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De Monnin KS, Terian E, Yeary J, Bathon E, Asaro P, Mintz CM, Baumgartner K. Emergency department initiation of pharmacotherapy for alcohol use disorder: A retrospective cohort study. Acad Emerg Med 2024; 31:525-528. [PMID: 37822078 PMCID: PMC11006820 DOI: 10.1111/acem.14819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Karlee S De Monnin
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Emily Terian
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Julianne Yeary
- Barnes-Jewish Hospital, Charles F. Knight Emergency and Trauma Center, St. Louis, Missouri, USA
| | - Elizabeth Bathon
- Barnes-Jewish Hospital, Charles F. Knight Emergency and Trauma Center, St. Louis, Missouri, USA
| | - Phillip Asaro
- Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Carrie M Mintz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Kevin Baumgartner
- Department of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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2
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Moskatel LS, Zhang N. Alcohol Use Disorder in Patients with Chronic Migraine: A Retrospective, Observational Study. Can J Neurol Sci 2024:1-11. [PMID: 38268310 DOI: 10.1017/cjn.2024.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE The relationship between migraine and alcohol consumption is unclear. We assessed the association between chronic migraine and alcohol use disorder(AUD), relative to chronic disease controls, and in conjunction with common comorbidities. METHODS We conducted a retrospective, observational study. The primary outcome was the odds ratio for AUD in patients with chronic migraine or with chronic migraine and additional comorbidities relative to controls. RESULTS A total of 3701 patients with chronic migraine, 4450 patients with low back pain, and 1780 patients with type 2 diabetes mellitus met inclusion criteria. Patients with chronic migraine had a lower risk of AUD relative to both controls of low back pain (OR 0.37; 95% CI: 0.29-0.47, p < 0.001) and type 2 diabetes mellitus (OR 0.39; 95% CI: 0.29-0.52, p < 0.001). Depression was associated with the largest OR for AUD in chronic migraine (OR 8.62; 95% CI: 4.99-14.88, p < 0.001), followed by post-traumatic stress disorder (OR 6.63; 95% CI: 4.13-10.64, p < 0.001) and anxiety (OR 3.58; 95% CI: 2.23-5.75, p < 0.001). CONCLUSION Patients with chronic migraine had a lower odds ratio of AUD relative to controls. But in patients with chronic migraine, those with comorbid depression, anxiety, or PTSD are at higher risk of AUD. When patients establish care, comorbid factors should be assessed and for those at higher risk, AUD should be screened for at every visit.
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Affiliation(s)
- Leon S Moskatel
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
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Johannessen A, Tevik K, Engedal K, Tjelta T, Helvik AS. Family' members experiences of their older relative's alcohol and substance misuse. Int J Qual Stud Health Well-being 2022; 17:2094059. [PMID: 35786387 PMCID: PMC9255228 DOI: 10.1080/17482631.2022.2094059] [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] [Accepted: 06/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Alcohol consumption in Norway and much of the western world has increased during the past decades, in particular among older adults (> 65 years). Although living with a family member's alcohol misuse has been shown to have a significant deleterious health impact, research on this topic is both lacking and urgently needed to develop targeted health services. AIM To generate knowledge of how family members are affected by their older relatives' alcohol and other substance misuse problems. METHOD In 2020, 17 individual interviews were carried out with the wives and adult children of older adults with alcohol and other substance misuse problems. Data were analysed using content analysis. FINDINGS Analyses revealed two main themes; the impact of living with psychological stress over time, and the impact over time on family relationships and functioning. Both included four subthemes, representing different dimensions of participants' experiences of the impact of their older relative's alcohol and substance misuse. CONCLUSION The challenges family members experienced through ongoing exposure to their relatives' alcohol and/or other substance misuse increased over time. These experiences had significant negative consequences for their health and life situation.
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Affiliation(s)
- Aud Johannessen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health and Social Science, University of South-Eastern Norway, Kongsberg, Norway
| | - Kjerstin Tevik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Knut Engedal
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Thomas Tjelta
- Faculty of Health and Social Science, University of South-Eastern Norway, Kongsberg, Norway
| | - Anne-Sofie Helvik
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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4
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Gerhardt S, Hoffmann S, Tan H, Gerchen MF, Kirsch P, Vollstädt-Klein S, Kiefer F, Bach P, Lenz B. Neural cue reactivity is not stronger in male than in female patients with alcohol use disorder. Front Behav Neurosci 2022; 16:1039917. [PMID: 36467741 PMCID: PMC9709253 DOI: 10.3389/fnbeh.2022.1039917] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/20/2022] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Males consume more alcohol than females, and alcohol use disorder (AUD) is more prevalent in males than females. However, females progress faster to AUD. Sex differences in neural alcohol cue reactivity were previously observed in young social drinkers, indicating a role of hypersensitivity to alcohol-related cues in very early stages of addiction. To our knowledge, this is the first study on patients diagnosed with AUD to test sex differences in neural reactivity to alcohol cues in order to widen previous findings. METHODS We analyzed data from previous studies, using a well-established functional magnetic resonance imaging (fMRI) paradigm to compare neural reactivity to alcohol cues between 42 female and 124 male patients with AUD (mean age 45 and 46 years) in predefined regions of interest that were implicated by previous studies (ventral and dorsal striatum as well as caudate, putamen, amygdala, hippocampus, insula, anterior cingulate cortex, and medial prefrontal cortex) using independent samples t-tests. Post-hoc, effect size calculations were performed. RESULTS Throughout all nine regions of interest, we found no statistically significant sex differences in neural reactivity toward alcoholic pictures alone or in comparison to neutral pictures (p > 0.05, FDR-corrected). Post-hoc effect size estimates indicated a magnitude between 0.137 and 0.418 (Hedge's g) on alcohol reactivity to alcohol cues compared to neutral cues and indicate very small to less than medium effect sizes in the direction of higher cue reactivity in female patients. CONCLUSION Previous studies showed sex differences in neural alcohol cue reactivity in younger social and problematic alcohol drinkers, i.e., stronger striatal cue-reactivity in males. After correction for multiple comparisons, we did not observe significant sex differences in a cohort of middle-aged females and males with AUD. Sex differences that are present during early phases of addiction development might disappear at later stages of AUD and might thus be considered as clinically less relevant in patients with more severe AUD.
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Affiliation(s)
- Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Haoye Tan
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Bernstein Center for Computational Neuroscience Heidelberg-Mannheim, Mannheim, Germany
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Bernstein Center for Computational Neuroscience Heidelberg-Mannheim, Mannheim, Germany
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Bernd Lenz
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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5
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Finanger T, Vaaler AE, Spigset O, Aamo TO, Andreassen TN, Gråwe RW, Skråstad RB. Identification of unhealthy alcohol use by self-report and phosphatidylethanol (PEth) blood concentrations in an acute psychiatric department. BMC Psychiatry 2022; 22:286. [PMID: 35449039 PMCID: PMC9026645 DOI: 10.1186/s12888-022-03934-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of standard screening methods could improve the detection rate of unhealthy alcohol use in patients admitted to psychiatric acute and emergency departments. The aim of the present study was to investigate the ability of the alcohol biomarker phosphatidylethanol (PEth) to identify patients with high levels of alcohol consumption prior to admission. METHODS The data were prospectively collected at admittance to an acute psychiatric department in the period January 2016 to June 2017. A blood sample for the analysis of PEth was available from 177 patients. We compared the PEth concentrations with the Alcohol Use Disorders Identification Test (AUDIT) scores during the hospital stay, and psychiatric diagnoses at discharge. RESULTS A total of 45.8% of the patients had a PEth concentration ≥ 0.03 μmol/L, indicating significant alcohol consumption. AUDIT scores consistent with unhealthy alcohol use were present in 51.7%. There was a significant positive correlation between PEth concentrations and AUDIT scores (r = 0.631, p < 0.001). PEth was above the detection limit of 0.03 μmol/L in 19% of those reporting an average daily intake of zero alcohol units per day during the last week before admission. PEth concentrations were significantly higher among those with an alcohol diagnosis than among those without such a diagnosis (0.82 μmol/L vs. 0.09 μmol/L, p = 0.001). CONCLUSION PEth provides supplementary information on recent alcohol consumption in a psychiatric population and would be particularly helpful in patients unable or unwilling to give such information at admission.
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Affiliation(s)
- Trine Finanger
- Clinic of Substance Use and Addiction Medicine, St. Olav University Hospital, Klostergata 48, 7030, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.
| | - Arne Einar Vaaler
- grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Health, St. Olav University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway
| | - Olav Spigset
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trond Oskar Aamo
- grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Trine Naalsund Andreassen
- grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
| | - Rolf Wilhelm Gråwe
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Research and Development, Division of Mental Health, St. Olav University Hospital, Trondheim, Norway
| | - Ragnhild Bergene Skråstad
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology – NTNU, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
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Williams IL. An Apologetic Interpretation of Alcoholics Anonymous (AA): Timeless Wisdom, Outdated Language. Subst Use Misuse 2021; 56:1079-1094. [PMID: 33970771 DOI: 10.1080/10826084.2021.1892134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Twelve Steps of Alcoholics Anonymous (AA) has proven to be an effective aid in recovery for many people with alcohol use disorder. While constructive criticisms of AA can be beneficial to the organization, other criticisms have merely served as rhetorical devices intent on discrediting the 12-step approach. OBJECTIVES This paper examines six prominent critiques of AA, paying special attention to the premises, tone, and factual basis of the statements. Interpretations grounded in AA literature are offered to address claims or critiques around prominent themes, which are organized into two main classes: purported causes of alcoholism and factors maintaining alcoholism. RESULTS Findings reveal tenuous statements in the AA literature that appear contradictory and thereby invite a misreading. These statements, some of which misrepresent the tenets of AA and its founders, underscore certain vocal criticisms that are not entirely unfounded. While many pages of the AA literature are imbued with timeless wisdom, even the most apologetic interpretations-distilled into benefit-of-the-doubt renderings-largely falter in defending the nature of the language that originated in the early 1900s at odds with 21st century understandings of alcohol use disorder. Conclusions/Importance: The AA literature essentially presents a valid target for critics, fueling resistance to this free community-based resource that may prevent people who could benefit from AA from seeking the help of the 12-steps.
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Helvik AS, Engedal K, Johannessen A. Elevated alcohol consumption among geriatric psychiatric in-patients. NORDIC STUDIES ON ALCOHOL AND DRUGS 2020; 37:400-410. [PMID: 35310925 PMCID: PMC8899249 DOI: 10.1177/1455072520936813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/02/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction: Although a clear relationship has been established between elevated alcohol consumption and psychiatric problems in old age, there are few descriptions of the prevalence of elevated alcohol consumption in older adults who have been referred to geriatric psychiatric treatment. Aim: To describe the prevalence of self-reported elevated alcohol consumption in men and women referred to geriatric psychiatry wards in Norway, and to explore factors associated with elevated alcohol consumption. Method: This cross-sectional study includes data from a registry of geriatric psychiatry patients aged ≥ 65 years from December 2016 until December 2018. The outcome measure was reported elevated alcohol consumption assessed with the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). The analyses used demographic data as well as a measure of cognitive function, psychiatric diagnosis and use of psychotropic drugs. Results: In total, 367 patients (131, 35.7% men) with a mean (SD) age of 74.7 (7.6) years were included. Of these patients, 27% scored above the pre-set cut-off for elevated alcohol consumption according to AUDIT-C (≥ 3 and 4 for women and men, respectively). The prevalence of elevated alcohol did not differ by gender. In adjusted logistic regression analysis, older age, living with someone and use of antidepressants were associated with reduced odds for reporting elevated alcohol consumption (OR 0.93, 95% CI 0.89–0.96; OR 0.54, 95% CI 0.31–0.97; and 0.54, 95% CI 0.32–0.92, respectively). Conclusion: A relatively high proportion of psychiatric patients aged 65 years or older reported elevated alcohol consumption, regardless of diagnosis. Older age, living with someone and use of antidepressants were associated with lower odds for elevated alcohol consumption.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim; and Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim, Norway
| | - Knut Engedal
- Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim, Norway
| | - Aud Johannessen
- Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim; and University of South-Eastern Norway, Norway
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Kalpakci A, Sofuoglu M, Petrakis I, Rosenheck RA. Gender differences among Veterans with alcohol use disorder nationally in the Veterans Health Administration. J Addict Dis 2019; 37:185-194. [PMID: 31429377 DOI: 10.1080/10550887.2019.1653739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alcohol use among women is increasing relative to men but no study has compared rates and characteristics of women with alcohol use disorder (AUD) to men among Veterans Health Administration (VHA) service users. To compare male and female VHA service users on rates of AUD, and among those with AUD, on sociodemographic characteristics, medical and physical comorbidities, and service and medication use national VHA data from fiscal year (FY) 2012 were used to identify Veterans diagnosed with AUD. Bivariate analyses evaluate gender differences in: sociodemographic characteristics; comorbid medical and psychiatric diagnoses; service use and psychotropic prescription fills. Multivariate stepwise logistic regression was used to identify a parsimonious set of differences. About 13,797 of all 349,430 women served by VHA in FY 2012 (3.94%) were diagnosed with AUD as compared to 331,407 of 5,102,877 men (6.50%) for a risk ratio of 0.608 for AUD among women. Women were younger, more likely to have served in recent Middle East conflicts and had more comorbid psychiatric and substance use diagnoses than men. They filled fewer psychotropic prescriptions (after taking greater number of psychiatric diagnoses in to account), but were more likely to fill a prescription for naltrexone than men. Women had fewer comorbid medical diagnoses than men. Women Veterans with an AUD have higher rates of psychiatric comorbidities than men, highlighting the need for better integration of treatment for AUD and comorbid psychiatric conditions, and suggesting different pathways and potential interventions for AUD in women.
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Affiliation(s)
- Allison Kalpakci
- Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, VA New England Mental Illness, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Mehmet Sofuoglu
- Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, VA New England Mental Illness, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Ismene Petrakis
- Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, VA New England Mental Illness, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Robert A Rosenheck
- Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, VA New England Mental Illness, West Haven, CT, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Lakhan R, Sagiraju HKR, Ekúndayò O, Sharma M. Substance Use Disorder in People with Intellectual Disabilities: Current Challenges in Low- and Middle-Income Countries. J Neurosci Rural Pract 2019; 10:301-305. [PMID: 31001021 PMCID: PMC6454939 DOI: 10.4103/jnrp.jnrp_393_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Use of illegal and prescription drugs has significantly increased in recent years all over the world in most populations. Greater worldwide awareness in this regard has substantially improved the epidemiological understanding of substance use, its risk factors, and impact on life. People with intellectual disabilities constitute 0.5%-1.5% of the world's population. It can be conjectured that they might be experiencing similar or even a greater burden of substance use in their lives. This article highlights some important aspects of substance use among this population in low- and middle-income countries that need urgent attention.
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Affiliation(s)
- Ram Lakhan
- Department of Health and Human Performance, Berea College, Berea, USA
| | | | - Olúgbémiga Ekúndayò
- Department of Allied Health, College of Health Science, Northern Kentucky University, Highland Heights, KY, USA
| | - Manoj Sharma
- Behavioral and Environment Health, Jackson State University, Jackson, Mississippi, USA
- College of Health Sciences, Walden University, Minneapolis, Minnesota, USA
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Degenhardt L, Bharat C, Bruno R, Glantz MD, Sampson NA, Lago L, Aguilar‐Gaxiola S, Alonso J, Andrade LH, Bunting B, Caldas‐de‐Almeida JM, Cia AH, Gureje O, Karam EG, Khalaf M, McGrath JJ, Moskalewicz J, Lee S, Mneimneh Z, Navarro‐Mateu F, Sasu CC, Scott K, Torres Y, Poznyak V, Chatterji S, Kessler RC. Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys. Addiction 2019; 114:534-552. [PMID: 30370636 PMCID: PMC7059958 DOI: 10.1111/add.14482] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/26/2018] [Accepted: 10/23/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. DESIGN Cross-sectional household surveys. SETTING Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. PARTICIPANTS Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. MEASUREMENTS Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). FINDINGS Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. CONCLUSIONS The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC)UNSW Sydney Australia
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre (NDARC)UNSW Sydney Australia
| | - Raimondo Bruno
- School of Medicine (Psychology)University of Tasmania Hobart Australia
| | - Meyer D. Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR)National Institute on Drug Abuse (NIDA), National Institute of Health (NIH) Bethesda Maryland USA
| | - Nancy A. Sampson
- Department of Health Care PolicyHarvard Medical School Boston Massachusetts USA
| | - Luise Lago
- National Drug and Alcohol Research Centre (NDARC)UNSW Sydney Australia
| | | | - Jordi Alonso
- Health Services Research UnitIMIM‐Hospital del Mar Medical Research Institute Barcelona Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP) Spain
- Pompeu Fabra University (UPF) Barcelona Spain
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica ‐ LIM 23Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo Brazil
| | - Brendan Bunting
- School of PsychologyUlster University Londonderry United Kingdom
| | - Jose Miguel Caldas‐de‐Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências MédicasUniversidade Nova de Lisboa Lisbon Portugal
| | | | - Oye Gureje
- Department of PsychiatryUniversity College Hospital Ibadan Nigeria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of MedicineBalamand University Beirut Lebanon
- Department of Psychiatry and Clinical PsychologySt George Hospital University Medical Center Beirut Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC) Beirut Lebanon
| | | | - John J. McGrath
- Queensland Centre for Mental Health ResearchThe Park Centre for Mental Health Wacol Australia
- Queensland Brain InstituteThe University of Queensland St Lucia Australia
- National Centre for Register‐based ResearchAarhus University Aarhus Denmark
| | | | - Sing Lee
- Department of PsychiatryChinese University of Hong Kong Tai Po Hong Kong
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social ResearchUniversity of Michigan Ann Arbor Michigan USA
| | - Fernando Navarro‐Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF‐SM)Servicio Murciano de Salud Murcia Spain
- IMIB‐Arrixaca Murcia Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP) Murcia Spain
| | - Carmen C. Sasu
- National School of Public HealthManagement and Professional Development Bucharest Romania
| | - Kate Scott
- Department of Psychological MedicineUniversity of Otago Dunedin Otago New Zealand
| | - Yolanda Torres
- Center for Excellence on Research in Mental HealthCES University Medellin Colombia
| | - Vladimir Poznyak
- Department of Mental Health and Substance AbuseWorld Health Organization Geneva Switzerland
| | - Somnath Chatterji
- Department of Information, Evidence and ResearchWorld Health Organization Geneva Switzerland
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical School Boston Massachusetts USA
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Kiluk BD, Frankforter TL, Cusumano M, Nich C, Carroll KM. Change in DSM-5 Alcohol Use Disorder Criteria Count and Severity Level as a Treatment Outcome Indicator: Results from a Randomized Trial. Alcohol Clin Exp Res 2018; 42:10.1111/acer.13807. [PMID: 29870051 PMCID: PMC6281805 DOI: 10.1111/acer.13807] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/30/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most clinical trials evaluating treatments for alcohol use target individuals meeting diagnostic criteria for alcohol use disorder (AUD), but few address change in diagnostic status following treatment or as a potential outcome indicator. This study evaluated whether DSM-5 AUD total criteria count or severity category was sensitive to change over time and treatment effects. METHODS Data were drawn from a randomized clinical trial that evaluated the efficacy of computer-based cognitive behavioral therapy program (CBT4CBT) for AUD. Sixty-eight individuals were randomized to 1 of the 3 weekly outpatient treatments for an 8-week period: (i) treatment as usual (TAU), (ii) TAU+CBT4CBT, and (iii) CBT4CBT+brief monitoring. Structured clinical interviews were used to determine current (past 30 days) AUD diagnosis at baseline, end-of-treatment, and 6 months following end-of-treatment. Change in the total number of DSM criteria endorsed, as well as severity categories (mild, moderate, severe), was evaluated across time and by treatment condition. RESULTS Generalized Poisson's linear mixed models revealed a significant reduction in the number of DSM criteria from baseline to treatment end point [time effect χ2 (1) = 35.54, p < 0.01], but no significant interactions between time and treatment condition. Fewer total criteria endorsed, as well as achieving at least a 2-level reduction in AUD severity category at end-of-treatment, were associated with better outcomes during follow-up. Chi-square results indicated a greater proportion of individuals assigned to TAU+CBT4CBT had at least a 2-level reduction in severity category compared to TAU, at trend-level significance [χ2 (2, 54) = 5.13, p = 0.07], consistent with primary alcohol use outcomes in the main trial. CONCLUSIONS This is the first study to demonstrate change in DSM-5 AUD total criteria count, as well as severity category, in a randomized clinical trial. These findings offer support for their use as a potential clinically meaningful outcome indicator.
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Affiliation(s)
- Brian D Kiluk
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Charla Nich
- Yale University School of Medicine, New Haven, Connecticut
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Fazel S, Yoon IA, Hayes AJ. Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction 2017; 112:1725-1739. [PMID: 28543749 PMCID: PMC5589068 DOI: 10.1111/add.13877] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/12/2016] [Accepted: 05/16/2017] [Indexed: 11/29/2022]
Abstract
AIMS The aims were to (1) estimate the prevalence of alcohol and drug use disorders in prisoners on reception to prison and (2) estimate and test sources of between study heterogeneity. METHODS Studies reporting the 12-month prevalence of alcohol and drug use disorders in prisoners on reception to prison from 1 January 1966 to 11 August 2015 were identified from seven bibliographic indexes. Primary studies involving clinical interviews or validated instruments leading to DSM or ICD diagnoses were included; self-report surveys and investigations that assessed individuals more than 3 months after arrival to prison were not. Random-effects meta-analysis and subgroup and meta-regression analyses were conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In total, 24 studies with a total of 18 388 prisoners across 10 countries were identified. The random-effects pooled prevalence estimate of alcohol use disorder was 24% [95% confidence interval (CI) = 21-27], with very high heterogeneity (I2 = 94%). These ranged from 16 to 51% in male and 10-30% in female prisoners. For drug use disorders, there was evidence of heterogeneity by sex, and the pooled prevalence estimate in male prisoners was 30% (95% CI = 22-38; I2 = 98%; 13 studies; range 10-61%) and, in female prisoners, was 51% (95% CI = 43-58; I2 = 95%; 10 studies; range 30-69%). On meta-regression, sources of heterogeneity included higher prevalence of drug use disorders in women, increasing rates of drug use disorders in recent decades, and participation rate. CONCLUSIONS Substance use disorders are highly prevalent in prisoners. Approximately a quarter of newly incarcerated prisoners of both sexes had an alcohol use disorder, and the prevalence of a drug use disorder was at least as high in men, and higher in women.
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Affiliation(s)
- Seena Fazel
- Department of PsychiatryUniversity of Oxford, Warneford HospitalOxfordUK
| | - Isabel A. Yoon
- Department of PsychiatryUniversity of Oxford, Warneford HospitalOxfordUK
| | - Adrian J. Hayes
- Department of PsychiatryUniversity of Oxford, Warneford HospitalOxfordUK
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13
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Stickel F, Moreno C, Hampe J, Morgan MY. The genetics of alcohol dependence and alcohol-related liver disease. J Hepatol 2017; 66:195-211. [PMID: 27575312 DOI: 10.1016/j.jhep.2016.08.011] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 12/19/2022]
Abstract
The susceptibility to developing alcohol dependence and significant alcohol-related liver injury is determined by a number of constitutional, environmental and genetic factors, although the nature and level of interplay between them remains unclear. The familiality and heritability of alcohol dependence is well-documented but, to date, no strong candidate genes conferring increased risk have emerged, although variants in alcohol dehydrogenase and acetaldehyde dehydrogenase have been shown to confer protection, predominantly in individuals of East Asian ancestry. Population contamination with confounders such as drug co-dependence and psychiatric and physical co-morbidity may explain the essentially negative genome-wide association studies in this disorder. The familiality and hereditability of alcohol-related cirrhosis is not as well-documented but three strong candidate genes PNPLA3, TM6SF2 and MBOAT7, have been identified. The mechanisms by which variants in these genes confer risk and the nature of the functional interplay between them remains to be determined but, when elucidated, will undoubtedly increase our understanding of the pathophysiology of this disease. The way in which this genetic information could potentially inform patient management has yet to be determined and tested.
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Affiliation(s)
- Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, Switzerland.
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jochen Hampe
- Medical Department 1, University Hospital Dresden, TU Dresden, Germany
| | - Marsha Y Morgan
- UCL Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, UK
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14
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Proctor SL, Williams DC, Kopak AM, Voluse AC, Connolly KM, Hoffmann NG. Diagnostic Concordance between DSM-5 and ICD-10 Cannabis Use Disorders. Addict Behav 2016; 58:117-22. [PMID: 26922159 DOI: 10.1016/j.addbeh.2016.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/11/2016] [Accepted: 02/14/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES With the recent federal mandate that all U.S. health care settings transition to ICD-10 billing codes, empirical evidence is necessary to determine if the DSM-5 designations map to their respective ICD-10 diagnostic categories/billing codes. The present study examined the concordance between DSM-5 and ICD-10 cannabis use disorder diagnoses. METHOD Data were derived from routine clinical assessments of 6871 male and 801 female inmates recently admitted to a state prison system from 2000 to 2003. DSM-5 and ICD-10 diagnostic determinations were made from algorithms corresponding to the respective diagnostic formulations. RESULTS Past 12-month prevalence rates of cannabis use disorders were comparable across classification systems. The vast majority of inmates with no DSM-5 diagnosis continued to have no diagnosis per the ICD-10, and a similar proportion with a DSM-5 severe diagnosis received an ICD-10 dependence diagnosis. Most of the variation in diagnostic classifications was accounted for by those with a DSM-5 moderate diagnosis in that approximately half of these cases received an ICD-10 dependence diagnosis while the remaining cases received a harmful use diagnosis. CONCLUSIONS Although there appears to be a generally high level of agreement between diagnostic classification systems for those with no diagnosis or those evincing symptoms of a more severe condition, concordance between DSM-5 moderate and ICD-10 dependence diagnoses was poor. Additional research is warranted to determine the appropriateness and implications of the current DSM-5 coding guidelines regarding the assignment of an ICD-10 dependence code for those with a DSM-5 moderate diagnosis.
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Affiliation(s)
| | - Daniel C Williams
- G.V. (Sonny) Montgomery VA Medical Center, Addictive Disorders Treatment Program, USA; University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, USA
| | - Albert M Kopak
- Western Carolina University, Department of Criminology and Criminal Justice, USA
| | - Andrew C Voluse
- G.V. (Sonny) Montgomery VA Medical Center, Addictive Disorders Treatment Program, USA; University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, USA
| | - Kevin M Connolly
- G.V. (Sonny) Montgomery VA Medical Center, Addictive Disorders Treatment Program, USA; University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, USA
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