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Domi A, Cadeddu D, Lucente E, Gobbo F, Edvardsson C, Petrella M, Jerlhag E, Ericson M, Söderpalm B, Adermark L. Pre- and postsynaptic signatures in the prelimbic cortex associated with "alcohol use disorder" in the rat. Neuropsychopharmacology 2024:10.1038/s41386-024-01887-2. [PMID: 38755284 DOI: 10.1038/s41386-024-01887-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/20/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
The transition to alcohol use disorder (AUD) involves persistent neuroadaptations in executive control functions primarily regulated by the medial prefrontal cortex. However, the neurophysiological correlates to behavioral manifestations of AUD are not fully defined. The association between cortical neuroadaptations and behavioral manifestations of addiction was studied using a multi-symptomatic operant model based on the DSM-5 diagnostic criteria for AUD. This model aimed to characterize an AUD-vulnerable and AUD-resistant subpopulation of outbred male Wistar rats and was combined with electrophysiological measurements in the prelimbic cortex (PL). Mirroring clinical observations, rats exhibited individual variability in their vulnerability to develop AUD-like behavior, including motivation to seek for alcohol (crit 1), increased effort to obtain the substance (crit 2), and continued drinking despite negative consequences (crit 3). Only a small subset of rats met all the aforementioned AUD criteria (3 crit, AUD-vulnerable), while a larger fraction was considered AUD-resilient (0 crit). The development of AUD-like behavior was characterized by disruptions in glutamatergic synaptic activity, involving decreased frequency of spontaneous excitatory postsynaptic currents (sEPSCs) and heightened intrinsic excitability in layers 2/3 PL pyramidal neurons. These alterations were concomitant with a significant impairment in the ability of mGlu2/3 receptors to negatively regulate glutamate release in the PL but not in downstream regions like the basolateral amygdala or nucleus accumbens core. In conclusion alterations in PL synaptic activity were strongly associated with individual addiction scores, indicating their role as potential markers of the behavioral manifestations linked to AUD psychopathology.
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Affiliation(s)
- Ana Domi
- Institute of Neuroscience and Physiology, Department of Pharmacology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 90, Sweden.
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 45, Sweden.
| | - Davide Cadeddu
- Institute of Neuroscience and Physiology, Department of Pharmacology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 90, Sweden
| | - Erika Lucente
- Institute of Neuroscience and Physiology, Department of Pharmacology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 90, Sweden
| | - Francesco Gobbo
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9JZ, UK
| | - Christian Edvardsson
- Institute of Neuroscience and Physiology, Department of Pharmacology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 90, Sweden
| | - Michele Petrella
- Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences, Linköping, Sweden
| | - Elisabet Jerlhag
- Institute of Neuroscience and Physiology, Department of Pharmacology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 90, Sweden
| | - Mia Ericson
- Institute of Neuroscience and Physiology, Department of Pharmacology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 90, Sweden
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 45, Sweden
| | - Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 45, Sweden
- The Clinic for Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Louise Adermark
- Institute of Neuroscience and Physiology, Department of Pharmacology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 90, Sweden
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, 413 45, Sweden
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Lange S, Jiang H, Bagge C, Probst C, Tran A, Rehm J. Gender-specific risk relationship between heavy alcohol use/alcohol use disorders and suicidal thoughts and behavior among adults in the United States over time. Soc Psychiatry Psychiatr Epidemiol 2022; 57:721-726. [PMID: 35032174 PMCID: PMC8969096 DOI: 10.1007/s00127-022-02225-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Suicidal thoughts and behaviors have been on the rise in the recent years in the US. There is a well-known link between heavy alcohol use/alcohol use disorders (AUDs) and suicidal thoughts and behaviors. An increase in the respective risk relationships is one way in which heavy alcohol use/AUDs may be driving the increase in the rate of suicidal thoughts and behaviors. The objective of the current study was to investigate whether the gender-specific risk relationships between heavy alcohol use/AUDs and past-year (1) suicidal thoughts and (2) attempted suicide have increased over time. METHODS Individual-level annual data from the National Survey on Drug Use and Health for the past 12 years (2008-2019) were utilized. Year- and gender-specific multivariate binary logistic regression analyses were first conducted. Gender-stratified random-effects meta-regressions across study years were then conducted. RESULTS Heavy alcohol use/AUDs were associated with elevated odds of past-year suicidal thoughts and attempted suicide for both men and women; however, a linear increase in the risk relationships over time was not found. CONCLUSION Although a temporal increase in the risk relationships of interest was not found, until additional research in this area is conducted, heavy alcohol use/AUDs cannot be ruled out as being a driving force behind the increasing rate of suicidal thoughts and behaviors in the US.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St., Room T521, Toronto, ON, M5S 2S1, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St., Room T521, Toronto, ON, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Courtney Bagge
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St., Room T521, Toronto, ON, M5S 2S1, Canada
- Heidelberg Institute for Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St., Room T521, Toronto, ON, M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St., Room T521, Toronto, ON, M5S 2S1, 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
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Dutey-Magni P, Brown J, Holmes J, Sinclair J. Concurrent validity of an estimator of weekly alcohol consumption (EWAC) based on the extended AUDIT. Addiction 2022; 117:580-589. [PMID: 34374144 DOI: 10.1111/add.15662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The three-question Alcohol Use Disorders Identification Test (AUDIT-C) is frequently used in healthcare for screening and brief advice about levels of alcohol consumption. AUDIT-C scores (0-12) provide feedback as categories of risk rather than estimates of actual alcohol intake, an important metric for behaviour change. The study aimed to (i) develop a continuous metric from the Extended AUDIT-C expressed in United Kingdom (UK) units (8 g pure ethanol), offering equivalent accuracy, and providing a direct estimator of weekly alcohol consumption (EWAC) and (ii) evaluate the EWAC's bias and error using the graduated-frequency (GF) questionnaire as a reference standard of alcohol consumption. DESIGN Cross-sectional diagnostic study based on a nationally-representative survey. SETTINGS Community dwelling households in England. PARTICIPANTS A total of 22 404 household residents aged ≥16 years reporting drinking alcohol at least occasionally. MEASUREMENTS Computer-assisted personal interviews consisting of (i) AUDIT questionnaire with extended response items (the 'Extended AUDIT') and (ii) GF. Primary outcomes were: mean deviation <1 UK unit (metric of bias); root-mean-square deviation <2 UK units (metric of total error) between EWAC and GF. The secondary outcome was the receiver operating characteristic area under the curve for predicting alcohol consumption in excess of 14 and 35 UK units. FINDINGS EWAC had a positive bias of 0.2 UK units (95% CI = 0.08, 0.4) compared with GF. Deviations were skewed: whereas the mean error was ±11 UK units/week [9.5, 11.9], in half of participants the deviation between EWAC and GF was between 0 and ±2.1 UK units/week. EWAC predicted consumption in excess of 14 UK units/week with a significantly greater area under the curve (0.918 [0.914, 0.923]) than AUDIT-C (0.870 [0.864, 0.876]) or the full AUDIT (0.854 [0.847, 0.860]). CONCLUSIONS A new estimator of weekly alcohol consumption, which uses answers to the Extended AUDIT-C, meets the targeted bias tolerance. It is superior in accuracy to AUDIT-C and the full 10-item AUDIT when predicting consumption thresholds, making it a reliable complement to the Extended AUDIT-C for health promotion interventions.
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Affiliation(s)
- Peter Dutey-Magni
- Institute of Health Informatics, University College London, London, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jamie Brown
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; Institute of Medical Science, Dalla Lana School of Public Health, and Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Robin Room
- Centre for Alcohol Policy Research, Turning Point, Fitzroy, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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Morojele NK, Shenoi SV, Shuper PA, Braithwaite RS, Rehm J. Alcohol Use and the Risk of Communicable Diseases. Nutrients 2021; 13:3317. [PMID: 34684318 PMCID: PMC8540096 DOI: 10.3390/nu13103317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/12/2023] Open
Abstract
The body of knowledge on alcohol use and communicable diseases has been growing in recent years. Using a narrative review approach, this paper discusses alcohol's role in the acquisition of and treatment outcomes from four different communicable diseases: these include three conditions included in comparative risk assessments to date-Human Immunodeficiency Virus (HIV)/AIDS, tuberculosis (TB), and lower respiratory infections/pneumonia-as well as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) because of its recent and rapid ascension as a global health concern. Alcohol-attributable TB, HIV, and pneumonia combined were responsible for approximately 360,000 deaths and 13 million disability-adjusted life years lost (DALYs) in 2016, with alcohol-attributable TB deaths and DALYs predominating. There is strong evidence that alcohol is associated with increased incidence of and poorer treatment outcomes from HIV, TB, and pneumonia, via both behavioral and biological mechanisms. Preliminary studies suggest that heavy drinkers and those with alcohol use disorders are at increased risk of COVID-19 infection and severe illness. Aside from HIV research, limited research exists that can guide interventions for addressing alcohol-attributable TB and pneumonia or COVID-19. Implementation of effective individual-level interventions and alcohol control policies as a means of reducing the burden of communicable diseases is recommended.
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Affiliation(s)
- Neo K. Morojele
- Department of Psychology, University of Johannesburg, Johannesburg 2006, South Africa
| | - Sheela V. Shenoi
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA;
- Yale Institute for Global Health, Yale University, New Haven, CT 06520, USA
| | - Paul A. Shuper
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; (P.A.S.); (J.R.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
| | - Ronald Scott Braithwaite
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU Grossman School of Medicine, New York University, New York, NY 10013, USA;
| | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; (P.A.S.); (J.R.)
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, 01187 Dresden, Germany
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
- Program on Substance Abuse, Public Health Agency of Catalonia, 08005 Barcelona, Spain
- Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
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Rehm J, Neufeld M, Yurasova E, Bunova A, Gil A, Gornyi B, Breda J, Bryun E, Drapkina O, Fadeeva E, Kalinina A, Khaltourina D, Klimenko T, Kontsevaya A, Koshkina E, Martynova N, Nadezhdin A, Soshkina K, Tetenova E, Vujnovic M, Vyshinsky K, Ferreira-Borges C. Adaptation of and Protocol for the Validation of the Alcohol Use Disorders Identification Test (AUDIT) in the Russian Federation for Use in Primary Healthcare. Alcohol Alcohol 2021; 55:624-630. [PMID: 32728707 PMCID: PMC7576502 DOI: 10.1093/alcalc/agaa067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 01/10/2023] Open
Abstract
Aims To adapt and validate the Alcohol Use Disorders Identification Test (AUDIT) for use in the Russian Federation and countries with Russian-speaking populations by: Methods Systematic review of past use and validation of the Russian-language AUDIT. Interviews to be conducted with experts to identify problems encountered in the use of existing Russian-language AUDIT versions. A pilot study using a revised translation of the Russian-language AUDIT that incorporates country-specific drinking patterns in the Russian Federation. Results and Conclusions The systematic review identified over 60 different Russian-language AUDIT versions without systematic validation studies. The main difficulties encountered with the use of the AUDIT in the Russian Federation were related to the lack of: A revised version of the Russian-language AUDIT was created based on the pilot studies, and was validated in primary healthcare facilities in all regions in 2019/2020.
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Affiliation(s)
- Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer St. 46, Dresden 01187, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, Ontario M5T 1R8, Canada.,Institute of Medical Science (IMS), 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.,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario M5T 3M7, Canada.,Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya St., 8, b. 2, Moscow 119992, Russian Federation
| | - Maria Neufeld
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Chemnitzer St. 46, Dresden 01187, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.,WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Elena Yurasova
- WHO Office in the Russian Federation, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Anna Bunova
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Artyom Gil
- Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya St., 8, b. 2, Moscow 119992, Russian Federation
| | - Boris Gornyi
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - João Breda
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Evgeniy Bryun
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Oxana Drapkina
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Eugenia Fadeeva
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Anna Kalinina
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Daria Khaltourina
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Dobrolyubov Street 11, Moscow 127254, Russian Federation
| | - Tatiana Klimenko
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Anna Kontsevaya
- National Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow 101990, Russian Federation
| | - Evgenia Koshkina
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Natalya Martynova
- Department of Public Health and Communications, Ministry of Health of the Russian Federation, Rakhmanovsky Pereulok 3, Moscow 127051, Russian Federation
| | - Alexey Nadezhdin
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Kristina Soshkina
- Department of Public Health and Communications, Ministry of Health of the Russian Federation, Rakhmanovsky Pereulok 3, Moscow 127051, Russian Federation
| | - Elena Tetenova
- Moscow Research and Practical Centre for Narcology of the Department of Public Health, Lublinskay Street 37/1, Moscow 109390, Russian Federation
| | - Melita Vujnovic
- WHO Office in the Russian Federation, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
| | - Konstantin Vyshinsky
- National Research Centre on Addictions-branch, V. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Maly Mogiltsevskiy Pereulok 3, Moscow 119034, Russian Federation
| | - Carina Ferreira-Borges
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Leontyevsky Pereulok 9, Moscow 125009, Russian Federation
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Jiang H, Lange S, Tran A, Imtiaz S, Rehm J. Determining the sex-specific distributions of average daily alcohol consumption using cluster analysis: is there a separate distribution for people with alcohol dependence? Popul Health Metr 2021; 19:28. [PMID: 34098997 PMCID: PMC8186209 DOI: 10.1186/s12963-021-00261-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It remains unclear whether alcohol use disorders (AUDs) can be characterized by specific levels of average daily alcohol consumption. The aim of the current study was to model the distributions of average daily alcohol consumption among those who consume alcohol and those with alcohol dependence, the most severe AUD, using various clustering techniques. METHODS Data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used in the current analyses. Clustering algorithms were applied in order to group a set of data points that represent the average daily amount of alcohol consumed. Gaussian Mixture Models (GMMs) were then used to estimate the likelihood of a data point belonging to one of the mixture distributions. Individuals were assigned to the clusters which had the highest posterior probabilities from the GMMs, and their treatment utilization rate was examined for each of the clusters. RESULTS Modeling alcohol consumption via clustering techniques was feasible. The clusters identified did not point to alcohol dependence as a separate cluster characterized by a higher level of alcohol consumption. Among both females and males with alcohol dependence, daily alcohol consumption was relatively low. CONCLUSIONS Overall, we found little evidence for clusters of people with the same drinking distribution, which could be characterized as clinically relevant for people with alcohol use disorders as currently defined.
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Affiliation(s)
- Huan Jiang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada.
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
| | - Shannon Lange
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Alexander Tran
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario, M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 6th Floor, 155 College Street, Toronto, Ontario, M5T 3M7, Canada
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, D-01187, Dresden, Germany
- Campbell Family Mental Health Research Institute, CAMH, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
- Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, 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
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246, Hamburg, Germany
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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.
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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
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Weatherall TJ, Conigrave JH, Conigrave KM, Perry J, Wilson S, Room R, Fitts MS, Hayman N, Lee KSK. Prevalence and correlates of alcohol dependence in an Australian Aboriginal and Torres Strait Islander representative sample: Using the Grog Survey App. Drug Alcohol Rev 2021; 41:125-134. [PMID: 33896067 DOI: 10.1111/dar.13292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Little is known about the prevalence of current alcohol dependence in Indigenous Australian communities. Here we identify the frequency of reported symptoms, estimate the prevalence and describe the correlates of current alcohol dependence. METHODS A representative sample of Indigenous Australians (16+ years) was recruited from an urban and remote community in South Australia. Data were collected between July and October 2019 via a tablet computer-based application. Participants were likely dependent if they reported two or more dependence symptoms (ICD-11; in the last 12 -months), weekly or more frequently. Chi-square tests described the relationship between demographics, remoteness and alcohol dependence. Spearman correlations estimated the relationship between symptoms of dependence, consumption characteristics and demographics. RESULTS A total of 775 Indigenous Australians participated. The most frequently reported symptoms were prioritising alcohol over other things and loss of control. Overall, 2.2% were likely dependent on alcohol (n = 17/775). Prevalence did not vary by remoteness. Participants who drank more and more frequently tended to report more frequent symptoms of dependence. In the urban site, men tended to report more frequent symptoms of dependence than women. Age, income and schooling were not linked to dependence. DISCUSSION AND CONCLUSIONS The prevalence of current alcohol dependence in this representative sample was similar to that of the general Australian and international estimates. Understanding risk factors for current alcohol dependence will be useful to inform the allocation of funding and support. Accurate estimates of the prevalence of current alcohol dependence are important to better identify specialist treatment needs.
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Affiliation(s)
- Teagan J Weatherall
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - James H Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
| | - Katherine M Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jimmy Perry
- Aboriginal Drug and Alcohol Council South Australia, Adelaide, Australia
| | - Scott Wilson
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia.,Aboriginal Drug and Alcohol Council South Australia, Adelaide, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Michelle S Fitts
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,Menzies School of Health Research, Alice Springs, Australia
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia.,National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
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10
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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.
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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.
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11
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Mravčík V, Chomynová P, Nechanská B, Černíková T, Csémy L. Alcohol use and its consequences in the Czech Republic. Cent Eur J Public Health 2020; 27 Suppl:S15-S28. [PMID: 31901189 DOI: 10.21101/cejph.a5728] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/10/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Alcohol consumption is associated with substantial public health burden. This article summarises available information on the patterns and prevalence of alcohol use in the Czech Republic with a focus on the heavy alcohol use and its health and social consequences. METHODS A non-systematic literature review was conducted. The data sources included primarily 3 series of surveys in the adult population, 2 series of surveys in the school population, routine monitoring system of per capita alcohol consumption, routine statistics on alcohol-related morbidity and mortality, and alcohol-related crime. RESULTS In recent years the registered alcohol consumption in the Czech Republic has been very high; 9.8 litres of pure alcohol were consumed per capita in 2017. Recently, the prevalence of hazardous alcohol consumption in the adult population has reached 16.8-17.6% and harmful alcohol consumption 9.0-9.3%. From 12% to 17% of adult population and 12% of adolescent population were heavy episodic drinkers. Alcohol-related disorders are disproportionately higher (2-3 times) among men. Mortality for alcohol-related causes fully attributable to alcohol (AAF = 100%) and their proportion in overall mortality is on increase. CONCLUSIONS Alcohol consumption as well as the prevalence of heavy episodic drinking in the Czech Republic belongs among the highest globally. On the other hand, declines in alcohol use have been recently observed among children and adolescents. Available data on alcohol-related morbidity indicate stable situation, though alcohol-related mortality is increasing. Alcohol-related burden is rather underestimated and evidence-based alcohol policy should be increasingly implemented.
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Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic.,Centre for Epidemiological and Clinical Research on Addictions, National Institute of Mental Health, Klecany, Czech Republic
| | - Pavla Chomynová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic.,Centre for Epidemiological and Clinical Research on Addictions, National Institute of Mental Health, Klecany, Czech Republic
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Centre for Epidemiological and Clinical Research on Addictions, National Institute of Mental Health, Klecany, Czech Republic.,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Tereza Černíková
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic
| | - Ladislav Csémy
- Centre for Epidemiological and Clinical Research on Addictions, National Institute of Mental Health, Klecany, Czech Republic.,National Institute of Public Health, Prague, Czech Republic
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12
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Manthey J, Lindemann C, Verthein U, Frischknecht U, Kraus L, Reimer J, Grün A, Kiefer F, Schulte B, Rehm J. [Provision of healthcare for people with risky alcohol use and severe alcohol use disorders in the state of Bremen, Germany: demand and guideline concordance?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:122-130. [PMID: 31828370 DOI: 10.1007/s00103-019-03072-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early detection of risky alcohol use and severe alcohol use disorders (AUDs) is crucial to avoid adverse health consequences. The German "Guidelines on Screening, Diagnosis and Treatment of Alcohol Use Disorders" recommend to routinely screen patients for hazardous alcohol use and to subsequently conduct brief interventions, for example in primary healthcare. For severe AUDs, provision of withdrawal treatment is recommended in inpatient settings if complications are anticipated. OBJECTIVES To estimate the proportion of people with hazardous alcohol use or severe AUDs receiving healthcare as stipulated by the guidelines. MATERIALS AND METHODS The prevalence of hazardous use (female ≥12 g; male ≥24 g) and severe AUDs (female ≥60 g; male ≥90 g) was estimated using per capita consumption of pure alcohol. Treatment rates were estimated using survey data (for hazardous use) and inpatient admissions (for severe AUDs). All estimates refer to the adult population (15 years or older) of the federal state of Bremen for 2016. RESULTS Physicians screened 2.9% of all people with hazardous alcohol use and conducted brief interventions with 1.4%. Among people with severe AUDs, 7.1% received inpatient treatment. Among people with severe AUDs who required inpatient treatment, 14.1% received withdrawal treatment in inpatient settings. Treatment rates below average were registered among 21- to 39-year-olds. CONCLUSIONS In Bremen, provision of guideline-conform healthcare for hazardous alcohol use and severe AUDs is insufficient, especially among 21- to 39-year-olds.
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Affiliation(s)
- Jakob Manthey
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Straße 46, 01187, Dresden, Deutschland. .,Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.
| | - Christina Lindemann
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Uwe Verthein
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Ulrich Frischknecht
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, München, Deutschland.,Department for Public Health Sciences, Stockholm University, Stockholm, Schweden.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | - Jens Reimer
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.,Gesundheit Nord, Bremen, Deutschland
| | | | - Falk Kiefer
- Feuerlein Centrum für Translationale Suchtmedizin, Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Bernd Schulte
- Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Jürgen Rehm
- Institut für Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Straße 46, 01187, Dresden, Deutschland.,Zentrum für Interdisziplinäre Suchtforschung (ZIS), Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Kanada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Kanada.,Department of Psychiatry, University of Toronto, Toronto, Kanada.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moskau, Russland
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13
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Rehm J, Shield KD. Global Burden of Alcohol Use Disorders and Alcohol Liver Disease. Biomedicines 2019; 7:E99. [PMID: 31847084 PMCID: PMC6966598 DOI: 10.3390/biomedicines7040099] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022] Open
Abstract
Alcohol use is a major risk factor for burden of mortality and morbidity. Alcoholic liver disease (ALD) and alcohol use disorders (AUDs) are important disease outcomes caused by alcohol use. We will describe the global mortality and burden of disease in disability-adjusted life years for ALD and AUDs, based on data from the comparative risk assessment of the World Health Organization for 2016. AUDs have a limited impact on mortality in this assessment, since alcohol poisonings are almost the only disease category directly attributable to AUDs; most other alcohol-related deaths are indirect, and the cause which directly led to the death, such as liver cirrhosis, is the one recorded on the death certificate. Burden of disease for AUDs is thus mainly due to disability resulting from alcohol use. In contrast to AUDs, ALD is one of the major lethal outcomes of alcohol use, and burden of disease is mainly due to (premature) years of life lost. Many of the negative outcomes attributable to both AUDs and ALD are due to their interactions with other factors, most notably economic wealth. To avoid alcohol-attributable morbidity and mortality, measures should be taken to reduce the AUDs and ALD burden globally, especially among the poor.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada;
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 1P8, Canada
- Institute of Medical Science, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5T 2S1, Canada
- Institute of Clinical Psychology and Psychotherapy & Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Chemnitzer Str. 46, D-01187 Dresden, Germany
- 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 119992, Russia
| | - Kevin D. Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada;
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 1P8, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5T 2S1, Canada
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14
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Rehm J, Heilig M, Gual A. ICD-11 for Alcohol Use Disorders: Not a Convincing Answer to the Challenges. Alcohol Clin Exp Res 2019; 43:2296-2300. [PMID: 31424579 PMCID: PMC6899584 DOI: 10.1111/acer.14182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy ResearchCentre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
- Campbell Family Mental Health Research InstituteCAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada
- Institute of Clinical Psychology and PsychotherapyCenter for Clinical Epidemiology and Longitudinal StudiesTechnische Universität DresdenDresdenGermany
- Department of International Health ProjectsInstitute for Leadership and Health ManagementI. M. Sechenov First Moscow State Medical UniversityMoscowRussian Federation
| | - Markus Heilig
- Center for Social and Affective NeuroscienceDepartment of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
| | - Antoni Gual
- Addictions UnitPsychiatry DepartmentNeurosciences Institute, Hospital ClínicBarcelonaSpain
- IDIBAPS (Institut per a la Recerca Biomèdica Agustí Pi i Sunyer)BarcelonaSpain
- Red de Trastornos AdictivosInstituto Carlos IIIMadridSpain
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15
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Carvalho AF, Heilig M, Perez A, Probst C, Rehm J. Alcohol use disorders. Lancet 2019; 394:781-792. [PMID: 31478502 DOI: 10.1016/s0140-6736(19)31775-1] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/30/2019] [Accepted: 06/25/2019] [Indexed: 12/12/2022]
Abstract
Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.
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Affiliation(s)
- Andre F Carvalho
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Markus Heilig
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany; Department of International Health Projects, Institute for Leadership and Health Management, IM Sechenov First Moscow State Medical University, Moscow, Russia.
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16
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Nutt DJ, Gual A, Anderson P, Rehm J. Why Less Is Always More in the Treatment of Alcohol Use Disorders. JAMA Psychiatry 2019; 76:359-360. [PMID: 30865234 DOI: 10.1001/jamapsychiatry.2018.2807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David J Nutt
- Centre for Academic Psychiatry, Imperial College, Hammersmith Hospital, London, United Kingdom
| | - Antoni Gual
- Addictions Unit, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne, United Kingdom.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
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17
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Anderson P, Gual A, Rehm J. Reducing the health risks derived from exposure to addictive substances. Curr Opin Psychiatry 2018; 31:333-341. [PMID: 29746421 DOI: 10.1097/yco.0000000000000432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW To discuss the health risks due to exposure to alcohol, illegal drugs and nicotine and how these risks might be reduced. RECENT FINDINGS In 2016, worldwide, alcohol, illegal drugs and nicotine were responsible for some 10 million deaths. There is evolutionary and biological evidence that humans are predisposed to consuming alcohol, illegal drugs and nicotine - present-day problems are caused by high levels of potency, exposure and drug delivery systems. The two priority substances for action are alcohol and smoked cigarettes; their exposure can be reduced by price increases, setting minimum prices per product, regulating a shift form smoked cigarettes to electronic nicotine delivery devices and, theoretically, reducing the ethanol content of existing beverages. Legalization of cannabis requires a strict regulatory framework. SUMMARY Purposeful policy can reduce the harm done by alcohol, illegal drugs and nicotine. In particular, policy to reduce exposure to alcohol requires considerable strengthening.
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Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic.,Institut d'Investigacions Biomèdiques.,August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia.,Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Madrid, Spain
| | - Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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18
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19
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Kelly JF, Bergman B, Hoeppner BB, Vilsaint C, White WL. Prevalence and pathways of recovery from drug and alcohol problems in the United States population: Implications for practice, research, and policy. Drug Alcohol Depend 2017; 181:162-169. [PMID: 29055821 PMCID: PMC6076174 DOI: 10.1016/j.drugalcdep.2017.09.028] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Alcohol and other drug (AOD) problems confer a global, prodigious burden of disease, disability, and premature mortality. Even so, little is known regarding how, and by what means, individuals successfully resolve AOD problems. Greater knowledge would inform policy and guide service provision. METHOD Probability-based survey of US adult population estimating: 1) AOD problem resolution prevalence; 2) lifetime use of "assisted" (i.e., treatment/medication, recovery services/mutual help) vs. "unassisted" resolution pathways; 3) correlates of assisted pathway use. Participants (response=63.4% of 39,809) responding "yes" to, "Did you use to have a problem with alcohol or drugs but no longer do?" assessed on substance use, clinical histories, problem resolution. RESULTS Weighted prevalence of problem resolution was 9.1%, with 46% self-identifying as "in recovery"; 53.9% reported "assisted" pathway use. Most utilized support was mutual-help (45.1%,SE=1.6), followed by treatment (27.6%,SE=1.4), and emerging recovery support services (21.8%,SE=1.4), including recovery community centers (6.2%,SE=0.9). Strongest correlates of "assisted" pathway use were lifetime AOD diagnosis (AOR=10.8[7.42-15.74], model R2=0.13), drug court involvement (AOR=8.1[5.2-12.6], model R2=0.10), and, inversely, absence of lifetime psychiatric diagnosis (AOR=0.3[0.2-0.3], model R2=0.10). Compared to those with primary alcohol problems, those with primary cannabis problems were less likely (AOR=0.7[0.5-0.9]) and those with opioid problems were more likely (AOR=2.2[1.4-3.4]) to use assisted pathways. Indices related to severity were related to assisted pathways (R2<0.03). CONCLUSIONS Tens of millions of Americans have successfully resolved an AOD problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term AOD problem resolution.
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Affiliation(s)
- John F. Kelly
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, and Harvard Medical School, Boston, MA, 02114, United States,Corresponding author at: Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, Boston, MA, 02114, United States. (J.F. Kelly)
| | - Brandon Bergman
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, and Harvard Medical School, Boston, MA, 02114, United States
| | - Bettina B. Hoeppner
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, and Harvard Medical School, Boston, MA, 02114, United States
| | - Corrie Vilsaint
- Recovery Research Institute, Massachusetts General Hospital, 151 Merrimac Street, and Harvard Medical School, Boston, MA, 02114, United States
| | - William L. White
- Chestnut Health Systems, W Chestnut St, Bloomington, IL, 61701, United States
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Rehm J, Anderson P, Prieto JAA, Armstrong I, Aubin HJ, Bachmann M, Bastus NB, Brotons C, Burton R, Cardoso M, Colom J, Duprez D, Gmel G, Gual A, Kraus L, Kreutz R, Liira H, Manthey J, Møller L, Okruhlica Ľ, Roerecke M, Scafato E, Schulte B, Segura-Garcia L, Shield KD, Sierra C, Vyshinskiy K, Wojnar M, Zarco J. Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union. BMC Med 2017; 15:173. [PMID: 28954635 PMCID: PMC5618725 DOI: 10.1186/s12916-017-0934-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 08/22/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. METHODS A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. RESULTS Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. CONCLUSIONS The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Peter Anderson
- Substance Use, Policy and Practice, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Alcohol and Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | | | - Iain Armstrong
- Health and Wellbeing Directorate, Public Health England, London, UK
| | - Henri-Jean Aubin
- CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France
| | | | | | - Carlos Brotons
- Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau, Barcelona, Spain
| | - Robyn Burton
- Health and Wellbeing Directorate, Public Health England, London, UK
| | - Manuel Cardoso
- General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), Lisbon, Portugal
| | - Joan Colom
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain
| | - Daniel Duprez
- Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, USA
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Implant Systems Group, National ICT Australia, Eveleigh, Australia
- Faculty of Engineering, University of New South Wales, Sydney, Australia
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Ludwig Kraus
- IFT Institut für Therapieforschung, Munich, Germany
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helena Liira
- General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia
- University of Helsinki, Department of General Practice, and Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Lars Møller
- Division of Noncommunicable Diseases through the Life Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Emanuele Scafato
- National Observatory on Alcohol, National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
- Società Italiana di Alcologia (SIA), Italian Society of Alcohology, Bologna, Italy
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, Hamburg University, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
| | - Lidia Segura-Garcia
- Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain
| | - Kevin David Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Cristina Sierra
- Hypertension and Vascular Risk Unit, Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Konstantin Vyshinskiy
- Research Institute on Addictions, Federal Medical Research Centre for Psychiatry and Narcology n.a. V. Serbsky, Moscow, Russia
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - José Zarco
- Drugs Intervention Group, semFYC, Ibiza Primary Health Care Center, Madrid, Spain
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Rehm J, Room R. The cultural aspect: How to measure and interpret epidemiological data on alcohol-use disorders across cultures. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:330-341. [PMID: 32934495 PMCID: PMC7450835 DOI: 10.1177/1455072517704795] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/24/2017] [Indexed: 12/20/2022] Open
Abstract
Aims: To examine the cultural impact on the diagnosis of alcohol-use disorders using European countries as examples. Design: Narrative review. Results: There are strong cultural norms guiding heavy drinking occasions and loss of control. These norms not only indicate what drinking behaviour is acceptable, but also whether certain behaviours can be reported or not. As modern diagnostic systems are based on lists of mostly behavioural criteria, where alcohol-use disorders are defined by a positive answer on at least one, two or three of these criteria, culture will inevitably co-determine how many people will get a diagnosis. This explains the multifold differences in incidence and prevalence of alcohol-use disorders, even between countries where the average drinking levels are similar. Thus, the incidence and prevalence of alcohol-use disorders as assessed by surveys or rigorous application of standardised instruments must be judged as measuring social norms as well as the intended mental disorder. Conclusions: Current practice to measure alcohol-use disorders based on a list of culture-specific diagnostic criteria results in incomparability in the incidence, prevalence or disease burden between countries. For epidemiological purposes, a more grounded definition of diagnostic criteria seems necessary, which could probably be given by using heavy drinking over time.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, Canada University of Toronto, Canada
| | - Robin Room
- La Trobe University, Australia Stockholm
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22
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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.
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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
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Imtiaz S, Shield KD, Roerecke M, Samokhvalov AV, Lönnroth K, Rehm J. Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease. Eur Respir J 2017; 50:1700216. [PMID: 28705945 PMCID: PMC5540679 DOI: 10.1183/13993003.00216-2017] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/08/2017] [Indexed: 11/29/2022]
Abstract
Meta-analyses of alcohol use, alcohol dosage and alcohol-related problems as risk factors for tuberculosis incidence were undertaken. The global alcohol-attributable tuberculosis burden of disease was also re-estimated.Systematic searches were conducted, reference lists were reviewed and expert consultations were held to identify studies. Cohort and case-control studies were included if there were no temporal violations of exposure and outcome. Risk relations (RRs) were pooled by using categorical and dose-response meta-analyses. The alcohol-attributable tuberculosis burden of disease was estimated by using alcohol-attributable fractions.36 of 1108 studies were included. RRs for alcohol use and alcohol-related problems were 1.35 (95% CI 1.09-1.68; I2: 83%) and 3.33 (95% CI 2.14-5.19; 87%), respectively. Concerning alcohol dosage, tuberculosis risk rose as ethanol intake increased, with evidence of a threshold effect. Alcohol consumption caused 22.02 incident cases (95% CI 19.70-40.77) and 2.35 deaths (95% CI 2.05-4.79) per 100 000 people from tuberculosis in 2014. Alcohol-attributable tuberculosis incidence increased between 2000 and 2014 in most high tuberculosis burden countries, whereas mortality decreased.Alcohol consumption was associated with an increased risk of tuberculosis in all meta-analyses. It was consequently a major contributor to the tuberculosis burden of disease.
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Affiliation(s)
- Sameer Imtiaz
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kevin D Shield
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andriy V Samokhvalov
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jürgen Rehm
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, 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
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Rehm J, Gmel GE, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. Addiction 2017; 112:968-1001. [PMID: 28220587 PMCID: PMC5434904 DOI: 10.1111/add.13757] [Citation(s) in RCA: 633] [Impact Index Per Article: 90.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/19/2016] [Accepted: 01/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). METHODS Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. RESULTS In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. CONCLUSIONS Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Campbell Family Mental Health Research Institute, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Institute for Clinical Psychology and Psychotherapy, TU DresdenDresdenGermany
| | - Gerhard E. Gmel
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Alcohol Treatment CenterLausanne University HospitalLausanneSwitzerland
- Addiction SwitzerlandLausanneSwitzerland
- University of the West of EnglandBristolUK
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
| | - Omer S. M. Hasan
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
| | - Svetlana Popova
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoOntarioCanada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute for Clinical Psychology and Psychotherapy, TU DresdenDresdenGermany
| | - Michael Roerecke
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Robin Room
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneVictoriaAustralia
- Centre for Social Research on Alcohol and DrugsStockholm UniversityStockholmSweden
| | - Andriy V. Samokhvalov
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Institute of Medical Science (IMS)University of TorontoTorontoOntarioCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Kevin D. Shield
- Section of Cancer SurveillanceInternational Agency for Research on CancerLyonFrance
| | - Paul A. Shuper
- Institute for Mental Health Policy Research, CAMHTorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
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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.
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Manthey J, Imtiaz S, Neufeld M, Rylett M, Rehm J. Quantifying the global contribution of alcohol consumption to cardiomyopathy. Popul Health Metr 2017; 15:20. [PMID: 28545449 PMCID: PMC5445448 DOI: 10.1186/s12963-017-0137-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/11/2017] [Indexed: 12/31/2022] Open
Abstract
Background The global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed. Methods A two-step model was developed based on aggregate-level data from 95 countries, including the most populous (data from 2013 or last available year). First, the crude mortality rate of alcoholic CM per 1,000,000 adults was predicted using a negative binomial regression based on prevalence of alcohol use disorders (AUD) and adult alcohol per capita consumption (APC) (n = 52 countries). Second, the proportion of alcoholic CM among all CM deaths (i.e., AAF) was predicted using a fractional response probit regression with alcoholic CM crude mortality rate (from Step 1), AUD prevalence, APC per drinker, and Global Burden of Disease region as predictions. Additional models repeated these steps by sex and for the wider Global Burden of Disease study definition of CM. Results There were strong correlations (>0.9) between the crude mortality rate of alcoholic CM and the AAFs, supporting the modeling strategy. In the first step, the population-weighted mean crude mortality rate was estimated at 8.4 alcoholic CM deaths per 1,000,000 (95% CI: 7.4–9.3). In the second step, the global AAFs were estimated at 6.9% (95% CI: 5.4–8.4%). Sex-specific figures suggested a lower AAF among females (2.9%, 95% CI: 2.3–3.4%) as compared to males (8.9%, 95% CI: 7.0–10.7%). Larger deviations between observed and predicted AAFs were found in Eastern Europe and Central Asia. Conclusions The model proposed promises to fill the gap to include AAFs for CM into comparative risk assessments in the future. These predictions likely will be underestimates because of the stigma involved in all fully alcohol-attributable conditions and subsequent problems in coding of alcoholic CM deaths. Electronic supplementary material The online version of this article (doi:10.1186/s12963-017-0137-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.,Institute of Medical Science (IMS), University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON, M5S 1A8, Canada
| | - Maria Neufeld
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Margaret Rylett
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.,Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.,Campbell Family Mental Health Research Institute, 250 College Street, Toronto, ON, M5T 1R8, Canada.,Institute of Medical Science (IMS), University of Toronto, Faculty of Medicine, 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.,PAHO/WHO Collaborating Centre for Mental Health and Addiction, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
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Glass JE, Andréasson S, Bradley KA, Finn SW, Williams EC, Bakshi AS, Gual A, Heather N, Sainz MT, Benegal V, Saitz R. Rethinking alcohol interventions in health care: a thematic meeting of the International Network on Brief Interventions for Alcohol & Other Drugs (INEBRIA). Addict Sci Clin Pract 2017; 12:14. [PMID: 28490342 PMCID: PMC5425968 DOI: 10.1186/s13722-017-0079-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/14/2017] [Indexed: 11/29/2022] Open
Abstract
In 2016, the International Network on Brief Interventions for Alcohol & Other Drugs convened a meeting titled “Rethinking alcohol interventions in health care”. The aims of the meeting were to synthesize recent evidence about screening and brief intervention and to set directions for research, practice, and policy in light of this evidence. Screening and brief intervention is efficacious in reducing self-reported alcohol consumption for some with unhealthy alcohol use, but there are gaps in evidence for its effectiveness. Because screening and brief intervention is not known to be efficacious for individuals with more severe unhealthy alcohol use, recent data showing the lack of evidence for referral to treatment as part of screening and brief intervention are alarming. While screening and brief intervention was designed to be a population-based approach, its reach is limited. Implementation in real world care also remains a challenge. This report summarizes practice, research, and policy recommendations and key research developments from our meeting. In order to move the field forward, a research agenda was proposed to (1) address evidence gaps in screening, brief intervention, and referral to treatment, (2) develop innovations to address severe unhealthy alcohol use within primary care, (3) describe the stigma of unhealthy alcohol use, which obstructs progress in prevention and treatment, (4) reconsider existing conceptualizations of unhealthy alcohol use that may influence health care, and (5) identify efforts needed to improve the capacity for addressing unhealthy alcohol consumption in all world regions.
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Affiliation(s)
- Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Sven Andréasson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Kaiser Foundation Health Plan of Washington, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.,Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Sara Wallhed Finn
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emily C Williams
- Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ann-Sofie Bakshi
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, ICN, Hospital Clínic, IDIBAPS, RTA, Barcelona, Spain
| | - Nick Heather
- Department of Psychology, Faculty of Health & Social Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Marcela Tiburcio Sainz
- Department of Social Sciences in Health, Ramón de la Fuente Muñiz, National Institute of Psychiatry, Mexico City, Mexico
| | - Vivek Benegal
- Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.,Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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Anderson P, O'Donnell A, Kaner E, Gual A, Schulte B, Pérez Gómez A, de Vries H, Natera Rey G, Rehm J. Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study. F1000Res 2017; 6:311. [PMID: 29188013 PMCID: PMC5686480 DOI: 10.12688/f1000research.11173.3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/27/2022] Open
Abstract
Background: While primary health care (PHC)-based prevention and management of heavy drinking is clinically effective and cost-effective, it remains poorly implemented in routine practice. Systematic reviews and multi-country studies have demonstrated the ability of training and support programmes to increase PHC-based screening and brief advice activity to reduce heavy drinking. However, gains have been only modest and short term at best. WHO studies have concluded that a more effective uptake could be achieved by embedding PHC activity within broader community and municipal support. Protocol: A quasi-experimental study will compare PHC-based prevention and management of heavy drinking in three intervention cities from Colombia, Mexico and Peru with three comparator cities from the same countries. In the implementation cities, primary health care units (PHCUs) will receive training embedded within ongoing supportive municipal action over an 18-month implementation period. In the comparator cities, practice as usual will continue at both municipal and PHCU levels. The primary outcome will be the proportion of consulting adult patients intervened with (screened and advice given to screen positives). The study is powered to detect a doubling of the outcome measure from an estimated 2.5/1,000 patients at baseline. Formal evaluation points will be at baseline, mid-point and end-point of the 18-month implementation period. We will present the ratio (plus 95% confidence interval) of the proportion of patients receiving intervention in the implementation cities with the proportions in the comparator cities. Full process evaluation will be undertaken, coupled with an analysis of potential contextual, financial and political-economy influencing factors. Discussion: This multi-country study will test the extent to which embedding PHC-based prevention and management of alcohol use disorder with supportive municipal action leads to improved scale-up of more patients with heavy drinking receiving appropriate advice and treatment. Study status: The four-year study will start on 1
st December 2017.
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Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6221 HA, Netherlands
| | - Amy O'Donnell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Antoni Gual
- Addictions Unit, Psychiatry Dept, Hospital Clínic of Barcelona, Barcelona, 08036, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, 08036, Spain.,Red de Trastornos Adictivo, Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Bernd Schulte
- Centre for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | | | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, 6200, Netherlands
| | | | - Jürgen Rehm
- Institute for Mental Health Policy Research, Toronto, ON, M5S 2S1, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, 01187, Germany
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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.
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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
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Rehm J, Gmel GE, Gmel G, Hasan OSM, Imtiaz S, Popova S, Probst C, Roerecke M, Room R, Samokhvalov AV, Shield KD, Shuper PA. The relationship between different dimensions of alcohol use and the burden of disease-an update. ADDICTION (ABINGDON, ENGLAND) 2017. [PMID: 28220587 DOI: 10.1111/add.13757.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Alcohol use is a major contributor to injuries, mortality and the burden of disease. This review updates knowledge on risk relations between dimensions of alcohol use and health outcomes to be used in global and national Comparative Risk Assessments (CRAs). METHODS Systematic review of reviews and meta-analyses on alcohol consumption and health outcomes attributable to alcohol use. For dimensions of exposure: volume of alcohol use, blood alcohol concentration and patterns of drinking, in particular heavy drinking occasions were studied. For liver cirrhosis, quality of alcohol was additionally considered. For all outcomes (mortality and/or morbidity): cause of death and disease/injury categories based on International Classification of Diseases (ICD) codes used in global CRAs; harm to others. RESULTS In total, 255 reviews and meta-analyses were identified. Alcohol use was found to be linked causally to many disease and injury categories, with more than 40 ICD-10 three-digit categories being fully attributable to alcohol. Most partially attributable disease categories showed monotonic relationships with volume of alcohol use: the more alcohol consumed, the higher the risk of disease or death. Exceptions were ischaemic diseases and diabetes, with curvilinear relationships, and with beneficial effects of light to moderate drinking in people without heavy irregular drinking occasions. Biological pathways suggest an impact of heavy drinking occasions on additional diseases; however, the lack of medical epidemiological studies measuring this dimension of alcohol use precluded an in-depth analysis. For injuries, except suicide, blood alcohol concentration was the most important dimension of alcohol use. Alcohol use caused marked harm to others, which has not yet been researched sufficiently. CONCLUSIONS Research since 2010 confirms the importance of alcohol use as a risk factor for disease and injuries; for some health outcomes, more than one dimension of use needs to be considered. Epidemiological studies should include measurement of heavy drinking occasions in line with biological knowledge.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Gerhard E Gmel
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Alcohol Treatment Center, Lausanne University Hospital, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,University of the West of England, Bristol, UK
| | - Gerrit Gmel
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada
| | - Svetlana Popova
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Michael Roerecke
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia.,Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
| | - Andriy V Samokhvalov
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kevin D Shield
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Paul A Shuper
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Rehm J, Imtiaz S. A narrative review of alcohol consumption as a risk factor for global burden of disease. Subst Abuse Treat Prev Policy 2016; 11:37. [PMID: 27793173 PMCID: PMC5084343 DOI: 10.1186/s13011-016-0081-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/19/2016] [Indexed: 01/09/2023] Open
Abstract
Since the original Comparative Risk Assessment (CRA) for alcohol consumption as part of the Global Burden of Disease Study for 1990, there had been regular updates of CRAs for alcohol from the World Health Organization and/or the Institute for Health Metrics and Evaluation. These studies have become more and more refined with respect to establishing causality between dimensions of alcohol consumption and different disease and mortality (cause of death) outcomes, refining risk relations, and improving the methodology for estimating exposure and alcohol-attributable burden. The present review will give an overview on the main results of the CRAs with respect to alcohol consumption as a risk factor, sketch out new trends and developments, and draw implications for future research and policy.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, T505, 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, 01187 Dresden, Germany
| | - Sameer Imtiaz
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, T505, Toronto, ON M5S 2S1 Canada
- Institute of Medical Science (IMS), University of Toronto, Medical Sciences Building, 1 King’s College Circle, Room 2374, Toronto, ON M5S 1A8 Canada
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Miquel L, Gual A, Vela E, Lligoña A, Bustins M, Colom J, Rehm J. Alcohol Consumption and Inpatient Health Service Utilization in a Cohort of Patients With Alcohol Dependence After 20 Years of Follow-up. Alcohol Alcohol 2016; 52:227-233. [DOI: 10.1093/alcalc/agw075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 11/13/2022] Open
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Zwrot w uzależnieniach – Udział nauk biologicznych i społecznych w przeformułowaniu polityki wobec substancji psychoaktywnych Streszczenie debaty naukowej (marzec 2016). ALCOHOLISM AND DRUG ADDICTION 2016. [DOI: 10.1016/j.alkona.2016.10.001] [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
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Rehm J. How should prevalence of alcohol use disorders be assessed globally? Int J Methods Psychiatr Res 2016; 25:79-85. [PMID: 27133364 PMCID: PMC6877138 DOI: 10.1002/mpr.1508] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/03/2015] [Accepted: 03/15/2016] [Indexed: 10/21/2022] Open
Abstract
Alcohol is a major risk factor for global burden of disease, and alcohol use disorders make up a considerable portion of this burden. Up to now, prevalence of alcohol use disorders has been estimated based on general population surveys with the Composite International Diagnostic Interview (CIDI) as the gold standard for assessment. However, three major problems have been identified with the current conceptualization of alcohol use disorders and its measurement via CIDI: cultural specificity of key criteria measured such as loss of control; lack of convergence of diagnoses identified by CIDI with clinically relevant diagnoses in primary health care; and impact of stigma on measurement. As a solution, it is proposed to measure alcohol use disorders via heavy drinking over time, with thresholds taken from the European Medicines Agency (60 and more grams on average per day of pure alcohol for men, and 40+ grams for women). Current data on level of drinking (per capita consumption) assessed via taxation and other means allow for a measure of less bias. If these thresholds are considered too low and there is more emphasis on need for specialized treatment, then thresholds for very heavy drinking can be taken as alternatively (100+, and 60+ grams per day pure alcohol for men and women, respectively). Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Institute of Medical Science (IMS), Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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35
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Rehm J, Anderson P, Manthey J, Shield KD, Struzzo P, Wojnar M, Gual A. Alcohol Use Disorders in Primary Health Care: What Do We Know and Where Do We Go? Alcohol Alcohol 2015; 51:422-7. [DOI: 10.1093/alcalc/agv127] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/20/2015] [Indexed: 11/14/2022] Open
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Rehm J. Commentary on Cherpitel et al. (2015): Improving global estimates of alcohol-attributable injury. Addiction 2015; 110:1733-4. [PMID: 26471156 DOI: 10.1111/add.13138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/21/2015] [Indexed: 12/21/2022]
Abstract
The analyses by Cherpitel and colleagues on alcohol-injury risk relations will help to improve global estimates of the alcohol-attributable injury burden by supplying more specific and empirically based risk relations. However, several issues still need to be addressed: generalizability, heterogeneity of drinkers, mortality outcomes and the quantification of causal impact.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health (CAMH) Toronto Canada
- Institute of Medical Science (IMS)University of Toronto Canada
- Institute for Clinical Psychology and PsychotherapyTU Dresden Germany
- Department of PsychiatryUniversity of Toronto Canada
- Dalla Lana School of Public HealthUniversity of Toronto Canada
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Laramée P, Leonard S, Buchanan-Hughes A, Warnakula S, Daeppen JB, Rehm J. Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis. EBioMedicine 2015; 2:1394-404. [PMID: 26629534 PMCID: PMC4634361 DOI: 10.1016/j.ebiom.2015.08.040] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 01/08/2023] Open
Abstract
Background Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. Methods MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. Findings We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). Interpretation AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption. A systematic review and meta-analysis were performed to investigate mortality risk in alcohol-dependent individuals. Alcohol dependence was associated with significantly higher mortality risk vs the general population, and vs alcohol abuse. Alcohol-dependent people with reduced alcohol consumption lowered their mortality risk, even if abstinence was not reached.
Individuals with alcohol dependence have a high risk of disease, disability or death. Treatment has traditionally focused on promoting abstinence, although some alcohol-dependent individuals would prefer to continue drinking in a controlled manner. By statistically combining results from previously published studies identified in a systematic literature review, we have shown that mortality among alcohol-dependent individuals is three to four times higher than in the general population. We have also found that individuals with alcohol dependence can reduce their risk of death by reducing alcohol consumption, even if they do not achieve abstinence.
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Affiliation(s)
- Philippe Laramée
- Université Claude Bernard Lyon I, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France ; Lundbeck SAS, 37-45, Quai du Président Roosevelt, Issy-les-Moulineaux, 92445 Paris, France
| | - Saoirse Leonard
- Costello Medical Consulting, City House, 126-130 Hills Road, Cambridge, CB2 1RE, UK
| | - Amy Buchanan-Hughes
- Costello Medical Consulting, City House, 126-130 Hills Road, Cambridge, CB2 1RE, UK
| | - Samantha Warnakula
- Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Jean-Bernard Daeppen
- University Alcohol Treatment Centre, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada ; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada ; Klinische Psychologie und Psychotherapie, TU Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
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Probst C, Moyo D, Purshouse R, Rehm J. Transition probabilities for four states of alcohol use in adolescence and young adulthood: what factors matter when? Addiction 2015; 110:1272-80. [PMID: 25959142 DOI: 10.1111/add.12985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/27/2014] [Accepted: 05/05/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND AIMS Risky single-occasion drinking (RSOD) is a health threat, particularly at younger ages. The study aimed to quantify transition probabilities (TPs) between abstinence, use of alcohol, RSOD and frequent RSOD, and to understand how TPs are associated with key demographic factors. DESIGN Cohort study (baseline, two follow-ups). A Markov model was fitted to estimate annual TPs and hazard ratios (HRs) for age, sex and socio-economic status (SES). SETTING Adolescent and young adult general population of Munich (Germany) and surrounding areas. PARTICIPANTS A total of 3021 people aged 14-25 years at baseline in 1995 followed-up in 1998/1999 (n = 2548) and 2003-2005 (n = 2210). MEASUREMENTS Alcohol use, RSOD status, age, sex and SES (subjective financial situation) were assessed in a standardized interview. FINDINGS The highest TPs (> 65%) were found for staying in the same drinking state. Higher age [hazard ratio (HR) for 1-year increase = 0.87, 95% confidence interval (CI) = 0.84-0.91], being female (HR = 0.30, 95% CI = 0.21-0.42), and a high SES (HR = 0.64, 95% CI = 0.43-0.97) were associated with a lower hazard to progress from use to RSOD. While age was associated predominantly with transitions between abstinence and alcohol use, sex was more relevant for transitions associated with RSOD and frequent RSOD. CONCLUSIONS German adolescents and young adults tend to be stable in the drinking states of abstinence, use of alcohol, risky single-occasion drinking and frequent risky single-occasion drinking. Females are less likely to transition to riskier states and more likely to transition back from frequent risky single-occasion drinking, higher age is associated with lower hazard of transitioning and participants of higher socio-economic status are less likely to transition from 'use of alcohol' to 'risky single-occasion drinking'.
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Affiliation(s)
- Charlotte Probst
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Centre for Addiction and Mental Health (CAMH), Social and Epidemiological Research Department, Toronto, ON, Canada
| | - Daniel Moyo
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Robin Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Centre for Addiction and Mental Health (CAMH), Social and Epidemiological Research Department, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Rehm J, Allamani A, Aubin HJ, Della Vedova R, Elekes Z, Frick U, Jakubczyk A, Kostogianni N, Landsmane I, Manthey J, Miquel L, Paille F, Pieper L, Probst C, Scafuri F, Shield KD, Snikere S, Struzzo P, Trapencieris M, Voller F, Wittchen HU, Gual A, Wojnar M. People with alcohol use disorders in specialized care in eight different European countries. Alcohol Alcohol 2015; 50:310-8. [PMID: 25716113 DOI: 10.1093/alcalc/agv009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 01/27/2015] [Indexed: 12/20/2022] Open
Abstract
AIM To provide a description of patients receiving alcohol treatment in eight different European countries, including the level of comorbidities and functional limitations. METHODS Drinking behaviours, DSM-IV alcohol use disorder (AUD), mental and somatic comorbidities, disability and health services utilization of 1767 patients from various specialized treatment settings were assessed as representative for regions of eight European countries. Severity of alcohol dependence (AD) in terms of drinking level was compared with a large representative US sample. RESULTS Patients in specialized care for AUDs showed high levels of consumption [average level of daily ethanol intake: 141.1 g, standard deviation (SD): 116.0 g], comorbidity [e.g. liver problems: 19.6%, 95% confidence interval (CI): 17.5-21.6%; depression: 43.2%, 95% CI: 40.7-45.8%; anxiety: 50.3%, 95% CI: 47.8-52.9%], disability and health services utilization (average number of nights spent in hospital(s) during the last 6 months: 8.8, SD: 19.5 nights). Severity of AD was similar to the US sample, but European men consumed on average more alcohol daily. CONCLUSIONS High levels of consumption, somatic and mental comorbidities, disability and functional losses were found in this representative treatment sample, indicating that treatment was initiated only at severe stages of AUDs. Earlier initiation of treatment could help avoid some of the health and social burden.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7, Canada Faculty of Medicine, Institute of Medical Science, 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 Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Allaman Allamani
- Agenzia Regionale di Sanità Toscana, Villa la Quiete Alle Montalve, Via Pietro Dazzi 1, 50141 Firenze, Italy
| | - Henri-Jean Aubin
- Centre D'Enseignement, de Recherche et de Traitement des Addictions, Hôpital Paul Brousse, AP-HP, Univ Paris-Sud, INSERM U669, 94804 Villejuif, France
| | - Roberto Della Vedova
- Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074 Monfalcone, GO, Italy
| | - Zsuzsanna Elekes
- Corvinus University of Budapest, Közraktár u. 4-6, H-1093 Budapest, Hungary
| | - Ulrich Frick
- Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland Department of Applied Psychology, Döpfer University of Applied Sciences, Cologne, Germany
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland
| | - Nikoleta Kostogianni
- Centre D'Enseignement, de Recherche et de Traitement des Addictions, Hôpital Paul Brousse, AP-HP, Univ Paris-Sud, INSERM U669, 94804 Villejuif, France
| | - Inga Landsmane
- Riga Centre of Psychiatry and Addiction Medicine, Tvaika Iela 2, Riga, Latvia
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Laia Miquel
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain (Catalonia) Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036, Barcelona, Spain (Catalonia) Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Calle Sinesio Delgado, 4, 28029 Madrid, Spain (Catalonia)
| | - François Paille
- Department of Addiction, CHU de Nancy, rue du Morvan, 54500 Vandoeuvre, France
| | - Lars Pieper
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Charlotte Probst
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Francesca Scafuri
- Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074 Monfalcone, GO, Italy
| | - Kevin D Shield
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada
| | - Sigita Snikere
- Institute of Sociological Research, Dzirnavu Iela 55 k2-2, Riga, Latvia
| | - Pierluigi Struzzo
- Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074 Monfalcone, GO, Italy
| | - Marcis Trapencieris
- Institute of Sociological Research, Dzirnavu Iela 55 k2-2, Riga, Latvia Institute of Philosophy and Sociology, University of Latvia, Akademijas Laukums 1, Riga, Latvia
| | - Fabio Voller
- Agenzia Regionale di Sanità Toscana, Villa la Quiete Alle Montalve, Via Pietro Dazzi 1, 50141 Firenze, Italy
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Spain (Catalonia) Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036, Barcelona, Spain (Catalonia) Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Calle Sinesio Delgado, 4, 28029 Madrid, Spain (Catalonia)
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
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Rehm J, Anderson P, Barry J, Dimitrov P, Elekes Z, Feijão F, Frick U, Gual A, Gmel G, Kraus L, Marmet S, Raninen J, Rehm MX, Scafato E, Shield KD, Trapencieris M, Gmel G. Prevalence of and potential influencing factors for alcohol dependence in Europe. Eur Addict Res 2015; 21:6-18. [PMID: 25342593 DOI: 10.1159/000365284] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/17/2014] [Indexed: 11/19/2022]
Abstract
Alcohol use disorders (AUDs), and alcohol dependence (AD) in particular, are prevalent and associated with a large burden of disability and mortality. The aim of this study was to estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and to investigate potential influencing factors. The 1-year prevalence of AD in the EU was estimated at 3.4% among people 18-64 years of age in Europe (women 1.7%, men 5.2%), resulting in close to 11 million affected people. Taking into account all people of all ages, AD, abuse and harmful use resulted in an estimate of 23 million affected people. Prevalence of AD varied widely between European countries, and was significantly impacted by drinking cultures and social norms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking, such as liver cirrhosis or injury, were moderate. These results suggest a need to rethink the definition of AUDs.
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Affiliation(s)
- Jürgen Rehm
- Social and Epidemiological Research (SER) Department, Centre for Addiction and Mental Health, Toronto, Ont., Canada
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Martin CS, Langenbucher JW, Chung T, Sher KJ. Truth or consequences in the diagnosis of substance use disorders. Addiction 2014; 109:1773-8. [PMID: 24913314 PMCID: PMC4441015 DOI: 10.1111/add.12615] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/25/2014] [Accepted: 04/29/2014] [Indexed: 01/09/2023]
Abstract
AIMS This commentary critically evaluates the use of substance-related negative psychosocial and health consequences to define and diagnose alcohol and other substance use disorders. METHODS Narrative review. RESULTS The consequences of substance use cause much suffering and are major public health and economic problems. However, there are a number of conceptual and measurement problems with using consequences as diagnostic criteria for substance disorders. Data indicate that substance-related consequences introduce systematic bias and degrade the validity of diagnostic systems. CONCLUSIONS Negative psychosocial and health consequences of substance use should play a fundamentally reduced role in modern diagnostic systems for, and definitions of, addictive disorders.
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Affiliation(s)
- Christopher S. Martin
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center of Alcohol Studies, Rutgers University, Piscataway, NJ, USA
| | | | - Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kenneth J. Sher
- University of Missouri-Columbia, Columbia, MO, USA
- Midwest Alcohol Research Center, Washington University School of Medicine, St Louis, MO, USA
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Blankers M, Frijns T, Belackova V, Rossi C, Svensson B, Trautmann F, van Laar M. Predicting cannabis abuse screening test (CAST) scores: a recursive partitioning analysis using survey data from Czech Republic, Italy, the Netherlands and Sweden. PLoS One 2014; 9:e108298. [PMID: 25264894 PMCID: PMC4180744 DOI: 10.1371/journal.pone.0108298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 05/06/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction Cannabis is Europe's most commonly used illicit drug. Some users do not develop dependence or other problems, whereas others do. Many factors are associated with the occurrence of cannabis-related disorders. This makes it difficult to identify key risk factors and markers to profile at-risk cannabis users using traditional hypothesis-driven approaches. Therefore, the use of a data-mining technique called binary recursive partitioning is demonstrated in this study by creating a classification tree to profile at-risk users. Methods 59 variables on cannabis use and drug market experiences were extracted from an internet-based survey dataset collected in four European countries (Czech Republic, Italy, Netherlands and Sweden), n = 2617. These 59 potential predictors of problematic cannabis use were used to partition individual respondents into subgroups with low and high risk of having a cannabis use disorder, based on their responses on the Cannabis Abuse Screening Test. Both a generic model for the four countries combined and four country-specific models were constructed. Results Of the 59 variables included in the first analysis step, only three variables were required to construct a generic partitioning model to classify high risk cannabis users with 65–73% accuracy. Based on the generic model for the four countries combined, the highest risk for cannabis use disorder is seen in participants reporting a cannabis use on more than 200 days in the last 12 months. In comparison to the generic model, the country-specific models led to modest, non-significant improvements in classification accuracy, with an exception for Italy (p = 0.01). Conclusion Using recursive partitioning, it is feasible to construct classification trees based on only a few variables with acceptable performance to classify cannabis users into groups with low or high risk of meeting criteria for cannabis use disorder. The number of cannabis use days in the last 12 months is the most relevant variable. The identified variables may be considered for use in future screeners for cannabis use disorders.
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Affiliation(s)
- Matthijs Blankers
- Department of Drug Monitoring, Trimbos Institute, Utrecht, the Netherlands
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
- Department of Research, Arkin, Amsterdam, the Netherlands
- * E-mail:
| | - Tom Frijns
- Department of Drug Monitoring, Trimbos Institute, Utrecht, the Netherlands
| | - Vendula Belackova
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Carla Rossi
- Centre for Biostatistics and Bioinformatics, University Rome Tor Vergata, Rome, Italy
| | - Bengt Svensson
- Department of Social Work, Malmö University, Malmö, Sweden
| | - Franz Trautmann
- Department of Drug Monitoring, Trimbos Institute, Utrecht, the Netherlands
| | - Margriet van Laar
- Department of Drug Monitoring, Trimbos Institute, Utrecht, the Netherlands
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Roerecke M, Rehm J. Chronic heavy drinking and ischaemic heart disease: a systematic review and meta-analysis. Open Heart 2014; 1:e000135. [PMID: 25332827 PMCID: PMC4189294 DOI: 10.1136/openhrt-2014-000135] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 12/11/2022] Open
Abstract
Previous meta-analyses have reported either a protective, neutral or detrimental association from chronic heavy drinking in relation to ischaemic heart disease (IHD). We investigated the potential for systematic error because of study design. Using MOOSE guidelines, studies were identified through MEDLINE, EMBASE and Web of Science up to end of March, 2014. Epidemiological studies reporting on chronic heavy drinking and IHD risk in population studies and samples of people with alcohol use disorder (AUD) were included. Random-effects meta-analysis was used to pool eligible studies. The I2 statistic was used to assess heterogeneity across studies. In total, 34 observational studies with 110 570 chronic heavy drinkers and 3086 IHD events were identified. In population studies among men, the pooled risk for IHD incidence (fatal+non-fatal events) among chronic heavy drinkers (on average ≥60 g pure alcohol/day) in comparison to lifetime abstainers (n=11 studies) was relative risk (RR)=1.04 (95% CI 0.83 to 1.31, I2=54%). Few studies were available for women. In patients with AUD, the risk of IHD mortality in comparison to the general population was elevated with a RR=1.62 (95% CI 1.34 to 1.95, I2=81%) in men and RR=2.09 (95% CI 1.28 to 3.41, I2=67%) in women. There was a general lack of adjustment other than sex and age in studies among patients with AUD. There is no systematic evidence for a protective association from any type of chronic heavy drinking on IHD risk. Patients with AUD were at higher risk for IHD mortality, but better quality evidence is needed with regard to potential confounding.
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Affiliation(s)
- Michael Roerecke
- Centre for Addiction and Mental Health (CAMH) , Toronto , Canada ; Dalla Lana School of Public Health (DLSPH), University of Toronto , Toronto , Canada
| | - Jürgen Rehm
- 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 ; Institute for Clinical Psychology and Psychotherapy, TU Dresden , Dresden , Germany ; Department of Psychiatry , University of Toronto , Toronto , Canada
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Shield KD, Rehm J, Rehm MX, Gmel G, Drummond C. The potential impact of increased treatment rates for alcohol dependence in the United Kingdom in 2004. BMC Health Serv Res 2014; 14:53. [PMID: 24499391 PMCID: PMC3923387 DOI: 10.1186/1472-6963-14-53] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 01/07/2014] [Indexed: 12/27/2022] Open
Abstract
Background Alcohol consumption has been linked to a considerable burden of disease in the United Kingdom (UK), with most of this burden due to heavy drinking and Alcohol Dependence (AD). However, AD is undertreated in the UK, with only 8% of those individuals with AD being treated in England and only 6% of those individuals with AD being treated in Scotland. Thus, the objective of this paper is to quantify the deaths that would have been avoided in the UK in 2004 if the treatment rate for AD had been increased. Methods Data on the prevalence of AD, alcohol consumption, and mortality were obtained from the Adult Psychiatric Morbidity Survey, the Global Information System on Alcohol and Health, and the 2004 Global Burden of Disease study respectively. Data on the effectiveness of pharmacological treatment and Motivational Interviewing/Cognitive Behavioural Therapy were obtained from Cochrane reviews and meta-analyses. Simulations were used to model the number of deaths under different treatment scenarios. Sensitivity analyses were performed to model the effects of Brief Interventions and to examine the effect of using AD prevalence data obtained from the National Institute for Health and Clinical Excellence. Results In the UK, 320 female and 1,385 male deaths would have been avoided if treatment coverage of pharmacological treatment had been increased to 20%. This decrease in the number of deaths represents 7.9% of all alcohol-attributable deaths (7.0% of all alcohol-attributable deaths for women and 8.1% of all alcohol-attributable deaths for men). If we used lower AD prevalence rates obtained from the National Institute for Health and Clinical Excellence, then treatment coverage of pharmacological treatment in hospitals for 20% of the population with AD would have resulted in the avoidance of 529 deaths in 2004 (99 deaths avoided for women and 430 deaths avoided for men). Conclusions Increasing AD treatment in the UK would have led to a large number of deaths being avoided in 2004. Increased AD treatment rates not only impact mortality but also impact upon the large burden of disability and morbidity attributable to AD, as well as the associated social and economic burdens.
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Affiliation(s)
- Kevin D Shield
- Centre for Addiction and Mental Health (CAMH), 33 Russell Street, Toronto, ON M5S 2S1, Canada.
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