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Maisto SA, Moskal D, Firkey MK, Bergman BG, Borsari B, Hallgren KA, Houck JM, Hurlocker M, Kiluk BD, Kuerbis A, Reid AE, Magill M. From alcohol and other drug treatment mediator to mechanism to implementation: A systematic review and the cases of self-efficacy, social support, and craving. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024. [PMID: 39182214 DOI: 10.1111/acer.15411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/14/2024] [Indexed: 08/27/2024]
Abstract
Research designed to establish alcohol and other drug (AOD) mechanisms of behavioral change (MOBC) has centered on what variables mediate the relation between AOD treatment and outcomes. The purpose of this paper was to review this research evidence to identify empirically supported mediators of alcohol and other drug use and related outcomes and then to evaluate their potential as being AOD treatment MOBC. The first phase was a systematic review of reviews (2008-2023) to identify the variables with the strongest empirical support as mediators of AOD treatment effects. Eligible reviews focused on AOD treatment modalities, included empirically tested mediators, and targeted adult samples. The second phase was a systematic review of empirical studies (1990-2023) testing the hypothesis that variables identified in phase one were AOD treatment mediators/mechanisms and then evaluating each eligible stage two study according to the Kazdin and Nock (Journal of Child Psychology and Psychiatry, 44, 1116) criteria. Eligible articles included empirical studies with adult samples attending AOD treatment and empirically tested one of the three treatment mechanisms as a mediator of an AOD-related outcome. Databases were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This systematic review was not preregistered. The first review of 11 eligible review articles identified self-efficacy, social support, and craving as having the strongest empirical support. The second review captured 48 individual studies. An evaluation of each of these studies by the Kazdin and Nock criteria suggested that they likely are MOBC and therefore are ready for implementation. The implementation of self-efficacy, social support, and craving into clinical practice and training is warranted. Six directions for future research to solidify and generalize empirical support for the case that self-efficacy, social support, and craving are MOBC are presented, as are five implications for clinical practice and training.
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Affiliation(s)
| | - Dezarie Moskal
- VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, USA
| | | | | | - Brian Borsari
- University of California-San Francisco, San Francisco, USA
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Ho MF, Zhang C, Moon I, Tuncturk M, Coombes BJ, Biernacka J, Skime M, Oesterle TS, Karpyak VM, Li H, Weinshilboum R. Molecular mechanisms involved in alcohol craving, IRF3, and endoplasmic reticulum stress: a multi-omics study. Transl Psychiatry 2024; 14:165. [PMID: 38531832 DOI: 10.1038/s41398-024-02880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
Alcohol use disorder (AUD) is the most prevalent substance use disorder worldwide. Acamprosate and naltrexone are anti-craving drugs used in AUD pharmacotherapy. However, molecular mechanisms underlying their anti-craving effect remain unclear. This study utilized a patient-derived induced pluripotent stem cell (iPSC)-based model system and anti-craving drugs that are used to treat AUD as "molecular probes" to identify possible mechanisms associated with alcohol craving. We examined the pathophysiology of craving and anti-craving drugs by performing functional genomics studies using iPSC-derived astrocytes and next-generation sequencing. Specifically, RNA sequencing performed using peripheral blood mononuclear cells from AUD patients with extreme values for alcohol craving intensity prior to treatment showed that inflammation-related pathways were highly associated with alcohol cravings. We then performed a genome-wide assessment of chromatin accessibility and gene expression profiles of induced iPSC-derived astrocytes in response to ethanol or anti-craving drugs. Those experiments identified drug-dependent epigenomic signatures, with IRF3 as the most significantly enriched motif in chromatin accessible regions. Furthermore, the activation of IRF3 was associated with ethanol-induced endoplasmic reticulum (ER) stress which could be attenuated by anti-craving drugs, suggesting that ER stress attenuation might be a target for anti-craving agents. In conclusion, we found that craving intensity was associated with alcohol consumption and treatment outcomes. Our functional genomic studies suggest possible relationships among craving, ER stress, IRF3 and the actions of anti-craving drugs.
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Affiliation(s)
- Ming-Fen Ho
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Cheng Zhang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Irene Moon
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mustafa Tuncturk
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Brandon J Coombes
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joanna Biernacka
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michelle Skime
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tyler S Oesterle
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor M Karpyak
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Hu Li
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Richard Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Wallach JD, Glick L, Gueorguieva R, O’Malley SS. Evidence of subgroup differences in meta-analyses evaluating medications for alcohol use disorder: An umbrella review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:5-15. [PMID: 38102794 PMCID: PMC10841726 DOI: 10.1111/acer.15229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023]
Abstract
Randomized controlled trials (RCTs) evaluating medications for alcohol use disorder (AUD) often examine heterogeneity of treatment effects through subgroup analyses that contrast effect estimates in groups of patients across individual demographic, clinical, and study design-related characteristics. However, these analyses are often not prespecified or adequately powered, highlighting the potential role of subgroup analyses in meta-analysis. Here, we conducted an umbrella review (i.e., a systematic review of meta-analyses) to determine the range and characteristics of reported subgroup analyses in meta-analyses of AUD medications. We searched PubMed to identify meta-analyses of RCTs evaluating medications for the management of AUD, alcohol abuse, or alcohol dependence in adults. We sought studies that measured drinking-related outcomes; quality of life, function, and rates of mortality; adverse events; and dropout. We considered meta-analyses that reported the results from formal subgroup analyses (comparing the summary effects across subgroup levels); summary effect estimates stratified across subgroup levels; and meta-regression, regression, or correlation-based subgroup analyses. We analyzed nine meta-analyses that included 61 formal subgroup analyses (median = 6 per meta-analysis), of which 33 (54%) were based on baseline participant-level and 28 (46%) were based on trial-level characteristics. Of the 58 subgroup analyses with either a p-value from a subgroup test or a statement by the authors that the subgroup analyses were not statistically significant, eight (14%) were statistically significant at the p < 0.05 level. Twelve meta-analyses reported the results of 102 meta-regression analyses, of which 25 (25%) identified statistically significant predictors of the relevant outcome of interest; nine (9%) were based on baseline participant-level and 93 (91%) were based on trial characteristics. Subgroup analyses across meta-analyses of AUD medications often focus on study-level characteristics, which may not be as clinically informative as subgroup analyses based on participant-level characteristics. Opportunities exist for future meta-analyses to standardize their subgroup methodology, focus on more clinically informative participant-level characteristics, and use predictive approaches to account for multiple relevant variables.
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Affiliation(s)
- Joshua D. Wallach
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Laura Glick
- Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hurlocker MC, Carlon H, Pearson MR, Hijaz D. Trajectories of change in subclinical anxiety and alcohol use during alcohol treatment: A parallel process growth model. Drug Alcohol Depend 2023; 246:109838. [PMID: 36989706 PMCID: PMC10121922 DOI: 10.1016/j.drugalcdep.2023.109838] [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: 09/24/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Anxiety is implicated in the course and prognosis of alcohol use disorder (AUD); however, it is unclear how current AUD treatments affect the joint trajectories of anxiety and alcohol use. We used data from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study to examine the longitudinal relationship between subclinical anxiety symptoms and alcohol use during and following AUD treatment in adults with AUD and no comorbid anxiety disorders. METHODS Univariate and parallel process growth models using five waves of COMBINE study data were analyzed from 865 adults randomized to medication (n = 429) or medication plus psychotherapy (n = 436). Weekly drinking quantity and average weekly anxiety symptoms were measured at baseline, mid-treatment, end-of-treatment, and three follow-up periods. RESULTS Significant positive associations of anxiety symptoms and drinking were found at mid-treatment and over time. Temporal associations revealed that higher mid-treatment anxiety predicted decreases in drinking over time. Baseline anxiety and drinking predicted mid-treatment anxiety and drinking. Only baseline anxiety predicted increases in drinking over time. Group differences revealed mid-treatment drinking predicted decreases in anxiety over time in the medication group. CONCLUSIONS Findings demonstrate the influence of subclinical anxiety on alcohol use during and up to one year after AUD treatment. Baseline anxiety symptoms may influence drinking behavior over the course of treatment. Findings suggest that greater attention to negative affect in AUD treatment is warranted even for those individuals who do have a comorbid anxiety disorder.
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Affiliation(s)
- Margo C Hurlocker
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States; Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM 87106, United States.
| | - Hannah Carlon
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States
| | - Matthew R Pearson
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States; Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, NM 87106, United States
| | - Donia Hijaz
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, United States
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Suffoletto B, Chung T. Desire to get drunk partially mediates effects of a combined text message-based alcohol intervention for young adults. Drug Alcohol Depend 2023; 246:109848. [PMID: 36989707 DOI: 10.1016/j.drugalcdep.2023.109848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND This study aimed to test the causal effect of different text message interventions on reducing alcohol consumption indirectly by altering desire to get drunk. METHODS Participants were young adults randomized to interventions with different behavior change techniques: self-monitoring alone (TRACK); pre-drinking plan feedback (PLAN); post-drinking alcohol consumption feedback (USE); pre- and post-drinking goal feedback (GOAL); and a combination of techniques (COMBO) who completed at least 2 days of both pre- and post-drinking assessments over 12 weeks of intervention exposure. On the two days per week they planned to drank alcohol, participants were asked to report desire to get drunk (0 "none" to 8 "completely"). The next day, participants reported drinking quantity. Outcomes included binge drinking (defined as 4+ drinks for a woman and 5+ drinks for a man) and drinks per drinking day. Mediation was tested using path models of simultaneous between-person and within-person effects using maximum likelihood estimation. RESULTS At the between-person level, controlling for race and baseline AUDIT-C and within-person associations, 35.9 % of the effects of USE and 34.4 % of the effects of COMBO on reducing binge drinking were mediated through desire to get drunk. 60.8 % of the effects of COMBO on reducing drinks per drinking day were mediated through desire to get drunk. We did not find significant indirect effects for any other text-message intervention. DISCUSSION Findings support the hypothesized mediation model where desire to get drunk partially mediates the effects of a text message intervention using a combination of behavior change techniques on reducing alcohol consumption.
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Affiliation(s)
- Brian Suffoletto
- Department of Emergency Medicine, Stanford University, United States.
| | - Tammy Chung
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, United States
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Garfield JBB, Piccoli LR, Whelan D, Staiger PK, Reynolds J, Piercy H, Lubman DI, Verdejo-Garcia A, Manning V. The effect of approach bias modification during alcohol withdrawal treatment on craving, and its relationship to post-treatment alcohol use in a randomised controlled trial. Drug Alcohol Depend 2022; 239:109621. [PMID: 36087564 DOI: 10.1016/j.drugalcdep.2022.109621] [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: 01/24/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Approach bias modification (ApBM) for alcohol use disorder helps prevent relapse, yet the psychological mechanisms underlying its efficacy remain unclear. Alcohol craving predicts relapse and appears to be related to the biased processing of alcohol stimuli which is reduced by ApBM. However, there is little research examining whether ApBM reduces alcohol craving. METHODS In a randomised controlled trial testing the effect of 4 ApBM sessions (vs. sham training) on post-treatment alcohol use in 300 alcohol withdrawal inpatients, we administered the Alcohol Craving Questionnaire - Short Form - Revised (ACQ-SF-R) pre and post-training and at 2-week, 3, 6 and 12-month follow ups; and a cue-induced craving measure pre and post training. RESULTS Groups did not significantly differ in terms of declines in ACQ-SF-R total scores (p = .712) or cue-induced craving (p = .841) between the first and last training session, nor in terms of ACQ-SF-R scores at follow-ups (p = .509). However, the ACQ-SF-R Expectancy subscale, which assesses craving based on anticipated positive reinforcement from alcohol, was significantly lower in the ApBM group than in controls following training (p = .030), although the group x time interaction for this subscale was non-significant (p = .062). Post-intervention Expectancy scores mediated only a small portion of ApBM's effect on post-discharge alcohol use (14% in intention-to-treat analysis, p = .046; 15% in per-protocol analysis, p = .020). CONCLUSIONS ApBM does not appear to have robust, sustained effects on alcohol craving. Reduced craving is unlikely to account for ApBM's relapse prevention effects. However, further research on whether ApBM's effects are related to devaluation of alcohol reward expectancy is warranted. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Identifier: ACTRN12617001241325.
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Affiliation(s)
- Joshua B B Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Lara R Piccoli
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Danielle Whelan
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Petra K Staiger
- School of Psychology, Deakin University, Geelong, Australia; Centre for Drug Use, Addictive and Antisocial Behaviour Research, Deakin University, Geelong, Australia.
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
| | - Antonio Verdejo-Garcia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia.
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Ho MF, Zhang C, Wei L, Zhang L, Moon I, Geske JR, Skime MK, Choi DS, Biernacka JM, Oesterle TS, Frye MA, Seppala MD, Karpyak VM, Li H, Weinshilboum RM. Genetic Variants Associated with Acamprosate Treatment Response in Alcohol Use Disorder Patients: A Multiple Omics Study. Br J Pharmacol 2022; 179:3330-3345. [PMID: 35016259 PMCID: PMC9177536 DOI: 10.1111/bph.15795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 12/31/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose Acamprosate is an anti‐craving drug used for the pharmacotherapy of alcohol use disorder (AUD). However, only some patients achieve optimal therapeutic outcomes. This study was designed to explore differences in metabolomic profiles between patients who maintained sobriety and those who relapsed, to determine whether those differences provide insight into variation in acamprosate treatment response phenotypes. Experimental Approach We previously conducted an acamprosate trial involving 442 AUD patients, and 267 of these subjects presented themselves for a 3‐month follow‐up. The primary outcome was abstinence. Clinical information, genomic data and metabolomics data were collected. Baseline plasma samples were assayed using targeted metabolomics. Key Results Baseline plasma arginine, threonine, α‐aminoadipic acid and ethanolamine concentrations were associated with acamprosate treatment outcomes and baseline craving intensity, a measure that has been associated with acamprosate treatment response. We next applied a pharmacometabolomics‐informed genome‐wide association study (GWAS) strategy to identify genetic variants that might contribute to variations in plasma metabolomic profiles that were associated with craving and/or acamprosate treatment outcome. Gene expression data for induced pluripotent stem cell‐derived forebrain astrocytes showed that a series of genes identified during the metabolomics‐informed GWAS were ethanol responsive. Furthermore, a large number of those genes could be regulated by acamprosate. Finally, we identified a series of single nucleotide polymorphisms that were associated with acamprosate treatment outcomes. Conclusion and Implications These results serve as an important step towards advancing our understanding of disease pathophysiology and drug action responsible for variation in acamprosate response and alcohol craving in AUD patients.
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Affiliation(s)
- Ming-Fen Ho
- Department of Molecular Pharmacology and Experimental Therapeutics
| | - Cheng Zhang
- Department of Molecular Pharmacology and Experimental Therapeutics
| | - Lixuan Wei
- Department of Molecular Pharmacology and Experimental Therapeutics
| | - Lingxin Zhang
- Department of Molecular Pharmacology and Experimental Therapeutics
| | - Irene Moon
- Department of Molecular Pharmacology and Experimental Therapeutics
| | - Jennifer R Geske
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics
| | | | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics
| | - Joanna M Biernacka
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics.,Department of Psychiatry and Psychology
| | | | | | | | | | - Hu Li
- Department of Molecular Pharmacology and Experimental Therapeutics
| | - Richard M Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics.,Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota
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Flanagan JC, Jarnecke AM, Leone RM, Oesterle DW. Effects of couple conflict on alcohol craving: Does intimate partner violence play a role? Addict Behav 2020; 109:106474. [PMID: 32485550 DOI: 10.1016/j.addbeh.2020.106474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Social stress in the form of maladaptive relationship conflict is a common precipitant to alcohol misuse and problems. Research has also established a clear causal association between alcohol misuse and relationship conflict in the form of intimate partner violence (IPV). Despite the robust literature linking relationship conflict and problematic drinking using survey methodology, no laboratory studies have examined the proximal association between relationship conflict and alcohol craving among couples, or the influence of IPV perpetration and victimization on this association. METHOD As part of a larger randomized controlled trial, 30 different-sex community couples with substance misuse completed a laboratory conflict resolution task. Participants reported subjective alcohol craving on a Likert-type scale immediately, before, and after the task. Conflict behaviors were coded by trained observers. Analyses were conducted using a multilevel modeling framework to account for the dyadic nature of the data. RESULTS Findings indicate that psychological and physical IPV perpetration and victimization strengthened the associations between negative and positive conflict behaviors and alcohol craving among men only. Contrary to our hypotheses, no main or moderating effects of conflict behaviors, IPV perpetration, or IPV victimization were found for women. CONCLUSIONS Findings from this exploratory study suggest that in this sample, relationship conflict and IPV in one's current relationship played a more impactful role on acute alcohol craving among men compared to women. Future studies should examine the role of specific conflict behaviors on alcohol craving and relapse risk, and patterns of communication that might increase or reduce risk for exacerbated alcohol craving.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC 29425, United States; Ralph H. Johnson VA Medical Center, United States.
| | - Amber M Jarnecke
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC 29425, United States
| | - Ruschelle M Leone
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States; Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States
| | - Daniel W Oesterle
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States; Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302, United States
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Haass-Koffler CL, Piacentino D, Li X, Long VM, Lee MR, Swift RM, Kenna GA, Leggio L. Differences in Sociodemographic and Alcohol-Related Clinical Characteristics Between Treatment Seekers and Nontreatment Seekers and Their Role in Predicting Outcomes in the COMBINE Study for Alcohol Use Disorder. Alcohol Clin Exp Res 2020; 44:2097-2108. [PMID: 32997422 PMCID: PMC7722230 DOI: 10.1111/acer.14428] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/29/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND One of the challenges in early-stage clinical research aimed at developing novel treatments for alcohol use disorder (AUD) is that the enrolled participants are heavy drinkers, but do not seek treatment for AUD. AIMS To compare nontreatment seekers with alcohol dependence (AD) from 4 human laboratory studies conducted at Brown University (N = 240; 65.4% male) to treatment seekers with AD from the multisite COMBINE study (N = 1,383; 69.1% male) across sociodemographic and alcohol-related clinical variables and to evaluate whether the variables that significantly differentiate the 2 samples predict the 3 main COMBINE clinical outcomes: time to relapse, percent days abstinent (PDA), and good clinical outcome. METHODS Sample characteristics were assessed by parametric and nonparametric testing. Three regression models measured the association between the differing variables and the 3 main COMBINE clinical outcomes. RESULTS The nontreatment seekers, compared to the treatment seekers, were more ethnically diverse, less educated, single, and working part-time or unemployed (p's < 0.05); they met fewer DSM-IV AD criteria and had significantly lower scores on alcohol-related scales (p's < 0.05); they were less likely to have a father with alcohol problems (p < 0.0001) and had a significantly earlier age of onset and longer duration of AD (p's < 0.05); they also had significantly more total drinks, drinks per drinking day, heavy drinking days (HDD), and lower PDA in the 30 days prior to baseline (p's < 0.0001 to <0.05). Having more HDD in the 30 days prior to baseline predicted all of the 3 COMBINE clinical outcomes. All the other characteristics mentioned above that differed significantly between the 2 groups predicted at least 1 of the 3 COMBINE clinical outcomes, except for level of education, age of onset, and duration of AD. CONCLUSIONS The observed differences between groups should be considered in efforts across participant recruitment at different stages of the development of new treatments for AUD.
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Affiliation(s)
- Carolina L. Haass-Koffler
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD
| | - Daria Piacentino
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD
- Center on Compulsive Behaviors, National Institutes of Health, Bethesda, MD
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Services, National Institutes of Health, Bethesda, MD
| | - Victoria M. Long
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Mary R. Lee
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD
| | - Robert M. Swift
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI
- Veterans Affairs Medical Center, Providence, RI
| | - George A. Kenna
- Center for Alcohol and Addiction Studies, Department of Psychiatry and Human Behavior, Brown University, Providence, RI
| | - Lorenzo Leggio
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD
- Center on Compulsive Behaviors, National Institutes of Health, Bethesda, MD
- Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD
- Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC
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10
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Magill M, Tonigan JS, Kiluk B, Ray L, Walthers J, Carroll K. The search for mechanisms of cognitive behavioral therapy for alcohol or other drug use disorders: A systematic review. Behav Res Ther 2020; 131:103648. [PMID: 32474226 PMCID: PMC7329023 DOI: 10.1016/j.brat.2020.103648] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/07/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
The emphasis in addictions research has shifted toward a greater interest in identifying the mechanisms involved in patient behavior change. This systematic review investigated nearly 30 years of mediation research on cognitive behavioral therapy (CBT) for alcohol or other drug use disorders (AUD/SUD). METHOD Study inclusion criteria targeted analyses occurring in the context of a randomized clinical trial where both intervention/intervention ingredient to mediator (a path) and mediator to outcome (b path) paths were reported. Between- and within-condition analyses were eligible, as were studies that formally tested mediation and those that conducted path analysis only. RESULTS The review sample included K = 15 reports of primarily between-condition analyses. Almost half of these reports utilized Project MATCH (k = 2) or COMBINE (k = 4) samples. Among the mediator candidates, support for changes in coping skills was strongest, although the specificity of this process to CBT or CBT-based treatment remains unclear. Similarly, support for self-efficacy as a statistical mediator was found in within-, but not between-condition analyses. CONCLUSIONS A coherent body of literature on CBT mechanisms is significantly lacking. Adopting methodological guidelines from the Science of Behavior Change Framework, we provide recommendations for future research in this area of study.
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Affiliation(s)
- Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI, USA.
| | | | | | - Lara Ray
- University of California at Los Angeles, Los Angeles, CA, USA
| | - Justin Walthers
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI, USA
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11
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Levak S, Kuerbis AN, Morgenstern J. Drink goal difficulty effect on outcomes in moderation-based alcohol treatment for sexual minority men. J Subst Abuse Treat 2020; 112:1-9. [PMID: 32076362 PMCID: PMC7030192 DOI: 10.1016/j.jsat.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sexual minority men (SMM) who drink heavily are at a greater risk for developing alcohol use disorders (AUD) and associated negative consequences. Barriers to treatment prevent SMM from accessing traditional care, and moderation-based alcohol treatment is a more desirable alternative. As such, investigating effective goal setting in moderation-based alcohol treatment, particularly, which goals yield the most effective outcomes, is warranted. Applying the tenets of Goal Setting Theory, this study explored the relationship between goal difficulty and goal achievement. In a secondary data analysis of a randomized controlled trial that delivered a combination of medication (i.e., naltrexone) and behavioral (i.e., Modified Behavioral Self-Control Training) treatment for SMM with AUD (N = 178), generalized estimating equations tested the effect of goal difficulty (defined as the proposed magnitude of change from current drinking in number of drinking days and number of heavy drinking days) on goal achievement at Months 0, 3, 6, and 9. Goal importance, self-efficacy, and AUD severity were tested as moderators. Findings yielded a significant positive relationship between goal difficulty and goal achievement for number of drinking days but a negative relationship for the number of heavy drinking days. Moderators of these relationships were not found. In order to increase the likelihood of achieving their goals in moderation-based alcohol treatment, SMM should initially consider setting more difficult goals for reducing drinking days. Additionally, goals of more conservative difficulty should be set for reducing heavy drinking days.
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Affiliation(s)
- Svetlana Levak
- Center for Addiction Services and Personalized Interventions Research, Northwell Health, 1010 Northern Blvd. Suite 311, Great Neck, N.Y., 11021
| | - Alexis N. Kuerbis
- Silberman School of Social Work, Hunter College, City University of New York, 2180 Third Avenue, New York, NY 10035
| | - Jon Morgenstern
- Center for Addiction Services and Personalized Interventions Research, Northwell Health, 1010 Northern Blvd. Suite 311, Great Neck, N.Y., 11021
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12
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Topiramate Pharmacotherapy for Alcohol Use Disorder and Other Addictions: A Narrative Review. J Addict Med 2020; 13:7-22. [PMID: 30096077 DOI: 10.1097/adm.0000000000000443] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
: Topiramate is a non-benzodiazepine anticonvulsant medication with multi-faceted pharmacologic action. It has emerged as an efficacious pharmacotherapeutic option for the treatment of addiction, especially alcohol use disorder (AUD). We present a broad narrative review of the putative mechanism of action and clinical utility of topiramate with regard to AUD and other substance use disorders. Collective evidence suggests topiramate is an effective treatment option in AUD, with notable efficacy in reducing harmful drinking patterns in AUD. Though not currently approved by the United States Food and Drug Administration for the indication of AUD, topiramate should be considered as a pharmacological treatment option with high utility among AUD patients. Early pharmacogenetic studies raise the intriguing possibility of identifying patients likely to respond to topiramate using genetic testing, and initial studies show that topiramate may also be useful in treating cocaine use disorder, smoking cessation and behavioral addictions. However, further research is needed in all these areas.
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13
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Stohs ME, Schneekloth TD, Geske JR, Biernacka JM, Karpyak VM. Alcohol Craving Predicts Relapse After Residential Addiction Treatment. Alcohol Alcohol 2019; 54:167-172. [DOI: 10.1093/alcalc/agy093] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/04/2018] [Accepted: 12/26/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew E Stohs
- Department of Psychiatry and Behavioral Health, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Jennifer R Geske
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Victor M Karpyak
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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14
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Hallgren KA, Delker BC, Simpson TL. Effects of Initiating Abstinence from Alcohol on Daily Craving and Negative Affect: Results from a Pharmacotherapy Clinical Trial. Alcohol Clin Exp Res 2018; 42:634-645. [PMID: 29286542 PMCID: PMC5832597 DOI: 10.1111/acer.13591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/21/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Craving and negative affect are distressing and commonly experienced during alcohol use disorder (AUD) treatment. Patients may assume that initiating abstinence will intensify their cravings and negative affect despite limited empirical data to support this assumption. This study extends and replicates, under improved methodological conditions, previous work that found reductions in daily craving associated with initiating abstinence. METHODS Seventy-eight adults (80.8% male, 57.1% Caucasian) in a clinical trial testing prazosin for AUD provided daily reports of drinking, craving, and negative affect for up to 12 weeks (mean = 64.77 daily reports). Participants were classified into 3 subgroups based on whether and when they initiated 14 days of continuous abstinence, including (i) "abstinence initiators" who quit drinking during treatment (n = 17), (ii) "already abstainers" who were abstinent at the start of treatment (n = 20), and (iii) "continued drinkers" who never initiated abstinence (n = 41). The timing and degree of change in craving and negative affect were compared across these groups using multivariate growth curve modeling. RESULTS All participant subgroups reported gradual reductions in craving over the course of treatment, with "abstinence initiators" reporting additional sudden reductions in craving upon initiating abstinence from alcohol. "Continued drinkers" reported higher levels of craving than "already abstainers" throughout the full course of treatment. Negative affect followed a different pattern of change, with "abstinence initiators" experiencing gradual reductions in negative affect after initiating abstinence but no changes prior to or immediately upon initiating abstinence, and with "already abstainers" and "continued drinkers" experiencing no changes in negative affect over time. CONCLUSIONS Initiating abstinence is associated with immediate reductions in craving, followed by gradual reductions in both craving and negative affect. Results provide insight into the timing and magnitude of changes in theoretically and clinically important variables and may help patients anticipate when to expect improvement in craving and negative effect.
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Affiliation(s)
- Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Brianna C. Delker
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Psychology, Western Washington University
| | - Tracy L. Simpson
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Center of Excellence in Substance Abuse Treatment and Education (CESATE) and Mental Illness Research Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle WA
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15
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O’Rourke HP, MacKinnon DP. Reasons for Testing Mediation in the Absence of an Intervention Effect: A Research Imperative in Prevention and Intervention Research. J Stud Alcohol Drugs 2018; 79:171-181. [PMID: 29553343 PMCID: PMC6019768 DOI: 10.15288/jsad.2018.79.171] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Mediation models are used in prevention and intervention research to assess the mechanisms by which interventions influence outcomes. However, researchers may not investigate mediators in the absence of intervention effects on the primary outcome variable. There is emerging evidence that in some situations, tests of mediated effects can be statistically significant when the total intervention effect is not statistically significant. In addition, there are important conceptual and practical reasons for investigating mediation when the intervention effect is nonsignificant. METHOD This article discusses the conditions under which mediation may be present when an intervention effect does not have a statistically significant effect and why mediation should always be considered important. RESULTS Mediation may be present in the following conditions: when the total and mediated effects are equal in value, when the mediated and direct effects have opposing signs, when mediated effects are equal across single and multiple-mediator models, and when specific mediated effects have opposing signs. Mediation should be conducted in every study because it provides the opportunity to test known and replicable mediators, to use mediators as an intervention manipulation check, and to address action and conceptual theory in intervention models. CONCLUSIONS Mediators are central to intervention programs, and mediators should be investigated for the valuable information they provide about the success or failure of interventions.
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Affiliation(s)
- Holly P. O’Rourke
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona,Correspondence may be sent to Holly P. O’Rourke at the T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Box 873701, Tempe, AZ 85287-3701, or via email at:
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16
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Khosravani V, Sharifi Bastan F, Ghorbani F, Kamali Z. Difficulties in emotion regulation mediate negative and positive affects and craving in alcoholic patients. Addict Behav 2017; 71:75-81. [PMID: 28273489 DOI: 10.1016/j.addbeh.2017.02.029] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/11/2017] [Accepted: 02/25/2017] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the mediating effects of difficulties in emotion regulation (DER) on the relations of negative and positive affects to craving in alcoholic patients. 205 treatment-seeking alcoholic outpatients were included. DER, positive and negative affects as well as craving were evaluated by the Difficulties in Emotion Regulation Scale (DERS), the Positive/Negative Affect Scales, and the Obsessive Compulsive Drinking Scale (OCDS) respectively. Clinical factors including depression and severity of alcohol dependence were investigated by the Alcohol Use Disorders Identification Test (AUDIT) and the Beck Depression Inventory-II (BDI-II) respectively. Results revealed that both increased negative affect and decreased positive affect indirectly influenced craving through limited access to emotion regulation strategies. It was concluded that limited access to emotion regulation strategies may be important in predicting craving for alcoholics who experience both increased negative affect and decreased positive affect. This suggests that treatment and prevention efforts focused on increasing positive affect, decreasing negative affect and teaching effective regulation strategies may be critical in reducing craving in alcoholic patients.
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17
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Hollett RC, Stritzke WGK, Edgeworth P, Weinborn M. Changes in the Relative Balance of Approach and Avoidance Inclinations to Use Alcohol Following Cue Exposure Vary in Low and High Risk Drinkers. Front Psychol 2017; 8:645. [PMID: 28533759 PMCID: PMC5420565 DOI: 10.3389/fpsyg.2017.00645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 04/11/2017] [Indexed: 02/04/2023] Open
Abstract
According to the ambivalence model of craving, alcohol craving involves the dynamic interplay of separate approach and avoidance inclinations. Cue-elicited increases in approach inclinations are posited to be more likely to result in alcohol consumption and risky drinking behaviors only if unimpeded by restraint inclinations. Current study aims were (1) to test if changes in the net balance between approach and avoidance inclinations following alcohol cue exposure differentiate between low and high risk drinkers, and (2) if this balance is associated with alcohol consumption on a subsequent taste test. In two experiments (N = 60; N = 79), low and high risk social drinkers were exposed to alcohol cues, and pre- and post- approach and avoidance inclinations measured. An ad libitum alcohol consumption paradigm and a non-alcohol exposure condition were also included in Study 2. Cue-elicited craving was characterized by a predominant approach inclination only in the high risk drinkers. Conversely, approach inclinations were adaptively balanced by equally strong avoidance inclinations when cue-elicited craving was induced in low risk drinkers. For these low risk drinkers with the balanced craving profile, neither approach or avoidance inclinations predicted subsequent alcohol consumption levels during the taste test. Conversely, for high risk drinkers, where the approach inclination predominated, each inclination synergistically predicted subsequent drinking levels during the taste test. In conclusion, results support the importance of assessing both approach and avoidance inclinations, and their relative balance following alcohol cue exposure. Specifically, this more comprehensive assessment reveals changes in craving profiles that are not apparent from examining changes in approach inclinations alone, and it is this shift in the net balance that distinguishes high from low risk drinkers.
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Affiliation(s)
- Ross C Hollett
- Cognition Research Group, School of Arts and Humanities, Edith Cowan University, JoondalupWA, Australia
| | - Werner G K Stritzke
- School of Psychological Science, University of Western Australia, CrawleyWA, Australia
| | - Phoebe Edgeworth
- School of Psychological Science, University of Western Australia, CrawleyWA, Australia
| | - Michael Weinborn
- School of Psychological Science, University of Western Australia, CrawleyWA, Australia
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18
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Ray LA, Bujarski S, Yardley MM, Roche DJO, Hartwell EE. Differences between treatment-seeking and non-treatment-seeking participants in medication studies for alcoholism: do they matter? THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:703-710. [PMID: 28426264 DOI: 10.1080/00952990.2017.1312423] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Medication development for alcoholism typically includes experimental pharmacology studies with non-treatment-seeking individuals with alcohol use disorder (AUD) paving the way for randomized controlled trials in treatment-seekers with AUD. OBJECTIVES The goal of this study is to provide a direct comparison between AUD treatment-seeking research participants and non-treatment-seeking participants on demographic and clinical variables and to test whether variables that differentiate the two groups are associated with clinical outcomes. METHOD Non-treatment-seeking AUD participants (n = 213; 76.3% male) who completed behavioral pharmacology studies were compared to treatment-seekers who completed the COMBINE Study (n = 1383; 69.1% male) on demographic and clinical variables. Analyses examined whether the variables that differentiated the two groups predicted treatment outcomes in the COMBINE Study. RESULTS Analyses revealed that treatment-seeking participants were older, had more years of education, higher Alcohol Dependence Scale scores, higher Drinker Inventory of Consequences scores, higher Obsessive Compulsive Drinking Scale scores, a greater number of DSM-IV symptoms of AUD, longer duration of AUD, and consumed more standard drinks and more drinks per drinking day (i.e., in the past 30 days) compared to non-treatment-seeking participants. Nearly all characteristics that differed between the groups predicted at least one of the primary clinical outcomes of the COMBINE Study. CONCLUSIONS This study highlights a host of clinical and demographic factors that differ between non-treatment-seeking and treatment-seeking research participants and the clinical significance of these variables. Differences between samples should be considered and addressed in order to promote greater consilience across stages of medication development.
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Affiliation(s)
- Lara A Ray
- a Department of Psychology , University of California , Los Angeles , CA , USA.,b Department of Psychiatry and Biobehavioral Sciences , University of California , Los Angeles , CA , USA
| | - Spencer Bujarski
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Megan M Yardley
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Daniel J O Roche
- a Department of Psychology , University of California , Los Angeles , CA , USA
| | - Emily E Hartwell
- a Department of Psychology , University of California , Los Angeles , CA , USA
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19
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Deng LY, Liu L, Xia CC, Lan J, Zhang JT, Fang XY. Craving Behavior Intervention in Ameliorating College Students' Internet Game Disorder: A Longitudinal Study. Front Psychol 2017; 8:526. [PMID: 28443046 PMCID: PMC5385373 DOI: 10.3389/fpsyg.2017.00526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 03/22/2017] [Indexed: 12/25/2022] Open
Abstract
Craving, as a central feature of addiction and a precursor of relapse, is targeted recently in addiction intervention. While Internet gaming disorder (IGD), conceptualized as a behavioral addiction, is lack of effective treatment practice and exploration of its mechanism. This research aims to test the effectiveness and detect the active ingredients of craving behavior intervention (CBI) in mitigation of IGD among young adults. A total of 63 male college students with IGD were assigned into the intervention group (six-session CBI intervention) or the waiting-list control group. Structured questionnaires were administered at pre-intervention (T1), post-intervention (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Compared to the control group, a significant decrease in the severity of IGD in intervention group was found at post-intervention and lasting to 6 months after intervention. The value changes of craving could partially mediate the relationship between intervention and changes of IGD among all effects tests (immediate, T2-T1; short-term, T3-T1; and long-term effects, T4-T1). Further, explorations of the active ingredients of intervention found depression relief and shift of psychological needs from Internet to real life significantly predict craving amelioration at both post-intervention and 6-month follow-up. Although preliminary, the current study provides evidence for the value of craving-aimed intervention practice in IGD treatment and identifies two potential active ingredients for mitigation of craving, and the long-term therapeutic benefits are further conferred. Registry name: The behavioral and brain mechanism of IGD; URL: https://www.clinicaltrials.gov/ct2/show/NCT02550405; Registration number: NCT02550405.
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Affiliation(s)
- Lin-Yuan Deng
- Faculty of Education, Beijing Normal UniversityBeijing, China
| | - Lu Liu
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China
| | - Cui-Cui Xia
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China.,Students Counseling Center, Beijing Normal UniversityBeijing, China
| | - Jing Lan
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China
| | - Jin-Tao Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Xiao-Yi Fang
- Faculty of Psychology, Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China
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20
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Yoshimura A, Komoto Y, Higuchi S. Exploration of Core Symptoms for the Diagnosis of Alcohol Dependence in the ICD-10. Alcohol Clin Exp Res 2016; 40:2409-2417. [PMID: 27716976 PMCID: PMC5108416 DOI: 10.1111/acer.13225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 08/21/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The classification of alcohol use disorder has changed over the past century. Now, the conceptualization of alcohol dependence is still controversial. Accumulating evidence has shown the reliability and validity for the diagnosis of alcohol dependence in the ICD-10 and DSM-IV. However, the meaning and association of the respective diagnostic items, which are descriptive of representative symptoms, have hardly been examined. The core symptom of substance use disorder has been debated in various situations, but has never been elucidated logically. METHODS We consecutively registered 192 patients with alcohol-related problems who visited our hospital for the first time during a certain period. The relations and principal components among the checked items of the ICD-10 diagnostic criteria were examined statistically. RESULTS Three diagnostic items in the ICD-10 were strongly correlated with each other and were thought to form the core symptoms of alcohol dependence: "strong desire," "difficulties in controlling," and "neglect of pleasures." One major physical phenomenon, "withdrawal," seemed to complement the core symptoms in the diagnosis of alcohol dependence. Another physical phenomenon, "tolerance," was demonstrated to be a relatively independent item. The principal component analysis also demonstrated that the diagnostic item "difficulties in controlling" had the maximum component loading value, followed by 2 items, "neglect of pleasures" and "strong desire." CONCLUSIONS The core symptomatic elements in the diagnosis of alcohol dependence were statistically suggested in this study. Knowledge of the relations and components among the diagnostic items of alcohol dependence might also be applicable to other forms of substance use dependence and behavioral addiction.
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Affiliation(s)
- Atsushi Yoshimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan. .,Department of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Yasunobu Komoto
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
| | - Susumu Higuchi
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Kanagawa, Japan
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21
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Dunn KE, Harrison JA, Leoutsakos JM, Han D, Strain EC. Continuous Abstinence During Early Alcohol Treatment is Significantly Associated with Positive Treatment Outcomes, Independent of Duration of Abstinence. Alcohol Alcohol 2016; 52:72-79. [PMID: 27567268 DOI: 10.1093/alcalc/agw059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/13/2016] [Accepted: 08/01/2016] [Indexed: 01/30/2023] Open
Abstract
AIMS Neither the predictive value of early continuous abstinence in alcohol use disorder (AUD) or the point at which this effect may emerge has been evaluated. This analysis of the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) clinical trial evaluated whether abstinence early in treatment was a predictor of longer term abstinence. METHODS Participants who stated a goal of total abstinence (N = 954) were dichotomized into Early Abstainer vs. Nonabstainers and were compared on a variety of drinking outcome measures that are frequently used in clinical trial evaluations of alcohol treatment strategies, as a function of duration of early continuous abstinence. RESULTS Significant differences existed for every outcome. Early Abstinence was significantly associated with fewer drinks per drinking day, number of drinking and number of heavy drinking days, and longer time to first drinking and first heavy drinking day. Effects were evident within the first week. The magnitude of all effects increased as the duration of early abstinence (1-4 weeks) increased, though the size of increase varied across the outcomes. CONCLUSIONS These data provide evidence that drinking at the beginning of alcohol treatment is significantly and robustly associated with drinking throughout and at the end of a clinical trial treatment for AUD. Early drinking may be a useful early index to identify whether patients are responding positively to a treatment strategy, and provides a useful method for tailoring treatment to patients that is consistent with a personalized medicine approach.
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Affiliation(s)
- Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Joseph A Harrison
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Jeannie-Marie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Dingfen Han
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
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22
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McHugh RK, Fitzmaurice GM, Griffin ML, Anton RF, Weiss RD. Association between a brief alcohol craving measure and drinking in the following week. Addiction 2016; 111:1004-10. [PMID: 26780476 PMCID: PMC4861663 DOI: 10.1111/add.13311] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/05/2015] [Accepted: 01/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Craving for alcohol is thought to be a predictor of alcohol use, particularly in the near future. The assessment of craving in clinical practice requires brief, simple measures that can be implemented routinely. This study tested whether greater alcohol craving was associated with a higher likelihood of alcohol use in the subsequent week. DESIGN The COMBINE Study (Combining Medications and Behavioral Interventions for Alcohol Dependence) was a large, multi-site clinical trial of treatment for alcohol dependence. Participants were randomized (stratified by site) to one of nine treatment conditions involving combinations of pharmacotherapy and psychotherapy. Craving was assessed every other week throughout the treatment period. SETTING Substance use disorder treatment settings at 11 academic sites across the United States. PARTICIPANTS Participants from the COMBINE Study (n = 1370) with available craving data. MEASUREMENTS Craving was assessed using the three-item self-report Craving Scale. Drinking was assessed using the Timeline Followback method, and was defined as alcohol use in each study week. FINDINGS There was an average of 5.8 (of a possible seven) observation pairs per participant. Craving was associated strongly with alcohol use in the following week [B = 0.27, standard error (SEB ) = 0.06, Wald χ(2) = 43.34, odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.16, 1.47, P < 0.001]. For each 1-unit increase in the Craving Scale, the likelihood of drinking in the next week was 31% higher. CONCLUSIONS Craving for alcohol is associated strongly with alcohol use in the following week. Clinicians can measure alcohol craving effectively using a brief self-report craving scale.
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Affiliation(s)
- R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Garrett M. Fitzmaurice
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill Street, Belmont, MA 02478
| | - Margaret L. Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA
| | - Roger D. Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
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23
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Worley MJ, Witkiewitz K, Brown SA, Kivlahan DR, Longabaugh R. Social network moderators of naltrexone and behavioral treatment effects on heavy drinking in the COMBINE study. Alcohol Clin Exp Res 2016; 39:93-100. [PMID: 25623409 DOI: 10.1111/acer.12605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 10/14/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral naltrexone is an efficacious medication for treatment of alcohol dependence, but small effect sizes and variability in outcomes suggest the presence of person-level moderators of naltrexone response. Identification of contextual or psychosocial moderators may assist in guiding clinical recommendations. Given the established importance of social networks in drinking outcomes, as well as the potential effects of naltrexone in reducing cue reactivity which may be especially important among those with more heavy drinkers and more alcohol cues in their networks, we examined pretreatment social network variables as potential moderators of naltrexone treatment effects in the COMBINE study. METHODS The sample included all COMBINE study participants in medication conditions with full data on the Important People Inventory (IPI) and covariates at intake (N = 1,197). The intake IPI assessed whether participants had any frequent drinkers in their network and the average frequency of contact with these drinkers. The effects of treatment condition, pretreatment network variables, and their interactions on percent heavy drinking days were tested in hierarchical linear models, controlling for demographics and baseline clinical covariates. RESULTS In treatment conditions involving medical management and combined behavioral intervention (CBI), the effects of active naltrexone on heavy drinking were significantly greater for individuals with frequent drinkers in their network (z = -2.66, p < 0.01) and greater frequency of contact with those drinkers (z = -3.19, p < 0.01). These network variables did not moderate the effects of active naltrexone without CBI. CONCLUSIONS When delivered in conjunction with behavioral interventions, naltrexone can be more potent for alcohol-dependent adults who have greater contact with frequent drinkers prior to treatment, which may indicate patterns of environmental exposure to alcohol. Contextual, social risk factors are a potential avenue to guide personalized treatment of alcohol dependence.
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Affiliation(s)
- Matthew J Worley
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
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24
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Hallgren KA, McCrady BS, Epstein EE. Trajectories of drinking urges and the initiation of abstinence during cognitive-behavioral alcohol treatment. Addiction 2016; 111:854-65. [PMID: 26709608 PMCID: PMC4826789 DOI: 10.1111/add.13291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/08/2015] [Accepted: 12/22/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Drinking urges during treatment for alcohol use disorders (AUDs) are common, can cause distress and predict relapse. Clients may have little awareness of how their drinking urges might be expected to change during AUD treatment in general and in response to initiating abstinence. The aim of the present study was to test whether drinking urges change on a daily level during treatment and after initiating abstinence. DESIGN Secondary data analysis was performed using daily drinking urge ratings from two randomized clinical trials. SETTING AND PARTICIPANTS Women (n = 98) and men (n = 79) with AUDs in separate clinical trials of out-patient AUD-focused cognitive-behavioral therapy. MEASUREMENTS Daily dichotomous indicators of any drinking urges or acute escalations in urges (i.e. at least two more urges compared with the previous day) were examined using generalized linear mixed growth-curve modeling. FINDINGS Participants who initiated abstinence reported reductions in urges immediately thereafter (log odds ratios: women B = -0.701, P < 0.001; men B = -0.628, P = 0.018), followed by additional, gradual reductions over time (women B = -0.118, P < 0.001; men B = -0.141, P < 0.001). Participants who entered treatment abstaining from alcohol also reported significant reductions in urges over time (women B = -0.147, P < 0.001; men B = -0.142, P < 0.001). Participants who drank throughout treatment had smaller (women B = -0.042, P = 0.012) or no reductions in urges (men B = 0.015, P = 0.545). There was no evidence that urges increased systematically in response to initiating abstinence. CONCLUSIONS Drinking urges during out-patient behavioral treatment for alcohol use disorders may be maintained in part by alcohol consumption. Initiating abstinence is associated with reductions in drinking urges immediately and then more gradually over time.
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Barbara S McCrady
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth E Epstein
- Department of Psychiatry, University of Massachusetts School of Medicine, Worcester, MA, USA
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25
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Law B, Gullo MJ, Daglish M, Kavanagh DJ, Feeney GFX, Young RM, Connor JP. Craving Mediates Stress in Predicting Lapse During Alcohol Dependence Treatment. Alcohol Clin Exp Res 2016; 40:1058-64. [DOI: 10.1111/acer.13034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/01/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Bonnie Law
- School of Medicine ; The University of Queensland; Brisbane Queensland Australia
| | - Matthew J. Gullo
- Alcohol and Drug Assessment Unit ; Princess Alexandra Hospital; Brisbane Queensland Australia
- Centre for Youth Substance Abuse Research ; Faculty of Health and Behavioural Sciences; The University of Queensland; Brisbane Queensland Australia
| | - Mark Daglish
- School of Medicine ; The University of Queensland; Brisbane Queensland Australia
- Hospital Alcohol and Drug Service ; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - David J. Kavanagh
- Institute of Health and Biomedical Innovation ; Queensland University of Technology; Brisbane Queensland Australia
| | - Gerald F. X. Feeney
- Alcohol and Drug Assessment Unit ; Princess Alexandra Hospital; Brisbane Queensland Australia
- Centre for Youth Substance Abuse Research ; Faculty of Health and Behavioural Sciences; The University of Queensland; Brisbane Queensland Australia
| | - Ross M. Young
- Alcohol and Drug Assessment Unit ; Princess Alexandra Hospital; Brisbane Queensland Australia
- Institute of Health and Biomedical Innovation ; Queensland University of Technology; Brisbane Queensland Australia
- Faculty of Health ; Queensland University of Technology; Brisbane Queensland Australia
| | - Jason P. Connor
- School of Medicine ; The University of Queensland; Brisbane Queensland Australia
- Alcohol and Drug Assessment Unit ; Princess Alexandra Hospital; Brisbane Queensland Australia
- Centre for Youth Substance Abuse Research ; Faculty of Health and Behavioural Sciences; The University of Queensland; Brisbane Queensland Australia
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26
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Piquet-Pessôa M, Fontenelle LF. Opioid antagonists in broadly defined behavioral addictions: a narrative review. Expert Opin Pharmacother 2016; 17:835-44. [PMID: 26798982 DOI: 10.1517/14656566.2016.1145660] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Naltrexone (NTX), a mu-opioid receptor antagonist, has been approved for the treatment of alcoholism and opioid dependence. More recently, however, NTX and a related drug, nalmefene (NMF), have also shown positive results for the treatment of gambling disorders. AREAS COVERED In this study, we reviewed the trials testing the effect of opioid antagonists (OA) in gambling disorders and in other broadly defined behavioral addictions, including selected DSM-5 disruptive, impulse-control, and conduct disorders, obsessive-compulsive and related disorders, eating disorders, and other conditions not currently recognized by official classification schemes. We found six randomized controlled trials (RCTs) of OA in gambling disorder, two RCTs of OA in trichotillomania (hair pulling disorder), two RCTs of OA in binge eating disorder, and one RCT of OA for kleptomania. We also reviewed case reports on hypersexual disorder, compulsive buying and skin picking disorders. EXPERT OPINION The reviewed data supported the use of OA, namely NTX and NMF, in gambling disorder (both) and kleptomania (NTX). We did not find enough evidence to support the use of NTX or NMF in trichotillomania (hair pulling disorder), excoriation (skin-picking) disorder, compulsive buying disorder, hypersexual disorder, or binge eating disorder.
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Affiliation(s)
- Marcelo Piquet-Pessôa
- a Obsessive, Compulsive, and Anxiety Spectrum Disorders Research Program, Institute of Psychiatry , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brasil
| | - Leonardo F Fontenelle
- a Obsessive, Compulsive, and Anxiety Spectrum Disorders Research Program, Institute of Psychiatry , Federal University of Rio de Janeiro (UFRJ) , Rio de Janeiro , Brasil.,b D'Or Institute for Research and Education (IDOR) , Rio de Janeiro , Brasil.,c Monash Institute of Cognitive and Clinical Neurosciences (MICCN), School of Psychological Sciences & Monash Biomedical Imaging (MBI) Facility , Monash University , Victoria , Australia
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27
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Nguyen TQ, Webb-Vargas Y, Koning IM, Stuart EA. Causal mediation analysis with a binary outcome and multiple continuous or ordinal mediators: Simulations and application to an alcohol intervention. STRUCTURAL EQUATION MODELING : A MULTIDISCIPLINARY JOURNAL 2016; 23:368-383. [PMID: 27158217 PMCID: PMC4855301 DOI: 10.1080/10705511.2015.1062730] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We investigate a method to estimate the combined effect of multiple continuous/ordinal mediators on a binary outcome: 1) fit a structural equation model with probit link for the outcome and identity/probit link for continuous/ordinal mediators, 2) predict potential outcome probabilities, and 3) compute natural direct and indirect effects. Step 2 involves rescaling the latent continuous variable underlying the outcome to address residual mediator variance/covariance. We evaluate the estimation of risk-difference- and risk-ratio-based effects (RDs, RRs) using the ML, WLSMV and Bayes estimators in Mplus. Across most variations in path-coefficient and mediator-residual-correlation signs and strengths, and confounding situations investigated, the method performs well with all estimators, but favors ML/WLSMV for RDs with continuous mediators, and Bayes for RRs with ordinal mediators. Bayes outperforms WLSMV/ML regardless of mediator type when estimating RRs with small potential outcome probabilities and in two other special cases. An adolescent alcohol prevention study is used for illustration.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Yenny Webb-Vargas
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
| | - Ina M. Koning
- Department of Interdisciplinary Social Science, University of Utrecht
| | - Elizabeth A. Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
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28
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Gueorguieva R, Wu R, Tsai WM, O'Connor PG, Fucito L, Zhang H, O'Malley SS. An analysis of moderators in the COMBINE study: Identifying subgroups of patients who benefit from acamprosate. Eur Neuropsychopharmacol 2015; 25:1586-99. [PMID: 26141511 PMCID: PMC4600651 DOI: 10.1016/j.euroneuro.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/28/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
The goal of the current study was to use tree-based methods to identify moderators of acamprosate effect on abstinence from heavy drinking in COMBINE, the largest study of pharmacotherapy for alcoholism in the United States to date. We used three different tree-based methods for identification of subgroups with enhanced treatment response on acamprosate based on over 100 predictors measured at baseline in COMBINE. No heavy drinking during the last two months of treatment was the considered outcome. All three methods identified consecutive days of abstinence prior to treatment as the most important moderator of treatment effect. Acamprosate was beneficial for participants with shorter abstinence (1 week or less) especially when body mass index was low or normal. In this group, 46% of participants receiving active acamprosate abstained from heavy drinking compared to 23% of those receiving placebo acamprosate. Prior treatment, age, drinking goal and cognitive inefficiency were identified as moderators of acamprosate effects by one of the three methods. In conclusion, acamprosate may be beneficial for participants with shorter abstinence who are not overweight or obese. One hypothesis for this finding is that this subgroup may have greater glutamatergic hyperactivity, a target of acamprosate, and may achieve better drug plasma levels based on their lower BMI. In contrast, those with extended pretreatment abstinence who have an otherwise good prognosis did not benefit from acamprosate. Further validation of the results in independent data sets is necessary.
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Affiliation(s)
- Ralitza Gueorguieva
- Department of Biostatistics, Yale University School of Public Health and School of Medicine, New Haven, CT 06520, USA.
| | - Ran Wu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Wan-Min Tsai
- Department of Biostatistics, Yale University School of Public Health and School of Medicine, New Haven, CT 06520, USA
| | - Patrick G O'Connor
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Lisa Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health and School of Medicine, New Haven, CT 06520, USA
| | - Stephanie S O'Malley
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
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29
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Hallgren KA, Owens MD, Brovko JM, Ladd BO, McCrady BS, Epstein EE. Trajectories of Drinking Urges During Individual- and Couple-based Cognitive-Behavioral Treatment for Alcohol Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2015; 33:161-184. [PMID: 27453630 DOI: 10.1080/07347324.2015.1018778] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals receiving treatment for alcohol use disorders (AUDs) often experience urges to drink, and reductions in drinking urges during cognitive-behavioral therapy (CBT) predict better treatment outcomes. However, little previous work has examined patterns of daily drinking urges during treatment. The present study examined patterns of change in daily drinking urges among participants in two randomized clinical trials of males (N = 80 with 4401 daily recordings) and females (N = 101 with 8011 daily recordings) receiving individual- or couples-based CBT. Drinking urges were common during treatment, occurring on 45.1% percent of days for men and 44.8% for women. Drinking urges and alcohol use for both genders decreased substantially during the course of treatment. Both genders had increases in drinking urges as more time elapsed since attending a treatment session. For men, this increase was most pronounced at the beginning of treatment, but for women it was most pronounced near the end of treatment. Alcohol use and drinking urges were both more likely to occur on weekends. The results suggest that these times may lead to higher risk for drinking, and clients may benefit from high-risk planning that is focused on these times.
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Affiliation(s)
- Kevin A Hallgren
- University of Washington, Center for the Study of Health and Risk Behaviors, Seattle, WA USA
| | - Mandy D Owens
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, NM USA
| | - Julie M Brovko
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, NM USA
| | - Benjamin O Ladd
- Reed College, Adolescent Health Research Program, Portland, OR USA
| | - Barbara S McCrady
- University of New Mexico, Center on Alcoholism, Substance Abuse, and Addictions, Albuquerque, NM USA
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30
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Abstract
This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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31
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Entering the Era of Data Science: Targeted Learning and the Integration of Statistics and Computational Data Analysis. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/502678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This outlook paper reviews the research of van der Laan’s group on Targeted Learning, a subfield of statistics that is concerned with the construction of data adaptive estimators of user-supplied target parameters of the probability distribution of the data and corresponding confidence intervals, aiming at only relying on realistic statistical assumptions. Targeted Learning fully utilizes the state of the art in machine learning tools, while still preserving the important identity of statistics as a field that is concerned with both accurate estimation of the true target parameter value and assessment of uncertainty in order to make sound statistical conclusions. We also provide a philosophical historical perspective on Targeted Learning, also relating it to the new developments in Big Data. We conclude with some remarks explaining the immediate relevance of Targeted Learning to the current Big Data movement.
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32
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Naimi AI, Kaufman JS, MacLehose RF. Mediation misgivings: ambiguous clinical and public health interpretations of natural direct and indirect effects. Int J Epidemiol 2014; 43:1656-61. [PMID: 24860122 DOI: 10.1093/ije/dyu107] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent methodological innovation is giving rise to an increasing number of applied papers in medical and epidemiological journals in which natural direct and indirect effects are estimated. However, there is a longstanding debate on whether such effects are relevant targets of inference in population health. In light of the repeated calls for a more pragmatic and consequential epidemiology, we review three issues often raised in this debate: (i) the use of composite cross-world counterfactuals and the need for cross-world independence assumptions; (ii) interventional vs non-interventional identifiability; and (iii) the interpretational ambiguity of natural direct and indirect effect estimates. We use potential outcomes notation and directed acyclic graphs to explain 'cross-world' assumptions, illustrate implications of this assumption via regression models and discuss ensuing issues of interpretation. We argue that the debate on the relevance of natural direct and indirect effects rests on whether one takes as a target of inference the mathematical object per se, or the change in the world that the mathematical object represents. We further note that public health questions may be better served by estimating controlled direct effects.
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Affiliation(s)
- Ashley I Naimi
- Department of Obstetrics and Gynecology and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Jay S Kaufman
- Department of Obstetrics and Gynecology and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Richard F MacLehose
- Department of Obstetrics and Gynecology and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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33
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Haass-Koffler CL, Leggio L, Kenna GA. Pharmacological approaches to reducing craving in patients with alcohol use disorders. CNS Drugs 2014; 28:343-60. [PMID: 24573997 PMCID: PMC3990000 DOI: 10.1007/s40263-014-0149-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Research on the concept of craving may lead to better understanding of the biobehavioural circuitries that contribute to the complexity of alcohol use disorders (AUDs). The experiences described as craving or desire to drink are often associated with physical responses such as increased salivation and heart rate, and alteration of stress hormones, as well as psychological responses such as anxiety and depression. Greater craving has been associated with an increased probability of alcohol relapse. Reversal of craving, which is understood as a symptom of protracted abstinence, offers the possibility of preventing relapses and treating alcoholism. Various medications have been studied to establish whether they are able to reduce craving; however, the results obtained from clinical studies have been inconsistent. Here, we review the interdisciplinary models developed to evaluate craving, then the different approaches used to assess and measure craving and, finally, the medications utilized and tested to lessen craving in patients suffering from AUDs.
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Affiliation(s)
| | - Lorenzo Leggio
- Center for Alcohol & Addiction Studies, Brown University, Providence, Rhode Island, USA
- Intramural Research Program, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Baltimore, Maryland, USA
| | - George A. Kenna
- Center for Alcohol & Addiction Studies, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
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34
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Anton RF. Commentary on Subbaraman et al. (2013) [corrected]: cravings as a mediator and moderator of drinking outcomes in the COMBINE Study. Addiction 2013; 108:1745-6. [PMID: 24033779 DOI: 10.1111/add.12328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Raymond F Anton
- Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, SC, USA.
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