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Walsh BE, Manzler CA, Noyes ET, Schlauch RC. Examining the daily reciprocal relations between alcohol abstinence self-efficacy and drinking among non-treatment seeking individuals with alcohol use disorder (AUD). Addict Behav 2024; 156:108068. [PMID: 38772225 DOI: 10.1016/j.addbeh.2024.108068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/01/2024] [Accepted: 05/17/2024] [Indexed: 05/23/2024]
Abstract
Theoretical and empirical models of alcohol use and misuse indicate that abstinence self-efficacy (ASE) predicts improvements in treatment outcomes among individuals with alcohol use disorder (AUD). More recently, studies have begun examining daily fluctuations in ASE to better understand in-the-moment determinants of drinking behaviors. With the goal of assessing how ASE is implicated in maintenance (rather than changing) of hazardous drinking patterns, the current study examined daily reciprocal relations between ASE and drinking among individuals with AUD. Non-treatment seeking adults (n = 63) with AUD were recruited and completed daily surveys assessing ASE and drinking behaviors for 14 days. Data were analyzed using time-lagged multilevel modeling. Results indicated that both within- and between-person elevations in ASE predicted decreased likelihood of drinking, but only within-person ASE predicted fewer drinks consumed on drinking days. Previous-day drinking behavior was unrelated to next-day ASE; however, higher percentage of drinking days during the monitoring period (between-person) was associated with lower daily ASE. These results demonstrate that confidence in one's ability to abstain from drinking varies considerably across days, and that fluctuations may be implicated in daily drinking decisions. The lack of effect of previous-day drinking on ASE (combined with the significant effect of average drinking frequency) may suggest that sustained periods of reduced drinking or abstinence are necessary to impact ASE. This study points to ASE's role in the maintenance of daily drinking behavior among non-treatment-seeking individuals with AUD and reiterates the importance of self-efficacy in behavioral control and decision-making at the daily level.
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Affiliation(s)
- Brendan E Walsh
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Charles A Manzler
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Emily T Noyes
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
| | - Robert C Schlauch
- Department of Psychology, University of South Florida, 3711 USF Citrus Drive, Tampa, FL 33620, USA.
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Halcomb ME, Dzemidzic M, Avena-Koenigsberger A, Hile KL, Durazzo TC, Yoder KK. Greater ventral striatal functional connectivity in cigarette smokers relative to non-smokers across a spectrum of alcohol consumption. Brain Imaging Behav 2024:10.1007/s11682-024-00903-9. [PMID: 39106000 DOI: 10.1007/s11682-024-00903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 08/07/2024]
Abstract
Cigarette smoking is associated with elevated risk of disease and mortality and contributes to heavy healthcare-related economic burdens. The nucleus accumbens is implicated in numerous reward-related behaviors, including reinforcement learning and incentive salience. The established functional connectivity of the accumbens includes regions associated with motivation, valuation, and affective processing. Although the high comorbidity of cigarette smoking with drinking behaviors may collectively affect brain activity, there could be independent effects of smoking in alcohol use disorder that impact brain function and behavior. We hypothesized that smoking status, independent of alcohol use, would be associated with aberrations of nucleus accumbens functional connectivity to brain regions that facilitate reward processing, salience attribution, and inhibitory control. Resting state functional magnetic resonance imaging data from thirty-one nonsmokers and nineteen smoking individuals were analyzed using seed-based correlations of the bilateral accumbens with all other brain voxels. Statistical models accounted for drinks consumed per week. The smoking group demonstrated significantly higher functional connectivity between the left accumbens and the bilateral insula and anterior cingulate cortex, as well as hyperconnectivity between the right accumbens and the insula. Confirmatory analyses using the insula and cingulate clusters generated from the original analysis as seed regions reproduced the hyperconnectivity in smokers between the bilateral insular regions and the accumbens. In conclusion, smoking status had distinct effects on neural activity; hyperconnectivity between the accumbens and insula in smokers may reflect enhanced encoding of the reinforcing effects of smoking and greater orientation toward smoking-associated stimuli.
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Affiliation(s)
- Meredith E Halcomb
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA
| | - Mario Dzemidzic
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA
- Department of Neurology, Indiana University School of Medicine, 355 W. 16th St., GH 4700, Indianapolis, IN, 46202, USA
| | - Andrea Avena-Koenigsberger
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA
| | - Karen L Hile
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA
| | - Timothy C Durazzo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Karmen K Yoder
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA.
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 355 W. 16th St., GH 4100, Indianapolis, IN, 46202, USA.
- Department of Psychology, Indiana University Purdue University Indianapolis, 402 N. Blackford St, Indianapolis, IN, 46202, USA.
- Stark Neurosciences Research Institute, 320 W. 15th St., NB 414, Indianapolis, IN, 46202, USA.
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Durazzo TC, Kraybill EP, Stephens LH, May AC, Meyerhoff DJ. Pro-atherogenic medical conditions are associated with widespread regional brain metabolite abnormalities in those with alcohol use disorder. Alcohol Alcohol 2024; 59:agae055. [PMID: 39127890 DOI: 10.1093/alcalc/agae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
AIMS Widespread brain metabolite abnormalities in those with alcohol use disorder (AUD) were reported in numerous studies, but the effects of the pro-atherogenic conditions of hypertension, type 2 diabetes mellitus, hepatitis C seropositivity, and hyperlipidemia on metabolite levels were not considered. These conditions were associated with brain metabolite abnormalities in those without AUD. We predicted treatment-seeking individuals with AUD and pro-atherogenic conditions (Atherogenic+) demonstrate lower regional metabolite markers of neuronal viability [N-acetylaspartate (NAA)] and cell membrane turnover/synthesis [choline-containing compounds (Cho)], compared with those with AUD without pro-atherogenic conditions (Atherogenic-) and healthy controls (CON). METHODS Atherogenic+ (n = 59) and Atherogenic- (n = 51) and CON (n = 49) completed a 1.5 T proton magnetic resonance spectroscopic imaging study. Groups were compared on NAA, Cho, total creatine, and myoinositol in cortical gray matter (GM), white matter (WM), and select subcortical regions. RESULTS Atherogenic+ had lower frontal GM and temporal WM NAA than CON. Atherogenic+ showed lower parietal GM, frontal, parietal and occipital WM and lenticular nuclei NAA level than Atherogenic- and CON. Atherogenic- showed lower frontal GM and WM NAA than CON. Atherogenic+ had lower Cho level than CON in the frontal GM, parietal WM, and thalamus. Atherogenic+ showed lower frontal WM and cerebellar vermis Cho than Atherogenic- and CON. CONCLUSIONS Findings suggest proatherogenic conditions in those with AUD were associated with increased compromise of neuronal integrity and cell membrane turnover/synthesis. The greater metabolite abnormalities observed in Atherogenic+ may relate to increased oxidative stress-related compromise of neuronal and glial cell structure and/or impaired arterial vasoreactivity/lumen viability.
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Affiliation(s)
- Timothy C Durazzo
- Mental Illness Research and Education Clinical Centers, VA Palo Alto Health Care System, 3801 Miranda Ave. (151Y), Palo Alto, CA 94304, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States
| | - Eric P Kraybill
- Mental Illness Research and Education Clinical Centers, VA Palo Alto Health Care System, 3801 Miranda Ave. (151Y), Palo Alto, CA 94304, United States
| | - Lauren H Stephens
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States
| | - April C May
- Mental Illness Research and Education Clinical Centers, VA Palo Alto Health Care System, 3801 Miranda Ave. (151Y), Palo Alto, CA 94304, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, United States
| | - Dieter J Meyerhoff
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco VA Medical Center, 4150 Clement St. (114M) San Francisco, CA 94121, United States
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus St., San Francisco, CA 94143, United States
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Lawson S, Bryant J, Freund M, Dizon J, Haber PS, Shakeshaft A, Jefferies M, Farrell M. Prevalence and factors associated with polydrug use among clients seeking treatment for alcohol misuse. Drug Alcohol Rev 2024; 43:1194-1203. [PMID: 38462541 DOI: 10.1111/dar.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The aim of this paper was to examine the client and psychosocial characteristics associated with polydrug use in patients with alcohol misuse as their primary drug of concern (PDC) seeking treatment from substance use treatment centres. METHODS Self-report surveys were undertaken with clients attending 1 of 34 community-based substance use treatment centres across Australia with alcohol as their PDC. Survey items included client's socio-demographic characteristics, level of alcohol dependence, use of other drugs including tobacco, health and wellbeing factors including health-related quality of life. The factors associated with polydrug use (alcohol use concurrent with at least one other drug) were examined. RESULTS In a sample of 1130 clients seeking treatment primarily for alcohol problems, 71% reported also using another drug. The most frequently used drug was tobacco (50%) followed by cannabis (21%) and benzodiazepines (15%). Excluding tobacco use, 35% of participants reported polydrug use. Factors associated with any polydrug use were younger age, lower education levels, lower levels of mental health related quality of life and housing risk (i.e., risk of eviction or experienced homelessness in past 4 weeks). When tobacco was excluded, factors associated with polydrug use were age, lower physical and mental health-related quality of life, and housing risk. DISCUSSION AND CONCLUSIONS Most adults seeking treatment for alcohol misuse as their PDC reported using another drug in addition to alcohol. Treatment services should be designed accordingly to maximise the likelihood of treatment engagement and success.
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Affiliation(s)
- Samuel Lawson
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Megan Freund
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Joshua Dizon
- Clinical Research Design and Statistics, Hunter Medical Research Institute, Newcastle, Australia
| | - Paul S Haber
- Edith Collins Centre, Royal Prince Alfred Hospital, and Specialty of Addiction Medicine, The University of Sydney, Sydney, Australia
| | - Anthony Shakeshaft
- Poche Centre for Indigenous Health, University of Queensland, Brisbane, Australia
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Meryem Jefferies
- Western Sydney Local Health District Drug Health, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Yang K, Du R, Yang Q, Zhao R, Fan F, Chen S, Luo X, Tan S, Wang Z, Yu T, Tian B, Le TM, Li CSR, Tan Y. Cortical thickness of the inferior parietal lobule as a potential predictor of relapse in men with alcohol dependence. Brain Imaging Behav 2024; 18:331-342. [PMID: 38078981 DOI: 10.1007/s11682-023-00838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
Alcohol dependence is a disorder with a high recurrence rate that leads to a considerable public health burden. The risk of relapse appears to be related to a complex interplay of multiple factors. Herein, we aimed to explore the potential neural predictors of relapse in Chinese male patients with alcohol dependence. This study enrolled 58 male patients with alcohol dependence who had undergone acute detoxification. General demographic information and clinical features were collected. Magnetic resonance imaging data were used to measure cortical thickness across 34 regions of the brain. Patients were followed up at six months, and 51 patients completed the follow-up visit. These patients were divided into a relapser and an abstainer group. A binary logistic regression analysis was performed to investigate the potential risk factors of relapse. Compared to abstainers, relapsers showed higher inattention and non-planning impulsivity on the 11th version of the Barratt Impulsive Scale. The cortical thicknesses of the inferior-parietal lobules were significantly higher in abstainers compared with those in relapsers. Furthermore, binary logistic regression analysis showed that the thickness of the inferior parietal lobule predicted relapse, and lower non-planning impulse was a protective factor against relapse. Relapsers show poorer impulse control than abstainers, and structural magnetic resonance imaging revealed a decreased thickness of the inferior parietal lobule in relapsers. Our results indicate the thickness of the inferior parietal lobule as a potential relapse predictor in male patients with alcohol dependence.
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Affiliation(s)
- Kebing Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Ruonan Du
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Qingyan Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Rongjiang Zhao
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Ting Yu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Thang M Le
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China.
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Dwyer CL, Padula CB. Context matters: Exploring the adaptive nature of self-regulation skills in predicting abstinence among veterans with alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:692-702. [PMID: 38551499 DOI: 10.1111/acer.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent among veterans in the United States. Self-regulation skills (e.g., coping and emotion regulation) are important biopsychosocial factors for preventing relapse. However, how variation in self-regulation skills supports abstinence based on contextual demands is understudied in veterans with AUD. METHODS In a prospective longitudinal design, treatment-seeking veterans (n = 120; 29 females) aged 23-91 with AUD completed the Alcohol Abstinence Self-Efficacy Scale to assess temptation to drink across several high-risk situations (i.e., negative affect, social/positive emotions, physical concerns, and craving/urges) as well as the Brief-COPE and Emotion Regulation Questionnaire to assess self-regulation skills. Abstinence status was assessed at 6 months. T-tests were used to identify self-regulation skills that differed between abstinent and non-abstinent individuals. Multivariate regression with model selection was performed using all possible interactions between each high-risk situation and the self-regulation skills that significantly differed between groups. RESULTS Overall, 33.3% of participants (n = 40; nine females) were abstinent at 6 months. Abstinent individuals reported significantly higher use of suppression (p = 0.015), acceptance (p = 0.005), and planning (p = 0.045). Multivariate regression identified significant interactions between (1) planning and physical concerns (p = 0.010) and (2) acceptance, suppression, and craving/urges (p = 0.007). Greater planning predicted abstinence in participants with higher temptation to drink due to physical concerns (e.g., pain). For individuals with lower temptation to drink due to cravings/urges, simultaneous higher suppression and acceptance increased the likelihood of abstinence. Conversely, for participants with higher cravings, greater acceptance with lower suppression was linked to a higher probability of abstinence. CONCLUSIONS Results suggest that the adaptiveness of self-regulation skills in predicting AUD recovery is dependent on contextual demands and highlight the need for culturally sensitive treatments. Collectively, these findings indicate that further research on coping and regulatory flexibility may be an important avenue for tailoring AUD treatment for veterans.
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Affiliation(s)
- Candice L Dwyer
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Claudia B Padula
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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Pars E, Hirzalla F, VanDerNagel JEL, Dijkstra BAG, Schellekens AFA. Not Two Sides of the Same Coin: A Qualitative Comparative Analysis of Post-Treatment Abstinence and Relapse. Subst Abuse Rehabil 2024; 15:9-19. [PMID: 38510337 PMCID: PMC10953711 DOI: 10.2147/sar.s447560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/04/2024] [Indexed: 03/22/2024] Open
Abstract
Purpose Substance use disorder (SUD) can be a chronic relapsing condition with poor treatment outcomes. Studies exploring factors associated with abstinence or relapse after treatment are often quantitative in nature, applying linear statistical approaches, while abstinence and relapse result from non-linear, complex, dynamic and synergistic processes. This study aims to explore these underlying dynamics using qualitative comparative analysis (QCA) as a mixed methods approach to further our understanding of factors contributing to post-treatment abstinence and relapse. Patients and Methods In a prospective study, we gathered both qualitative and quantitative data pertaining to post-treatment substance use and the factors linked to substance use outcomes. These factors encompassed psychiatric comorbidity, intellectual disability, social disintegration, post-treatment support, and engagement in activities among patients who had undergone inpatient treatment for severe SUD (n = 58). QCA, a set-theoretic approach that considers the complex interplay of multiple conditions, was applied to discern which factors were necessary or sufficient for the occurrence of either abstinence or relapse. Results We found two solutions predicting abstinence, and five for relapse. Post-treatment conditions (support and engagement in activities) were important for retaining abstinence. For relapse, individual baseline characteristics (intellectual disability, social disintegration, psychiatric comorbidity) combined with (post-)treatment factors (post-treatment support, activities) were important. Conclusion Although abstinence and relapse represent opposing outcomes, they each exhibit distinct dynamics. To gain a comprehensive understanding of these dynamics, it is advisable to examine them as separate outcomes. For clinical practice, it can be worthwhile to recognize that fostering the conditions conducive to abstinence may differ from preventing the factors that trigger relapse.
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Affiliation(s)
- Esther Pars
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Department of Human Media Interaction, University of Twente, Enschede, the Netherlands
- Salvation Army, Ugchelen, The Netherlands
| | - Fadi Hirzalla
- Department of Public Administration and Sociology, Erasmus University, Rotterdam, the Netherlands
| | - Joanne E L VanDerNagel
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Department of Human Media Interaction, University of Twente, Enschede, the Netherlands
- Tactus Addiction Care, Deventer, the Netherlands
- Aveleijn, Borne, the Netherlands
| | - Boukje A G Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
- Novadic-Kentron, Vught, the Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, the Netherlands
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Branagan WT, Norvell JP. Assessment and Evaluation of Alcohol Use Disorder in Liver Transplant. Transplantation 2024; 108:654-661. [PMID: 37408098 DOI: 10.1097/tp.0000000000004722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Alcohol-related liver disease is the most common indication for liver transplantation. It is essential for providers in transplantation to be informed of the state of the science in evaluation of alcohol use disorder (AUD). This review examines the broad range of approaches to the evaluation of AUD ranging from traditional interview approaches to recent literature on artificial intelligence models. The empirical support for methods of evaluation is examined. The authors discuss the use of each method in the context of patients seeking a liver transplant for alcohol-related liver disease. This review emphasizes the importance of using objective assessments so that transplant centers make evidence-based decisions and reduce cognitive bias. The review concludes with a proposed assessment battery for evaluation and bridges to future directions in the field of AUD assessment in liver transplantation.
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Affiliation(s)
- William T Branagan
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - J P Norvell
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
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Durazzo TC, Stephens LH, Kraybill EP, May AC, Meyerhoff DJ. Regional cortical brain volumes at treatment entry relates to post treatment WHO risk drinking levels in those with alcohol use disorder. Drug Alcohol Depend 2024; 255:111082. [PMID: 38219355 PMCID: PMC10895709 DOI: 10.1016/j.drugalcdep.2024.111082] [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: 10/23/2023] [Revised: 12/08/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Abstinence following treatment for alcohol use disorder (AUD) is associated with significant improvements in psychiatric and physical health, however, recent studies suggest resumption of low risk levels of alcohol use can also be beneficial. The present study assessed whether post-treatment levels of alcohol use were associated with cortical brain volumedifferences at treatment entry. METHODS Individuals seeking treatment for AUD (n=75) and light/non-drinking controls (LN, n=51) underwent 1.5T magnetic resonance imaging. The volumes of 34 bilateral cortical regions of interest (ROIs) were quantitated via FreeSurfer. Individuals with AUD were classified according to post-treatment alcohol consumption using the WHO risk drinking levels (abstainers: AB; low risk: RL; or higher risk: RH). Regional volumes for AB, RL and RH, at treatment entry, were compared to LN. RESULTS Relative to LN, AB demonstrated smaller volumes in 18/68 (26%), RL in 24/68 (35%) and RH in 34/68 (50%) ROIs with the largest magnitude volume differences observed between RH and LN. RH and RL reported a higher frequency of depressive disorders than AB. Among RH and RL, level of depressive and anxiety symptomatology were associated with daily number of drinks consumed after treatment. CONCLUSIONS Volumetric differences, at treatment entry, in brain regions implicated in executive function and salience networks corresponded with post-treatment alcohol consumption levels suggesting that pre-existing differences in neural integrity may contribute to treatment outcomes. Depressive and anxiety symptomatology was also associated with brain morphometrics and alcohol use patterns, highlighting the importance of effectively targeting these conditions during AUD treatment.
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Affiliation(s)
- Timothy C Durazzo
- Sierra-Pacific Mental Illness Research and Education Clinical Centers, VA Palo Alto Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA.
| | - Lauren H Stephens
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Eric P Kraybill
- Sierra-Pacific Mental Illness Research and Education Clinical Centers, VA Palo Alto Health Care System, USA
| | - April C May
- Sierra-Pacific Mental Illness Research and Education Clinical Centers, VA Palo Alto Health Care System, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Dieter J Meyerhoff
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco VA Medical Center, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Watkins LE, Patton SC, Wilcox T, Drexler K, Rauch SAM, Rothbaum BO. Substance Use after Completion of an Intensive Treatment Program with Concurrent Treatment for Posttraumatic Stress Disorder and Substance Use among Veterans: Examining the Role of PTSD Symptoms. J Dual Diagn 2024; 20:16-28. [PMID: 38122816 DOI: 10.1080/15504263.2023.2290167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) are costly and highly co-occurring diagnoses, particularly among veterans, suggesting a need to understand this comorbidity and effectively treat both disorders among this population. METHODS The current study aimed to examine substance use outcomes among post-9/11 veterans and service members (N = 48) who completed a two-week intensive outpatient program with concurrent treatment for and PTSD using Prolonged Exposure and substance use. Substance use was assessed at two weeks and three months posttreatment. RESULTS The intensive program had high completion rates and demonstrated decreases in substance use at two weeks and three months posttreatment. Additionally, lower PTSD symptoms at treatment completion were related to less substance use posttreatment. CONCLUSIONS Concurrent intensive treatment of PTSD and SUDs can lead to symptom improvement in a short period of time. Findings support the self-medication model, such that PTSD symptoms at treatment completion were related to substance use at follow-up.
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Affiliation(s)
| | | | - Tiffany Wilcox
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Karen Drexler
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sheila A M Rauch
- Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Padula CB, McCalley DM, Tenekedjieva LT, MacNiven K, Rauch A, Morales JM, Knutson B, Humphreys K, Williams LM, Durazzo TC. A pilot, randomized clinical trial: Left dorsolateral prefrontal cortex intermittent theta burst stimulation improves treatment outcomes in veterans with alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:164-177. [PMID: 38197808 DOI: 10.1111/acer.15224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) offers a promising treatment avenue to modulate brain function in alcohol use disorder (AUD). To the best of our knowledge, this pilot study is the first randomized, double-blind, sham-controlled trial to deliver intermittent theta burst stimulation to the left dorsolateral prefrontal cortex (DLPFC) among US veterans with AUD. We hypothesized that 20 sessions of real TMS are tolerable and feasible. As a secondary line of inquiry, we hypothesized that, relative to sham TMS, individuals receiving real TMS would experience greater reductions in 6-month relapse rates, anhedonia, and alcohol cue-reactivity. METHODS Veterans (n = 17, one woman) were enrolled in a double-blind, sham-controlled trial (2-3 sessions/day; 7-10 days; 600 pulses/session; 20 sessions). Pre- and posttreatment assessments included responses to self-report questionnaires and functional magnetic resonance imaging measures of alcohol cue-reactivity. Alcohol consumption was assessed for 6 months. Linear mixed-effects models were constructed to predict posttreatment craving, mood, and cue-reactivity. RESULTS Individuals who received active iTBS (n = 8) were less likely to relapse within 3 months after treatment than the sham-treated group (n = 9) (OR = 12.0). Greater reductions in anhedonia were observed following active iTBS (Cohen's d = -0.59), relative to sham (d = -0.25). Alcohol cue-reactivity was reduced following active iTBS and increased following sham within the left insula (d = -0.19 vs. 0.51), left thalamus (d = -0.28 vs. 0.77), right insula (d = 0.18 vs. 0.52), and right thalamus (d = -0.06 vs. 0.62). CONCLUSIONS Relative to sham, we demonstrate that 20 sessions of real left DLPFC iTBS reduced the likelihood of relapse for at least 3 months. The potential utility of this approach is underscored by observed decreases in anhedonia and alcohol cue-reactivity-strong predictors of relapse among veterans. These initial data offer a valuable set of effect sizes to inform future clinical trials in this patient population.
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Affiliation(s)
- Claudia B Padula
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel M McCalley
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Lea-Tereza Tenekedjieva
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Kelly MacNiven
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Andrew Rauch
- Department of Psychology, Loyola University Chicago, Chicago, Illinois, USA
| | - Jairelisse Morales Morales
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Brian Knutson
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California, USA
| | - Leanne M Williams
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Timothy C Durazzo
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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Xing X, Shang X, Deng X, Guo K, Fenfen E, Zhou L, Wang Y, Yang C, Yang K, Li X. Efficacy and safety of pharmacological intervention for smoking cessation in smokers with diseases: A systematic review and network meta-analysis. J Evid Based Med 2023; 16:520-533. [PMID: 38102895 DOI: 10.1111/jebm.12570] [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: 09/08/2022] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To investigate the most effective and best-tolerated drugs for treating diseased smokers. METHODS Eight databases were searched for randomized controlled trials (RCTs) involving different pharmacological interventions for smoking cessation in disease patients (January 2023). Network meta-analysis was performed using STATA 15.1 software. The Cochrane Risk of Bias Tool assessed the risk of bias, and confidence in evidence was assessed using CINeMA. RESULTS A total of 60 RCTs involving 13,009 patients of 12 disease categories were included. All trials reported 13 interventions, resulting in 78 comparisons. Network meta-analysis showed that varenicline (OR = 2.30, 95% CI (1.77, 3.00)) and bupropion (OR = 1.65, 95% CI (1.29, 2.11)) showed favorable abstinence effects compared to placebo in the cardiovascular disease population. Nicotine replacement therapy (NRT) had better withdrawal advantages than placebo (OR = 11.18, 95% CI (2.25, 55.54)) in the chronic obstructive pulmonary disease (COPD) population. Some combination treatments showed better results than monotherapy, such as bupropion + NRT was superior to bupropion (OR = 8.45, 95% CI (1.84, 38.89)) and NRT (OR = 4.98, 95% CI (1.25, 19.78)) in mental illness population. The final surface under the cumulative ranking curve indicated that bupropion + NRT achieved the best smoking cessation effect. Overall confidence in the evidence was low. In a comparison of drugs, the results showed that bupropion + NRT had the best safety. CONCLUSIONS Most interventions show the benefit of quitting smoking compared with placebo, including monotherapy and combination therapy. Moreover, varenicline or bupropion combined with NRT is superior to some monotherapies.
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Affiliation(s)
- Xin Xing
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- School of Public Health, Gansu University Of Chinese Medicine, Lanzhou, China
| | - Xue Shang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Xinxin Deng
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Kangle Guo
- Department of infection management, Gansu Provincial Hospital, Lanzhou, China
| | - E Fenfen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liying Zhou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yongsheng Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Chaoqun Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
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Caudle MM, Klaming R, Fong C, Harlé K, Taylor C, Spadoni A, Bomyea J. Approach avoidance training versus Sham in veterans with alcohol use disorder: protocol for a randomized controlled trial. BMC Psychiatry 2023; 23:499. [PMID: 37438722 PMCID: PMC10337098 DOI: 10.1186/s12888-023-04961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care. METHODS One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment. DISCUSSION This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD. REGISTRY NAME AAT for Alcohol Use Disorder in Veterans. TRIAL REGISTRATION ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022.
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Affiliation(s)
- M M Caudle
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - R Klaming
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - C Fong
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - K Harlé
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - C Taylor
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - A Spadoni
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - J Bomyea
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA.
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
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Flook EA, Feola B, Benningfield MM, Silveri MM, Winder DG, Blackford JU. Alterations in BNST Intrinsic Functional Connectivity in Early Abstinence from Alcohol Use Disorder. Alcohol Alcohol 2023; 58:298-307. [PMID: 36847484 PMCID: PMC10168710 DOI: 10.1093/alcalc/agad006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/03/2023] [Accepted: 01/22/2023] [Indexed: 03/01/2023] Open
Abstract
AIMS Maintaining abstinence from alcohol use disorder (AUD) is extremely challenging, partially due to increased symptoms of anxiety and stress that trigger relapse. Rodent models of AUD have identified that the bed nucleus of the stria terminalis (BNST) contributes to symptoms of anxiety-like behavior and drug-seeking during abstinence. In humans, however, the BNST's role in abstinence remains poorly understood. The aims of this study were to assess BNST network intrinsic functional connectivity in individuals during abstinence from AUD compared to healthy controls and examine associations between BNST intrinsic functional connectivity, anxiety and alcohol use severity during abstinence. METHODS The study included resting state fMRI scans from participants aged 21-40 years: 20 participants with AUD in abstinence and 20 healthy controls. Analyses were restricted to five pre-selected brain regions with known BNST structural connections. Linear mixed models were used to test for group differences, with sex as a fixed factor given previously shown sex differences. RESULTS BNST-hypothalamus intrinsic connectivity was lower in the abstinent group relative to the control group. There were also pronounced sex differences in both the group and individual analyses; many of the findings were specific to men. Within the abstinent group, anxiety was positively associated with BNST-amygdala and BNST-hypothalamus connectivity, and men, not women, showed a negative relationship between alcohol use severity and BNST-hypothalamus connectivity. CONCLUSIONS Understanding differences in connectivity during abstinence may help explain the clinically observed anxiety and depression symptoms during abstinence and may inform the development of individualized treatments.
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Affiliation(s)
- Elizabeth A Flook
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
- Vanderbilt Center for Addiction Research, Vanderbilt University, 2215 Garland Ave, Nashville, TN 37232, USA
| | - Brandee Feola
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
| | - Margaret M Benningfield
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
- Vanderbilt Center for Addiction Research, Vanderbilt University, 2215 Garland Ave, Nashville, TN 37232, USA
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
| | - Marisa M Silveri
- Neurodevelopmental Laboratory on Addictions and Mental Health, Brain Imaging Center, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
| | - Danny G Winder
- Vanderbilt Center for Addiction Research, Vanderbilt University, 2215 Garland Ave, Nashville, TN 37232, USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University, 2215 Garland Avenue, Nashville, TN 37212, USA
- Department of Pharmacology, Vanderbilt University, 465 21st Avenue South, Nashville, TN 37240, USA
| | - Jennifer Urbano Blackford
- Vanderbilt Center for Addiction Research, Vanderbilt University, 2215 Garland Ave, Nashville, TN 37232, USA
- Department of Psychiatry and Behavioral Science, Vanderbilt University Medical Center, 1601 23rd Avenue South, Nashville, TN 37212, USA
- Munroe-Meyer Institute, University of Nebraska Medical Center, 6902 Pine Street, Omaha, NE 68106, USA
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Durazzo TC, McNerney MW, Hansen AM, Gu M, Sacchet MD, Padula CB. BDNF rs6265 Met carriers with alcohol use disorder show greater age-related decline of N-acetylaspartate in left dorsolateral prefrontal cortex. Drug Alcohol Depend 2023; 248:109901. [PMID: 37146499 DOI: 10.1016/j.drugalcdep.2023.109901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/04/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) is implicated in neuronal and glial cell growth and differentiation, synaptic plasticity, and apoptotic mechanisms. A single-nucleotide polymorphism of the BDNF rs6265 gene may contribute to the pattern and magnitude of brain metabolite abnormalities apparent in those with an Alcohol Use Disorder (AUD). We predicted that Methionine (Met) carriers would demonstrate lower magnetic resonance spectroscopy (MRS) measures of N-acetylaspartate level (NAA) and greater age-related decline in NAA than Valine (Val) homozygotes. METHODS Veterans with AUD (n=95; 46±12 years of age, min = 25, max = 71) were recruited from VA Palo Alto residential treatment centers. Single voxel MRS, at 3 Tesla, was used to obtain NAA, choline (Cho) and creatine (Cr) containing compounds from the left dorsolateral prefrontal cortex (DLPFC). Metabolite spectra were fit with LC Model and NAA and Cho were standardized to total Cr level and NAA was also standardized to Cho. RESULTS Val/Met (n=35) showed markedly greater age-related decline in left DLPFC NAA/Cr level than Val/Val (n=60); no differences in mean metabolite levels were observed between Val/Met and Val/Val. Val/Met demonstrated greater frequency of history of MDD and higher frequency of cannabis use disorder over 12 months prior to study. CONCLUSIONS The greater age-related decline in left DLPFC NAA/Cr and the higher frequency of MDD history and Cannabis Use disorder in BDNF rs6265 Met carriers with AUD are novel and may have implications for non-invasive brain stimulation targeting the left DLFPC and other psychosocial interventions typically utilized in the treatment of AUD.
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Affiliation(s)
- Timothy C Durazzo
- Palo Alto Veterans Affairs Health Care System, Mental Illness Research and Education Clinical Centers (MIRECC) Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - M Windy McNerney
- Palo Alto Veterans Affairs Health Care System, Mental Illness Research and Education Clinical Centers (MIRECC) Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Annika M Hansen
- Palo Alto Veterans Affairs Health Care System, Mental Illness Research and Education Clinical Centers (MIRECC) Palo Alto, CA, USA
| | - Meng Gu
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew D Sacchet
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Claudia B Padula
- Palo Alto Veterans Affairs Health Care System, Mental Illness Research and Education Clinical Centers (MIRECC) Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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16
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Wang D, Yin Y, Yuan W, Li B, Wang H, Hu J, Chen M, Gong Y, Yuan TF, Yu T. Post-error slowing predicts for relapse in individuals with alcohol use disorder. J Psychiatr Res 2023; 161:441-448. [PMID: 37059028 DOI: 10.1016/j.jpsychires.2023.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Relapse characterizes addiction. The cognitive phenotype underlying relapse in individuals with alcohol use disorder (AUD) remain unelucidated. Here we aimed to investigate the potential changes in behavioral adjustment in AUD, and the association with relapse. METHOD Forty-seven subjects with AUD at Shandong Mental Health Center completed the stop-signal task, the PACS, the Beck Depression Inventory and the State-Trait anxiety questionnaires. Thirty age-matched male healthy subjects served as the control group (HC). In the follow-up, twenty-one subjects remained abstinent, while twenty-six subjects relapsed. Independent sample t-test was applied to measure differences between two groups and logistic regression analysis was conducted to explore the potential predictors on relapse. RESULTS The results showed that there were significant differences in stop signal reaction time (SSRT) and trigger failure between the AUD and HC groups. Relapsed group showed longer post-error slowing (PES) when compared to the non-relapsed group. The PES could predict relapse in alcohol use disorder. CONCLUSION Individuals with AUD showed impaired inhibitory control, which may predict relapse.
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Affiliation(s)
- Duanwei Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Yuanyuan Yin
- School of Mental Healthy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Yuan
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Bin Li
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Hairong Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Ji Hu
- School of Life Sciences, ShanghaiTech University, Shanghai, China
| | - Meng Chen
- Brain and Cognitive Neuroscience Research Center, Liaoning Normal University, Dalian, China
| | - Yuandong Gong
- Shandong Mental Health Center, Jinan, Shandong, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China.
| | - Tiangui Yu
- Shandong Mental Health Center, Jinan, Shandong, China.
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Yang K, Du R, Yang Q, Zhao R, Fan F, Chen S, Luo X, Tan S, Wang Z, Yu T, Tian B, Le TM, Li CSR, Tan Y. Cortical thickness of the inferior parietal lobule as a potential predictor of relapse in men with alcohol dependence. RESEARCH SQUARE 2023:rs.3.rs-2628081. [PMID: 36945425 PMCID: PMC10029073 DOI: 10.21203/rs.3.rs-2628081/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Background Alcohol dependence (AD) is a disorder with a high recurrence rate that leads to a considerable public health burden. The risk of relapse appears to be related to a complex interplay of multiple factors. Herein, we aimed to explore the potential neural predictors of relapse in Chinese male patients with AD. Methods This study enrolled 58 male patients with AD who had undergone acute detoxification. General demographic information and clinical features were collected. Magnetic resonance imaging (MRI) data were used to measure cortical thickness across 34 regions of the brain. Patients were followed up at 6 months, and 51 patients completed the follow-up visit. These patients were divided into a relapser and an abstainer group. A binary logistic regression analysis was performed to investigate the potential risk factors of relapse. Results Compared to abstainers, relapsers showed higher inattention and non-planning impulsivity on the 11th version of the Barratt Impulsive Scale. The cortical thicknesses of the inferior-parietal lobule were significantly greater in abstainers compared with those in relapsers. Furthermore, binary logistic regression analysis showed that the thickness of the inferior parietal lobule predicted relapse. Conclusions Relapsers show poorer impulse control than abstainers, and MRI imaging shows a decreased thickness of the inferior parietal lobule in relapsers. Our results indicate the thickness of the inferior parietal lobule as a potential relapse predictor in male patients with AD.
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Affiliation(s)
- Kebing Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Ruonan Du
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Qingyan Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Rongjiang Zhao
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | | | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Ting Yu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | | | | | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
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Pepe M, Di Nicola M, Panaccione I, Franza R, De Berardis D, Cibin M, Janiri L, Sani G. Impulsivity and alexithymia predict early versus subsequent relapse in patients with alcohol use disorder: A 1-year longitudinal study. Drug Alcohol Rev 2023; 42:367-372. [PMID: 36269103 DOI: 10.1111/dar.13568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Longitudinal psychopathological predictors of relapse in alcohol use disorder are unclear. METHODS Relapses, sociodemographic and psychopathological risk factors were assessed in 171 alcohol use disorder outpatients within a 1-year follow up. Impulsivity and alexithymia were evaluated using the Barratt Impulsiveness Scale and the Toronto Alexithymia Scale, respectively. RESULTS At endpoint, 39% of patients maintained abstinence, 30.9% relapsed at ≤1 month from detoxification (early), 30.1% at >1 month (subsequent). Baseline Barratt Impulsiveness Scale score was predictive of early versus subsequent relapse (odds ratio 1.12, p = 0.005) and versus abstinence (odds ratio 1.17, p < 0.001). Toronto Alexithymia Scale score was a risk factor for subsequent versus early relapse (odds ratio 1.13, p = 0.003) and versus abstinence (odds ratio 1.21, p < 0.001). DISCUSSION AND CONCLUSIONS Impulsivity predicted relapse within the first 4-weeks; alexithymia showed delayed effects. Time-varying effects of specific relapse factors emphasise the need for preliminary careful assessment and personalised interventions to promote long-term abstinence.
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Affiliation(s)
- Maria Pepe
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Raffaella Franza
- Service of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico De Berardis
- Department of Mental Health Psychiatric Service, Diagnosis and Treatment Hospital Giuseppe Mazzini, Teramo, Italy
| | | | - Luigi Janiri
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Maillard A, Laniepce A, Segobin S, Lahbairi N, Boudehent C, Vabret F, Cabé N, Pitel AL. Prognostic factors for low-risk drinking and relapse in alcohol use disorder: A multimodal analysis. Addict Biol 2022; 27:e13243. [PMID: 36301210 DOI: 10.1111/adb.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023]
Abstract
This study aims to specify the determinants of low-risk alcohol drinking and relapse at different time points after detoxification in patients with severe alcohol use disorder (AUD). Fifty-four patients with AUD and 36 healthy controls (HC) were evaluated early in abstinence (T1). They underwent clinical, neuropsychological and neuroimaging (structural MRI and 18 FDG-PET) investigations. Patients with AUD were subsequently classified as "low-risk drinkers" (LR) or "relapsers" (R) based on their alcohol drinking at 6 months (T2) and 1 year (T3) after discharge, using their medical record or self-reported drinking estimation at follow-up. Based on the alcohol status at T2 and compared with HC, only R had alexithymia, lower grey matter volume in the midbrain and hypermetabolism in the cerebellum and hippocampi. Based on the alcohol status at T3 and compared with HC, only R had more severe nicotinic dependence, lower episodic and working memory performance, lower grey matter volume in the amygdala, ventromedial prefrontal cortex and anterior cingulate gyrus and hypermetabolism in cerebellum, hippocampi and anterior cingulate gyrus. Moreover, R had bilateral frontal hypometabolism, whereas LR only presented right frontal hypometabolism. Nicotine dependence, memory impairments and structural brain abnormalities in regions involved in impulsivity and decision-making might contribute to a 1-year relapse. Treatment outcome at 1 year may also be associated with an imbalance between a hypermetabolism of the limbic system and a hypometabolism of the frontal executive system. Finally, cerebellar hypermetabolism and alexithymia may be determinants of relapse at both 6 months and 1 year.
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Affiliation(s)
- Angéline Maillard
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Alice Laniepce
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France.,Normandie Univ, UNIROUEN, CRFDP (EA7475), Rouen, France
| | - Shailendra Segobin
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Najlaa Lahbairi
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - Céline Boudehent
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France.,Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - François Vabret
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France.,Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Nicolas Cabé
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France.,Service d'Addictologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Normandie Univ, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France.,Institut Universitaire de France (IUF), Paris, France
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20
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Muacevic A, Adler JR, Subramanian K, Subramanian E. Determinants of Treatment Outcome, Follow-Up, and Abstinence Rates Among Patients With Alcohol Use Disorder: A Prospective Study. Cureus 2022; 14:e31356. [PMID: 36514662 PMCID: PMC9741730 DOI: 10.7759/cureus.31356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background The treatment of alcohol use problems needs to have a multidimensional approach for early recovery and better outcome. Objective The study aimed to study the socio-demographic, clinical, and psychological factors associated with the three-month clinical outcomes among patients with alcohol use disorder treated in a tertiary care general hospital psychiatric unit in southern India. Methods This is a prospective three-month follow-up study. Patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for alcohol use disorder were selected for the study. The baseline severity of alcohol use was assessed by the Severity of Alcohol Dependence Questionnaire, alcohol craving by Alcohol Craving Questionnaire (ACQ), impulsivity by Barratt Impulsiveness Scale, anxiety and depression by Hospital Anxiety and Depression Scale and personality traits by Personality inventory for DSM-5. Craving was assessed at 2, 4, 8 and 12 weeks post-discharge. Results A total of 110 patients participated in the study. After 3 months of follow-up, 75.5% of the patients remained abstinent throughout the follow-up period. The sample was divided into two groups based on the abstinent status at 12 weeks. Both the abstinent and relapsed users were compared based on socio-demographic, marital, family, illness-related, alcohol-usage, and psychological characteristics, the baseline and follow-up craving indices. There were no statistically significant differences between the two groups based on socio-demographic characteristics. Compared to the relapsed group, the abstinent individuals displayed increased adherence to follow-up visits and attended more frequent individual therapy sessions, however, there were no significant differences between the two groups in the number of group therapy sessions attended. Also, the abstinent group demonstrated lower subjective craving at both the baseline and during follow-up. The relapsed users had reported a significantly greater proportion of history of suicide in the family. Further correlational analyses were done to find the direction of associations between psychological characteristics and alcohol-usage characteristics. High attentional impulsivity and motor impulsivity were associated with early age of first use. High attentional impulsivity, motor impulsivity and impulsive planning were associated with early age of dependence. Early age of dependence was associated with increased levels of antagonism and psychoticism. Younger onset of alcohol use was associated with increased levels of craving at baseline. The baseline alcohol use severity and the baseline craving towards alcohol were positively correlated with follow-up craving indices as per ACQ and craving index (CI) scales. Conclusion The patients who were abstinent displayed reduced subjective craving towards alcohol at baseline and were more adherent in attending individual and group therapy sessions. Among the relapsed users, most relapsed before four weeks and had a family history of alcohol dependence, family history of psychosis, and suicide, which is indicative of high genetic loading of substance abuse leading to early initiation and early onset of alcohol dependence. The effects of genetic loading could be possibly mediated by traits of high impulsivity, psychoticism, and antagonism.
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Affiliation(s)
| | | | - Karthick Subramanian
- Psychiatry, Mahatma Gandhi Medical College and Research Institute, Pondicherry, IND
| | - Eswaran Subramanian
- Psychiatry, Mahatma Gandhi Medical College and Research Institute, Pondicherry, IND
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21
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Stevenson BL, Kunicki ZJ, Brick L, Blevins CE, Stein M, Abrantes AM. Using Ecological Momentary Assessments and Fitbit Data to Examine Daily Associations Between Physical Activity, Affect and Alcohol Cravings in Patients with Alcohol Use Disorder. Int J Behav Med 2022; 29:543-552. [PMID: 34750719 PMCID: PMC9079186 DOI: 10.1007/s12529-021-10039-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preliminary studies show that structured physical activity (PA) interventions can reduce negative affect and alcohol use in patients recovering from alcohol use disorder (AUD). The current study tested whether the association between PA, affect, and alcohol cravings can be observed in patients' natural environments (i.e., without a structured intervention) as well. METHOD Twenty-five participants with AUD completed 3 weeks of ecological momentary assessment (EMA) monitoring and wore Fitbit devices to measure physical activity directly after discharge from partial hospitalization treatment for AUD. PA was operationalized as total steps and consecutive 10-min bouts of moderate-intensity exercise (100 steps/minute). RESULTS Only 56% of participants engaged in any bouts of moderate-intensity physical activity throughout the 3-week study period (mode = 1 bout), and participants logged an average of 8183 steps/day (SD = 5560). Daily steps were associated with a higher positive affect and lower alcohol cravings, and with higher positive affect the next day, but the effects were very small. No relationships were observed between PA and affect or alcohol cravings at the hourly level except a random effect signifying that bouts of PA were either positively associated or not associated with negative affect in the next hour for different participants. CONCLUSIONS Overall, results suggest that naturalistic PA may be beneficial for a small subset of patients in recovery from AUD, but the majority did not engage in regular exercise or experience improvements in affect and cravings as a result of PA.
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Affiliation(s)
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Leslie Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Claire E Blevins
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, USA.
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22
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Carlon HA, Hurlocker MC, Witkiewitz K. Mechanisms of quality-of-life improvement in treatment for alcohol use disorder. J Consult Clin Psychol 2022; 90:601-612. [PMID: 36066862 PMCID: PMC9899433 DOI: 10.1037/ccp0000750] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE For individuals in alcohol use disorder (AUD) treatment, many argue that holistic indicators such as quality of life (QoL) should be more consistently used in addition to drinking-related indicators. QoL increases from pre- to post-AUD treatment, but the mechanisms are unclear. The present study examined the roles of positive and negative affect in QoL change during AUD treatment and additionally explored the relationship between QoL change and medication adherence. METHOD We examined the mediating roles of end-of-treatment positive affect (i.e., vigor) and negative affect (i.e., stress and tension) in the relationship between baseline (BL) and 26-week QoL among participants in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence study randomized to medication management (MM; n = 468) or medication management plus combined behavioral intervention (MMCBI; n = 479) for AUD. We also explored whether changes in QoL were associated with medication adherence. RESULTS Change in psychological health QoL was mediated by increased vigor (i.e., positive affect) and decreased stress, and change in environmental QoL was mediated by decreased stress. There were also differences by treatment group, with stress mediating changes in environmental QoL among participants in MM, and vigor mediating changes in psychological health QoL among participants in MMCBI. Medication adherence was not associated with greater QoL after controlling for posttreatment alcohol use. CONCLUSIONS The present study identified potential mechanisms of QoL change in AUD treatment, thus contributing to the growing knowledge surrounding alternative indicators of treatment success for AUD treatment and recovery. Targeting affective states and stress during treatment may improve QoL and recovery outcomes for persons with AUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Hannah A. Carlon
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
| | - Margo C. Hurlocker
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Department of Psychology, Albuquerque, NM, 87131, USA
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23
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van Amsterdam J, van den Brink W. Smoking As an Outcome Moderator In the Treatment of Alcohol Use Disorders. Alcohol Alcohol 2022; 57:664-673. [PMID: 35589093 DOI: 10.1093/alcalc/agac027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
AIMS To clarify whether smoking interferes with successful treatment of alcohol use disorder (AUD). METHODS The current systematic review investigates the potential moderating effect of smoking on behavioural and pharmacological treatment of AUD. In addition, this review summarizes the results of randomized controlled trials investigating the effect of smoking cessation treatments in subjects with AUD on drinking outcomes. RESULTS Overall, the results show that 16 out of the 31 pharmacological and psychotherapeutic alcohol treatment studies showed that being a non-smoker or decreased tobacco consumption during AUD treatment is associated with beneficial drinking outcomes, including reduced drinking, later relapse and prolonged alcohol abstinence. As such, smoking predicts poorer drinking outcomes in alcohol treatments. In the stop-smoking studies in patients with AUD, reduced smoking had virtually no effect on drinking behaviours. The inverse association between smoking and drinking outcome observed here indicates that non-smokers may be more successful to attain alcohol abstinence than smokers do. However, this association does not imply per se that smoking triggers alcohol consumption, since it can also mean that alcohol consumption promotes smoking. CONCLUSIONS It is concluded that (continued) tobacco smoking may have a negative moderating effect on the treatment outcome of AUD treatments. To optimize treatment outcome of AUD one may consider informing and counselling patients with AUD about the risks of smoking for treatment outcomes and offering support for smoking cessation.
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Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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24
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Schückher F, Berglund K, Engström I, Sellin T. Predictors for Abstinence in Socially Stable Women Receiving Treatment for Alcohol Use Disorder. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2021.2018957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Fides Schückher
- Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | | | - Ingemar Engström
- Faculty of Medicine and Health, Örebro University, Orebro, Sweden
| | - Tabita Sellin
- Faculty of Medicine and Health, University Healthcare Research Center, Örebro University, Sweden
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25
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Padula CB, Tenekedjieva LT, McCalley DM, Al-Dasouqi H, Hanlon CA, Williams LM, Kozel FA, Knutson B, Durazzo TC, Yesavage JA, Madore MR. Targeting the Salience Network: A Mini-Review on a Novel Neuromodulation Approach for Treating Alcohol Use Disorder. Front Psychiatry 2022; 13:893833. [PMID: 35656355 PMCID: PMC9152026 DOI: 10.3389/fpsyt.2022.893833] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Alcohol use disorder (AUD) continues to be challenging to treat despite the best available interventions, with two-thirds of individuals going on to relapse by 1 year after treatment. Recent advances in the brain-based conceptual framework of addiction have allowed the field to pivot into a neuromodulation approach to intervention for these devastative disorders. Small trials of repetitive transcranial magnetic stimulation (rTMS) have used protocols developed for other psychiatric conditions and applied them to those with addiction with modest efficacy. Recent evidence suggests that a TMS approach focused on modulating the salience network (SN), a circuit at the crossroads of large-scale networks associated with AUD, may be a fruitful therapeutic strategy. The anterior insula or dorsal anterior cingulate cortex may be particularly effective stimulation sites given emerging evidence of their roles in processes associated with relapse.
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Affiliation(s)
- Claudia B Padula
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Lea-Tereza Tenekedjieva
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel M McCalley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.,Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
| | - Hanaa Al-Dasouqi
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Leanne M Williams
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Brian Knutson
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - Timothy C Durazzo
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jerome A Yesavage
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Michelle R Madore
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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26
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Hong L, Wen L, Niculescu M, Zhou F, Zou Y, Shen G, Wang W, Liu Y, Chen YH, Wang F, Chen L. The Interaction Between POMC rs2071345 Polymorphism and Alcohol Dependence in Anxiety Symptoms Among Chinese Male Problem Drinkers. Front Psychiatry 2022; 13:878960. [PMID: 35592377 PMCID: PMC9110641 DOI: 10.3389/fpsyt.2022.878960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/08/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Alcohol dependence can increase the level of anxiety. A growing body of research has identified a link between anxiety symptoms of problem drinkers and their genetic or environment factors, respectively. However, to date few studies have directly examined gene-environment (G × E) interaction on their anxiety symptoms during the acute alcohol withdrawal. The present study aims to examine the interaction between the proopiomelanocortin (POMC) rs2071345 polymorphism and alcohol dependence on anxiety symptoms of male problem drinkers, and further test the exact form of interaction on two competing models: the diathesis-stress model vs. the differential susceptibility model. METHODS A total of 440 male problem drinkers (M age = 44.5 years, SD = 9.45) were recruited from nine main psychiatric hospitals of northern China during acute alcohol withdrawal. Blood samples were collected for genotyping, self-reported anxiety symptoms, and levels of alcohol dependence were assessed. RESULTS Results indicated that the POMC rs2071345 polymorphism significantly moderated anxiety symptoms associated with alcohol dependence. A region of significance (RoS) test showed that male problem drinkers with T allele were more likely to experience more anxiety symptoms than those with CC homozygote when the standardized score of concurrent alcohol dependence was above 0.31. Confirmatory model evaluation indicated that the interaction effect involving POMC gene polymorphism conformed to the diathesis-stress model rather than differential-susceptibility model of person × environment interaction. CONCLUSIONS This study suggested that the SNP in POMC rs2071345 was associated with alcohol dependence in anxiety symptoms of male problem drinkers and further provided evidence in support of the diathesis-stress hypothesis of alcohol dependence in terms of anxiety symptoms.
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Affiliation(s)
- Liuzhi Hong
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Lutong Wen
- Department of Neurosurgery, Affiliated Cixi Hospital, Wenzhou Medical University, Ningbo, China
| | - Michelle Niculescu
- Department of Social Sciences, Chatham University, Pittsburgh, PA, United States
| | - Fan Zhou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Yang Zou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Guanghui Shen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Wei Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yu-Hsin Chen
- Department of Psychology, College of Liberal Arts, Wenzhou-Kean University, Wenzhou, China
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China.,Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.,The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, China
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27
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Guo K, Li J, Li J, Chen N, Li Y, Yang K, Li X. The effects of pharmacological interventions on smoking cessation in people with alcohol dependence: A systematic review and meta-analysis of nine randomized controlled trials. Int J Clin Pract 2021; 75:e14594. [PMID: 34228852 DOI: 10.1111/ijcp.14594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pharmacotherapies are widely used for smoking cessation. However, their efficacy for people with alcohol dependence remains unclear. OBJECTIVE This study aimed to explore the effects of pharmacotherapies on smoking cessation for people with alcohol dependence. METHODS Five electronic databases were searched in January 2021 for randomized controlled trials (RCTs) reporting the use of pharmacotherapies to promote smoking cessation in people with alcohol dependence. The risk of bias was assessed using the Cochrane tool. RevMan version 5.3 was used to perform meta-analyses of the changes in smoking behaviour, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. RESULTS The search identified nine RCTs involving 908 smokers with alcohol dependence; eight were published in the USA and one in Canada. The risk of bias was low in three studies and unclear in the remaining six. The meta-analysis results showed that, compared with the placebo group, Varenicline had a significant effect on short-term smoking cessation (three RCTs, odds ratio [OR] = 6.27, 95% confidence interval [CI]: [2.49, 15.78], P < .05, very low certainty). Naltrexone had no significant effect on smoking cessation in short-term or long-term observations (three RCTs, OR = 0.99, 95% CI: [0.54, 1.81], P = .97, moderate certainty), and Topiramate had no significant effects (two RCTs, OR = 1.56, 95% CI: [0.67, 3.46], P > .05, low certainty). Only one trial reported that Bupropion did not affect smoking cessation. CONCLUSION Varenicline may promote smoking cessation in people with alcohol dependence. However, Naltrexone, Topiramate and Bupropion have no clear effect on increasing smoking abstinence among drinkers. The small number of studies and the low certainty of evidence indicate that the results should be interpreted cautiously.
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Affiliation(s)
- Kangle Guo
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jingwen Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jieyun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Nan Chen
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yanfei Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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28
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Guliyev C, İnce-Guliyev E, Ögel K. Predictors of Relapse to Alcohol and Substance Use: Are There Any Differences between 3 and 12 Months after Inpatient Treatment? J Psychoactive Drugs 2021; 54:358-367. [PMID: 34553671 DOI: 10.1080/02791072.2021.1976887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Understanding the factors that lead to relapse is important for developing effective treatment strategies. The aim of this study is to examine sociodemographic and clinical factors that predict relapse 3 and 12 months after inpatient treatment in patients with alcohol and substance use disorders. 247 patients were included in the study. A sociodemographic data form and the Addiction Profile Index-Clinical Form (API-C) were filled out during the first days of hospitalization and relapse information was obtained through outpatient interviews. Logistic regression analysis was used to assess predictive factors. Rates of relapse for the 3rd and 12th months were 40.5% and 74.6%, respectively. Motivation to quit substance use, risk of depression, being on probation, and being employed predicted relapse within the 3-month period. At the 12th month, substance use intensity and motivation to quit were the factors associated with relapse. To conclude, motivation to quit is critical to maintaining both early and sustained remission. Moreover, divergent factors may be relevant at different stages of treatment. Defining relapse predictors early in the process and being vigilant to the change in the needs of patients as the treatment continues may help to develop a more effective and focused treatment plan.
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Affiliation(s)
- Cavid Guliyev
- Alcohol and Substance Treatment Center, Moodist Hospital, Istanbul, Turkey
| | - Ezgi İnce-Guliyev
- Department of Psychiatry, Van Research and Training Hospital, Van, Turkey
| | - Kültegin Ögel
- Alcohol and Substance Treatment Center, Moodist Hospital, Istanbul, Turkey
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Petker T, Yanke C, Rahman L, Whalen L, Demaline K, Whitelaw K, Bang D, Holshausen K, Amlung M, MacKillop J. Naturalistic Evaluation of an Adjunctive Yoga Program for Women with Substance Use Disorders in Inpatient Treatment: Within-Treatment Effects on Cravings, Self-efficacy, Psychiatric Symptoms, Impulsivity, and Mindfulness. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211026651. [PMID: 34262285 PMCID: PMC8246483 DOI: 10.1177/11782218211026651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/17/2021] [Indexed: 12/02/2022]
Abstract
Addiction continues to be a major public health concern, and rates of relapse following currently-available treatments remain high. There is increasing interest in the adjunctive use of mindfulness-based interventions, such as yoga, to improve treatment outcomes. The current study was a preliminary naturalistic investigation of a novel trauma-informed yoga intervention in an inpatient treatment program for women with substance use disorder (SUD). Changes and differences in somatic symptoms, psychiatric symptoms, and psychological mechanisms were evaluated in women receiving treatment-as-usual (n = 36) and treatment-as-usual plus the yoga intervention (n = 42). For both groups, statistically significant within-subjects changes were present for somatic and psychiatric symptoms, cravings, self-efficacy, and multiple facets of impulsivity and mindfulness. Compared to standard treatment alone, participants in the treatment plus yoga condition significantly improved in range of motion and the Lack of Premeditation facet of impulsivity. Although most domains were not selectively affected, these initial within-treatment findings in this naturalistic evaluation suggest some promise for adjunctive yoga and a need for further evaluation, especially using larger samples and longer term follow-up.
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Affiliation(s)
- Tashia Petker
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton ON, Canada
| | - Christine Yanke
- Womankind Addiction Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Liah Rahman
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton ON, Canada
| | - Laurel Whalen
- Womankind Addiction Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Karen Demaline
- Womankind Addiction Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Kari Whitelaw
- Womankind Addiction Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Debbie Bang
- Womankind Addiction Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | | | - Michael Amlung
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton ON, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton ON, Canada.,Homewood Research Institute, Guelph, ON, Canada
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Wang M, Pinilla G, Leung C, Peddada A, Yu E, Akmal S, Cha Y, Dyson L, Kumar A, Kaplin A. Relapse risk factors for patients with comorbid affective disorders and substance abuse disorders from an intensive treatment unit. Am J Addict 2021; 30:461-467. [PMID: 34075661 DOI: 10.1111/ajad.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/08/2021] [Accepted: 05/02/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The prevalence of substance use disorders (SUD), particularly involving opiates and benzodiazepines, has increased to the detriment of public health and the economy. Here, we evaluate relapse factors among the high-risk demographic of patients with SUD and comorbid affective disorders. METHODS A retrospective chart review of 76 patients discharged after detoxification and simultaneous psychiatric care for concomitant affective disorders and SUDs. Relapse was assessed by two independent evaluators via postdischarge chart review, which included state-wide healthcare utilization, by patient, through healthcare information exchange systems. A Cox Hazards analysis was performed to characterize relapse risk factors. RESULTS Benzodiazepine use, admission through the emergency department (ED) rather than direct admission, frequent ED use in the preceding year, and history of prior attendance at multiple detoxification programs were risk factors for shortened time-to-relapse. Polysubstance use and intravenous drug use prolonged time to relapse. DISCUSSION AND CONCLUSIONS Notable findings include the significant relapse risk associated with benzodiazepine abuse and frequent prior ED utilization. These risk factors could reflect a number of underlying mediators for relapse, including anxiety, disease burden, and malingering. Additionally, this study recapitulates the observation in other patient populations that the majority of health resource utilization is attributed to a small population of patients. SCIENTIFIC SIGNIFICANCE This study is the first to identify relapse predictors among dual-diagnosis affective disorder and SUD patients in survival analysis, and replicates the alarming and largely unknown effect that benzodiazepines have on increasing relapse risk.
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Affiliation(s)
- Mike Wang
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gabriel Pinilla
- Department of Medicine, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | - Curtis Leung
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Apoorva Peddada
- Tees, Esk and Wear Valleys NHS Foundation Trust, Chester le Street Health Centre, Chester-le-Street, UK
| | - Eileen Yu
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarfraz Akmal
- Department of Medicine, Rutgers University, Newark, New Jersey, USA
| | - Youngjae Cha
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laketa Dyson
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anupama Kumar
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adam Kaplin
- Departments of Psychiatry and Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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31
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Navarrete F, García-Gutiérrez MS, Gasparyan A, Austrich-Olivares A, Manzanares J. Role of Cannabidiol in the Therapeutic Intervention for Substance Use Disorders. Front Pharmacol 2021; 12:626010. [PMID: 34093179 PMCID: PMC8173061 DOI: 10.3389/fphar.2021.626010] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/04/2021] [Indexed: 01/04/2023] Open
Abstract
Drug treatments available for the management of substance use disorders (SUD) present multiple limitations in efficacy, lack of approved treatments or alarming relapse rates. These facts hamper the clinical outcome and the quality of life of the patients supporting the importance to develop new pharmacological agents. Lately, several reports suggest that cannabidiol (CBD) presents beneficial effects relevant for the management of neurological disorders such as epilepsy, multiple sclerosis, Parkinson's, or Alzheimer's diseases. Furthermore, there is a large body of evidence pointing out that CBD improves cognition, neurogenesis and presents anxiolytic, antidepressant, antipsychotic, and neuroprotective effects suggesting potential usefulness for the treatment of neuropsychiatric diseases and SUD. Here we review preclinical and clinical reports regarding the effects of CBD on the regulation of the reinforcing, motivational and withdrawal-related effects of different drugs of abuse such as alcohol, opioids (morphine, heroin), cannabinoids, nicotine, and psychostimulants (cocaine, amphetamine). Furthermore, a special section of the review is focused on the neurobiological mechanisms that might be underlying the 'anti-addictive' action of CBD through the regulation of dopaminergic, opioidergic, serotonergic, and endocannabinoid systems as well as hippocampal neurogenesis. The multimodal pharmacological profile described for CBD and the specific regulation of addictive behavior-related targets explains, at least in part, its therapeutic effects on the regulation of the reinforcing and motivational properties of different drugs of abuse. Moreover, the remarkable safety profile of CBD, its lack of reinforcing properties and the existence of approved medications containing this compound (Sativex®, Epidiolex®) increased the number of studies suggesting the potential of CBD as a therapeutic intervention for SUD. The rising number of publications with substantial results on the valuable therapeutic innovation of CBD for treating SUD, the undeniable need of new therapeutic agents to improve the clinical outcome of patients with SUD, and the upcoming clinical trials involving CBD endorse the relevance of this review.
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Affiliation(s)
- Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | - María Salud García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | - Ani Gasparyan
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
| | | | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
- Red Temática de Investigación Cooperativa en Salud (RETICS), Red de Trastornos Adictivos, Instituto de Salud Carlos III, MICINN and FEDER, Madrid, Spain
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Durazzo TC, Meyerhoff DJ. Changes of frontal cortical subregion volumes in alcohol dependent individuals during early abstinence: associations with treatment outcome. Brain Imaging Behav 2021; 14:1588-1599. [PMID: 31197582 DOI: 10.1007/s11682-019-00089-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We previously reported that at 1-and-4 weeks of sobriety, those who relapsed after treatment demonstrated significantly smaller total frontal cortical volume than individuals who maintained abstinence for at least 12 months post treatment. The segmentation method employed did not permit examination of frontal subregions that serve as nodes of the executive, salience and emotional regulation networks; structural abnormalities in these circuits are associated with relapse in those seeking treatment for alcohol use disorders (AUD). The primary goal of this study was to determine if frontal cortical subregion volume recovery during early abstinence is associated with long-term abstinence from alcohol. We compared bilateral components of the dorsal prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex and insula volumes, at 1 and 4 weeks of abstinence, between individuals who resumed drinking within 12 months of treatment (Relapsers) those who showed sustained abstinence over 12 months following treatment (Abstainers) and healthy Controls. At 1 and 4 weeks of sobriety, Relapsers demonstrated significantly smaller volumes than Controls in 15 of 20 regions of interest, while Abstainers only had smaller volumes than Controls in 5 of 20 regions. In Relapsers, increasing volumes over 1 month in multiple frontal subregions and the insula were associated with longer duration of abstinence after treatment. The persistent bilateral frontal and insula volume deficits in Relapsers over 4 weeks from last alcohol use may have implications for neurostimulation methods targeting anterior frontal/insula regions, and represent an endophenotype that differentiates those who respond more favorably to available psychosocial and pharmacological interventions.
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Affiliation(s)
- Timothy C Durazzo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
- Mental Illness Research and Education Clinical Centers (151Y) and Sierra-Pacific War Related Illness and Injury Study Centers, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.
| | - Dieter J Meyerhoff
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
- Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, San Francisco, CA, USA
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33
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Pandey S, Bolstad I, Lien L, Bramness JG. Antisocial Personality Disorder Among Patients in Treatment for Alcohol Use Disorder (AUD): Characteristics and Predictors of Early Relapse or Drop-Out. Subst Abuse Rehabil 2021; 12:11-22. [PMID: 33907489 PMCID: PMC8064678 DOI: 10.2147/sar.s296526] [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: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background Patients with alcohol use disorders (AUD) vary significantly in many clinically important characteristics making them a heterogenous group. AUD patients with comorbid antisocial personality disorder (ASPD) form an important sub-group, and studies indicate that these patients may have poorer treatment outcomes. Therefore, we aimed to investigate the characteristics of AUD inpatients with comorbid ASPD and identify predictors of early relapse or treatment drop-out in these patients. Methods In a longitudinal study of AUD patients (n = 113; 30 females; aged 27 to 72 years) in treatment at three residential rehabilitation clinics in Norway, we used interviews and self-report questionnaires to collect data on alcohol use, mental health, and trauma experience. In addition, we assessed biochemical parameters. The patients were followed up at 6 weeks to identify early relapse or drop-out. Results Prevalence of ASPD among AUD patients was 15%. AUD patients with comorbid ASPD were exclusively male, of younger age, and reported more childhood trauma, and adult attention-deficit-hyperactivity-disorder symptoms. They reported more hazardous drinking behavior and more often had dependence on substances in addition to alcohol. The presence of ASPD did not predict early relapse or drop-out. However, early relapse or drop-out in ASPD patients was associated with childhood and adult trauma, younger age of drinking debut, and higher baseline prolactin levels. Conclusion AUD patients with ASPD had different clinical characteristics to other AUD patients and they had specific predictors of early relapse or drop-out. Our findings indicate that the early relapse or drop-out among AUD patients with ASPD may be attributed to environmental and possibly biological vulnerability. However, further studies with larger sample size are warranted to confirm these preliminary associations.
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Affiliation(s)
- Susmita Pandey
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingeborg Bolstad
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Health and Social Science, Innlandet University of Applied Science, Elverum, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Department of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
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34
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Hansen EM, Mejldal A, Nielsen AS. Predictors of Readmission Following Outpatient Treatment for Alcohol Use Disorder. Alcohol Alcohol 2021; 55:291-298. [PMID: 32166313 DOI: 10.1093/alcalc/agaa018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/14/2020] [Accepted: 02/22/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To identify predictors of readmission to outpatient treatment for alcohol use disorder (AUD) with a view to identifying underlying mechanisms for preventing relapse. METHODS A consecutive clinical cohort of 2130 AUD outpatients treated between 1 January 2006 and 1 June 2016 was studied. Data were collected by means of the Addiction Severity Index upon treatment entry and at discharge. Outcome measures were readmission to outpatient treatment and time to readmission. Potential predictors were tested for significance using Cox Proportional Hazards multivariate analysis. RESULTS A total of 22% were readmitted during the follow-up time. Patients readmitted within 1 year of treatment conclusion differed significantly from those not readmitted on age, cohabitation status and completion status of index treatment. Significant predictors of readmission during follow-up time were younger age (hazard ratio (HR) = 0.99, 95% confidence interval (CI), 0.98-1.00), history of psychiatric illness (HR = 1.24, 95% CI, 1.02-1.50), drop-out from index treatment (HR = 1.41, 95% CI, 1.15-1.72) and length of index treatment (HR = 1.02, 95% CI, 1.00-1.04). CONCLUSION Premature drop-out from treatment, a history of psychiatric illness, younger age and longer treatment episodes appear to be the most important predictors of readmission.
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Affiliation(s)
- Emmanuel Mangkornkaew Hansen
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C
| | - Anna Mejldal
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C
| | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C.,Psychiatric Hospital, University section, Region of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C
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35
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Predicting relapse after alcohol use disorder treatment in a high-risk cohort: The roles of anhedonia and smoking. J Psychiatr Res 2020; 126:1-7. [PMID: 32403028 PMCID: PMC8476113 DOI: 10.1016/j.jpsychires.2020.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/05/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
On average, two-thirds of individuals treated for alcohol use disorder (AUD) relapse within six months. There is a critical need to identify modifiable risk factors associated with relapse that can be addressed during AUD treatment. Candidate factors include mood disorders and cigarette smoking, which frequently co-occur with AUD. We predicted that co-occurrence of mood disorders, cigarette smoking, and other modifiable conditions will predict relapse within six months of AUD treatment. Ninety-five Veterans, 23-91 years old, completed assessments of multiple characteristics including demographic information, co-occurring psychiatric disorders, and medical conditions during residential treatment for AUD. Participants' alcohol consumption was monitored over six months after participation. Logistic regression was used to determine if, mood disorders, cigarette smoking status, alcohol consumption, educational level, and comorbid general medical conditions are associated with relapse after AUD treatment. Sixty-nine percent of Veterans (n = 66) relapsed within six months of study while 31% remained abstinent (n = 29). While education, comorbid general medical conditions, and mood disorder diagnoses were not predictors of relapse, Veterans with greater symptoms of anhedonia, active smokers, and fewer days of abstinence prior to treatment showed significantly greater odds for relapse within six months. Anhedonia and cigarette smoking are modifiable risk factors, and effective treatment of underlying anhedonic symptoms and implementation of smoking cessation concurrent with AUD-focused interventions may decrease risk of relapse.
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36
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Durazzo TC, Nguyen LC, Meyerhoff DJ. Medical Conditions Linked to Atherosclerosis Are Associated With Magnified Cortical Thinning in Individuals With Alcohol Use Disorders. Alcohol Alcohol 2020; 55:382-390. [PMID: 32445335 PMCID: PMC7307314 DOI: 10.1093/alcalc/agaa034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 01/21/2023] Open
Abstract
AIMS Magnetic resonance imaging (MRI) studies report widespread cortical thinning in individuals with alcohol use disorder (AUD), but did not consider potential effects of pro-atherogenic conditions such as hypertension, type 2 diabetes mellitus, hepatitis C seropositivity and hyperlipidemia on cortical thickness. The conditions are associated with regional cortical thinning in those without AUD. We predicted that individuals with concurrent AUD and pro-atherogenic conditions demonstrate the greatest regional cortical thinning in areas most vulnerable to decreased perfusion. METHODS Treatment-seeking individuals with AUD (n = 126) and healthy controls (CON; n = 49) completed a 1.5 T MRI study. Regional cortical thickness was quantitated via FreeSurfer. Individuals with AUD and pro-atherogenic conditions (Atherogenic+), AUD without pro-atherogenic conditions (Atherogenic-) and CON were compared on regional cortical thickness. RESULTS Individuals with AUD showed significant bilateral cortical thinning compared to CON, but Atherogenic+ demonstrated the most widespread and greatest magnitude of regional thinning, while Atherogenic- had reduced thickness primarily in anterior frontal and posterior parietal lobes. Atherogenic+ also showed a thinner cortex than Atherogenic- in lateral orbitofrontal and dorso/dorsolateral frontal cortex, mesial and lateral temporal and inferior parietal regions. CONCLUSIONS Our results demonstrate significant bilateral cortical thinning in individuals with AUD relative to CON, but the distribution and magnitude were influenced by comorbid pro-atherogenic conditions. The magnitude of cortical thinning in Atherogenic+ strongly corresponded to cortical watershed areas susceptible to decreased perfusion, which may result in morphometric abnormalities. The findings indicate that pro-atherogenic conditions may contribute to cortical thinning in those seeking treatment for AUD.
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Affiliation(s)
- Timothy C Durazzo
- Mental Illness Research and Education Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Linh-Chi Nguyen
- Mental Illness Research and Education Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Dieter J Meyerhoff
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco VA Medical Center, San Francisco, CA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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37
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Meyerhoff DJ, Durazzo TC. Not All Is Lost for Relapsers: Relapsers With Low WHO Risk Drinking Levels and Complete Abstainers Have Comparable Regional Gray Matter Volumes. Alcohol Res 2020. [PMCID: PMC7383772 DOI: 10.1111/acer.14377] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Dieter J. Meyerhoff
- From the Center for Imaging of Neurodegenerative Diseases (CIND) (DJM) San Francisco VA Medical Center San Francisco California
- Department of Radiology and Biomedical Imaging (DJM) University of California San Francisco California
| | - Timothy C. Durazzo
- Mental Illness Research and Education Clinical Centers (TCD) VA Palo Alto Health Care System Palo Alto California
- Department of Psychiatry and Behavioral Sciences (TCD) Stanford University School of Medicine Stanford California
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38
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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Burchi E, Makris N, Lee MR, Pallanti S, Hollander E. Compulsivity in Alcohol Use Disorder and Obsessive Compulsive Disorder: Implications for Neuromodulation. Front Behav Neurosci 2019; 13:70. [PMID: 31139059 PMCID: PMC6470293 DOI: 10.3389/fnbeh.2019.00070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/22/2019] [Indexed: 01/22/2023] Open
Abstract
Alcohol use Disorder (AUD) is one of the leading causes of morbidity and mortality worldwide. The progression of the disorder is associated with the development of compulsive alcohol use, which in turn contributes to the high relapse rate and poor longer term functioning reported in most patients, even with treatment. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines AUD by a cluster of symptoms, parsing its heterogeneous phenotype by domains of behavior such as compulsivity may be a critical step to improve outcomes of this condition. Still, neurobiological underpinnings of compulsivity need to be fully elucidated in AUD in order to better design targeted treatment strategies. In this manuscript, we review and discuss findings supporting common mechanisms between AUD and OCD, dissecting the construct of compulsivity and focusing specifically on characteristic disruptions in habit learning and cognitive control in the two disorders. Finally, neuromodulatory interventions are proposed as a probe to test compulsivity as key pathophysiologic feature of AUD, and as a potential therapy for the subgroup of individuals with compulsive alcohol use, i.e., the more resistant stage of the disorder. This transdiagnostic approach may help to destigmatize the disorder, and suggest potential treatment targets across different conditions.
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Affiliation(s)
- Elisabetta Burchi
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Nikolaos Makris
- Center for Morphometric Analysis, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Mary R Lee
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, Bethesda, MD, United States
| | - Stefano Pallanti
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States
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40
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Frequency and Predictors of Alcohol-Related Outcomes Following Alcohol Residential Rehabilitation Programs: A 12-Month Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050722. [PMID: 30823386 PMCID: PMC6427603 DOI: 10.3390/ijerph16050722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 01/12/2023]
Abstract
Excessive use of alcohol has been identified as a major risk factor for diseases, injury conditions and increased mortality. The aims of this study were to estimate the frequency of success (abstinence and no alcohol related hospitalization) at 6- and 12-month follow-up after hospital discharge, and to identify the predictors of success. In 2009, a total of 1040 patients at their first admission in one of the 12 Residential Alcohol Abuse Rehabilitation Units (RAARUs) participating in the CORRAL (COordinamento of Residenzialità Riabilitative ALcologiche) project were included in the study. Several socio-demographic and clinical variables, and the number of treatments' strategies during the rehabilitation were collected. Information on alcohol abstinence and no alcohol related hospitalization was assessed through a phone interview using a health worker-administered structured questionnaire at six and 12 months after discharge. An inverse probability weighted, repeated measures Poisson regression model with robust variance was applied to estimate the association between patients' characteristics and the study's outcomes, accounting for non-responders status. The frequencies of abstinence and non-alcohol related hospitalization were 68.38% and 90.73% at six months, respectively, and 68.65% and 87.6% at 12 months, respectively. Patients that were already abstainers in the month before RAARUs' admission have an increased probability of being abstainers after discharge (relative risk: RR 1.20, 95% confidence interval: 95%CI 1.08⁻1.33) and of having an alcohol related hospitalization at 12 months. Subjects undergoing more than four treatment strategies (RR 1.19; 95% CI 1.01⁻1.40) had a higher abstinence probability and lower probability of no alcohol related hospitalizations after 12 months. Finally, patients with dual diagnosis (co-occurrence of alcohol abuse/dependence and psychiatric disorders) have a decreased probability of not being hospitalized for alcohol-related problems (RR 0.95; 95% CI 0.91⁻0.99). The results of this study suggest that specific attention should be paid to the intensity of treatment, with particular regard to a multidisciplinary rehabilitation in order to respond to the complexity of alcohol dependent patients.
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Weinberger AH, Pacek LR, Giovenco D, Galea S, Zvolensky MJ, Gbedemah M, Goodwin RD. Cigarette Use Among Individuals with Alcohol Use Disorders in the United States, 2002 to 2016: Trends Overall and by Race/Ethnicity. Alcohol Clin Exp Res 2018; 43:79-90. [PMID: 30408209 DOI: 10.1111/acer.13922] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Individuals with alcohol use disorders (AUDs) who smoke cigarettes experience greater health risks than those using either substance alone. Further, disparities exist in AUDs and smoking by race/ethnicity. Although smoking has declined in the general population, it is not known whether the smoking prevalence has changed over time for individuals with AUDs. The current study used representative U.S. data to estimate the prevalence of current cigarette use from 2002 to 2016 by AUD status and severity overall and by race/ethnicity. METHODS Data were drawn from the National Survey on Drug Use and Health, an annual cross-sectional study of U.S. individuals, from 2002 to 2016 (total analytic sample n = 837,326). Cigarette smoking prevalence was calculated annually among those with and without past-year AUD and by AUD severity level (mild, moderate, severe AUD). Time trends in smoking prevalence by AUD status and severity were tested using logistic regression for the overall sample and significant interactions were subsequently stratified by race/ethnicity (non-Hispanic [NH] White, NH Black, Hispanic, NH Other). RESULTS Cigarette use was persistently over twice as common among those with AUDs compared to without AUDs (2016: 37.84% vs. 16.29%). Cigarette use was also more common among those at each level of AUD severity criteria (2016: mild AUD 34.59%; moderate AUD 35.35%; severe AUD 52.23%). Approximately half of NH Black respondents with AUDs, and three-quarters of NH Black respondents with severe AUDs, reported smoking in 2016. The prevalence of smoking decreased significantly over time among respondents with and without AUDs; however, there were differences by race. There was no decline in smoking prevalence among NH Black respondents with AUDs over time in contrast to a significant decrease for every other racial/ethnic group with and without AUDs. CONCLUSIONS Individuals with AUDs may need additional resources and interventions to quit smoking, especially NH Black individuals.
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Affiliation(s)
- Andrea H Weinberger
- Ferkauf Graduate School of Psychology , Yeshiva University, Bronx, New York.,Department of Epidemiology & Population Health , Albert Einstein College of Medicine, Bronx, New York
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences , Duke University School of Medicine, Durham, North Carolina
| | - Daniel Giovenco
- Department of Sociomedical Sciences , Mailman School of Public Health, Columbia University, New York, New York
| | - Sandro Galea
- Department of Epidemiology , Boston University School of Public Health, Boston, Massachusetts
| | | | - Misato Gbedemah
- Department of Epidemiology and Biostatistics , Graduate School of Public Health and Health Policy, The City University of New York, New York, New York.,Institute for Implementation Science in Population Health , The City University of New York, New York, New York
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics , Graduate School of Public Health and Health Policy, The City University of New York, New York, New York.,Institute for Implementation Science in Population Health , The City University of New York, New York, New York.,Department of Epidemiology , Mailman School of Public Health, Columbia University, New York, New York
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Creswell KG, Chung T. Treatment for Alcohol Use Disorder: Progress in Predicting Treatment Outcome and Validating Nonabstinent End Points. Alcohol Clin Exp Res 2018; 42:1874-1879. [PMID: 30047988 DOI: 10.1111/acer.13846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/20/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Kasey G Creswell
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Zou X, Durazzo TC, Meyerhoff DJ. Regional Brain Volume Changes in Alcohol-Dependent Individuals During Short-Term and Long-Term Abstinence. Alcohol Clin Exp Res 2018; 42:1062-1072. [PMID: 29672876 DOI: 10.1111/acer.13757] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Widespread brain atrophy in alcohol-dependent individuals (ALC) has been consistently documented in pathological and magnetic resonance imaging (MRI) studies. Longitudinal MRI studies have shown that the regional brain volume losses in ALC are partially reversible during abstinence from alcohol. The goal of this study was to determine volume reductions in cortical and subcortical regions functionally important to substance use behavior and their changes during short-term (1 week to 1 month) and long-term abstinence (1 to 7 months) from alcohol. The regions of interest (ROIs) were as follows: anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex (OFC), insula, amygdala, and hippocampus. METHODS A total of 85 unique ALC were assessed at 1 week (n = 65), 1 month (n = 82), and 7 months (n = 36) of abstinence. In addition, 17 light/nondrinking healthy controls (CON) were assessed at baseline and follow-up over a 10-month interval. Regional brain volumes were derived from FreeSurfer. Cross-sectional statistical analyses using 1-way analysis of variance or Fisher's exact test were applied to identify group differences. Longitudinal statistical analyses using linear mixed models were applied to identify regional volume increases and nonlinear volume recovery trajectories. RESULTS We demonstrated significant regional volume reductions in ACC, DLPFC, and hippocampus. Older age was associated with smaller DLPFC and OFC, and higher average monthly drinking over 1 year prior to study was associated with smaller OFC. We also demonstrated significant volume increases of all ROIs except amygdala in ALC and significant nonlinear volume recovery trajectories of DLPFC, OFC, and insula. CONCLUSIONS Results showed significant volume reductions in key regions of the executive control, salience, and emotion networks in ALC at entry into treatment and significant volume increases during short-term and long-term abstinence that were nonlinear over the entire abstinence period for the DLPFC, OFC, and insula. This gray matter plasticity during alcohol abstinence may have important neurobiological and neurocognitive implications in ALC, and it may contribute to an individual's ability to maintain abstinence from alcohol at different phases.
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Affiliation(s)
- Xiaowei Zou
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.,Center for Imaging of Neurodegenerative Diseases (CIND), Veterans Administration Medical Center, San Francisco, California
| | - Timothy C Durazzo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California.,Mental Illness Research and Education Clinical Centers and Sierra-Pacific War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Livermore, California
| | - Dieter J Meyerhoff
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.,Center for Imaging of Neurodegenerative Diseases (CIND), Veterans Administration Medical Center, San Francisco, California
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Petit G, Luminet O, Cordovil de Sousa Uva M, Zorbas A, Maurage P, de Timary P. Differential spontaneous recovery across cognitive abilities during detoxification period in alcohol-dependence. PLoS One 2017; 12:e0176638. [PMID: 28767647 PMCID: PMC5540274 DOI: 10.1371/journal.pone.0176638] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/13/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE There is a lack of consensus regarding the extent to which cognitive dysfunctions may recover upon cessation of alcohol intake by alcohol-dependents (AD), and the divergent findings are most likely due to methodological differences between the various studies. The present study was aimed at conducting a very strict longitudinal study of cognitive recovery in terms of assessment points, the duration of abstinence, control of age and duration of the addiction, and by use of individual analyses in addition to mean group comparisons. Our study further focused on the 2-3 week phase of alcohol detoxification that is already known to positively affect many biological, emotional, motivational, as well as neural variables, followed by longer-term therapies for which good cognitive functioning is needed. METHODS 41 AD inpatients undergoing a detoxification program, and 41 matched controls, were evaluated twice in terms of five cognitive functions (i.e., short-term memory, working memory, inhibition, cognitive flexibility, and verbal fluency) within a three-week interval [on the first day (T1) and the 18th day (T2) of abstinence for AD patients]. Emotional (positive and negative affectivity and depression) and motivational (craving) variables were also measured at both evaluation times. RESULTS Although verbal fluency, short-term memory, and cognitive flexibility did not appear to be affected, the patients exhibited impaired inhibition and working memory at T1. While no recovery of inhibition was found to occur, the average working memory performance of the patients was comparable to that of the controls at T2. Improvements in emotional and motivational dimensions were also observed, although they did not correlate with the ones in working memory. Individual analysis showed that not all participants were impaired or recover the same functions. CONCLUSIONS While inhibition deficits appear to persist after 18 days of detoxification, deficits in working memory, which is a central component of cognition, are greatly reduced after alcohol detoxification. Individual differences in the trajectory of recovery do arise however, and it might be worth implementing individual assessments of impaired functions at the end of the detoxification phase in order to maximize the chances of success in longer-term treatments and abstinence.
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Affiliation(s)
- Géraldine Petit
- Research Institute for Psychological Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Department of Adult Psychiatry, Saint-Luc Academic Hospital, Université catholique de Louvain, Brussels, Belgium
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Olivier Luminet
- Research Institute for Psychological Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- The Belgian National Fund for Scientific Research (FRS-FNRS), Brussels, Belgium
| | - Mariana Cordovil de Sousa Uva
- Research Institute for Psychological Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Department of Adult Psychiatry, Saint-Luc Academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Alexis Zorbas
- Research Institute for Psychological Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Department of Adult Psychiatry, Saint-Luc Academic Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Maurage
- Research Institute for Psychological Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- The Belgian National Fund for Scientific Research (FRS-FNRS), Brussels, Belgium
| | - Philippe de Timary
- Department of Adult Psychiatry, Saint-Luc Academic Hospital, Université catholique de Louvain, Brussels, Belgium
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, Université catholique de Louvain, Louvain-la-Neuve, Belgium
- Unité Intégrée d’Hépatologie, Saint-Luc Academic Hospital, Université catholique de Louvain, Brussels, Belgium
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