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Alessi J, Dzemidzic M, Benson K, Chittum G, Kosobud A, Harezlak J, Plawecki MH, O'Connor SJ, Kareken DA. High-intensity sweet taste as a predictor of subjective alcohol responses to the ascending limb of an intravenous alcohol prime: an fMRI study. Neuropsychopharmacology 2024; 49:396-404. [PMID: 37550441 PMCID: PMC10724194 DOI: 10.1038/s41386-023-01684-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023]
Abstract
High-intensity sweet-liking has been linked to alcohol use disorder (AUD) risk. However, the neural underpinning of this association is poorly understood. To find a biomarker predictive of AUD, 140 participants (social and heavy drinkers, ages 21-26) underwent functional magnetic resonance imaging (fMRI) during a monetary incentive delay (MID) task and stimulation with high (SucroseHigh)- and low-concentration sucrose, as well as viscosity-matched water. On another day after imaging, and just before free-access intravenous alcohol self-administration, participants experienced a 30 mg% alcohol prime (10 min ascent) using the Computerized Alcohol Infusion System. Principal component analysis (PCA) of subjective responses (SR) to the prime's ascending limb generated enjoyable (SRenjoy) and sedative (SRsed) intoxication components. Another PCA created one component reflective of self-administered alcohol exposure (AE) over 90 min. Component loadings were entered as regressors in a voxel-wise general linear fMRI model, with reward type as a fixed factor. By design, peak prime breath alcohol concentration was similar across participants (29 ± 3.4 mg%). SRenjoy on the prime's ascending limb correlated positively with [SucroseHigh > Water] in the supplementary motor area and right dorsal anterior insula, implicating the salience network. Neither SR component correlated with the brain's response to MID. AE was unrelated to brain reward activation. While these findings do not support a relationship between alcohol self-administration and (1) subjective liking of or (2) regional brain response to an intensely sweet taste, they show that alcohol's enjoyable intoxicating effects on the rising limb correspond with anterior insular and supplementary motor area responses to high-concentration sucrose taste. No such associations were observed with MID despite robust activation in those regions. Insula and supplementary motor area responses to intense sensations relate to a known risk factor for AUD in a way that is not apparent with a secondary (monetary) reward.
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Affiliation(s)
- Jonathan Alessi
- Medical Neuroscience Graduate Program, Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mario Dzemidzic
- Indiana Alcohol Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katherine Benson
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Clinical Psychology Graduate Program, Department of Psychology and Neuroscience, University of North Carolina- Chapel Hill, Chapel Hill, NC, USA
| | - George Chittum
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Pharmacology & Toxicology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ann Kosobud
- Indiana Alcohol Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jaroslaw Harezlak
- Indiana Alcohol Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | - Martin H Plawecki
- Indiana Alcohol Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean J O'Connor
- Indiana Alcohol Research Center, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David A Kareken
- Indiana Alcohol Research Center, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
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Olsson Y, Hodzic K, Wass C, Lidö H, Stangl BL, O'Connor S, Plawecki MH, Ramchandani VA, Söderpalm B, Jerlhag E. Free-access intravenous alcohol self-administration in social drinkers and individuals with alcohol use disorder: Evaluation of relationships with phosphatidylethanol and self-reported alcohol consumption. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:1453-1466. [PMID: 37331818 DOI: 10.1111/acer.15132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The free-access (FA) intravenous alcohol self-administration (IV-ASA) paradigm is an experimental approach that can identify modulators of alcohol consumption in humans. Moreover, the outcome measures of IV-ASA paradigms are associated with self-reported alcohol intake using the timeline follow-back method (TLFB). To evaluate how FA IV-ASA reflects drinking in real life, we examined the relationship between an objective marker of recent alcohol intake, phosphatidylethanol in blood (B-PEth), and TLFB and measures obtained during IV-ASA in individuals with alcohol use disorder (AUD) and social drinkers (SD). We also explored the associations between these measures and gut-brain peptides involved in AUD pathophysiology. METHODS Thirty-eight participants completed a laboratory session in which they self-administered alcohol intravenously. The safety limit was 200 mg%, and main outcomes were mean and peak breath alcohol concentrations (BrAC). Blood samples were drawn prior to IV-ASA and subjective alcohol effects were rated during the experiment. RESULTS The study sample comprised 24 SD and 14 participants with DSM-5 mild AUD. Although BrACs were not associated with B-PEth or TLFB in the full sample or AUD subgroup, there was an association with TLFB in SD. In both subgroups, BrACs were associated with alcohol craving but with differential timing. Total ghrelin levels were higher in AUD participants than in SD. CONCLUSIONS No associations between B-PEth levels and achieved BrACs were observed in the mild AUD group, the SD group, or the full sample. The ability for FA IV-ASA to reflect recent drinking was confirmed only for TLFB in SD, whereas there were no associations within the smaller subsample of participants with mild AUD or in the full sample. Further studies that include a larger AUD sample are warranted. The association of BrACs with craving for alcohol suggests that the IV-ASA method may be useful for assessing interventions that target craving. This could be explored by using the FA IV-ASA model to evaluate the effects on craving of approved pharmacotherapies for AUD.
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Affiliation(s)
- Yasmin Olsson
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kenan Hodzic
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Wass
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helga Lidö
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bethany L Stangl
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland, USA
| | - Sean O'Connor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Martin H Plawecki
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vijay A Ramchandani
- Human Psychopharmacology Laboratory, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, Maryland, USA
| | - Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Beroendekliniken, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabet Jerlhag
- Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Spreer M, Grählert X, Klut IM, Al Hamdan F, Sommer WH, Plawecki MH, O'Connor S, Böttcher M, Sauer C, Smolka MN, Zimmermann US. Using naltrexone to validate a human laboratory test system to screen new medications for alcoholism (TESMA)- a randomized clinical trial. Transl Psychiatry 2023; 13:113. [PMID: 37019884 PMCID: PMC10076427 DOI: 10.1038/s41398-023-02404-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
This registered clinical trial sought to validate a laboratory test system devised to screen medications for alcoholism treatment (TESMA) under different contingencies of alcohol reinforcement. Forty-six nondependent, but at least medium-risk drinkers were given the opportunity to earn intravenous infusions of ethanol, or saline, as rewards for work in a progressive-ratio paradigm. Work demand pattern and alcohol exposure dynamics were devised to achieve a gradual shift from low-demand work for alcohol (WFA) permitting quickly increasing breath alcohol concentrations (BrAC) to high-demand WFA, which could only decelerate an inevitable decrease of the previously earned BrAC. Thereby, the reward contingency changed, modeling different drinking motivations. The experiment was repeated after at least 7 days of randomized, double-blinded treatment with naltrexone, escalated to 50 mg/d, or placebo. Subjects treated with naltrexone reduced their cumulative WFA (cWFA) slightly more than participants receiving placebo. This difference was not statistically significant in the preplanned analysis of the entire 150 min of self-administration, i.e., our primary endpoint (p = 0.471, Cohen's d = 0.215). Naltrexone serum levels correlated with change in cWFA (r = -0.53; p = 0.014). Separate exploratory analyses revealed that naltrexone significantly reduced WFA during the first, but not the second half of the experiment (Cohen's d = 0.643 and 0.14, respectively). Phase-dependent associations of WFA with changes in subjective stimulation, wellbeing and desire for alcohol suggested that the predominant reinforcement of WFA was positive during the first phase only, and might have been negative during the second. We conclude that the TESMA is a safe and practical method. It bears the potential to quickly and efficiently screen new drugs for their efficacy to attenuate positively reinforced alcohol consumption. It possibly also provides a condition of negative reinforcement, and for the first time provides experimental evidence suggesting that naltrexone's effect might depend on reward contingency.
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Affiliation(s)
- Maik Spreer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany.
| | - Xina Grählert
- Coordination Centre for Clinical Trials, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ina-Maria Klut
- Hospital-Pharmacy, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Feras Al Hamdan
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - Wolfgang H Sommer
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Bethanian Hospital for Psychiatry, Psychosomatics and Psychotherapy Greifswald, Greifswald, Germany
| | - Martin H Plawecki
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean O'Connor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael Böttcher
- Department of Toxicology, MVZ Medizinische Labore Dessau Kassel GmbH, Dessau-Rosslau, Germany
| | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - Ulrich S Zimmermann
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
- Department of Addiction Medicine and Psychotherapy, kbo Isar-Amper-Klinikum Region München, Munich, Germany
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Ray LA, Nieto SJ, Grodin EN. Translational models of addiction phenotypes to advance addiction pharmacotherapy. Ann N Y Acad Sci 2023; 1519:118-128. [PMID: 36385614 PMCID: PMC10823887 DOI: 10.1111/nyas.14929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Alcohol and substance use disorders are heterogeneous conditions with limited effective treatment options. While there have been prior attempts to classify addiction subtypes, they have not been translated into clinical practice. In an effort to better understand heterogeneity in psychiatric disorders, the National Institute for Mental Health Research Domain Criteria (RDoC) has challenged scientists to think beyond diagnostic symptoms and to consider the underlying features of psychopathology from a neuroscience-based framework. The field of addiction has grappled with this approach by considering several key constructs with the potential to capture RDoC domains. This critical review will focus on the efforts to apply translational models of addiction phenomenology in human clinical samples, including their relative strengths and weaknesses. Opportunities for forward and reverse translation are also discussed. Deep behavioral phenotyping using neuroscience-informed batteries shows promise for a better understanding of the clinical neuroscience of addiction and advancing precision medicine for alcohol and substance use disorders.
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Affiliation(s)
- Lara A. Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
- Shirley & Stefan Hatos Center for Neuropharmacology, University of California at Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Steven J. Nieto
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Erica N. Grodin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA
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Marks RM, Bennett ME, Williams JBW, DuMez EL, Roche DJO. SIGH, what's in a name? An examination of the factor structure and criterion validity of the (Structured Interview Guide for the) Hamilton Anxiety scale (SIGH-A) in a sample of African American adults with co-occurring trauma experience and heavy alcohol use. Exp Clin Psychopharmacol 2022; 30:841-852. [PMID: 34291990 PMCID: PMC9447374 DOI: 10.1037/pha0000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The Hamilton Anxiety Inventory (HAM-A) is one of the oldest and most commonly used anxiety rating scales in clinical research. Despite its ubiquity, no studies have examined the scale's underlying factor structure and criterion validity among Black and African American adults with psychopathology (Mage = 42.25, SD = 11.44). Therefore, we estimated a confirmatory factor analysis of the commercially available Structured Interview Guide for the Hamilton Anxiety scale (SIGH-A; Williams, 1996) among African American adults (n = 88; 43% female) with co-occurring heavy alcohol use and trauma-related symptoms. Next, we examined the criterion validity of its Psychic and Somatic factors and overall anxiety severity score from participants who completed a single screening session (i.e., cross-sectional analysis) for a larger study. Results indicated that a two-factor solution provided an adequate fit to the data. Regression analyses indicated that the total SIGH-A score, but not its subscales, significantly predicted posttraumatic stress disorder (PTSD) severity. Neither the SIGH-A subscales nor total scores were significant predictors of alcohol consumption. The current findings suggest that the SIGH-A factor structure among African American adults with alcohol and trauma-related conditions is similar to previous reports that have tested largely White samples but highlight potential shortcomings when its subscales are used independently. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Russell M. Marks
- Department of Psychiatry, Baltimore VA Medical Center, Baltimore, MD, United States
| | - Melanie E. Bennett
- Department of Psychiatry, Baltimore VA Medical Center, Baltimore, MD, United States
- Department of Psychiatry, University of Maryland Baltimore
| | | | - Emma L. DuMez
- Department of Psychiatry, University of Maryland Baltimore
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Wycoff AM, Motschman CA, Griffin SA, Freeman LK, Trull TJ. Momentary subjective responses to alcohol as predictors of continuing to drink during daily-life drinking episodes. Drug Alcohol Depend 2022; 241:109675. [PMID: 36332592 PMCID: PMC10233448 DOI: 10.1016/j.drugalcdep.2022.109675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 09/27/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Subjective response to alcohol's stimulating and sedating effects is a person-level risk factor for heavy drinking and alcohol use disorder. Longitudinal and laboratory studies have demonstrated that at-risk individuals experience greater stimulation and lower sedation while drinking. While between-person subjective responses inform risk and etiology, in-the-moment assessments during daily-life drinking may elucidate the within-person processes by which stimulation and sedation may lead to heavier drinking. We aimed to characterize these momentary processes by testing momentary stimulation and sedation during drinking as predictors of subsequently continuing to drink during densely sampled, daily-life drinking episodes. PROCEDURES 113 adults (54 with borderline personality disorder and 59 community participants; 77.9% female) completed ecological momentary assessment for 21 days, reporting momentary subjective stimulation and sedation throughout drinking episodes and momentary alcohol use after drink initiation (i.e., continued drinking). FINDINGS GLMMs demonstrated that greater day-level stimulation (OR=1.48, 95% CI=[1.20, 1.82], p<.001), greater person-level stimulation (OR=1.63, 95% CI=[1.05, 2.53], p=.031), and lower momentary sedation (OR=0.54, 95% CI=[0.41, 0.71], p<.001) predicted continued drinking. CONCLUSIONS Although greater stimulation and lower sedation have been conceptualized as individual-level risk factors for heavy drinking, our findings suggest that these associations are accompanied by processes that operate within person. Our results suggest that greater stimulation may confer risk for heavy drinking at the level of the drinking episode, possibly acting as positive reinforcement that may contribute to heavier drinking during future episodes. In contrast, lower sedation may primarily confer in-the-moment risk by contributing to momentary decisions to keep drinking within an episode.
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Affiliation(s)
- Andrea M Wycoff
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO 65211, USA.
| | - Courtney A Motschman
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO 65211, USA
| | - Sarah A Griffin
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO 65211, USA
| | - Lindsey K Freeman
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO 65211, USA
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO 65211, USA
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Meredith LR, Green R, Grodin EN, Chorpita M, Miotto K, Ray LA. Ibudilast moderates the effect of mood on alcohol craving during stress exposure. Exp Clin Psychopharmacol 2022; 30:620-631. [PMID: 36102596 PMCID: PMC9484034 DOI: 10.1037/pha0000458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neuroinflammation is implicated in the development and maintenance of alcohol use disorder (AUD) and neuroimmune therapeutics show promise in treating AUD. Proinflammatory signaling contributes to progressive elevations in the dysfunction of mood and alcohol craving. The current study sought to examine potential biobehavioral mechanisms of neuroimmune modulation in AUD under experimental conditions. In a community sample of individuals with AUD who completed a placebo-controlled crossover trial of ibudilast, we tested the effect of ibudilast on the relationship between mood states and alcohol craving. Multilevel modeling analyses tested the hypothesis that ibudilast would moderate the effect of positive and negative mood states on alcohol craving during stress and cue exposures. Results revealed that after stress-induction, participants' feelings of depression and happiness were more strongly predictive of their craving for alcohol while taking ibudilast as compared with placebo (ps < .03). These results suggest that with neuroimmune modulation, positive and negative mood states may have a stronger influence on one's desire to drink, such that craving may be more mood dependent. No moderating effect of ibudilast on mood states and craving were observed after alcohol cue exposure. Given the potential of anti-inflammatory treatments to reduce depressive symptomatology, this strengthened relationship between mood and craving under ibudilast might reduce the likelihood of stress-related craving and subsequent drinking over time. Moreover, ibudilast may enhance the benefits of happiness, such that maintaining positive mood in the face of acute stress may attenuate craving. Future trials directly testing the clinical implications of these mechanistic findings are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Marie Chorpita
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Cannabis use and subjective response to alcohol in the human laboratory. Drug Alcohol Depend 2022; 236:109481. [PMID: 35523112 PMCID: PMC9203930 DOI: 10.1016/j.drugalcdep.2022.109481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/04/2022] [Accepted: 04/27/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cannabis is often used in combination with alcohol; yet, whether cannabis use impacts risk factors for alcohol use disorder (AUD) remains unknown. Subjective response (SR) to alcohol represents a biobehavioral risk factor for subsequent heavy drinking and for developing AUD. Given the high prevalence of alcohol and cannabis co-use, it is plausible to hypothesize that cannabis users differ in SR to alcohol compared to non-cannabis users. The purpose of this study is to examine the influence of past-month cannabis use on subjective response to alcohol in the human laboratory. METHODS This study culled data from multiple alcohol administration trials to test whether cannabis users, compared to non-cannabis users, differed in subjective response to alcohol, comprised of four domains: stimulation, sedation, negative affect, and craving. Non-treatment-seeking heavy drinkers (N = 168) completed a battery of self-report scales of mood and alcohol/cigarette/cannabis use and problems. All participants completed an intravenous alcohol administration session wherein SR domains were measured at the following breath alcohol concentrations (BrAC): baseline (i.e., 0), 20, 40, and 60 mg%. RESULTS Multilevel statistical analyses revealed that cannabis users had a greater reduction in negative affect during alcohol administration, compared to non-cannabis users. No significant differences were found for the other SR domains. CONCLUSIONS Using a large sample and advanced data analytic methods, this study extends the literature by suggesting that cannabis users are more sensitive to alcohol-induced reductions in negative affect compared to non-cannabis users. This work extends research on how cannabis use may influence risk factors for AUD, such as subjective response to alcohol.
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Venegas A, Du H, Cooper ZD, Ray LA. Cannabis and alcohol co-use: the effects of intensity of cannabis use among heavy drinkers. Addict Behav 2022; 135:107443. [DOI: 10.1016/j.addbeh.2022.107443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/04/2022] [Accepted: 07/23/2022] [Indexed: 11/15/2022]
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Nieto SJ, Venegas A, Burnette EM, MacKillop J, Ray LA. Additive roles of tobacco and cannabis co-use in relation to delay discounting in a sample of heavy drinkers. Psychopharmacology (Berl) 2022; 239:1387-1395. [PMID: 34652499 PMCID: PMC9059652 DOI: 10.1007/s00213-021-05993-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE Alcohol use disorder (AUD) is associated with steeper delay discounting rates; however, it is unknown whether substance co-use, particularly cannabis use, has an additive effect on discounting rates among heavy drinkers. Furthermore, it is unclear whether substance co-use and delay discounting are independently associated with AUD severity. OBJECTIVES The purpose of this study was to determine whether alcohol, tobacco, and cannabis co-use impacts delay discounting rates. We also sought to determine whether substance co-use and delay discounting were associated with AUD symptom counts. METHODS The study sample was culled from several human laboratory studies and consisted of 483 heavy drinking individuals who completed a baseline visit (prior to experimental procedures). Participants were divided into groups based on self-reported alcohol, tobacco, and cannabis use during the past 30 days: alcohol only (n = 184), alcohol + cigarettes (n = 89), alcohol + cannabis (n = 82), and tri-use (n = 128). We examined discounting rates across the 4 groups and used multiple linear regression to test whether co-use and delay discounting were associated with AUD symptoms. RESULTS After adjusting for covariates, individuals in the alcohol + cannabis group and the tri-use group had steeper discounting rates relative to the alcohol-only group. In addition, tri-use and delay discounting rates were independently correlated with a greater number of AUD symptoms. CONCLUSIONS Delay discounting rates were significantly greater among subgroups reporting cannabis use providing partial support for an additive effect, while also highlighting the importance of co-use substance type. Both tri-use and delay discounting were associated with greater AUD severity, which may provide relevant intervention targets.
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Affiliation(s)
- Steven J Nieto
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Alexandra Venegas
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Elizabeth M Burnette
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Lara A Ray
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.
- Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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Claus ED, Blaine SK, Witkiewitz K, Ansell EB. Sex moderates effects of alcohol and cannabis co-use on alcohol and stress reactivity. Alcohol Clin Exp Res 2022; 46:530-541. [PMID: 35229336 PMCID: PMC9018602 DOI: 10.1111/acer.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Simultaneous or concurrent use (co-use) of alcohol and cannabis is associated with greater use of both substances over time, academic difficulties, more severe substance use consequences, and adverse impacts on cognitive functioning than the use of a single substance or no substance use. This study examined potential neural mechanisms underlying co-use behaviors in comparison to single substance use. Specifically, we compared alcohol cue reactivity and stress-cue reactivity among individuals who reported frequent same-day co-use of alcohol and cannabis and individuals who reported only alcohol use. METHODS The sample included 88 individuals (41 women) who reported only alcohol use and 24 individuals (8 women) who reported co-use of alcohol and cannabis on at least 50% of drinking occasions. All participants completed fMRI stress and alcohol cue reactivity tasks. Because of known sex effects on stress reactivity and alcohol cue reactivity, we tested sex by co-use interactions. RESULTS During alcohol cue presentation, co-users had less activation in the thalamus and dorsomedial prefrontal cortex than alcohol-only users, effects that were driven by differences in responses to neutral cues. Examination of stress cue reactivity revealed sex by co-use interactions in the lingual gyrus, with women co-users showing a greater difference between negative and neutral cue reactivity than all other groups. In addition, women co-users had greater connectivity between the nucleus accumbens and both the medial orbitofrontal cortex and the rostral anterior cingulate cortex during negative cue presentation than the other groups. CONCLUSIONS These results provide preliminary evidence of enhanced stress cue reactivity in individuals reporting co-use of alcohol and cannabis, particularly women co-users.
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Affiliation(s)
- Eric D Claus
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sara K Blaine
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Emily B Ansell
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
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12
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Nieto SJ, Grodin EN, Ho D, Baskerville WA, Ray LA. Moderators of subjective response to alcohol in the human laboratory. Alcohol Clin Exp Res 2022; 46:468-476. [PMID: 35084054 PMCID: PMC9153269 DOI: 10.1111/acer.14783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subjective response (SR) to alcohol represents a biobehavioral risk factor for heavy drinking and for developing alcohol use disorder (AUD). Identifying moderators of SR have been hindered by small sample sizes that are often used in alcohol administration studies. METHODS This study combined data from multiple alcohol administration trials to test whether sex, family history of alcohol problems, and impulsivity (via delay discounting) predict SR to alcohol, comprised of four domains: stimulation, sedation, negative affect, and craving. Non-treatment-seeking heavy drinkers (N = 250) completed a battery of self-report scales and behavioral measures of alcohol use and problems, mood, and impulsivity. All participants completed an intravenous alcohol administration session wherein SR domains were measured at baseline, 20, 40, and 60 mg%. RESULTS Analyses using multilevel modeling showed that male sex independently predicted higher alcohol-induced stimulation and alcohol craving, after controlling for other moderators. A family history of alcohol problems also independently predicted alcohol craving after controlling for other moderators. CONCLUSIONS Using a large sample and advanced data analytic methods, this study extends the literature on alcohol administration by identifying important moderators of SR in heavy drinkers: namely, male sex and family history of alcohol problems. These findings consolidate and extend a growing body of research aimed at differentiating individuals most likely to report the SR features that confer risk for AUD.
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Affiliation(s)
- Steven J. Nieto
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Erica N. Grodin
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Diana Ho
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | | | - Lara A. Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA,University of California Los Angeles, Brain Research Institute, Los Angeles, CA, USA,University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA
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13
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Venegas A, Meredith LR, Green R, Cooper ZD, Ray LA. Sex-dependent effects of alcohol administration on the urge to use cannabis. Exp Clin Psychopharmacol 2021; 29:689-695. [PMID: 32658530 PMCID: PMC8409139 DOI: 10.1037/pha0000409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol and cannabis couse is highly prevalent and associated with various negative consequences. The likelihood of same day couse is high, especially among men, however, underlying mechanisms to their couse and its sex-dependent nature remain poorly understood. This study aims to elucidate the effects of controlled alcohol administration on the urge to use cannabis and considers sex-dependent effects. A community sample of non-treatment-seeking heavy drinkers (N = 37, 46% female) reporting cannabis use in the past 6 months completed an alcohol administration paradigm. Participants rated their urge to use cannabis and drink alcohol at baseline and at rising levels of breath alcohol concentration (BrAC). Mixed model analyses examined the effects of BrAC, sex, and their interaction on craving for cannabis. The relationships across urge for cannabis, urge for alcohol, and subjective responses to alcohol were also tested. There was a significant BrAC × Sex interaction on the urge to use cannabis, such that males reported increases in the urge to use cannabis at rising BrACs but females did not. Urge for alcohol significantly predicted urge for cannabis across rising levels of BrAC and this relationship was stronger in males than in females. Lastly, stimulation, but not sedation, during alcohol administration was positively associated with the urge for cannabis. Overall, these results suggest that the pharmacological effects of alcohol on the urge to use cannabis are sex-dependent and that the stimulant effects of alcohol are associated with a higher urge for cannabis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - ReJoyce Green
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Ziva D. Cooper
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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14
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Cyders MA, Plawecki MH, Whitt ZT, Kosobud AEK, Kareken DA, Zimmermann US, O’Connor SJ. Translating preclinical models of alcohol seeking and consumption into the human laboratory using intravenous alcohol self-administration paradigms. Addict Biol 2021; 26:e13016. [PMID: 33543589 PMCID: PMC8339186 DOI: 10.1111/adb.13016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/08/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
Preclinical models of alcohol use disorder (AUD) have advanced theoretical, mechanistic, and pharmacological study of the human condition. "Liking" and "wanting" behaviors reflect core processes underlying several models of AUD. However, the development and application of translational models of these preclinical approaches are at an incipient stage. The goal of this study was to examine how intravenous free-access and progressive-ratio, operant-response human alcohol self-administration paradigms can be used as translational human model parallels of preclinical "liking" and "wanting." Participants were 40 adults (mean age = 23.7, SD = 2.0; 45% female) of European descent who reported 12.6 drinking days (SD = 5.2) out of the previous 30 (average = 4.1 drinks per drinking day [SD = 1.7]). Individuals diverged in their alcohol self-administration behavior, such that free-access and progressive-ratio paradigm outcomes were not significantly correlated (p = 0.44). Free-access alcohol seeking was related to enjoying alcohol (p < 0.001), but not craving (p = 0.48), whereas progressive-ratio seeking at similar levels of alcohol exposure was related to craving (p = 0.02), but not enjoying (p = 0.30). Family history of alcoholism, venturesomeness traits, and disinhibition traits were unrelated (ps > 0.70) to preferred level of breath alcohol concentration (BrAC) in the free-access session, a measure of liking alcohol. Family history of alcoholism, disinhibition traits, and recent drinking history were significantly related (ps < 0.05) to alcohol seeking in the progressive-ratio paradigm, a measure of wanting alcohol. We conclude that intravenous alcohol self-administration paradigms show promise in modeling behaviors that characterize and parallel alcohol "liking" and "wanting" in preclinical models. These paradigms provide a translational link between preclinical methods and clinical trials.
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Affiliation(s)
- Melissa A. Cyders
- Department of Psychology, Indiana University—Purdue University, Indianapolis
| | | | - Zachary T. Whitt
- Department of Psychology, Indiana University—Purdue University, Indianapolis
| | | | | | - Ulrich S. Zimmermann
- Technische Universität Dresden School of Medicine, Dresden, Germany
- Department of Addiction Medicine and Psychotherapy, kbo Isar-Amper-Klinikum, Munich, Germany
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15
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Nieto SJ, Grodin EN, Aguirre CG, Izquierdo A, Ray LA. Translational opportunities in animal and human models to study alcohol use disorder. Transl Psychiatry 2021; 11:496. [PMID: 34588417 PMCID: PMC8481537 DOI: 10.1038/s41398-021-01615-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 12/16/2022] Open
Abstract
Animal and human laboratory paradigms offer invaluable approaches to study the complex etiologies and mechanisms of alcohol use disorder (AUD). We contend that human laboratory models provide a "bridge" between preclinical and clinical studies of AUD by allowing for well-controlled experimental manipulations in humans with AUD. As such, examining the consilience between experimental models in animals and humans in the laboratory provides unique opportunities to refine the translational utility of such models. The overall goal of the present review is to provide a systematic description and contrast of commonly used animal paradigms for the study of AUD, as well as their human laboratory analogs if applicable. While there is a wide breadth of animal species in AUD research, the paradigms discussed in this review rely predominately on rodent research. The overarching goal of this effort is to provide critical analysis of these animal models and to link them to human laboratory models of AUD. By systematically contrasting preclinical and controlled human laboratory models, we seek to identify opportunities to enhance their translational value through forward and reverse translation. We provide future directions to reconcile differences between animal and human work and to improve translational research for AUD.
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Affiliation(s)
- Steven J. Nieto
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Erica N. Grodin
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Claudia G. Aguirre
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Alicia Izquierdo
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Lara A. Ray
- grid.19006.3e0000 0000 9632 6718Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA ,grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
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16
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Nieto SJ, Baskerville W, Donato S, Bujarski S, Ray L. Lifetime heavy drinking years predict alcohol use disorder severity over and above current alcohol use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:630-637. [PMID: 34134588 DOI: 10.1080/00952990.2021.1938100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Preclinical studies demonstrate that chronic and heavy alcohol use facilitates neuroadaptations that perpetuate addiction-like behaviors. In clinical studies, it is unclear whether the extent of heavy alcohol use over the lifetime contributes to alcohol use disorder (AUD) severity over and above current alcohol use patterns (i.e. last 30 days to 3-months). Such information may improve our understanding of the phenomenology of AUD.Objectives: The purpose of this study was to examine lifetime heavy drinking years in relation to a clinical assessment of AUD.Methods: Participants, who were non-treatment-seeking and engaged in heavy drinking (n = 140; 50% male), completed an interview-based assessment of lifetime regular and heavy drinking years along with a battery of measures indexing alcohol use and problems, drinking motives, and depression and anxiety symptomatology.Results: Lifetime heavy drinking years was positively associated with lifetime regular drinking years, current alcohol use, alcohol problems, tonic alcohol craving, drinking for the enhancing effects of alcohol, and drinking to cope (r's = .21-.58). Adjusting for lifetime regular drinking years and current alcohol use, lifetime heavy drinking years predicted higher scores on the Alcohol Use Disorder Identification Test (AUDIT; B = .382; SE = .123). A multivariate logistic regression found that lifetime heavy drinking years predicted greater odds of more severe AUD over and above current alcohol use (OR = 1.147).Conclusion: Our findings suggest that lifetime heavy drinking years are a clinically meaningful indicator of AUD severity that is not redundant with current alcohol use measures.
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Affiliation(s)
- Steven J Nieto
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Wave Baskerville
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Suzanna Donato
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Spencer Bujarski
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lara Ray
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
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17
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King A, Vena A, Hasin D, deWit H, O’Connor SJ, Cao D. Subjective Responses to Alcohol in the Development and Maintenance of Alcohol Use Disorder. Am J Psychiatry 2021; 178:560-571. [PMID: 33397141 PMCID: PMC8222099 DOI: 10.1176/appi.ajp.2020.20030247] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Alcohol use disorder (AUD) remains an urgent public health problem. Longitudinal data are needed to clarify the role of acute subjective responses to alcohol in the development and maintenance of excessive drinking and AUD. The authors report on 10 years of repeated examination of acute alcohol responses in the Chicago Social Drinking Project. METHODS Young adult drinkers (N=190) participated in an initial alcohol challenge (0.8 g/kg of alcohol compared with placebo) that was repeated 5 and 10 years later. They were also assessed on drinking behavior and AUD symptoms at numerous intervals across the decade. Retention was high, as 184 of the 185 (99%) nondeceased active participants completed the 10-year follow-up, and 91% (163 of 179) of those eligible for alcohol consumption engaged in repeated laboratory testing during this interval. RESULTS At the end of the decade, 21% of participants met criteria for past-year AUD. Individuals who reported the greatest alcohol stimulation, liking, and wanting at the initial alcohol challenge were most likely to have developed AUD 10 years later. Further, alcohol-induced stimulation and wanting increased in reexamination testing among those with the highest AUD symptoms as the decade progressed. CONCLUSIONS Initial stimulant and rewarding effects of alcohol predicted heavy alcohol use, and the magnitude of these positive subjective effects increased over a 10-year period in those who developed AUD compared with those who did not develop the disorder. The findings demonstrate systematic changes in subjective responses to alcohol over time, providing an empirical basis for prevention, early intervention, and treatment strategies.
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Affiliation(s)
- Andrea King
- University of Chicago, Department of Psychiatry & Behavioral Neuroscience, Chicago IL
| | - Ashley Vena
- University of Chicago, Department of Psychiatry & Behavioral Neuroscience, Chicago IL
| | - Deborah Hasin
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, Mailman School of Public Health, Department of Epidemiology, New York, NY
| | - Harriet deWit
- University of Chicago, Department of Psychiatry & Behavioral Neuroscience, Chicago IL
| | - Sean J. O’Connor
- Indiana University School of Medicine and Purdue University, Departments of Psychiatry and Biomedical Engineering, Indianapolis and West Lafayette, IN
| | - Dingcai Cao
- University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences, Chicago, IL
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18
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Grodin EN, Montoya AK, Bujarski S, Ray LA. Modeling motivation for alcohol in humans using traditional and machine learning approaches. Addict Biol 2021; 26:e12949. [PMID: 32725863 DOI: 10.1111/adb.12949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/26/2020] [Accepted: 07/19/2020] [Indexed: 01/22/2023]
Abstract
Given the significant cost of alcohol use disorder (AUD), identifying risk factors for alcohol seeking represents a research priority. Prominent addiction theories emphasize the role of motivation in the alcohol seeking process, which has largely been studied using preclinical models. In order to bridge the gap between preclinical and clinical studies, this study examined predictors of motivation for alcohol self-administration using a novel paradigm. Heavy drinkers (n = 67) completed an alcohol infusion consisting of an alcohol challenge (target breath alcohol = 60 mg%) and a progressive-ratio alcohol self-administration paradigm (maximum breath alcohol 120 mg%; ratio requirements range = 20-3 139 response). Growth curve modeling was used to predict breath alcohol trajectories during alcohol self-administration. K-means clustering was used to identify motivated (n = 41) and unmotivated (n = 26) self-administration trajectories. The data were analyzed using two approaches: a theory-driven test of a-priori predictors and a data-driven, machine learning model. In both approaches, steeper delay discounting, indicating a preference for smaller, sooner rewards, predicted motivated alcohol seeking. The data-driven approach further identified phasic alcohol craving as a predictor of motivated alcohol self-administration. Additional application of this model to AUD translational science and treatment development appear warranted.
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Affiliation(s)
- Erica N. Grodin
- Department of Psychology University of California Los Angeles Los Angeles California USA
| | - Amanda K. Montoya
- Department of Psychology University of California Los Angeles Los Angeles California USA
| | - Spencer Bujarski
- Department of Psychology University of California Los Angeles Los Angeles California USA
| | - Lara A. Ray
- Department of Psychology University of California Los Angeles Los Angeles California USA
- Department of Psychiatry and Biobehavioral Sciences University of California Los Angeles Los Angeles California USA
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19
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Farokhnia M, Deschaine SL, Sadighi A, Farinelli LA, Lee MR, Akhlaghi F, Leggio L. A deeper insight into how GABA-B receptor agonism via baclofen may affect alcohol seeking and consumption: lessons learned from a human laboratory investigation. Mol Psychiatry 2021; 26:545-555. [PMID: 30382188 PMCID: PMC6494745 DOI: 10.1038/s41380-018-0287-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/16/2018] [Accepted: 09/26/2018] [Indexed: 12/15/2022]
Abstract
Previous studies suggest that GABA-B receptor agonism may represent an effective pharmacological approach to treat addictive disorders. Baclofen is a selective GABA-B receptor agonist which has been investigated as a potential treatment for alcohol use disorder. However, research is needed to understand the biobehavioral mechanisms underlying baclofen's effect on alcohol use. In the present randomized, double-blind, placebo-controlled study, thirty-four alcohol-dependent individuals were randomized to receive baclofen (30 mg/d) or placebo for a week, and then participated in a laboratory experiment consisting of three procedures: alcohol cue-reactivity, priming, and self-administration. During the experiment, craving and other subjective responses to alcohol were assessed, and blood samples were collected for pharmacokinetic measurements. The effects of baclofen on the relationships between different alcohol-related laboratory parameters were investigated. Baclofen pharmacokinetic parameters and their correlations with behavioral measures were also examined. Results showed that baclofen disrupted the link between alcohol priming and self-administration, as indicated by significant interaction effects between drug condition (baclofen vs. placebo) and some of the priming variables (alcohol craving: F3,9 = 6.03, p = 0.01; alcohol sedation: F3,6 = 7.16, p = 0.01) on the total amount of alcohol self-administered. Considerable interindividual variability in baclofen pharmacokinetic parameters was observed. Maximum plasma concentrations of baclofen negatively correlated with cue-induced alcohol craving (r = -0.57, p = 0.03) and priming-induced ratings of 'like more' (r = -0.59, p = 0.02). In conclusion, baclofen may work by dissociating the link between an initial drink (priming) and subsequent alcohol consumption (self-administration). Considerable pharmacokinetic variability is an important factor to take into account when employing baclofen as a treatment for alcohol use disorder.
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Affiliation(s)
- Mehdi Farokhnia
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Sara L Deschaine
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Armin Sadighi
- Clinical Pharmacokinetics Research Laboratory, Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Lisa A Farinelli
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Mary R Lee
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Fatemeh Akhlaghi
- Clinical Pharmacokinetics Research Laboratory, Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA.
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.
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20
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Ray LA, Grodin EN. Clinical Neuroscience of Addiction: What Clinical Psychologists Need to Know and Why. Annu Rev Clin Psychol 2021; 17:465-493. [PMID: 33472009 DOI: 10.1146/annurev-clinpsy-081219-114309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The last three decades in psychological research have been marked by interdisciplinary science. Addiction represents a prime example of a disorder marked by a complex interaction among psychosocial and biological factors. This review highlights critical findings in the basic neuroscience of addiction and translates them into clinical language that can inform clinical psychologists in their research, teaching, and practice. From mechanisms of reward processing, learning and memory, allostasis, incentive-sensitization, withdrawal, tolerance, goal-directed decision making, habit learning, genetics, inflammation, and the microbiome, the common theme of this review is to illustrate the clinical utility of basic neuroscience research and to identify opportunities for clinical science. The thoughtful integration of basic and clinical science provides a powerful tool to fulfill the scientific mission of improving health care. Clinical psychologists have a crucial role to play in the translational science of addiction.
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Affiliation(s)
- Lara A Ray
- Department of Psychology, University of California, Los Angeles, California 90095, USA; .,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California 90095, USA.,Brain Research Institute, University of California, Los Angeles, California 90095, USA
| | - Erica N Grodin
- Department of Psychology, University of California, Los Angeles, California 90095, USA;
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21
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Kramer J, Dick DM, King A, Ray LA, Sher KJ, Vena A, Vendruscolo LF, Acion L. Mechanisms of Alcohol Addiction: Bridging Human and Animal Studies. Alcohol Alcohol 2020; 55:603-607. [PMID: 32781467 DOI: 10.1093/alcalc/agaa068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/27/2022] Open
Abstract
AIM The purpose of this brief narrative review is to address the complexities and benefits of extending animal alcohol addiction research to the human domain, emphasizing Allostasis and Incentive Sensitization, two models that inform many pre-clinical and clinical studies. METHODS The work reviewed includes a range of approaches, including: a) animal and human studies that target the biology of craving and compulsive consumption; b) human investigations that utilize alcohol self-administration and alcohol challenge paradigms, in some cases across 10 years; c) questionnaires that document changes in the positive and negative reinforcing effects of alcohol with increasing severity of addiction; and d) genomic structural equation modeling based on data from animal and human studies. RESULTS Several general themes emerge from specific study findings. First, positive reinforcement is characteristic of early stage addiction and sometimes diminishes with increasing severity, consistent with both Allostasis and Incentive Sensitization. Second, evidence is less consistent for the predominance of negative reinforcement in later stages of addiction, a key tenant of Allostasis. Finally, there are important individual differences in motivation to drink at a given point in time as well as person-specific change patterns across time. CONCLUSIONS Key constructs of addiction, like stage and reinforcement, are by necessity operationalized differently in animal and human studies. Similarly, testing the validity of addiction models requires different strategies by the two research domains. Although such differences are challenging, they are not insurmountable, and there is much to be gained in understanding and treating addiction by combining pre-clinical and clinical approaches.
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Affiliation(s)
- John Kramer
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 1882JPP, Iowa City, IA 52242-1009, USA
| | - Danielle M Dick
- Department of Psychology, Virginia Commonwealth University, 612 N. Lombardy St., Richmond, VA 23284, USA.,Department Human and Molecular Genetics, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA 23284, USA
| | - Andrea King
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Ave., Room L470, Chicago, IL 60637, USA
| | - Lara A Ray
- Department of Psychology, UCLA, 1285 Franz Hall, Los Angeles, CA 90095, USA
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO 65211, USA
| | - Ashley Vena
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Ave., Room L470, Chicago, IL 60637, USA
| | - Leandro F Vendruscolo
- Neurobiology of Addiction Section, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, 251 Bayview Boulevard, Baltimore, MD 21224, USA
| | - Laura Acion
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr, 1882JPP, Iowa City, IA 52242-1009, USA.,Instituto de Cálculo, Universidad de Buenos Aires-CONICET, Intendente Güiraldes 2160, C1428EGA, Buenos Aires, Argentina
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22
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Vena A, Howe M, Fridberg D, Cao D, King AC. The Feasibility, Tolerability, and Safety of Administering a Very High Alcohol Dose to Drinkers with Alcohol Use Disorder. Alcohol Clin Exp Res 2020; 44:2588-2597. [PMID: 33038271 DOI: 10.1111/acer.14478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/30/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There remains a paucity of research quantifying alcohol's effects in drinkers with alcohol use disorder (AUD), particularly responses to very high alcohol doses (≥0.8 g/kg). As drinkers with AUD frequently engage in very heavy drinking (8 to 10 drinks/occasion), doses of ≤0.8 g/kg may lack ecological validity. The present study examined the feasibility, tolerability, and safety of administering a very high alcohol dose (1.2 g/kg) to non-treatment-seeking AUD participants. METHODS Sixty-one young adult AUD drinkers enrolled in the Chicago Social Drinking Project and completed 3 laboratory sessions at which they consumed a beverage with 1.2, 0.8, and 0.0 g/kg alcohol. Physiological responses (vital signs, nausea and vomiting, breath alcohol concentrations [BrAC]) were monitored throughout the sessions. After each session, participants completed a next-day survey of substance use, engagement in risky behaviors, and related consequences. RESULTS Overall, the sample demonstrated good compliance with study procedures; 93% of participants adhered to presession alcohol abstinence requirements (indicated by BrAC < 0.003 g/dl), with no participants exhibiting serious alcohol withdrawal symptoms at arrival to study visits. The 1.2 g/kg alcohol dose achieved an expected mean peak BrAC of 0.13 g/dl at 60 minutes after drinking, which was well tolerated; the majority of the sample did not experience nausea (70%) or vomiting (93%), and dose effects on vital signs were not clinically significant. Finally, we demonstrated that the 1.2 g/kg alcohol dose is safe and not associated with postsession consequences, including reduced sleep time, atypical substance use, accidents or injuries, and severe hangovers. CONCLUSION Results support the feasibility, tolerability, and safety of administering a very high alcohol dose to young adult drinkers with AUD within the context of a well-validated laboratory alcohol challenge paradigm. Utilizing an alcohol dose more consistent with naturalistic drinking patterns may foster greater ecological validity of laboratory paradigms for persons with moderate to severe AUD.
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Affiliation(s)
- Ashley Vena
- From the, Department of Psychiatry and Behavioral Neuroscience, (AV, MH, DF, ACK), University of Chicago, Chicago, Illinois
| | - Meghan Howe
- From the, Department of Psychiatry and Behavioral Neuroscience, (AV, MH, DF, ACK), University of Chicago, Chicago, Illinois
| | - Daniel Fridberg
- From the, Department of Psychiatry and Behavioral Neuroscience, (AV, MH, DF, ACK), University of Chicago, Chicago, Illinois
| | - Dingcai Cao
- Department of Ophthalmology and Visual Sciences, (DC), University of Illinois at Chicago, Chicago, Illinois
| | - Andrea C King
- From the, Department of Psychiatry and Behavioral Neuroscience, (AV, MH, DF, ACK), University of Chicago, Chicago, Illinois
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23
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Grodin EN, Green RJ, Ray LA. An Exploratory Factor Analysis of the Stimulant, Sedative, and Affective Responses to Alcohol. Alcohol Clin Exp Res 2020; 44:2298-2306. [PMID: 32944932 DOI: 10.1111/acer.14458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subjective response (SR) to acute alcohol reflects individual variance to the sensitivity of alcohol's pharmacological effects. It has been argued that measures of stimulation and sedation may not fully capture the full-range SR, with 2 novel domains proposed: high arousal negative and low arousal positive. While substantial progress has been made in the field of SR and alcohol use risk, it remains unknown how these novel domains correspond to traditional SR measures. Therefore, the current study examined the latent structure of traditional and novel SR measures at rising breath alcohol concentrations (BrACs) during alcohol administration. METHODS Heavy drinkers (n = 67; 36M/31F) participated in an intravenous alcohol administration. Questionnaires assessing stimulation, sedation, mood, valence and arousal, and craving were assessed at baseline and at BrACs of 20, 40, and 60 mg%. A series of exploratory factor analyses were conducted to examine the latent factor structure of SR at each time point. Correlations examined the association between the generated factors and measures of problematic alcohol use. RESULTS The analysis generated a 3-factor solution, consistent across all time points. The factors measured the following effects of SR: (i) stimulation and positive mood, (ii) sedation and aversive effects, and (iii) tension reduction. The tension reduction factor was most commonly associated with problematic alcohol use in this sample. CONCLUSION This study extends upon the literature evaluating the biobehavioral effects of alcohol by examining a novel combination of SR to alcohol measures. This study demonstrates that the proposed low arousal positive domain, which loaded onto the tension reduction factor, provides novel information not captured by previous SR measures. Going forward, studies of alcohol's subjective effects should use this dimensional approach to reduce multiple comparisons across a wide range of scales and to build a literature grounded on the underlying structure of SR as a translational phenotype for AUD.
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Affiliation(s)
- Erica N Grodin
- From the, Department of Psychology, (ENG, RG, LAR), University of California, Los Angeles, Los Angeles, California, USA
| | - Re Joyce Green
- From the, Department of Psychology, (ENG, RG, LAR), University of California, Los Angeles, Los Angeles, California, USA
| | - Lara A Ray
- From the, Department of Psychology, (ENG, RG, LAR), University of California, Los Angeles, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, (LAR), University of California, Los Angeles, Los Angeles, California, USA
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24
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Hernández-Serrano O, Ghiţă A, Figueras-Puigderrajols N, Fernández-Ruiz J, Monras M, Ortega L, Mondon S, Teixidor L, Gual A, Ugas-Ballester L, Fernández M, Montserrat R, Porras-Garcia B, Ferrer-Garcia M, Gutiérrez-Maldonado J. Predictors of Changes in Alcohol Craving Levels during a Virtual Reality Cue Exposure Treatment among Patients with Alcohol Use Disorder. J Clin Med 2020; 9:E3018. [PMID: 32962176 PMCID: PMC7565669 DOI: 10.3390/jcm9093018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET). METHOD A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-affective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated. RESULTS The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group (χ2 = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group (χ2 = 13.818; p = 0.003) but not within the TAU group (χ2 = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed. CONCLUSIONS Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment.
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Affiliation(s)
- Olga Hernández-Serrano
- Department of Physical Therapy, Escola Universitària de la Salut i l’Esport (EUSES)-University of Girona, Carrer Francesc Macià, 65, Campus of Salt, 17190 Girona PC, Spain;
| | - Alexandra Ghiţă
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
| | - Natàlia Figueras-Puigderrajols
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
| | - Jolanda Fernández-Ruiz
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
| | - Miquel Monras
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona PC, Spain; (M.M.); (L.O.); (S.M.); (L.T.); (A.G.)
| | - Lluïsa Ortega
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona PC, Spain; (M.M.); (L.O.); (S.M.); (L.T.); (A.G.)
| | - Silvia Mondon
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona PC, Spain; (M.M.); (L.O.); (S.M.); (L.T.); (A.G.)
| | - Lidia Teixidor
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona PC, Spain; (M.M.); (L.O.); (S.M.); (L.T.); (A.G.)
| | - Antoni Gual
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona PC, Spain; (M.M.); (L.O.); (S.M.); (L.T.); (A.G.)
| | - Lidia Ugas-Ballester
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
| | - Maribel Fernández
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
| | - Roger Montserrat
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
| | - Bruno Porras-Garcia
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
| | - Marta Ferrer-Garcia
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
| | - José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron, 175, 08035 Barcelona PC, Spain; (A.G.); (N.F.-P.); (J.F.-R.); (L.U.-B.); (M.F.); (R.M.); (B.P.-G.); (M.F.-G.)
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25
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Venegas A, Meredith LR, Cooper ZD, Towns B, Ray LA. Inclusion of Cannabis Users in Alcohol Research Samples: Screening In, Screening Out, and Implications. Alcohol Alcohol 2020; 55:416-423. [PMID: 32328657 PMCID: PMC7307319 DOI: 10.1093/alcalc/agaa023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/10/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Alcohol and cannabis are frequently co-used, as 20-50% of those who drink alcohol report co-using cannabis. This study is based on the argument that alcohol researchers should enroll cannabis users in human laboratory studies of alcohol use disorder (AUD) to strengthen generalizability. This study examines how heavy drinking cannabis users differ from non-cannabis using heavy drinkers. METHODS In a community sample of non-treatment-seeking heavy drinkers (n = 551, 35% female), cannabis users were identified through: (a) self-reported cannabis use in the past 6 months and (b) positive urine toxicology test for tetrahydrocannabinol (THC). Cannabis users, identified as described previously, were compared with non-cannabis users on demographic and clinical characteristics. RESULTS Those who endorsed cannabis use in the past 6 months reported more binge drinking days. Participants who tested positive for THC had higher Alcohol Use Disorder Identification Test scores and more binge drinking days. Younger age and being a tobacco smoker were associated with an increased likelihood of cannabis use in the past 6 months, whereas male gender and being a tobacco use were associated with a greater likelihood of testing positive for THC. Individuals with cannabis use disorder (CUD) endorsed more depression and anxiety and had higher AUD symptom counts than cannabis users without CUD. CONCLUSIONS The inclusion of cannabis users in AUD samples allows for increased clinical severity. Excluding cannabis users from AUD studies may limit representativeness and expend unnecessary study resources. Lastly, tobacco use may explain a large portion of the effects of cannabis use on sample characteristics. SHORT SUMMARY Alcohol and cannabis are frequently co-used substances. In a sample of non-treatment-seeking heavy drinkers (n = 551, 35% female), cannabis users reported higher alcohol use and higher likelihood of tobacco use than non-cannabis users. Including cannabis users in alcohol research studies will improve representativeness and likely increase clinical severity.
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Affiliation(s)
- Alexandra Venegas
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Lindsay R Meredith
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Ziva D Cooper
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA,University of California, Los Angeles, Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Brandon Towns
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Lara A Ray
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA,University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA,Corresponding author: Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA. Tel.: +1 (310) 794-5383; Fax: +1 (310) 206-5985; E-mail:
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26
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Grodin EN, Nguyen XT, Ho D, Bujarski S, Ray LA. Sensitivity and specificity of a commercial urinary ethyl glucuronide (ETG) test in heavy drinkers. Addict Behav Rep 2020; 11:100249. [PMID: 32467838 PMCID: PMC7244915 DOI: 10.1016/j.abrep.2020.100249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction To advance the use of alcohol metabolites as biomarkers in the context of alcohol research, the present study tested the sensitivity and specificity of a commercially available urinary ethyl glucuronide (uEtG) test (DrugConfirm Advanced 80hr EtG) in a clinical research context. Methods A community sample of heavy drinkers (N = 68) completed the 30-day Timeline Follow-Back (TLFB) interview and provided a urine sample for uEtG analysis. Analyses of sensitivity and specificity of the uEtG assay were conducted using the following outcomes: (a) past day drinking, (b) past day binge drinking (defined as ≥4 drinks for women and ≥5 drinks for men), (c) past 3-day drinking, and (d) past 3-day binge drinking. Results The majority of participants reported past-3-day drinking (80.9%) and a sizeable minority reported past day drinking (33.8%). While uEtG-based detection of past day drinking and binge drinking was acceptable (sensitivity = 73.91%, and 83.33%; specificity = 80.00% and 66.13%, respectively), detection of any drinking and binge drinking in the past 3 days was poor (sensitivity and specificity of 43.64% and 84.62%, and 39.39% and 62.86%, respectively). Conclusions This study contributes to the mixed findings on the validity of EtG tests, which suggest that commercial uEtG tests with conservative detection thresholds are not a reliable alcohol biomarker without corroborating self-report data. Lower detection thresholds are recommended when using uEtG as an alcohol biomarker. Efforts to reach acceptable levels of sensitivity and specificity with commercial assays hold potential to advance the measurement of alcohol intake, overcoming the pitfalls of self-report data.
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Affiliation(s)
- Erica N Grodin
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Xuan-Thanh Nguyen
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Diana Ho
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Spencer Bujarski
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Lara A Ray
- University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA.,University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA.,University of California Los Angeles, Brain Research Institute, Los Angeles, CA, USA
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27
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Lim AC, Green R, Grodin EN, Venegas A, Meredith LR, Donato S, Burnette E, Ray LA. Alcohol Cue-Induced Ventral Striatum Activity Predicts Subsequent Alcohol Self-Administration. Alcohol Clin Exp Res 2020; 44:1224-1233. [PMID: 32406553 DOI: 10.1111/acer.14342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Human laboratory paradigms are a pillar in medication development for alcohol use disorders (AUD). Neuroimaging paradigms, in which individuals are exposed to cues that elicit neural correlates of alcohol craving (e.g., mesocorticolimbic activation), are increasingly utilized to test the effects of AUD medications. Elucidation of the translational effects of these neuroimaging paradigms on human laboratory paradigms, such as self-administration, is warranted. The current study is a secondary analysis examining whether alcohol cue-induced activation in the ventral striatum is predictive of subsequent alcohol self-administration in the laboratory. METHODS Non-treatment-seeking heavy drinkers of East Asian descent (n = 41) completed a randomized, placebo-controlled, double-blind, crossover experiment on the effects of naltrexone on neuroimaging and human laboratory paradigms. Participants completed 5 days of study medication (or placebo); on day 4, they completed a neuroimaging alcohol taste cue-reactivity task. On the following day (day 5), participants completed a 60-minute alcohol self-administration paradigm. RESULTS Multilevel Cox regressions indicated a significant effect of taste cue-elicited ventral striatum activation on latency to first drink, Wald χ2 = 2.88, p = 0.05, such that those with higher ventral striatum activation exhibited shorter latencies to consume their first drink. Similarly, ventral striatum activation was positively associated with total number of drinks consumed, F(1, 38) = 5.90, p = 0.02. These effects were significant after controlling for alcohol use severity, OPRM1 genotype, and medication. Other potential regions of interest (anterior cingulate, thalamus) were not predictive of self-administration outcomes. CONCLUSIONS Neuroimaging alcohol taste cue paradigms may be predictive of laboratory paradigms such as self-administration. Elucidation of the relationships among different paradigms will inform how these paradigms may be used synergistically in experimental medicine and medication development.
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Affiliation(s)
- Aaron C Lim
- From the, Department of Psychology, (ACL, RG, ENG, AV, LRM, SD, EB, LAR), University of California, Los Angeles, Los Angeles, California, United States
| | - ReJoyce Green
- From the, Department of Psychology, (ACL, RG, ENG, AV, LRM, SD, EB, LAR), University of California, Los Angeles, Los Angeles, California, United States
| | - Erica N Grodin
- From the, Department of Psychology, (ACL, RG, ENG, AV, LRM, SD, EB, LAR), University of California, Los Angeles, Los Angeles, California, United States
| | - Alexandra Venegas
- From the, Department of Psychology, (ACL, RG, ENG, AV, LRM, SD, EB, LAR), University of California, Los Angeles, Los Angeles, California, United States
| | - Lindsay R Meredith
- From the, Department of Psychology, (ACL, RG, ENG, AV, LRM, SD, EB, LAR), University of California, Los Angeles, Los Angeles, California, United States
| | - Suzanna Donato
- From the, Department of Psychology, (ACL, RG, ENG, AV, LRM, SD, EB, LAR), University of California, Los Angeles, Los Angeles, California, United States
| | - Elizabeth Burnette
- From the, Department of Psychology, (ACL, RG, ENG, AV, LRM, SD, EB, LAR), University of California, Los Angeles, Los Angeles, California, United States
| | - Lara A Ray
- From the, Department of Psychology, (ACL, RG, ENG, AV, LRM, SD, EB, LAR), University of California, Los Angeles, Los Angeles, California, United States.,Department of Psychiatry and Biobehavioral Sciences, (LAR), University of California, Los Angeles, Los Angeles, California, USA
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Cyders MA, Plawecki MH, Corbin W, King A, McCarthy DM, Ramchandani VA, Weafer J, O'Connor SJ. To Infuse or Ingest in Human Laboratory Alcohol Research. Alcohol Clin Exp Res 2020; 44:764-776. [PMID: 32056250 DOI: 10.1111/acer.14305] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/02/2020] [Indexed: 02/06/2023]
Abstract
Human alcohol laboratory studies use two routes of alcohol administration: ingestion and infusion. The goal of this paper was to compare and contrast these alcohol administration methods. The work summarized in this report was the basis of a 2019 Research Society on Alcoholism Roundtable, "To Ingest or Infuse: A Comparison of Oral and Intravenous Alcohol Administration Methods for Human Alcohol Laboratory Designs." We review the methodological approaches of each and highlight strengths and weaknesses pertaining to different research questions. We summarize methodological considerations to aid researchers in choosing the most appropriate method for their inquiry, considering exposure variability, alcohol expectancy effects, safety, bandwidth, technical skills, documentation of alcohol exposure, experimental variety, ecological validity, and cost. Ingestion of alcohol remains a common and often a preferable, methodological practice in alcohol research. Nonetheless, the main problem with ingestion is that even the most careful calculation of dose and control of dosing procedures yields substantial and uncontrollable variability in the participants' brain exposures to alcohol. Infusion methodologies provide precise exposure control but are technically complex and may be limited in ecological validity. We suggest that alcohol ingestion research may not be the same thing as alcohol exposure research; investigators should be aware of the advantages and disadvantages that the choice between ingestion and infusion of alcohol invokes.
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Affiliation(s)
- Melissa A Cyders
- Department of Psychology, Indiana University Purdue University - Indianapolis, Indianapolis, Indiana, United States
| | - Martin H Plawecki
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - William Corbin
- Department of Psychology, Arizona State University, Tempe, Arizona, United States
| | - Andrea King
- Department of Psychiatry, University of Chicago School of Medicine, Chicago, Illinois, United States
| | - Denis M McCarthy
- Department of Psychological Sciences, Universtiy of Missouri - Columbia, Columbia, Missouri, United States
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, United States
| | - Jessica Weafer
- Department of Psychology, University of Kentucky, Lexington, Kentucky, United States
| | - Sean J O'Connor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, United States
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Cofresí RU, Bartholow BD, Piasecki TM. Evidence for incentive salience sensitization as a pathway to alcohol use disorder. Neurosci Biobehav Rev 2019; 107:897-926. [PMID: 31672617 PMCID: PMC6878895 DOI: 10.1016/j.neubiorev.2019.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022]
Abstract
The incentive salience sensitization (ISS) theory of addiction holds that addictive behavior stems from the ability of drugs to progressively sensitize the brain circuitry that mediates attribution of incentive salience (IS) to reward-predictive cues and its behavioral manifestations. In this article, we establish the plausibility of ISS as an etiological pathway to alcohol use disorder (AUD). We provide a comprehensive and critical review of evidence for: (1) the ability of alcohol to sensitize the brain circuitry of IS attribution and expression; and (2) attribution of IS to alcohol-predictive cues and its sensitization in humans and non-human animals. We point out gaps in the literature and how these might be addressed. We also highlight how individuals with different alcohol subjective response phenotypes may differ in susceptibility to ISS as a pathway to AUD. Finally, we discuss important implications of this neuropsychological mechanism in AUD for psychological and pharmacological interventions attempting to attenuate alcohol craving and cue reactivity.
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Affiliation(s)
- Roberto U Cofresí
- University of Missouri, Department of Psychological Sciences, Columbia, MO 65211, United States.
| | - Bruce D Bartholow
- University of Missouri, Department of Psychological Sciences, Columbia, MO 65211, United States
| | - Thomas M Piasecki
- University of Missouri, Department of Psychological Sciences, Columbia, MO 65211, United States
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30
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Grodin EN, Bujarski S, Venegas A, Baskerville WA, Nieto SJ, Jentsch JD, Ray LA. Reward, Relief and Habit Drinking: Initial Validation of a Brief Assessment Tool. Alcohol Alcohol 2019; 54:574-583. [PMID: 31557278 PMCID: PMC7306183 DOI: 10.1093/alcalc/agz075] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS Alcohol use disorder is highly heterogeneous. One approach to understanding this heterogeneity is the identification of drinker subtypes. A candidate classification consists of reward and relief subtypes. The current study examines a novel self-report measure of reward, relief, and habit drinking for its clinical correlates and subjective response (SR) to alcohol administration. METHODS Non-treatment-seeking heavy drinkers (n = 140) completed the brief reward, relief, habit drinking scale (RRHDS). A subset of this sample (n = 67) completed an intravenous alcohol administration. Individuals were classified into drinker subtypes. A crowdsourced sample of heavy drinkers (n = 187) completed the RRHDS and a validated reward relief drinking scale to compare drinking classification results. RESULTS The majority of the sample was classified as reward drinkers (n = 100), with fewer classified as relief (n = 19) and habit (n = 21) drinkers. Relief and habit drinkers reported greater tonic alcohol craving compared to reward drinkers. Reward drinkers endorsed drinking for enhancement, while relief drinkers endorsed drinking for coping. Regarding the alcohol administration, the groups differed in negative mood, such that relief/habit drinkers reported a decrease in negative mood during alcohol administration, compared to reward drinkers. The follow-up crowdsourcing study found a 62% agreement in reward drinker classification between measures and replicated the tonic craving findings. CONCLUSIONS Our findings suggest that reward drinkers are dissociable from relief/habit drinkers using the brief measure. However, relief and habit drinkers were not successfully differentiated, which suggests that these constructs may overlap phenotypically. Notably, measures of dysphoric mood were better at detecting group differences than measures capturing alcohol's rewarding effects.
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Affiliation(s)
- Erica N Grodin
- Department of Psychology, University of California 1285 Franz Hall, Box 951563 Los Angeles, CA 90095
- Department of Psychiatry and Biobehavioral Sciences University of California 760 Westwood Plaza Los Angeles, CA 90095
| | - Spencer Bujarski
- Department of Psychology, University of California 1285 Franz Hall, Box 951563 Los Angeles, CA 90095
| | - Alexandra Venegas
- Department of Psychology, University of California 1285 Franz Hall, Box 951563 Los Angeles, CA 90095
| | - Wave-Ananda Baskerville
- Department of Psychology, University of California 1285 Franz Hall, Box 951563 Los Angeles, CA 90095
| | - Steven J Nieto
- Department of Psychology, University of California 1285 Franz Hall, Box 951563 Los Angeles, CA 90095
| | - J David Jentsch
- Department of Psychology Binghamton University State University of New York PO Box 6000 Binghamton NY 13902
| | - Lara A Ray
- Department of Psychology, University of California 1285 Franz Hall, Box 951563 Los Angeles, CA 90095
- Department of Psychiatry and Biobehavioral Sciences University of California 760 Westwood Plaza Los Angeles, CA 90095
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Ray LA, Green R, Roche DJ, Magill M, Bujarski S. Naltrexone effects on subjective responses to alcohol in the human laboratory: A systematic review and meta-analysis. Addict Biol 2019; 24:1138-1152. [PMID: 31148304 DOI: 10.1111/adb.12747] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/13/2019] [Accepted: 02/24/2019] [Indexed: 02/03/2023]
Abstract
Naltrexone (NTX) has been widely studied for the treatment of alcohol use disorder with overall support for its efficacy. The mechanisms of action of naltrexone are thought to involve attenuation of the hedonic effects of alcohol and potentiation of its aversive effects. In order to provide a quantitative estimate of the effects of naltrexone on subjective response to alcohol, the aims of this meta-analytic review are to examine the effects of naltrexone across four domains of subjective response. Meta-analyses of naltrexone effects on alcohol craving (k = 16, N = 686), stimulation (k = 15, N = 675), sedation (k = 18, N = 777), and negative mood (k = 9, N = 281) suggested that under laboratory conditions and compared with placebo, naltrexone reduces craving (Hedges g = -0.252; SE = 0.054; 95% CI, -0.375 to -0.130; P < 0.01), reduces stimulation (g = -0.223; SE = 0.067; 95% CI, -0.372 to -0.074; P < 0.01), increases sedation (g = 0.251; SE = 0.064; 95% CI, 0.112-0.389; P < 0.01), and increases negative mood (g = 0.227; SE = 0.047; 95% CI, 0.100-0.354; P < 0.01). Results were robust when drinks per month and alcohol dose were added to the models as covariates. The effects of naltrexone varied by severity of alcohol use with medication effects on craving and stimulation being observed in sample of both heavy drinkers and AUD individuals. These results are consistent with the hypothesized mechanisms of action of NTX, although the effects are of small magnitude. This meta-analysis aggregates across multiple human laboratory studies of NTX's effects on subjective response to alcohol, providing a comprehensive summary of a key mechanism of NTX efficacy, namely, alteration of the subjective experience of alcohol.
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Affiliation(s)
- Lara A. Ray
- Department of PsychologyUniversity of California, Los Angeles Los Angeles CA USA
- Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los Angeles Los Angeles CA USA
| | - ReJoyce Green
- Department of PsychologyUniversity of California, Los Angeles Los Angeles CA USA
| | | | - Molly Magill
- Center for Alcohol and Addiction StudiesBrown University Providence RI USA
| | - Spencer Bujarski
- Department of PsychologyUniversity of California, Los Angeles Los Angeles CA USA
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Roche DJO, Bujarski S, Green R, Hartwell EE, Leventhal AM, Ray LA. Alcohol, tobacco, and marijuana consumption is associated with increased odds of same-day substance co- and tri-use. Drug Alcohol Depend 2019; 200:40-49. [PMID: 31085377 PMCID: PMC6675401 DOI: 10.1016/j.drugalcdep.2019.02.035] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Little is known about event-level patterns of marijuana co- or tri-use with alcohol and tobacco. Thus, the study goal was to examine patterns of same-day alcohol, cigarette, and marijuana co- and tri-use at the individual level in non-treatment-seeking alcohol users. METHODS Participants (N = 551) completed an in-person interview for alcohol, cigarette, and marijuana use over the previous 30 days, and the event-level substance use patterns of n = 179 participants who reported using each of these substances at least once per month were analyzed. RESULTS The use of alcohol, marijuana, or cigarettes independently increased the probability of subsequent, simultaneous co-use of one of the two remaining substances. The co-use of alcohol with cigarettes and marijuana with cigarettes produced generally additive effects on the odds of same day tri-use of marijuana and alcohol, respectively. Conversely, the co-use of alcohol and marijuana produced sub-additive effects on likelihood of cigarette use. Sex moderated several of the observed patterns of co- and tri-use: the relationship between alcohol or cigarette use predicting marijuana co-use was stronger in men, whereas the observed additive relationships between drug co-use leading to tri-use was stronger in women. CONCLUSIONS The presented results may aid in the understanding of how simultaneous co-use of marijuana with alcohol and/or tobacco relates to the etiology, maintenance, and treatment of comorbid and trimorbid substance use disorder. Replication and extension of the results in treatment seeking populations using more fine-grained analysis approaches, e.g. ecological momentary assessment, is needed.
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Affiliation(s)
- D J O Roche
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - S Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - R Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - E E Hartwell
- Mental Illness Research, Education and Clinical Center, Corporal Michael J Crescenz VA Medical Center, Philadelphia, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - A M Leventhal
- Departments of Preventive Medicine and Psychpology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - L A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
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Convergence between the Penn Alcohol Craving Scale and diagnostic interview for the assessment of alcohol craving. Addict Behav Rep 2019; 10:100198. [PMID: 31304230 PMCID: PMC6599943 DOI: 10.1016/j.abrep.2019.100198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction The Penn Alcohol Craving Scale (PACS) is one of the most widely used instruments to measure craving for alcohol. Recent research has suggested that scores on the PACS can be used as a “stand in” for the diagnostic criterion of alcohol craving with a proposed cutoff of >20 on the PACS indicating a “positive” alcohol craving symptom. The present study examined the convergence between the PACS and face-to-face diagnostic interview for the assessment of alcohol craving. Method A sample of non-treatment seeking heavy drinkers (N = 338) enrolled in experimental studies of AUD completed the PACS as well as a face-to-face diagnostic interview for AUD, which included the craving item from the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). Results Using the PACS cut-off score of >20, 12.9% (N = 43) of the sample met criteria for alcohol craving compared to 21% (N = 74) of the sample meeting criteria based on the diagnostic interview. Using the PACS cutoff of >20, sensitivity (i.e., true positive rate) was 41% and specificity (i.e., true negative rate) was 95%. Exploratory analyses suggested that a cut-off score of ≥15 achieved the optimal balance of sensitivity (67%) and specificity (81%) in our sample. Conclusions Advancing the assessment of alcohol craving and the conversion from DSM-IV to DSM-5 diagnostic criteria represents an important research direction. The present study recommends that a PACS score cut off of ≥15 should be used as an indicator of clinically significant alcohol craving in community samples of non-treatment seekers. The relationship between self-report and clinician-administered measures of alcohol craving is poorly understood. Previous studies have used the PACS as a stand-in for diagnostic data, using a score of 20 as a cut off. Using a PACS of >20, 12.9% of the sample would meet for craving; however, this cut off yielded poor sensitivity. Exploratory analysis showed a cut off of >15 produced an acceptable balance of sensitivity and specificity in this sample.
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Green R, Grodin E, Lim AC, Venegas A, Bujarski S, Krull J, Ray LA. The Interplay Between Subjective Response to Alcohol, Craving, and Alcohol Self-Administration in the Human Laboratory. Alcohol Clin Exp Res 2019; 43:907-915. [PMID: 30860603 PMCID: PMC6519957 DOI: 10.1111/acer.14001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/17/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite a rich literature on human laboratory paradigms of subjective response (SR) to alcohol, craving for alcohol, and alcohol self-administration, few studies have examined the interplay across these 3 constructs. The present study addresses this gap in the literature by examining the interplay between SR, craving, and self-administration in the human laboratory. METHODS Data were culled from a medication study (NCT02026011) in which heavy drinking participants of East Asian ancestry completed 2 double-blinded and counterbalanced experimental sessions. In each experimental session, participants received a priming dose of intravenous (IV) alcohol to a target breath alcohol concentration (BrAC) of 0.06 g/dl and measures of SR (stimulation and sedation) and alcohol craving were collected across rising BrACs. The IV alcohol challenge was immediately followed by a 1-hour alcohol self-administration period. RESULTS Mixed model analyses found a positive and significant relationship between the slope of stimulation and the slope of craving during the alcohol challenge. The relationship between sedation and craving, however, was not significant. The slope of craving during the alcohol challenge significantly predicted a higher number of mini-drinks consumed and lower latency to first drink. Further, mediation analyses found that craving was a significant mediator of the relationship between stimulation and total number of mini-drinks consumed, but the same pattern was not found for sedation. CONCLUSIONS Insofar as alcohol self-administration represents the end point of interest for a host of experimental and clinical research questions, the present study suggests that alcohol craving represents a more proximal predictor of self-administration than measures of alcohol-induced stimulation. It is recommended that human laboratory models interpret measures of SR and craving in light of their relative predictive utility for drinking outcomes.
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Affiliation(s)
- ReJoyce Green
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Erica Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Jennifer Krull
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
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