Longitudinal phenotypes for alcoholism: Heterogeneity of course, early identifiers, and life course correlates

Associated and intermediate factors between genetic variants of the dopaminergic D2 receptor gene and harmful alcohol use in young adults

Dopamine receptor D2 (DRD2) and ankyrin repeat and kinase domain-containing protein 1 (ANKK1) genes have received considerable attention for their involvement in alcohol use disorder (AUD), but many questions remain on their exact role. We conducted a population-based case-control and genetic association study in a large sample of young adults. Our aim was to assess the association between DRD2 and ANKK1 single nucleotide polymorphisms (SNPs) and harmful alcohol use, disentangling associated and possible intermediate factors. A total of 1841 college students from the French region Champagne-Ardennes, aged between 18 and 21 years and who reported at least one lifetime alcohol consumption, were included in this study. Allele frequencies were analysed according to harmful alcohol use (assessed through the Alcohol Use Disorder Identification Test [AUDIT] questionnaire). Different substance use disorders, including nicotine and cannabis dependences, were also assessed through questionnaires, as was a list of potential associated factors (e.g., major depressive episode, conduct disorder, attention-deficit/hyperactivity disorder [ADHD], school failure, sugar consumption, sexual trauma, parents' use of alcohol, tobacco or cannabis). We found that DRD2 rs1800498 was associated with harmful alcohol use. Many factors were detected, but a global path analysis revealed that DRD2 rs1800498 had a significant direct effect on harmful alcohol use and that early age at first alcohol consumption and depressive symptoms moderated this effect. This study suggests an interplay between harmful alcohol use, DRD2 genotypes and other risk factors that, with a full understanding, could be useful for preventive purposes.

Adolescent Substance Use Disorders

Adolescent Substance Use DisordersSubstance use disorders contribute to the leading causes of death among adolescents, including homicide and suicide. Here, Simon et al. review the most recent published data on adolescent substance use disorders and the implications for clinical practice.

Individual differences in the development of youth externalizing problems predict a broad range of adult psychosocial outcomes

This study examined how youth aggressive and delinquent externalizing problem behaviors across childhood and adolescence are connected to consequential psychosocial life outcomes in adulthood. Using data from a longitudinal, high-risk sample (N = 1069) that assessed children and their parents regularly from early childhood (ages 3-5) through adulthood, multilevel growth factors of externalizing behaviors were used to predict adult outcomes (age 24-31), providing a sense of how externalizing problems across development were related to these outcomes via maternal, paternal, teacher, and child report. Findings indicated strong support for the lasting connections between youth externalizing problems with later educational attainment and legal difficulties, spanning informants and enduring beyond other meaningful contributors (i.e., child sex, cognitive ability, parental income and education, parental mental health and relationship quality). Some support was also found, although less consistently, linking externalizing problems and later alcohol use as well as romantic relationship quality. Delinquent/rule-breaking behaviors were often stronger predictors of later outcomes than aggressive behaviors. Taken together, these results indicate the importance of the role youth externalizing behaviors have in adult psychosocial functioning one to two decades later.

Heterogeneity in DSM-5 Symptom Criteria: Phenotypes of Alcohol Use Disorder in a Sample Seeking Alcohol Treatment

AIMS

This study sought to identify phenotypic variations among individuals with alcohol use disorder (AUD) that may, in part, help improve the effectiveness of existing AUD interventions.

METHODS

Latent class analysis was conducted to examine the potential heterogeneity of AUD in a sample (N = 220; Mage = 51.19 years, standard deviation = 9.94; 37.7% female) of treatment-seeking participants diagnosed with AUD using DSM-5 criteria.

RESULTS AND CONCLUSIONS

Three distinct patterns of responses to the 11 DSM-5 AUD symptoms emerged: Class 1 (n = 114, 51.8%), Class 2 (n = 78, 35.5%) and Class 3 (n = 28, 12.7%). The identified profiles were further differentiated by demographics, alcohol-related constructs, individual difference characteristics and diagnostic and treatment variables. The findings have implications for refining AUD assessment as well as optimizing personalized treatment.

Multiple trajectories of alcohol use and the development of alcohol use disorder: Do Swiss men mature-out of problematic alcohol use during emerging adulthood?

(A) OBJECTIVE

This study aimed to identify trajectories of alcohol use (AU) and their associations with the development of alcohol use disorder (AUD) among young men with different weekly drinking patterns.

(B) METHOD

A longitudinal latent class analysis integrating several aspects of AU, such as drinking quantity and frequency on weekends vs workweek days, involving 4719 young Swiss men at ages 20, 21, and 25, and collected by the Cohort Study on Substance Use Risk Factors, was used to identify different AU trajectories over time. The development of AUD scores in these trajectories was investigated using generalized linear mixed models.

(C) RESULTS

Six AU trajectory classes, similar to those described in the literature, were identified: 'abstainers-light drinkers', 'light workweek increasers', 'light decreasers', 'moderate weekend decreasers', 'moderate workweek increasers', and 'heavy drinkers'. Only 12% of participants were assigned to a trajectory class with decreasing AU associated with a decline in their AUD score. AUD scores increased in trajectory classes exhibiting increasing AU on workweek days, despite low and moderate general AU. Finally, more than 59% of participants were on an AU trajectory presenting no change in their mean AUD score over time.

(D) CONCLUSIONS

Maturing out of problematic AU in emerging adulthood is not the norm in Switzerland, and the AUD score developed in late adolescence remains until at least emerging adulthood. AU on workweek days is a more practical marker of potentially problematic AU. This calls for timely interventions in adolescence and concerning regular drinking on workweek days in emerging adulthood.

Intelligence in young adulthood and alcohol use disorders in a prospective cohort study of Danish men: the role of psychiatric disorders and parental psychiatric history

OBJECTIVES

The aims were to estimate the association between intelligence measured in young adulthood and risk of alcohol use disorders (AUD) in men and to investigate the potential modification of this association by psychiatric disorders, parental AUD and parental psychiatric disorders.

DESIGN

Prospective cohort study based on a linkage of intelligence test scores from draft board examinations and register data on AUD diagnoses during 36 years of follow-up.

SETTING

Denmark.

PARTICIPANTS

3287 Danish men from the Copenhagen Perinatal Cohort (born 1959-1961) who appeared before the draft board at a mean age of 18.7 years.

PRIMARY OUTCOME MEASURE

First registration with AUD during follow-up was the primary outcome. Information on AUD was based on diagnoses retrieved from national hospital and outpatient treatment registers, defined according to the International Classification of Diseases.

RESULTS

361 (11.0%) men were registered with AUD during follow-up. Low intelligence scores were associated with increased odds of AUD adjusting for parental AUD, parental psychiatric disorders, maternal smoking during pregnancy, birth weight, maternal age at birth, parity and childhood socioeconomic position (OR per SD decrease in intelligence=1.69, 95% CI 1.49 to 1.92). Separate analyses indicated significant interaction (p<0.001) between intelligence and psychiatric disorders. The adjusted OR per SD decrease in intelligence score was 2.04 (95% CI 1.67 to 2.49) in men without other psychiatric disorders whereas the OR was 1.21 (95% CI 1.01 to 1.46) in men with other psychiatric disorders. No interaction was found between intelligence and parental AUD or between intelligence and parental psychiatric disorders.

CONCLUSIONS

The association between intelligence in young adulthood and AUD is modified by other psychiatric disorders as low intelligence is primarily a risk factor for men without other psychiatric disorders. Future studies should take other psychiatric disorders into account when investigating associations between intelligence and AUD.

The dopamine transporter VNTR polymorphism moderates the relationship between acute response to alcohol and future alcohol use disorder symptoms

Alcohol use disorder (AUD) is a genetically influenced disease with peak onset in young adulthood. Identification of factors that predict whether AUD symptoms will diminish or persist after young adulthood is a critical public health need. King and colleagues previously reported that acute response to alcohol predicted future AUD symptom trajectory. Genes associated with brain dopamine signaling, which underlies alcohol's rewarding effects, might influence this finding. This study analyzed whether variation at a variable number tandem repeat polymorphism in DAT1/SLC6A3, the gene encoding the dopamine transporter, moderated the predictive relationships between acute response to alcohol and future AUD symptoms among participants enrolled in the Chicago Social Drinking Project (first two cohorts). Heavy-drinking young adults (N = 197) completed an alcohol challenge, in which acute response (liking, wanting, stimulation, and sedation) was measured. Alcohol use disorder symptoms were assessed over the following 6 years. DAT1 genotype significantly moderated the interactions between follow-up time and alcohol liking (P = 0.006) and wanting (P = 0.006) in predicting future AUD symptoms. These predictive effects were strongest among participants who carried the DAT1 9-repeat allele, previously associated with enhanced striatal dopamine tone relative to the 10-repeat allele. Exploratory analyses indicated that DAT1 effects on the relationship between alcohol liking and AUD symptoms appeared stronger for females (n = 79) than males (n = 118) (P = 0.0496). These data suggest that heavy-drinking DAT1 9-repeat allele carriers who display high alcohol-induced reward in young adulthood may be predisposed to persistent AUD symptoms and support combining genotypic and phenotypic information to predict future AUD risk.

Dynamic Features of Problematic Drinking: Alcohol Use Disorder Latent Classes Across Ages 18-64

Aims

Alcohol use disorders (AUDs) are linked with numerous severe detrimental outcomes. Evidence suggests that there is a typology of individuals with an AUD based on the symptoms they report. Scant research has identified how these groups may vary in prevalence by age, which could highlight aspects of problematic drinking behavior that are particularly salient at different ages. Our study aimed to (a) identify latent classes of drinkers with AUD that differ based on symptoms of AUD and (b) examine prevalences of latent classes by age.

Short summary

Our findings advocate for personalized treatment approaches for AUD and highlight the need for carefully considering the role of age in prevention and intervention efforts.

Methods

We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). Current drinkers aged 18-64 who met criteria for a past-year AUD were included (n = 5402).

Results

Latent class analysis (LCA) based on 11 AUD criteria revealed 5 classes: 'Alcohol-Induced Injury' (25%), 'Highly Problematic, Low Perceived Life Interference' (21%), 'Adverse Effects Only' (34%), 'Difficulty Cutting Back' (13%) and 'Highly Problematic' (7%). Using time-varying effect modeling (TVEM), each class was found to vary in prevalence across age. The Adverse Effects Only and Highly Problematic, Low Perceived Life Interference classes were particularly prevalent among younger adults, and the Difficulty Cutting Back and Alcohol-Induced Injury classes were more prevalent as age increased.

Conclusions

Findings suggest that experience of AUD is not only heterogeneous in nature but also that the prevalence of these subgroups vary across age.

Psychosocial and neural indicators of resilience among youth with a family history of substance use disorder

BACKGROUND

Little is known regarding the combined influence of psychosocial and neural protective mechanisms against substance use. The present study examined the extent to which neuroimaging measures of disinhibition predicted resilience against binge drinking and marijuana use among youth with a family history of substance use disorder (SUD; FH+), accounting for psychosocial measures of behavioral control.

METHODS

Participants were 57 FH+ youth from the Michigan Longitudinal Study categorized into resilient and high-risk groups based on patterns of weekly binge drinking and monthly marijuana use during early adulthood. Psychosocial measures of behavioral control (reactive control and externalizing behavior during early and late adolescence) and neural measures of disinhibition (Go/No-Go task and Monetary Incentive Delay Task (MIDT) measured through functional magnetic resonance imaging (fMRI)) were entered sequentially in hierarchical logistic regression models to predict resilient versus high-risk groups.

RESULTS

Greater activation in the right dorsolateral prefrontal cortex (DLPFC) during correctly inhibited trials on the Go/No-Go task was a significant predictor of resilience (OR = 2.46, p < 0.05), over and above greater reactive control in early adolescence (OR = 4.96, p < 0.05) and lower externalizing behavior in late adolescence (OR = 0.64, p < 0.05). Neural activation in the ventral striatum associated with reward anticipation during the MIDT was not a significant predictor of resilience.

CONCLUSIONS

Brain function in the right DLPFC associated with inhibitory control may be a neural indicator of resilience against elevated substance use among FH+ youth, even after accounting for psychosocial measures of behavioral control.

Course of psychiatric comorbidity and utilization of mental health care after laryngeal cancer: a prospective cohort study

In a German multi-center prospective cohort study, we wanted to assess the course of psychiatric comorbidity, utilization of mental health care and psychosocial care needs in laryngeal cancer patients during the first year after partial laryngectomy (PRL). Structured interviews with patients were conducted before surgery, 1 week (1 w), 3 months (3 m) and 1 year (12 m) after PRL. Psychiatric comorbidity was assessed using the Structured Clinical Interview for DSM-IV (SCID). Psychosocial care needs and utilization of mental health care were evaluated with standardized face-to-face interviews. In 176 patients, psychiatric disorders were prevalent in 11 % (1 w), 15 % (3 m) and 14 % (12 m), respectively, of which 4 % (12 m) underwent psychiatric treatment or psychotherapy. Two percent had acute, 15 % emerging and 6 % chronic psychiatric comorbidity. Chronically mental ill patients were more frequently younger than 65 years (p = 0.026), female (p = 0.045) and experienced more often a need for psychological counseling (p ≤ 0.001). One year after surgery, 27 % of the comorbid psychiatric patients expressed a need for additional psychological counseling. Alcohol-related disorders were diagnosed in 3 % (1 w), 3 % (3 m) and 8 % (12 m), respectively. Only one of these patients received psychological treatment, while 14 % expressed a need for psychological counseling and 7 % for additional medical consultations. The non-treatment of alcohol-related disorders measured in our sample indicates a major problem since continued alcohol consumption in laryngeal cancer patients is associated with reduced global quality of life, increased functional impairments and reduced overall survival. Screening instruments integrated into acute care are necessary to detect harmful drinking behavior.