1
|
Nissilä E, Hynninen M, Jalkanen V, Kuitunen A, Bäcklund M, Inkinen O, Hästbacka J. The effectiveness of a brief intervention for intensive care unit patients with hazardous alcohol use: a randomized controlled trial. Crit Care 2024; 28:145. [PMID: 38689346 PMCID: PMC11061909 DOI: 10.1186/s13054-024-04925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Screening for hazardous alcohol use and performing brief interventions (BIs) are recommended to reduce alcohol-related negative health consequences. We aimed to compare the effectiveness (defined as an at least 10% absolute difference) of BI with usual care in reducing alcohol intake in intensive care unit survivors with history of hazardous alcohol use. METHODS We used Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) score to assess history of alcohol use. PATIENTS Emergency admitted adult ICU patients in three Finnish university hospitals, with an AUDIT-C score > 5 (women), or > 6 (men). We randomized consenting eligible patients to receive a BI or treatment as usual (TAU). INTERVENTION BI was delivered by the time of ICU discharge or shortly thereafter in the hospital ward. CONTROLS Control patients received TAU. OUTCOME The primary outcome was self-reported alcohol consumption during the preceding week 6 and 12 months after randomization. Secondary outcomes were the change in AUDIT-C scores from baseline to 6 and 12 months, health-related quality of life, and mortality. The trial was terminated early due to slow recruitment during the pandemic. RESULTS We randomized 234 patients to receive BI (N = 117) or TAU (N = 117). At 6 months, the median alcohol intake in the BI and TAU groups were 6.5 g (interquartile range [IQR] 0-141) and 0 g (0-72), respectively (p = 0.544). At 12 months, it was 24 g (0-146) and 0 g (0-96) in the BI and TAU groups, respectively (p = 0.157). Median change in AUDIT-C from baseline to 6 months was - 1 (- 4 to 0) and 2 (- 6 to 0), (p = 0.144) in the BI and TAU groups, and to 12 months - 3 (- 5 to - 1) and - 4 (- 7 to - 1), respectively (p = 0.187). In total, 4% (n = 5) of patients in the BI group and 11% (n = 13) of patients in the TAU group were abstinent at 6 months, and 10% (n = 12) and 15% (n = 17), respectively, at 12 months. No between-groups difference in mortality emerged. CONCLUSION As underpowered, our study cannot reject or confirm the hypothesis that a single BI early after critical illness is effective in reducing the amount of alcohol consumed compared to TAU. However, a considerable number in both groups reduced their alcohol consumption. TRIAL REGISTRATION ClinicalTrials.gov (NCT03047577).
Collapse
Affiliation(s)
- Eliisa Nissilä
- Department of Perioperative and Intensive Care Medicine, Intensive Care Units, Helsinki University Hospital and Helsinki University, Haartmaninkatu 2, PL 340, 00029, Helsinki, Finland.
| | - Marja Hynninen
- Department of Perioperative and Intensive Care Medicine, Intensive Care Units, Helsinki University Hospital and Helsinki University, Haartmaninkatu 2, PL 340, 00029, Helsinki, Finland
| | - Ville Jalkanen
- Department of Intensive Care, Tampere University Hospital, Wellbeing District of Pirkanmaa and Tampere University, Tampere, Finland
| | - Anne Kuitunen
- Department of Intensive Care, Tampere University Hospital, Wellbeing District of Pirkanmaa and Tampere University, Tampere, Finland
| | - Minna Bäcklund
- Department of Perioperative and Intensive Care Medicine, Intensive Care Units, Helsinki University Hospital and Helsinki University, Haartmaninkatu 2, PL 340, 00029, Helsinki, Finland
| | - Outi Inkinen
- Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Wellbeing District of Southwest Finland and University of Turku, Turku, Finland
| | - Johanna Hästbacka
- Department of Perioperative and Intensive Care Medicine, Intensive Care Units, Helsinki University Hospital and Helsinki University, Haartmaninkatu 2, PL 340, 00029, Helsinki, Finland
- Department of Intensive Care, Tampere University Hospital, Wellbeing District of Pirkanmaa and Tampere University, Tampere, Finland
| |
Collapse
|
2
|
de Bejczy A, Lidö H, Söderpalm B. A randomized, double-blind, placebo-controlled, multicentre trial on the efficacy of varenicline and bupropion in combination and alone for treatment of alcohol use disorder: Protocol for the COMB study. PLoS One 2024; 19:e0296118. [PMID: 38206930 PMCID: PMC10783749 DOI: 10.1371/journal.pone.0296118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 12/04/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Alcohol Use Disorder (AUD) is a major cause of premature death, disability and suffering. Available treatments are of modest efficacy and under-prescribed so there is a pressing need for a well-tolerated and effective treatment option for AUD. Dopamine is hypothesized to be involved in the development of alcohol dependence. To challenge the low-dopamine hypothesis of addiction, this randomized, double-blind, placebo-controlled, 13-week, multicentre clinical trial with four parallel arms is designed to evaluate the efficacy of two substances raising dopamine levels, varenicline and bupropion, alone and in combination vs. placebo on alcohol consumption in AUD. Varenicline, a partial agonist at brain nicotinic acetylcholine receptors increases dopamine release, whereas bupropion is a centrally-acting, norepinephrine-dopamine reuptake inhibitor. Varenicline is previously shown to reduce alcohol intake in individuals with AUD. We hypothesize that the effect size of a combination of two drugs affecting dopamine levels in the brain will exceed that of approved AUD therapies. METHODS Consenting individuals with AUD will be recruited via media advertisements. Those fulfilling the eligibility criteria (N = 380) will be randomized to one of four interventions (n = 95 per arm). Treatment will comprise one week of titration (varenicline 0.5‒2 mg; bupropion SR 150‒300 mg) plus 12 weeks at steady state. Efficacy will be evaluated using two primary endpoints of alcohol consumption: Heavy Drinking Days and blood levels of phosphatidylethanol. Secondary objectives, exploratory and subgroup analyses will be also performed. The modified Intention-to-Treat and Per Protocol datasets will be evaluated using Analysis of Covariance. Last patient out is estimated to occur in December, 2022. DISCUSSION The COMB Study aims to evaluate the efficacy of the combination of varenicline and bupropion, two drugs affecting dopamine, on alcohol consumption, and to challenge the low-dopamine hypothesis of addiction. Study Code COMB-BO8, EudraCT 2018-000048-24, Version 3.2, Lidö & deBejczy, 2020-06-16; https://clinicaltrials.gov identifier NCT04167306.
Collapse
Affiliation(s)
- Andrea de Bejczy
- Addiction Biology Unit, Psychiatry and Neurochemistry Section, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helga Lidö
- Addiction Biology Unit, Psychiatry and Neurochemistry Section, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bo Söderpalm
- Addiction Biology Unit, Psychiatry and Neurochemistry Section, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
3
|
Eék N, Sundström C, Kraepelien M, Lundgren J, Kaldo V, Berman AH. High- versus low-intensity internet interventions for alcohol use disorders (AUD): A two-year follow-up of a single-blind randomized controlled trial. Internet Interv 2023; 33:100630. [PMID: 37293578 PMCID: PMC10244691 DOI: 10.1016/j.invent.2023.100630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Alcohol Use Disorders (AUD) are widespread and have serious consequences, but are among the most undertreated mental disorders. Internet interventions have been found effective in treating AUD, but we know little about long-term outcomes, two years or more after treatment. This study explored 12- and 24-month outcomes in alcohol consumption following initial 6-month improvements after a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention among individuals with alcohol use disorder. Between-group comparisons were analyzed, as well as within-group comparisons with (1) pre-treatment measurements (2) post-treatment measurements. Participants consisted of a general population sample of internet help-seekers in Sweden. A total of 143 adults (47% men) with a score of 14 (women)/16 (men) or more on the Alcohol Use Disorders Identification Test, alcohol consumption of 11 (women)/14 (men) or more standard drinks the preceding week and ≥ 2 DSM-5 alcohol use disorder (AUD) criteria based on a diagnostic interview were included. The high- and low-intensity internet interventions (n = 72 and n = 71 respectively) consisted of modules based on relapse prevention and cognitive-behavioral therapy. The primary outcome was self-reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days. Attrition from self-reported questionnaires was 36% at the 12-month follow-up and 53% at the 24-month follow-up. No significant between-group differences occurred in outcomes at either long-term follow-up. Regarding within-group differences, compared to pre-treatment, alcohol consumption was lower in both high- and low-intensity interventions at both long-term follow-ups [within-group standard drinks effect sizes varied between g = 0.38-1.04 and heavy drinking days effect sizes varied between g = 0.65-0.94]. Compared to post-treatment, within-group alcohol consumption in the high intensity intervention increased at both follow-ups; for the low-intensity intervention, within-group consumption decreased at 12-month follow-up, but did not differ compared to post-treatment at 24 months. Both high- and low-intensity internet interventions for AUD were thus associated with overall reductions in alcohol consumption at long term follow-ups, with no significant differences between the two. However, conclusions are hampered by differential and non-differential attrition.
Collapse
Affiliation(s)
- Niels Eék
- University of Gothenburg, Department of Psychology, Sweden
| | - Christopher Sundström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
- Linnaeus University Faculty of Health and Life Sciences, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | | | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
- Linnaeus University Faculty of Health and Life Sciences, Sweden
| | | |
Collapse
|
4
|
Dykstra RE, Beadnell B, Rosengren DB, Schumacher JA, Daugherty R. A Lifestyle Risk Reduction Model for Preventing High-Risk Substance Use Across the Lifespan. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:863-875. [PMID: 37269468 PMCID: PMC10409837 DOI: 10.1007/s11121-023-01549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
While effective models of alcohol and drug prevention exist, they often focus solely on youth or young adults. This article describes the Lifestyle Risk Reduction Model (LRRM), an approach applicable across the lifespan. The intent behind the LRRM is to guide the development of prevention and treatment programs provided to individuals and small groups. The LRRM authors' goals are to help individuals reduce risk for impairment, addiction, and substance use's negative consequences. The LRRM identifies six key principles that conceptualize the development of substance-related problems by drawing parallels with health conditions, such as heart disease and diabetes, which often result from combined effects of biological risk and behavioral choices. The model also proposes five conditions that describe important steps for individuals as they progress toward greater perception of risk and lower risk behavior. One LRRM-based indicated prevention program (Prime For Life) shows positive results in cognitive outcomes and in impaired driving recidivism for people across the lifespan. The model emphasizes common elements across the lifespan, responds to contexts and challenges that change across the life course, complements other models, and is usable for universal, selective, and indicated prevention programs.
Collapse
|
5
|
Romero-Rodríguez E, Pérula-Jiménez C, Fernández-López S, Cabello-Gracia G, Fernández-García JÁ, Pérula-de Torres LÁ, Roldán-Villalobos A, Leiva-Cepas F, Fernández-Márquez R, Parras-Rejano JM. Effectiveness of a brief motivational intervention in the management of risky alcohol use in primary care: ALCO-AP20 study protocol. Front Med (Lausanne) 2023; 9:1008832. [PMID: 36714106 PMCID: PMC9880185 DOI: 10.3389/fmed.2022.1008832] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023] Open
Abstract
Background Motivational interviewing (MI) could be a method for minimizing alcohol-related harm. The study aims to assess the effectiveness of a brief intervention, based on a MI, in patients with risky alcohol use attended in Primary Care (PC). Materials and methods A cluster-randomized, two-arm parallel, multicenter, open-label, controlled clinical trial. Fifty PC healthcare professionals from the province of Córdoba (Spain) will be randomized to one of the two study groups: (1) Experimental Group (EG): MI-based approach; (2) Control Group (CG): Usual care based on health advice. EG intervention: Professionals will receive a training program focused on MI, consisting of a training workshop and the use of pre- and post-workshop questionnaires to measure knowledge and skills acquired, as well as the degree of empathy, with a videotape of the health professionals with standardized patients, before and after the workshop, and subsequent training feedback. CG intervention: Workshop on the management of risky alcohol use based on health advice; participants will also complete the pre-and post-workshop questionnaires and be videotaped. Study population: Patients ≥ 14 years old with risky alcohol consumption (28 Standard Drink Units-SDU-/week in men and 17 SDU/week in women) or excessive alcohol use (≥ 6 SDU in men or ≥ 4 SDU in women, in less than 2 h). It would be necessary to include 110 subjects/group to find a difference of 20% between the percentage of patients in abstinence between EG (37%) and CG (20%), alpha error of 5%, and statistical power of 80%. Assuming a loss rate of 5% and the cluster design effect, the number of subjects to be recruited is estimated at 197/group. The follow-up period will be 12 months. The primary outcome variables will be the self-reported alcohol use level and the Alcohol Use Disorders Identification Test (AUDIT) questionnaire score. Discussion The study aims to demonstrate the effectiveness of the motivational approach in the comprehensive treatment of the patient with risky alcohol use, improving the empathy of the healthcare professionals and strengthening the healthcare professional-patient relationship to achieve the behavioral change of the patients with this problem in primary care consultations. Clinical trial registration ClinicalTrials.gov.
Collapse
Affiliation(s)
- Esperanza Romero-Rodríguez
- Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain,Multiprofessional Teaching Unit of Family and Community Care of Córdoba, Health District of Córdoba and Guadalquivir, Córdoba, Spain,Andalusian Health Service, Carlos Castilla del Pino Health Center, Córdoba, Spain,*Correspondence: Esperanza Romero-Rodríguez,
| | - Celia Pérula-Jiménez
- Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain,Andalusian Health Service, Montoro Health Center, Córdoba, Spain
| | - Sara Fernández-López
- Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain,Andalusian Health Service, Montoro Health Center, Córdoba, Spain,Andalusian Health Service, Peñarroya Health Center, Córdoba, Spain
| | | | - José Ángel Fernández-García
- Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain,Villarrubia Center, Occidente-Azahara Health Center, Córdoba, Spain
| | - Luis Ángel Pérula-de Torres
- Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain,Multiprofessional Teaching Unit of Family and Community Care of Córdoba, Health District of Córdoba and Guadalquivir, Córdoba, Spain,Luis Ángel Pérula-de Torres,
| | - Ana Roldán-Villalobos
- Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain,Andalusian Health Service, Carlos Castilla del Pino Health Center, Córdoba, Spain
| | - Fernando Leiva-Cepas
- Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain,Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | | | - Juan Manuel Parras-Rejano
- Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Córdoba, Córdoba, Spain,Andalusian Health Service, Sector Sur Health Center, Córdoba, Spain
| | | |
Collapse
|
6
|
Lubman DI, Grigg J, Reynolds J, Hall K, Baker AL, Staiger PK, Tyler J, Volpe I, Stragalinos P, Harris A, Best D, Manning V. Effectiveness of a Stand-alone Telephone-Delivered Intervention for Reducing Problem Alcohol Use: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:1055-1064. [PMID: 36129698 PMCID: PMC9494267 DOI: 10.1001/jamapsychiatry.2022.2779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022]
Abstract
Importance Despite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established. Objective To examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample. Design, Setting, and Participants This double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020. Interventions The telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets. Main Outcomes and Measures The primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument. Results This study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis). Conclusions and Relevance Based on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment. Trial Registration ANZCTR Identifier: ACTRN12618000828224.
Collapse
Affiliation(s)
- Dan I. Lubman
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Kate Hall
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Petra K. Staiger
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre of Drug, Addictive and Anti-social Behaviour Research, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Tyler
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Isabelle Volpe
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peta Stragalinos
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - David Best
- Department of Criminology, University of Derby, Derby, United Kingdom
| | - Victoria Manning
- Turning Point, Eastern Health, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Lemp JM, Pengpid S, Buntup D, Bärnighausen TW, Geldsetzer P, Peltzer K, Rehm J, Sornpaisarn B, Probst C. Addressing alcohol use among blood pressure patients in Thai primary care: Lessons from a survey-based stakeholder consultation. Prev Med Rep 2022; 29:101954. [PMID: 36161118 PMCID: PMC9502666 DOI: 10.1016/j.pmedr.2022.101954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/20/2022] Open
Abstract
Alcohol use is a major risk factor for noncommunicable diseases in Thailand, and one of its pathways is high blood pressure. Given that brief intervention can effectively reduce hazardous alcohol consumption, this study aimed to investigate how hypertensive patients with concomitant alcohol use are identified and treated in Thai primary care settings and what this may mean for screening and lifestyle intervention strategies. In a cross-sectional, mixed-method design, we surveyed 91 participants from three different groups of Thai stakeholders: policy- and decisionmakers; healthcare practitioners; and patients diagnosed with hypertension. Data was collected between December 2020 and May 2021. Responses were analyzed descriptively and using open coding tools to identify current practices, barriers, facilitators, and implications for interventions. All stakeholder groups regarded alcohol use as an important driver of hypertension. While lifestyle interventions among hypertensive patients were perceived as beneficial, current lifestyle support was limited. Barriers included limited resources in primary healthcare facilities, lack of continuous monitoring or follow-up, missing tools or procedures for risk assessment and lifestyle intervention, and stigmatization of alcohol use. Our results suggest that although screening for lifestyle risk factors (including alcohol use) and lifestyle interventions are not yet sufficiently established, a wide range of stakeholders still recognize the potential of interventions targeted at hazardous alcohol use among hypertensive patients. Future interventions may establish standardized assessment tools, be tailored to high-risk groups, and include electronic or remote elements.
Collapse
Affiliation(s)
- Julia M. Lemp
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Doungjai Buntup
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand
| | - Till W. Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Bundit Sornpaisarn
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Faculty of Public Health, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Charlotte Probst
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Corresponding author at: Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| |
Collapse
|
8
|
Jané Llopis E, O'Donnell A, Kaner E, Anderson P. Are Lower-Strength Beers Gateways to Higher-Strength Beers? Time Series Analyses of Household Purchases from 64,280 British Households, 2015-2018. Alcohol Alcohol 2022; 57:520-528. [PMID: 35512687 PMCID: PMC9270994 DOI: 10.1093/alcalc/agac025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Abstract
Aims Buying and consuming no- (per cent alcohol by volume, ABV = 0.0%) and low- (ABV = >0.0% and ≤ 3.5%) alcohol beers could reduce alcohol consumption but only if they replace buying and drinking higher-strength beers. We assess whether buying new no- and low-alcohol beers increases or decreases British household purchases of same-branded higher strength beers. Methods Generalized linear models and interrupted time series analyses, using purchase data of 64,280 British households from Kantar Worldpanel’s household shopping panel, 2015–2018. We investigate the extent to which the launch of six new no- and low-alcohol beers affected the likelihood and volume of purchases of same-branded higher-strength beers. Results Households that had never previously bought a same-branded higher-strength beer but bought a new same-branded no- or low-alcohol beer were less than one-third as likely to go on and newly buy the same-branded higher-strength product. When they did later buy the higher-strength product, they bought half as much volume as households that had not bought a new same-branded no- or low-alcohol beer. For households that had previously purchased a higher-strength beer, the introduction of the new same-branded no- or low-alcohol beer was associated with decreased purchases of the volume of the higher-strength beer by, on average, one-fifth. Conclusions The increased availability of new no- and low-alcohol beers does not seem to be a gateway to purchasing same-branded higher-strength beers but rather seems to replace purchases of these higher-strength products. Thus, introduction of new no- and low-alcohol beers could contribute to reducing alcohol consumption.
Collapse
Affiliation(s)
- Eva Jané Llopis
- ESADE Business School, Ramon Llull University, Barcelona 08034, Spain.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6200 MD, Netherlands.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| | - Peter Anderson
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6200 MD, Netherlands.,Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| |
Collapse
|
9
|
Helle AC, Boness CL, Sher KJ. College students' receptiveness to intervention approaches for alcohol and cannabis use. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2022; 36:157-176. [PMID: 33749290 PMCID: PMC8455707 DOI: 10.1037/adb0000699] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Addressing high-risk alcohol and cannabis use represent major challenges to institutions of higher education. A range of evidence-based treatment approaches are available, but little is known concerning students' receptiveness to such approaches. Prior work identified that students were most open to individual therapy and self-help options for reducing alcohol use, but less open to medication. The current study examines student receptiveness to intervention approaches across a wider range of intervention approaches (e.g., remote/telehealth), and extends to evaluate cannabis intervention receptiveness. METHOD Undergraduate students reported on alcohol and cannabis use, motives for and reasons against use, and openness to an array of interventions for reducing alcohol and cannabis use. RESULTS Informal options (self-help, talking with family/friends), individual therapy, and appointments with a primary care provider (PCP) were endorsed most frequently. Group therapy and medication were less commonly endorsed, though medication was endorsed at a higher prevalence than in prior studies. Women generally expressed higher receptiveness than men. Lower alcohol consumption was associated with increased receptiveness to some approaches. Students at high risk for alcohol and/or cannabis dependence were less receptive to many treatment options. CONCLUSIONS College students were open to a wide variety of approaches for reducing their alcohol and cannabis use. These results can inform selection, implementation, and availability of campus-wide services, especially as low-cost technological-based approaches are expanding. Further attention to existing services (e.g., PCP) for addressing alcohol and cannabis use may be considered, given students' receptiveness to such approaches. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
- Ashley C. Helle
- University of Missouri, Department of Psychological
Sciences, 200 South 7 Street, Columbia, MO 65211, United State
- Corresponding author:
| | - Cassandra L. Boness
- University of Missouri, Department of Psychological
Sciences, 200 South 7 Street, Columbia, MO 65211, United State
| | - Kenneth J. Sher
- University of Missouri, Department of Psychological
Sciences, 200 South 7 Street, Columbia, MO 65211, United State
| |
Collapse
|
10
|
Hyland K, Hammarberg A, Andreasson S, Jirwe M. Treatment of alcohol dependence in Swedish primary care: perceptions among general practitioners. Scand J Prim Health Care 2021; 39:247-256. [PMID: 34151724 PMCID: PMC8293973 DOI: 10.1080/02813432.2021.1922834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To describe general practitioners' (GPs) attitudes to the management of patients with alcohol dependence in primary care and current treatment routines and their view on a new treatment approach; internet-based Cognitive Behavioral Therapy (iCBT). DESIGN A qualitative interview study with ten GPs participating in a randomized controlled trial. The interviews were analyzed using qualitative content analysis. SETTING The participating GPs were recruited via purposeful sampling from primary care clinics in Stockholm. SUBJECTS The GPs were participants in an RCT investigating if iCBT when added to treatment as usual (TAU) was more effective than TAU only when treating alcohol dependence in primary care. RESULTS The GPs found alcohol important to discuss in many consultations and perceived most patients open to discuss their alcohol habits. Lack of training and treatment options were expressed as limiting factors when working with alcohol dependence. According to the respondents, routines for treating alcohol dependence were rare. CONCLUSION GPs believed that iCBT might facilitate raising questions about alcohol use and thought iCBT may serve as an attractive treatment option to some patients. The iCBT program did not require GPs to acquire skills in behavioral treatment, which could make implementation more feasible.KEY POINTSAlcohol dependence is highly prevalent, has a large treatment gap and is relevant to discuss with patients in many consultations in primary care.This study is based on interviews with 10 GPs participating in a randomized controlled trial comparing internet-based Cognitive Behavioral Therapy (iCBT) for alcohol-dependent patients to treatment as usual.GPs viewed alcohol habits as important to discuss and they perceived most patients are open to discuss this.The access to iCBT seemed to increase GPs' willingness to ask questions about alcohol and was viewed as an attractive treatment for some patients.The iCBT program did not require GPs to acquire skills in behavioral treatment, which might be timesaving and make implementation more feasible.
Collapse
Affiliation(s)
- Karin Hyland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- CONTACT Karin Hyland Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Sven Andreasson
- Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Maria Jirwe
- Department of Health Sciences, Red Cross University College, Huddinge, Sweden
| |
Collapse
|
11
|
Mittal R, Su L, Ramgobin D, Garg A, Jain R, Jain R. A narrative review of chronic alcohol-induced atrial fibrillation. Future Cardiol 2021; 18:27-34. [PMID: 33860684 DOI: 10.2217/fca-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Alcohol use disorder (AUD) is highly prevalent and can lead to many cardiovascular complications, including arrhythmias. Chronic alcohol use has a dose-dependent relationship with incidence of atrial fibrillation (AF), where higher alcohol intake (>3 drinks a day) is associated with higher risk of AF. Meanwhile, low levels of chronic alcohol intake (<1 drink a day) is not associated with increased risk of AF. Mechanistically, chronic alcohol intake alters the structural, functional and electrical integrity of the atria, predisposing to AF. Increased screening can help identify AUD patients early on and provide the opportunity to educate on chronic alcohol use related risks, such as AF. The ideal treatment to reduce risk of incident or recurrent AF in AUD populations is abstinence.
Collapse
Affiliation(s)
- Rea Mittal
- School of Medicine, Pennsylvania State College of Medicine, Hershey, PA17033, USA
| | - Lilly Su
- School of Medicine, Pennsylvania State College of Medicine, Hershey, PA17033, USA
| | - Devyani Ramgobin
- Touro College of Osteopathic Medicine, Middletown, NY 10940, USA
| | - Ashwani Garg
- Department of Internal Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA
| | - Rahul Jain
- Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Rohit Jain
- Department of Internal Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA
| |
Collapse
|
12
|
Rehm J, Patra J, Brennan A, Buckley C, Greenfield TK, Kerr WC, Manthey J, Purshouse RC, Rovira P, Shuper PA, Shield KD. The role of alcohol use in the aetiology and progression of liver disease: A narrative review and a quantification. Drug Alcohol Rev 2021; 40:1377-1386. [PMID: 33783063 PMCID: PMC9389623 DOI: 10.1111/dar.13286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/16/2020] [Accepted: 03/10/2021] [Indexed: 12/16/2022]
Abstract
Issues. Alcohol use has been shown to impact on various forms of liver disease, not restricted to alcoholic liver disease. Approach. We developed a conceptual framework based on a narrative review of the literature to identify causal associations between alcohol use and various forms of liver disease including the complex interactions of alcohol with other major risk factors. Based on this framework, we estimate the identified relations for 2017 for the USA. Key Findings. The following pathways were identified and modelled for the USA for the year 2017. Alcohol use caused 35 200 (95% uncertainty interval 32 800–37 800) incident cases of alcoholic liver cirrhosis. There were 1700 (uncertainty interval 1100–2500) acute hepatitis B and C virus (HBV and HCV) infections attributable to heavy-drinking occasions, and 14 000 (uncertainty interval 5900–19 500) chronic HBV and 1700 (uncertainty interval 700–2400) chronic HCV infections due to heavy alcohol use interfering with spontaneous clearance. Alcohol use and its interactions with other risk factors (HBV, HCV, obesity) led to 54 500 (uncertainty interval 50 900–58 400) new cases of liver cirrhosis. In addition, alcohol use caused 6600 (uncertainty interval 4200–9300) liver cancer deaths and 40 700 (uncertainty interval 36 600–44 600) liver cirrhosis deaths. Implications. Alcohol use causes a substantial number of incident cases and deaths from chronic liver disease, often in interaction with other risk factors. Conclusion. This additional disease burden is not reflected in the current alcoholic liver disease categories. Clinical work and prevention policies need to take this into consideration.
Collapse
Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Institute of Clinical Psychology and Psychotherapy, Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jayadeep Patra
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlotte Buckley
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | | | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, USA
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Robin C Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Pol Rovira
- Program on Substance Abuse, Public Health Agency of Catalonia, Barcelona, Spain
| | - Paul A Shuper
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| |
Collapse
|
13
|
Loeffelman JE, Steinley D, Boness CL, Trull TJ, Wood PK, Brusco MJ, Sher KJ. Combinatorial Optimization of Clustering Decisions: An Approach to Refine Psychiatric Diagnoses. MULTIVARIATE BEHAVIORAL RESEARCH 2021; 56:57-69. [PMID: 32054331 PMCID: PMC8428183 DOI: 10.1080/00273171.2020.1717921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Using complete enumeration (e.g., generating all possible subsets of item combinations) to evaluate clustering problems has the benefit of locating globally optimal solutions automatically without the concern of sampling variability. The proposed method is meant to combine clustering variables in such a way as to create groups that are maximally different on a theoretically sound derivation variable(s). After the population of all unique sets is permuted, optimization on some predefined, user-specific function can occur. We apply this technique to optimizing the diagnosis of Alcohol Use Disorder. This is a unique application, from a clustering point of view, in that the decision rule for clustering observations into the "diagnosis" group relies on both the set of items being considered and a predefined threshold on the number of items required to be endorsed for the "diagnosis" to occur. In optimizing diagnostic rules, criteria set sizes can be reduced without a loss of significant information when compared to current and proposed, alternative, diagnostic schemes.
Collapse
|
14
|
Neufeld M, Bobrova A, Davletov K, Štelemėkas M, Stoppel R, Ferreira-Borges C, Breda J, Rehm J. Alcohol control policies in Former Soviet Union countries: A narrative review of three decades of policy changes and their apparent effects. Drug Alcohol Rev 2020; 40:350-367. [PMID: 33155370 PMCID: PMC7936953 DOI: 10.1111/dar.13204] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/19/2020] [Accepted: 09/20/2020] [Indexed: 01/06/2023]
Abstract
Issues. The last Soviet anti-alcohol campaign of 1985 resulted in considerably reduced alcohol consumption and saved thousands of lives. But once the campaign’s policies were abandoned and the Soviet alcohol monopoly broken up, a steep rise in mortality was observed in many of the newly formed successor countries, although some kept their monopolies. Almost 30 years after the campaign’s end, the region faces diverse challenges in relation to alcohol. Approach. The present narrative review sheds light on recent drinking trends and alcohol policy developments in the 15 Former Soviet Union (FSU) countries, highlighting the most important setbacks, achievements and best practices. Vignettes of alcohol control policies in Belarus, Estonia, Kazakhstan, Lithuania and Uzbekistan are presented to illustrate the recent developments. Key Findings. Over the past decade, drinking levels have declined in almost all FSU countries, paralleled by the introduction of various alcohol-control measures. The so-called three ‘best buys’ put forward by the World Health Organization to reduce alcohol-attributable burden (taxation and other measures to increase price, restrictions on alcohol availability and marketing) are relatively well implemented across the countries. Implications. In recent years, evidence-based alcohol policies have been actively implemented as a response to the enormous alcohol-attributable burden in many of the countries, although there is big variance across and within different jurisdictions. Conclusion. Strong declines in alcohol consumption were observed in the 15 FSU countries, which have introduced various alcohol control measures in recent years, resulting in a reduction of alcohol consumption in the World Health Organization European region overall.
Collapse
Affiliation(s)
- Maria Neufeld
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Anastacia Bobrova
- Institute of Economics, National Academy of Sciences, Minsk, Belarus
| | - Kairat Davletov
- Health Research Institute, Faculty of Medicine, Al-Farabi Kazakh National University Almaty, Almaty, Kazakhstan
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Relika Stoppel
- Department of Economics, University of Potsdam, Potsdam, Germany
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - João Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russia
| | - Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Department of International Health Projects, Institute for Leadership and Health Management, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| |
Collapse
|
15
|
Anderson P, Jané Llopis E, O'Donnell A, Manthey J, Rehm J. Impact of low and no alcohol beers on purchases of alcohol: interrupted time series analysis of British household shopping data, 2015-2018. BMJ Open 2020; 10:e036371. [PMID: 33046462 PMCID: PMC7552865 DOI: 10.1136/bmjopen-2019-036371] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/02/2020] [Accepted: 06/29/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To assess the impact of new low and no alcohol beers and reformulated beers in Great Britain on household purchases of grams of alcohol. DESIGN Interrupted time series analysis. SETTING Purchase data from Kantar Worldpanel's household shopping panel for 2015-2018. PARTICIPANTS 64 286 British households. INTERVENTIONS Introduction of new no and low alcohol beers during 2017-2018 and reformulation of existing beers to contain less alcohol during 2018. MAIN OUTCOME MEASURES Average alcoholic strength of beer and number of grams of alcohol purchased by households. RESULTS As assessed by British household purchase data, 46 new low and no alcohol beer products were introduced during 2015-2018, with a step-jump in volume purchased occurring at the beginning of March 2017 (event 1). During 2015-2018, 33 beer products were reformulated to contain less alcohol, with a step-jump in volume purchased occurring during mid-March 2018 (event 2). Interrupted time series analyses found a combined associated impact of both events with relative reductions of alcohol by volume of beer between 1.2% and 2.3%; purchases of grams of alcohol within beer between 7.1% and 10.2%; and purchases of grams of alcohol as a whole between 2.6% and 3.9%. The reductions were greater for reformulation than for the introduction of new low and no alcohol products. Reductions were independently higher for younger age groups of shoppers and for households that bought the most alcohol. CONCLUSIONS Even though the events were associated with significant beneficial changes, the volume of purchases of new low and no alcohol beer products (2.6% of the volume of all beers purchased during 2018) and of new reformulated beer products (6.9% of the volume of all beers purchased during 2018) was very small. This indicates that there are future opportunities to increase the volume of such products so as to reduce the harm done by alcohol.
Collapse
Affiliation(s)
- Peter Anderson
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eva Jané Llopis
- ESADE Business School, Ramon Llull University, Barcelona, Spain
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jürgen Rehm
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Boness CL, Loeffelman JE, Steinley D, Trull T, Sher KJ. Using Complete Enumeration to Derive "One-Size-Fits-All" Versus "Subgroup-Specific" Diagnostic Rules for Substance Use Disorder. Assessment 2020; 27:1075-1088. [PMID: 32037845 PMCID: PMC7694888 DOI: 10.1177/1073191120903092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The use of fixed diagnostic rules, whereby the same diagnostic algorithms are applied across all individuals regardless of personal attributes, has been the tradition in the Diagnostic and Statistical Manual of Mental Disorders. This practice of "averaging" across individuals inevitably introduces diagnostic error. Furthermore, these average rules are typically derived through expert consensus rather than through data-driven approaches. Utilizing National Survey on Drug Use and Health 2013 (N = 23, 889), we examined whether subgroup-specific, "customized" alcohol use disorder diagnostic rules, derived using deterministic optimization, perform better than an average, "one-size-fits-all" diagnostic rule. The average solution for the full sample included a set size of six and diagnostic threshold of three. Subgroups had widely varying set sizes (M = 6.870; range = 5-10) with less varying thresholds (M = 2.70; range = 2-4). External validation verified that the customized algorithms performed as well, and sometimes better than, the average solution in the prediction of relevant correlates. However, the average solution still performed adequately with respect to external validators.
Collapse
|
17
|
Knox J, Scodes J, Witkiewitz K, Kranzler HR, Mann K, O'Malley SS, Wall M, Anton R, Hasin DS. Reduction in World Health Organization Risk Drinking Levels and Cardiovascular Disease. Alcohol Clin Exp Res 2020; 44:1625-1635. [PMID: 32619058 DOI: 10.1111/acer.14386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reductions in World Health Organization (WHO) risk drinking levels have recently been shown to lower the risk of multiple adverse health outcomes, but prior work has not examined reductions in WHO risk drinking levels in relation to cardiovascular disease (CVD), the leading cause of death for men and women in the United States and of global mortality. This study examined associations between reductions in WHO risk drinking levels and subsequent risk for CVD. METHODS In a US national survey, 1,058 very-high-risk and high-risk drinkers participated in Wave 1 interviews (2001 to 2002) and Wave 2 follow-ups (2004 to 2005). Self-reported CVD history that was communicated to the participant by a doctor or other healthcare professionals included arteriosclerosis, hypertension, angina, tachycardia, or myocardial infarction. We used logistic regression to estimate adjusted odds ratios (aOR) evaluating relationships between ≥2-level reductions in WHO risk drinking levels from Wave 1 to Wave 2 and the risk of Wave 2 CVD, controlling for baseline characteristics. RESULTS Reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD in individuals who at Wave 1 were very-high-risk (aOR = 0.58 [0.41 to 0.80]) or high-risk drinkers (aOR = 0.81 [0.70 to 0.94]). Interaction terms showed that this relationship varied by age. Among individuals >40 years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among very-high-risk drinkers (aOR = 0.42 [0.28 to 0.63]) but not high-risk drinkers (p = 0.50). Among individuals ≤40 years old at Wave 1, reductions of ≥2 WHO risk drinking levels were associated with significantly lower odds of CVD among high-risk drinkers (aOR = 0.50 [0.37 to 0.69]) but not very-high-risk drinkers (p = 0.27). CONCLUSIONS These results show that reductions in WHO risk drinking levels are associated with reduced CVD risk among very-high-risk and high-risk drinkers in the US general population, and provide further evidence that reducing high levels of drinking provides important benefit across multiple clinical domains.
Collapse
Affiliation(s)
- Justin Knox
- Columbia University Mailman School of Public Health, New York, New York.,New York State Psychiatric Institute, New York, New York
| | | | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | | | - Melanie Wall
- Columbia University Mailman School of Public Health, New York, New York.,New York State Psychiatric Institute, New York, New York
| | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Deborah S Hasin
- Columbia University Mailman School of Public Health, New York, New York.,New York State Psychiatric Institute, New York, New York
| | | |
Collapse
|
18
|
Myrzamatova AO, Kontsevaya AV, Gorny BE, Drapkina OM. Population-based preventive measures aimed at reducing alcohol consumption: international practice and prospects for escalating measures in the Russian Federation. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To conduct a review of international studies and guidelines on the implementation of population-based preventive measures aimed at reducing alcohol consumption, and identify measures recommended by the World Health Organization, which have the potential for use in the Russian Federation.Material and methods. We used the following databases: PubMed, Science Citation Index, Scopus, The Campbell Collaboration Library of Systematic Reviews. The review includes systematic and non-systematic studies of measures related to alcohol consumption. The effectiveness of the identified measures was assessed according to the following criteria: behavioral changes (consumption/sales/level); incidence changes; mortality changes.Results. According to international practice of population-based prevention, effective measures that can be implemented in the Russian Federation include reducing the blood alcohol concentration legal driving limit, increasing the minimum legal drinking age, a complete ban on alcohol advertising, and a further increase in excise taxes.Conclusion. In the Russian Federation, significant progress has been achieved in implementing alcohol restriction measures, which has led to a reduction in its consumption and related consequences. Despite this, levels of alcohol consumption remain high and the potential for introducing population-based measures to reduce it has not been exhausted.
Collapse
Affiliation(s)
- A. O. Myrzamatova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - B. E. Gorny
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| |
Collapse
|
19
|
Llamosas-Falcón L, Shield KD, Gelovany M, Manthey J, Rehm J. Alcohol use disorders and the risk of progression of liver disease in people with hepatitis C virus infection - a systematic review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:45. [PMID: 32605584 PMCID: PMC7325038 DOI: 10.1186/s13011-020-00287-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/23/2020] [Indexed: 02/08/2023]
Abstract
Liver cirrhosis and other chronic liver diseases are usually compartmentalized into separate categories based on etiology (e.g., due to alcohol, virus infection, etc.), but it is important to study the intersection of, and possible interactions between, risk factors. The aim of this study is to summarize evidence on the association between alcohol use disorders (AUDs) and decompensated liver cirrhosis and other complications in patients with chronic Hepatitis C virus (HCV) infection. A systematic search of epidemiological studies was conducted using Ovid Medline databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Relative Risk estimates were combined using random-effects meta-analyses. The proportion of cases with liver disease progression that could be avoided if no person with a chronic HCV infection had an AUD was estimated using an attributable fraction methodology. A total of 11 studies fulfilled the inclusion criteria, providing data from 286,641 people with chronic HCV infections, of whom 63,931 (22.3%) qualified as having an AUD. Using decompensated liver cirrhosis as the outcome for the main meta-analysis (n = 7 unique studies), an AUD diagnosis was associated with a 3.3-fold risk for progression of liver disease among people with a chronic HCV infection (95% Confidence Interval (CI): 1.8–4.8). In terms of population-attributable fractions, slightly less than 4 out of 10 decompensated liver cirrhosis cases were attributable to an AUD: 35.2% (95% CI: 16.2–47.1%). For a secondary analyses, all outcomes related to liver disease progression were pooled (i.e., liver deaths or cirrhosis in addition to decompensated liver cirrhosis), which yielded a similar overall effect (n = 13 estimates; OR = 3.7; 95% CI: 2.2–5.3) and a similar attributable fraction (39.3%; 95% CI: 21.9–50.4%). In conclusion, AUDs were frequent in people with chronic HCV infections and contributed to worsening the course of liver disease. Alcohol use and AUDs should be assessed in patients who have liver disease of any etiology, and interventions should be implemented to achieve abstinence or to reduce consumption to the greatest possible extent.
Collapse
Affiliation(s)
- Laura Llamosas-Falcón
- Preventive Medicine and Public Health, Preventive Medicine, Universitary Hospital "12 de Octubre", Avda de Córdoba s/n 28041, Madrid, Spain.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Room T420, Toronto, Ontario, M5S 2S1, Canada
| | - Kevin D Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Room T420, Toronto, Ontario, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 1P8, Canada
| | - Maya Gelovany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Room T420, Toronto, Ontario, M5S 2S1, Canada
| | - Jakob Manthey
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany.,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Room T420, Toronto, Ontario, M5S 2S1, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 1P8, Canada. .,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. .,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, M5T 2S1, Canada. .,Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, M5S 1A8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, Moscow, Russian Federation, 119992.
| |
Collapse
|
20
|
Anderson P, Jané Llopis E, Rehm J. Evaluation of Alcohol Industry Action to Reduce the Harmful Use of Alcohol: Case Study from Great Britain. Alcohol Alcohol 2020; 55:424-432. [PMID: 32419026 DOI: 10.1093/alcalc/agaa029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS To describe a case study in the British market of one of the global beer-producing companies that has set a target to increase the proportion of its products with an alcohol by volume (ABV) of 3.5% or less, and to reduce the mean ABV of its beer products. METHODS Descriptive statistics and time-series analyses using Kantar Worldpanel's British household purchase data for 2015-2018. RESULTS As assessed by British household purchase data, 15.7% of the company's beer products had an ABV of 3.5% or less in 2018, compared with 8.8% in 2015. The mean ABV of its beer products dropped from 4.69 in 2015 to 4.55 in 2018. Associated with these changes, the increase in purchased grams of alcohol in all beer that occurred during 2015-2016 (standardized coefficient = 0.007), plateaued during 2017 (standardized coefficient = -0.006) and decreased during 2018 (standardized coefficient = -0.034). Similar findings applied to the purchased grams of alcohol in beer other than ABI beer, suggesting some switching from other beer products to ABI products; and in all alcohol, suggesting, on balance, no overall switching to higher strength products. Greater decreases in purchases were found in the younger age groups, the highest purchasing households in terms of grams of alcohol, class groups D and E, and Scotland; there was no clear pattern by household income. CONCLUSIONS The proportion of the company's beer purchased in Great Britain that had an ABV of 3.5% or less increased since the launch of the target, and the mean ABV of its beer products decreased. The changes were associated with reduced purchases of grams of alcohol within its beer products. The associated reductions in purchases of alcohol in all beer and in all alcohol products suggest no evidence of overall switching to other higher strength beer or alcohol products. Other beer-producing companies should undertake similar initiatives. A regulatory tax environment should be introduced to ensure a level-playing field favouring lower alcohol concentration across all beer and other alcohol products.
Collapse
Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.,Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, Maastricht HA 6221, The Netherlands
| | - Eva Jané Llopis
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, Maastricht HA 6221, The Netherlands.,Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada.,ESADE Business School, Ramon Llull University, Av. Esplugues 92-96, Barcelona 08034, Spain
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, TU Dresden, Dresden 01087, Germany.,I.M. Sechenov First Moscow State Medical University, Moscow 119146, Russian Federation.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario ON M5S 2S1, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario ON M5S, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario ON M5T 1RB, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario ON M5T 3M7, Canada
| |
Collapse
|
21
|
Ravat V, Ajibawo T, Parvataneni T, Pereira KN, Yen TY, Patel RS. National Trends of Arrhythmia Hospitalizations and Comorbid Alcohol Use Disorders in the United States. Cureus 2020; 12:e8835. [PMID: 32742846 PMCID: PMC7384718 DOI: 10.7759/cureus.8835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective To study the trends of arrhythmia hospitalizations with comorbid alcohol use disorders (AUDs) in terms of demographic characteristics and inpatient outcomes. Methods We used the Nationwide Inpatient Sample (NIS) data from 2010 to 2014 and included 570,556 arrhythmia inpatients (age, 15-54 years), and 55,730 inpatients had comorbid AUD. We used the linear-by-linear association test for measuring the differences in demographics, comorbidities, and hospital outcomes over the study period of 2010 to 2014, and the analysis of variance (ANOVA) for measuring the changes seen in the length of stay (LOS) and total charges. Results Arrhythmia inpatients with AUD were majorly males (85.9%), and older-age adults (45 to 54 years, 68%). Hypertension (52.2%), tobacco abuse (42.3%), and elevated cholesterol and lipids (22.6%) were the most prevalent comorbidities in the study population. There was a statistically significant increasing trend in arrhythmia inpatients with AUD with comorbid diabetes, hypertension, and obesity over the five-year period. In-hospital mortality had a variable trend from 1.1% in 2010 to 1.3% in 2014, but there was a statistically non-significant difference in the trend (P = 0.418). Mean LOS was three days with statistically no significant change during the study period (P = 0.080), whereas total charges have been increasing significantly (P <0.001), averaging $37,473 per hospitalization. Conclusion The prevalence trend of arrhythmia hospitalizations with comorbid AUD is increasing in the United States population, and is majorly seen in older-age men. Overall, in-hospital mortality in arrhythmia inpatients with comorbid AUD was 1.4%. So, this necessitates the development of an integrated clinical care model for early diagnosis and management of alcohol abuse and dependence in order to improve the arrhythmia patient outcomes and quality of life.
Collapse
Affiliation(s)
| | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | - Tarun Parvataneni
- Psychiatry, Siddavanahalli Nijalingappa Medical College and HSK Hospital and Research Centre, Bagalkot, IND
| | | | - Ting Yu Yen
- Medicine, Poznan University of Medical Sciences, Poznan, POL
| | | |
Collapse
|
22
|
Barbosa C, Dowd WN, Aldridge AP, Timko C, Zarkin GA. Estimating Long-Term Drinking Patterns for People with Lifetime Alcohol Use Disorder. Med Decis Making 2019; 39:765-780. [PMID: 31580211 DOI: 10.1177/0272989x19873627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background. There is a lack of data on alcohol consumption over time. This study characterizes the long-term drinking patterns of people with lifetime alcohol use disorders who have engaged in treatment or informal care. Methods. We developed multinomial logit models using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to estimate short-term transition probabilities (TPs) among the 4 World Health Organization drinking risk levels (low, medium, high, and very high risk) and abstinence by age, sex, and race/ethnicity. We applied an optimization algorithm to convert 3-year TPs from NESARC to 1-year TPs, then used simulated annealing to calibrate TPs to a propensity-scored matched set of participants derived from a separate 16-year study of alcohol consumption. We validated the resulting long-term TPs using NESARC-III, a cross-sectional study conducted on a different cohort. Results. Across 24 demographic groups, the 1-year probability of remaining in the same state averaged 0.93, 0.81, 0.49, 0.51, and 0.63 for abstinent, low, medium, high, and very high-risk states, respectively. After calibration to the 16-year study data (N = 420), resulting TPs produced state distributions that hit the calibration target. We find that the abstinent or low-risk states are very stable, and the annual probability of leaving the very high-risk state increases by about 20 percentage points beyond 8 years. Limitations. TPs for some demographic groups had small cell sizes. The data used to calibrate long-term TPs are based on a geographically narrow study. Conclusions. This study is the first to characterize long-term drinking patterns by combining short-term representative data with long-term data on drinking behaviors. Current research is using these patterns to estimate the long-term cost effectiveness of alcohol treatment.
Collapse
Affiliation(s)
- Carolina Barbosa
- Behavioral Health Research Division, RTI International, Chicago, IL, USA
| | - William N Dowd
- Behavioral Health Research Division, RTI International, Chicago, IL, USA
| | - Arnie P Aldridge
- Behavioral Health Research Division, RTI International, Chicago, IL, USA
| | - Christine Timko
- Health Services Research & Development Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary A Zarkin
- Behavioral Health Research Division, RTI International, Chicago, IL, USA
| |
Collapse
|
23
|
Abstract
OBJECTIVES To systematically summarize the risk relationship between different levels of alcohol consumption and incidence of liver cirrhosis. METHODS MEDLINE and Embase were searched up to March 6, 2019, to identify case-control and cohort studies with sex-specific results and more than 2 categories of drinking in relation to the incidence of liver cirrhosis. Study characteristics were extracted and random-effects meta-analyses and meta-regressions were conducted. RESULTS A total of 7 cohort studies and 2 case-control studies met the inclusion criteria, providing data from 2,629,272 participants with 5,505 cases of liver cirrhosis. There was no increased risk for occasional drinkers. Consumption of one drink per day in comparison to long-term abstainers showed an increased risk for liver cirrhosis in women, but not in men. The risk for women was consistently higher compared to men. Drinking ≥5 drinks per day was associated with a substantially increased risk in both women (relative risk [RR] = 12.44, 95% confidence interval [CI]: 6.65-23.27 for 5-6 drinks, and RR = 24.58, 95% CI: 14.77-40.90 for ≥7 drinks) and men (RR = 3.80, 95% CI: 0.85-17.02, and RR = 6.93, 95% CI: 1.07-44.99, respectively). Heterogeneity across studies indicated an additional impact of other risk factors. DISCUSSION Alcohol is a major risk factor for liver cirrhosis with risk increasing exponentially. Women may be at higher risk compared to men even with little alcohol consumption. More high-quality research is necessary to elucidate the role of other risk factors, such as genetic vulnerability, body weight, metabolic risk factors, and drinking patterns over the life course. High alcohol consumption should be avoided, and people drinking at high levels should receive interventions to reduce their intake.
Collapse
|
24
|
Day E, Rudd JHF. Alcohol use disorders and the heart. Addiction 2019; 114:1670-1678. [PMID: 31309639 PMCID: PMC6771559 DOI: 10.1111/add.14703] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/16/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022]
Abstract
Alcohol use is an important preventable and modifiable cause of non-communicable disease, and has complex effects on the cardiovascular system that vary with dose. Observational and prospective studies have consistently shown a lower risk of cardiovascular and all-cause mortality in people with low levels of alcohol consumption when compared to abstainers (the 'J'-shaped curve). Maximum potential benefit occurs at 0.5 to one standard drinks (7-14 g pure ethanol) per day for women (18% lower all-cause mortality, 95% confidence interval (CI) = 13-22%) and one to two standard drinks (14-28 g ethanol) per day for men (17% lower all-cause mortality, 95% CI = 15-19%). However, this evidence is contested, and overall the detrimental effects of alcohol far outweigh the beneficial effects, with the risk of premature mortality increasing steadily after an average consumption of 10 g ethanol/day. Blood pressure (BP) is increased by regular alcohol consumption in a dose-dependent manner, with a relative risk for hypertension (systolic BP > 140 mm Hg or diastolic > 90 mm Hg) of 1.7 for 50 g ethanol/day and 2.5 at 100 g/day. Important reductions in BP readings can be expected after as little as 1 month of abstinence from alcohol. Heavy alcohol consumption in a binge pattern is associated with the development of acute cardiac arrhythmia, even in people with normal heart function. Atrial fibrillation is the most common arrhythmia associated with chronic high-volume alcohol intake, and above 14 g alcohol/day the relative risk increases 10% for every extra standard drink (14 g ethanol). Ethanol and its metabolites have toxic effects on cardiac myocytes, and alcoholic cardiomyopathy (ACM) accounts for a third of all cases of non-ischaemic dilated cardiomyopathy. Screening people drinking alcohol above low-volume levels and delivering a brief intervention may prevent the development of cardiovascular complications. Although people with established cardiovascular disease show improved outcomes with a reduction to low-volume alcohol consumption, there is no safe amount of alcohol to drink and patients with ACM should aim for abstinence in order to optimize medical treatment.
Collapse
Affiliation(s)
- Ed Day
- Institute for Mental Health, School of Psychology, University of Birmingham, and Honorary Consultant in Addiction Psychiatry, Solihull Integrated Addiction ServiceUK
| | - James H. F. Rudd
- Division of Cardiovascular MedicineUniversity of Cambridge, Honorary Consultant Cardiologist, Addenbrooke's HospitalCambridgeUK
| |
Collapse
|
25
|
Knox J, Wall M, Witkiewitz K, Kranzler HR, Falk DE, Litten R, Mann K, O’Malley SS, Scodes J, Anton R, Hasin DS. Reduction in non-abstinent World Health Organization (WHO) drinking risk levels and drug use disorders: 3-year follow-up results in the US general population. Drug Alcohol Depend 2019; 201:16-22. [PMID: 31174140 PMCID: PMC6662197 DOI: 10.1016/j.drugalcdep.2019.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND To provide information on the clinical relevance of a reduction in the World Health Organization (WHO) drinking risk categories, we examined their relationship to an important indicator of how individuals feel and function: drug use disorders (DUDs), i.e., those involving substances other than alcohol. METHOD Current drinkers in a U.S. national survey (n = 22,005) were interviewed in 2001-02 and re-interviewed 3 years later. WHO drinking risk levels and DSM-IV-defined DUD were assessed at both waves. The relationship of changes in WHO drinking risk levels to the presence of DUD were examined using adjusted odds ratios (aOR). RESULTS At Wave 1, 2.5% of respondents were WHO very-high-risk drinkers, and 2.5%, 4.8%, and 90.2% were high-risk, moderate-risk, and low-risk drinkers, respectively. Among Wave 1 very-high-risk drinkers, significantly lower odds of DUD at Wave 2 were predicted by reductions in WHO risk levels of one, two or three levels (aOR = 0.15, 0.01, 0.24, respectively; all p-values <.0001). Among participants who initially were drinking at lower risk levels, reductions in drinking or abstinence were generally associated with significantly lower odds of DUD, although the results were less consistent. CONCLUSIONS Among very-high-risk drinkers, reduction in the WHO drinking risk categories were associated with lower risk of a DUD. These results add to findings indicating that reductions in WHO drinking risk levels are a meaningful indicator of how individuals feel and function and could therefore serve as informative outcomes in alcohol clinical trials. WHO risk levels can also guide treatment goals and clinical recommendations on drinking reduction.
Collapse
Affiliation(s)
- Justin Knox
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Melanie Wall
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA,Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Daniel E. Falk
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Deborah S. Hasin
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | | |
Collapse
|
26
|
Stevens JE, Steinley D, McDowell YE, Boness CL, Trull TJ, Martin CS, Sher KJ. Toward more efficient diagnostic criteria sets and rules: The use of optimization approaches in addiction science. Addict Behav 2019; 94:57-64. [PMID: 30777336 PMCID: PMC6544486 DOI: 10.1016/j.addbeh.2019.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/24/2019] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
Psychiatric diagnostic systems, such as The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), use expert consensus to determine diagnostic criteria sets and rules (DCSRs), rather than exploiting empirical techniques to arrive at optimal solutions (OS). Our project utilizes complete enumeration (i.e., generating all possible subsets of item combinations A and B with all possible thresholds, T) to evaluate all possible DCSRs given a set of relevant diagnostic data. This method yields the entire population distribution of diagnostic classifications (i.e., diagnosis of the disorder versus no diagnosis) produced by a set of dichotomous predictors (i.e., diagnostic criteria). Once unique sets are enumerated, optimization on some predefined correlate or predictor will maximally separate diagnostic groups on one or more, disorder-specific "outcome" criteria. We used this approach to illustrate how to create a common Substance Use Disorder (SUD) DCSR that is applicable to multiple substances. We demonstrate the utility of this approach with respect to alcohol use disorder and Cannabis Use Disorder (CUD) using DSM-5 criteria as input variables. The optimal SUD solution with a moderate or above severity grading included four criteria (i.e. 1) having a strong urge or craving for the substance (CR), 2) failure to fulfill major role obligations at work school or home (FF), 3) continued use of the substance despite social or interpersonal problems caused by the substance use (SI) and 4) physically hazardous use (HU)) with a diagnostic threshold of two. The derived DCSR was validated with known correlates of SUD and performed as well as DSM-5. Our findings illustrate the value of using an empirical approach to what is typically a subjective process of choosing criteria and algorithms that is prone to bias. The optimization of diagnostic criteria can reduce criteria set sizes, resulting in decreased research, clinician, and patient burden.
Collapse
Affiliation(s)
- Jordan E Stevens
- Department of Psychological Science, University of Missouri, United States.
| | - Douglas Steinley
- Department of Psychological Science, University of Missouri, United States
| | - Yoanna E McDowell
- Department of Psychological Science, University of Missouri, United States
| | - Cassandra L Boness
- Department of Psychological Science, University of Missouri, United States
| | - Timothy J Trull
- Department of Psychological Science, University of Missouri, United States
| | | | - Kenneth J Sher
- Department of Psychological Science, University of Missouri, United States
| |
Collapse
|
27
|
Boness CL, Stevens JE, Steinley D, Trull T, Sher KJ. Deriving alternative criteria sets for alcohol use disorders using statistical optimization: Results from the National Survey on Drug Use and Health. Exp Clin Psychopharmacol 2019; 27:283-296. [PMID: 30556734 PMCID: PMC6538450 DOI: 10.1037/pha0000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
Much of the foundation of clinical practice, psychiatric epidemiology, and research into the etiology, course, prevention, and treatment of alcohol use disorder (AUD) rests on psychiatric diagnosis. However, existing research has failed to adequately exploit empirical techniques and existing databases to derive criteria considered optimal with respect to predicting external correlates. The current project adopts a novel approach to deriving new diagnostic criteria sets and rules for AUD. Utilizing the 2010 (N = 24,120) and 2013 (N = 23,627) National Survey on Drug Use and Health (NSDUH; Substance Abuse and Mental Health Services Administration [SAMHSA], 2011, 2014) data sets, we performed a statistical optimization procedure, using complete enumeration, on participants 21 or older who had consumed at least 1 alcoholic beverage in the past year. The goal was to maximize the distance (based on Cohen's d) between mean levels of the optimization criteria (i.e., consumption and functional impairment) in those with an AUD diagnosis versus those without. In contrast with current convention, AUD is derived transparently using a data-driven approach. The best solution included 9 criteria with a diagnostic threshold of 3, while the second-best solution comprised 5 criteria with a threshold of 2. External validation demonstrated both solutions perform similarly, suggesting it is appropriate to use either, depending on the goal of the diagnosis. Overall, statistical optimization approaches can yield highly efficient criteria sets and rules, although multiple, near equivalently performing solutions can be generated. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
28
|
Knox J, Scodes J, Wall M, Witkiewitz K, Kranzler HR, Falk D, Litten R, Mann K, O’Malley SS, Anton R, Hasin DS. Reduction in non-abstinent WHO drinking risk levels and depression/anxiety disorders: 3-year follow-up results in the US general population. Drug Alcohol Depend 2019; 197:228-235. [PMID: 30852375 PMCID: PMC6440807 DOI: 10.1016/j.drugalcdep.2019.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/28/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Non-abstinent drinking reductions that predict improvement in how individuals feel or function, such as the World Health Organization (WHO) drinking risk levels, may be useful outcomes in clinical trials for alcohol use disorders (AUD). METHODS Current drinkers in a U.S. national survey (n = 22,005) were interviewed in 2001-02 (Wave 1) and re-interviewed 3 years later (Wave 2). WHO drinking risk levels, a 4- level categorization system (very-high-risk, high-risk, moderate-risk, and low-risk drinkers) defined using estimated mean ethanol consumption (grams) per day in the prior 12 months, and DSM-IV depressive and anxiety disorders were assessed at both waves. Logistic regression was used to produce adjusted odds ratios (aOR) testing the associations of changes between Wave 1 and Wave 2 WHO risk levels to the presence or persistence of depression and/or anxiety disorder by each initial Wave 1 risk level. RESULTS Among Wave 1 very-high-risk drinkers, lower odds of depression and/or anxiety disorders at Wave 2 were predicted by reductions in WHO risk levels of one-, two- or three-levels (aOR = 0.42, 0.37, 0.67, p-values 0.04-<.0001), as was the persistence of depression and/or anxiety disorders among those with such disorders at Wave 1 (aOR = 0.37, 0.29, 0.51, p-values .03-<.0001). Results were less consistent for participants initially drinking at lower risk levels. CONCLUSIONS Among very-high-risk drinkers, reductions in the WHO drinking risk categories were associated with lower risk of depression and/or anxiety disorders. These results add to findings indicating reductions in WHO risk levels are a meaningful indicator of how individuals feel and function.
Collapse
Affiliation(s)
- Justin Knox
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Melanie Wall
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA,Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, 6700B Rockledge Drive, Bethesda, MD 20892, USA
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT 06511, USA
| | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Deborah S. Hasin
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA,New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | | |
Collapse
|
29
|
Boness CL, Lane SP, Sher KJ. Not all alcohol use disorder criteria are equally severe: Toward severity grading of individual criteria in college drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:35-49. [PMID: 30676037 DOI: 10.1037/adb0000443] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol use disorder (AUD) diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) contains a severity gradient based on number of criteria endorsed, implicitly assuming criteria are interchangeable. However, criteria vary widely in endorsement rates, implying differences in the latent severity associated with a symptom (e.g., Lane, Steinley, & Sher, 2016) and demonstrating criteria are not interchangeable (Lane & Sher, 2015). We evaluated whether variation in the severity of criteria could be resolved by employing multiple indicators of each criterion varying in item-level severity. We assessed 909 undergraduate students aged 18 years or older with at least 12 drinking occasions in the past year. Participants self-administered questions on alcohol consumption and past year AUD symptoms via an online survey. For each of the 11 AUD criteria, we selected three indicators based on the difficulty values of the one-parameter logistic item response theory model ranging from low to high. We first tested a higher order AUD factor defined by 11 lower order criterion factors, χ2(551) = 2,959.35, p < .0001; root mean square error of approximation = 0.09. The 33 items were used to create severity scores: a criterion count (0-11), symptom count (0-33), and factor scores derived from a bifactor model. Though our new scores resulted in incremental validity over DSM-5 across a range of external validators, when the standardized regression estimates were compared, the new scores did not consistently outperform the DSM-5 suggesting this approach is viable for developing more sensitive diagnostic instruments but needs further refinement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Sean P Lane
- Department of Psychological Sciences, Purdue University
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri
| |
Collapse
|
30
|
Effectiveness and treatment moderators of internet interventions for adult problem drinking: An individual patient data meta-analysis of 19 randomised controlled trials. PLoS Med 2018; 15:e1002714. [PMID: 30562347 PMCID: PMC6298657 DOI: 10.1371/journal.pmed.1002714] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/13/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Face-to-face brief interventions for problem drinking are effective, but they have found limited implementation in routine care and the community. Internet-based interventions could overcome this treatment gap. We investigated effectiveness and moderators of treatment outcomes in internet-based interventions for adult problem drinking (iAIs). METHODS AND FINDINGS Systematic searches were performed in medical and psychological databases to 31 December 2016. A one-stage individual patient data meta-analysis (IPDMA) was conducted with a linear mixed model complete-case approach, using baseline and first follow-up data. The primary outcome measure was mean weekly alcohol consumption in standard units (SUs, 10 grams of ethanol). Secondary outcome was treatment response (TR), defined as less than 14/21 SUs for women/men weekly. Putative participant, intervention, and study moderators were included. Robustness was verified in three sensitivity analyses: a two-stage IPDMA, a one-stage IPDMA using multiple imputation, and a missing-not-at-random (MNAR) analysis. We obtained baseline data for 14,198 adult participants (19 randomised controlled trials [RCTs], mean age 40.7 [SD = 13.2], 47.6% women). Their baseline mean weekly alcohol consumption was 38.1 SUs (SD = 26.9). Most were regular problem drinkers (80.1%, SUs 44.7, SD = 26.4) and 19.9% (SUs 11.9, SD = 4.1) were binge-only drinkers. About one third were heavy drinkers, meaning that women/men consumed, respectively, more than 35/50 SUs of alcohol at baseline (34.2%, SUs 65.9, SD = 27.1). Post-intervention data were available for 8,095 participants. Compared with controls, iAI participants showed a greater mean weekly decrease at follow-up of 5.02 SUs (95% CI -7.57 to -2.48, p < 0.001) and a higher rate of TR (odds ratio [OR] 2.20, 95% CI 1.63-2.95, p < 0.001, number needed to treat [NNT] = 4.15, 95% CI 3.06-6.62). Persons above age 55 showed higher TR than their younger counterparts (OR = 1.66, 95% CI 1.21-2.27, p = 0.002). Drinking profiles were not significantly associated with treatment outcomes. Human-supported interventions were superior to fully automated ones on both outcome measures (comparative reduction: -6.78 SUs, 95% CI -12.11 to -1.45, p = 0.013; TR: OR = 2.23, 95% CI 1.22-4.08, p = 0.009). Participants treated in iAIs based on personalised normative feedback (PNF) alone were significantly less likely to sustain low-risk drinking at follow-up than those in iAIs based on integrated therapeutic principles (OR = 0.52, 95% CI 0.29-0.93, p = 0.029). The use of waitlist control in RCTs was associated with significantly better treatment outcomes than the use of other types of control (comparative reduction: -9.27 SUs, 95% CI -13.97 to -4.57, p < 0.001; TR: OR = 3.74, 95% CI 2.13-6.53, p < 0.001). The overall quality of the RCTs was high; a major limitation included high study dropout (43%). Sensitivity analyses confirmed the robustness of our primary analyses. CONCLUSION To our knowledge, this is the first IPDMA on internet-based interventions that has shown them to be effective in curbing various patterns of adult problem drinking in both community and healthcare settings. Waitlist control may be conducive to inflation of treatment outcomes.
Collapse
|
31
|
Knox J, Wall M, Witkiewitz K, Kranzler HR, Falk D, Litten R, Mann K, O'Malley SS, Scodes J, Anton R, Hasin DS. Reduction in Nonabstinent WHO Drinking Risk Levels and Change in Risk for Liver Disease and Positive AUDIT-C Scores: Prospective 3-Year Follow-Up Results in the U.S. General Population. Alcohol Clin Exp Res 2018; 42:2256-2265. [PMID: 30204248 PMCID: PMC6263142 DOI: 10.1111/acer.13884] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/04/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Abstinence is often the treatment aim for alcohol use disorders (AUD), but this may deter individuals who prefer drinking reduction goals from entering treatment, and be an overly restrictive end point in alcohol clinical trials. Nonabstinent drinking reductions that predict improvement in how individuals feel or function may be useful clinical trial outcomes, for example, reductions in the 4-category World Health Organization (WHO) drinking risk levels. To investigate the clinical relevance of these reductions, we examined their relationship with 2 outcomes of interest to medical providers: liver disease, and positive scores on an alcohol screening measure. METHODS Current drinkers in a U.S. national survey (n = 21,925) were interviewed in 2001 to 2002 (Wave 1) and re-interviewed 3 years later (Wave 2). WHO drinking risk levels, liver disease, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were assessed at both waves. Adjusted odds ratios (aORs) were used to indicate the association of change in WHO drinking risk levels with Wave 2 liver disease and AUDIT-C scores. RESULTS Wave 1 very-high-risk drinkers who reduced 1, 2, or 3 WHO drinking risk levels had significantly lower odds of Wave 2 liver disease (aORs = 0.34, 0.23, 0.17) and positive AUDIT-C scores (aORs = 0.27, 0.09, 0.03). Wave 1 high-risk drinkers who reduced 1 or 2 WHO risk levels had significantly lower odds of positive AUDIT-C scores (aORs = 0.61, 0.25). Adjusting for alcohol dependence or AUDIT-C scoring variations did not affect results. CONCLUSIONS In the highest-risk drinkers, reductions in WHO drinking risk levels predicted lower likelihood of liver disease and positive AUDIT-C scores. Results add to findings that reductions in the 4-category WHO drinking risk levels are a meaningful indicator of how individuals feel and function, and could serve as nonabstinent end points in clinical trials. Results also connect the WHO risk drinking levels to commonly used alcohol screening questions, which may be more familiar to healthcare providers.
Collapse
Affiliation(s)
- Justin Knox
- Department of Epidemiology, Columbia University Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Melanie Wall
- Department of Epidemiology, Columbia University Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
- Department of Biostatistics, Columbia University Medical Center, New York, New York
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Karl Mann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University Medical Center, New York, New York
- New York State Psychiatric Institute, New York, New York
| |
Collapse
|
32
|
Gili-Miner M, López-Méndez J, Vilches-Arenas A, Ramírez-Ramírez G, Franco-Fernández D, Sala-Turrens J, Béjar-Prado L. Multiple sclerosis and alcohol use disorders: in-hospital mortality, extended hospital stays, and overexpenditures. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
33
|
Bruguera P, Barrio P, Oliveras C, Braddick F, Gavotti C, Bruguera C, López‐Pelayo H, Miquel L, Segura L, Colom J, Ortega L, Vieta E, Gual A. Effectiveness of a Specialized Brief Intervention for At-risk Drinkers in an Emergency Department: Short-term Results of a Randomized Controlled Trial. Acad Emerg Med 2018; 25:517-525. [PMID: 29418049 DOI: 10.1111/acem.13384] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/19/2018] [Accepted: 02/01/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs have been developed, evaluated, and shown to be effective, particularly in primary care and general practice. Nevertheless, effectiveness of SBIRT in emergency departments (EDs) has not been clearly established. OBJECTIVE We aimed to evaluate the feasibility and efficacy of an SBIRT program conducted by highly specialized professionals in the ED of a tertiary hospital. METHODS We conducted a randomized controlled trial to study the feasibility and efficacy of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the three-item version of the Alcohol Use Disorder Identification Test (AUDIT-C). Patients were randomized to two groups, with the control group receiving two leaflets-one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. The primary outcomes were the proportion of at-risk alcohol use measured by AUDIT-C scale and the proportion of patients attending specialized treatment at 1.5 months. RESULTS Of 3,027 patients presenting to the ED, 2,044 (67%) were potentially eligible to participate, 247 (12%) screened positive for at-risk drinking, and 200 agreed to participate. Seventy-two percent of the participating sample were men, and the mean (±SD) age was 43 (±16.7) years. Follow-up rates were 76.5%. At 1.5 months, the intervention group showed greater reductions in alcohol consumption and fewer patients continuing with at-risk alcohol use (27.8% vs. 48.1%; p = 0.01). The SBIRT program also increased the probability of attending specialized treatment, compared to the control condition (23% vs. 9.8%, p = 0.0119) CONCLUSION: The SBIRT program in the ED was found to be feasible and effective in identifying at-risk drinkers, reducing at-risk alcohol use, and increasing treatment for alcohol problems.
Collapse
Affiliation(s)
- Pol Bruguera
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Pablo Barrio
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Clara Oliveras
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
| | - Fleur Braddick
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
| | - Carolina Gavotti
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
| | - Carla Bruguera
- Program on Substance Abuse Public Health Agency Government of Catalonia Barcelona Spain
| | - Hugo López‐Pelayo
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Laia Miquel
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Lídia Segura
- Program on Substance Abuse Public Health Agency Government of Catalonia Barcelona Spain
| | - Joan Colom
- Program on Substance Abuse Public Health Agency Government of Catalonia Barcelona Spain
| | - Lluisa Ortega
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Eduard Vieta
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM) Madrid Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| | - Antoni Gual
- Addictive Behaviors Unit Clinical Neuroscience Institute, Hospital Clínic Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology University of Barcelona Barcelona Spain
- Grup de Recerca en Addiccions Clínic Hospital Clínic de Barcelona IDIBAPS Universitat de Barcelona Red de Trastornos Adictivos (RETICS) Barcelona Spain
- Bipolar Disorder Program Institute of Neuroscience Hospital Clínic University of Barcelona IDIBAPS Barcelona Spain
| |
Collapse
|
34
|
Kaner EFS, Beyer FR, Muirhead C, Campbell F, Pienaar ED, Bertholet N, Daeppen JB, Saunders JB, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2018; 2:CD004148. [PMID: 29476653 PMCID: PMC6491186 DOI: 10.1002/14651858.cd004148.pub4] [Citation(s) in RCA: 256] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Excessive drinking is a significant cause of mortality, morbidity and social problems in many countries. Brief interventions aim to reduce alcohol consumption and related harm in hazardous and harmful drinkers who are not actively seeking help for alcohol problems. Interventions usually take the form of a conversation with a primary care provider and may include feedback on the person's alcohol use, information about potential harms and benefits of reducing intake, and advice on how to reduce consumption. Discussion informs the development of a personal plan to help reduce consumption. Brief interventions can also include behaviour change or motivationally-focused counselling.This is an update of a Cochrane Review published in 2007. OBJECTIVES To assess the effectiveness of screening and brief alcohol intervention to reduce excessive alcohol consumption in hazardous or harmful drinkers in general practice or emergency care settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and 12 other bibliographic databases to September 2017. We searched Alcohol and Alcohol Problems Science Database (to December 2003, after which the database was discontinued), trials registries, and websites. We carried out handsearching and checked reference lists of included studies and relevant reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. The comparison group was no or minimal intervention, where a measure of alcohol consumption was reported. 'Brief intervention' was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 minutes. Any more was considered an extended intervention. Digital interventions were not included in this review. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We carried out subgroup analyses where possible to investigate the impact of factors such as gender, age, setting (general practice versus emergency care), treatment exposure and baseline consumption. MAIN RESULTS We included 69 studies that randomised a total of 33,642 participants. Of these, 42 studies were added for this update (24,057 participants). Most interventions were delivered in general practice (38 studies, 55%) or emergency care (27 studies, 39%) settings. Most studies (61 studies, 88%) compared brief intervention to minimal or no intervention. Extended interventions were compared with brief (4 studies, 6%), minimal or no intervention (7 studies, 10%). Few studies targeted particular age groups: adolescents or young adults (6 studies, 9%) and older adults (4 studies, 6%). Mean baseline alcohol consumption was 244 g/week (30.5 standard UK units) among the studies that reported these data. Main sources of bias were attrition and lack of provider or participant blinding. The primary meta-analysis included 34 studies (15,197 participants) and provided moderate-quality evidence that participants who received brief intervention consumed less alcohol than minimal or no intervention participants after one year (mean difference (MD) -20 g/week, 95% confidence interval (CI) -28 to -12). There was substantial heterogeneity among studies (I² = 73%). A subgroup analysis by gender demonstrated that both men and women reduced alcohol consumption after receiving a brief intervention.We found moderate-quality evidence that brief alcohol interventions have little impact on frequency of binges per week (MD -0.08, 95% CI -0.14 to -0.02; 15 studies, 6946 participants); drinking days per week (MD -0.13, 95% CI -0.23 to -0.04; 11 studies, 5469 participants); or drinking intensity (-0.2 g/drinking day, 95% CI -3.1 to 2.7; 10 studies, 3128 participants).We found moderate-quality evidence of little difference in quantity of alcohol consumed when extended and no or minimal interventions were compared (-14 g/week, 95% CI -37 to 9; 6 studies, 1296 participants). There was little difference in binges per week (-0.08, 95% CI -0.28 to 0.12; 2 studies, 456 participants; moderate-quality evidence) or difference in days drinking per week (-0.45, 95% CI -0.81 to -0.09; 2 studies, 319 participants; moderate-quality evidence). Extended versus no or minimal intervention provided little impact on drinking intensity (9 g/drinking day, 95% CI -26 to 9; 1 study, 158 participants; low-quality evidence).Extended intervention had no greater impact than brief intervention on alcohol consumption, although findings were imprecise (MD 2 g/week, 95% CI -42 to 45; 3 studies, 552 participants; low-quality evidence). Numbers of binges were not reported for this comparison, but one trial suggested a possible drop in days drinking per week (-0.5, 95% CI -1.2 to 0.2; 147 participants; low-quality evidence). Results from this trial also suggested very little impact on drinking intensity (-1.7 g/drinking day, 95% CI -18.9 to 15.5; 147 participants; very low-quality evidence).Only five studies reported adverse effects (very low-quality evidence). No participants experienced any adverse effects in two studies; one study reported that the intervention increased binge drinking for women and two studies reported adverse events related to driving outcomes but concluded they were equivalent in both study arms.Sources of funding were reported by 67 studies (87%). With two exceptions, studies were funded by government institutes, research bodies or charitable foundations. One study was partly funded by a pharmaceutical company and a brewers association, another by a company developing diagnostic testing equipment. AUTHORS' CONCLUSIONS We found moderate-quality evidence that brief interventions can reduce alcohol consumption in hazardous and harmful drinkers compared to minimal or no intervention. Longer counselling duration probably has little additional effect. Future studies should focus on identifying the components of interventions which are most closely associated with effectiveness.
Collapse
Affiliation(s)
- Eileen FS Kaner
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona R Beyer
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Colin Muirhead
- Newcastle UniversityInstitute of Health and SocietyRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Fiona Campbell
- The University of SheffieldSchool of Health and Related ResearchRegent StreetSheffieldUKS1 4DA
| | - Elizabeth D Pienaar
- South African Medical Research CouncilCochrane South AfricaPO Box 19070TygerbergCape TownSouth Africa7505
| | - Nicolas Bertholet
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - Jean B Daeppen
- Lausanne University HospitalAlcohol Treatment Center, Department of Community Medicine and HealthLausanneSwitzerland
| | - John B Saunders
- Royal Brisbane and Women's HospitalDepartment of PsychiatryCentre for Drug & Alcohol StudiesSchool of MedicineUniversity of Queensland/Royal Brisbane HospitalQueenslandAustralia4029
| | - Bernard Burnand
- Lausanne University HospitalCochrane Switzerland, Institute of Social and Preventive MedicineBiopôle 2Route de la Corniche 10LausanneVaudSwitzerlandCH‐1010
| | | |
Collapse
|
35
|
Anderson P, Jané-Llopis E, Hasan OSM, Rehm J. City-based action to reduce harmful alcohol use: review of reviews. F1000Res 2018; 7:120. [PMID: 29862017 PMCID: PMC5843824 DOI: 10.12688/f1000research.13783.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 02/03/2023] Open
Abstract
Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms ("review" or "literature review" or "review literature" or "data pooling" or "comparative study" or "systematic review" or "meta-analysis" or "pooled analysis"), and "alcohol", and "intervention" and ("municipal" or "city" or "community"). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol. Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.
Collapse
Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne , NE2 4AX, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, Maastricht, 6221 HA , Netherlands
| | - Eva Jané-Llopis
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- ESADE Business School, Ramon Llull University, Av. Esplugues 92-96, Barcelona, 08034, Spain
| | - Omer Syed Muhammad Hasan
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8, Canada
- Institute of Medical Science (IMS) , University of Toronto, Medical Sciences Building,1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, Dresden, 01187 , Germany
| |
Collapse
|
36
|
Anderson P, Jané-Llopis E, Hasan OSM, Rehm J. City-based action to reduce harmful alcohol use: review of reviews. F1000Res 2018; 7:120. [PMID: 29862017 PMCID: PMC5843824 DOI: 10.12688/f1000research.13783.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms ("review" or "literature review" or "review literature" or "data pooling" or "comparative study" or "systematic review" or "meta-analysis" or "pooled analysis"), and "alcohol", and "intervention" and ("municipal" or "city" or "community"). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol. Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.
Collapse
Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne , NE2 4AX, UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, Maastricht, 6221 HA , Netherlands
| | - Eva Jané-Llopis
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- ESADE Business School, Ramon Llull University, Av. Esplugues 92-96, Barcelona, 08034, Spain
| | - Omer Syed Muhammad Hasan
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, ON M5T 1R8, Canada
- Institute of Medical Science (IMS) , University of Toronto, Medical Sciences Building,1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer Str. 46, Dresden, 01187 , Germany
| |
Collapse
|
37
|
Söderpalm B, Lidö HH, Ericson M. The Glycine Receptor-A Functionally Important Primary Brain Target of Ethanol. Alcohol Clin Exp Res 2017; 41:1816-1830. [PMID: 28833225 DOI: 10.1111/acer.13483] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/15/2017] [Indexed: 12/27/2022]
Abstract
Identification of ethanol's (EtOH) primary molecular brain targets and determination of their functional role is an ongoing, important quest. Pentameric ligand-gated ion channels, that is, the nicotinic acetylcholine receptor, the γ-aminobutyric acid type A receptor, the 5-hydroxytryptamine3 , and the glycine receptor (GlyR), are such targets. Here, aspects of the structure and function of these receptors and EtOH's interaction with them are briefly reviewed, with special emphasis on the GlyR and the importance of this receptor and its ligands for EtOH pharmacology. It is suggested that GlyRs are involved in (i) the dopamine-activating effect of EtOH, (ii) regulating EtOH intake, and (iii) the relapse preventing effect of acamprosate. Exploration of the GlyR subtypes involved and efforts to develop subtype specific agonists or antagonists may offer new pharmacotherapies for alcohol use disorders.
Collapse
Affiliation(s)
- Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Helga H Lidö
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Mia Ericson
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW The aim of this study is to summarise the current literature on both the impact and the implementation of primary health care-based screening and advice programmes to reduce heavy drinking, as an evidence-based component of managing alcohol use disorder in primary health care. RECENT FINDINGS Systematic reviews of reviews find conclusive evidence for the impact of primary health care delivered screening and brief advice programmes in reducing heavy drinking. The content, length of advice and which profession delivers the advice seems less important than the actual encounter between provider and patient. Despite the global burden of disease due to heavy drinking and the evidence that this can be reduced by screening and brief advice programmes delivered in primary health care, such programmes remain poorly implemented. Were such programmes widely implemented, there would be substantial health and productivity gains. Systematic reviews and international studies indicate that improved implementation requires tailoring of training and programme content to match the needs of providers, training and ongoing support and embedding of programmes within local community support, championed by local leaders. The next stage of implementation and scale-up of evidence-based screening and brief advice programmes should take place embedded within supportive local community action, with appropriate research to demonstrate impact.
Collapse
Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, 6221 HA Maastricht, Netherlands
| | - Amy O’Donnell
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| |
Collapse
|
39
|
Charlet K, Heinz A. Harm reduction-a systematic review on effects of alcohol reduction on physical and mental symptoms. Addict Biol 2017; 22:1119-1159. [PMID: 27353220 DOI: 10.1111/adb.12414] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 03/31/2016] [Accepted: 04/28/2016] [Indexed: 12/20/2022]
Abstract
Based on the knowledge that alcohol misuse causes a multitude of diseases and increased mortality, this systematic review examines whether a reduction of the individual alcohol consumption can contribute to a minimization of health risks within a harm reduction approach. In fact, the reviewed 63 studies indicate that interventions aiming at alcohol reduction (including total abstinence as one possible therapeutic aim) indeed resulted in or were associated with positive effects in harmful, hazardous or alcohol-dependent drinkers. Major benefits were observed for reducing alcohol-associated injuries, recovery of ventricular heart function in alcoholic cardiomyopathy, blood pressure lowering, normalization of biochemical parameter, body weight reduction, histological improvement in pre-cirrhotic alcohol-related liver disease and slowed progression of an already existing alcohol-attributable liver fibrosis. Furthermore, reduced withdrawal symptoms, prevalence of psychiatric episodes and duration of in-patient hospital days, improvement of anxiety and depression symptoms, self-confidence, physical and mental quality of life, fewer alcohol-related adverse consequences as well as lower psychosocial stress levels and better social functioning can result from reduced alcohol intake. The reviewed literature demonstrated remarkable socioeconomic cost benefits in areas such as the medical health-care system or workforce productivity. Individuals with heightened vulnerability further benefit significantly from alcohol reduction (e.g. hypertension, hepatitis C, psychiatric co-morbidities, pregnancy, but also among adolescents and young adults). Concluding, the reviewed studies strongly support and emphasize the importance and benefits of early initial screening for problematic alcohol use followed by brief and other interventions in first contact medical health-care facilities to reduce alcohol intake.
Collapse
Affiliation(s)
- Katrin Charlet
- Department of Psychiatry and Psychotherapy, Campus Mitte; Charité - Universitätsmedizin Berlin; Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Mitte; Charité - Universitätsmedizin Berlin; Germany
| |
Collapse
|
40
|
Luquiens A, Owens L, Whalley D, Rahhali N, Laramée P, Crawford R, Llorca PM, Falissard B, Aubin HJ. Health-related quality of life in alcohol dependence: Similar cross-cultural impact beyond specific drinking habits. J Ethn Subst Abuse 2017; 18:279-295. [PMID: 28805530 DOI: 10.1080/15332640.2017.1355765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study explores sociocultural differences in alcohol-related impact on quality of life between France and United Kingdom. We included 38 alcohol-dependent patients in France and United Kingdom in 10 focus groups. We used a text-mining approach. Three classes of each corpus regarded identical themes across the countries: (a) core impact on quality of life, (b) drinking habits, (c) sources of help. Core impact was similar between the two countries. Main differences were in drinking habits and referral to sources of help. Despite differences in drinking habits, the domains of life impacted by alcohol were non-country specific.
Collapse
Affiliation(s)
- Amandine Luquiens
- a Hôpital Paul Brousse, APHP , Villejuif , France.,b CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France
| | - Lynn Owens
- c Royal Liverpool and Broadgreen University Hospital Trust Alcohol Services , Liverpool , United Kingdom
| | - Diane Whalley
- d RTI Health Solutions , Didsbury , Manchester , United Kingdom
| | - Nora Rahhali
- e Lundbeck S.A.S., Issy-les-Moulineaux Cedex France
| | | | | | | | - Bruno Falissard
- b CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France
| | - Henri-Jean Aubin
- a Hôpital Paul Brousse, APHP , Villejuif , France.,b CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay , Villejuif , France
| |
Collapse
|
41
|
Anderson P, Coulton S, Kaner E, Bendtsen P, Kłoda K, Reynolds J, Segura L, Wojnar M, Mierzecki A, Deluca P, Newbury-Birch D, Parkinson K, Okulicz-Kozaryn K, Drummond C, Gual A. Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial. Ann Fam Med 2017; 15:335-340. [PMID: 28694269 PMCID: PMC5505452 DOI: 10.1370/afm.2051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/02/2017] [Accepted: 01/11/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians' delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool. METHODS We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months. RESULTS Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. CONCLUSIONS Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.
Collapse
Affiliation(s)
- Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond).
| | - Simon Coulton
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Preben Bendtsen
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Karolina Kłoda
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Jillian Reynolds
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Lidia Segura
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Marcin Wojnar
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Artur Mierzecki
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Paolo Deluca
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Dorothy Newbury-Birch
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Kathryn Parkinson
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Katarzyna Okulicz-Kozaryn
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Colin Drummond
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| | - Antoni Gual
- Institute of Health and Society, Newcastle University, Newcastle, England (Anderson, Kaner, Parkinson); Department of Family Medicine, Maastricht University, Maastricht, the Netherlands (Anderson); Centre for Health Service Studies, University of Kent, Canterbury, England (Coulton); Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden (Bendtsen); Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland (Kłoda, Mierzecki); Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain (Reynolds, Gual); Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain (Segura); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (Wojnar); National Addiction Centre, Institute of Psychiatry, King's College London, London, England (Deluca, Drummond); Health and Social Care Institute, Teesside University, Middesbrough, United Kingdom (Newbury-Birch); State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland (Okulicz-Kozaryn); National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, England (Drummond)
| |
Collapse
|
42
|
Hasin DS, Wall M, Witkiewitz K, Kranzler HR, Falk D, Litten R, Mann K, O'Malley SS, Scodes J, Robinson RL, Anton R. Change in non-abstinent WHO drinking risk levels and alcohol dependence: a 3 year follow-up study in the US general population. Lancet Psychiatry 2017; 4:469-476. [PMID: 28456501 PMCID: PMC5536861 DOI: 10.1016/s2215-0366(17)30130-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alcohol dependence is often untreated. Although abstinence is often the aim of treatment, many drinkers prefer drinking reduction goals. Therefore, if supported by evidence of benefit, drinking reduction goals could broaden the appeal of treatment. Regulatory agencies are considering non-abstinent outcomes as efficacy indicators in clinical trials, including reduction in WHO drinking risk levels-very high, high, moderate, and low-defined in terms of mean ethanol consumption (in grams) per day. We aimed to study the relationship between reductions in WHO drinking risk levels and subsequent reduction in the risk of alcohol dependence. METHODS In this population-based cohort study, we included data from 22 005 drinkers who were interviewed in 2001-02 (Wave 1) and re-interviewed 3 years later (2004-05; Wave 2) in the US National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol consumption (WHO drinking risk levels) and alcohol dependence (at least three of seven DSM-IV criteria in the previous 12 months) were assessed at both waves. We used logistic regression to test the relationship between change in WHO drinking risk levels between Waves 1 and 2, and alcohol dependence at Wave 2. FINDINGS At Wave 1, 2·5% (weighted proportion) of the respondents were very-high-risk drinkers, 2·5% were high-risk drinkers, 4·8% were moderate-risk drinkers, and most (90·2%) were low-risk drinkers. Reduction in WHO drinking risk level predicted significantly lower odds of alcohol dependence at Wave 2, particularly among very-high-risk drinkers (adjusted odds ratios 0·27 [95% CI 0·18-0·41] for reduction by one level, 0·17 [0·10-0·27] for two levels, and 0·07 [0·05-0·10] for three levels) and high-risk drinkers (0·64 [0·54-0·75] for one level and 0·12 [0·09-0·15] for two levels), and among those with alcohol dependence at Wave 1 (0·29 [0·15-0·57] for one level, 0·06 [0·04-0·10] for two levels, and 0·04 [0·03-0·06] for three levels in very-high-risk drinkers). INTERPRETATION Our results support the use of reductions in WHO drinking risk levels as an efficacy outcome in clinical trials. Because these risk levels can be readily translated into standard drink equivalents per day of different countries, the WHO risk levels could also be used internationally to guide treatment goals and clinical recommendations on drinking reduction. FUNDING US National Institute on Alcohol Abuse and Alcoholism, New York State Psychiatric Institute, the Alcohol Clinical Trials Initiative.
Collapse
Affiliation(s)
- Deborah S Hasin
- Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Melanie Wall
- Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Daniel Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Raye Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Karl Mann
- Central Institute of Mental Health, Mannheim, Germany
| | | | | | | | - Raymond Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
43
|
Rehm J, Hasan OSM, Imtiaz S, Neufeld M. Quantifying the contribution of alcohol to cardiomyopathy: A systematic review. Alcohol 2017; 61:9-15. [PMID: 28599715 DOI: 10.1016/j.alcohol.2017.01.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 12/21/2016] [Accepted: 01/20/2017] [Indexed: 02/07/2023]
Abstract
Alcohol has a direct toxic impact on the heart, and while there is an ICD code for alcoholic cardiomyopathy, the burden of alcohol-attributable cardiomyopathy is not clear. For the usual estimation of this burden via population-attributable fractions, one would need to determine the risk relationships, i.e., average risk associated with different dimensions of alcohol exposure. The most important among these risk relationships is the dose-response relationship with different levels of average alcohol consumption. To establish risk relationships, we systematically searched for all studies on dose-response relationships, directly and indirectly, via reviews. The results did not permit computation of pooled estimates through meta-analyses. There were clear indications that heavy drinking (≥80 g per day) over several years was linked to high risk of cardiomyopathy, with greater lifetime exposure of alcohol linked to higher risks. Some studies indicated potential effects of patterns of drinking as well. As such, the global quantification of alcohol-attributable cardiomyopathy will have to rely on other methods than those used conventionally.
Collapse
|
44
|
Are Brief Alcohol Interventions Adequately Embedded in UK Primary Care? A Qualitative Study Utilising Normalisation Process Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14040350. [PMID: 28350364 PMCID: PMC5409551 DOI: 10.3390/ijerph14040350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 12/03/2022]
Abstract
Despite substantial evidence for their effectiveness, the adoption of alcohol screening and brief interventions (ASBI) in routine primary care remains inconsistent. Financial incentive schemes were introduced in England between 2008 and 2015 to encourage their delivery. We used Normalisation Process Theory-informed interviews to understand the barriers and facilitators experienced by 14 general practitioners (GPs) as they implemented ASBI during this period. We found multiple factors shaped provision. GPs were broadly cognisant and supportive of preventative alcohol interventions (coherence) but this did not necessarily translate into personal investment in their delivery (cognitive participation). This lack of investment shaped how GPs operationalised such “work” in day-to-day practice (collective action), with ASBI mostly delegated to nurses, and GPs reverting to “business as usual” in their management and treatment of problem drinking (reflexive monitoring). We conclude there has been limited progress towards the goal of an effectively embedded preventative alcohol care pathway in English primary care. Future policy should consider screening strategies that prioritise patients with conditions with a recognised link with excessive alcohol consumption, and which promote more efficient identification of the most problematic drinkers. Improved GP training to build skills and awareness of evidence-based ASBI tools could also help embed best practice over time.
Collapse
|
45
|
Anderson P, Berridge V, Conrod P, Dudley R, Hellman M, Lachenmeier D, Lingford-Hughes A, Miller D, Rehm J, Room R, Schmidt L, Sullivan R, Ysa T, Gual A. Reframing the science and policy of nicotine, illegal drugs and alcohol - conclusions of the ALICE RAP Project. F1000Res 2017; 6:289. [PMID: 28435669 PMCID: PMC5381624 DOI: 10.12688/f1000research.10860.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2017] [Indexed: 01/09/2023] Open
Abstract
In 2013, illegal drug use was responsible for 1.8% of years of life lost in the European Union, alcohol was responsible for 8.2% and tobacco for 18.2%, imposing economic burdens in excess of 2.5% of GDP. No single European country has optimal governance structures for reducing the harm done by nicotine, illegal drugs and alcohol, and existing ones are poorly designed, fragmented, and sometimes cause harm. Reporting the main science and policy conclusions of a transdisciplinary five-year analysis of the place of addictions in Europe, researchers from 67 scientific institutions addressed these problems by reframing an understanding of addictions. A new paradigm needs to account for evolutionary evidence which suggests that humans are biologically predisposed to seek out drugs, and that, today, individuals face availability of high drug doses, consequently increasing the risk of harm. New definitions need to acknowledge that the defining element of addictive drugs is 'heavy use over time', a concept that could replace the diagnostic artefact captured by the clinical term 'substance use disorder', thus opening the door for new substances to be considered such as sugar. Tools of quantitative risk assessment that recognize drugs as toxins could be further deployed to assess regulatory approaches to reducing harm. Re-designed governance of drugs requires embedding policy within a comprehensive societal well-being frame that encompasses a range of domains of well-being, including quality of life, material living conditions and sustainability over time; such a frame adds arguments to the inappropriateness of policies that criminalize individuals for using drugs and that continue to categorize certain drugs as illegal. A health footprint, modelled on the carbon footprint, and using quantitative measures such as years of life lost due to death or disability, could serve as the accountability tool that apportions responsibility for who and what causes drug-related harm.
Collapse
Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Virginia Berridge
- Centre for History in Public Health, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Patricia Conrod
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Dudley
- Department of Integrative Biology, University of California, Berkeley, California, USA
| | - Matilda Hellman
- Center for Research on Addiction, Control and Governance (CEACG), Department of Social Research, University of Helsinki, Helsinki, Finland.,School of Social Sciences and Humanities, University of Tampere, Tampere, Finland
| | - Dirk Lachenmeier
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Karlsruhe, Germany
| | - Anne Lingford-Hughes
- Centre for Psychiatry, Division of Brain Sciences, Imperial College, Hammersmith Hospital, London, UK
| | - David Miller
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robin Room
- Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Laura Schmidt
- Institute for Health Policy Studies and Department of Anthropology, History and Social Medicine, School of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Roger Sullivan
- Department of Anthropology, California State University, Sacramento, Sacramento, California, USA
| | - Tamyko Ysa
- Esade-Gov and Department of Strategy, Esade Business School, Ramon Llull University, Barcelona, Spain
| | - Antoni Gual
- Addictions Unit, Department of Psychiatry, Clínic Institute of Neurosciences (ICN), Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
46
|
Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health 2017; 2:e108-e120. [PMID: 29253389 PMCID: PMC6118407 DOI: 10.1016/s2468-2667(17)30003-8] [Citation(s) in RCA: 257] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although it is well established that heavy alcohol consumption increases the risk of hypertension, little is known about the effect of a reduction of alcohol intake on blood pressure. We aimed to assess the effect of a reduction in alcohol consumption on change in blood pressure stratified by initial amount of alcohol consumption and sex in adults. METHODS In this systematic review and meta-analysis, we searched MedLine, Embase, CENTRAL, and ClinicalTrials.gov from database inception up to July 13, 2016, for trials investigating the effect of a change of alcohol consumption on blood pressure in adults using keywords and MeSH terms related to alcohol consumption, blood pressure, and clinical trials, with no language restrictions. We also searched reference lists of identified articles and published meta-analyses and reviews. We included full-text articles with original human trial data for the effect of a change of alcohol consumption on blood pressure in adults, which reported a quantifiable change in average alcohol consumption that lasted at least 7 days and a corresponding change in blood pressure. We extracted data from published reports. We did random-effects meta-analyses stratified by amount of alcohol intake at baseline. All meta-analyses were done with Stata (version 14.1). For the UK, we modelled the effect of a reduction of alcohol consumption for 50% of the population drinking more than two standard drinks per day (ie, 12 g pure alcohol per drink). FINDINGS 36 trials with 2865 participants (2464 men and 401 women) were included. In people who drank two or fewer drinks per day, a reduction in alcohol was not associated with a significant reduction in blood pressure; however, in people who drank more than two drinks per day, a reduction in alcohol intake was associated with increased blood pressure reduction. Reduction in systolic blood pressure (mean difference -5·50 mm Hg, 95% CI -6·70 to -4·30) and diastolic blood pressure (-3·97, -4·70 to -3·25) was strongest in participants who drank six or more drinks per day if they reduced their intake by about 50%. For the UK, the results would translate into more than 7000 inpatient hospitalisations and 678 cardiovascular deaths prevented every year. INTERPRETATION Reducing alcohol intake lowers blood pressure in a dose-dependent manner with an apparent threshold effect. Implementation of effective alcohol interventions in people who drink more than two drinks per day would reduce the disease burden from both alcohol consumption and hypertension, and should be prioritised in countries with substantial alcohol-attributable risk. FUNDING National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIH).
Collapse
Affiliation(s)
- Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Canada.
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Sheldon W Tobe
- Department of Medicine, University of Toronto, Toronto, Canada; Northern Ontario School of Medicine, Ontario, Canada
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; School of Electrical Engineering and Telecommunication, The University of New South Wales, New South Wales, Sydney, Australia
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Canada; Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Campbell Family Mental Health Research Institute, CAMH, Toronto, Canada
| |
Collapse
|
47
|
Mann K, Aubin HJ, Witkiewitz K. Reduced Drinking in Alcohol Dependence Treatment, What Is the Evidence? Eur Addict Res 2017; 23:219-230. [PMID: 28934736 DOI: 10.1159/000481348] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/03/2017] [Indexed: 12/22/2022]
Abstract
Abstinence from alcohol has been the prevailing treatment goal for individuals with alcohol dependence (AD) within the context of specialty alcohol treatment. Yet, alcohol use has been conceptualized as existing on a continuum. Importantly, most people who meet criteria for AD and could benefit from treatment never receive treatment. About half of these individuals do not seek treatment because they report a desire to continue drinking. To increase acceptability of treatment, reductions in alcohol consumption have been examined as alternative outcomes in treatment trials for AD. The current study reviews data which indicate that long-term reduction in alcohol consumption among patients with AD is possible. Controlled studies have tested reduced alcohol consumption and show sustained improvements in drinking reductions for many patients following behavioral treatments and pharmacotherapy. Evidence-based treatment guidelines and medicines development guidance authorities have taken note of these developments and accept "intermediate harm reduction" (European Medicines Agency) or "low-risk drinking limits" (US Federal Drug Administration) as optional trial endpoints. In conclusion, while abstinence remains the safest treatment goal for individuals with AD, evidence supports that reduced drinking approaches may be an important extension in the treatment of AD.
Collapse
Affiliation(s)
- Karl Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | | |
Collapse
|
48
|
Anderson P, Bendtsen P, Spak F, Reynolds J, Drummond C, Segura L, Keurhorst MN, Palacio-Vieira J, Wojnar M, Parkinson K, Colom J, Kłoda K, Deluca P, Baena B, Newbury-Birch D, Wallace P, Heinen M, Wolstenholme A, van Steenkiste B, Mierzecki A, Okulicz-Kozaryn K, Ronda G, Kaner E, Laurant MGH, Coulton S, Gual T. Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial. Addiction 2016; 111:1935-1945. [PMID: 27237081 DOI: 10.1111/add.13476] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/27/2015] [Accepted: 05/25/2016] [Indexed: 12/19/2022]
Abstract
AIM To test if training and support, financial reimbursement and option of referring screen-positive patients to an internet-based method of giving advice (eBI) can increase primary health-care providers' delivery of Alcohol Use Disorders Identification Test (AUDIT)-C-based screening and advice to heavy drinkers. DESIGN Cluster randomized factorial trial with 12-week implementation and measurement period. SETTING Primary health-care units (PHCU) in different locations throughout Catalonia, England, the Netherlands, Poland and Sweden. PARTICIPANTS A total of 120 PHCU, 24 in each of Catalonia, England, the Netherlands, Poland and Sweden. INTERVENTIONS PHCUs were randomized to one of eight groups: care as usual, training and support (TS), financial reimbursement (FR) and eBI; paired combinations of TS, FR and eBI, and all of FR, TS and eBI. MEASUREMENTS The primary outcome measure was the proportion of eligible adult (age 18+ years) patients screened during a 12-week implementation period. Secondary outcome measures were proportion of screen-positive patients advised; and proportion of consulting adult patients given an intervention (screening and advice to screen-positives) during the same 12-week implementation period. FINDINGS During a 4-week baseline measurement period, the proportion of consulting adult patients who were screened for their alcohol consumption was 0.059 per PHCU (95% CI 0.034 to 0.084). Based on the factorial design, the ratio of the logged proportion screened during the 12-week implementation period was 1.48 (95% CI = 1.13-1.95) in PHCU that received TS versus PHCU that did not receive TS; for FR, the ratio was 2.00 (95% CI = 1.56-2.56). The option of referral to eBI did not lead to a higher proportion of patients screened. The ratio for TS plus FR was 2.34 (95% CI = 1.77-3.10), and the ratio for TS plus FR plus eBI was1.68 (95% CI = 1.11-2.53). CONCLUSIONS Providing primary health-care units with training, support and financial reimbursement for delivering Alcohol Use Disorders Identification Test-C-based screening and advice to heavy drinkers increases screening for alcohol consumption. Providing primary health-care units with the option of referring screen-positive patients to an internet-based method of giving advice does not appear to increase screening for alcohol consumption.
Collapse
Affiliation(s)
- Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle, UK. .,Department of Family Medicine, Maastricht University, Maastricht, the Netherlands.
| | - Preben Bendtsen
- Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Sweden
| | - Fredrik Spak
- Department of Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jillian Reynolds
- Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Lidia Segura
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Myrna N Keurhorst
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands
| | - Jorge Palacio-Vieira
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Kathryn Parkinson
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Karolina Kłoda
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - Begoña Baena
- Program on Substance Abuse, Public Health Agency, Government of Catalonia, Barcelona, Spain
| | | | - Paul Wallace
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Maud Heinen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands
| | - Amy Wolstenholme
- National Addiction Centre, Institute of Psychiatry, King's College London, London, UK
| | - Ben van Steenkiste
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Artur Mierzecki
- Independent Laboratory of Family Physician Education, Pomeranian Medical University, Szczecin, Poland
| | | | - Gaby Ronda
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Miranda G H Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands.,HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Simon Coulton
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Toni Gual
- Institut Clínic de Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| |
Collapse
|
49
|
Gili-Miner M, López-Méndez J, Vilches-Arenas A, Ramírez-Ramírez G, Franco-Fernández D, Sala-Turrens J, Béjar-Prado L. Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures. Neurologia 2016; 33:S0213-4853(16)30173-6. [PMID: 27780613 DOI: 10.1016/j.nrl.2016.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/30/2016] [Accepted: 07/20/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. METHODS We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. RESULTS The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). CONCLUSIONS According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures.
Collapse
Affiliation(s)
- M Gili-Miner
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J López-Méndez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - A Vilches-Arenas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena, Sevilla, España
| | - G Ramírez-Ramírez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Virgen Macarena, Sevilla, España
| | - D Franco-Fernández
- Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, España; Servicio de Salud Mental, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J Sala-Turrens
- Unidad de Documentación Clínica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - L Béjar-Prado
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España
| |
Collapse
|
50
|
Rolland B, Paille F, Gillet C, Rigaud A, Moirand R, Dano C, Dematteis M, Mann K, Aubin HJ. Pharmacotherapy for Alcohol Dependence: The 2015 Recommendations of the French Alcohol Society, Issued in Partnership with the European Federation of Addiction Societies. CNS Neurosci Ther 2016; 22:25-37. [PMID: 26768685 DOI: 10.1111/cns.12489] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The latest French good practice recommendations (GPRs) for the screening, prevention, and treatment of alcohol misuse were recently published in partnership with the European Federation of Addiction Societies (EUFAS). This article aims to synthesize the GPRs focused on the pharmacotherapy of alcohol dependence. METHODS A four-member European steering committee defined the questions that were addressed to an 18-member multiprofessional working group (WG). The WG developed the GPRs based on a systematic, hierarchical, and structured literature search and submitted the document to two review processes involving 37 French members from multiple disciplines and 5 non-French EUFAS members. The final GPRs were graded A, B, or C, or expert consensus (EC) using a reference recommendation grading system. RESULTS The treatment of alcohol dependence consists of either alcohol detoxification or abstinence maintenance programs or drinking reduction programs. The therapeutic objective is the result of a decision made jointly by the physician and the patient. For alcohol detoxification, benzodiazepines (BZDs) are recommended in first-line (grade A). BZD dosing should be guided by regular clinical monitoring (grade B). Residential detoxification is more appropriate for patients with a history of seizures, delirium tremens, unstable psychiatric comorbidity, or another associated substance use disorder (grade B). BZDs are only justified beyond a 1-week period in the case of persistent withdrawal symptoms, withdrawal events or associated BZD dependence (grade B). BZDs should not be continued for more than 4 weeks (grade C). The dosing and duration of thiamine (vitamin B1) during detoxification should be adapted to nutritional status (EC). For relapse prevention, acamprosate and naltrexone are recommended as first-line medications (grade A). Disulfiram can be proposed as second-line option in patients with sufficient information and supervision (EC). For reducing alcohol consumption, nalmefene is indicated in first line (grade A). The second-line prescription of baclofen, up to 300 mg/day, to prevent relapse or reduce drinking should be carried out according to the "temporary recommendation for use" measure issued by the French Health Agency (EC). During pregnancy, abstinence is recommended (EC). If alcohol detoxification is conducted during pregnancy, BZD use is recommended (grade B). No medication other than those for alcohol detoxification should be initiated in pregnant or breastfeeding women (EC). In a stabilized pregnant patient taking medication to support abstinence, the continuation of the drug should be considered on a case-by-case basis, weighing the benefit/risk ratio. Only disulfiram should be always stopped, given the unknown risks of the antabuse effect on the fetus (EC). First-line treatments to help maintain abstinence or reduce drinking are off-label for people under 18 years of age and should thus be considered on a case-by-case basis after the repeated failure of psychosocial measures alone (EC). Short half-life BZDs should be preferred for the detoxification of elderly patients (grade B). The initial doses of BZDs should be reduced by 30 to 50% in elderly patients (EC). In patients with chronic alcohol-related physical disorders, abstinence is recommended (EC). Any antidepressant or anxiolytic medication should be introduced after a psychiatric reassessment after 2-4 weeks of alcohol abstinence or low-risk use (grade B). A smoking cessation program should be offered to any smokers involved in an alcohol treatment program (grade B).
Collapse
Affiliation(s)
- Benjamin Rolland
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Service d'Addictologie, CHRU de Lille, INSERM U1171, Univ Lille, Lille, France
| | - François Paille
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Service d'Addictologie, CHU de Nancy, Vandœuvre-lès-Nancy, Nancy, France
| | - Claudine Gillet
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Centre d'Addictologie, Hôpital Villemin, Nancy, France
| | - Alain Rigaud
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Pôle d'addictologie, EPSM Marne, Châlons-en-Champagne et Reims, Reims, France.,Association Nationale de Prévention en Alcoologie et Addictologue (ANPAA), Paris, France
| | - Romain Moirand
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,CHU de Rennes, Unité d'Addictologie, Rennes, France.,INSERM, UMR 991, Rennes, France
| | - Corine Dano
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Service d'Addictologie, CHU d'Angers, Angers, France
| | - Maurice Dematteis
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,Clinique d'Addictologie, CHU de Grenoble, Université Grenoble Alpes, Grenoble, France
| | - Karl Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD), Clinic Hospital of Barcelona, Addictive Behaviors Unit, Barcelona, Spain
| | - Henri-Jean Aubin
- Société Française d'Alcoologie, Issy-les-Moulineaux, France.,EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD), Clinic Hospital of Barcelona, Addictive Behaviors Unit, Barcelona, Spain.,Département de Psychiatrie et d'Addictologie, INSERM U1178, Hôpital Paul Brousse, APHP Villejuif, Villejuif, France
| |
Collapse
|