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Karlsson P, Callinan S, Gmel G, Raninen J. How well do DSM-5 criteria measure alcohol use disorder in the general population of older Swedish adolescents? An item response theory analysis. Addict Behav 2024; 154:108007. [PMID: 38460492 DOI: 10.1016/j.addbeh.2024.108007] [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: 11/08/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND This study assesses the psychometric properties of DSM-5 criteria of AUD in older Swedish adolescents using item response theory models, focusing specifically on the precision of the scale at the cut-offs for mild, moderate, and severe AUD. METHODS Data from the second wave of Futura01 was used. Futura01 is a nationally representative cohort study of Swedish people born 2001 and data for the second wave was collected when participants were 17/18 years old. This study included only participants who had consumed alcohol during the past 12 months (n = 2648). AUD was measured with 11 binary items. A 2-parameter logistic item response theory model (2PL) estimated the items' difficulty and discrimination parameters. RESULTS 31.8% of the participants met criteria for AUD. Among these, 75.6% had mild AUD, 18.3% had moderate, and 6.1% had severe AUD. A unidimensional AUD model had a good fit and 2PL models showed that the scale measured AUD over all three cut-offs for AUD severity. Although discrimination parameters ranged from moderate (1.24) to very high (2.38), the more commonly endorsed items discriminated less well than the more difficult items, as also reflected in less precision of the estimates at lower levels of AUD severity. The diagnostic uncertainty was pronounced at the cut-off for mild AUD. CONCLUSION DSM-5 criteria measure AUD with better precision at higher levels of AUD severity than at lower levels. As most older adolescents who fulfil an AUD diagnosis are in the mild category, notable uncertainties are involved when an AUD diagnosis is set in this group.
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Affiliation(s)
- Patrik Karlsson
- Department of Social Work, Stockholm University, Stockholm, Sweden.
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Gerhard Gmel
- Addiction Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 23A, 1011 Lausanne, Switzerland; Research Department, Addiction Switzerland, Avenue Louis-Ruchonnet 14, 1003 Lausanne, Switzerland; Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 250 College Street, Toronto, ON M5T 1R8, Canada; Alcohol and Research Unit, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Jonas Raninen
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia; Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
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Lowik A, Mniszak C, Pang M, Ziafat K, Karamouzian M, Knight R. A sex- and gender-based analysis of alcohol treatment intervention research involving youth: A methodological systematic review. PLoS Med 2024; 21:e1004413. [PMID: 38829916 PMCID: PMC11182506 DOI: 10.1371/journal.pmed.1004413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 06/17/2024] [Accepted: 05/08/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND While there is widespread consensus that sex- and gender-related factors are important for how interventions are designed, implemented, and evaluated, it is not currently known how alcohol treatment research accounts for sex characteristics and/or gender identities and modalities. This methodological systematic review documents and assesses how sex characteristics, gender identities, and gender modalities are operationalized in alcohol treatment intervention research involving youth. METHODS AND FINDINGS We searched MEDLINE, Embase, Cochrane Central Registry of Controlled Trials, PsycINFO, CINAHL, LGBT Life, Google Scholar, Web of Science, and grey literature from 2008 to 2023. We included articles that reported genders and/or sexes of participants 30 years of age and under and screened participants using AUDIT, AUDIT-C, or a structured interview using DSM-IV criteria. We limited the inclusion to studies that enrolled participants in alcohol treatment interventions and used a quantitative study design. We provide a narrative overview of the findings. Of 8,019 studies screened for inclusion, 86 articles were included in the review. None of the studies defined, measured, and reported both sex and gender variables accurately. Only 2 studies reported including trans participants. Most of the studies used gender or sex measures as a covariate to control for the effects of sex or gender on the intervention but did not discuss the rationale for or implications of this procedure. CONCLUSIONS Our findings identify that the majority of alcohol treatment intervention research with youth conflate sex and gender factors, including terminologically, conceptually, and methodologically. Based on these findings, we recommend future research in this area define and account for a spectrum of gender modalities, identities, and/or sex characteristics throughout the research life cycle, including during study design, data collection, data analysis, and reporting. It is also imperative that sex and gender variables are used expansively to ensure that intersex and trans youth are meaningfully integrated. TRIAL REGISTRATION Registration: PROSPERO, registration number: CRD42019119408.
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Affiliation(s)
- A.J. Lowik
- British Columbia Centre on Substance Use, Vancouver, Canada
- Institute for Gender, Race, Sexuality and Social Justice, University of British Columbia, Vancouver, Canada
| | - Caroline Mniszak
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Michelle Pang
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kimia Ziafat
- British Columbia Centre on Substance Use, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, Canada
- Université de Montréal, École de santé publique, Montréal, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Canada
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Durazzo TC, Humphreys K, LaRocca MA. Leadership Styles Experienced During Military Service Predict Later Anhedonic Depressive Symptoms and Self-Efficacy in Veterans With Alcohol Use Disorder. Mil Med 2024; 189:e1064-e1071. [PMID: 37897693 DOI: 10.1093/milmed/usad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/12/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023] Open
Abstract
INTRODUCTION Lifetime and past-year alcohol use disorder (AUD) prevalence is significantly higher in US Armed Services Veterans than in non-veterans across adulthood. This study examined the associations of perceived transformational leadership styles (TLS) experienced during military service and anhedonic depression and self-efficacy related to confidence to abstain or reduce alcohol consumption in Veterans seeking treatment for AUD. The ramifications of perceived leadership styles on multiple aspects of follower psychiatric functioning, including depressive and PTSD symptomatology, during and after military service, may be substantial and enduring. Higher anhedonic depression and lower abstinence self-efficacy are related to increased risk of relapse after treatment. We predicted Veterans, in treatment for AUD, who reported higher perceived levels of transformational leadership during military service, demonstrate lower anhedonic depressive symptoms and higher alcohol abstinence self-efficacy. MATERIALS AND METHODS Veterans with AUD (n = 60; 50 ± 14 years of age) were recruited from residential treatment at the VA Palo Alto Health Care System. All procedures were approved by the VA Palo Alto Health Care System and Stanford University institutional review boards. A series of mediation analyses were completed with The Multifactor Leadership Questionnaire measures of TLS (average across leadership measures [transformational leadership average; TLS average]) as predictor and the Alcohol Abstinence Self-Efficacy Scale, Mood and Anxiety Symptom Questionnaire, anhedonic depression subscale, as dependent measures. PTSD Checklist for DSM-5 score was tested as a mediator variable. RESULTS Higher reported perceived TLS average during military service was significantly related to lower anhedonic depressive symptoms. Higher TLS average was related to higher self-efficacy to resist alcohol use in contexts involving experience of physical issues and withdrawal/cravings and urges. These relationships were not mediated by PTSD symptomatology or duration of military service, age, education, time since military service, military branch, combat exposure, or current psychiatric diagnosis. CONCLUSIONS The significant associations of perceived TLS during military service with anhedonic depression and alcohol use self-efficacy are clinically relevant because these measures are associated with relapse risk after AUD treatment. Further study of the implications of perceived TLS during military service for AUD and other substance use disorder treatment outcome is warranted in Veterans.
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Affiliation(s)
- Timothy C Durazzo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine,Stanford, CA 94305, USA
- Mental Illness Research and Clinical Centers (TCD), Center for Innovation to Implementation (KH), VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
- 297th Medical Company Area Support, California Army National Guard, San Mateo, CA 94401, USA
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine,Stanford, CA 94305, USA
- Mental Illness Research and Clinical Centers (TCD), Center for Innovation to Implementation (KH), VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Michael A LaRocca
- Department of Psychology, Virginia Military Institute, Carroll Hall, Lexington, VA 24450, USA
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Durazzo TC, Stephens LH, Meyerhoff DJ. Regional cortical thickness recovery with extended abstinence after treatment in those with alcohol use disorder. Alcohol 2024; 114:51-60. [PMID: 37657667 PMCID: PMC10902196 DOI: 10.1016/j.alcohol.2023.08.011] [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: 05/23/2023] [Revised: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
Several cross-sectional investigations reported widespread cortical thinning in those with alcohol use disorder (AUD). The few longitudinal studies investigating cortical thickness changes during abstinence are limited to the first month of sobriety. Consequently, cortical thickness changes during extended abstinence in those with AUD is unclear. In this study, AUD participants were studied at approximately 1 week (n = 68), 1 month (n = 88), and 7.3 months (n = 40) of abstinence. Forty-five never-smoking controls (CON) completed a baseline study, and 15 were reassessed after approximately 9.6 months. Participants completed magnetic resonance imaging studies at 1.5T, and cortical thickness for 34 bilateral regions of interest (ROI) was quantitated with FreeSurfer. AUD participants demonstrated significant linear thickness increases in 25/34 ROI over 7.3 months of abstinence. The rate of change from 1 week to 1 month was greater than 1 month to 7.3 months in 19/34 ROIs. Proatherogenic conditions were associated with lower thickness recovery in anterior frontal, inferior parietal, and lateral/mesial temporal regions. After 7.3 months of abstinence, AUD participants were statistically equivalent to CON on cortical thickness in 24/34 ROIs; the cortical thickness differences between AUD and CON in the banks superior temporal gyrus, post central, posterior cingulate, superior parietal, supramarginal, and superior frontal cortices were driven by thinner cortices in AUD with proatherogenic conditions relative to CON. In actively smoking AUD, increasing pack-years was associated with decreasing thickness recovery primarily in the anterior frontal ROIs. Widespread bilateral cortical thickness recovery over 7.3 months of abstinence was the central finding for this AUD cohort. The longitudinal and cross-sectional findings for AUD with proatherogenic suggests alterations in perfusion or vascular integrity may relate to structural recovery in those with AUD. These results support the adaptive and beneficial effects of sustained sobriety on brain structural recovery in people with AUD.
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Affiliation(s)
- Timothy C Durazzo
- Sierra-Pacific Mental Illness Research and Education Clinical Centers, Veterans Administration 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.
| | - Lauren H Stephens
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Dieter J Meyerhoff
- Center for Imaging of Neurodegenerative Diseases (CIND), San Francisco Veterans Administration Medical Center, San Francisco, CA, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
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Bailey AJ, McHugh RK. Examination of the mild, moderate, and severe alcohol use disorder severity indicators using a nationally representative sample. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023:2024-37574-001. [PMID: 38127523 PMCID: PMC11190027 DOI: 10.1037/adb0000983] [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] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The Diagnostic and Statistical Manual of Mental Disorders, fifth edition conceptualizes alcohol use disorder (AUD) as a single continuum with indicators to denote the level of severity along this spectrum with the presence of 2-3, 4-5, or 6 + symptoms indicating mild, moderate, and severe AUD, respectively. However, despite the labels of these indicators, it remains unclear how individuals compare across these indicators, both in terms of AUD severity, but also risk for other related problems (e.g., depression). METHOD Confirmatory factor analysis was conducted on past year AUD symptoms to obtain estimates of latent AUD severity using data from the 2020 National Survey on Drug Use and Health (unweighted n = 31,941). The range and distribution of latent trait estimates were then compared across AUD diagnostic statuses (i.e., no AUD, mild, moderate, and severe). Multinomial regressions were then used to compare diagnostic groups based on alcohol use, problems with other substances, treatment utilization, and mental/physical health. RESULTS Results indicated very limited overlap in latent severity estimates between individuals with different severity indicators. Multinomial regression results demonstrated that some measures increased in a roughly stepwise fashion across AUD indicators (e.g., alcohol use and drinking behavior), while many did not. CONCLUSIONS Results partially support the current AUD indicators as AUD severity and co-occurring problems did broadly increase across the indicators. However, the present study also explores several ways to improve these indicators in future AUD formulations. For example, having indicators that account not only for the quantitative but also the qualitative differences in AUD presentation at different severity levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Allen J. Bailey
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, Department of Psychiatry, Harvard Medical School, Boston, MA, 115 Mill Street, Administration Building, G06, Belmont, MA 02478
| | - R. Kathryn McHugh
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, Department of Psychiatry, Harvard Medical School, Boston, MA, 115 Mill Street, Administration Building, G06, Belmont, MA 02478
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Miller AP, Kuo SIC, Johnson EC, Tillman R, Brislin SJ, Dick DM, Kamarajan C, Kinreich S, Kramer J, McCutcheon VV, Plawecki MH, Porjesz B, Schuckit MA, Salvatore JE, Edenberg HJ, Bucholz KK, Meyers JL, Agrawal A. Diagnostic Criteria for Identifying Individuals at High Risk of Progression From Mild or Moderate to Severe Alcohol Use Disorder. JAMA Netw Open 2023; 6:e2337192. [PMID: 37815828 PMCID: PMC10565602 DOI: 10.1001/jamanetworkopen.2023.37192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/22/2023] [Indexed: 10/11/2023] Open
Abstract
Importance Current Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnoses of substance use disorders rely on criterion count-based approaches, disregarding severity grading indexed by individual criteria. Objective To examine correlates of alcohol use disorder (AUD) across count-based severity groups (ie, mild, moderate, mild-to-moderate, severe), identify specific diagnostic criteria indicative of greater severity, and evaluate whether specific criteria within mild-to-moderate AUD differentiate across relevant correlates and manifest in greater hazards of severe AUD development. Design, Setting, and Participants This cohort study involved 2 cohorts from the family-based Collaborative Study on the Genetics of Alcoholism (COGA) with 7 sites across the United States: cross-sectional (assessed 1991-2005) and longitudinal (assessed 2004-2019). Statistical analyses were conducted from December 2022 to June 2023. Main Outcomes and Measures Sociodemographic, alcohol-related, psychiatric comorbidity, brain electroencephalography (EEG), and AUD polygenic score measures as correlates of DSM-5 AUD levels (ie, mild, moderate, severe) and criterion severity-defined mild-to-moderate AUD diagnostic groups (ie, low-risk vs high-risk mild-to-moderate). Results A total of 13 110 individuals from the cross-sectional COGA cohort (mean [SD] age, 37.8 [14.2] years) and 2818 individuals from the longitudinal COGA cohort (mean baseline [SD] age, 16.1 [3.2] years) were included. Associations with alcohol-related, psychiatric, EEG, and AUD polygenic score measures reinforced the role of increasing criterion counts as indexing severity. Yet within mild-to-moderate AUD (2-5 criteria), the presence of specific high-risk criteria (eg, withdrawal) identified a group reporting heavier drinking and greater psychiatric comorbidity even after accounting for criterion count differences. In longitudinal analyses, prior mild-to-moderate AUD characterized by endorsement of at least 1 high-risk criterion was associated with more accelerated progression to severe AUD (adjusted hazard ratio [aHR], 11.62; 95% CI, 7.54-17.92) compared with prior mild-to-moderate AUD without endorsement of high-risk criteria (aHR, 5.64; 95% CI, 3.28-9.70), independent of criterion count. Conclusions and Relevance In this cohort study of a combined 15 928 individuals, findings suggested that simple count-based AUD diagnostic approaches to estimating severe AUD vulnerability, which ignore heterogeneity among criteria, may be improved by emphasizing specific high-risk criteria. Such emphasis may allow better focus on individuals at the greatest risk and improve understanding of the development of AUD.
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Affiliation(s)
- Alex P. Miller
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Sally I-Chun Kuo
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Emma C. Johnson
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Sarah J. Brislin
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Danielle M. Dick
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Chella Kamarajan
- Department of Psychiatry and Behavioral Sciences, State University of New York Health Sciences University, Brooklyn
| | - Sivan Kinreich
- Department of Psychiatry and Behavioral Sciences, State University of New York Health Sciences University, Brooklyn
| | - John Kramer
- Department of Psychiatry, University of Iowa, Iowa City
| | - Vivia V. McCutcheon
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | | | - Bernice Porjesz
- Department of Psychiatry and Behavioral Sciences, State University of New York Health Sciences University, Brooklyn
| | - Marc A. Schuckit
- Department of Psychiatry, University of California San Diego Medical School, San Diego
| | - Jessica E. Salvatore
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Howard J. Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University, Indianapolis
| | - Kathleen K. Bucholz
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Jaquelyn L. Meyers
- Department of Psychiatry and Behavioral Sciences, State University of New York Health Sciences University, Brooklyn
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
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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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Shmulewitz D, Stohl M, Greenstein E, Roncone S, Walsh C, Aharonovich E, Wall MM, Hasin DS. Validity of the DSM-5 craving criterion for alcohol, tobacco, cannabis, cocaine, heroin, and non-prescription use of prescription painkillers (opioids). Psychol Med 2023; 53:1955-1969. [PMID: 35506791 PMCID: PMC9096712 DOI: 10.1017/s0033291721003652] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the DSM-5 was adopted in 2013, the validity of the new substance use disorder (SUD) diagnosis and craving criterion has not been investigated systematically across substances. METHODS Adults (N = 588) who engaged in binge drinking or illicit drug use and endorsed at least one DSM-5 SUD criterion were included. DSM-5 SUD criteria were assessed for alcohol, tobacco, cannabis, cocaine, heroin, and opioids. Craving was considered positive if "wanted to use so badly that could not think of anything else" (severe craving) or "felt a very strong desire or urge to use" (moderate craving) was endorsed. Baseline information on substance-related variables and psychopathology was collected, and electronic daily assessment queried substance use for the following 90 days. For each substance, logistic regression estimated the association between craving and validators, i.e. variables expected to be related to craving/SUD, and whether association with the validators differed for DSM-5 SUD diagnosed with craving as a criterion v. without. RESULTS Across substances, craving was associated with most baseline validators (p values<0.05); neither moderate nor severe craving consistently showed greater associations. Baseline craving predicted subsequent use [odds ratios (OR): 4.2 (alcohol) - 234.3 (heroin); p's ⩽ 0.0001], with stronger associations for moderate than severe craving (p's < 0.05). Baseline DSM-5 SUD showed stronger associations with subsequent use when diagnosed with craving than without (p's < 0.05). CONCLUSION The DSM-5 craving criterion as operationalized in this study is valid. Including craving improves the validity of DSM-5 SUD diagnoses, and clinical relevance, since craving may cause impaired control over use and development and maintenance of SUD.
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Affiliation(s)
- D Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - M Stohl
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Greenstein
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - S Roncone
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - C Walsh
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - E Aharonovich
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - MM Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - DS Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
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Ranney RM, Bernhard PA, Vogt D, Blosnich JR, Hoffmire CA, Cypel Y, Schneiderman AI, Maguen S. Alcohol use and treatment utilization in a national sample of veterans and nonveterans. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208964. [PMID: 36880905 DOI: 10.1016/j.josat.2023.208964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/01/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Research comparing prevalence of alcohol use problems and alcohol treatment utilization between veterans and nonveterans is lacking. Whether predictors of alcohol use problems and alcohol treatment utilization differ in veterans vs. nonveterans is also unclear. METHODS Using survey data from national samples of post-9/11 veterans and nonveterans (N = 17,298; 13,451 veterans, 3847 nonveterans), we investigated associations between veteran status and 1) alcohol consumption, 2) need for intensive alcohol treatment, and 3) past-year and lifetime alcohol treatment utilization. We also investigated associations between predictors and these three outcomes in separate models for veterans and nonveterans. Predictors included age, gender, racial/ethnic identity, sexual orientation, marital status, education, health coverage, financial difficulty, social support, adverse childhood experiences (ACEs), and adult sexual trauma. RESULTS Population weighted regression models demonstrated that veterans reported modestly higher alcohol consumption than nonveterans, but were not significantly more likely to need intensive alcohol treatment. Veterans and nonveterans did not differ in past-year alcohol treatment utilization, but veterans were 2.8 times more likely to utilize lifetime treatment than nonveterans. We found several differences between veterans and nonveterans in associations between predictors and outcomes. For veterans, being male, having higher financial difficulty, and lower social support were associated with need for intensive treatment, but for nonveterans, only ACEs were associated with need for intensive treatment. CONCLUSIONS Veterans may benefit from interventions with social and financial support to reduce alcohol problems. These findings can help to identify veterans and nonveterans who are more likely to need treatment.
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Affiliation(s)
- Rachel M Ranney
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA; Sierra Pacific Mental Illness Research Education, and Clinical Center, 4150 Clement St, San Francisco, CA 94121, USA.
| | - Paul A Bernhard
- Health Outcomes of Military Exposures, Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, 810 Vermont Ave NW, Washington, DC 20420, USA
| | - Dawne Vogt
- VA Boston Health Care System, 150 S Huntington Ave, Boston, MA 02130, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - John R Blosnich
- University of Southern California, 669 W 34th St, Los Angeles, CA 90089-0411, USA; VA Pittsburgh Healthcare System, 4100 Allequippa St, Pittsburgh, PA 15240, USA
| | - Claire A Hoffmire
- VA Rocky Mountain MIRECC for Suicide Prevention, 1700 N Wheeling St, Aurora, CO 80045, USA; University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, 13001 E 17(th) Pl, Aurora, CO 80045, USA
| | - Yasmin Cypel
- Health Outcomes of Military Exposures, Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, 810 Vermont Ave NW, Washington, DC 20420, USA
| | - Aaron I Schneiderman
- Health Outcomes of Military Exposures, Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, 810 Vermont Ave NW, Washington, DC 20420, USA
| | - Shira Maguen
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA 94121, USA; University of California - San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
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10
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de Ternay J, Larrieu A, Sauvestre L, Montègue S, Guénin M, Icard C, Rolland B. Insufficient Physical Activity Is a Global Marker of Severity in Alcohol Use Disorder: Results from a Cross-Sectional Study in 382 Treatment-Seeking Patients. Nutrients 2022; 14:nu14234958. [PMID: 36500988 PMCID: PMC9739230 DOI: 10.3390/nu14234958] [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: 10/25/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Improving physical activity (PA) in patients with alcohol use disorder (AUD) has recently emerged as an important component of the global treatment strategy to improve drinking outcomes and quality of life. However, this new approach should focus on AUD patients with insufficient baseline PA and requires this subgroup to be better characterized. In a population of 382 treatment-seeking AUD patients, PA was assessed using the International Physical Activity Questionnaire, and participants were divided into two groups: insufficient PA group and sufficient PA group. The severity of the AUD was assessed using the DSM-5 criteria, the Alcohol Use Disorder Identification Test, and the Severity of Alcohol Dependence Questionnaire. In logistic regression models, individuals with insufficient PA were more likely than other AUD individuals to present a higher Body Mass Index (p < 0.001), a higher number of AUD DSM-5 criteria (p < 0.05), more frequent opioid use (p < 0.05), higher scores at the Fagerström Test for Nicotine Dependence (p < 0.001), State-Trait Anxiety Inventory (p < 0.001), impulsivity scale (p < 0.05), Pittsburgh Sleep Quality Inventory (p < 0.05), and lower WHO Quality of Life (p < 0.001) scores. In AUD, an insufficient baseline PA is associated with several markers of severity, and physical exercise interventions should be part of a multimodal treatment program integrating the global impairments of patients.
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Affiliation(s)
- Julia de Ternay
- Service Universitaire d’Addictologie de Lyon (SUAL), Hôpital Édouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
- Correspondence:
| | - Agathe Larrieu
- Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, 69678 Lyon, France
| | - Laura Sauvestre
- Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, 69678 Lyon, France
| | - Solène Montègue
- Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, 69678 Lyon, France
| | - Monique Guénin
- Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, 69678 Lyon, France
| | - Christophe Icard
- Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, 69678 Lyon, France
| | - Benjamin Rolland
- Service Universitaire d’Addictologie de Lyon (SUAL), Hôpital Édouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
- Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, 69678 Lyon, France
- Centre de Recherche en Neurosciences de Lyon (Psychiatric Disorders, PSYR2), Université Claude Bernard Lyon 1, Inserm U1028, CNRS UMR 5292, 69100 Lyon, France
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11
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Fink DS, Shmulewitz D, Mannes ZL, Stohl M, Livne O, Wall M, Hasin DS. Construct validity of DSM-5 cannabis use disorder diagnosis and severity levels in adults with problematic substance use. J Psychiatr Res 2022; 155:387-394. [PMID: 36182768 PMCID: PMC9590423 DOI: 10.1016/j.jpsychires.2022.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/02/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
The DSM-5 definition of cannabis use disorder (CUD) differs from DSM-IV by combining abuse and dependence criteria (without the legal criterion) and including withdrawal and craving criteria. Information on construct validity of the DSM-5 CUD diagnosis and severity levels is lacking. This study examines the associations between DSM-5 CUD and severity classification and a set of concurrent validators. Adults with problematic substance use were recruited from two settings: a research setting in an urban medical center and a suburban inpatient addiction treatment program. Participants who reported past-year cannabis use (n = 392) were included in this study and completed a semi-structured, clinician-administered diagnostic interview. Regression models estimated the associations between binary DSM-5 CUD and severity levels with a set of validators, including cannabis use variables, psychopathology, and functional impairment. DSM-5 CUD and all severity levels were associated with cannabis use validators, including number of days used, self-reporting that cannabis use was a major problem, and greater cannabis craving. DSM-5 CUD and severe CUD were associated with other psychiatric disorders and social impairment. Findings add information about the validity of DSM-5 CUD diagnosis and severity levels, with severe CUD receiving the strongest support from its association with validators across all domains, as distinct from the mild and moderate CUD measures that were associated with cannabis-specific validators alone. Severe CUD is likely to require more intensive treatment to bolster physical, psychiatric, and social functioning, whereas the mild and moderate severity thresholds provide useful information for identifying less severe disorders for prevention and brief intervention.
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Affiliation(s)
- David S Fink
- New York State Psychiatric Institute, New York, NY, USA
| | - Dvora Shmulewitz
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Zachary L Mannes
- New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Malka Stohl
- New York State Psychiatric Institute, New York, NY, USA
| | - Ofir Livne
- New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melanie Wall
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah S Hasin
- New York State Psychiatric Institute, New York, NY, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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12
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Padula CB, Durazzo TC. Active Cigarette Smoking Is Associated With Increased Age-Related Decline on Measures of Visuospatial Learning and Memory and Executive Function in Alcohol Use Disorder. Alcohol Alcohol 2022; 57:656-663. [PMID: 35552594 DOI: 10.1093/alcalc/agac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/21/2022] [Accepted: 04/08/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS The goal of this study was to determine if active cigarette smoking in Veterans with alcohol use disorder (AUD) was associated with greater age-related neurocognitive decline. METHODS Veterans with AUD, in residential treatment (n = 125; 47 ± 14 years of age, min = 24, max = 76, 29 ± 26 days of abstinence), completed measures of executive functions, learning and memory, processing speed and working memory. Actively smoking AUD (AsAUD, n = 47) were active daily cigarette smokers; former smoking AUD (FsAUD, n = 45) were predominately daily smokers prior to study but did not smoke at the time of study; non-smoking AUD (NsAUD, n = 33) never used cigarettes or smoked 'only a few times' during lifetime. RESULTS AsAUD demonstrated greater age-related decline on measures of visuospatial learning and memory, and response inhibition/cognitive flexibility, primarily relative to NsAUD; there were no age-related differences between FsAUD and NsAUD on any measure. There were few significant mean differences between groups across the 15 neurocognitive measures. In AsAUD, higher scores on indices of smoking severity were associated with poorer performance on measures of auditory-verbal learning and memory, response inhibition, set-shifting and working memory. In FsAUD, longer smoking cessation duration was related to lower PTSD, anxiety and depressive symptomatology. CONCLUSIONS Active smoking was associated with accelerated age-related decline on cognitive functions implicated in response to common evidence-based AUD interventions. Results suggest that smoking history contributes to the considerable heterogeneity observed in neurocognitive function in early AUD recovery, and reinforce the clinical movement to offer smoking cessation resources concurrent with treatment for AUD.
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Affiliation(s)
- Claudia B Padula
- Palo Alto Veterans Affairs Health Care System, Mental Illness Research and Education Clinical Centers (MIRECC), Palo Alto, CA 94304, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Timothy C Durazzo
- Palo Alto Veterans Affairs Health Care System, Mental Illness Research and Education Clinical Centers (MIRECC), Palo Alto, CA 94304, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
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13
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Validity of the DSM-5 tobacco use disorder diagnostics in adults with problematic substance use. Drug Alcohol Depend 2022; 234:109411. [PMID: 35338898 PMCID: PMC9035622 DOI: 10.1016/j.drugalcdep.2022.109411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND DSM-5 tobacco use disorder (TUD) nosology differs from DSM-IV nicotine dependence (ND) by including craving and DSM-IV abuse criteria, a lower threshold (≥ 2 criteria), and severity levels (mild; moderate; severe). We assessed concurrent and prospective validity of the DSM-5 TUD diagnosis and severity and compared validity with DSM-IV ND diagnosis. METHODS The sample included U.S. adults with current problematic substance use and past year cigarette smoking (N = 396). Baseline assessment collected information on DSM-IV ND and DSM-5 TUD criteria, smoking-related variables, and psychopathology. Over the following 90 days, electronic daily assessments queried smoking and cigarette craving. Variables expected to be related to TUD were validators: cigarette consumption, cigarette craving scale, Fagerström Test for Nicotine Dependence, and psychiatric disorders. Regression models estimated the association of each validator with DSM-5 TUD and severity levels, and differential association between DSM-5 TUD and DSM-IV ND diagnoses. RESULTS DSM-5 TUD and DSM-IV ND were associated with most baseline validators (p-values < 0.05), with significantly stronger associations with DSM-5 TUD for number of days smoked (p = 0.023) and cigarette craving scale (p = 0.007). Baseline DSM-5 TUD and DSM-IV ND predicted smoking and craving on any given day during follow-up, with stronger associations for DSM-5 TUD (association difference [95% CI%]: any smoking, 0.53 [0.27, 0.77]; number of cigarettes smoked, 1.36 [0.89, 1.78]; craving scale, 0.19 [0.09, 0.28]). Validators were associated with TUD severity in a dose-dependent manner. CONCLUSION DSM-5 TUD diagnostic measures as operationalized here demonstrated concurrent and prospective validity. Inclusion of new criteria, particularly craving, improved validity and clinical relevance.
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