Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Findings from the Australian National Survey of Mental Health and Well Being

Co-occurring psychological distress and alcohol or other drug use among Indigenous Australians: Data from the National Aboriginal and Torres Strait Islander Health Survey

OBJECTIVES

To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older.

METHODS

This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia.

RESULTS

A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions.

CONCLUSION

A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions.

Disentangling differing relationships between internalizing disorders and alcohol use

Both internalizing disorders and alcohol use have dramatic, wide-spread implications for global health. Previous work has established common phenotypic comorbidity among these disorders, as well as shared genetic variation underlying them both. We used genomic structural equation modeling to investigate the shared genetics of internalizing, externalizing, and alcohol use traits, as well as to explore whether specific domains of internalizing symptoms mediate the contrasting relationships with problematic alcohol use compared to alcohol consumption. We also examined patterns of genetic correlations between similar traits within additional Finnish and East Asian ancestry groups. When the shared genetic influence of externalizing psychopathology was accounted for, the genetic effect of internalizing traits on alcohol use was reduced, suggesting the important role of common genetic factors underlying multiple psychiatric disorders and their genetic influences on comorbidity of internalizing and alcohol use traits. Individual internalizing domains had contrasting effects on frequency of alcohol consumption, which demonstrate the complex system of pleiotropy that exists, even within similar disorders, and can be missed when evaluating only relationships among formal diagnoses. Future work must consider the broad effects of shared psychopathology along with the fine-scale effects of heterogeneity within disorders to more fully understand the biology underlying complex traits.

Developmental genetic effects on externalizing behavior and alcohol use: Examination across two longitudinal samples

Externalizing behavior in early adolescence is associated with alcohol use in adolescence and early adulthood and these behaviors often emerge as part of a developmental sequence. This pattern can be the result of heterotypic continuity, in which different behaviors emerge over time based on an underlying shared etiology. In particular, there is largely a shared genetic etiology underlying externalizing and substance use behaviors. We examined whether polygenic risk for alcohol use disorder predicted (1) externalizing behavior in early adolescence and alcohol use in adolescence in the Early Steps Multisite sample and (2) externalizing behavior in adolescence and alcohol use in early adulthood in the Project Alliance 1 (PAL1) sample. We examined associations separately for African Americans and European Americans. When examining European Americans in the Early Steps sample, greater polygenic risk was associated with externalizing behavior in early adolescence. In European Americans in PAL1, we found greater polygenic risk was associated with alcohol use in early adulthood. Effects were largely absent in African Americans in both samples. Results imply that genetic predisposition for alcohol use disorder may increase risk for externalizing and alcohol use as these behaviors emerge developmentally.

Psilocybin-assisted therapy for severe alcohol use disorder: protocol for a double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial

BACKGROUND

A significant number of individuals with alcohol use disorder remain unresponsive to currently available treatments, which calls for the development of new alternatives. In parallel, psilocybin-assisted therapy for alcohol use disorder has recently yielded promising preliminary results. Building on extant findings, the proposed study is set to evaluate the feasibility and preliminary clinical efficacy of psilocybin-assisted therapy when incorporated as an auxiliary intervention during inpatient rehabilitation for severe alcohol use disorder. Moreover, it intends to pinpoint the modifications in the two core neurocognitive systems underscored by dual-process models of addiction.

METHODS

In this double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial, 62 participants aged 21-64 years will be enrolled to undergo psilocybin-assisted therapy as part of a 4-week inpatient rehabilitation for severe alcohol use disorder. The experimental group will receive a high dose of psilocybin (30 mg), whereas the control group will receive an active placebo dose of psilocybin (5 mg), both within the context of a brief standardized psychotherapeutic intervention drawing from key elements of acceptance and commitment therapy. The primary clinical outcome is the between-group difference regarding the change in percentage of heavy drinking days from baseline to four weeks posthospital discharge, while safety and feasibility metrics will also be reported as primary outcomes. Key secondary assessments include between-group differences in terms of changes in (1) drinking behavior parameters up to six months posthospital discharge, (2) symptoms of depression, anxiety, trauma, and global functioning, (3) neuroplasticity and key neurocognitive mechanisms associated with addiction, and (4) psychological processes and alcohol-related parameters.

DISCUSSION

The discussion outlines issues that might arise from our design.

TRIAL REGISTRATION

EudraCT 2022-002369-14 and NCT06160232.

Alcohol relapse prevention health care after alcohol withdrawal in New South Wales prisons, Australia: A patient file review

INTRODUCTION

People who enter custody have complex health issues and comorbidities may include alcohol use disorders. We investigated clinical service provision and comorbidities recorded among individuals with a likely alcohol withdrawal syndrome within prison in New South Wales, Australia.

METHODS

For this clinical case series review, electronic medical data were used to identify 50 people entering custody between August and November 2018 who likely had a treated alcohol withdrawal syndrome. We aimed for a 3:2 ratio of men and women, and a 1:1 ratio of Aboriginal and non-Aboriginal individuals. Data were extracted using a purposefully designed tool which included current alcohol withdrawal management, comorbidities and alcohol relapse prevention approaches used or recommended.

RESULTS

Thirty-eight men and 12 women, of whom 22 were Aboriginal, were included. Twenty-nine individuals (58%) reported a history of medical comorbidities. Thirty-five (70%) reported using other substances and over half (60%) had a diagnosis of mental health disorders. Fourteen (28%) individuals had a record of receiving brief intervention and five (10%) of motivational interviewing. Twenty-three individuals (46%) were referred to and seen by drug and alcohol clinicians. Only seven (14%) of the sample had pre-release community care plans.

DISCUSSION AND CONCLUSIONS

Individuals treated for an alcohol withdrawal syndrome in New South Wales prisons have a high prevalence of medical comorbidities and other substance use. Clinical interventions focused on alcohol withdrawal management, and relapse prevention interventions were not recorded for most individuals. Service innovation and expansion are needed to increase the provision of post-withdrawal management.

Anxiety-specific associations with substance use: Evidence of a protective factor in adolescence and a risk factor in adulthood

Externalizing psychopathology is a strong risk factor for substance use, whereas the role of internalizing manifestations of distress, and anxiety in particular, in predicting substance use remains unclear. Studies have suggested that anxiety may be either a protective or risk factor for substance use. The present study aimed to clarify evidence for anxiety-specific associations with substance use, examining sex and developmental period (adolescence vs. adulthood) as potential moderators that may help explain conflicting results in the literature. In a longitudinal twin sample, cross-sectional associations of anxiety with substance use differed in adolescents and adults and in girls/women and boys/men. Controlling for externalizing psychopathology and depression, anxiety was associated with reduced substance use in adolescent girls and increased substance use in adult women. In contrast, anxiety-specific associations with substance use were not significant in boys and men. Possible explanations for these contrasting results across development and sex are discussed.

Deconstructing the heterogeneity of alcohol use disorder: lifetime comorbid non-alcohol substance use disorder as a distinct behavioral phenotype?

BACKGROUND

Alcohol use disorder (AUD) is an etiologically and clinically heterogeneous condition. Accumulating evidence suggests that persons with lifetime histories of comorbid AUD and non-alcohol substance use disorder (DRUG) constitute an important subgroup of AUD. This study evaluated the distinctiveness of the comorbid AUD/DRUG behavioral phenotype in a community sample with respect to risk factors, AUD course features, and outcome variables assessed at age 30. Contrast groups included persons with histories of AUD only, DRUG only, and neither AUD nor DRUG.

METHODS

This research utilized a prospective study design with an age-based cohort (n = 732). Participants completed four comprehensive diagnostic evaluations during the high-risk periods of adolescence, emerging adulthood, and young adulthood.

RESULTS

The comorbid AUD/DRUG group was distinguished from the AUD only group by risk factors, AUD course features, and outcomes. Group differences in outcomes were also explained by overall substance use disorder (SUD) severity. Persons with AUD/DRUG comorbidity were indistinguishable from those with DRUG only histories with respect to risk factors and outcomes but demonstrated greater overall SUD severity. Persons with AUD only were indistinguishable from those with neither AUD nor DRUG histories in risk factor endorsements and were mostly similar in outcomes.

CONCLUSIONS

Findings collectively suggest that young adults with histories of AUD only and those with comorbid AUD/DRUG are drawn from dissimilar populations. Similarities between the AUD only group with those absent AUD or DRUG histories are likely related to the former group's developmentally limited AUD course accompanied by relatively few or short-lived alcohol-related problems.

Sticking with it? Factors associated with exercise adherence in people with alcohol use disorder

BACKGROUND

Emerging evidence suggests that exercise may be an efficacious treatment for alcohol use disorder (AUD), but adherence is suboptimal. We examined factors associated with adherence to an exercise intervention for non-treatment seeking adults with AUD.

METHODS

This secondary analysis of a randomized controlled trial included 95 physically inactive adults aged 18-75 years with clinician-diagnosed AUD. Study participants were randomly assigned to 12-weeks fitness centre-based, supervised aerobic exercise or yoga classes and asked to attend at least three times/week. Adherence was assessed both objectively (based on use of a keycard at entry) and subjectively using an activity calendar. The association between AUD and other predictor variables with adherence was assessed using logistic and Poisson regression models.

RESULTS

Just under half of participants (47/95, 49%) completed ≥ 12 supervised exercise sessions. When both supervised classes and self-reported sessions were included, 32/95 (34%) participants completed ≤ 11 sessions, 28/95 (29%) did 12-23 sessions and 35/95 (37%) completed ≥ 24 sessions. In univariate logistic regression analyses, lower education was associated with non-adherence (<12 sessions) (OR = 3.02, 95%CI = 1.19-7.61). In models adjusted for demographic and clinical variables, moderate AUD (OR = 0.11, 95%CI = 0.02-0.49) and severe AUD (OR = 0.12, 95%CI = 0.02-0.69) were associated with non-adherence, when compared to low severity AUD. Higher body mass index (OR = 0.80, 95%CI = 0.68-0.93) was also associated with non-adherence. Results were materially the same when objective and subjective adherence data were combined.

CONCLUSION

Adults with AUD can be supported to engage in yoga and aerobic exercise. Additional support may be required for those with moderate or severe AUD, higher BMI, and lower education.

Food-restricted alcohol consumption: relation to psychopathology in college students

Objective: Food-restricted alcohol consumption (FRAC) is a growing concern among college students. We investigated demographic and lifestyle characteristics and psychiatric symptoms associated with FRAC. Participants: College students (n = 561) at a large southeastern university in the United States. Methods: Participants completed online self-reported questionnaires assessing past-year FRAC, demographic and lifestyle characteristics, and psychiatric symptoms. Results: The past-year prevalence of FRAC was 23.89%. In the bivariate analyses, students engaging in FRAC had higher mean scores of multiple psychiatric symptoms, reported more harmful or hazardous drinking and suicidality, and were more likely to report a history of an eating disorder than their peers without FRAC. In a hierarchical regression model, binge eating, cognitive restraint, self-reported history of an eating disorder, and harmful or hazardous drinking were significantly associated with FRAC (ps < 0.05) after other psychiatric symptoms were included in the model. Conclusion: Our findings stress the importance of heightened awareness of FRAC in college.

Pain Intensity Moderates the Association between Obsessive-Compulsive Symptoms and Problematic Alcohol Use among Emerging Adults

Objective: Emerging adulthood is a vulnerable period for problematic alcohol use, defined by a pattern of use associated with physical and functional impairment. Obsessive-compulsive psychopathology, which demonstrates high rates of onset in emerging adults, seems to be related to problematic alcohol use in this age group, consistent with research among the general population suggesting an association between emotional disorders and alcohol use in the context of coping drinking motives. Pain intensity, another risk factor of problematic alcohol use, may link obsessive-compulsive symptoms to problematic alcohol use among emerging adults. Therefore, the current study examined the moderating role of pain intensity on the association between obsessive-compulsive symptoms and problematic alcohol use among emerging adults. Methods: Participants were 198 college students (81.30% female, M_age = 22.33, SD = 4.38) who reported problematic alcohol use. Results: Results from the current study supported a significant moderation role of pain intensity for the association between obsessive-compulsive symptoms and problematic alcohol use, whereby the association between obsessive-compulsive symptoms and problematic alcohol use was stronger for emerging adults with high compared to low pain intensity. Conclusions: These results highlighted a clinically-relevant interaction between obsessive-compulsive symptoms and pain intensity concerning the risk of problematic alcohol use among emerging adults as a vulnerable population.

Male involvement in randomised trials testing psychotherapy or behavioural interventions for depression: a scoping review

The prevalence of Major Depressive Disorder in men is half that of women, yet depression affects approximately 109 million men worldwide. Alarmingly, men account for three quarters of suicides in Western countries but are unlikely to seek help for mental health concerns. It is possible that existing mental health treatments are not engaging or accessible to men. The aim of this review was to quantify the number of men involved in randomised trials of psychotherapy or lifestyle behaviour change targeting depression. Results found men represented 26% of participants in 110 eligible articles compared to 73% women. Men's representation was low across all intervention characteristics (e.g., delivery mode). No studies used a completely male sample, compared to 19 studies targeting women only. Men are substantially underrepresented in research trials targeting depression.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-022-04017-7.

MM, Villanueva-Silvestre V, Vázquez-Martínez A. Relationship Between Depression and Risky Alcohol Consumption in Women: the Mediating Role of Coping Styles and Age

Women are more likely to use alcohol as a coping strategy for psychological distress, with higher rates of comorbidity with depression being found in those with an alcohol use disorder. The objective of this study was to analyze changes in problematic alcohol consumption and depression during the COVID-19 lockdown, and to establish a predictive model based on age. A total of 1889 women aged 18-64 years (M = 36.14) participated. The Patient Health Questionnaire was applied for depression, the Alcohol Use Disorders Identification Test-Short Version for alcohol, and active and avoidant coping were considered. In the period prior to the pandemic, depression and avoidant coping were good predictors of alcohol consumption in women, regardless of age. During lockdown, this predictive capacity was only maintained in women aged 35-64 years. In the mediational models, differences were observed according to age. For women aged 18-34 years, depression was the predictor variable of problematic alcohol consumption, but for women aged 35-64 years it was the avoidant coping style, which is the predominant style in women of this age with clinical depression. The relevance of age in the combined treatments of depression and problematic alcohol consumption is highlighted, and training in active coping strategies is suggested.

Exploring Factors Associated With Mobile Phone Behaviors and Attitudes Toward Technology Among Adults With Alcohol Use Disorder and Implications for mHealth Interventions: Exploratory Study

BACKGROUND

Alcohol use disorder (AUD) is associated with severe chronic medical conditions and premature mortality. Expanding the reach or access to effective evidence-based treatments to help persons with AUD is a public health objective. Mobile phone or smartphone technology has the potential to increase the dissemination of clinical and behavioral interventions (mobile health interventions) that increase the initiation and maintenance of sobriety among individuals with AUD. Studies about how this group uses their mobile phone and their attitudes toward technology may have meaningful implications for participant engagement with these interventions.

OBJECTIVE

This exploratory study examined the potential relationships among demographic characteristics (race, gender, age, marital status, and income), substance use characteristics (frequency of alcohol and cannabis use), and clinical variables (anxiety and depression symptoms) with indicators of mobile phone use behaviors and attitudes toward technology.

METHODS

A sample of 71 adults with AUD (mean age 42.9, SD 10.9 years) engaged in an alcohol partial hospitalization program completed 4 subscales from the Media Technology Usage and Attitudes assessment: Smartphone Usage measures various mobile phone behaviors and activities, Positive Attitudes and Negative Attitudes measure attitudes toward technology, and the Technological Anxiety/Dependence measure assesses level of anxiety when individuals are separated from their phone and dependence on this device. Participants also provided demographic information and completed the Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale. Lastly, participants reported their frequency of alcohol use over the past 3 months using the Drug Use Frequency Scale.

RESULTS

Results for the demographic factors showed a significant main effect for age, Smartphone Usage (P=.003; ηp2=0.14), and Positive Attitudes (P=.01; ηp2=0.07). Marital status (P=.03; ηp2=0.13) and income (P=.03; ηp2=0.14) were associated only with the Technological Anxiety and Dependence subscale. Moreover, a significant trend was found for alcohol use and the Technological Anxiety/Dependence subscale (P=.06; R2=0.02). Lastly, CES-D scores (P=.03; R2=0.08) and GAD symptoms (P=.004; R2=0.13) were significant predictors only of the Technological Anxiety/Dependence subscale.

CONCLUSIONS

Findings indicate differences in mobile phone use patterns and attitudes toward technology across demographic, substance use, and clinical measures among patients with AUD. These results may help inform the development of future mHealth interventions among this population.

Positive but not negative affect is associated with increased daily drinking likelihood in non-clinical populations: systematic review and meta-analyses

Background: Recent meta-analytical findings indicate that affect regulation plays an important role in alcohol craving, consumption volume, and substance use. However, in view of mixed findings, the affect and drinking likelihood literature remains in need of clarification and consolidation.Objectives: This systematic review with meta-analyses interrogated the results from peer-reviewed studies among non-clinical populations that examined the relationship between daily affective states and intraday likelihood of alcohol consumption.Method: A PRISMA guided search of PsychINFO, PsycARTICLES, Science Direct, Wiley Online Library, PubMed, SCOPUS, and JSTOR databases was conducted. Multilevel meta-analyses yielded 11 eligible negative affect studies (2751 participants, 23 effect sizes) and nine studies on positive affect (2244 participants, 14 effect sizes).Results: The pooled associations between intra-day affect and alcohol consumption likelihood revealed no significant association between negative affective state and drinking likelihood (OR = .90, 95% CI [.73, 1.12]) and that positive affect was associated with increased drinking likelihood (OR = 1.17, 95% CI [1.09, 1.27]). Egger's test, P-curve, fail-safe N, and selection models analyses suggested that the obtained results were unlikely to be the product of publication bias and p-hacking alone.Conclusions: Results converge to suggest that, independent of age, affect measure used, and study design, a significant albeit modest relationship between positive affect and alcohol consumption likelihood exists, which does not appear to be the case for negative affect. In conjunction with other recent meta-analyses, current findings help map out a more nuanced understanding of the affect-alcohol/substance use relationship, with potential implications for interventions.

Do symptoms of depression and anxiety contribute to heavy episodic drinking? A 3-wave longitudinal study of adult community members

Heavy episodic drinking (or binge drinking) is a significant public health concern. Self-medication using alcohol is often thought to explain the co-occurrence of heavy episodic drinking with depression and anxiety. Yet, there is little longitudinal work examining both depressive and anxiety symptoms and how they are independently related to heavy episodic drinking in adult community samples. To this end, we invited adult community members (N = 102) to come to the lab to complete validated measures of depressive symptoms (composite of CES-D-SF, SCL-90-D, and DASS-21-D), anxiety symptoms (DASS-21-A), and heavy episodic drinking (composite of frequency, severity, and perceptions) at baseline, and again three and six months later. Using a three-wave cross-lagged panel model, we tested reciprocal relations between heavy episodic drinking and each internalizing symptom. We found strong temporal stability in our study variables. Depressive symptoms were associated with increases in heavy episodic drinking, and anxiety symptoms were associated with decreases in heavy episodic drinking. In contrast, heavy episodic drinking did not predict either internalizing symptom over time. Results are consistent with the notion that individuals with greater depressive symptoms use alcohol to self-medicate, and that anxiety symptoms (particularly autonomic arousal) may be potentially protective against future heavy episodic drinking.

Predictors of persistent alcohol use disorder and co-occurring depressive symptoms: Insights from the longitudinal college experiences study

INTRODUCTION

Problematic alcohol use and depression are prevalent in the college student population. The purpose of this study was to identify how personality and social-contextual factors in the first year of college work together to predict stable and potentially co-occurring alcohol use disorder (AUD) and depressive symptoms over a period of approximately 4 years.

METHODS

Participants were first-year college students from the Southeastern United States (N = 209, 90% white, 62% female). Baseline data were collected in the first year of college and follow-up assessments were completed ~1 and ~4 years later (retention rates: 80%+, average ages ~19, 20, and 23 years, respectively). At each assessment, participants completed a comprehensive online survey assessing mental health and substance use, as well as personality, social support, stress, sleep, and other features of peer and romantic partner affiliations.

RESULTS

Results from our random-intercept cross-lagged panel model indicated AUD and depressive symptoms were more likely to co-occur in the transition out of rather than into college. Significant predictors of stable AUD symptoms across the ~4-year period included greater alcohol quantity, marijuana frequency, affiliation with antisocial/substance-using peers, and frequency of drinking with romantic partner in the first year of college. Significant predictors of stable depressive symptoms included greater constraint, greater negative emotionality, lower positive emotionality, greater stress, and less weekday sleep.

CONCLUSIONS

Findings suggest that personality factors, stress, and sleep in the first year of college may be useful targets to screen for in efforts to reduce long-term depressive symptoms in the college context. Disrupting affiliation with antisocial/substance-using peers and romantic partners and reducing the high quantity of alcohol and frequency of marijuana may be more relevant to reducing long-term problematic alcohol use. Implications for incorporating individually-tailored approaches to prevention/intervention are addressed.

Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database

BACKGROUND

Long-term use of testosterone can be associated with mood destabilizing effects. Most studies investigating psychiatric complications of anabolic steroids have used small samples, but a comprehensive assessment of the risk of developing mental health disorders after testosterone use has not been performed at the population level.

AIM

To determine whether testosterone therapy is associated with major depressive disorder or suicide attempts in men.

METHODS

We conducted a retrospective cohort study of 70.3 million electronic health records collected from 46 healthcare organizations encompassing flagship hospitals, satellite hospitals, and outpatient clinics since 2008 to determine whether testosterone use is associated with major depressive disorder and suicide attempts in a large population. We included men 18 or older who either used testosterone or did not, defined by reported use, insurance claim, or prescription use of testosterone documented in the electronic health record. We propensity-score matched by age, race, ethnicity, obesity, and alcohol-related disorder. Additionally, a sub-group analysis was performed in testosterone deficient (<300 ng/dL) men comparing those with TD on testosterone therapy to a control group of men with TD who are not using testosterone.

OUTCOMES

We determined measures of association with a new diagnosis of major depressive disorder and suicide attempt or intentional self-harm following testosterone use within 5 years.

RESULTS

A total of 263,579 men who used testosterone and 17,838,316 men who did not were included in the analysis. Testosterone use was independently associated with both Major Depressive Disorder (OR 1.99, 95% CI 1.94-2.04, P < .0001) and Suicide Attempt/Intentional Self-Harm (OR 1.52, 95% CI 1.40-1.65, P < .0001). Results remained significant in testosterone deficient sub-group analysis.

CLINICAL IMPLICATIONS

Men who use testosterone should be screened for and counseled about risks of depression and suicidality.

STRENGTHS AND LIMITATIONS

Strengths of this study include a large sample size, the ability to account for chronology of diagnoses, the use of propensity score matching to control for potentially confounding variables, and the consistency of results with sub-group analyses. Limitations include the potential for incorrect coding within the electronic health record, a lack of granular information regarding testosterone therapy adherence, the possibility that unrecorded testosterone or anabolic steroid use were prevalent but not captured within the control group, and a lack of data regarding testosterone withdrawal.

CONCLUSION

Testosterone use is independently associated with new-onset mental health disorders. Future studies are necessary to elucidate the role that androgen withdrawal plays and whether a causal relationship exists. Nackeeran S, Patel MS, Nallakumar DT, et al. Testosterone Therapy is Associated With Depression, Suicidality, and Intentional Self-Harm: Analysis of a National Federated Database. J Sex Med 2022;19:933-939.

Alcohol-related liver disease mortality and missed opportunities in secondary care: A United Kingdom retrospective observational study

Introduction

Alcohol‐related liver disease (ARLD) is a preventable cause of mortality. Historical epidemiological studies on ARLD often lack a detailed linked assessment of health‐related contacts prior to death which limits understanding of opportunities for intervention. We aimed to analyse retrospective population‐based data of all adult residents of Nottinghamshire dying from ARLD to determine the factors associated with delayed diagnosis of ARLD and the potential missed opportunities for interventions.

Methods

We linked the Office for National Statistics and Hospital Episode Statistics databases to identify adult (≥18 years) residents of Nottinghamshire, who died of ARLD over the 5‐year period (1 January 2012 to 31 December 2017). Death was used as the primary outcome, and logistic regression analysis was conducted to test the association between key variables and mortality due to ARLD.

Results

Over 5 years, 799 ARLD deaths were identified. More than half had no diagnosis or a diagnosis of ARLD less than 6 months before death. Emergency presentation at first ARLD diagnosis and White ethnicity were significantly associated with a delay in diagnosis. Overall, the cohort had a median of five hospital admissions, four accident and emergency attendances and 16 outpatient appointments in the 5 years before death. Treatment was provided by a range of specialities, with general medicine the most common. Alcohol was associated with most admissions.

Discussion and Conclusions

This study identified deficiencies in ARLD secondary care and provides us with a powerful methodology that can be used to evaluate and improve how alcohol issues are managed and where action can be best targeted.

Outcomes of Hospitalized Acute Alcoholic Hepatitis (AH) in Patients With Bipolar 1 Disorder (B1D)

Introduction: Alcoholic hepatitis (AH) is a common cause of hospital admissions and is associated with a high mortality rate. AH occurs frequently in patients with heavy alcohol use. Alcohol use disorder (AUD) commonly presents with comorbid psychiatric disorders such as bipolar disorder. Bipolar disorder patients are also known to be at an increased risk for chronic liver diseases. Bipolar 1 disorder (B1D) is often considered the most severe presentation among different types of bipolar disorder. This study assesses the clinical outcomes of patients admitted for AH with concomitant B1D.

Methods: Adult patients with AH were identified within the 2014 National Inpatient Sample (NIS) database. International Classification of Diseases, Ninth Edition Revision, Clinical Modification (ICD-9 CM) codes were used to select for all of the diagnoses for this study. AH patients were subdivided into those with and without B1D. The outcomes of interest were sepsis, hepatic encephalopathy, acute respiratory failure, acute kidney injury, ischemic stroke, hepatic failure, coagulopathy, and inpatient mortality. A multivariate logistic regression analysis was performed to explore whether B1D is an independent predictor for the outcomes.

Results: Among 4,453 patients with AH identified, 166 patients also had B1D. AH patients with comorbid B1D were seen to be younger (42.9 years old vs. 46.2 years old, p < 0.05) and more commonly female (55.4% vs. 36.5%, p < 0.05). The B1D subgroup of AH patients were found to less likely develop acute hepatic failure (adjusted odds ratio (aOR) 0.13, 95% confidence interval (CI): 0.02-0.97, p < 0.05). The adjusted odds ratios for the remaining outcomes were not statistically significant.

Conclusions: Our study indicates that B1D may be an independent protective factor against acute hepatic failure in patients hospitalized with AH. This finding can be explained by frequent laboratory monitoring and psychiatric assessments performed by psychiatrists treating B1D patients, as well as the impact B1D has on cortisol release induced by hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis.

Using Facebook language to predict and describe excessive alcohol use

BACKGROUND

Assessing risk for excessive alcohol use is important for applications ranging from recruitment into research studies to targeted public health messaging. Social media language provides an ecologically embedded source of information for assessing individuals who may be at risk for harmful drinking.

METHODS

Using data collected on 3664 respondents from the general population, we examine how accurately language used on social media classifies individuals as at-risk for alcohol problems based on Alcohol Use Disorder Identification Test-Consumption score benchmarks.

RESULTS

We find that social media language is moderately accurate (area under the curve = 0.75) at identifying individuals at risk for alcohol problems (i.e., hazardous drinking/alcohol use disorders) when used with models based on contextual word embeddings. High-risk alcohol use was predicted by individuals' usage of words related to alcohol, partying, informal expressions, swearing, and anger. Low-risk alcohol use was predicted by individuals' usage of social, affiliative, and faith-based words.

CONCLUSIONS

The use of social media data to study drinking behavior in the general public is promising and could eventually support primary and secondary prevention efforts among Americans whose at-risk drinking may have otherwise gone "under the radar."

Are emotional symptoms and depression among young people with parental alcohol problems modified by socioeconomic position?

The aim was to test the hypothesis that parental alcohol problems and low socioeconomic position would be associated with higher odds ratio of emotional symptoms and depression as compared to high socioeconomic position and parental alcohol problems. Data came from Danish National Youth Study 2014, a web-based national survey with 75,853 high school and vocational school students participating, merged with register-data on family socioeconomic position. Multi-level logistic regression models (nesting participants within schools) were used to assess the association between perceived parental alcohol problems and frequent emotional symptoms and depression and effect modification by financial strains in the family, family income, or parental educational level. All analyses were adjusted for age, sex, education, immigration status, and cohabitation with parents. Young people with parental alcohol problems had higher odds ratio of experiencing frequent emotional symptoms (OR = 1.56 [1.46-1.66]) and depression (OR = 2.07 [1.88-2.28]), compared to young people without parental alcohol problems. There was no effect modification between severity of parental alcohol problems and the measures of socioeconomic position on the odds ratio of frequent emotional symptoms and depression. This study found that young people with parental alcohol problems in all social strata had higher odds ratios of frequent emotional symptoms and depression compared to young people without parental alcohol problems; the more severely they had been affected by parent's alcohol problems, the higher the odds ratios of frequent emotional symptoms and depression.

Premature death and causes of death among patients with panic disorder and comorbid psychiatric disorders: A nationwide cohort study

OBJECTIVES

Panic disorder (PD) is associated with high psychiatric and physical comorbidity, but the cause of mortality has not been well studied. This study investigated mortality rates and causes of death in an Asian cohort with PD.

METHODS

We enrolled a nationwide retrospective cohort of 298,466 persons diagnosed with PD from January 1, 2001, to December 31, 2016. Each cohort member was matched with a comparison one randomly selected from the general population with the same sex, age at entry, and birth year. The data of both the PD cohort and the comparison group were linked with the national mortality database to obtain each individual's mortality status. We used mortality rate ratios (MRRs) to compare mortality risks between the patients with PD and the general population. Stratified analysis of mortality risks was performed based on sex and psychiatric comorbidities.

RESULTS

PD was associated with a slightly increased mortality risk (MRR, 1.14 [99% CI, 1.11-1.17]). The risk of unnatural death (MRR, 2.83 [99% CI, 2.59-3.10]) was significantly higher among the individuals with PD than among the general population, whereas the risk of overall natural death across all categories was not (MRR, 1.01 [99% CI, 0.98-1.04]). The mortality risk was the highest for suicide (MRR, 4.94 [99% CI, 4.32-5.72]) and was higher in women (MRR, 6.37 [99% CI, 5.25-7.96]) than in men (MRR, 3.77 [99% CI, 3.14-4.64]). Comorbid substance use disorders increased the risk of mortality from natural (MRR, 3.23 [99% CI, 2.59-4.14]) and unnatural (MRR, 9.45 [99% CI, 6.29-17.85]) causes.

CONCLUSION

PD was associated with increased all-cause mortality, especially suicide. Substance use further increased mortality risk in persons with PD. Targeted treatment for substance use and suicide prevention are essential among persons with PD.

Employment, Economic, and Sociodemographic Factors Associated with Changes in Smoking and Drinking Behaviors during the COVID-19 Pandemic in South Korea

The societal disruptions resulting from the coronavirus disease 2019 (COVID-19) pandemic may have caused changes in smoking and alcohol consumption. Using data from the Koreans’ Happiness Survey, a nationally representative survey in South Korea, we (1) described population-level smoking and drinking behaviors; (2) assessed changes in smoking and drinking behaviors during the COVID-19 pandemic; and (3) identified employment, economic, and sociodemographic factors associated with these changes using multinomial logistic regression. The overall amount of smoking and drinking decreased during the pandemic, but the changes were heterogeneous across subgroups. Male gender, receipt of the basic living allowance, self-employment, unemployment, and chronic disease status were associated with increased smoking, while higher household income, temporary worker status, living with someone (versus alone), and having fewer offline friends were associated with decreased smoking. Male gender, self-employment, living alone, having more offline friends, and chronic disease status were associated with increased drinking, while younger age, male gender, low and high household income (i.e., a U-shaped relationship), long-term rent with a deposit, temporary worker status, and chronic disease status were associated with decreased drinking. Our findings provide evidence on changes in smoking and drinking during the COVID-19 pandemic in South Korea and differential changes across subgroups.

Indirect Associations Between Posttraumatic Stress Symptoms and Other Psychiatric Symptoms, Alcohol Use, and Well-being via Psychological Flexibility Among Police Officers

Police officers experience a high number of potentially traumatic events (PTEs) often associated with elevated posttraumatic stress symptoms (PTSS). In addition, PTSS are related to co-occurring psychiatric symptoms (e.g., anxiety, depression), alcohol misuse, and low perceived well-being. Yet, behavioral processes that may account for the associations between PTSS and unfavorable outcomes remain unspecified. Psychological flexibility, or one's response to private experiences (e.g., PTE-related memories) with an open, aware, and active approach, may be one such process. The present study aimed to evaluate psychological flexibility as both a mediator and moderator of PTSS and commonly co-occurring psychiatric symptoms, alcohol use, and general well-being, using cross-sectional data provided by a sample of police officers (N = 459) recruited from three regionally distributed U.S. police agencies. Structural equation modeling indicated a well-fitting model wherein psychological flexibility indirectly accounted for associations among PTSS and endogenous outcomes, χ² (107, N = 457) = 225.33, p < .001, CFI = .99, TLI = .98, RMSEA = .05, 90% CI [.04, .06], SRMR = .03. Psychological flexibility also moderated associations between PTSS and psychiatric symptoms, B = 1.58 (SE = 0.22), p < .001; and well-being, B = -3.84 (SE = 0.46), p < .001. Although additional research is needed, these preliminary results suggest psychological flexibility may be a behavioral process that accounts for negative outcomes associated with PTSS and a productive intervention target in the context of PTSS and generalized distress. Further research regarding the role of psychological flexibility in PTSS-related outcomes for police officers appears warranted.

An epigenetic mechanism for over-consolidation of fear memories

Excessive fear is a hallmark of anxiety disorders, a major cause of disease burden worldwide. Substantial evidence supports a role of prefrontal cortex-amygdala circuits in the regulation of fear and anxiety, but the molecular mechanisms that regulate their activity remain poorly understood. Here, we show that downregulation of the histone methyltransferase PRDM2 in the dorsomedial prefrontal cortex enhances fear expression by modulating fear memory consolidation. We further show that Prdm2 knock-down (KD) in neurons that project from the dorsomedial prefrontal cortex to the basolateral amygdala (dmPFC-BLA) promotes increased fear expression. Prdm2 KD in the dmPFC-BLA circuit also resulted in increased expression of genes involved in synaptogenesis, suggesting that Prdm2 KD modulates consolidation of conditioned fear by modifying synaptic strength at dmPFC-BLA projection targets. Consistent with an enhanced synaptic efficacy, we found that dmPFC Prdm2 KD increased glutamatergic release probability in the BLA and increased the activity of BLA neurons in response to fear-associated cues. Together, our findings provide a new molecular mechanism for excessive fear responses, wherein PRDM2 modulates the dmPFC -BLA circuit through specific transcriptomic changes.

Alcohol binge drinking in adolescence and psychological profile: Can the preclinical model crack the chicken-or-egg question?

During adolescence, internal and external factors contribute to engaging with alcohol binge drinking (ABD), putting at risk the neurodevelopment of brain regions crucial for emotional control and stress coping. This research assessed the prevalence of ABD in late adolescent students of Southern Italy and characterized their psychological profile and drinking motives. Translational effects of alcohol binge drinking in the animal model were also studied. Seven hundred and fifty-nine high school students of both sexes (aged 18-20) were recruited. Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), Drinking Motives Questionnaire-Revised Short Form, Millon Clinical Multiaxial Inventory-Third Ed., State-Trait Anxiety Inventory, Connor-Davidson Resilience Scale, and Basic Self-Esteem Scale identified alcohol habits, drinking motives, and psychopathological profile. Eighty-five percentage of the students drank alcohol and 28% of them engaged in ABD; AUDIT-C correlated with enhancement, coping, and conformity motives. ABD was related to a greater likelihood of presenting clinical syndromes and personality disorders, as well as low resilience and self-esteem. Thereafter, in the pre-clinical model, adolescent male rats were exposed to alcohol (3.5 g/kg) in an intermittent binge-like paradigm and tested during prolonged abstinence. Rats were evaluated for anxiety-like behavior, motivated behaviors, resilience, and stress response following a psychosocial challenge. Binge-like alcohol-exposed adolescent rats displayed high integrated z-score for social- and novelty-induced anxiety, altered motivation-driven output, decreased resilience, and a blunted HPA axis response to psychosocial stress, with respect to respective controls. Our data confirm that ABD is the chosen pattern of drinking in a significant percentage of high school students in Southern Italy, and highlights AUDIT-C score as a relevant parameter able to predict the occurrence of affective disturbances. The evidence from the preclinical model shows that ABD produces detrimental consequences in the adolescent rat brain, resulting in negative affect, emotional dysregulation, and aberrant stress response, pointing to decreasing excessive alcohol drinking as a primary goal for the global act for brain health.

Associations Between Lifetime Panic Attacks, Posttraumatic Stress Disorder, and Substance Use Disorders in a Nationally Representative Sample

Objective: Rates of lifetime substance use disorder (SUD) are high among people with lifetime posttraumatic stress disorder (PTSD). Panic attacks are also prevalent among trauma survivors and people with SUD, yet studies on PTSD/SUD have rarely examined comorbid panic. This potentially creates additional barriers to effective treatment for people with PTSD/SUD, in that panic may be under-diagnosed among people with PTSD/SUD and consequently attenuate treatment outcome. Additionally, research on PTSD/SUD often combines people with alcohol use disorder (AUD) and people with drug use disorders (DUDs) into a single group despite evidence that these two PTSD/SUD subgroups differ along important sociodemographic and clinical variables. This study tested the hypothesis that among adults with lifetime PTSD, panic attacks would be associated with greater lifetime risk for both AUD and DUD. We also explored whether panic attacks were associated with specific DUDs that frequently co-occur with PTSD (cannabis, sedatives/tranquilizers, heroin/opioids, and cocaine). Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a cross-sectional national study. Adults with lifetime PTSD (N = 2,230) were classified into one of three groups based on diagnostic interview data: adults with PTSD/AUD (i.e., met criteria for PTSD and AUD but not DUD; n = 656), adults with PTSD/DUD (i.e., met criteria for PTSD and DUD, regardless of AUD diagnostic status; n = 643), or adults with PTSD-only (i.e., met criteria for PTSD but not AUD or DUD; n = 1,031). Results: Weighted logistic regression analyses showed that lifetime risk of PTSD/AUD and PTSD/DUD, each relative to PTSD-only, was greater for adults who were younger at the time of data collection, were male, and had a history of panic attacks. Panic attacks did not predict specific DUD diagnoses comorbid with PTSD in exploratory analyses adjusting for sociodemographic and clinical covariates. Conclusions: Findings highlight the importance of assessing and targeting panic in PTSD/SUD clinics, but suggest panic may not discriminate between specific DUDs that commonly co-occur with PTSD. Study limitations and future directions are discussed.

Social support and subjective well-being among postgraduate medical students: the mediating role of anxiety and the moderating role of alcohol and tobacco use

Medical students often face pressures from various sources in the course of postgraduate studies, and these factors have a negative impact on their subjective well-being. Previous researches have revealed that social support is a vital factor influencing subjective well-being, but unfortunately the underlying mechanism for this is unclear, especially for postgraduate medical students. The current study has inspected the effects of social support on subjective well-being of postgraduate medical students, the mediating role of anxiety and the moderating role of alcohol and tobacco use in the association between social support and subjective well-being of postgraduate medical students. A sample of 900 postgraduate medical students (Mage = 27.01 years, SD = 3.33) from The Second Affiliated Hospital of Nanchang University completed the Social Support Rating Scale, the Generalized Anxiety Disorder-7, the Tobacco and Alcohol Use Questionnaire and the Subjective Well-Being Scale. Analysis of the structural equation model revealed that anxiety partially mediated the relationship between social support and subjective well-being of postgraduate medical students, while alcohol and tobacco use moderated the relationship between anxiety and subjective well-being of postgraduate medical students. This study revealed how social support act upon subjective well-being of postgraduate medical students. This study provides a theoretical basis for promoting and enhancing the subjective well-being of postgraduate medical students.

Measuring self-reported change in alcohol and cannabis consumption during the second wave of the COVID-19 pandemic in Canada

This study presents nationally representative estimates of self-reported changes in alcohol and cannabis consumption since the onset of COVID-19 in Canada. We used data from the Survey on COVID-19 and Mental Health (collected from September to December 2020) to calculate the prevalence of self-reported change in alcohol and cannabis consumption. We found that 15.7% of respondents self-reported an increase in alcohol consumption and 5.4% in cannabis consumption since the start of the pandemic. Sociodemographic disparities were also observed, indicating that increased alcohol and cannabis consumption may be more prevalent among certain populations.

Social Support Effects on Neural Stress and Alcohol Reward Responses

Social support (SS), or having people to depend on during times of stress, may offer an emotional and neurological buffer to problem drinking. Specifically, SS may modulate reward and stress-related brain responses to mitigate perceptions of alcohol reward and stress. There is limited evidence, however, on this topic and specifically on brain networks that may modulate SS effects on stress and alcohol reward. Here we present a review of the current literature on this topic as well as data from a large community sample of 115 social drinkers. Findings from a novel fMRI task viewing alcohol cue, stress, and neutral images, in separate blocks, while providing ratings on subjective feelings of alcohol craving, stress, and arousal are included. Lower SS significantly predicted greater alcohol craving during alcohol cue and stress conditions, higher baseline levels of stress, and greater arousal in the alcohol cue, relative to neutral condition. Remarkably, individuals with low SS showed greater reward activation (ventral medial prefrontal cortex (VmPFC) and ventral striatum) during alcohol cue exposure, while those with high SS showed no such activation (p < 0.001, family wise error corrected at 0.05). Furthermore, individuals with lower SS showed greater stress circuit (VmPFC, dorsal striatum, and periaqueductal gray) activation not observed in the high SS groups. Both groups showed increased amygdala activation under stress condition. The findings support the notion that SS is a powerful modulator of stress response and reward motivation. High SS buffers neural and subjective stress responses, while low SS potentiates greater reward seeking with higher alcohol craving and greater brain activation during alcohol cue exposure. Previous research and current results suggest the need to further explore the role of SS in those at risk of developing alcohol use disorder and assess novel prevention strategies to boost SS in at-risk drinkers.

Access to Mental Health and Substance Use Resources for 2SLGBTQ+ Youth during the COVID-19 Pandemic

Previous research has established that gender and sexual minority (2SLGBTQ+) youth experience worse mental health and substance use outcomes than their heterosexual and cisgender counterparts. Research suggests that mental health and substance use concerns have been exacerbated by the COVID-19 pandemic. The current study used self-reported online survey responses from 1404 Canadian 2SLGBTQ+ youth which included, but were not limited to, questions regarding previous mental health experiences, diagnoses, and substance use. Additional questions assessed whether participants had expressed a need for mental health and/or substance use resources since the beginning of the COVID-19 pandemic (March 2020) and whether they had experienced barriers when accessing this care. Bivariate and multinomial logistic regression analyses were conducted to determine associations between variables and expressing a need for resources as well as experiencing barriers to accessing these resources. Bivariate analyses revealed multiple sociodemographic, mental health, and substance use variables significantly associated with both expressing a need for and experiencing barriers to care. Multinomial regression analysis revealed gender identity, sexual orientation, ethnicity, and level of educational attainment to be significantly correlated with both cases. This study supports growing research on the mental health-related harms that have been experienced during the COVID-19 pandemic and could be used to inform tailored intervention plans for the 2SLGBTQ+ youth population.

Stress-induced escalation of alcohol self-administration, anxiety-like behavior, and elevated amygdala Avp expression in a susceptible subpopulation of rats

Comorbidity between alcohol use and anxiety disorders is associated with more severe symptoms and poorer treatment outcomes than either of the conditions alone. There is a well-known link between stress and the development of these disorders, with post-traumatic stress disorder as a prototypic example. Post-traumatic stress disorder can arise as a consequence of experiencing traumatic events firsthand and also after witnessing them. Here, we used a model of social defeat and witness stress in rats, to study shared mechanisms of stress-induced anxiety-like behavior and escalated alcohol self-administration. Similar to what is observed clinically, we found considerable individual differences in susceptibility and resilience to the stress. Both among defeated and witness rats, we found a subpopulation in which exposure was followed by emergence of increased anxiety-like behavior and escalation of alcohol self-administration. We then profiled gene expression in tissue from the amygdala, a key brain region in the regulation of stress, alcohol use, and anxiety disorders. When comparing "comorbid" and resilient socially defeated rats, we identified a strong upregulation of vasopressin and oxytocin, and this correlated positively with the magnitude of the alcohol self-administration and anxiety-like behavior. A similar trend was observed in comorbid witness rats. Together, our findings provide novel insights into molecular mechanisms underpinning the comorbidity of escalated alcohol self-administration and anxiety-like behavior.

Efficacy of the Unified Protocol for the treatment of comorbid alcohol use and anxiety disorders: Study protocol and methods

Alcohol Use Disorder (AUD) and anxiety disorders (ANX) are each highly prevalent and frequently co-occur, resulting in a complex clinical presentation. The existing literature to date has not yet identified how to best treat comorbid AUD/ANX, partially due to limitations in understanding what factors and mechanisms are implicated in their co-occurrence. This manuscript describes the rationale and methods for an ongoing randomized-controlled trial designed to evaluate the efficacy of a cognitive behavioral intervention, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), compared to Take Control (TC), a psychosocial and motivational treatment serving as a control condition in this study, for comorbid AUD/ANX. Sixty individuals with comorbid AUD/ANX will be randomized to UP or TC, and complete assessments at pre- and post-treatment, as well as one- and six-month follow-up points. We hypothesize that the UP, compared to TC, will result in significantly greater reductions in drinking-related outcomes, as well as anxiety and depressive-related outcomes. Additionally, the current study is designed to evaluate exploratory aims to contribute to our theoretical understanding of why AUD and ANX frequently co-occur. Specifically, we will examine the relationship between changes in AUD and ANX symptoms in relation to changes in emotional disorder mechanisms, such as emotion regulation. Because the UP is a transdiagnostic treatment that specifically targets underlying components of emotional disorders generally, it may be well suited to effectively target comorbid AUD/ANX.

Novel characterization of the multivariate genetic architecture of internalizing psychopathology and alcohol use

Genetic correlations suggest that the genetic relationship of alcohol use with internalizing psychopathology depends on the measure of alcohol use. Problematic alcohol use (PAU) is positively genetically correlated with internalizing psychopathology, whereas alcohol consumption ranges from not significantly correlated to moderately negatively correlated with internalizing psychopathology. To explore these different genetic relationships of internalizing psychopathology with alcohol use, we performed a multivariate genome-wide association study of four correlated factors (internalizing psychopathology, PAU, quantity of alcohol consumption, and frequency of alcohol consumption) and then assessed genome-wide and local genetic covariance between these factors. We identified 14 significant regions of local, largely positive, genetic covariance between PAU and internalizing psychopathology and 12 regions of significant local genetic covariance (including both positive and negative genetic covariance) between consumption factors and internalizing psychopathology. Partitioned genetic covariance among functional annotations suggested that brain tissues contribute significantly to positive genetic covariance between internalizing psychopathology and PAU but not to the genetic covariance between internalizing psychopathology and quantity or frequency of alcohol consumption. We hypothesize that genome-wide genetic correlations between alcohol use and psychiatric traits may not capture the more complex shared or divergent genetic architectures at the locus or tissue specific level. This study highlights the complexity of genetic architectures of alcohol use and internalizing psychopathology, and the differing shared genetics of internalizing disorders with PAU compared to consumption.

[Dual diagnosis: depression and alcohol use disorder]

A combination of depression and alcohol use disorder (AUD) is a typical and most common example of a dual diagnosis at the intersection of general psychiatry and addiction psychiatry. A comorbidity of depression and AUD is more common than it can be brought about by mere coincidence, which might be explained to some extent by the synergetic effect of both diseases, with each of them complicating the course and worsening the prognosis of the other. Treatment protocols for patients with depression and comorbid AUD include antidepressants, specific medications for alcohol dependence, and psychotherapy. The first-line antidepressants in the treatment of patients with a comorbid combination of depression and alcohol use disorder, as in other clinical situations implying use of antidepressants, are selective serotonin reuptake inhibitors (SSRIs). Fluvoxamine has certain advantages over the other SSRIs in the treatment of patients with a depression and comorbid AUD.

Cardiac response in aversive and appetitive olfactory conditioning: Evidence for a valence-independent CS-elicited bradycardia

While the examination of conditioned cardiac responses is well established in human fear conditioning research, comparable studies using less-aversive or rather appetitive unconditioned stimuli (UCS) are sparse and results are mixed. Therefore, the aim of this study was a systematic analysis of cardiac reactions in aversive and appetitive conditioning. Olfactory stimuli were used as unconditioned stimuli as they are suitable reinforcers in both an aversive and an appetitive conditioning offering the opportunity for a comparison between conditioned responses. In total, n = 86 participants took part in both an aversive and an appetitive differential conditioning task with a counterbalanced order across participants. Aversive or appetitive odors, respectively, served as UCS and neutral geometrical figures as CS. Subjective ratings, skin conductance response (SCRs), and evoked cardiac reactions were analyzed and compared between tasks. Conditioned responses in subjective ratings could be observed in both aversive conditioning and appetitive conditioning, while SCRs discriminated between CS+ and CS- in aversive conditioning only. Regarding conditioned cardiac responses, the deceleration for the CS+ was longer than for the CS- in both tasks. In addition, a higher deceleration magnitude and a shorter acceleration for the CS+ as compared to the CS- were found in aversive but not in appetitive conditioning. There were medium-size correlations between aversive and appetitive CRs for subjective ratings and none for physiological responses. The results suggest similarities between cardiac response patterns in aversive and appetitive conditioning, which implies that bradycardia in conditioning might not be fear-specific but presents a valence-independent CS-elicited bradycardia.

Systematische Literaturübersicht der Wirksamkeit von Acamprosat, Naltrexon, Disulfiram und Nalmefen zur Trinkmengenreduktion und Aufrechterhaltung der Abstinenz bei Alkoholabhängigkeit

Das Ziel der vorliegenden Übersichtsarbeit ist die systematische Darstellung der aktuellen Evidenz zur Wirksamkeit von Acamprosat, Naltrexon, Disulfiram und Nalmefen für die Aufrechterhaltung der Abstinenz oder Trinkmengenreduktion bei alkoholabhängigen Patient:innen. Bezogen auf den Zeitraum 2005 bis 2020 wurden insgesamt 27 Studien identifiziert, die alle Einschlusskriterien (u. a. RCT, mind. 8 Wochen Behandlungsdauer) erfüllten. Es wurden überwiegend Hinweise zur Wirksamkeit von Nalmefen gefunden. Acamprosat war nicht (zusätzlich) wirksam. Naltrexon trug in kombinierten Interventionen einen zusätzlichen Nutzen bei, dies galt jedoch nicht für die Mehrzahl der Studien. Disulfiram war nicht wirksam darin, einen zusätzlichen Nutzen zur Erhaltung der Abstinenz beizutragen, im Vergleich zu Topiramat, einem Antikonvulsivum, jedoch effektiver. Die Ergebnisse stehen nicht im Einklang mit dem bisher bekannten Forschungsstand, der Acamprosat, Naltrexon und Nalmefen als überwiegend effektiv und sicher einstuft und Disulfiram als mäßig wirksam. Der pharmakologische Interventionsbedarf sollte bei Bestehen alkoholbezogener Probleme exploriert und ggf. erwogen werden, damit diesbezüglich Vorbehalte abgebaut und ein umfassendes und zugleich individuelles Behandlungsangebot geschaffen wird. Hinsichtlich der Trinkmengenreduktion sollten Aspekte der Schadensminderung als Behandlungsziel berücksichtigt werden.

Rumination and worry as putative mediators explaining the association between emotional disorders and alcohol use disorder in a longitudinal study

INTRODUCTION

The high rate of comorbidity between alcohol use and emotional disorders is well demonstrated, but the mechanisms underlying their relationship remain largely unidentified. One possibility is maladaptive responding to negative affect, such as worry and rumination. The present study sought to examine worry and rumination as putative mediators explaining the link between emotional disorders and alcohol use disorders. Methods Mediational analyses were conducted using a sample (n = 232) derived from a larger late adolescence/early adulthood longitudinal dataset (Youth Emotion Project; Zinbarg et al., 2010). Results A significant indirect effect was observed for emotional disorder severity on alcohol use disorder severity via rumination, but not via worry or the shared variance between worry and rumination. Conclusions These findings suggest that rumination may specifically confer risk for the development of alcohol use disorder for individuals with emotional disorders. Further, ruminative thinking may serve as a specific treatment target to reduce vulnerability to alcohol use disorder.

Clinical Risk Constellations for the Development of Bipolar Disorders

The early recognition of psychiatric disorders has been a focus of research in the last decades and has led to improvements in clinical care, especially in the area of early psychosis. Like non-affective psychosis, bipolar disorders are often diagnosed with a delay that can lead to long periods of untreated illness and impact long-term outcomes. This article presents the rationale for early recognition in bipolar disorder and presents the current evidence for the identification of risk factors, their assessment and validity in predicting the onset of bipolar disorder.

Anxiety symptoms and alcohol abuse during the COVID-19 pandemic: A cross-sectional study with Brazilian dental undergraduate students

Aim

The aim of this study is to assess whether anxiety symptoms are associated with alcohol abuse in Brazilian undergraduate dental students during the COVID‐19 pandemic.

Method

A cross‐sectional study was conducted. A semi‐structured questionnaire addressing the variables of interest was hosted on Google Forms and shared with dental undergraduate students from all Brazilian regions between July 8 and 27, 2020. Alcohol abuse was measured using the Cut down, Annoyed, Guilty, Eye opener (CAGE) questionnaire score of ≥2. All participants responded to the seven‐item Generalized Anxiety Disorder Scale (GAD‐7). Hierarchical logistic regression was also conducted.

Results

Among the 1050 students evaluated, 18.7% (n = 196) had a positive screening for alcohol abuse during the pandemic. The prevalence of mild (GAD‐7 = 5–9), moderate (GAD‐7 = 10–14), and severe (GAD‐7 ≥15) anxiety among students were 31.3%, 29.6%, and 24.2%, respectively. The final hierarchical logistic regression model showed that during the COVID‐19 pandemic, anxiety levels predict the likelihood of alcohol abuse among students with moderate (OR 10.05 [95% IC: 4.12–24.52]) or severe (OR 15.82 [95% IC: 6.46–38.73]) anxiety, especially for male students (moderate anxiety: OR 17.06 [95% CI: 8.36–34.78]; severe anxiety: OR 28.38 [95% CI: 8.62–38.24]).

Conclusion

The prevalence of alcohol abuse and moderate or severe anxiety in Brazilian undergraduate dental students during the COVID‐19 pandemic was high. Male students may be more sensitive to the presence of anxiety symptoms in this period, thus contributing to higher levels of alcohol consumption, in comparison to female students. Intervention strategies that promote the adoption of healthier lifestyles can enable the effective management of anxiety symptoms during the pandemic and thus, hold the potential to reduce exacerbated alcohol intake in this population.

The prevalence of hazardous and harmful drinking in the UK Police Service, and their co-occurrence with job strain and mental health problems

AIMS

Due to the stressful nature of policing, police employees are at risk of mental health problems and problematic alcohol use. We aim to determine the prevalence of hazardous and harmful alcohol use in the UK Police Service, and to explore the associations with job strain and mental health problems.

METHODS

Cross-sectional data from the Airwave Health Monitoring Study (N = 40 986) included measures of alcohol consumption (total units in past week), mental health (depression, anxiety and post-traumatic stress disorder [PTSD]) and job strain. The associations between mental health and job strain with alcohol consumption (i.e. abstinence, low-risk [<14 units per week, reference group], hazardous [>14 to 35 units for women, >14 to 50 units for men], harmful [>35 units for women, >50 units for men]), were analysed using multinomial logistic regressions, adjusting for potential confounders (i.e. age, gender, ethnicity, marital status, children under 18, income and smoking status).

RESULTS

A total of 32.6% of police employees reported hazardous drinking, with 3.0% drinking at harmful levels. Compared to those without a mental health problem, police employees with depression, anxiety or PTSD were twice as likely to be harmful drinkers and were also 1.3 times more likely to report abstinence. Those reporting low strain (reference group) were more likely to drink hazardously compared to those reporting high strain, which was statistically moderated by mental health. When the sample was stratified by mental health status, the association between low strain (compared to all other categories) and hazardous drinking, was significant only in those without a mental health problem.

CONCLUSIONS

These findings indicate that police employees may be an occupational group at risk of alcohol harm, with one-third drinking hazardously. The J-shaped relationship between mental health and alcohol use highlights a need for an integration of mental health and alcohol services, tailored for the UK Police Service.

Genetic Basis of Dual Diagnosis: A Review of Genome-Wide Association Studies (GWAS) Focusing on Patients with Mood or Anxiety Disorders and Co-Occurring Alcohol-Use Disorders

(1) Background: Comorbidity between Alcohol Use Disorders (AUD), mood, and anxiety disorders represents a significant health burden, yet its neurobiological underpinnings are elusive. The current paper reviews all genome-wide association studies conducted in the past ten years, sampling patients with AUD and co-occurring mood or anxiety disorder(s). (2) Methods: In keeping with PRISMA guidelines, we searched EMBASE, Medline/PUBMED, and PsycINFO databases (January 2010 to December 2020), including references of enrolled studies. Study selection was based on predefined criteria and data underwent a multistep revision process. (3) Results: 15 studies were included. Some of them explored dual diagnoses phenotypes directly while others employed correlational analysis based on polygenic risk score approach. Their results support the significant overlap of genetic factors involved in AUDs and mood and anxiety disorders. Comorbidity risk seems to be conveyed by genes engaged in neuronal development, connectivity, and signaling although the precise neuronal pathways and mechanisms remain unclear. (4) Conclusion: given that genes associated with complex traits including comorbid clinical presentations are of small effect, and individually responsible for a very low proportion of the total variance, larger samples consisting of multiple refined comorbid combinations and confirmed by re-sequencing approaches will be necessary to disentangle the genetic architecture of dual diagnosis.

The monoamine stabilizer OSU6162 has anxiolytic-like properties and reduces voluntary alcohol intake in a genetic rat model of depression

Alcohol use disorders (AUD) often co-occur with anxiety and depressive disorders, and anxiety often drives relapse during alcohol abstinence. Optimal AUD pharmacotherapies may thus need to target both excessive alcohol intake and elevated anxiety. (−)-OSU6162 (OSU) is a monoamine stabilizer that attenuates alcohol-mediated behaviors in both preclinical and clinical settings. However, OSU’s effect on anxiety-like behavior following long-term drinking remains unknown. To this end, we utilized a genetic rat model that exhibits increased anxiety- and depression-like behaviors (Flinders Sensitive Line; FSL) and their controls (Flinders Resistant Line; FRL). Using the novelty suppressed feeding (NSF) test, we evaluated anxiety-like behaviors (1) at baseline, (2) following long-term voluntary drinking and after 24 h of alcohol deprivation, and (3) following OSU administration in the same animals. At baseline, FSL animals displayed significantly elevated anxiety-like characteristics compared to FRL. Compared to alcohol-naïve animals, long-term drinking significantly reduced anxiety-like behaviors in FSL, without any significant effects in FRL animals. Compared to vehicle, OSU administration significantly reduced anxiety-like behaviors in alcohol-naïve FSL and long-term drinking FRL animals. While there was no significant difference in alcohol intake between FSL and FRL, OSU attenuated alcohol intake in both strains. Conclusively, in addition to the compound’s previously identified ability to suppress alcohol-mediated behaviors, OSU may also possess anxiolytic properties, warranting further clinical evaluation in both AUD and anxiety disorder settings.

Associations of antidepressant use with alcohol use and problem drinking: Ontario population data from 1999 to 2017

OBJECTIVE

This study investigated the rates of and change in past-year antidepressant use from 1999 to 2017 among a representative sample of Ontario adults and past-year alcohol users and problem drinkers. It examined whether alcohol use and problem drinking are associated with antidepressant use over time, whether gender moderated the effect of problem drinking on antidepressant use, and the potential correlates of past-year antidepressant use.

METHOD

This study utilized data from the Centre for Addiction and Mental Health Monitor study, a repeat cross-sectional telephone survey of the Ontario general adult population. Data are from 15 annual cycles of the survey 1999-2017 (where relevant variables were included), resulting in a sample size of N = 35,210. Variables of interest included demographic variables, past-year antidepressant use, past-year alcohol use, and past-year problem drinking (e.g., 8+ on the Alcohol Use Disorders Identification Test).

RESULTS

Past-year antidepressant use increased from 1999 to 2017 similarly among the full sample, past-year alcohol users, and past-year problem drinkers. Approximately 9% of Ontarians reported past-year antidepressant use in 2017. Overall, past-year problem drinkers were 1.5 times more likely to use antidepressants than non-problem drinkers. Past-year alcohol use was not associated with antidepressant use. Gender moderated the association between past-year problem drinking and antidepressant use.

CONCLUSION

This study determined that past-year antidepressant use increased from 1999 to 2017, that past-year problem drinkers are more likely to use antidepressants than non-problem drinkers, and that past-year problem drinking is associated with past-year antidepressant use among women but not among men.

The impact of alcohol use disorders and alcohol consumption on treatment-seeking individuals with social anxiety disorder

Comorbid social anxiety and alcohol use disorders (SAD-AUD) in the community and the complex interactions that occur between these disorders have emerged as a significant clinical, public health, and research issue. The authors examined (a) the rates of comorbid SAD-AUD, (b) the impact of comorbid SAD-AUD on outcomes targeting social anxiety disorder, and (c) the effect of pretreatment alcohol consumption and alcohol use before, during, and after social situations on a composite measure of social anxiety in 172 adults presenting with social anxiety disorder. There was low incidence of AUD in this sample of individuals with SAD. Results indicated that alcohol consumption did not lead to worse social anxiety symptoms; however, alcohol use before and during social situations was associated with more severe social anxiety symptoms. These findings suggest that the function of alcohol use may be more important than the overall level of alcohol use and has implications for treatment.

Characterization of alcohol polygenic risk scores in the context of mental health outcomes: Within-individual and intergenerational analyses in the Avon Longitudinal Study of Parents and Children

BACKGROUND

Heavy alcohol consumption often co-occurs with mental health problems; this could be due to confounding, shared biological mechanisms, or causal effects. Polygenic risk scores (PRS) for alcohol use can be used to explore this association at critical life stages.

DESIGN

We characterized a PRS reliably associated with patterns of adult alcohol consumption by 1) validating whether it predicts own alcohol use at different life-stages (pregnancy, adolescence) of interest for mental health impact. Additionally, we explored associations of alcohol PRS on mental health phenotypes 2) within-individuals (using own alcohol PRS on own phenotypes) and 3) intergenerationally (using maternal alcohol PRS on offspring phenotypes). We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 960-7841). Additional substance abuse behaviors and mental health/behavioral outcomes were investigated (alcohol phenotypes n = 22; health phenotypes n = 91).

FINDINGS

Maternal alcohol PRS was associated with consumption during pregnancy (strongest signal: alcohol frequency at 18 weeks' gestation: β = 0.041, 95%CI = 0.0.02-0.06), p = 1.01 × 10-5, adjusted R2 = 1.6 %), offspring alcohol PRS did not predict offspring alcohol consumption. We found evidence for an association of maternal alcohol PRS with own perinatal depression (OR  = 1.10, 95% CI = 1.02 to 1.18, p = 0.022) and decreased offspring intellectual ability (β=-0.209, 95% CI -0.38 to -0.04, p= 0.016).

CONCLUSIONS

These alcohol PRS are a valid proxy for maternal alcohol use in pregnancy. Offspring alcohol PRS was not associated with drinking in adolescence. Consistently with results from different study designs, we found evidence that maternal alcohol PRS are associated with both prenatal depression and decreased offspring intellectual ability.

Obsessive-compulsive symptoms and problematic alcohol use: The explanatory role of drinking motives

The purpose of the present investigation was to examine the unique explanatory role of alcohol use motives above the effects of each other, using a multiple mediation model, for the relationship between obsessive-compulsive symptomatology and problematic alcohol use among a young ethno-racially diverse sample of college students with current (past-month) alcohol use. Participants were 454 college students (81.72% female, Mage = 22.46, SD = 4.71). Results indicated that coping motives significantly explained the relationship between obsessive-compulsive symptoms, and alcohol consumption (past year), risky drinking, and recent alcohol use (past month) as behavioral indices of problematic drinking after controlling for the variance accounted for by recent cannabis use, smoking, and anxiety and depressive symptoms (with small to medium effect sizes). These findings are discussed in terms of the development of specialized treatments to specifically target coping oriented alcohol use motives in the context of obsessive-compulsive symptoms among young adults with clinically significant OCD symptoms and comorbid problematic alcohol use.

Chronic Voluntary Alcohol Drinking Causes Anxiety-like Behavior, Thiamine Deficiency, and Brain Damage of Female Crossed High Alcohol Preferring Mice

The central nervous system is vulnerable to chronic alcohol abuse, and alcohol dependence is a chronically relapsing disorder which causes a variety of physical and mental disorders. Appropriate animal models are important for investigating the underlying cellular and molecular mechanisms. The crossed High Alcohol Preferring mice prefer alcohol to water when given free access. In the present study, we used female cHAP mice as a model of chronic voluntary drinking to evaluate the effects of alcohol on neurobehavioral and neuropathological changes. The female cHAP mice had free-choice access to 10% ethanol and water, while control mice had access to water alone at the age of 60-day-old. The mice were exposed to alcohol for 7 months then subjected to neurobehavioral tests including open field (OF), elevated plus maze (EPM), and Morris water maze (MWM). Results from OF and EPM tests suggested that chronic voluntary drinking caused anxiety-like behaviors. After behavior tests, mice were sacrificed, and brain tissues were processed for biochemical analyses. Alcohol altered the levels of several neurotransmitters and neurotrophic factors in the brain including gamma-Aminobutyric acid (GABA), corticotropin-releasing factor, cAMP response element-binding protein (CREB) and brain-derived neurotrophic factor. Alcohol increased the expression of neuroinflammation markers including interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1) and C-C chemokine receptor 2 (CCR2). Alcohol also induced cleaved caspase-3 and glial fibrillary acidic protein, indicative of neurodegeneration and gliosis. In addition, alcohol inhibited the expression of thiamine transporters in the brain and reduced thiamine levels in the blood. Alcohol also caused oxidative stress and endoplasmic reticulum (ER) stress, and stimulated neurogenesis.