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Richards DK, Tuchman FR, Hallgren KA, Kranzler HR, Aubin HJ, O’Malley SS, Mann K, Aldridge A, Anton RF, Witkiewitz K. Reductions in World Health Organization Risk Drinking Level Are Associated With Reductions in Alcohol Use Disorder Diagnosis and Criteria: Evidence From an Alcohol Pharmacotherapy Trial. J Addict Med 2024; 18:418-424. [PMID: 38606854 PMCID: PMC11290995 DOI: 10.1097/adm.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVES This study aimed to evaluate the validity of World Health Organization (WHO) risk drinking level reductions as meaningful endpoints for clinical practice and research. This study examined whether such reductions were associated with a lower likelihood of a current alcohol use disorder (AUD) diagnosis and fewer AUD criteria. METHODS We conducted a secondary data analysis to address these objectives using data from a multisite randomized controlled trial of gabapentin enacarbil extended release in treating moderate to severe AUD among adults (N = 346). Participants received gabapentin enacarbil extended release or placebo for 6 months. The timeline follow-back was used to assess WHO risk drinking level reductions, and the Mini-International Neuropsychiatric Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis and criteria at baseline (past year) and end of treatment (past month). RESULTS Most participants (80.1%) achieved at least a 1-level reduction in the WHO risk drinking levels from baseline to end of treatment, and nearly half of participants (49.8%) achieved at least a 2-level reduction. At least a 1-level reduction or at least a 2-level reduction in WHO risk drinking level predicted lower odds of an active AUD diagnosis (1-level: odds ratio, 0.74 [95% confidence interval (CI), 0.66-0.84]; 2-level: odds ratio, 0.71 [95% CI, 0.64-0.79]) and fewer AUD criteria (1-level: B , -1.66 [95% CI, -2.35 to -0.98]; 2-level: B , -1.76 [95% CI, -2.31 to -1.21]) at end of treatment. CONCLUSIONS World Health Organization risk drinking level reductions correlate with Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis and criteria, providing further evidence for their use as endpoints in alcohol intervention trials, which has potential implications for broadening the base of AUD treatment.
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Affiliation(s)
- Dylan K. Richards
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, USA
| | - Felicia R. Tuchman
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kevin A. Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Henry R. Kranzler
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania and VISN4 MIRECC, Crescenz VAMC, Philadelphia, PA, USA
| | - Henri-Jean Aubin
- French Institute of Health and Medical Research, Paris, Île-de-France, FRAN
| | - Stephanie S. O’Malley
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Karl Mann
- Zentralinstitut für Seelische Gesundheit (ZI), Mannheim, Baden-Württemberg, DE
| | - Arnie Aldridge
- Behavioral Health Financing, Economics and Evaluation Department, Research Triangle Institute International (RTI), Durham, NC, USA
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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Lang C, Weisel KK, Saur S, Fuhrmann LM, Schoenleber A, Reichl D, Enewoldsen N, Steins-Loeber S, Berking M. Support after return to alcohol use: a mixed-methods study on how abstinence motivation and app use change after return to alcohol use in an app-based aftercare intervention for individuals with alcohol use disorder. Addict Sci Clin Pract 2024; 19:35. [PMID: 38711152 PMCID: PMC11071226 DOI: 10.1186/s13722-024-00457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation. METHODS Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data. RESULTS Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants' reported use behavior. CONCLUSIONS The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether. TRIAL REGISTRATION The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).
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Affiliation(s)
- Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Lukas M Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Antonie Schoenleber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
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Balán IC, Marone RO, Barreda V, Naar S, Wang Y. Integration of an Electronic Screening, Brief Intervention, and Referral to Treatment Program Into an HIV Testing Program to Reduce Substance Use and HIV Risk Behavior Among Men Who Have Sex With Men: Protocol for Intervention Development and a Pilot Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e56683. [PMID: 38483463 PMCID: PMC10979339 DOI: 10.2196/56683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionally affected by HIV and drug and alcohol use; however, few effective HIV prevention interventions for MSM who use substances exist. Screening, Brief Intervention, and Referral to Treatment is an early intervention for non-treatment-seeking individuals with problematic substance use and for timely referral to treatment for those with substance use disorders. Electronic screening and brief interventions (e-SBIs) reduce implementation challenges. An e-SBI tailored for MSM at the time of HIV testing might be particularly opportune to strengthen their motivation to reduce substance use and HIV risk behavior. OBJECTIVE This study aims to develop a tailored e-SBI program to reduce substance use and HIV risk behavior among MSM seeking HIV testing at Nexo Asociación Civil, our community partners in Argentina (primary); assess the feasibility and acceptability of integrating the e-SBI into the Nexo HIV testing program (primary); assess the feasibility and acceptability of implementing an adapted Men's Health Project (MHP) at Nexo (secondary); and finally, explore preliminary findings on substance use and sexual risk reduction outcomes (exploratory). METHODS This mixed methods study has 2 stages. During stage 1 (development), we will use the User Centered Rapid App Design process consisting of focus groups (n=16), individual interviews (n=24), and a pilot deployment of the e-SBI (n=50) to iteratively develop the e-SBI. Quantitative and qualitative assessments at each step will inform the revision of the e-SBI. Furthermore, we will use the assessment, decision, administration, production, topic experts, integration, training, testing framework to adapt MHP. During stage 2 (pilot randomized controlled trial [RCT]), we will randomize 200 MSM coming to Nexo for HIV testing. They will complete a baseline assessment and then their assigned intervention (e-SBI vs screening only) and will be followed-up for 6 months. We will also conduct in-depth interviews with up to 45 participants: 15 participants from either study condition who entered or completed MHP or other substance abuse treatment and 15 from each arm who met the criteria for MHP but did not request it. RESULTS The study began recruitment in October 2022, and the stage-1 pilot study is near completion. Preliminary findings from stage 1 show high e-SBI acceptability. Data analysis of the stage-1 pilot is now beginning. The stage-2 pilot RCT will be launched in March 2024, with all data collection completed by May 2025. CONCLUSIONS This study will allow us to assess the acceptability and feasibility of e-SBI implementation during HIV testing encounters. We will also build the necessary research infrastructure for a subsequent RCT to assess the efficacy of e-SBIs in reducing substance use and HIV sexual risk behavior among MSM in this setting. TRIAL REGISTRATION ClinicalTrials.gov NCT05542914; https://tinyurl.com/yyjj64dm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56683.
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Affiliation(s)
- Iván C Balán
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
| | | | | | - Sylvie Naar
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
| | - Yuxia Wang
- Center for Translational Behavioral Science, Department of Behavioral Science and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, United States
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Aubin HJ. Repurposing drugs for treatment of alcohol use disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2024; 175:153-185. [PMID: 38555115 DOI: 10.1016/bs.irn.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Repurposing drugs for the treatment of alcohol dependence involves the use of drugs that were initially developed for other conditions, but have shown promise in reducing alcohol use or preventing relapse. This approach can offer a more cost-effective and time-efficient alternative to developing new drugs from scratch. Currently approved medications for alcohol use disorder (AUD) include acamprosate, disulfiram, naltrexone, nalmefene, baclofen, and sodium oxybate. Acamprosate was developed specifically for AUD, while disulfiram's alcohol-deterrent effects were discovered incidentally. Naltrexone and nalmefene were originally approved for opioids but found secondary applications in AUD. Baclofen and sodium oxybate were repurposed from neurological conditions. Other drugs show promise. Topiramate and zonisamide, anticonvulsants, demonstrate efficacy in reducing alcohol consumption. Another anticonvulsant, gabapentin has been disappointing overall, except in cases involving alcohol withdrawal symptoms. Varenicline, a nicotinic receptor agonist, benefits individuals with less severe AUD or concurrent nicotine use. Ondansetron, a 5-HT3 antagonist, has potential for early-onset AUD, especially when combined with naltrexone. Antipsychotic drugs like aripiprazole and quetiapine have limited efficacy. Further investigation is needed for potential repurposing of α1 adrenergic receptor antagonists prazosin and doxazosin, glucocorticoid receptor antagonist mifepristone, the phosphodiesterase inhibitor Ibudilast, the cysteine prodrug N-acetylcysteine, and the OX1R and OX2R blocker Suvorexant. This review supports repurposing drugs as an effective strategy for expanding treatment options for AUD.
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Affiliation(s)
- Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, Villejuif, France; AP-HP, Université Paris Saclay, Villejuif, France.
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Ingesson-Hammarberg S, Jayaram-Lindström N, Hammarberg A. Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking. Addict Sci Clin Pract 2024; 19:12. [PMID: 38388959 PMCID: PMC10882804 DOI: 10.1186/s13722-024-00443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Research is lacking on predictors of outcome for the treatment of alcohol use disorder (AUD) with a goal of controlled drinking (CD). The aim of the study was to investigate one-year outcomes of an RCT, investigating Behavioral Self-Control Training (BSCT) and Motivational Enhancement Therapy (MET) and predictors of positive outcome for weekly alcohol consumption, CD and symptom reduction in AUD. METHODS This study is based on secondary analyses from a randomized controlled trial including 250 individuals with AUD (52% men) recruited from three specialized addiction clinics in Stockholm, Sweden. Linear and logistic mixed regression models were used for outcomes at 52 weeks, and linear and logistic regression models for the predictor analyses. RESULTS BSCT was superior to MET for the change between baseline to 52 weeks for the outcome of CD, defined as low-risk drinking below ten standard drinks per week for both genders (p = 0.048). A total of 57% of individuals in BSCT attained a level of CD, as opposed to 43% in MET. Females were significantly better in attaining low-risk drinking levels compared to men. The predictor for obtaining CD and reducing weekly alcohol consumption, was a lower baseline alcohol consumption. Predictors of symptom reduction in AUD were lower baseline level of AUD, and a lower self-rated impaired control over alcohol consumption. CONCLUSIONS BSCT was superior to MET in obtaining CD levels, and women were superior to men for the same outcome. The study corroborated baseline consumption levels as an important predictor of outcome in CD treatments. The study contributes with important knowledge on key treatment targets, and knowledge to support and advice patients in planning for treatment with a goal of controlled drinking. TRIAL REGISTRATION The original study was registered retrospectively at isrtcn.com (14539251).
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Affiliation(s)
- Stina Ingesson-Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
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Hammarberg SI, Wallhed Finn S, Rosendahl I, Andréasson S, Jayaram-Lindström N, Hammarberg A. Behavioural self-control training versus motivational enhancement therapy for individuals with alcohol use disorder with a goal of controlled drinking: A randomized controlled trial. Addiction 2024; 119:86-101. [PMID: 37658776 DOI: 10.1111/add.16325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 07/21/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIMS Controlled drinking (CD) is an attractive treatment goal for a large proportion of individuals with alcohol use disorder (AUD), but the availability of treatment methods supporting a goal of CD is scarce. We tested if behavioural self-control training (BSCT) was superior to motivational enhancement therapy (MET) for individuals with AUD with a treatment goal of CD. DESIGN Randomized controlled two-group trial. Follow-ups were conducted at 12 and 26 weeks (primary end-point) after inclusion. SETTING Three specialized dependency care clinics in Stockholm, Sweden. PARTICIPANTS Two hundred and fifty self-referred adults (52% men) fulfilling criteria of AUD (DSM-5) and a stated treatment goal of CD. INTERVENTION AND COMPARATOR BSCT (n = 125), a five-session treatment based on cognitive behavioural therapy versus the active comparator, MET (n = 125), containing four sessions based on Motivational Interviewing. MEASUREMENTS Primary outcome measure was mean weekly alcohol consumption at the 26-week follow-up, adjusted for baseline consumption. CONCLUSIONS A randomized controlled trial found no evidence of a difference between behavioural self-control training and motivational enhancement therapy in reducing weekly alcohol consumption. Both groups substantially reduced consumption and behavioural self-control training was superior in reducing hazardous drinking.
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Affiliation(s)
- Stina Ingesson Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sara Wallhed Finn
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Andréasson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Jemberie WB, Snellman F, Eriksson M, Hammarberg A. 'Ageing with an alcohol problem is not what I envision': reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems. BMC Geriatr 2023; 23:866. [PMID: 38104085 PMCID: PMC10724916 DOI: 10.1186/s12877-023-04573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Eliciting and understanding older persons' descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing. METHODS Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews. RESULTS Three themes were identified: "Tipping the balance", "Staying behind a veil" and "Lifting the vail". First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery. CONCLUSIONS Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons' desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.
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Affiliation(s)
- Wossenseged Birhane Jemberie
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden.
- Centre for Demography and Aging Research (CEDAR), Umeå University, Umeå, Sweden.
- The Swedish National Graduate School for Competitive Science On Aging and Health (SWEAH), Faculty of Medicine, Lund University, Lund, Sweden.
| | - Fredrik Snellman
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden
| | - Malin Eriksson
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Russell AM, Montemayor BN, Chiang SC, Milaham PJ, Barry AE, Lin HC, Bergman BG, Massey PM. Characterizing Twitter chatter about temporary alcohol abstinence during "Dry January". Alcohol Alcohol 2023; 58:589-598. [PMID: 37652745 PMCID: PMC10642608 DOI: 10.1093/alcalc/agad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
With roots as a public health campaign in the United Kingdom, "Dry January" is a temporary alcohol abstinence initiative encouraging participants to abstain from alcohol use during the month of January. Dry January has become a cultural phenomenon, gaining increasing news media attention and social media engagement. Given the utility of capturing naturalistic discussions around health topics on social media, we examined Twitter chatter about Dry January and associated temporary abstinence experiences. Public tweets were collected containing the search terms "dry january" or "dryjanuary" posted between 15 December and 15 February across 3 years (2020-2). A random subsample stratified by year (n = 3145) was pulled for manual content analysis by trained coders. Final codebook accounted for user sentiment toward Dry January, user account type, and themes related to Dry January participation. Engagement metadata (e.g. likes) were also collected. Though user sentiment was mixed, most tweets expressed positive or neutral sentiment toward Dry January (74.7%). Common themes included encouragement and support for Dry January participation (14.1%), experimentation with and promotion of nonalcoholic drinks (14.0%), and benefits derived from Dry January participation (10.4%). While there is promise in the movement to promote positive alcohol-related behavior change, increased efforts to deliver the campaign within a public health context are needed. Health communication campaigns designed to inform participants about evidence-based treatment and recovery support services proven to help people quit or cut down on their drinking are likely to maximize benefits.
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Affiliation(s)
- Alex M Russell
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac St., Floor 4, Boston, MA 02114, United States
| | - Ben N Montemayor
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, United States
| | - Shawn C Chiang
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, United States
| | - Plangkat J Milaham
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, United States
| | - Adam E Barry
- Department of Health Behavior, Texas A&M University, College Station, TX 77843, United States
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN 47405, United States
| | - Brandon G Bergman
- Recovery Research Institute, Massachusetts General Hospital and Harvard Medical School, 151 Merrimac St., Floor 4, Boston, MA 02114, United States
| | - Philip M Massey
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA 90095, United States
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Caudle MM, Klaming R, Fong C, Harlé K, Taylor C, Spadoni A, Bomyea J. Approach avoidance training versus Sham in veterans with alcohol use disorder: protocol for a randomized controlled trial. BMC Psychiatry 2023; 23:499. [PMID: 37438722 PMCID: PMC10337098 DOI: 10.1186/s12888-023-04961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care. METHODS One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment. DISCUSSION This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD. REGISTRY NAME AAT for Alcohol Use Disorder in Veterans. TRIAL REGISTRATION ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022.
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Affiliation(s)
- M M Caudle
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - R Klaming
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - C Fong
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - K Harlé
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - C Taylor
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - A Spadoni
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - J Bomyea
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA.
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
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Ware OD, Labos B, Hudgins D, Irvin NA, Buresh ME, Bergeria CL, Sweeney MM. Prior Periods of Abstinence Among Adults With an Alcohol Use
Disorder: A Qualitative Template Analysis. SUBSTANCE ABUSE: RESEARCH AND TREATMENT 2023; 17:11782218231162468. [PMID: 36968973 PMCID: PMC10034338 DOI: 10.1177/11782218231162468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
Abstaining from substance use is a goal of many people with alcohol use disorder
(AUD). Understanding patient perspectives of a period of abstinence may assist
persons with AUD in achieving this goal. We accessed the electronic health
records of adults with AUD entering an emergency department in Baltimore,
Maryland, who received a brief peer support intervention for substance use. Data
contained open-ended text entered by staff after a patient indicated ever having
a sustained period of substance abstinence. Using qualitative template analysis
methodology, we identified codes and themes from these open-ended responses from
N = 153 adults with AUD. The sample was primarily male (n = 109, 71.2%) and
White (n = 98, 64.1%) with an average age of 43.8 years (SD = 11.2). Themes
identified included the abstinence length, abstinence reason, relapse, triggers,
time of relapse, and treatment. The most common code for abstinence length was
“between 1 and 5 years” (n = 55, 35.9%). Other abstinence length codes included
“less than 1 year” and “more than 5 years.” Relapse triggers included “family
(non-death),” “death of a loved one,” “social,” “economic,” and
“treatment-related” reasons. Findings from this study could be used to inform
strategies for peer support interventions to assist patients with substance
abstinence.
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Affiliation(s)
- Orrin D. Ware
- School of Social Work, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Orrin D. Ware, School of Social Work,
University of North Carolina at Chapel Hill, 325 Pittsboro Street, Chapel Hill,
NC 27599, USA.
| | - Breanna Labos
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Daniella Hudgins
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Nathan A. Irvin
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Emergency Medicine, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan E. Buresh
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Medicine, Division of
Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD,
USA
- Department of Epidemiology, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cecilia L. Bergeria
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
| | - Mary M. Sweeney
- Johns Hopkins University School of
Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral
Sciences, Behavioral Pharmacology Research Unit, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
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Hallgren KA, Galloway GP, Witkiewitz K, Linde P, Nix B, Mendelson JE. Treatment retention and reductions in blood alcohol concentration (BAC) during the first 90 days of a telehealth program for alcohol use disorder. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:249-259. [PMID: 36881813 DOI: 10.1080/00952990.2023.2175322] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Background: Alcohol use disorder (AUD) treatments, including medications, are increasingly offered via telehealth.Objective: This study characterizes 90-day treatment retention and changes in objectively measured blood alcohol concentration (BAC) in a large cohort receiving AUD telehealth.Methods: Patients received AUD treatment through Ria, a virtual (telehealth) program offering AUD treatment that is tailored to patient goals (e.g. abstinence or controlled drinking). Patients were encouraged to complete breathalyzer readings twice daily for measurement-based care. We characterized rates of 90-day treatment retention (i.e. completing a BAC reading or medical/coaching encounter on the 90th day or later) and used growth curve analyses to model changes in daily estimated peak BAC over 90 days.Results: Of 4121 patients (51.5% women), 50.1% had 90-day treatment retention (n = 2066, 52.2% women). Most patients received prescriptions for AUD medications (84.6%) and completed encounters with medical providers (86.7%) and coaches (86.1%). Patients with 90-day retention provided 184,817 BAC readings in the first 90 days. Growth curve analyses revealed significant reductions in daily estimated peak BAC (p < .001) from a mean of 0.092 (day 1) to 0.038 (day 90). Similar magnitudes of BAC reduction were observed for men and women and for patients with abstinence and controlled drinking goals.Conclusion: Telehealth appears to be a viable approach to delivering AUD treatments in a manner that promotes drinking reductions. Telehealth approaches can yield reductions in objectively measured BAC, including for some patient subgroups that have historically faced greater stigma in AUD treatment settings, such as women and people with non-abstinence drinking goals.
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
| | | | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use, And Addictions, University of New Mexico, Albuquerque, NM, USA
| | | | - Bob Nix
- Ria Health, San Francisco, CA
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12
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Barré T, Ramier C, Antwerpes S, Costa M, Bureau M, Maradan G, Di Beo V, Cutarella C, Leloutre J, Riccobono-Soulier O, Hedoire S, Frot E, Vernier F, Vassas-Goyard S, Dufort S, Protopopescu C, Marcellin F, Casanova D, Coste M, Carrieri P. A novel community-based therapeutic education program for reducing alcohol-related harms and stigma in people with alcohol use disorders: A quasi-experimental study (ETHER study). Drug Alcohol Rev 2023; 42:664-679. [PMID: 36721903 DOI: 10.1111/dar.13605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/07/2022] [Accepted: 12/19/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is associated with a significant disease burden in France, where alcohol use is deeply rooted in culture. However, the treatment gap is large because of several barriers, including stigmatisation and drinkers' apprehension about total abstinence. However, standardised and evidence-based interventions based on controlled-drinking for people with AUD are lacking. We aimed to assess the effectiveness of a novel community-based French therapeutic patient education (TPE) program for people with AUD named Choizitaconso. METHODS A before-after non-randomised quasi-experimental study, named ETHER, was designed and implemented with people living with AUD, over a period of 6 months. The primary outcome was percentage change in the number of alcohol-related harms experienced. Secondary outcomes were percentage changes in psycho-social patient-reported and community-validated outcomes. Participants in the intervention group (n = 34) benefited from the 10-week TPE program Choizitaconso, while the comparison group (n = 58) received standard care. The Kruskall-Wallis and chi-squared or Fisher's exact tests were used to compare before-after changes in variables in both groups. Linear regression models were used to test for the effect of study group on each outcome and to test for the effect of alcohol consumption as a confounder. RESULTS At 6 months, all outcomes but one either remained stable or numerically improved in both groups. Internalised stigma significantly improved in the intervention group (p = 0.026) but not in the comparison group (p = 0.207), with a significant group effect (p = 0.014). DISCUSSION AND CONCLUSIONS This study demonstrates the effectiveness of the Choizitaconso TPE program on community-validated outcomes, especially internalised stigma.
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Affiliation(s)
- Tangui Barré
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Clémence Ramier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Saskia Antwerpes
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Marie Costa
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Morgane Bureau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Gwenaelle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Vincent Di Beo
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Christophe Cutarella
- Clinique Saint-Barnabé, Marseille, France
- Association Addictions France, Salon-de-Provence, France
| | | | | | | | - Elodie Frot
- Association Addictions France, Digne-les-Bains, France
| | | | | | - Sabine Dufort
- Association Addictions France, Digne-les-Bains, France
| | - Camelia Protopopescu
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | | | - Marion Coste
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Aix Marseille Univ, CNRS, AMSE, Marseille, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Botwright S, Sutawong J, Kingkaew P, Anothaisintawee T, Dabak SV, Suwanpanich C, Promchit N, Kampang R, Isaranuwatchai W. Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence. BMC Public Health 2023; 23:382. [PMID: 36823618 PMCID: PMC9948368 DOI: 10.1186/s12889-023-15152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND This study aimed to identify targeted interventions for the prevention and treatment of harmful alcohol use. Umbrella review methodology was used to summarise the effectiveness across a broad range of interventions, in order to identify which interventions should be considered for inclusion within universal health coverage schemes in low- and middle-income countries. METHODS AND FINDINGS We included systematic reviews with meta-analysis of randomised controlled trials (RCTs) on targeted interventions addressing alcohol use in harmful drinkers or individuals with alcohol use disorder. We only included outcomes related to alcohol consumption, heavy drinking, binge drinking, abstinence, or alcohol-attributable accident, injury, morbidity or mortality. PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and the International HTA Database were searched from inception to 3 September 2021. Risk of bias of reviews was assessed using the AMSTAR2 tool. After reviewing the abstracts of 9,167 articles, results were summarised narratively and certainty in the body of evidence for each intervention was assessed using GRADE. In total, 86 studies met the inclusion criteria, of which the majority reported outcomes for brief intervention (30 studies) or pharmacological interventions (29 studies). Overall, methodological quality of included studies was low. CONCLUSIONS For harmful drinking, brief interventions, cognitive behavioural therapy, and motivational interviewing showed a small effect, whereas mentoring in adolescents and children may have a significant long-term effect. For alcohol use disorder, social network approaches and acamprosate showed evidence of a significant and durable effect. More evidence is required on the effectiveness of gamma-hydroxybutyric acid (GHB), nalmefene, and quetiapine, as well as optimal combinations of pharmacological and psychosocial interventions. As an umbrella review, we were unable to identify the extent to which variation between studies stemmed from differences in intervention delivery or variation between country contexts. Further research is required on applicability of findings across settings and best practice for implementation. Funded by the Thai Health Promotion Foundation, grant number 61-00-1812.
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Affiliation(s)
- Siobhan Botwright
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand.
| | - Jiratorn Sutawong
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand.
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Thunyarat Anothaisintawee
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Saudamini Vishwanath Dabak
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Chotika Suwanpanich
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Nattiwat Promchit
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Roongnapa Kampang
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Department of Health, Ministry of Public Health, Tiwanon Rd, 6Th Floor, 6Th Building, Muang, 11000, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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14
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Wyler H, Maisch A, Berger T, Kieser U, Schleifer R, Liebrenz M. Alcohol use disorder and disability insurance in Switzerland: the attitudes and views of lawyers, insurance medical experts, and addiction-specialist therapists. Subst Abuse Treat Prev Policy 2022; 17:69. [PMID: 36303216 PMCID: PMC9615404 DOI: 10.1186/s13011-022-00495-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND According to a landmark decision by the Swiss Federal Supreme Court, people with a substance use disorder (SUD) are now eligible for disability benefits if their disorder impairs their ability to work. Alcohol use disorder (AUD) is one of the most common SUDs in Switzerland and is associated with high societal and economic costs. This study aimed to gain an in-depth understanding of the views of professional stakeholder groups regarding AUD and their opinions on the new legal precedent. METHODS Swiss social insurance lawyers, insurance medical experts, and addiction-specialist therapists (N = 79) answered an online questionnaire. Due to violations of the assumption of normality, non-parametric tests are reported in most cases. RESULTS Therapists held significantly higher regard for patients with AUD than both lawyers and insurance medical experts. All three groups strongly supported a disease view of AUD but agreed significantly less that it was a disease like cancer, suggesting that AUDs might be seen as at least partially self-inflicted. Overall, moralist views of AUD received considerably less support than the disease view, with lawyers agreeing with moralist views more than therapists. All groups were well-informed and largely supportive about the new legal precedent. When asked about stipulating participation in medical treatment to mitigate damages associated with a claim, attending therapy was supported the most amongst the groups (80% of participants felt this was somewhat or fully appropriate), followed by a reduction in drinking quantity (58%), and abstinence (18%). In all three groups, we identified associations between certain views and opinions on AUD and support for the new legal precedent. CONCLUSIONS Whilst there were differences between the stakeholder groups in their regard for and views of AUD, all three adopted a clear harm-reduction approach with respect to measures to mitigate damages associated with the insurance disability claim. A possible connection of this stance with the Swiss national drug policy in recent years is discussed together with limitations of the study and practical implications of the findings.
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Affiliation(s)
- Helen Wyler
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Anja Maisch
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Thomas Berger
- grid.5734.50000 0001 0726 5157Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ueli Kieser
- grid.15775.310000 0001 2156 6618Institute for Legal Studies and Legal Practice, University of St. Gallen, St. Gallen, Switzerland
| | - Roman Schleifer
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
| | - Michael Liebrenz
- grid.5734.50000 0001 0726 5157Department of Forensic Psychiatry, University of Bern, Falkenplatz 16/18, 3012 Bern, Switzerland
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15
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Fischler PV, Soyka M, Seifritz E, Mutschler J. Off-label and investigational drugs in the treatment of alcohol use disorder: A critical review. Front Pharmacol 2022; 13:927703. [PMID: 36263121 PMCID: PMC9574013 DOI: 10.3389/fphar.2022.927703] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Compounds known to be successful in the treatment of alcohol use disorder include the aversive agent, Disulfiram, the glutamatergic NMDA receptor antagonist, Acamprosate, and the opioid receptor antagonists, Naltrexone and Nalmefene. Although all four are effective in maintaining abstinence or reduction of alcohol consumption, only a small percentage of patients receive pharmacological treatment. In addition, many other medications have been investigated for their therapeutic potential in the treatment of alcohol use disorder. In this review we summarize and compare Baclofen, Gabapentin, Topiramate, Ondansetron, Varenicline, Aripiprazole, Quetiapine, Clozapine, Antidepressants, Lithium, Neuropeptide Y, Neuropeptide S, Corticotropin-releasing factor antagonists, Oxytocin, PF-05190457, Memantine, Ifenprodil, Samidorphan, Ondelopran, ABT-436, SSR149415, Mifepristone, Ibudilast, Citicoline, Rimonabant, Surinabant, AM4113 and Gamma-hydroxybutyrate While some have shown promising results in the treatment of alcohol use disorder, others have disappointed and should be excluded from further investigation. Here we discuss the most promising results and highlight medications that deserve further preclinical or clinical study. Effective, patient-tailored treatment will require greater understanding provided by many more preclinical and clinical studies.
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Affiliation(s)
- Pascal Valentin Fischler
- Department for Gynecology and Obstetrics, Women’s Clinic Lucerne, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- *Correspondence: Pascal Valentin Fischler,
| | - Michael Soyka
- Psychiatric Hospital University of Munich, Munich, Germany
| | - Erich Seifritz
- Director of the Clinic for Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Clinic Zürich, Zürich, Switzerland
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16
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Lambert L, Serre F, Thirioux B, Jaafari N, Auriacombe M. Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment. Drug Alcohol Depend 2022; 234:109391. [PMID: 35306397 DOI: 10.1016/j.drugalcdep.2022.109391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Low clinical insight in psychiatry is defined as poor recognition of one's mental illness, including disability to self-evaluate symptom severity. It has been reported as common in addiction and is associated with lower treatment compliance. Longitudinal studies suggest that low clinical insight could be linked to more relapse. However, association with successful quit attempts remains unknown. OBJECTIVE Our objective was to examine the prospective link between baseline clinical insight level and self-reports of successful attempts to quit / control use during the first 3 months of outpatient addiction treatment. METHODS Participants were recruited from the ADDICTAQUI cohort at outpatient treatment intake for substance or behavioral addictions. They completed a baseline evaluation using the Addiction Severity Index (ASI), the Mini International Neuropsychiatric Interview (MINI), and the modified Hanil Alcohol Insight Scale (m-HAIS) with a follow-up ASI 3 months later. Data were analyzed using multiple logistic regression and non-parametric tests. RESULTS Lower clinical insight level at baseline was associated with less successful quit / control attempts during the first 3 months of outpatient treatment compared to a higher clinical insight level, controlling for sociodemographic factors, baseline addiction severity, and comorbidities (n = 54; exp(B) = 0.76; p (FDRcor) = 0.033). CONCLUSION Poor clinical insight may be a barrier to treatment success, and future studies should examine underlying mechanisms.
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Affiliation(s)
- L Lambert
- University of Bordeaux, SANPSY, F-33076 Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France
| | - F Serre
- University of Bordeaux, SANPSY, F-33076 Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France
| | - B Thirioux
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, F-86000 Poitiers, France; Université de Poitiers, CNRS 7295, Centre de Recherches sur la Cognition et l'Apprentissage, 86021 Poitiers, France
| | - N Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, F-86000 Poitiers, France; Université de Poitiers, CNRS 7295, Centre de Recherches sur la Cognition et l'Apprentissage, 86021 Poitiers, France
| | - M Auriacombe
- University of Bordeaux, SANPSY, F-33076 Bordeaux, France; CNRS, SANPSY, UMR 6033, F-33076 Bordeaux, France; Pôle Interétablissement d'Addictologie, CH Ch. Perrens and CHU de Bordeaux, F-33076 Bordeaux, France; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
Alcohol use disorder (AUD) is a highly prevalent but severely under-treated disorder, with only three widely-approved pharmacotherapies. Given that AUD is a very heterogeneous disorder, it is unlikely that one single medication will be effective for all individuals with an AUD. As such, there is a need to develop new, more effective, and diverse pharmacological treatment options for AUD with the hopes of increasing utilization and improving care. In this qualitative literature review, we discuss the efficacy, mechanism of action, and tolerability of approved, repurposed, and novel pharmacotherapies for the treatment of AUD with a clinical perspective. Pharmacotherapies discussed include: disulfiram, acamprosate, naltrexone, nalmefene, topiramate, gabapentin, varenicline, baclofen, sodium oxybate, aripiprazole, ondansetron, mifepristone, ibudilast, suvorexant, prazosin, doxazosin, N-acetylcysteine, GET73, ASP8062, ABT-436, PF-5190457, and cannabidiol. Overall, many repurposed and novel agents discussed in this review demonstrate clinical effectiveness and promise for the future of AUD treatment. Importantly, these medications also offer potential improvements towards the advancement of precision medicine and personalized treatment for the heterogeneous AUD population. However, there remains a great need to improve access to treatment, increase the menu of approved pharmacological treatments, and de-stigmatize and increase treatment-seeking for AUD.
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18
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Antwerpes S, Costa M, Coste M, Bureau M, Maradan G, Cutarella C, Leloutre J, Riccobono-Soulier O, Hedoire S, Frot E, Vernier F, Vassas-Goyard S, Barré T, Casanova D, Carrieri P. Evaluation of a novel therapeutic education programme for people with alcohol use disorder in France: a mixed-methods intervention study protocol (ETHER). Harm Reduct J 2022; 19:2. [PMID: 35012570 PMCID: PMC8751002 DOI: 10.1186/s12954-021-00587-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND ETHER ("Education THEérapeutique pour la Réduction des dommages en alcoologie" or Therapeutic education for alcohol-related harm reduction) is a multicentre community-based mixed-methods study, which aims to evaluate the effectiveness of the innovative therapeutic patient education (TPE) programme 'Choizitaconso' in a sample of French people with alcohol use disorder (people with AUD). Choizitaconso teaches people with AUD psychosocial skills to help them (re)establish controlled drinking and reduce alcohol-related harms. Recruitment started in October 2019. We present here the protocol of the ETHER study. METHODS ETHER's quantitative component involves a 6-month controlled intervention study which evaluates Choizitaconso's effectiveness by comparing 30 people with AUD following the programme with a control group of 60 people with AUD not enrolled in it, using a questionnaire co-constructed by the research team and members of the people with AUD community. Thirty-four alcohol-related harms are assessed and summed to provide an individual measure of the 'harm burden' from consuming alcohol (primary outcome). Secondary outcomes are anticipated and internalized stigma, alcohol consumption measures, craving for alcohol, coping strategies, health-related quality of life, self-confidence to control or abstain from drinking, treatment self-regulation, anxiety and depressive symptoms, alcohol-related neuropsychological impairments, and capabilities (a measure of wellbeing in adults). Data will be collected in face-to-face and phone-based interviews at enrolment and 6 months later. Linear regression models will be used to assess the impact of the TPE programme on changes in the primary and secondary outcomes, while adjusting for other correlates and confounders. The study's qualitative component comprises semi-structured interviews with 16 people with AUD who have already completed the TPE programme at least 6 months before the interview. Qualitative interviews will be analysed using thematic analysis. RESULTS AND CONCLUSIONS ETHER is the first evaluation study of an innovative TPE programme specifically designed to reduce alcohol-related harms and reach controlled drinking in France. The involvement of the people with AUD community in selecting which experienced and perceived alcohol-related harms to measure ensures that ETHER will provide healthcare staff and researchers with a relevant set of harm reduction criteria for use in future research. Finally, ETHER will provide scientific justification for implementing novel alcohol-related harm reduction approaches and champion controlled drinking as a therapeutic goal. Trial registration ClinicalTrials.gov, NCT03954054. Registered 17 May 2019-Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03954054?cond=alcohol&cntry=FR&city=Marseille&draw=1&rank=1 .
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Affiliation(s)
- Saskia Antwerpes
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Marie Costa
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Marion Coste
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Morgane Bureau
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Gwenaelle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
| | - Christophe Cutarella
- Clinique Saint-Barnabé, Marseille, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
| | - Jacques Leloutre
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Avignon, France
| | - Olivier Riccobono-Soulier
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Avignon, France
| | | | - Elodie Frot
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Avignon, France
| | - Fabienne Vernier
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Avignon, France
| | - Stéphanie Vassas-Goyard
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Avignon, France
| | - Tangui Barré
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France.
| | - Danielle Casanova
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Association Addictions France, Digne-les-Bains, France
- CSAPA, Centre de Soins, d'accompagnement Et de Prévention en Addictologie, Avignon, France
| | - Patrizia Carrieri
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Économiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, 27 Bd Jean Moulin, 13385, Marseille, France
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19
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Grundinger N, Gerhardt S, Karl D, Mann K, Kiefer F, Vollstädt-Klein S. The effects of nalmefene on the impulsive and reflective system in alcohol use disorder: A resting-state fMRI study. Psychopharmacology (Berl) 2022; 239:2471-2489. [PMID: 35426492 PMCID: PMC9293828 DOI: 10.1007/s00213-022-06137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/31/2022] [Indexed: 11/12/2022]
Abstract
RATIONALE Central aspects of alcohol use disorder (AUD) are the irresistible desire for alcohol and impaired control over its intake. According to the triadic neurocognitive model of addiction, this arises from aberrant functioning of different neural and cognitive systems: an impulsive system, a reflective system, and the abnormal dynamics between both systems based on an insular-dependent system. OBJECTIVES In this study, we examined the effects of a single dose of nalmefene on resting-state functional connectivity (rsFC) patterns within and between these addiction-related neural systems in AUD. METHODS Non-treatment seeking participants with AUD (N = 17; 19-66 years, 6 female) took part in a randomized, placebo-controlled, double-blind, crossover study and received either a single dose of 18 mg nalmefene or a placebo. Using seed-based correlation analyses on resting-state functional magnetic resonance imaging data, we examined the effects of nalmefene on key nodes related to the (1) impulsive system; (2) reflective system; (3) salience network; and (4) default mode network. RESULTS Under nalmefene, participants showed reduced rsFC between components of the impulsive system (Nucleus accumbens-putamen/pallidum/insula). Reduced rsFC was found between elements of the reflective system and impulsive system (orbitofrontal cortex-insula/putamen/pallidum), salience network (orbitofrontal cortex-insula/inferior frontal gyrus), and default mode network (lateral prefrontal cortex-precuneus/cuneus). Components of the salience network showed both increased (anterior cingulate cortex) and decreased (insular cortex) rsFC to elements of the reflective system. CONCLUSION A single dose of nalmefene impacts rsFC and alters the interaction between key nodes of addiction-related neural systems in non-treatment seeking participants with AUD. Nalmefene may normalize rsFC patterns by weakening the impulsive system while strengthening the reflective system. TRIAL REGISTRATION clinicaltrials.gov: NCT02372318.
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Affiliation(s)
- Nadja Grundinger
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Sarah Gerhardt
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Damian Karl
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Karl Mann
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, PO Box 12 21 20, 68072 Mannheim, Germany
| | - Falk Kiefer
- grid.413757.30000 0004 0477 2235Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, PO Box 12 21 20, 68072 Mannheim, Germany ,grid.7700.00000 0001 2190 4373Feuerlein Center On Translational Addiction Medicine (FCTS), University of Heidelberg, Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, PO Box 12 21 20, 68072, Mannheim, Germany. .,Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
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20
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Exploring the Potential of Implementing Managed Alcohol Programmes to Reduce Risk of COVID-19 Infection and Transmission, and Wider Harms, for People Experiencing Alcohol Dependency and Homelessness in Scotland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312523. [PMID: 34886249 PMCID: PMC8657286 DOI: 10.3390/ijerph182312523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023]
Abstract
People who experience homelessness and alcohol dependency are more vulnerable than the general population to risks/harms relating to COVID-19. This mixed methods study explored stakeholder perspectives concerning the impact of COVID-19 and the potential utility of introducing managed alcohol programmes (MAPs) in Scotland as part of a wider health/social care response for this group. Data sources included: 12 case record reviews; 40 semi-structured qualitative interviews; and meeting notes from a practitioner-researcher group exploring implementation of MAPs within a third sector/not-for-profit organisation. A series of paintings were curated as a novel part of the research process to support knowledge translation. The case note review highlighted the complexity of health problems experienced, in addition to alcohol dependency, including polysubstance use, challenges related to alcohol access/use during lockdown, and complying with stay-at-home rules. Qualitative analysis generated five subthemes under the theme of ‘MAPs as a response to COVID-19′: changes to alcohol supply/use including polysubstance use; COVID-19-related changes to substance use/homelessness services; negative changes to services for people with alcohol problems; the potential for MAPs in the context of COVID-19; and fears and concerns about providing MAPs as a COVID-19 response. We conclude that MAPs have the potential to reduce a range of harms for this group, including COVID-19-related harms.
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21
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Rehman A, Mehta KJ. Betaine in ameliorating alcohol-induced hepatic steatosis. Eur J Nutr 2021; 61:1167-1176. [PMID: 34817678 PMCID: PMC8921017 DOI: 10.1007/s00394-021-02738-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/03/2021] [Indexed: 01/15/2023]
Abstract
Alcohol-associated liver disease (AALD) is one of most common chronic liver diseases. Hepatic steatosis is the earliest stage in AALD pathological spectrum, reversible by alcohol abstinence. Untreated steatosis can progress to steatohepatitis, fibrosis and/or cirrhosis. Considering the difficulties in achieving complete abstinence, challenges in disease reversal at advanced stages, high costs of AALD management and lack of standardised prescribed medications for treatment, it is essential to explore low-cost natural compounds that can target AALD at an early stage and halt or decelerate disease progression. Betaine is a non-hazardous naturally occurring nutrient. Here, we address the mechanisms of alcohol-induced hepatic steatosis, the role of betaine in reversing the effects i.e., its action against hepatic steatosis in animal models and humans, and the associated cellular and molecular processes. Accordingly, the review discusses how betaine restores the alcohol-induced reduction in methylation potential by elevating the levels of S-adenosylmethionine and methionine. It details how betaine reinstates alcohol-induced alterations in the expressions and/or activities of protein phosphtase-2A, FOXO1, PPAR-α, AMPK, SREBP-1c, fatty acid synthase, diacylglycerol transferase-2, adiponectin and nitric oxide. Interrelationships between these factors in preventing de novo lipogenesis, reducing hepatic uptake of adipose-tissue-derived free fatty acids, promoting VLDL synthesis and secretion, and restoring β-oxidation of fatty acids to attenuate hepatic triglyceride accumulation are elaborated. Despite its therapeutic potential, very few clinical trials have examined betaine’s effect on alcohol-induced hepatic lipid accumulation. This review will provide further confidence to conduct randomised control trials to enable maximum utilisation of betaine’s remedial properties to treat alcohol-induced hepatic steatosis.
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Affiliation(s)
- Aisha Rehman
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Kosha J Mehta
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK.
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22
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Venegas A, Donato S, Meredith LR, Ray LA. Understanding low treatment seeking rates for alcohol use disorder: A narrative review of the literature and opportunities for improvement. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:664-679. [PMID: 34464542 PMCID: PMC9059657 DOI: 10.1080/00952990.2021.1969658] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Despite a well-documented global burden of disease attributable to alcohol use disorder (AUD), treatment seeking rates remain low. In this qualitative literature review, we address treatment seeking for AUD from a host of perspectives and summarize the literature on key factors. First, we summarize the rates of alcohol treatment seeking across various epidemiological surveys, spanning decades. Second, we discuss the definition of treatment seeking and 'what' is typically considered formal treatment. Third, we consider timing and discuss 'when' individuals are most likely to seek treatment. Fourth, we review the literature on 'who' is most likely to seek treatment, including demographic and clinical correlates. Fifth, we address the critical question of 'why' so few people receive clinical services for AUD, relative to the number of individuals affected by the disorder, and review barriers to treatment seeking at the treatment- and person-levels of analysis. Finally, we identify opportunities to improve treatment seeking rates by focusing on tangible points of intervention. Specifically, we recommend a host of adaptations to models of care including efforts to make treatment more appealing across stages of AUD severity, accept a range of health-enhancing drinking goals as opposed to an abstinence-only model, educate providers and consumers about evidence-based behavioral and pharmacological treatments, and incentivize the delivery of evidence-based services.
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Affiliation(s)
- Alexandra Venegas
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Suzanna Donato
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lindsay R. Meredith
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
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23
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Reward Deficiency Syndrome (RDS): A Cytoarchitectural Common Neurobiological Trait of All Addictions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111529. [PMID: 34770047 PMCID: PMC8582845 DOI: 10.3390/ijerph182111529] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023]
Abstract
Alcohol and other substance use disorders share comorbidity with other RDS disorders, i.e., a reduction in dopamine signaling within the reward pathway. RDS is a term that connects addictive, obsessive, compulsive, and impulsive behavioral disorders. An estimated 2 million individuals in the United States have opioid use disorder related to prescription opioids. It is estimated that the overall cost of the illegal and legally prescribed opioid crisis exceeds one trillion dollars. Opioid Replacement Therapy is the most common treatment for addictions and other RDS disorders. Even after repeated relapses, patients are repeatedly prescribed the same opioid replacement treatments. A recent JAMA report indicates that non-opioid treatments fare better than chronic opioid treatments. Research demonstrates that over 50 percent of all suicides are related to alcohol or other drug use. In addition to effective fellowship programs and spirituality acceptance, nutrigenomic therapies (e.g., KB220Z) optimize gene expression, rebalance neurotransmitters, and restore neurotransmitter functional connectivity. KB220Z was shown to increase functional connectivity across specific brain regions involved in dopaminergic function. KB220/Z significantly reduces RDS behavioral disorders and relapse in human DUI offenders. Taking a Genetic Addiction Risk Severity (GARS) test combined with a the KB220Z semi-customized nutrigenomic supplement effectively restores dopamine homeostasis (WC 199).
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Witkiewitz K, Morris J, Tucker JA. Commentary on Henssler et al.: The public health case for promoting and valuing drinking reductions in the treatment of alcohol use disorder. Addiction 2021; 116:1988-1989. [PMID: 33554367 DOI: 10.1111/add.15429] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - James Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Jalie A Tucker
- Department of Health Education and Behavior and Center for Behavioral Economic Health Research, University of Florida, Gainesville, FL, USA
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25
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Körkel J. Treating patients with multiple substance use in accordance with their personal treatment goals: a new paradigm for addiction treatment. DRUGS AND ALCOHOL TODAY 2021. [DOI: 10.1108/dat-10-2020-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to present the theoretical foundation and practical approach of “open-target addiction treatment” (OTAT). Traditional treatment programmes are usually-oriented towards fixed predefined goals (abstinence, reduced consumption and harm reduction) and often focus on one substance only (e.g. alcohol). However, as a rule, people who use drugs consume several substances and sometimes additionally exhibit behavioural addictions. For many of these addictions, there is more or less motivation for change, but commonly it is not abstinence as a consistent goal. The paradigm of OTAT systematically considers multi-substance use, expects high readiness to change and is aware that commonly clients lack the willingness to abstain permanently.
Design/methodology/approach
The theory and practice of OTAT involve three components, namely, first, to create a systematic inventory of all psychoactive substances consumed and addictive behaviours performed, second, to clarify, which substance-related change goals clients pursue and third, to choose adequate treatment options matching the substance-specific goals of the clients. Furthermore, OTAT includes didactic tools to support working along with these three steps (e.g. a set of cards to gain an overview over the psychoactive substances used and addictive behaviours performed).
Findings
The systematic implementation of OTAT requires fundamentally different concepts about addiction and its treatment, specific competencies of the staff and a corresponding portfolio of interventions within the treatment facilities.
Research limitations/implications
Future research should focus more on patients’ goal preferences and their impact on their willingness to take up treatment and its outcomes.
Practical implications
To implement OTAT treatment, institutions have to undergo a systematic process of team and organizational development.
Social implications
OTAT has the potential to reduce the treatment gap and to serve severely addicted individuals in a more comprehensive way.
Originality/value
The OTAT approach has not been described in the addiction treatment literature so far.
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