Biological Systems Are a Common Link Between Alcohol Use Disorder and Co-Occurring Psychiatric and Medical Conditions

Heavy Alcohol Use and HIV Outcomes: The Moderating Role of Pain

Pain and heavy alcohol consumption are prevalent among people living with HIV/AIDS (PLWH), each contributing to impaired functioning and diminished quality of life. Each of these conditions may have negative effects on the HIV care continuum, but less is known about their combined influences. The current study examined how heavy drinking and pain were associated with HIV viral suppression and CD4 cell count among participants receiving antiretroviral therapy (ART). The study sample consisted of 220 PLWH with past 12-month substance dependence or ever injection drug use enrolled in a large HIV cohort study. Logistic regression analyses showed an interaction between pain level (no/mild pain vs moderate/severe) and heavy drinking on viral suppression such that heavy drinking was a significant predictor of poorer viral suppression only for those who experienced moderate/severe pain. We also examined whether ART adherence differentially mediated the association between heavy drinking and HIV viral suppression by level of pain. Although there was a significant indirect effect of heavy drinking on viral suppression among those with moderate/severe pain, moderated mediational analyses did not indicate that the indirect effect of heavy drinking on viral suppression through ART adherence differed significantly by level of pain. Pain level did not significantly moderate the association between heavy drinking and CD4 cell count. We conclude that heavy drinking may be particularly likely to be associated with poorer HIV viral suppression among PLWH with moderate or severe pain. Providers should routinely address comorbid heavy drinking and pain to improve HIV outcomes.

An empirically derived method for measuring human gut microbiome alpha diversity: Demonstrated utility in predicting health-related outcomes among a human clinical sample

The human gut microbiome has emerged as a potential key factor involved in the manifestation of physical and mental health. Despite an explosion of cross-disciplinary interest in researching the gut microbiome, there remains to be a gold-standard method for operationalizing gut microbiome alpha diversity. Given researchers' interest in examining the relationships among gut microbiome alpha diversity and health-related outcomes of interest, a way of operationalizing the microbiome that yields a numeric value, which could be used in common statistical approaches, is needed. Thus, the current study aims to provide methodological guidance for how to operationalize microbiome alpha diversity. Findings suggest that alpha diversity of the human gut microbiome is comprised of two sub-constructs (richness and evenness), and we propose a step-by-step method of creating alpha diversity composite measures based on this key insight. Finally, we demonstrate that our empirically derived richness and evenness composite measures are significantly associated with health-related variables of interest (alcohol use, symptoms of depression) among a human clinical sample.

Behavioral health and new models of service delivery for an aging world: Public/private partnerships to develop best practices of care for older adults

Individual and societal initiatives in areas of research, education, and health care policy have resulted in unprecedented gains in life expectancy. It is true that today more people in the world are living longer and have opportunities for higher quality lives than ever before. However, the resulting rapid rise in number of older adults has become a source of concern: Experts of many countries, in anticipation of looming problems, such as overburdened health care and pension systems, are now seeking opportunities to work together to find common solutions for globally-shared problems. The good news is that while all countries are experiencing change brought on by aging populations, the rate of change varies substantially from country to country; differences in historical events have produced differences in demographic profiles. Some countries have relatively large numbers of older adults, comprising large percentages of their populations; others have fewer older adults, with slower growth in numbers and percentages of older adults relative to other age groups. These differences have led to variations for the type and pace of response mounted by individual countries for problems associated with increasingly large older adult populations. In turn, these variations in response provide opportunities for countries to learn from one another. This brief review will outline potential issues associated with aging populations and discuss strengths and challenges for the integration of primary medical care with behavioral health as an innovative, best practices approach to the provision of care for aging persons of the world.