University of New York at Buffalo, Buffalo, NY, USA
| | - Gregory E Wilding
- PhD, is professor, Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY, USA
| | - Paul R Stasiewicz
- PhD, is professor and Janet B. Wattles endowed chair, School of Social Work, State University of New York at Buffalo, Buffalo, NY, USA
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Belete H, Yimer TM, Dawson D, Espinosa DC, Ambaw F, Connor JP, Chan G, Hides L, Leung J. Alcohol use and alcohol use disorders in sub-Saharan Africa: A systematic review and meta-analysis. Addiction 2024; 119:1527-1540. [PMID: 38715159 DOI: 10.1111/add.16514] [Citation(s) in RCA: 1] [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: 10/19/2023] [Accepted: 03/27/2024] [Indexed: 08/03/2024]
Abstract
BACKGROUND AND AIMS Population-level alcohol use data are available from high-income countries, but limited research has been conducted in sub-Saharan Africa. This systematic review and meta-analysis aimed to summarize population-level alcohol use in sub-Saharan Africa. METHOD Databases searched included PubMed, EMBASE, PsycINFO and AJOL, without language restrictions. Searches were also conducted in the Global Health Data Exchange (GHDx) and Google Scholar. Search terms encompassed 'substance' or 'substance-related disorders' and 'prevalence' and 'sub-Saharan Africa'. We included general population studies on alcohol use (including any use, high-risk alcohol use and alcohol use disorders) from 2018 onwards. Prevalence data for alcohol use among sub-Saharan African adolescents (10-17) and adults (18+) were extracted. Analyses included life-time and past 12- and 6-month alcohol use. RESULTS We included 141 papers. Among adolescents, the life-time prevalence of alcohol use was 23.3% [95% confidence interval (CI) = 11.3-37.1%], 36.2% (CI = 18.4-56.1%) in the past year and 11.3% (CI = 4.5-20.4%) in the past 6 months. Among adolescents, 12-month prevalence of alcohol use disorder and alcohol dependence were 7.7% (CI = 0.0-27.8%) and 4.1% (CI = 1.4-7.9%), respectively. Among adults, the life-time prevalence of alcohol use was 34.9% (CI = 17.7-54.1%), 27.1% (CI = 5.0-56.4%) in the past year and 32.2% (CI = 19.8-46.0%) in the past 6 months. Among adults, the 12-month prevalence of alcohol use disorder and alcohol dependence were 9.5% (CI = 0.0-30.4%) and 4.3% (CI = 0.8-9.8%), respectively. The highest weighted life-time prevalence of alcohol use, 86.4%, was reported in Tanzania among adults. The highest weighted past 6-month prevalence of alcohol use, 80.6%, was found in Zambia among adolescents. CONCLUSION Alcohol use patterns vary across countries and subregions within sub-Saharan Africa, and comprehensive population-level data on alcohol use remain scarce in numerous sub-Saharan African countries. The prevalence of alcohol use disorder is common among adolescents in sub-Saharan Africa.
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Affiliation(s)
- Habte Belete
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tesfa Mekonen Yimer
- Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Danielle Dawson
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | | | - Fentie Ambaw
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Discipline of Psychiatry, The University of Queensland, Brisbane, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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Dun-Campbell K, Hartwell G, Maani N, Tompson A, van Schalkwyk MC, Petticrew M. Commercial determinants of mental ill health: An umbrella review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003605. [PMID: 39196874 DOI: 10.1371/journal.pgph.0003605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/24/2024] [Indexed: 08/30/2024]
Abstract
Mental ill health has complex and interrelated underlying causes, with wider determinants of health often overlooked as risk factors. The 'commercial determinants of health' are gradually receiving more attention and recognition but there is a relative lack of awareness of the commercial determinants of mental health. This aim of this umbrella review was to synthesise systematic review level evidence for the association between commercial determinants and mental health outcomes. This umbrella review included evidence from high, middle, and low-income countries. We included terms related to broader commercial activities and terms focused on six key unhealthy commodities (tobacco, alcohol, ultra-processed foods, gambling, social media, fossil fuels) and the impacts of fossil fuel consumption (climate change, air pollution, wider pollution). We included 65 reviews and found evidence from high quality reviews for associations between alcohol, tobacco, gambling, social media, ultra-processed foods and air pollution and depression; alcohol, tobacco, gambling, social media, climate change and air pollution with suicide; climate change and air pollution with anxiety; and social media with self-harm. There was a lack of evidence examining wider practices of commercial industries. Our umbrella review demonstrates that by broadening the focus on commercial determinants, the influence of commercial products and activities on mental ill health can be better understood. The lack of research examining broader commercial practices on mental ill health is an area that should be addressed. Our review highlights the existing base of high-quality evidence for many of these unhealthy commodities' impacts on mental ill health and indicates that commercial determinants is a valuable framework for understanding the drivers of mental ill health.
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Affiliation(s)
- Kate Dun-Campbell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Greg Hartwell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nason Maani
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Alice Tompson
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - May Ci van Schalkwyk
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Petticrew
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Evans-Polce RJ, Kcomt L, Veliz P, Boyd CJ, McCabe SE. Associations of sexual identity change and identity-attraction discordance with symptomatic alcohol and other drug use. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1389-1399. [PMID: 38095678 PMCID: PMC11176265 DOI: 10.1007/s00127-023-02600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/20/2023] [Indexed: 06/15/2024]
Abstract
PURPOSE National studies examining alcohol and other drug use by sexual orientation have been primarily cross-sectional. Understanding changes in sexual orientation over time may further elucidate the mechanisms behind sexual orientation differences in alcohol and other drug use. This national longitudinal study examines changes in sexual orientation across four waves (2013-2019), and the associations with symptomatic alcohol and other drug use. METHODS Data from Waves 1 through 5 of the Population Assessment of Tobacco and Health (PATH) study were used to examine associations of sexual identity change/stability and sexual identity-attraction discordance/concordance from baseline to follow-up with symptomatic substance use at follow-up. We examined four outcomes: any symptomatic substance use, symptomatic alcohol use, symptomatic other drug use, and symptomatic alcohol + other drug use. Mixed effects logistic regression models were used and all analyses were weighted and stratified by sex. RESULTS In models adjusting for potential confounders, greater likelihood of symptomatic alcohol and other drug use outcomes was found among males and females experiencing a change from a heterosexual to sexual minority identity and among females with new or consistent sexual identity-attraction discordance. CONCLUSION These findings highlight important sex differences and suggest that the period of transitioning to a sexual minority identity is a particularly vulnerable period for symptomatic alcohol and other drug use. For females, incongruent sexual identity and attraction is also a risk factor. Interventions that assist individuals during this transitional period and during a time when identity and attraction are incongruent, may reduce symptomatic substance use during this period.
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Affiliation(s)
- Rebecca J Evans-Polce
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA.
| | - Luisa Kcomt
- School of Social Work, Wayne State University, Detroit, MI, USA
| | - Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Research On Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls St, Ann Arbor, MI, 48108, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Institute for Research On Women and Gender, University of Michigan, Ann Arbor, MI, USA
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
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Ghosh A, Morgan N, Calvey T, Scheibein F, Angelakis I, Panagioti M, Ferri M, Krupchanka D. Effectiveness of psychosocial interventions for alcohol use disorder: a systematic review and meta-analysis update. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:442-454. [PMID: 38904466 DOI: 10.1080/00952990.2024.2350056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/12/2024] [Accepted: 04/24/2024] [Indexed: 06/22/2024]
Abstract
Background: Given the accumulating research, evolving psychosocial treatment, and equivocal findings, updating WHO's Mental Health Gap Action Programme-2015 was necessary to ensure guidelines reflect effective strategies for alcohol use disorder (AUD).Objective: To estimate the effects of psychosocial interventions on drinking and related outcomes.Methods: We included randomized controlled trials published between January 2015 and June 2022 on adults with alcohol dependence (ICD 10/DSM-IV) and moderate to severe AUD (DSM-5), and those examined psychosocial interventions against treatment-as-usual (TAU) and active controls. Eight databases and registries were searched. Relative Risk (RR) and standardized mean difference (SMD) were used for dichotomous and continuous outcomes. We used Cochrane's risk of bias assessment (RoB2).Results: Of 873 screened records, 14 and 13 studies in the narrative synthesis and meta-analysis. Of the 2,575 participants, 71.5% were men. Thirteen studies used ICD 10/DSM IV diagnosis. Compared to TAU, any psychosocial intervention increased the relative risk of abstinence by 28% [N = 7, RR = 1.28, 95% CI: 1.07 to 1.53, p = .01, NNT = 9]. There were minimal heterogeneity and no evidence of publication bias. Psychosocial interventions were not effective in reducing the drinking frequency (n = 2, Hedge's g = -0.10, 95% CI: -0.46 to 0.26, p = .57) and drinks/drinking days (N = 5, g = -0.10, 95% CI: -0.37 to 0.16, p = .43). Treatment discontinuation did not differ between intervention and control groups [RR = 1.09, 95% CI: 0.66 to 1.80].Conclusion: Psychosocial interventions are effective in improving abstinence but not in reducing drinking frequency or amount. Policymakers must consider this evidence to generate AUD treatment guidelines.Registration: PROSPERO 2022 CRD42022342608.
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Affiliation(s)
- Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Tanya Calvey
- Department of Human Biology and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Ioannis Angelakis
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marica Ferri
- Head of Sector, Support to Practice, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Dzmitry Krupchanka
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Carr T, Kilian C, Llamosas-Falcón L, Zhu Y, Lasserre AM, Puka K, Probst C. The risk relationships between alcohol consumption, alcohol use disorder and alcohol use disorder mortality: A systematic review and meta-analysis. Addiction 2024; 119:1174-1187. [PMID: 38450868 PMCID: PMC11156554 DOI: 10.1111/add.16456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/15/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIMS Increasing levels of alcohol use are associated with a risk of developing an alcohol use disorder (AUD), which, in turn, is associated with considerable burden. Our aim was to estimate the risk relationships between alcohol consumption and AUD incidence and mortality. METHOD A systematic literature search was conducted, using Medline, Embase, PsycINFO and Web of Science for case-control or cohort studies published between 1 January 2000 and 8 July 2022. These were required to report alcohol consumption, AUD incidence and/or AUD mortality (including 100% alcohol-attributable deaths). The protocol was registered with PROSPERO (CRD42022343201). Dose-response and random-effects meta-analyses were used to determine the risk relationships between alcohol consumption and AUD incidence and mortality and mortality rates in AUD patients, respectively. RESULTS Of the 5904 reports identified, seven and three studies from high-income countries and Brazil met the inclusion criteria for quantitative and qualitative syntheses, respectively. In addition, two primary US data sources were analyzed. Higher levels of alcohol consumption increased the risk of developing or dying from an AUD exponentially. At an average consumption of four standard drinks (assuming 10 g of pure alcohol/standard drink) per day, the risk of developing an AUD was increased sevenfold [relative risk (RR) = 7.14, 95% confidence interval (CI) = 5.13-9.93] and the risk of dying fourfold (RR = 3.94, 95% CI = 3.53-4.40) compared with current non-drinkers. The mortality rate in AUD patients was 3.13 (95% CI = 1.07-9.13) per 1000 person-years. CONCLUSIONS There are exponential positive risk relationships between alcohol use and both alcohol use disorder incidence and mortality. Even at an average consumption of 20 g/day (about one large beer), the risk of developing an alcohol use disorder (AUD) is nearly threefold that of current non-drinkers and the risk of dying from an AUD is approximately double that of current non-drinkers.
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Affiliation(s)
- Tessa Carr
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
| | - Carolin Kilian
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
| | - Laura Llamosas-Falcón
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
| | - Yachen Zhu
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Aurélie M Lasserre
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Klajdi Puka
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Charlotte Probst
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
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Chakrabarti S, Christopher A, Scott S, Kishore A, Nguyen PH. Effects of a large-scale alcohol ban on population-level alcohol intake, weight, blood pressure, blood glucose, and domestic violence in India: a quasi-experimental population-based study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 26:100427. [PMID: 38827143 PMCID: PMC11140782 DOI: 10.1016/j.lansea.2024.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024]
Abstract
Background Globally, alcohol consumption is a leading risk factor for deaths and disability and a causal factor in over 200 diseases, injuries, and health conditions. In April 2016, the manufacture, transport, sale, and consumption of alcohol was banned in Bihar, a populous Indian state. We sought to estimate the impacts of this ban on health outcomes and domestic violence. Methods Data from the Indian National Family Health Surveys (2005-06, 2015-16, 2019-21), Annual Health Survey (2013), and District Level Household Survey (2012), were used to conduct difference-in-differences (DID) analysis, comparing Bihar (n = 10,733 men, n = 88,188 women) and neighbouring states (n = 38,674 men, n = 284,820 women) before and after the ban. Outcomes included frequent (daily or weekly) alcohol consumption, underweight, obesity, hypertension, diabetes, and intimate partner violence. A triple difference model adding male-female interaction to the DID model was also estimated. Attributable averted cases were calculated to estimate the impact of the ban. Findings Across all models, the ban led to reduced frequent alcohol consumption (DID: -7.1 percentage points (pp) (95% CI -9.6pp, -4.6pp), lower overweight/obesity (-5.6pp (-8.9, -2.2) among males, and reduced experiences of emotional (-4.8pp (-8.2pp, -1.4pp) and sexual (-5.5pp (-8.7pp, -2.3pp) violence among females. The ban prevented approximately 2.4 million cases of daily/weekly alcohol consumption and 1.8 million cases of overweight/obesity among males, and 2.1 million cases of intimate partner violence among females. Interpretation Strict alcohol regulation policies may yield significant population level health benefits for frequent drinkers and many victims of intimate partner violence. Funding No funding was received for this work.
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Affiliation(s)
- Suman Chakrabarti
- The International Food Policy Research Institute, Poverty, Health and Nutrition Division, Washington, DC, USA
| | - Anita Christopher
- The International Food Policy Research Institute, Development Support and Governance Division, Washington, DC, USA
| | - Samuel Scott
- The International Food Policy Research Institute, Poverty, Health and Nutrition Division, Washington, DC, USA
| | - Avinash Kishore
- The International Food Policy Research Institute, Development Support and Governance Division, Washington, DC, USA
| | - Phuong Hong Nguyen
- The International Food Policy Research Institute, Poverty, Health and Nutrition Division, Washington, DC, USA
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Kroener J, Eickholt ML, Sosic-Vasic Z. Group based metacognitive therapy for alcohol use disorder: a pilot study. Front Psychiatry 2024; 15:1375960. [PMID: 39015882 PMCID: PMC11249785 DOI: 10.3389/fpsyt.2024.1375960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/12/2024] [Indexed: 07/18/2024] Open
Abstract
Introduction Alcohol use disorder (AUD) is a severe clinical disorder, which has been associated with 5.3% of death worldwide. Although several treatments have been developed to improve AUD symptomatology, treatment effects were moderate, with a certain amount of patients displaying symptom deterioration after treatment termination. Moreover, outpatient treatment placements become increasingly scarce, thus necessitating more efficient treatment options. Therefore, the aim of the present study was to investigate the efficacy, feasibility, and acceptability of a newly invented, short, group based metacognitive therapy (MCT) for patients diagnosed with AUD. Method Seven patients were treated with eight sessions of group based MCT using a single case series design with an A-B replication across patients. Patients were assessed one month and one week before treatment, as well as one week and three months after treatment termination. Results Patients improved significantly and with large effect sizes regarding dysfunctional metacognitive beliefs, desire thinking/craving and depressive symptoms up to three months after treatment termination. AUD symptomatology as well as positive and negative metacognitive beliefs improved at post-treatment, but improvements could not be maintained at follow-up. All included patients completed the treatment and were highly satisfied. Conclusion The presented findings show preliminary evidence for the efficacy, feasibility, and acceptability of the implemented group based MCT treatment. Large scale randomized controlled trials (RCTs) are needed to confirm the effectiveness of the developed program for patients diagnosed with AUD.
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Affiliation(s)
- Julia Kroener
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Goeppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | - Maja Lara Eickholt
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Goeppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
| | - Zrinka Sosic-Vasic
- Department of Applied Psychotherapy and Psychiatry, Christophsbad Goeppingen, Goeppingen, Germany
- Medical Department, University of Ulm, Ulm, Germany
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Punia K, Scott W, Manuja K, Sabbineni M, Campbell K, Balodis IM, MacKillop J. SAEM GRACE: Anti-craving medications for alcohol use disorder treatment in the emergency department: A systematic review of direct evidence. Acad Emerg Med 2024; 31:504-514. [PMID: 37735346 DOI: 10.1111/acem.14806] [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: 04/14/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Alcohol-related concerns commonly present to the emergency department (ED), with a subset of individuals experiencing the symptoms of an alcohol use disorder (AUD). As such, examining the efficacy of pharmacological anti-craving treatment for AUD in the ED is of increasing interest. The objective of this systematic review was to evaluate the direct evidence assessing the efficacy of providing anti-craving medications for AUD treatment in the ED. METHODS A systematic search was conducted according to the patient-intervention-control-outcome question: (P) adults (≥18 years old) presenting to the ED with an AUD (including suspected AUD); (I) anti-craving medications (i.e., naltrexone, acamprosate, gabapentin); (C) no prescription or placebo; (O) reduction of repeat ED visits, engagement in addiction services, reductions in heavy drinking days, reductions in any drinking and amount consumed (or abstinence), and in relapse. Two reviewers independently assessed articles for inclusion and conducted risk of bias assessments for included studies. RESULTS From 143 potentially relevant articles, 6 met inclusion criteria: 3 clinical trials, and 3 case studies. The clinical trials identified evaluated oral versus extended-release naltrexone, monthly extended-release naltrexone injections, and disulfiram. Both oral and extended-release naltrexone resulted in decreased alcohol consumption. Monthly extended-release naltrexone injections resulted in significant improvements in drinking and quality of life. Although out of scope, the disulfiram studies identified did not result in an improvement in drinking in comparison to no medication. CONCLUSIONS Overall, there are few studies directly examining the efficacy of anti-craving medications for AUD in the ED, although the limited evidence that exists is supportive of naltrexone pharmacotherapy, particularly extended-release injection formulation. Additional randomized controlled trials are necessary for substantive direct evidence on anti-craving medication initiation in the ED.
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Affiliation(s)
- Kiran Punia
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, Ontario, Canada
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - William Scott
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kriti Manuja
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
| | - Monica Sabbineni
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Iris M Balodis
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare, Hamilton/McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Perumalswami PV, Winder GS, Fernandez AC, Mellinger JL. Practical Considerations to Optimize Care for Patients With Alcohol-Associated Liver Disease in General Gastroenterology Practice. Am J Gastroenterol 2024; 119:591-595. [PMID: 37725695 DOI: 10.14309/ajg.0000000000002517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Ponni V Perumalswami
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Gastroenterology Section, Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Gerald Scott Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica L Mellinger
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
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11
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Leung J, Yimer TM, Chiu V, Hall WD, Connor JP, Chan GCK. Participation in Australian drug treatment programs for individuals engaging in high-risk substance use: Data from a nationally representative sample. Drug Alcohol Rev 2024; 43:688-693. [PMID: 38087847 DOI: 10.1111/dar.13792] [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: 04/05/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Substance use, including drugs, alcohol and smoking have a significant health, social and economic impact. We aim to assess the rate and factors associated with treatment access among individuals with high-risk substance use. METHOD This study is a cross-sectional analysis of the 2019 Australian National Drug Strategy Household Survey (N = 22,015). Participants were persons with high-risk substance use based on the Alcohol, Smoking and Substance Involvement Screening Test-Lite (ASSIST-Lite) and current smokers. We measured self-reports of past 12-month engagement in a tobacco, alcohol or other drugs treatment program. RESULTS Overall, 0.4% had high-risk drug use (0.3% cannabis, 0.1% meth/amphetamine or 0.1% opioids), 7.4% had high-risk alcohol use, and 14.0% currently smoked. Among high-risk users, past 12-month treatment access rates were 50.6% [22.3-78.9%] for opioids, 27.1% [8.1-46.1%] for meth/amphetamine, 14.5% [4.3-24.7%] for cannabis, 9.6% [8.1-11.0%] for alcohol and 11.7% [10.6-12.9%] for current smoking. The primary source of treatment support was information and education (12.7% drugs, 4.6% alcohol, 4.0% smoking), followed by counselling (6.7% drugs, 4.5% alcohol, 3.0% smoking). Online or internet support was accessed by 5.9% (drug) and 1.6% (alcohol) people with high-risk use. Psychological distress was associated with treatment access (drugs: odds ratio 3.03 [0.77-11.95], p = 0.111; alcohol: odds ratio 3.16 [2.20-4.56], p ≤ 0.001; smoking: odds ratio 1.95 [1.52-2.49], p ≤ 0.001). DISCUSSION AND CONCLUSIONS The proportion of people engaging in risky substance use who had used treatment programs remains low, especially for alcohol. Public health strategies to scale up treatment access are warranted.
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Affiliation(s)
- Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Tesfa Mekonen Yimer
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Vivian Chiu
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Gary Chung Kai Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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12
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Makoha G, Denov M. War, forced displacement, and alcohol abuse: experiences and perceptions of war-affected south Sudanese refugee youth living in Bidibidi refugee settlement in northern Uganda. Front Public Health 2024; 12:1232504. [PMID: 38375335 PMCID: PMC10875737 DOI: 10.3389/fpubh.2024.1232504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/11/2024] [Indexed: 02/21/2024] Open
Abstract
Refugees are at high risk of alcohol abuse due to their experiences of structural, physical, sexual, and psychological violence in their countries of origin, during flight, and within host communities. Given the prolonged civil war in their country, South Sudanese have continued to flee profound forms of violence and now constitute the largest population of refugees in Uganda. However, little is known about their displacement experiences, as well as the reality of alcohol use and abuse within refugee settlements. Drawing upon the direct voices of a sample of war-affected South Sudanese young people, this article explores their experiences of forced displacement and their links to alcohol abuse, as well as their perceptions regarding appropriate alcohol treatment interventions for refugees in the camp. A total of 22 semi-structured qualitative interviews were conducted with 14 refugee youth (aged 18-25) alongside eight adult key informants who work with the youth (religious leaders, sports coaches, educators, social workers, and settlement administrators). Using thematic analysis, the study revealed a series of key themes influencing and shaping the high incidence of alcohol abuse among the youth. These included traumatic wartime and migration experiences, family separation, poor prospects, and the ubiquitous availability of alcohol in the settlement. In addition, we show how alcohol operates as a strategic tool for survival for the youth, as well as highlight how these perceptions can help to inform alcohol treatment interventions in the Bidibidi refugee settlement. To our knowledge, this is the first in-depth study of alcohol abuse among war-affected South Sudanese refugee youth in Uganda, addressing a significant gap in the current literature on war-affected youth, forced displacement, and alcohol abuse. We contend that involving youth in the design of interventions can be helpful for culturally sensitive and relevant prevention, treatment, and care in refugee settings. In addition, providing employment opportunities and meaningful engagement for growth through social participation can help to address harmful alcohol use among youth in the camps.
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Affiliation(s)
- Godfrey Makoha
- School of Social Work, McGill University, Montreal, QC, Canada
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13
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Redwood L, Saarinen K, Ivers R, Garne D, de Souza P, Bonney A, Rhee J, Mullan J, Thomas SJ. Alcohol consumption and health-related quality of life in regional, rural and metropolitan Australia: analysis of cross-sectional data from the Community Health and Rural/Regional Medicine (CHARM) study. Qual Life Res 2024; 33:349-360. [PMID: 37878225 PMCID: PMC10850261 DOI: 10.1007/s11136-023-03522-x] [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] [Accepted: 09/19/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Relationships between alcohol consumption and health are complex and vary between countries, regions, and genders. Previous research in Australia has focused on estimating the effect of alcohol consumption on mortality. However, little is known about the relationships between alcohol consumption and health-related quality of life (QoL) in Australia. This study aimed to investigate the levels of alcohol intake and QoL in males and females in rural, regional and metropolitan areas of Australia. METHOD Participants (n = 1717 Australian adults) completed an online cross-sectional study. Males and females were compared on measures including the AUDIT-C and WHOQOL-BREF. Data were stratified into risk of alcohol use disorder (AUD) and associations were examined between alcohol consumption and QoL, adjusting for sociodemographic variables. RESULTS Males had higher alcohol consumption and were at greater risk of AUD than females (20% vs 8%). Relationships between alcohol consumption and QoL were positive or non-significant for low-moderate AUD risk categories and negative in the severe AUD risk category. Males in regional communities reported higher alcohol consumption (AUDIT-C score 6.6 vs 4.1, p < 0.01) than metropolitan areas. Regression analyses identified that after adjusting for sociodemographic variables, alcohol consumption was positively related to overall, environmental, and physical QoL and general health. CONCLUSION The results indicate that alcohol consumption is negatively related to QoL only in those with severe risk of AUD. Males in regional areas reported higher alcohol consumption than those in metropolitan areas. These results provide further information about relationships between alcohol intake and health in Australia that can help inform prevention, screening and delivery of interventions.
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Affiliation(s)
- Lisa Redwood
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- MIND the GaP, University of Wollongong, Wollongong, NSW, Australia
| | - Karli Saarinen
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - David Garne
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Paul de Souza
- Nepean Clinical School, University of Sydney, Kingswood, NSW, Australia
| | - Andrew Bonney
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Joel Rhee
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Discipline of General Practice, School of Population Health, UNSW Sydney, Kensington, NSW, Australia
| | - Judy Mullan
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Susan J Thomas
- Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
- MIND the GaP, University of Wollongong, Wollongong, NSW, Australia.
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14
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Qiu J, Dong F, Zhuge H, Han Q, Li J, Guo R, Dou X, Li J, Li S. Preventive effect of low-carbohydrate high-fat dietary pattern on liver disease caused by alcohol consumption via a 6pgd-involved mechanism in mice. Food Funct 2024; 15:732-746. [PMID: 38117162 DOI: 10.1039/d3fo04335e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
A low-carbohydrate high-fat (LCHF) dietary pattern has been reported to improve chronic metabolic diseases. However, whether and how the LCHF diet affects the pathological progression in patients with alcohol-related liver diseases (ALD) is largely unknown. This study was conducted to evaluate the effect of the LCHF diet on ALD and clarify its potential mechanism(s). The ALD model was established by feeding C57BL/6N mice with a Lieber-DeCarli liquid alcohol diet with a modified carbohydrate/fat ratio under an isoenergetic pattern. After an eight-week intervention, we observed that the LCHF diet significantly reduced alcohol-induced hepatic steatosis and liver injury, along with improved lipid metabolic-related gene disorders and redox imbalance. The alcohol-stimulated increase in pro-inflammatory cytokine cytokines expression, including TNF-α, IL-1β, and IL-6, was markedly reversed by the LCHF diet. Liver transcriptome sequencing and qPCR validation showed that twenty-four alcohol-disturbed genes were significantly reversed by LCHF-diet intervention. The top differentially expressed genes were selected for further investigation. Among them, 6-phosphogluconate dehydrogenase (6PGD) was significantly up-regulated by alcohol treatment in both the liver and cultured hepatocytes. Spearman correlation analysis revealed that 6PGD was positively associated with hepatic steatosis, liver injury, and oxidative stress indexes. In vitro, the 6PGD knockdown ameliorated alcohol-induced hepatotoxicity and intracellular lipid accumulation, as well as lipid metabolic-related gene disorders, implying the involvement of 6PGD in LCHF-protected ALD. In conclusion, LCHF diet intervention alleviated chronic alcohol consumption-induced liver dysfunction in mice. 6PGD is a potential novel target for ALD prevention that contributes to LCHF-improved ALD. A LCHF diet might be a promising choice for ALD management.
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Affiliation(s)
- Jiannan Qiu
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China.
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China
| | - Fan Dong
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China.
| | - Hui Zhuge
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China
| | - Qiang Han
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China.
| | - Jiaomei Li
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China.
| | - Rui Guo
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China.
| | - Xiaobing Dou
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China
| | - Jiayu Li
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China.
| | - Songtao Li
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR. China.
- Department of Clinical Nutrition, Affiliated Zhejiang Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, PR. China
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15
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Palmer B, Irwin C, Desbrow B. A review of factors influencing drinking behaviours in young Australian adults using a behavioural framework approach. Drug Alcohol Rev 2024; 43:170-187. [PMID: 37830638 DOI: 10.1111/dar.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
ISSUES Young adults (aged 18-24 years) are more likely to binge drink than any other age group in Australia. These behaviours expose young adults to possible adverse events, with potential for acute harms. APPROACH A behavioural framework (capability, opportunity, motivation-behaviour [COM-B model]) was used to explore factors that influence the drinking behaviours of young Australian adults. Potential studies were identified by searching four online data bases. Content pertaining to factors moderating young adults' alcohol consumption behaviours (either increasing or decreasing alcohol consumption) in an Australian population was extracted. Factors were then categorised/mapped into the six sub-components of the COM-B model. A narrative synthesis/discussion was subsequently undertaken. KEY FINDINGS Factors increasing or reducing alcohol consumption behaviours were identified across all components of the COM-B model. Overall, alcohol consumption behaviours appear strongly influenced by physical and social opportunities, and young adults have reflective and automatic motivations (i.e., habitual processes, emotional responding and analytical decisional making that directs behaviour) to consume alcohol with purpose and/or reason. IMPLICATIONS AND CONCLUSION The use of a behavioural framework (e.g., the COM-B model) facilitates an integrated understanding of factors influencing alcohol consumption behaviours. Future harm minimisation strategies need to consider the interrelated, contemporary factors underpinning a young adult's decision to consume alcohol within the context of modern Australian society.
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Affiliation(s)
- Blake Palmer
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Christopher Irwin
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Ben Desbrow
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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16
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Cheng B, Lim CCW, Rutherford BN, Huang S, Ashley DP, Johnson B, Chung J, Chan GCK, Coates JM, Gullo MJ, Connor JP. A systematic review and meta-analysis of the relationship between youth drinking, self-posting of alcohol use and other social media engagement (2012-21). Addiction 2024; 119:28-46. [PMID: 37751678 DOI: 10.1111/add.16304] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/20/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND AIM Social networking sites (SNS) are interactive internet-based social platforms that facilitate information sharing. A growing body of literature on exposure to, and self-posting of, alcohol-related content on SNS has examined the relationship between SNS use and alcohol consumption in young people. This study aims to synthesise the literature exploring the relationship between exposure (i.e. viewing or listening of alcohol-related media) and self-posting (i.e. uploading images or text of alcohol content) of alcohol-related media on SNS on alcohol consumption. METHODS A pre-registered systematic review was conducted in June 2022 within PubMed, Scopus, PsycINFO and Web of Science. Original prospective and cross-sectional studies assessing youth and young adults (≤ 24 years of age) that measured exposure to alcohol-related media or posting of alcohol-related content on SNS and self-reported alcohol consumption outcomes were included. Meta-analyses were conducted on comparable methodologies. RESULTS Thirty studies were included (n = 19,386). Meta-analyses of cross-sectional studies showed both greater exposure (five studies; pooled β = 0.34, 95% confidence interval [CI] = 0.23, 0.44, i2 = 27.7%) and self-posting of alcohol-related content (six studies; pooled β = 0.57, 95%CI = 0.25,0.88, i2 = 97.8%) was associated with greater alcohol consumption. Meta-analyses of three prospective studies also identified that greater exposure predicted greater future alcohol consumption (three studies; pooled β = 0.13, 95%CI = 0.11,0.15, i2 = 0.0%). Narrative analyses of studies that could not be meta-analysed due to incompatible methodologies were also conducted. Most studies (all four prospective, one of two cross-sectional) identified positive associations between exposure to alcohol-related content and greater average consumption. Most studies (three of four prospective, four of six cross-sectional) reported a positive association between of alcohol-related self-posting and greater average alcohol consumption. CONCLUSIONS Both exposure to, and self-posting of, alcohol-related content on social networking sites are positively associated with current average consumption, problem drinking, and drinking frequency.
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Affiliation(s)
- Brandon Cheng
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Brienna N Rutherford
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Sandy Huang
- School of Medicine, The University of Queensland, Herston, Australia
| | - Daniel P Ashley
- School of Medicine, The University of Queensland, Herston, Australia
| | - Ben Johnson
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Jack Chung
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Gary C K Chan
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Jason M Coates
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
| | - Matthew J Gullo
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Jason P Connor
- National Centre for Youth Substance Use Research, The University of Queensland, St Lucia, Australia
- School of Psychology, The University of Queensland, St Lucia, Australia
- School of Medicine, The University of Queensland, Herston, Australia
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17
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Yimer TM, Chan GCK, Belete H, Hides L, Leung J. Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia. Glob Ment Health (Camb) 2023; 10:e92. [PMID: 38179466 PMCID: PMC10765018 DOI: 10.1017/gmh.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/24/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024] Open
Abstract
Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.
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Affiliation(s)
- Tesfa Mekonen Yimer
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gary CK Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Habte Belete
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
- Psychiatry Department, Bahir Dar University, Bahir Dar, Ethiopia
| | - Leanne Hides
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, Australia
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Australia
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18
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Balbinot P, Bottaro CL, Gandolfo N, Pellicano R, Testino G. Alcohol use disorder identification test renamed Glu-Glu Test in an area of north-west of Italy: preliminary descriptive results. Minerva Gastroenterol (Torino) 2023; 69:517-522. [PMID: 35904474 DOI: 10.23736/s2724-5985.22.03249-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND The first two causes of liver cirrhosis and hepatocellular carcinoma are alcoholic and dysmetabolic. In the early stages alcohol related liver disease (ALD) is silent. For this reason, more efforts should be made to identify early individuals with hazardous/harmful alcohol consumption (AC). Alcohol use disorder identification test (AUDIT) is a validated test. METHODS ASL3 (Ligurian Local Health Company 3) has included the AUDIT renamed Glu-Glu Test on its institutional website dedicated to citizens. The renaming was carried out to bring citizens closer to the test with greater ease, especially younger citizens. At the end of the compilation of the test, the calculator provides the citizen with his score: in relation to his possible risk band, provides him with the appropriate advice. In case of a score higher than 7, ultrasonography and elastography (2D-SWE) are proposed. RESULTS From December 15, 2021, to July 15, 2022, 270 asymptomatic subjects requested a medical examination autonomously, without the indication of a health worker. In 167 patients the score found hazardous AC, in 65 harmful AC and in 38 alcohol addiction. In case of hazardous AC, fibrosis grade 1-2 was evidenced in 16.7%, fibrosis grade 3 in 4.8% and fibrosis grade 4 in 3.6% of subjects. In case of harmful AC fibrosis grade 1-2 was evidenced in 37%, grade 3 in 9%, grade 4 in 6%. In this group an HCC nodule was diagnosed. In case of alcohol addiction, fibrosis grade 1-2 was evidenced in 73.6%, grade 3 in 10.5% and grade 4 in 10.5%. CONCLUSIONS This preliminary experience clearly tells us that it is possible to make an early diagnosis of fibrosis and HCC starting from the AC reported autonomously by citizens.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3 Liguria, IRCCS San Martino University Hospital, Genoa, Italy
- Mutual-Self-Help, Community Programs and Caregiver Training Center, ASL3 Liguria, Genoa, Italy
| | | | | | | | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, ASL3 Liguria, IRCCS San Martino University Hospital, Genoa, Italy
- Mutual-Self-Help, Community Programs and Caregiver Training Center, ASL3 Liguria, Genoa, Italy
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19
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Blake H, Adams EJ, Chaplin WJ, Morris L, Mahmood I, Taylor MG, Langmack G, Jones L, Miller P, Coffey F. Alcohol Prevention in Urgent and Emergency Care (APUEC): Development and Evaluation of Workforce Digital Training on Screening, Brief Intervention, and Referral for Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7028. [PMID: 37998259 PMCID: PMC10671475 DOI: 10.3390/ijerph20227028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Excessive alcohol consumption carries a significant health, social and economic burden. Screening, brief intervention and referral to treatment (SBIRT) is one approach to identifying patients with excessive alcohol consumption and providing interventions to help them reduce their drinking. However, healthcare workers in urgent and emergency care settings do not routinely integrate SBIRT into clinical practice and raise a lack of training as a barrier to SBIRT delivery. Therefore, "Alcohol Prevention in Urgent and Emergency Care" (APUEC) training was developed, delivered, and evaluated. APUEC is a brief, stand-alone, multimedia, interactive digital training package for healthcare workers. The aim of APUEC is to increase positive attitudes, knowledge, confidence and skills related to SBIRT through the provision of (a) education on the impact of alcohol and the role of urgent and emergency care in alcohol prevention, and (b) practical guidance on patient assessment, delivery of brief advice and making referral decisions. Development involved collaborative-participatory design approaches and a rigorous six-step ASPIRE methodology (involving n = 28 contributors). APUEC was delivered to healthcare workers who completed an online survey (n = 18) and then participated in individual qualitative interviews (n = 15). Analysis of data was aligned with Levels 1-3 of the Kirkpatrick Model of Training Evaluation. Survey data showed that all participants (100%) found the training useful and would recommend it to others. Insights from the qualitative data showed that APUEC digital training increases healthcare workers' perceived knowledge, confidence and skills related to alcohol prevention in urgent and emergency care settings. Participants viewed APUEC to be engaging and relevant to urgent and emergency care workers. This digital training was perceived to be useful for workforce skills development and supporting the implementation of SBIRT in clinical practice. While the impact of APUEC on clinician behaviour and patient outcomes is yet to be tested, APUEC digital training could easily be embedded within education and continuing professional development programmes for healthcare workers and healthcare trainees of any discipline. Ultimately, this may facilitate the integration of SBIRT into routine care and contribute to population health improvement.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
| | - Emma J. Adams
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Wendy J. Chaplin
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Lucy Morris
- Department of Research and Education in Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Ikra Mahmood
- General Surgery Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Michael G. Taylor
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Gillian Langmack
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Lydia Jones
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
| | - Philip Miller
- Health Innovation East Midlands, Nottingham NG7 2TU, UK;
| | - Frank Coffey
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK; (E.J.A.); (W.J.C.); (M.G.T.); (G.L.); (L.J.); (F.C.)
- Department of Research and Education in Emergency Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
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Davis AK, Arterberry BJ, Xin Y, Hubbard SM, Schwarting CM, Bonar EE. Incremental Predictive Validity of the Dualistic Model of Passion for Cannabis Use Among College Undergraduate Students With and Without a Cannabis Use Disorder. CANNABIS (ALBUQUERQUE, N.M.) 2023; 6:105-126. [PMID: 38035170 PMCID: PMC10683744 DOI: 10.26828/cannabis/2023/000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Introduction We examined whether the Dualistic Model of Passion (DMP; i.e., obsessive passion [OP] and harmonious passion [HP]) for cannabis use was prospectively associated with cannabis use and use-related outcomes, and with academic performance, relationship attachment style, and social connectedness among college students. We also explored whether the DMP was associated with outcomes when included in a model using established constructs (e.g., coping motives, refusal self-efficacy, cannabis use disorder [CUD] symptoms) as predictors of cannabis use and outcomes. Methods Using a longitudinal cohort design (baseline, 5-month, 10-month [timepoints chosen to better correspond to 9-month academic year]), 513 undergraduate students from two universities who reported using cannabis at least four times in the past month completed a baseline survey (308 meeting criteria for CUD). We used Generalized Estimating Equations to assess longitudinal associations between OP/HP and cannabis use and academic/social outcomes at 5-month and 10-month. Results At baseline, participants were young adults (Mean age = 20.57, SD = 2.51), 78.8% non-Hispanic, 83.8% White, 55.0% female, and 72.3% heterosexual. Greater HP was not associated with greater past month cannabis use or cannabis-related problems. Greater OP was associated with greater past month cannabis use and more cannabis-related problems. There were no significant passion by time interactions. Greater HP was associated with more anxious attachment. OP was associated with less social connection. Conclusion This research suggests that the DMP provides novel information about factors associated with cannabis use and use-related consequences, which can aid in our understanding of cannabis use, misuse, and CUD among college students.
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Affiliation(s)
- Alan K Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University. Columbus, OH USA
- Institute for Population Research, University of Michigan, Ann Arbor, MI USA
| | - Brooke J Arterberry
- Institute for Population Research, University of Michigan, Ann Arbor, MI USA
- Department of Psychology, Iowa State University, Ames, IA USA
| | - Yitong Xin
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University. Columbus, OH USA
| | | | | | - Erin E Bonar
- University of Michigan - Department of Psychiatry; Ann Arbor, MI, USA
- University of Michigan - Addiction Center; Ann Arbor, MI, USA
- University of Michigan - Injury Prevention Center; Ann Arbor, MI, USA
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21
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Patrick ME, Parks MJ, Peterson SJ. High-intensity drinking and hours spent drinking. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2081-2089. [PMID: 38226758 PMCID: PMC10792248 DOI: 10.1111/acer.15189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND High-intensity drinking (HID) is associated with negative consequences, but it remains unclear whether a time qualifier (i.e., time spent drinking) is needed to identify individuals at highest risk. To improve the measurement and conceptualization of HID, we examined the utility of adding a time qualifier to define what constitutes an occasion of HID using repeated daily surveys in a sample of young adults. METHODS Participants were selected from a nationally representative sample of 12th-grade students in the United States who participated in the Monitoring the Future (MTF) study in Spring 2018. In 2019 and 2020, young adults (at modal ages 19-20) responded to annual and daily (14 consecutive days per year) online surveys about their alcohol use. RESULTS When we compared moderate drinking days (less than 4/5 drinks for women/men), binge drinking days (4-7/5-9 drinks), and HID days (8+/10+ drinks), HID days had the longest duration of drinking (5.2 h), highest peak estimated blood alcohol concentration (eBAC, 0.30%), and greatest drinking pace (2.58 drinks/h). HID was associated with a greater number of negative consequences than either moderate or binge drinking; adjusting for time spent drinking did not impact this interpretation. HID was reported on 10.9% of days; when defined as 8/10+ drinks in 4 h or 2 h, HID was reported on 4.8% and 1.0% of days, respectively. Nearly all differences in eBAC and negative consequences persisted across drinking intensity despite the introduction of time constraints. CONCLUSIONS HID days were characterized by both a longer time spent drinking and a more rapid pace of drinking. Adding a time qualifier to the definition of HID would restrict variability by only describing the minority of days and does not improve the distinctions among levels of risk.
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Affiliation(s)
| | - Michael J. Parks
- Hazelden Betty Ford Foundation, Butler Center for Research
- University of Minnesota, Center for Applied Research and Educational Improvement
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22
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Madigan S, Tashkent Y, Trehan S, Muller K, Wigg A, Woodman R, Ramachandran J. Acute on chronic liver failure: A South Australian experience. JGH Open 2023; 7:717-723. [PMID: 37908287 PMCID: PMC10615173 DOI: 10.1002/jgh3.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/21/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023]
Abstract
Background and Aim Acute on chronic liver failure (ACLF) is a clinical syndrome described in patients with acute decompensation (AD) of cirrhosis, characterized by organ failures and high mortality. Intensive management, including liver transplantation (LT), has been shown to improve survival. To address the limited Australian data on ACLF, we describe the prevalence, clinical profile, and outcome of ACLF in an Australian cohort of hospitalized patients. Methods A retrospective review of hepatology admissions in a tertiary hospital from 1 January 2017 to 31 December 2019 identified AD and ACLF cohorts, as defined by the European Association for Study of the Liver definition. Patient characteristics, clinical course, survival at 28- and 90-day survival, and feasibility of LT were analyzed. Results Among the 192 admissions with AD, 74 admissions (39%) met ACLF criteria. A prior diagnosis of alcohol-related cirrhosis was highly prevalent in both cohorts. Grade-1 ACLF was the most frequent (60%), with renal failure being the commonest organ failure; 28-day (23% vs 2%, P = <0.001) and 90-day mortality (36% vs 16%, P = 0.002) were higher in ACLF than AD. Due to ongoing alcohol use disorder (AUD), only six patients underwent LT assessment during ACLF admission. Conclusion ACLF was common in our cohort of cirrhosis with AD and was associated with high mortality. AUD despite prior cirrhosis diagnosis was a barrier to LT. Prioritization of ACLF patients for LT after addressing AUD and relaxation of the 6-month abstinence rule may improve ACLF survival and should be addressed in prospective studies.
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Affiliation(s)
- Shauna Madigan
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Yasmina Tashkent
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Sharad Trehan
- Department of General MedicineFlinders Medical CentreBedford ParkSouth AustraliaAustralia
| | - Kate Muller
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Alan Wigg
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Richard Woodman
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Jeyamani Ramachandran
- Department of Gastroenterology and HepatologyFlinders Medical CentreBedford ParkSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
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23
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Chong MK, Hickie IB, Cross SP, McKenna S, Varidel M, Capon W, Davenport TA, LaMonica HM, Sawrikar V, Guastella A, Naismith SL, Scott EM, Iorfino F. Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study. JMIR Form Res 2023; 7:e45161. [PMID: 37682588 PMCID: PMC10517388 DOI: 10.2196/45161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals' risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. OBJECTIVE The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm's allocation based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts' ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention.
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Affiliation(s)
- Min K Chong
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | | | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Mathew Varidel
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Tracey A Davenport
- Design and Strategy Division, Australian Digital Health Agency, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Vilas Sawrikar
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam Guastella
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Healthy Brain Ageing Program, University of Sydney, Sydney, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
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Eék N, Sundström C, Kraepelien M, Lundgren J, Kaldo V, Berman AH. High- versus low-intensity internet interventions for alcohol use disorders (AUD): A two-year follow-up of a single-blind randomized controlled trial. Internet Interv 2023; 33:100630. [PMID: 37293578 PMCID: PMC10244691 DOI: 10.1016/j.invent.2023.100630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Alcohol Use Disorders (AUD) are widespread and have serious consequences, but are among the most undertreated mental disorders. Internet interventions have been found effective in treating AUD, but we know little about long-term outcomes, two years or more after treatment. This study explored 12- and 24-month outcomes in alcohol consumption following initial 6-month improvements after a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention among individuals with alcohol use disorder. Between-group comparisons were analyzed, as well as within-group comparisons with (1) pre-treatment measurements (2) post-treatment measurements. Participants consisted of a general population sample of internet help-seekers in Sweden. A total of 143 adults (47% men) with a score of 14 (women)/16 (men) or more on the Alcohol Use Disorders Identification Test, alcohol consumption of 11 (women)/14 (men) or more standard drinks the preceding week and ≥ 2 DSM-5 alcohol use disorder (AUD) criteria based on a diagnostic interview were included. The high- and low-intensity internet interventions (n = 72 and n = 71 respectively) consisted of modules based on relapse prevention and cognitive-behavioral therapy. The primary outcome was self-reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days. Attrition from self-reported questionnaires was 36% at the 12-month follow-up and 53% at the 24-month follow-up. No significant between-group differences occurred in outcomes at either long-term follow-up. Regarding within-group differences, compared to pre-treatment, alcohol consumption was lower in both high- and low-intensity interventions at both long-term follow-ups [within-group standard drinks effect sizes varied between g = 0.38-1.04 and heavy drinking days effect sizes varied between g = 0.65-0.94]. Compared to post-treatment, within-group alcohol consumption in the high intensity intervention increased at both follow-ups; for the low-intensity intervention, within-group consumption decreased at 12-month follow-up, but did not differ compared to post-treatment at 24 months. Both high- and low-intensity internet interventions for AUD were thus associated with overall reductions in alcohol consumption at long term follow-ups, with no significant differences between the two. However, conclusions are hampered by differential and non-differential attrition.
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Affiliation(s)
- Niels Eék
- University of Gothenburg, Department of Psychology, Sweden
| | - Christopher Sundström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
- Linnaeus University Faculty of Health and Life Sciences, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | | | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
- Linnaeus University Faculty of Health and Life Sciences, Sweden
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Kiyak C, Deluca P, Norton S, Simonetti ME, Preti E. The Impact of Cue-Elicited Multisensory Imagery on Alcohol Craving: A Randomised Controlled Trial. Eur Addict Res 2023; 29:353-362. [PMID: 37643589 DOI: 10.1159/000531844] [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: 03/25/2023] [Accepted: 06/16/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Elaborated intrusion theory suggests that imagery is central to craving; however, the possibility that cue-elicited multisensory imagery produces such urges has not been studied enough in the literature. Thus, we investigated the role of cue-elicited multisensory imagery on alcohol craving in individuals who are hazardous and social drinkers compared to mental and neutral imagery conditions. METHODS In an online experiment, hazardous and social drinkers (N = 348) between 18 and 45 years old were randomised to multisensory, mental, and neutral imagery exposure. The level of craving intensity was measured before and after imagery exposure. Also, participants rated vividness and sensory features scales after the exposure. RESULTS The level of craving was significantly higher in multisensory imagery condition compared to neutral condition (b = 1.94, p < 0.001, SE = 0.30, t(344) = 6.52, standardised mean difference [SMD] = 0.89) and in mental imagery condition compared to neutral condition (b = 1.82, SE = 0.30, t(344) = 6.52, p < 0.001, SMD = 0.83). The difference between the level of craving intensity between the multisensory and mental was not significant (b = 0.12, SE = 0.22, t(344) = 0.53, p = 0.594, SMD = 0.06). Moreover, craving intensity in response to multisensory versus neutral imagery was significantly stronger among hazardous drinkers (b = -2.90, SE = 0.83, t(341) = -3.50, p < 0.001). The level of vividness was not significantly different between any conditions. The difference between levels of sensory features was higher in multisensory imagery condition compared to neutral (b = 0.95, SE = 0.30, t(345) = 3.17, p = 0.002, SMD = 0.49) and mental imagery condition (b = 0.67, SE = 0.23, t(345) = 2.36, p = 0.004, SMD = 0.35). CONCLUSION Results suggest that cue-elicited multisensory imagery may be a useful tool for eliciting alcohol craving responses and provide an additional means for better understanding the multi-layered mechanism of craving.
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Affiliation(s)
- Ceyda Kiyak
- School of Psychology, University of East Anglia, Norwich, UK,
| | - Paolo Deluca
- Institute of Psychology, RWTH Aachen University, Aachen, Germany
| | - Sam Norton
- Institute of Psychology, RWTH Aachen University, Aachen, Germany
| | - Matilde E Simonetti
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Emanuele Preti
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
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Kintu TM, Kaggwa MM, Namagembe R, Muganzi DJ, Kihumuro BR, Luyinda GS, Nabwana BW, Moses M, Nnyombi M, Kirega A, Kabakyenga JK, Maling S. Alcohol use disorder among healthcare professional students: a structural equation model describing its effect on depression, anxiety, and risky sexual behavior. BMC Psychiatry 2023; 23:505. [PMID: 37438721 DOI: 10.1186/s12888-023-04989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/29/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Mental health problems such as depression, anxiety and alcohol use disorders are among the leading causes of disability worldwide. Among university students, alcohol use and poor mental health are associated with risky sexual behavior. Given the syndemic occurrence of these disorders most especially in young adults, we describe the relationship between them so as to guide and intensify current interventions on reducing their burden in this population. METHODS This was a cross-sectional study based on an online survey among healthcare professional university students that captured sociodemographic characteristics, risky sexual behavior, alcohol use disorder, generalized anxiety disorder, and depression. Structural equation modelling was used to describe the relationship between these variables using RStudio. RESULTS We enrolled a total of 351 participants of which 11% (37/351) had Alcohol Use Disorder, 33% (117/351) had depressive symptoms and 32% (111/351) had symptoms of anxiety. A model describing the relationship between these variables was found to fit well both descriptively and statistically [χ2 = 44.437, df = 21, p-value = 0.01, CFI = 0.989, TFI = 0.980, RMSEA = 0.056]. All observed variables were found to fit significantly and positively onto their respective latent factors (AUD, anxiety, depression and risky sexual behavior). AUD was found to be significantly associated with risky sexual behavior (β = 0.381, P < 0.001), depression (β = 0.152, P = 0.004), and anxiety (β = 0.137, P = 0.001). CONCLUSION AUD, depression and anxiety are a significant burden in this health professional student population and there's need to consider screening for anxiety and depression in students reporting with AUD so as to ensure appropriate interventions. A lot of attention and efforts should be focused on the effect of AUD on risky sexual behavior and continued health education is still required even among health professional students.
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Affiliation(s)
- Timothy Mwanje Kintu
- Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
| | - Mark Mohan Kaggwa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Robinah Namagembe
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - David Jolly Muganzi
- Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Bernard Raymond Kihumuro
- Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Garvin Ssali Luyinda
- Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | | | - Muwanguzi Moses
- Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Marvin Nnyombi
- Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Alex Kirega
- Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Jerome Kahuma Kabakyenga
- Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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Laurens MC, Postel MG, Brusse-Keizer M, Pieterse ME, Ben Allouch S, Bohlmeijer ET, Salemink E. Augmenting outpatient alcohol treatment as usual with online approach bias modification training: A double-blind randomized controlled trial. Addict Behav 2023; 142:107630. [PMID: 36881944 DOI: 10.1016/j.addbeh.2023.107630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
Previous research shows that automatic tendency to approach alcohol plays a causal role in problematic alcohol use and can be retrained by Approach Bias Modification (ApBM). ApBM has been shown to be effective for patients diagnosed with alcohol use disorder (AUD) in inpatient treatment. This study aimed to investigate the effectiveness of adding an online ApBM to treatment as usual (TAU) in an outpatient setting compared to receiving TAU with an online placebo training. 139 AUD patients receiving face-to-face or online treatment as usual (TAU) participated in the study. The patients were randomized to an active or placebo version of 8 sessions of online ApBM over a 5-week period. The weekly consumed standard units of alcohol (primary outcome) was measured at pre-and post-training, 3 and 6 months follow-up. Approach tendency was measured pre-and-post ApBM training. No additional effect of ApBM was found on alcohol intake, nor other outcomes such as craving, depression, anxiety, or stress. A significant reduction of the alcohol approach bias was found. This research showed that approach bias retraining in AUD patients in an outpatient treatment setting reduces the tendency to approach alcohol, but this training effect does not translate into a significant difference in alcohol reduction between groups. Explanations for the lack of effects of ApBM on alcohol consumption are treatment goal and severity of AUD. Future ApBM research should target outpatients with an abstinence goal and offer alternative, more user-friendly modes of delivering ApBM training.
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Affiliation(s)
- Melissa C Laurens
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands; Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands.
| | - Marloes G Postel
- Research Group Technology, Health & Care, Saxion University of Applied Sciences, Enschede, Netherlands
| | - Marjolein Brusse-Keizer
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands; Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marcel E Pieterse
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | - Somaya Ben Allouch
- Informatics Institute, University of Amsterdam, Netherlands; Research Group Digital Life, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, Centre for eHealth and Well-being Research, University of Twente, Enschede, Netherlands
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
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Niemelä O, Bloigu A, Bloigu R, Aalto M, Laatikainen T. Associations between Liver Enzymes, Lifestyle Risk Factors and Pre-Existing Medical Conditions in a Population-Based Cross-Sectional Sample. J Clin Med 2023; 12:4276. [PMID: 37445311 DOI: 10.3390/jcm12134276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
While alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) enzymes are commonly used indicators of liver dysfunction recent studies have suggested that these may also serve as predictive biomarkers in the assessment of extrahepatic morbidity. In order to shed further light on the interactions between serum liver enzyme abnormalities, factors of lifestyle and health status we examined ALT and GGT activities in a population-based sample of 8743 adult individuals (4048 men, 4695 women from the National FINRISK 2002 Study, mean age 48.1 ± 13.1 years) with different levels of alcohol drinking, smoking, physical activity, body weight and the presence or absence of various pre-existing medical conditions. The assessments also included laboratory tests for inflammation, lipid status and fatty liver index (FLI), a proxy for fatty liver. The prevalence of ALT and GGT abnormalities were significantly influenced by alcohol use (ALT: p < 0.0005 for men; GGT: p <0.0005 for both genders), smoking (GGT: p <0.0005 for men, p =0.002 for women), adiposity (p < 0.0005 for all comparisons), physical inactivity (GGT: p <0.0005; ALT: p <0.0005 for men, p <0.05 for women) and coffee consumption (p <0.0005 for GGT in both genders; p <0.001 for ALT in men). The total sum of lifestyle risk factor scores (LRFS) influenced the occurrence of liver enzyme abnormalities in a rather linear manner. Significantly higher LRFS were observed in the subgroups of individuals with pre-existing medical conditions when compared with those having no morbidities (p <0.0005). In logistic regression analyses adjusted for the lifestyle factors, both ALT and GGT associated significantly with fatty liver, diabetes and hypertension. GGT levels also associated with coronary heart disease, angina pectoris, cardiac insufficiency, cerebrovascular disease, asthma and depression. Combinations of abnormal ALT and GGT activities significantly increased the odds for hypertension coinciding with abnormalities in biomarkers of inflammation, lipid status and FLI. The data indicates that ALT and GGT activities readily respond to unfavorable factors of lifestyle associating also with a wide array of pre-existing medical conditions. The data supports close links between both hepatic and extrahepatic morbidities and lifestyle risk factors and may open new insights on a more comprehensive use of liver enzymes in predictive algorithms for assessing mechanistically anchored disease conditions.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Aini Bloigu
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
| | - Risto Bloigu
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90014 Oulu, Finland
| | - Mauri Aalto
- Department of Psychiatry, Seinäjoki Central Hospital and Tampere University, 33100 Tampere, Finland
| | - Tiina Laatikainen
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services, 80210 Joensuu, Finland
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29
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Abstract
The medical disorders of alcoholism rank among the leading public health problems worldwide and the need for predictive and prognostic risk markers for assessing alcohol use disorders (AUD) has been widely acknowledged. Early-phase detection of problem drinking and associated tissue toxicity are important prerequisites for timely initiations of appropriate treatments and improving patient's committing to the objective of reducing drinking. Recent advances in clinical chemistry have provided novel approaches for a specific detection of heavy drinking through assays of unique ethanol metabolites, phosphatidylethanol (PEth) or ethyl glucuronide (EtG). Carbohydrate-deficient transferrin (CDT) measurements can be used to indicate severe alcohol problems. Hazardous drinking frequently manifests as heavy episodic drinking or in combinations with other unfavorable lifestyle factors, such as smoking, physical inactivity, poor diet or adiposity, which aggravate the metabolic consequences of alcohol intake in a supra-additive manner. Such interactions are also reflected in multiple disease outcomes and distinct abnormalities in biomarkers of liver function, inflammation and oxidative stress. Use of predictive biomarkers either alone or as part of specifically designed biological algorithms helps to predict both hepatic and extrahepatic morbidity in individuals with such risk factors. Novel approaches for assessing progression of fibrosis, a major determinant of prognosis in AUD, have also been made available. Predictive algorithms based on the combined use of biomarkers and clinical observations may prove to have a major impact on clinical decisions to detect AUD in early pre-symptomatic stages, stratify patients according to their substantially different disease risks and predict individual responses to treatment.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, Seinäjoki, Finland.
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Rodríguez FD, Sánchez ML, Coveñas R. Neurotensin and Alcohol Use Disorders: Towards a Pharmacological Treatment. Int J Mol Sci 2023; 24:ijms24108656. [PMID: 37240004 DOI: 10.3390/ijms24108656] [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: 04/05/2023] [Revised: 05/06/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Harmful alcohol use is responsible for a group of disorders collectively named alcohol use disorders (AUDs), according to the DSM-5 classification. The damage induced by alcohol depends on the amount, time, and consumption patterns (continuous and heavy episodic drinking). It affects individual global well-being and social and familial environments with variable impact. Alcohol addiction manifests with different degrees of organ and mental health detriment for the individual, exhibiting two main traits: compulsive drinking and negative emotional states occurring at withdrawal, frequently causing relapse episodes. Numerous individual and living conditions, including the concomitant use of other psychoactive substances, lie in the complexity of AUD. Ethanol and its metabolites directly impact the tissues and may cause local damage or alter the homeostasis of brain neurotransmission, immunity scaffolding, or cell repair biochemical pathways. Brain modulator and neurotransmitter-assembled neurocircuitries govern reward, reinforcement, social interaction, and consumption of alcohol behaviors in an intertwined manner. Experimental evidence supports the participation of neurotensin (NT) in preclinical models of alcohol addiction. For example, NT neurons in the central nucleus of the amygdala projecting to the parabrachial nucleus strengthen alcohol consumption and preference. In addition, the levels of NT in the frontal cortex were found to be lower in rats bred to prefer alcohol to water in a free alcohol-water choice compared to wild-type animals. NT receptors 1 and 2 seem to be involved in alcohol consumption and alcohol effects in several models of knockout mice. This review aims to present an updated picture of the role of NT systems in alcohol addiction and the possible use of nonpeptide ligands modulating the activity of the NT system, applied to experimental animal models of harmful drinking behavior mimicking alcohol addiction leading to health ruin in humans.
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Affiliation(s)
- Francisco D Rodríguez
- Department of Biochemistry and Molecular Biology, Faculty of Chemical Sciences, University of Salamanca, 37008 Salamanca, Spain
- Group GIR-USAL: BMD (Bases Moleculares del Desarrollo), University of Salamanca, 37008 Salamanca, Spain
| | - Manuel Lisardo Sánchez
- Laboratory of Neuroanatomy of the Peptidergic Systems, Institute of Neurosciences of Castilla and León (INCYL), University of Salamanca, C/Pintor Fernando Gallego 1, 37007 Salamanca, Spain
| | - Rafael Coveñas
- Group GIR-USAL: BMD (Bases Moleculares del Desarrollo), University of Salamanca, 37008 Salamanca, Spain
- Laboratory of Neuroanatomy of the Peptidergic Systems, Institute of Neurosciences of Castilla and León (INCYL), University of Salamanca, C/Pintor Fernando Gallego 1, 37007 Salamanca, Spain
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Greene MC, Kane J, Alto M, Giusto A, Lovero K, Stockton M, McClendon J, Nicholson T, Wainberg ML, Johnson RM, Tol WA. Psychosocial and pharmacologic interventions to reduce harmful alcohol use in low- and middle-income countries. Cochrane Database Syst Rev 2023; 5:CD013350. [PMID: 37158538 PMCID: PMC10167787 DOI: 10.1002/14651858.cd013350.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Harmful alcohol use is defined as unhealthy alcohol use that results in adverse physical, psychological, social, or societal consequences and is among the leading risk factors for disease, disability and premature mortality globally. The burden of harmful alcohol use is increasing in low- and middle-income countries (LMICs) and there remains a large unmet need for indicated prevention and treatment interventions to reduce harmful alcohol use in these settings. Evidence regarding which interventions are effective and feasible for addressing harmful and other patterns of unhealthy alcohol use in LMICs is limited, which contributes to this gap in services. OBJECTIVES To assess the efficacy and safety of psychosocial and pharmacologic treatment and indicated prevention interventions compared with control conditions (wait list, placebo, no treatment, standard care, or active control condition) aimed at reducing harmful alcohol use in LMICs. SEARCH METHODS We searched for randomized controlled trials (RCTs) indexed in the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, the Cochrane Clinical Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, Embase, PsycINFO, CINAHL, and the Latin American and Caribbean Health Sciences Literature (LILACS) through 12 December 2021. We searched clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, Web of Science, and Opengrey database to identify unpublished or ongoing studies. We searched the reference lists of included studies and relevant review articles for eligible studies. SELECTION CRITERIA All RCTs comparing an indicated prevention or treatment intervention (pharmacologic or psychosocial) versus a control condition for people with harmful alcohol use in LMICs were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 66 RCTs with 17,626 participants. Sixty-two of these trials contributed to the meta-analysis. Sixty-three studies were conducted in middle-income countries (MICs), and the remaining three studies were conducted in low-income countries (LICs). Twenty-five trials exclusively enrolled participants with alcohol use disorder. The remaining 51 trials enrolled participants with harmful alcohol use, some of which included both cases of alcohol use disorder and people reporting hazardous alcohol use patterns that did not meet criteria for disorder. Fifty-two RCTs assessed the efficacy of psychosocial interventions; 27 were brief interventions primarily based on motivational interviewing and were compared to brief advice, information, or assessment only. We are uncertain whether a reduction in harmful alcohol use is attributable to brief interventions given the high levels of heterogeneity among included studies (Studies reporting continuous outcomes: Tau² = 0.15, Q =139.64, df =16, P<.001, I² = 89%, 3913 participants, 17 trials, very low certainty; Studies reporting dichotomous outcomes: Tau²=0.18, Q=58.26, df=3, P<.001, I² =95%, 1349 participants, 4 trials, very low certainty). The other types of psychosocial interventions included a range of therapeutic approaches such as behavioral risk reduction, cognitive-behavioral therapy, contingency management, rational emotive therapy, and relapse prevention. These interventions were most commonly compared to usual care involving varying combinations of psychoeducation, counseling, and pharmacotherapy. We are uncertain whether a reduction in harmful alcohol use is attributable to psychosocial treatments due to high levels of heterogeneity among included studies (Heterogeneity: Tau² = 1.15; Q = 444.32, df = 11, P<.001; I²=98%, 2106 participants, 12 trials, very low certainty). Eight trials compared combined pharmacologic and psychosocial interventions with placebo, psychosocial intervention alone, or another pharmacologic treatment. The active pharmacologic study conditions included disulfiram, naltrexone, ondansetron, or topiramate. The psychosocial components of these interventions included counseling, encouragement to attend Alcoholics Anonymous, motivational interviewing, brief cognitive-behavioral therapy, or other psychotherapy (not specified). Analysis of studies comparing a combined pharmacologic and psychosocial intervention to psychosocial intervention alone found that the combined approach may be associated with a greater reduction in harmful alcohol use (standardized mean difference (standardized mean difference (SMD))=-0.43, 95% confidence interval (CI): -0.61 to -0.24; 475 participants; 4 trials; low certainty). Four trials compared pharmacologic intervention alone with placebo and three with another pharmacotherapy. Drugs assessed were: acamprosate, amitriptyline, baclofen disulfiram, gabapentin, mirtazapine, and naltrexone. None of these trials evaluated the primary clinical outcome of interest, harmful alcohol use. Thirty-one trials reported rates of retention in the intervention. Meta-analyses revealed that rates of retention between study conditions did not differ in any of the comparisons (pharmacologic risk ratio (RR) = 1.13, 95% CI: 0.89 to 1.44, 247 participants, 3 trials, low certainty; pharmacologic in addition to psychosocial intervention: RR = 1.15, 95% CI: 0.95 to 1.40, 363 participants, 3 trials, moderate certainty). Due to high levels of heterogeneity, we did not calculate pooled estimates comparing retention in brief (Heterogeneity: Tau² = 0.00; Q = 172.59, df = 11, P<.001; I2 = 94%; 5380 participants; 12 trials, very low certainty) or other psychosocial interventions (Heterogeneity: Tau² = 0.01; Q = 34.07, df = 8, P<.001; I2 = 77%; 1664 participants; 9 trials, very low certainty). Two pharmacologic trials and three combined pharmacologic and psychosocial trials reported on side effects. These studies found more side effects attributable to amitriptyline relative to mirtazapine, naltrexone and topiramate relative to placebo, yet no differences in side effects between placebo and either acamprosate or ondansetron. Across all intervention types there was substantial risk of bias. Primary threats to validity included lack of blinding and differential/high rates of attrition. AUTHORS' CONCLUSIONS In LMICs there is low-certainty evidence supporting the efficacy of combined psychosocial and pharmacologic interventions on reducing harmful alcohol use relative to psychosocial interventions alone. There is insufficient evidence to determine the efficacy of pharmacologic or psychosocial interventions on reducing harmful alcohol use largely due to the substantial heterogeneity in outcomes, comparisons, and interventions that precluded pooling of these data in meta-analyses. The majority of studies are brief interventions, primarily among men, and using measures that have not been validated in the target population. Confidence in these results is reduced by the risk of bias and significant heterogeneity among studies as well as the heterogeneity of results on different outcome measures within studies. More evidence on the efficacy of pharmacologic interventions, specific types of psychosocial interventions are needed to increase the certainty of these results.
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Affiliation(s)
- M Claire Greene
- Program on Forced Migration and Health, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeremy Kane
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Alto
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Kathryn Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Melissa Stockton
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Jasmine McClendon
- Department of Psychiatry, UC Davis Medical Center, Sacramento, CALIFORNIA, USA
| | - Terriann Nicholson
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University/NYSPI, New York, New York, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wietse Anton Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, USA
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Sipilä PN, Keski-Rahkonen A, Lindbohm JV, Rose RJ, Kaprio J. Paternal and Maternal Problem Drinking and Lifetime Problem Drinking of Their Adult Children. Twin Res Hum Genet 2023; 26:152-163. [PMID: 37092738 PMCID: PMC11000696 DOI: 10.1017/thg.2023.12] [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] [Indexed: 04/25/2023]
Abstract
Parents' alcohol use is associated with alcohol use of their adolescent offspring, but does this association extend to the adulthood of the offspring? We examined associations of paternal and maternal problem drinking with lifetime problem drinking of their adult offspring prospectively assessed in a population-based Finnish twin-family cohort (FinnTwin16). Problem drinking (Malmö-modified Michigan Alcoholism Screening Test) was self-reported separately by mothers and fathers when their children were 16. The children reported on an extended lifetime version of the same measure during their mid-twenties (21-28 years) and mid-thirties (31-37 years). 1235 sons and 1461 daughters in mid-twenties and 991 sons and 1278 daughters in mid-thirties had complete data. Correlations between fathers' and their adult children's problem drinking ranged from .12 to .18. For mothers and their adult children, these correlations ranged from .09 to .14. In multivariate models, adjustment for potential confounders had little effect on the observed associations. In this study, parental problem drinking was modestly associated with lifetime problem drinking of their adult children. This association could be detected even when the children had reached the fourth decade of life.
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Affiliation(s)
- Pyry N Sipilä
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anna Keski-Rahkonen
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Joni V Lindbohm
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Richard J Rose
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - Jaakko Kaprio
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
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33
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Atmaca M, Tabara MF, Koc M, Gurok MG, Baykara S, Korkmaz S, Mermi O. Cortical Thickness of the Orbitofrontal Cortex in Patients with Alcohol Use Disorder. Brain Sci 2023; 13:brainsci13040552. [PMID: 37190518 DOI: 10.3390/brainsci13040552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Aims: In the present study, it was hypothesised that compared to healthy control subjects, significant differences in the cortical thickness of the orbitofrontal cortex (OFC) region of the brain, which is relevant to both impulsivity and decision making, would be identified. Methods: The subject groups included in the study were composed of 15 individuals who met the criteria for alcohol use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 (SCID), and were admitted to the Firat University School of Medicine Department of Psychiatry or were hospitalised, and 17 healthy control comparisons were made. The volumes of and cortical thickness of the OFC were measured in the subjects. Results: It was found that patients with alcohol use disorder had reduced volumes of the OFC bilaterally and a thinner cortical thickness of the same region bilaterally compared to those of the healthy control comparisons. Conclusions: Consequently, it is suggested that the OFC region of the brain appears to be statistically significantly smaller in patients with alcohol use disorder, both in terms of cortical thickness and volume, compared to healthy controls. Future research should focus on the status of these relationships longitudinally and should assess the causality of the association with the treatment response.
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Singh G, Kaloiya GS, Dhawan A, Mishra AK, Balhara YPS. Does Cognitive Therapy Change the Early Maladaptive Schemas in Individuals with Alcohol Dependence? Evidence from a Randomized Controlled Trial. Indian J Psychol Med 2023; 45:124-131. [PMID: 36925491 PMCID: PMC10011844 DOI: 10.1177/02537176221105529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Although early maladaptive schemas (EMSs) have been suggested as potential vulnerability markers for alcohol dependence (AD), there is less emphasis on addressing these schemas in substance abuse treatment programs. We thus aimed to examine the change in schemas in response to cognitive therapy in individuals with AD. Methods In this an open-label randomized controlled study, individuals with alcohol dependence syndrome (ADS, n = 84) were randomized to the intervention group (n = 45), which received six cognitive therapy sessions combined with treatment as usual (TAU), or the control group (n = 39), which was on TAU only. Participants were assessed on the measures of EMSs, alcohol use severity, and perceived stress at baseline and posttreatment. Results The intervention group showed significant improvement in 5 out of 18 EMSs, that is, emotional deprivation, defectiveness, self-sacrifice, unrelenting standard, and negativity, compared to the control group, at the end of the treatment. There was a significant between-group effect for perceived stress but not for alcohol use severity. Conclusion EMSs can be changed with cognitive therapy in individuals with AD and could be a crucial area to address in treatment programs. Further studies with long-term follow-up are warranted. The trial was registered with the Clinical Trials Registry-India (CTRI/2015/12/006441) on December 17, 2015.
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Affiliation(s)
- Geeta Singh
- Dept. of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Gauri Shanker Kaloiya
- National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anju Dhawan
- National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashwani Kumar Mishra
- National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Yatan Pal Singh Balhara
- National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Rao R(T. Editorial. ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-02-2023-051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Wu YC, Yao Y, Tao LS, Wang SX, Hu Y, Li LY, Hu S, Meng X, Yang DS, Li H, Xu T. The role of acetaldehyde dehydrogenase 2 in the pathogenesis of liver diseases. Cell Signal 2023; 102:110550. [PMID: 36464104 DOI: 10.1016/j.cellsig.2022.110550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/12/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
Common liver tissue damage is mainly due to the accumulation of toxic aldehydes in lipid peroxidation under oxidative stress. Cumulative toxic aldehydes in the liver can be effectively metabolized by acetaldehyde dehydrogenase 2 (ALDH2), thereby alleviating various liver diseases. Notably, gene mutation of ALDH2 leads to impaired ALDH2 enzyme activity, thus aggravating the progress of liver diseases. However, the relationship and specific mechanism between ALDH2 and liver diseases are not clear. Consequently, the review explains the relationship between ALDH2 and liver diseases such as alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), liver fibrosis and hepatocellular carcinoma (HCC). In addition, this review also discusses ALDH2 as a potential therapeutic target for various liver diseases,and focuses on summarizing the regulatory mechanism of ALDH2 in these liver diseases.
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Affiliation(s)
- Yin-Cui Wu
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China
| | - Yan Yao
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China
| | - Liang-Song Tao
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China
| | - Shu-Xian Wang
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China
| | - Ying Hu
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China
| | - Liang-Yun Li
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China
| | - Shuang Hu
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China
| | - Xiang Meng
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Da-Shuai Yang
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China
| | - He Li
- The Second Hospital of Anhui Medical University, Hefei, Anhui Province 230001, China.
| | - Tao Xu
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, 230032, China; Institute for Liver Diseases of Anhui Medical University, China.
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Raluthaga N, Shilubane HN, Lowane MP. Relapse among MHCUs after a Short-Term Admission in an Acute Psychiatric Unit: Primary Caregivers' Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1384. [PMID: 36674139 PMCID: PMC9859106 DOI: 10.3390/ijerph20021384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
South Africa has taken initiative to strengthen its mental health system, by improving the Mental Health Care Act 17 of 2002 which proclaims that mental healthcare users (MHCUs) can be treated in communities and homes. Due to short-term hospitalisations for acute MHCUs and advocacy for community-based care, families play a significant role in providing care to severe mental healthcare users. The objective of the study was to explore primary caregivers' perspective regarding the relapse of MHCUs following a short-term admission in acute psychiatric units. A qualitative explorative design was used. In-depth individual interviews were conducted with 18 primary caregivers whose family members were readmitted to four hospitals with units designated for acute MHCUs in Limpopo. NVivo computer software version 11 was used to analyse data. The findings are that MHCUs deny the mental health condition. Mental illness is considered a short illness that can be cured, which shows misconceptions about self-mental health conditions. Refusal of direct observed treatment support also emerged; hence, it is difficult for caregivers to identify if the patient is taking the correct doses or not taking the medication at all. Perceived wrong beliefs about mental illness can affect the patient's desire to seek proper management and it can be damaging in many ways. Drugs and alcohol abuse makes MHCUs display disruptive behaviours and contribute to treatment non-adherence resulting in caregivers becoming reluctant to be around them. In conclusion, mixing traditional and faith-based mental healthcare practices as reported by primary caregivers can mean that tailor-fabricated culture-specific mental healthcare is required.
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Affiliation(s)
- Nelson Raluthaga
- Department of Advanced Nursing Science, University of Venda, Private Bag X5050, Thohoyandou 0950, South Africa
| | - Hilda N. Shilubane
- Department of Advanced Nursing Science, University of Venda, Private Bag X5050, Thohoyandou 0950, South Africa
| | - Mygirl Pearl Lowane
- Department of Public Health, Sefako Makgatho Health Sciences University, P.O. Box 215, Medunsa, Pretoria 0204, South Africa
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Gurok MG, Tabara MF, Koc M, Saritoy S, Baykara S, Atmaca M. Pituitary Volumes Are Reduced in Patients With Alcohol Use Disorder. Alcohol Alcohol 2023; 58:107-112. [PMID: 36458440 DOI: 10.1093/alcalc/agac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/01/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS To determine whether there is a difference in pituitary gland volumes in patients with alcohol use disorder compared to healthy people. METHODS The subjects included in the study consisted of 15 individuals who met the criteria for alcohol use disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 and were admitted to Firat University School of Medicine, Department of Psychiatry, or were hospitalized, and 17 healthy controls. The volumes of pituitary were measured in subjects. RESULTS Absolute pituitary gland volumes of patients with alcohol use disorder and healthy controls were compared in the analysis performed using the independent samples t-test. The mean volume of the patient group was significantly smaller than the healthy controls (58.02 ± 7.24 mm3 in patients with alcohol use disorder vs. 83.08 ± 12.11 mm3, P < 0.01), a difference which persisted after controlling for age, gender and total brain size. CONCLUSIONS Patients with alcohol use disorder in this study had smaller pituitary gland volumes compared to those of healthy control subjects. However, this study has limitations including small sample size and not adjusting for previous or current medication use or current anxiety and depression.
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Affiliation(s)
- Mehmet Gurkan Gurok
- Department of Psychiatry, Firat University School of Medicine, Elazig 23100, Turkey
| | | | - Mustafa Koc
- Department of Radiology, Firat University School of Medicine, Elazig 23100, Turkey
| | - Sumeyra Saritoy
- Department of Radiology, Firat University School of Medicine, Elazig 23100, Turkey
| | - Sema Baykara
- Department of Psychiatry, Firat University School of Medicine, Elazig 23100, Turkey
| | - Murad Atmaca
- Department of Psychiatry, Firat University School of Medicine, Elazig 23100, Turkey
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Hoven M, Schluter RS, Schellekens AF, van Holst RJ, Goudriaan AE. Effects of 10 add-on HF-rTMS treatment sessions on alcohol use and craving among detoxified inpatients with alcohol use disorder: a randomized sham-controlled clinical trial. Addiction 2023; 118:71-85. [PMID: 35971295 PMCID: PMC10087396 DOI: 10.1111/add.16025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 08/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Alcohol use disorder (AUD) is a chronic disorder with high relapse rates. There are currently few clinical trials of high frequency repetitive transcranial magnetic stimulation (HF-rTMS) to reduce alcohol use among AUD patients, and results are mixed. The current study tested the effect of 10 add-on sessions of HF-rTMS over the right dorsolateral pre-frontal cortex (DLPFC) on alcohol use and craving. DESIGN Single-center, single blind sham-controlled parallel-group RCT (n = 80), with 3 and 6 months follow-up. SETTING Clinical treatment center in Amsterdam, the Netherlands. PARTICIPANTS Eighty detoxified and abstinent AUD inpatients in clinical treatment (20 females, average age = 44.35 years). INTERVENTION Ten sessions of active or sham HF-rTMS (60 10 Hz trains of 5 sec at 110% motor threshold) over the right DLPFC on 10 consecutive work-days. MEASUREMENTS The primary outcome measure is the number of abstinent days over 6-month follow-up (FU). Secondary outcome measures are craving over 6-month FU (alcohol urge questionnaire and obsessive-compulsive drinking scale), time to first relapse over 6-month FU and grams of alcohol consumed over 6-month FU. Additional outcome measures: full abstinence over 6-month FU and treatment success over 12-month FU. FINDINGS HF-rTMS did not affect the number of abstinent days over 6 months FU [sham = 124 ± 65.9 days, active = 115 ± 69.8 days, difference: 9 days, 95% confidence interval (CI) = Poisson model: 0.578-3.547]. Moreover, HF-rTMS did not affect craving (AUQ/OCDS) (sham = 15.38/5.28, active = 17.48/4.75, differences = 2.1/-0.53, 95% CI mixed-effects model = -9.14 to 2.07/-1.44 to 2.40). CONCLUSIONS There was no clear evidence that high-frequency repetitive transcranial magnetic stimulation over the right dorsolateral pre-frontal cortex treatment has a long-term positive effect on alcohol use or craving as add-on treatment for alcohol use disorder. High treatment response at 6-month follow-up could have limited the possibility to find an effect.
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Affiliation(s)
- Monja Hoven
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands
| | - Renée S Schluter
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands
| | - Arnt F Schellekens
- Donders Institute for Brain, Cognition, and Behavior, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, the Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
| | - Ruth J van Holst
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands.,Center for Urban Mental Health, University of Amsterdam, the Netherlands
| | - Anna E Goudriaan
- Amsterdam UMC, Department of Psychiatry, University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands.,Center for Urban Mental Health, University of Amsterdam, the Netherlands.,Arkin and Jellinek, Mental Health Care, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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40
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Kidd C, Connor JP, F. X. Feeney G, Gullo MJ. Improving assessment and progress monitoring in alcohol use disorder: An implementation evaluation of the instant assessment and personalised feedback system (iAx). Addict Behav 2022; 135:107438. [DOI: 10.1016/j.addbeh.2022.107438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022]
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Shah I, Bocchino R, Ahmed A, Freedman SD, Kothari DJ, Sheth SG. Impact of recurrent acute pancreatitis on the natural history and progression to chronic pancreatitis. Pancreatology 2022; 22:1084-1090. [PMID: 36150985 DOI: 10.1016/j.pan.2022.09.237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/14/2022] [Accepted: 09/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS It is believed that acute pancreatitis (AP), recurrent AP (RAP) and chronic pancreatitis (CP) represent stages of the same disease spectrum. We aimed to identify risk factors, clinical presentation and outcomes in patients with prior RAP who develop CP. METHODS We retrospectively reviewed patients with CP who were seen at our Pancreas Center during 2016-2021. We divided them into two groups: with and without RAP (≥2 episodes of AP). We compared demographics, clinical presentation and resource utilization between the two groups. RESULTS We identified 440 patients with CP, of which 283 (64%) patients had preceding RAP. These patients were younger (55.6 vs 63.1 years), active smokers (36% vs 20%) and had alcohol-related CP (49% vs 25%) compared to those without RAP and CP (p < 0.05). More patients with RAP had chronic abdominal pain (89% vs 67.9%), nausea (43.3% vs 27.1%) and exocrine pancreatic insufficiency (65.8% vs 46.5%) (p < 0.05). More patients with RAP used opioids (58.4% vs 32.3%) and gabapentinoids (56.6% vs 34.8%) (p < 0.05). They also had more ED visits resulting in an opioid prescription (9.68% vs 2%) and more CP flares requiring hospitalization (3.09 vs 0.87) (p < 0.05). CONCLUSION Young age, smoking and alcohol use are seen in patients with RAP who progress to CP. These patients are highly symptomatic and use more healthcare resources, suggestive of an overall a more course compared to those patients who develop CP without preceding RAP. Early identification and counselling of these patients may slow down progression to CP.
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Affiliation(s)
- Ishani Shah
- Division of Gastroenterology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Rachel Bocchino
- Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Awais Ahmed
- Division of Gastroenterology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Steven D Freedman
- Division of Gastroenterology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Darshan J Kothari
- Division of Gastroenterology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Sunil G Sheth
- Division of Gastroenterology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
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Attenuation of the levels of pro-inflammatory cytokines prevents depressive-like behavior during ethanol withdrawal in mice. Brain Res Bull 2022; 191:9-19. [DOI: 10.1016/j.brainresbull.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/18/2022]
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Niemelä O, Bloigu A, Bloigu R, Halkola AS, Niemelä M, Aalto M, Laatikainen T. Impact of Physical Activity on the Characteristics and Metabolic Consequences of Alcohol Consumption: A Cross-Sectional Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15048. [PMID: 36429766 PMCID: PMC9690068 DOI: 10.3390/ijerph192215048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Sedentary lifestyle and excessive alcohol drinking are major modifiable risk factors of health. In order to shed further light on the relationships between physical activity and health consequences of alcohol intake, we measured biomarkers of liver function, inflammation, lipid status and fatty liver index tests in a large population-based sample of individuals with different levels of physical activity, alcohol drinking and other lifestyle risk factors. The study included 21,050 adult participants (9940 men, 11,110 women) (mean age 48.2 ± 13.3 years) of the National FINRISK Study. Data on physical activity, alcohol drinking, smoking and body weight were recorded. The participants were classified to subgroups according to gender, levels of physical activity (sedentary, low, moderate, vigorous, extreme), alcohol drinking levels (abstainers, moderate drinkers, heavy drinkers) and patterns (regular or binge, types of beverages preferred in consumption). Serum liver enzymes (GGT, ALT), C-reactive protein (CRP) and lipid profiles were measured using standard laboratory techniques. Physical activity was linearly and inversely related with the amount of alcohol consumption, with the lowest alcohol drinking levels being observed in those with vigorous or extreme activity (p < 0.0005). Physically active individuals were less frequently binge-type drinkers, cigarette smokers or heavy coffee drinkers than those with sedentary activity (p < 0.0005 for linear trend in all comparisons). In the General Linear Model to assess the main and interaction effects of physical activity and alcohol consumption on biomarker status, as adjusted for anthropometric measures, smoking and coffee consumption, increasing levels of physical activity were found to be associated with more favorable findings on serum GGT (p < 0.0005), ALT (p < 0.0005 for men), cholesterol (p = 0.025 for men; p < 0.0005 for women), HDL-cholesterol (p < 0.0005 for men, p = 0.001 for women), LDL-cholesterol (p < 0.03 for men), triglycerides (p < 0.0005 for men, p < 0.03 for women), CRP (p < 0.0005 for men, p = 0.006 for women) and fatty liver index (p < 0.0005). The data support the view that regular moderate to vigorous physical activity may counteract adverse metabolic consequences of alcohol consumption on liver function, inflammation and lipid status. The role of physical activity should be further emphasized in interventions aimed at reducing health problems related to unfavorable risk factors of lifestyle.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine, Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Aini Bloigu
- Center for Life Course Health Research, University of Oulu, 90570 Oulu, Finland
| | - Risto Bloigu
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, 90570 Oulu, Finland
| | - Anni S. Halkola
- Department of Laboratory Medicine, Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Markus Niemelä
- Department of Laboratory Medicine, Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
- Department of Anesthesiology, Oulu University Hospital, 90220 Oulu, Finland
| | - Mauri Aalto
- Department of Psychiatry, Seinäjoki Central Hospital and Tampere University, 33100 Tampere, Finland
| | - Tiina Laatikainen
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services, 80210 Joensuu, Finland
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44
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Niemelä O, Aalto M, Bloigu A, Bloigu R, Halkola AS, Laatikainen T. Alcohol Drinking Patterns and Laboratory Indices of Health: Does Type of Alcohol Preferred Make a Difference? Nutrients 2022; 14:4529. [PMID: 36364789 PMCID: PMC9658819 DOI: 10.3390/nu14214529] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 09/10/2023] Open
Abstract
Although excessive alcohol consumption is a highly prevalent public health problem the data on the associations between alcohol consumption and health outcomes in individuals preferring different types of alcoholic beverages has remained unclear. We examined the relationships between the amounts and patterns of drinking with the data on laboratory indices of liver function, lipid status and inflammation in a national population-based health survey (FINRISK). Data on health status, alcohol drinking, types of alcoholic beverages preferred, body weight, smoking, coffee consumption and physical activity were recorded from 22,432 subjects (10,626 men, 11,806 women), age range 25-74 years. The participants were divided to subgroups based on the amounts of regular alcohol intake (abstainers, moderate and heavy drinkers), patterns of drinking (binge or regular) and the type of alcoholic beverage preferred (wine, beer, cider or long drink, hard liquor or mixed). Regular drinking was found to be more typical in wine drinkers whereas the subjects preferring beer or hard liquor were more often binge-type drinkers and cigarette smokers. Alcohol use in all forms was associated with increased frequencies of abnormalities in the markers of liver function, lipid status and inflammation even at rather low levels of consumption. The highest rates of abnormalities occurred, however, in the subgroups of binge-type drinkers preferring beer or hard liquor. These results demonstrate that adverse consequences of alcohol occur even at moderate average drinking levels especially in individuals who engage in binge drinking and in those preferring beer or hard liquor. Further emphasis should be placed on such patterns of drinking in policies aimed at preventing alcohol-induced adverse health outcomes.
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Affiliation(s)
- Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Mauri Aalto
- Department of Psychiatry, Seinäjoki Central Hospital, Tampere University, 33100 Tampere, Finland
| | - Aini Bloigu
- Center for Life Course Health Research, University of Oulu, 90570 Oulu, Finland
| | - Risto Bloigu
- Infrastructure of Population Studies, Faculty of Medicine, University of Oulu, 90570 Oulu, Finland
| | - Anni S. Halkola
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital and Tampere University, 60220 Seinäjoki, Finland
| | - Tiina Laatikainen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), 00271 Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70210 Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services, 80210 Joensuu, Finland
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45
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Leung J, Quinn C, Carlyle M, Ellem R, Tisdale C, Davidson L, White MJ, Kavanagh DJ, Hides L. Retrospective Self-Reports of How Adolescent Substance Use Changed with the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013680. [PMID: 36294257 PMCID: PMC9602900 DOI: 10.3390/ijerph192013680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 06/01/2023]
Abstract
The final year of high school is a challenging phase of adolescents' lives and substance use can play an important role. We examined changes in the frequency and quantity of alcohol and cannabis use, and demographic correlates among Grade 12 students of 2020. Students (N = 844) from nine schools retrospectively self-reported changes in substance use after the easing of COVID-19 lockdowns (back to school), compared to before the pandemic. Changes in use were examined with age, gender, Aboriginal or Torres Islander, parental and family characteristics, and truancy. Thirty-one percent of students reported that they used alcohol less frequently, and 24% reported that they used it more frequently compared to pre-COVID-19. Most students (46%) reported that they used cannabis less, while a subset reported using more frequently (22%). A history of truancy was associated with an increased frequency (OR = 2.13 [1.18-3.83]) of cannabis use. A substantial minority of adolescents used more alcohol and cannabis after the initial COVID-19 lockdown period. Students in their final year who reported increased use may benefit from increased support to manage their substance use.
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Affiliation(s)
- Janni Leung
- Lives Lived Well Group (LLW), School of Psychology, The University of Queensland, St. Lucia, QLD 4072, Australia
- National Centre for Youth Substance Use Research (NCYSUR), The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Catherine Quinn
- Lives Lived Well Group (LLW), School of Psychology, The University of Queensland, St. Lucia, QLD 4072, Australia
- National Centre for Youth Substance Use Research (NCYSUR), The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Molly Carlyle
- Lives Lived Well Group (LLW), School of Psychology, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Rhiannon Ellem
- Lives Lived Well Group (LLW), School of Psychology, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Calvert Tisdale
- Lives Lived Well Group (LLW), School of Psychology, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Lily Davidson
- Lives Lived Well Group (LLW), School of Psychology, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Melanie J. White
- School of Psychology and Counselling, Queensland University of Technology, Brisbane City, QLD 4000, Australia
| | - David J. Kavanagh
- School of Psychology and Counselling, Queensland University of Technology, Brisbane City, QLD 4000, Australia
| | - Leanne Hides
- Lives Lived Well Group (LLW), School of Psychology, The University of Queensland, St. Lucia, QLD 4072, Australia
- National Centre for Youth Substance Use Research (NCYSUR), The University of Queensland, St. Lucia, QLD 4072, Australia
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Chan GCK, Lim C, Sun T, Stjepanovic D, Connor J, Hall W, Leung J. Causal inference with observational data in addiction research. Addiction 2022; 117:2736-2744. [PMID: 35661462 PMCID: PMC9545953 DOI: 10.1111/add.15972] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
Randomized controlled trials (RCTs) are the gold standard for making causal inferences, but RCTs are often not feasible in addiction research for ethical and logistic reasons. Observational data from real-world settings have been increasingly used to guide clinical decisions and public health policies. This paper introduces the potential outcomes framework for causal inference and summarizes well-established causal analysis methods for observational data, including matching, inverse probability treatment weighting, the instrumental variable method and interrupted time-series analysis with controls. It provides examples in addiction research and guidance and analysis codes for conducting these analyses with example data sets.
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Affiliation(s)
- Gary C. K. Chan
- National Centre for Youth Substance Use ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Carmen Lim
- National Centre for Youth Substance Use ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Tianze Sun
- National Centre for Youth Substance Use ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Daniel Stjepanovic
- National Centre for Youth Substance Use ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Jason Connor
- National Centre for Youth Substance Use ResearchUniversity of QueenslandBrisbaneQLDAustralia,Discipline of PsychiatryFaculty of Medicine, University of QueenslandBrisbaneQLDAustralia
| | - Wayne Hall
- National Centre for Youth Substance Use ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Janni Leung
- National Centre for Youth Substance Use ResearchUniversity of QueenslandBrisbaneQLDAustralia
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Shenoy A, Salajegheh A, Shen NT. Multimodal multidisciplinary management of alcohol use disorder in liver transplant candidates and recipients. Transl Gastroenterol Hepatol 2022; 7:28. [PMID: 35892051 PMCID: PMC9257538 DOI: 10.21037/tgh.2020.02.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/06/2019] [Indexed: 08/01/2023] Open
Abstract
Alcohol-related liver disease (ALD) is the most common indication for liver transplantation (LT) in the United States. The judicious allocation of organs and improvement in outcomes requires identification and monitoring of patients with ALD at high-risk for relapse post-transplantation. The controversial movement toward early LT for severe alcohol-related hepatitis (SAH) has also raised concern for alcohol relapse. While LT cures ALD, treatment of alcohol use disorder (AUD) must be included in the care plan to prevent a return to drinking and subsequent graft ALD. Patients with underlying AUD must be recognized, offered brief interventions and referred for multimodal multidisciplinary treatment that includes medications and psychotherapies along with sober support groups, family engagement, and a new dedication to healthy living in order to help sustain remission. Such comprehensive care will increase LT candidacy in patients with ALD while optimizing clinical outcomes of patients transplanted with AUD.
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Affiliation(s)
- Akhil Shenoy
- Director of Transplant Psychiatry, Assistant Professor, Columbia University Medical Center, Psychiatric Liaison to the Center for Liver Disease and Transplantation, New York-Presbyterian Hospital-Columbia, New York, NY, USA
| | - Anna Salajegheh
- Assistant Professor, Weill Cornell Psychiatry, Psychiatric Liaison to the Center for Liver Disease and Transplantation, New York-Presbyterian Hospital-Cornell, New York, NY, USA
| | - Nicole T. Shen
- Weill Cornell Medicine, Division of Clinical Epidemiology and Evaluative Sciences Research, Fellow, Transplant Hepatology, New York-Presbyterian Hospitals-Columbia and Cornell, New York, NY, USA
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48
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Stryhn L, Larsen MB, Mejldal A, Sibbersen C, Nielsen DG, Nielsen B, Nielsen AS, Stenager E, Mellentin AI. Relapse prevention for alcohol use disorders: combined acamprosate and cue exposure therapy as aftercare. Nord J Psychiatry 2022; 76:394-402. [PMID: 34622734 DOI: 10.1080/08039488.2021.1985169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS Many patients with alcohol use disorders are challenged by cravings leading to repeated relapses. Both cue exposure therapy (CET) and acamprosate target alcohol cravings and are often combined (CET + acamprosate). The main aim of this study was to investigate whether aftercare treatment consisting of CET combined with acamprosate is equivalent to (A) CET as monotherapy, (B) aftercare as usual (AAU) as monotherapy or (C) AAU combined with acamprosate. METHODS Patients were randomized to receive either CET with urge-specific coping skills (USCS) as aftercare or AAU. Acamprosate prescription data were extracted from patient case records. Alcohol consumption, cravings, and USCS were assessed at pre-aftercare, post-aftercare, and 6-month follow-up. RESULTS Overall, patients increased their alcohol consumption during and following aftercare treatment, thereby relapsing despite any treatment. However, CET + acamprosate achieved greater abstinence compared to AAU + acamprosate at follow-up (p=.047). CET + acamprosate also reduced number of drinking days (p=.020) and number of days with excessive drinking (p=.020) at post-aftercare, when compared to AAU monotherapy. CET monotherapy increased sensible drinking at post-aftercare compared to AAU monotherapy (p=.045) and AAU + acamprosate (p=.047). Only CET monotherapy showed improvement in cravings, when compared to AAU at follow-up (mean urge level: p=.032; peak urge level: p=.014). CONCLUSION The study showed that CET both as monotherapy and combined with acamprosate was superior to AAU monotherapy and AAU + acamprosate in reducing alcohol consumption. Only CET + acamprosate was capable of reducing alcohol consumption in the longer term, indicating that anti-craving medication may not impede CET from exerting an effect on alcohol consumption. Trial registration: ClinicalTrials.gov ID: NCT02298751 (24/11-2014).
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Affiliation(s)
- Lene Stryhn
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark.,Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark.,Psychiatric Research Academy, Odense, Denmark
| | - Mathias Bach Larsen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark.,Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark.,Psychiatric Research Academy, Odense, Denmark
| | - Anna Mejldal
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark
| | - Christian Sibbersen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark
| | - Dorthe Grüner Nielsen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark
| | - Bent Nielsen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark.,Department of Clinical Research, Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, Odense, Denmark
| | - Angelina Isabella Mellentin
- Department of Clinical Research, Unit for Clinical Alcohol Research, Unit for Psychiatric Research, University of Southern Denmark, Odense, Denmark.,Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark.,Department of Clinical Research, Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), University of Southern Denmark, Odense, Denmark
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49
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Predictors of Frequent Emergency Department Use and Hospitalization among Patients with Substance-Related Disorders Recruited in Addiction Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116607. [PMID: 35682194 PMCID: PMC9180458 DOI: 10.3390/ijerph19116607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022]
Abstract
Few studies have assessed the overall impact of outpatient service use on acute care use, comparing patients with different types of substance-related disorders (SRD) and multimorbidity. This study aimed to identify sociodemographic and clinical characteristics and outpatient service use that predicted both frequent ED use (3+ visits/year) and hospitalization among patients with SRD. Data emanated from 14 Quebec (Canada) addiction treatment centers. Quebec administrative health databases were analyzed for a cohort of 17,819 patients over a 7-year period. Multivariable logistic regression models were produced. Patients with polysubstance-related disorders, co-occurring SRD-mental disorders, severe chronic physical illnesses, and suicidal behaviors were at highest risk of both frequent ED use and hospitalization. Having a history of homelessness, residing in rural areas, and using more outpatient services also increased the risk of acute care use, whereas high continuity of physician care protected against acute care use. Serious health problems were the main predictor for increased risk of both frequent ED use and hospitalization among patients with SRD, whereas high continuity of care was a protective factor. Improved quality of care, motivational, outreach and crisis interventions, and more integrated and collaborative care are suggested for reducing acute care use.
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50
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Development of an individualized procedure to induce reward-related impulsivity and evaluating its impact on drinking control. Addict Behav 2022; 133:107378. [PMID: 35644056 DOI: 10.1016/j.addbeh.2022.107378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022]
Abstract
High impulsivity predisposes young adults to engage in hazardous alcohol use. Experimental research has shown that reward-related impulsivity is causally-related to heavier drinking. Correlational studies suggest that positive alcohol outcome expectancies mediate this effect, but causation has yet to be established. This study sought to clarify this relationship by: 1) developing a new, individualized procedure for inducing reward-related impulsivity with high generalizability; 2) experimentally manipulating positive alcohol expectancies to determine its mechanistic role in reward-related impulsivity risk for drinking. Eighty-seven young adults (67% female; Mage = 19.19, SD = 2.01) received either a covert manipulation to reduce positive alcohol expectancies (n = 43) or control (n = 44) after being administered the Individualized Reward-Seeking Induction Schedule (IRIS). The primary outcome was self-reported confidence in the ability to refuse alcohol in cued situations (drinking refusal self-efficacy). Results showed that IRIS increased reward-related impulsivity (p < .001, drm = 0.48) and reduced drinking refusal self-efficacy (p = .029, η2P = .055, ωp2 = .043). Experimentally diminishing positive alcohol expectancies had a marginal effect on the reward-seeking induction when controlling for covariates (p = .057, η2P = .044). Findings provide preliminary validation of IRIS as a new methodology for investigating the causal role of reward-related impulsivity in alcohol-related cognition and youth drinking.
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