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O'Dean SM, Mewton L, Chung T, Clay P, Clare PJ, Bruno R, Yuen WS, McBride N, Swift W, Isik A, Upton E, Tibbetts J, Johnson P, Kypri K, Slade T. Definition matters: assessment of tolerance to the effects of alcohol in a prospective cohort study of emerging adults. Addiction 2022; 117:2955-2964. [PMID: 35792050 PMCID: PMC9796318 DOI: 10.1111/add.15991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/12/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Tolerance to the effects of alcohol is an important element in the diagnosis of alcohol use disorders (AUD); however, there is ongoing debate about its utility in the diagnosis AUD in adolescents and young adults. This study aimed to refine the assessment of tolerance in young adults by testing different definitions of tolerance and their associations with longitudinal AUD outcomes. DESIGN Prospective cohort study. SETTINGS Australia. PARTICIPANTS A contemporary cohort of emerging adults across Australia (n = 565, mean age = 18.9, range = 18-21 at baseline). MEASUREMENTS Clinician-administered Structured Clinical Interview for DSM-IV Research Version (SCID-IV-RV) assessed for AUD criteria across five interviews, at 6-month intervals over 2.5 years. Tolerance definitions were operationalized using survey-type response (yes/no), clinician judgement (SCID-IV-RV), different initial drinking quantity and percentage increase thresholds and average heavy consumption metrics. AUD persistence was operationalized by the number of times AUD was present across the 2.5-year study period (n = 491), and new-onset AUD was operationalized as any new incidence of AUD during the follow-up period (n = 461). FINDINGS The (i) SCID-IV-RV clinician judgement [odds ratio (OR) = 2.50, P = 0.005], (ii) an initial drinking quantity threshold of four to five drinks and 50% minimum increase (OR = 2.48, P = 0.007) and (iii) 50% increase only (OR = 2.40, P = 0.005) were the tolerance definitions more strongly associated with any new onset of AUD throughout the four follow-up time-points than other definitions. However, these definitions were not associated with persistent AUD (Ps > 0.05). Average heavy consumption definitions of tolerance were most strongly associated with persistent AUD (OR = 6.66, P = 0.001; OR = 4.65, P = 0.004) but not associated with new-onset AUD (Ps > 0.05). CONCLUSIONS Initial drink and percentage change thresholds appear to improve the efficacy of change-based tolerance as an indicator for new-onset alcohol use disorder diagnosis in self-report surveys of young adults. When predicting persistent alcohol use disorder, average heavy consumption-based indicators appear to be a better way to measure tolerance than self-reported change-based definitions.
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Affiliation(s)
- Siobhan M. O'Dean
- The Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
| | - Louise Mewton
- Centre for Healthy Brain AgeingUniversity of New South WalesSydneyNSWAustralia
| | - Tammy Chung
- Department of Psychiatry, RutgersThe State University of New Jersey, Institute for Health, Healthcare Policy and Aging ResearchNew JerseyUSA
| | - Peter Clay
- The Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
| | - Philip J. Clare
- Prevention Research CollaborationUniversity of SydneySydneyAustralia,National Drug and Alcohol Research Centre, UNSWSydneyAustralia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, UNSWSydneyAustralia,School of Psychological SciencesUniversity of TasmaniaHobartTASAustralia
| | - Wing See Yuen
- National Drug and Alcohol Research Centre, UNSWSydneyAustralia
| | - Nyanda McBride
- National Drug Research Institute and enAble InstituteCurtin UniversityPerthAustralia
| | - Wendy Swift
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred HospitalCamperdownNSWAustralia
| | - Ashling Isik
- The Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
| | - Emily Upton
- National Drug and Alcohol Research Centre, UNSWSydneyAustralia
| | - Joel Tibbetts
- The Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
| | - Phoebe Johnson
- The Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
| | - Kypros Kypri
- School of Medicine and Public HealthUniversity of NewcastleNSWAustralia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance UseUniversity of SydneySydneyAustralia
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van Amsterdam JG, Benschop A, van Binnendijk S, Snijder MB, Lok A, Schene AH, Derks EM, van den Brink W. A Comparison of Excessive Drinking, Binge Drinking and Alcohol Dependence in Ethnic Minority Groups in the Netherlands: The HELIUS Study. Eur Addict Res 2020; 26:66-76. [PMID: 31812961 PMCID: PMC7114898 DOI: 10.1159/000504881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Dutch multi-ethnic Healthy Life in an Urban Setting study recently showed that alcohol consumption was lower in ethnic minority groups than those of Dutch origin, but that binge drinking in drinkers of Turkish and Moroccan origin was relatively high. The aim of the current study is to examine factors that may contribute to the differences in drinking patterns and how they relate to the relationship between drinking patterns and alcohol dependence (AD) across ethnic groups. METHODS The rate of last year alcohol use, alcohol use patterns and AD was assessed in 4,635 Dutch, 4,317 Moroccan, 4,036 Turkish, 2,459 Ghanaian, 4,426 African Surinamese and 3,357 South-Asian Surinamese participants (both men and women) born in Amsterdam, the Netherlands. RESULTS Compared to the Dutch, the prevalence of (regular) drinking is substantially lower in all ethnic minority groups and regular drinkers among most ethnic minority groups have a lower adjusted risk to develop binge drinking and AD than the Dutch. For the prevalence of regular drinking, the ethnic differences are bigger than for the prevalence of current drinking. However, regular drinkers of Moroccan origin have a risk similar to the Dutch to develop binge drinking and AD; a finding that could not be explained by group differences in age, sex, religiosity, perceived discrimination, depression or guilt feelings about drinking. DISCUSSION The prevalence data show that current drinking is lower and that regular drinking is much lower in ethnic minorities and - with the exception of those of Moroccan origin - ethnic minority regular drinkers also have a significant lower risk to develop binge drinking or AD than regular drinkers of Dutch origin. This implies that the magnitude of problematic alcohol use is substantially smaller in ethnic minorities than in the ethnic Dutch population of Amsterdam. Unfortunately, no explanation was found for the special risk situation of regular drinkers of Moroccan origin.
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Affiliation(s)
- Jan G.C. van Amsterdam
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,*Dr. Jan G.C. van Amsterdam, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, NL–1105 AZ Amsterdam (The Netherlands), E-Mail: ;
| | - Annemieke Benschop
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone van Binnendijk
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke B. Snijder
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart H. Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Eske M. Derks
- Translational Neurogenomics Group, QIMR Berghofer, Brisbane, Queensland, Australia
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Fan AZ, Chou SP, Zhang H, Jung J, Grant BF. Prevalence and Correlates of Past-Year Recovery From DSM-5 Alcohol Use Disorder: Results From National Epidemiologic Survey on Alcohol and Related Conditions-III. Alcohol Clin Exp Res 2019; 43:2406-2420. [PMID: 31580502 DOI: 10.1111/acer.14192] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/21/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Little is known about remission, recovery, and other outcomes of alcohol use disorder (AUD) as defined by the DSM-5. METHODS Data from a large representative sample of the United States was used to examine correlates of past-year AUD status among individuals with prior-to-past-year AUD: persistent AUD, symptomatic high-risk drinking, asymptomatic high-risk drinking, symptomatic low-risk drinking, asymptomatic low-risk drinking (nonabstinent recovery, NAR), and abstainer (abstinent recovery, AR). Multiple logistic regression analyses were conducted to compare: (i) AR and NAR with persistent AUD, (ii) AR with NAR, and (iii) asymptomatic and symptomatic high-risk drinking with AR and NAR. RESULTS Among individuals with AUD prior to past year (n = 7,785), 34.2% were classified with persistent AUD, 8.8 and 1.6% were symptomatic high-risk and symptomatic low-risk drinkers, respectively, 21.5% were asymptomatic high-risk drinkers, 17.9% were asymptomatic low-risk drinkers, and 16.0% were abstainers. One-quarter of individuals with AUD prior to past year achieved AR or NAR without the benefit of treatment, while a much greater percentage of individuals achieving AR (43.2%) reported receiving treatment relative to those with NAR (12.3%). The number of lifetime AUD symptoms was greater among those achieving AR (among the treated) and lower among those achieving NAR relative to persistent AUD. The number of AUD symptoms was also greater among those achieving AR than NAR and lower among asymptomatic and symptomatic risk drinkers relative to those achieving AR and NAR. Consumption was greater among those achieving AR relative to those achieving NAR and greater among asymptomatic and symptomatic risk drinkers relative to AR and NAR. Odds of achieving AR or NAR relative to persistent AUD were generally lower among non-Hispanic Blacks and those with higher education, greater among women and married individuals, and lower among illicit drug users and individuals with histories of a personality disorder or mood/anxiety disorder. CONCLUSIONS There appears to be a substantial level of recovery from AUD. Information on specific factors associated with AUD outcomes can be useful in targeting appropriate treatment efforts.
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Affiliation(s)
- Amy Z Fan
- From the, Epidemiology and Biometry Branch, (AZF, SPC, HZ, JJ), National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
| | - Sanchen Patricia Chou
- From the, Epidemiology and Biometry Branch, (AZF, SPC, HZ, JJ), National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
| | - Haitao Zhang
- From the, Epidemiology and Biometry Branch, (AZF, SPC, HZ, JJ), National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
| | - Jeesun Jung
- From the, Epidemiology and Biometry Branch, (AZF, SPC, HZ, JJ), National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, Bethesda, Maryland
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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Seeley JR, Farmer RF, Kosty DB, Gau JM. Prevalence, incidence, recovery, and recurrence of alcohol use disorders from childhood to age 30. Drug Alcohol Depend 2019; 194:45-50. [PMID: 30399499 PMCID: PMC7018515 DOI: 10.1016/j.drugalcdep.2018.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the course of alcohol use disorders (AUDs) in representative samples during high-risk periods of adolescence and early adulthood. The primary objective of this research is to describe the prevalence and course of initial AUD episodes experienced between childhood and age 30 in a regionally representative cohort sample. METHODS Study data are from an epidemiological study of 816 youth. Participants were initially selected at random from nine high schools in western Oregon, USA. Four waves of data collection were conducted between ages 16 and 30. AUD course milestones are referenced to participants' age. RESULTS Results indicated that male participants (43%) were significantly more likely to be diagnosed with a lifetime AUD than female participants (28%), OR [CI95] = 1.97 [1.47-2.65], and rate of first incidence was especially high between ages 18 and 24.9, a developmental period that also corresponded to the peak interval in prevalence rates. The rate of first AUD incidence substantially diminished beginning around age 25. Among those with an initial AUD episode, 87% recovered by age 30 and, of these, the average episode length was 23 months. Among recovered cases, 33% went on to experience a second AUD episode (i.e., a recurrence) after a minimum 12-month asymptomatic recovery period. Risk for recurrence remained relatively high within the 5 years following initial AUD offset. CONCLUSIONS AUDs are common lifetime conditions in representative samples, whereby most affected individuals by age 30 experience a time-limited course rather than a recurring or persistent course.
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Affiliation(s)
- John R. Seeley
- University of Oregon, College of Education, 1215 University St., Eugene, OR, 97403, USA,Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, USA
| | - Richard F. Farmer
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, USA
| | - Derek B. Kosty
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, USA
| | - Jeff M. Gau
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, USA
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Proctor SL, Williams DC, Kopak AM, Voluse AC, Connolly KM, Hoffmann NG. Diagnostic Concordance between DSM-5 and ICD-10 Cannabis Use Disorders. Addict Behav 2016; 58:117-22. [PMID: 26922159 DOI: 10.1016/j.addbeh.2016.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/11/2016] [Accepted: 02/14/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES With the recent federal mandate that all U.S. health care settings transition to ICD-10 billing codes, empirical evidence is necessary to determine if the DSM-5 designations map to their respective ICD-10 diagnostic categories/billing codes. The present study examined the concordance between DSM-5 and ICD-10 cannabis use disorder diagnoses. METHOD Data were derived from routine clinical assessments of 6871 male and 801 female inmates recently admitted to a state prison system from 2000 to 2003. DSM-5 and ICD-10 diagnostic determinations were made from algorithms corresponding to the respective diagnostic formulations. RESULTS Past 12-month prevalence rates of cannabis use disorders were comparable across classification systems. The vast majority of inmates with no DSM-5 diagnosis continued to have no diagnosis per the ICD-10, and a similar proportion with a DSM-5 severe diagnosis received an ICD-10 dependence diagnosis. Most of the variation in diagnostic classifications was accounted for by those with a DSM-5 moderate diagnosis in that approximately half of these cases received an ICD-10 dependence diagnosis while the remaining cases received a harmful use diagnosis. CONCLUSIONS Although there appears to be a generally high level of agreement between diagnostic classification systems for those with no diagnosis or those evincing symptoms of a more severe condition, concordance between DSM-5 moderate and ICD-10 dependence diagnoses was poor. Additional research is warranted to determine the appropriateness and implications of the current DSM-5 coding guidelines regarding the assignment of an ICD-10 dependence code for those with a DSM-5 moderate diagnosis.
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Affiliation(s)
| | - Daniel C Williams
- G.V. (Sonny) Montgomery VA Medical Center, Addictive Disorders Treatment Program, USA; University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, USA
| | - Albert M Kopak
- Western Carolina University, Department of Criminology and Criminal Justice, USA
| | - Andrew C Voluse
- G.V. (Sonny) Montgomery VA Medical Center, Addictive Disorders Treatment Program, USA; University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, USA
| | - Kevin M Connolly
- G.V. (Sonny) Montgomery VA Medical Center, Addictive Disorders Treatment Program, USA; University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, USA
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7
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Palm A, Olofsson N, Danielsson I, Skalkidou A, Wennberg P, Högberg U. Motivational interviewing does not affect risk drinking among young women: A randomised, controlled intervention study in Swedish youth health centres. Scand J Public Health 2016; 44:611-8. [PMID: 27289105 DOI: 10.1177/1403494816654047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to analyse risk and binge drinking at 12-month follow-up in young women with risk drinking who received motivational interviewing compared with controls. METHODS Young women attending Swedish youth health centres were randomised into intervention or control groups. The intervention group members were asked about their alcohol consumption by a midwife/social worker using the Alcohol Use Disorders Identification Test Consumption. A score of ⩾5 was used as the cut-off value for risk drinking. Participants with risk drinking in the intervention group received motivational interviewing within the same visit. Participants in the control group had a regular visit with a midwife/social worker and answered the same questions about alcohol consumption in a questionnaire after their visit. A questionnaire with the same questions was administered to participants 12 months after baseline. RESULTS Of 1445 eligible young women, 1051 (73%) consented to randomisation and were enrolled in the study. The follow-up rate was 54%. There was a significant decrease in risk- and binge drinking, from baseline to follow-up, in both the intervention and the control groups. Generalised estimating equation analyses demonstrated no significant effect between groups. Of participants who did not have risk drinking at baseline, about 20% in both groups had developed high-risk drinking by the 12-month follow-up. CONCLUSIONS NO SIGNIFICANT DIFFERENCES IN RISK DRINKING BETWEEN YOUNG WOMEN WHO RECEIVED MOTIVATIONAL INTERVIEWING AND CONTROLS WERE FOUND THERE WAS A LARGE INTRA-INDIVIDUAL MOBILITY IN YOUNG WOMEN'S RISK DRINKING BEHAVIOUR THIS HIGHLIGHTS THE IMPORTANCE OF FINDING RELIABLE SCREENING TOOLS THAT CAN CAPTURE THE MOBILITY IN DRINKING BEHAVIOUR IN YOUTH MORE RESEARCH IS NEEDED BEFORE RECOMMENDATIONS CAN BE MADE.
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Affiliation(s)
- Anna Palm
- Department of Women's and Children's Health, Uppsala University, Sweden Department of Gynaecology and Obstetrics, Sundsvall Hospital, Sweden
| | - Niclas Olofsson
- Department of Health Sciences, Mid Sweden University, Sweden
| | - Ingela Danielsson
- Department of Clinical Sciences Obstetrics and Gynaecology, Umeå University, Sweden
| | | | - Peter Wennberg
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Sweden
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, Sweden
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Stewart DG, Arlt VK, Siebert EC, Chapman MK, Hu EM. Implications ofDSM-IV toDSM-5 Substance Use Disorder Diagnostic Changes in Adolescents Enrolled in a School-Based Intervention. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016. [DOI: 10.1080/1067828x.2015.1049390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Jakubczyk A, Rehm J, Manthey J, Gual A, Wojnar M. Rozpoznawanie uzależnienia od alkoholu przez lekarzy podstawowej opieki zdrowotnej: polskie wyniki europejskiego projektu badawczego Alcoholism in Primary Care. ALCOHOLISM AND DRUG ADDICTION 2015. [DOI: 10.1016/j.alkona.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Wakefield JC, Schmitz MF. The harmful dysfunction model of alcohol use disorder: revised criteria to improve the validity of diagnosis and prevalence estimates. Addiction 2015; 110:931-42. [PMID: 25622535 DOI: 10.1111/add.12859] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/31/2014] [Accepted: 01/14/2015] [Indexed: 11/30/2022]
Abstract
AIMS To formulate harmful dysfunction (HD) diagnostic criteria for alcohol use disorder (AUD) and test whether they increase validity relative to standard DSM criteria, as evidenced by lowered prevalence, increased validator levels including service use, severity and family history and enhanced specificity. DESIGN DSM-IV AUD, DSM-IV dependence, DSM-5 AUD and HD AUD definitions were compared on eight validity related tests using nationally representative community data. SETTING United States. PARTICIPANTS National Epidemiologic Survey of Alcoholism and Related Conditions (NESARC) respondents, aged 18-54 years (wave 1, n = 29 673; wave 2, n = 24 244). MEASURES NESARC DSM-IV and DSM-5 criteria were taken from published studies. Whereas DSM-5 diagnosis requires any two AUD symptoms, HD criteria were constructed from NESARC items to require symptoms of both impaired-control dysfunction [withdrawal, drink to prevent/stop withdrawal, cannot stop/reduce drinking, or craving (wave 2 only)] and harm (sacrificed important activities, problems caring for home/family, job/school problems, health problems, psychological problems or problems with family/friends). Validators included service use, severity and family history, among others. Specificity was tested using a teen transient drinker criterion group. FINDINGS Compared with DSM-5 AUD (DSM-IV results were similar), HD criteria yielded lower prevalence (95% confidence intervals): HD life-time 6.7% (6.2, 7.2%), 1-year 2.3% (2.0, 2.5%); and DSM-5 life-time 38.2% (36.5, 39.9%), 1-year 12.4% (11.7, 13.1%). HD AUD was higher than DSM-5 on pathology validators, including: life-time alcohol-related service use: HD 41.0% (38.1, 43.9%), DSM-5 11.5% (10.7, 12.3%); severity (number of life-time alcohol symptoms): HD 20.8 (20.4, 21.2), DSM-5 10.6 (10.4, 10.8); and family history of alcohol problems: HD 50.1% (47.3, 52.9), DSM-5 32.8% (31.6, 34.0). HD criteria eliminated 83% of a DSM-5 teen transient drinker false-positives criterion group. CONCLUSIONS Prevalence estimates of alcohol use disorder are lowered and diagnostic validity improved when using 'harmful dysfunction' diagnostic criteria compared with standard DSM criteria, partly by reducing misdiagnosis of teenage transient drinkers.
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Affiliation(s)
- Jerome C Wakefield
- School of Social Work and Department of Psychiatry, New York University, New York, NY,, USA
| | - Mark F Schmitz
- School of Social Work, Temple University, Philadelphia, PA,, USA
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11
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Witkiewitz K, Dearing RL, Maisto SA. Alcohol use trajectories among non-treatment-seeking heavy drinkers. J Stud Alcohol Drugs 2014; 75:415-22. [PMID: 24766753 DOI: 10.15288/jsad.2014.75.415] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Heavy drinking, often defined as more than five drinks per occasion, is a major public health problem worldwide, yet most individuals who drink heavily never receive treatment. Focusing on those who receive treatment, numerous studies have found that alcohol use following treatment is discontinuous, with periods of abstinence alternating with periods of heavy drinking. In contrast, little is known about changes in alcohol use among the majority of individuals who engage in heavy drinking and never receive treatment. The goal of this study was to examine changes in alcohol consumption (proportion of heavy drinking days) in a sample of non-treatment-seeking heavy drinkers (n = 151). METHOD The current study focused on three quantitative models--latent growth curve, latent growth mixture, and latent Markov models--to examine changes in the frequency of heavy drinking days (i.e., ≥ 5/4 drinks per day for men/women) among a sample of heavy drinkers who did not receive any form of treatment or self-help over a 2-year period. RESULTS Participants significantly reduced their frequency of heavy drinking over a 2-year period, and changes in drinking did not show the discontinuity in trajectories often observed in treatment samples. Alcohol use disorder diagnosis predicted higher initial levels of frequent heavy drinking but did not predict changes in the frequency of heavy drinking over time. CONCLUSIONS Most individuals, with or without an alcohol use disorder, reported significant reductions in heavy drinking frequency over time. These results have important implications for a public health approach to the problem of heavy drinking.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Ronda L Dearing
- Research Institute on Addictions, The State University of New York, University at Buffalo, Buffalo, New York
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
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Ahacic K, Kennison RF, Kåreholt I. Alcohol abstinence, non-hazardous use and hazardous use a decade after alcohol-related hospitalization: registry data linked to population-based representative postal surveys. BMC Public Health 2014; 14:874. [PMID: 25150844 PMCID: PMC4153888 DOI: 10.1186/1471-2458-14-874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 08/18/2014] [Indexed: 12/20/2022] Open
Abstract
Background Although there is evident association between alcohol-related hospitalization and alcohol use, the relationship has not been well examined. This study analyzed the extent of alcohol abstinence, non-hazardous use and hazardous use among people who had experienced alcohol-related hospitalization during the preceding decade. Method Registry data concerning alcohol-related hospitalizations between 1996 and 2007 were linked to two representative surveys, in 2006 and 2007, of residents of Stockholm County. Relevant contrasts were modeled, using logistic regression, in the pooled sample (n = 54 955). Ages were 23–84 years at follow-up. Results Among persons previously hospitalized (n = 576), half reported non-hazardous use. Non-hazardous use was less prevalent than in the general population – and the extent of non-hazardous use did not change over time following hospitalization. There were no significant age differences, but non-hazardous use was less frequent among people with repeated episodes of care. One in six was abstinent. Abstinence was more common among the old, while hazardous use (exceeding 14 drinks per week for men, and 9 drinks per week for women) decreased with age. Abstinence also increased over time; among persons hospitalized ten years ago, the abstinence rate was twice that of the general population. Associations with hazardous use over time were less conclusive. Hazardous use among those previously hospitalized decreased over time in one sample but not in the other. After pooling the data, there were indications of a decrease over time following hospitalization, but more prevalent hazardous use than in the general population. Conclusions Following alcohol-related hospitalization, abstinence increased, and there was no evidence of regression towards the mean, i.e., towards non-hazardous use. Abstinence was also more widespread among previously hospitalized persons of older ages. With advancing age, changing hazardous alcohol habits among previously hospitalized appears to yield a trend towards promotion of abstinence.
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Affiliation(s)
- Kozma Ahacic
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden.
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13
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Tuithof M, ten Have M, van den Brink W, Vollebergh W, de Graaf R. Alcohol consumption and symptoms as predictors for relapse of DSM-5 alcohol use disorder. Drug Alcohol Depend 2014; 140:85-91. [PMID: 24793368 DOI: 10.1016/j.drugalcdep.2014.03.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Alcohol consumption levels and alcohol use disorder (AUD) symptoms may serve as easily quantifiable markers for AUD relapse after remission and might help prevention workers identify at-risk individuals. We investigated the predictive value of alcohol consumption and AUD symptoms on relapse. METHODS Data are from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). We selected 506 people in ≥12-month DSM-5 AUD remission at baseline and assessed their status at 3-year follow-up. AUD symptoms and drinking patterns were assessed using the Composite International Diagnostic Interview 3.0. Time since remission was assessed retrospectively at baseline and ranged from 1 to 48 years. Predictors for relapse were examined using Cox regression analysis. RESULTS Cumulative AUD relapse rate was 5.6% at 5 years, 9.1% at 10 years and 12.0% at 20 years. Relapse was predicted by both medium (15-28/22-42 drinks weekly for women/men) and high (≥29/43) past alcohol intake, 6+ lifetime AUD symptoms, 'impaired control over use', and at-risk (≥8/15) current intake. The risk of relapse was especially high when medium or high past intake or 6+ lifetime symptoms coincided with current at-risk drinking. CONCLUSIONS Only a minority of people in DSM-5 AUD remission relapsed, but the risk of relapse increased substantially with the presence of at least one of the risk factors. Moreover, at-risk current drinking coupled with other risk factors substantially increased the likelihood of relapse. Therefore, current drinking may provide an adequate reference point for relapse prevention.
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Affiliation(s)
- Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands.
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Wilma Vollebergh
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
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Schellekens AFA, de Jong CAJ, Buitelaar JK, Verkes RJ. Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment. Eur Psychiatry 2014; 30:128-36. [PMID: 24630346 DOI: 10.1016/j.eurpsy.2013.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Alcohol dependence and anxiety disorders often co-occur. Yet, the effect of co-morbid anxiety disorders on the alcohol relapse-risk after treatment is under debate. This study investigated the effect of co-morbid anxiety disorders on relapse rates in alcohol dependence. We hypothesized that co-morbid anxiety disorders would be particularly predictive for early relapse, but not late relapse. SUBJECTS AND METHODS In a prospective design, male alcohol dependent patients (n=189) were recruited from an inpatient detoxification clinic. Psychiatric diagnoses and personality traits were assessed using the Mini International Neuropsychiatric Interview for psychiatric disorders and the Temperament and Character Inventory. The addiction severity index was used to assess addiction severity and follow-up. RESULTS One year after detoxification, 81 patients (53%) relapsed and nine patients (7%) were deceased, due to alcohol related causes. Co-morbid anxiety disorder, marital status, addiction severity, in particular legal problems, and harm avoidance predicted relapse. Anxiety disorders specifically predicted early relapse. CONCLUSION Alcohol dependence is a severe mental disorder, with high relapse rates and high mortality. Alcohol dependent patients with co-morbid anxiety disorders are particularly prone to relapse during the first three months of treatment. These patients may therefore require additional medical and psychological attention.
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Affiliation(s)
- A F A Schellekens
- Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands; Nijmegen Institute for Science Practitioners in Addiction (NISPA).
| | - C A J de Jong
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)
| | - J K Buitelaar
- Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands
| | - R J Verkes
- Department of Cognitive Neuroscience, University Medical Centre
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15
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Wakefield JC, Schmitz MF. How Many People have Alcohol Use Disorders? Using the Harmful Dysfunction Analysis to Reconcile Prevalence Estimates in Two Community Surveys. Front Psychiatry 2014; 5:10. [PMID: 24550847 PMCID: PMC3910138 DOI: 10.3389/fpsyt.2014.00010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 01/17/2014] [Indexed: 11/22/2022] Open
Abstract
Community prevalence rates of alcohol use disorders (AUDs) provided by epidemiological studies using DSM-based diagnostic criteria pose several challenges: the rates appear implausibly high to many epidemiologists; they do not converge across similar studies; and, due to low service utilization by those diagnosed as disordered, they yield estimates of unmet need for services so high that credibility for planning purposes is jeopardized. For example, two early community studies using DSM diagnostic criteria, the Epidemiologic Catchment Area Study (ECA) and the National Comorbidity Survey (NCS), yielded lifetime AUD prevalence rates of 14 and 24%, respectively, with NCS unmet need for services 19% of the entire population. Attempts to address these challenges by adding clinical significance requirements to diagnostic criteria have proven unsuccessful. Hypothesizing that these challenges are due to high rates of false-positive diagnoses of problem drinking as AUDs, we test an alternative approach. We use the harmful dysfunction (HD) analysis of the concept of mental disorder as a guide to construct more valid criteria within the framework of the standard out-of-control model of AUD. The proposed HD criteria require harm and dysfunction, where harm can be any negative social, personal, or physical outcome, and dysfunction requires either withdrawal symptoms or inability to stop drinking. Using HD criteria, ECA and NCS lifetime prevalences converge to much-reduced rates of 6 and 6.8%, respectively. Due to higher service utilization rates, NCS lifetime unmet need is reduced to 3.4%. Service use and duration comparisons suggest that HD criteria possess increased diagnostic validity. Moreover, HD criteria eliminate 90% of transient teenage drinking from disorder status. The HD version of the out-of-control model thus potentially resolves the three classic prevalence challenges while offering a more rigorous approach to distinguishing AUDs from problematic drinking.
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Affiliation(s)
- Jerome C. Wakefield
- Silver School of Social Work and Department of Psychiatry, School of Medicine, New York University, New York, NY, USA
| | - Mark F. Schmitz
- School of Social Work, Temple University, Philadelphia, PA, USA
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16
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Jackson KM, Bucholz KK, Wood PK, Steinley D, Grant JD, Sher KJ. Towards the characterization and validation of alcohol use disorder subtypes: integrating consumption and symptom data. Psychol Med 2014; 44:143-159. [PMID: 23551901 PMCID: PMC3856175 DOI: 10.1017/s0033291713000573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is evidence that measures of alcohol consumption, dependence and abuse are valid indicators of qualitatively different subtypes of alcohol involvement yet also fall along a continuum. The present study attempts to resolve the extent to which variations in alcohol involvement reflect a difference in kind versus a difference in degree. METHOD Data were taken from the 2001-2002 National Epidemiologic Survey of Alcohol and Related Conditions. The sample (51% male; 72% white/non-Hispanic) included respondents reporting past 12-month drinking at both waves (wave 1: n = 33644; wave 2: n = 25186). We compared factor mixture models (FMMs), a hybrid of common factor analysis (FA) and latent class analysis (LCA), against FA and LCA models using past 12-month alcohol use disorder (AUD) criteria and five indicators of alcohol consumption reflecting frequency and heaviness of drinking. RESULTS Model comparison revealed that the best-fitting model at wave 1 was a one-factor four-class FMM, with classes primarily varying across dependence and consumption indices. The model was replicated using wave 2 data, and validated against AUD and dependence diagnoses. Class stability from waves 1 to 2 was moderate, with greatest agreement for the infrequent drinking class. Within-class associations in the underlying latent factor also revealed modest agreement over time. CONCLUSIONS There is evidence that alcohol involvement can be considered both categorical and continuous, with responses reduced to four patterns that quantitatively vary along a single dimension. Nosologists may consider hybrid approaches involving groups that vary in pattern of consumption and dependence symptomatology as well as variation of severity within group.
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Affiliation(s)
- K. M. Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - K. K. Bucholz
- Washington University School of Medicine in St Louis, St Louis, MO, USA
- Midwest Alcoholism Research Center
| | - P. K. Wood
- Midwest Alcoholism Research Center
- University of Missouri-Columbia, Columbia, MO, USA
| | - D. Steinley
- Midwest Alcoholism Research Center
- University of Missouri-Columbia, Columbia, MO, USA
| | - J. D. Grant
- Washington University School of Medicine in St Louis, St Louis, MO, USA
- Midwest Alcoholism Research Center
| | - K. J. Sher
- Midwest Alcoholism Research Center
- University of Missouri-Columbia, Columbia, MO, USA
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17
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Dawson DA. Commentary on Tuithof et al. (2013): Implications of the DSM-5 revision for the analysis of persistence/remission of alcohol use disorder. Addiction 2013; 108:2100-1. [PMID: 24237899 PMCID: PMC4098938 DOI: 10.1111/add.12351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Deborah A. Dawson
- Senior Scientist, Kelly Government Services and Contractor, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda Maryland, USA
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18
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Tuithof M, Ten Have M, van den Brink W, Vollebergh W, de Graaf R. Predicting persistency of DSM-5 alcohol use disorder and examining drinking patterns of recently remitted individuals: a prospective general population study. Addiction 2013; 108:2091-9. [PMID: 23889861 DOI: 10.1111/add.12309] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/06/2013] [Accepted: 07/17/2013] [Indexed: 12/18/2022]
Abstract
AIMS To establish the 3-year persistency rate of alcohol use disorder (AUD) and its predictors, and to examine drinking patterns of recently remitted individuals. DESIGN AND SETTING The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) surveyed a nationally representative sample of adults (aged 18-64 years) at baseline (response = 65.1%) and 3-year follow-up (response = 80.4%). PARTICIPANTS People with AUD at baseline, as defined by DSM-5 (n = 198). MEASUREMENTS AUD, drinking patterns and mental disorders were assessed using the Composite International Diagnostic Interview 3.0. Other predictors were assessed with an additional questionnaire. Predictors of persistency were examined with univariable and multivariable logistic regression analyses. RESULTS The AUD persistency rate was 29.5% [95% confidence intervals (CI) = 20.0-39.0]. In the multivariable model, the older (25-34 and 35-44) age groups had lower AUD persistency [odds ratio (OR) = 0.05; 95% CI = 0.00-0.49 and OR = 0.14; 95% CI = 0.02-0.79, respectively] than the youngest age group (18-24). A higher number of weekly drinks and a comorbid anxiety disorder predicted AUD persistency (OR = 1.03; 95% CI = 1.00-1.07 and OR = 4.56; 95% CI = 1.04-20.06, respectively). Furthermore, remission was associated with a reduction of six drinks per week between T0 and T1 . It should be noted, however, that 35.8% (95% CI = 22.4-49.2) of people in diagnostic remission still drank more than the recommended maximum (more than seven/14 drinks weekly for women/men). CONCLUSIONS Only a minority of people in the Netherlands with alcohol use disorder as defined by DSM-5 still have the disorder 3 years later. Factors that help to identify people at risk of alcohol use disorder persistence are: younger age, a higher number of weekly drinks and a comorbid anxiety disorder. A substantial number of people recently in diagnostic remission still drink above the maximum recommended level.
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Affiliation(s)
- Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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19
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Tuithof M, ten Have M, van den Brink W, Vollebergh W, de Graaf R. The Relationship Between Excessive Alcohol Consumption and Alcohol Use Disorders According to DSM-IV and DSM-5. Alcohol Clin Exp Res 2013; 38:249-56. [DOI: 10.1111/acer.12248] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/05/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction ; Utrecht the Netherlands
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction ; Utrecht the Netherlands
| | - Wim van den Brink
- Department of Psychiatry ; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - Wilma Vollebergh
- Department of Interdisciplinary Social Science ; Utrecht University; Utrecht the Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction ; Utrecht the Netherlands
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20
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van Amsterdam J, van den Brink W. The high harm score of alcohol. Time for drug policy to be revisited? J Psychopharmacol 2013; 27:248-55. [PMID: 23325370 DOI: 10.1177/0269881112472559] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this paper is to create awareness of the negative health impact and economic burden and benefits associated to alcohol consumption. Worldwide about two billion people consume alcohol. Low intake of alcohol has a minor protective cardiovascular effect. On the other hand, even moderate alcohol consumption appears to be weakly, but significantly, associated to a limited number of chronic diseases. Alcohol causes a considerable economic burden to society due to the high absolute number of alcohol consumers. As such, alcohol abuse is more harmful for public health and society than illicit drug use. Some 3.7% of alcohol consumers (worldwide 76 million people) have an alcohol use disorder leading to 60-70% of the societal costs related to alcohol. Therefore, policy measures should, in addition to regulatory measures to reduce alcohol use, aim at closing the treatment gap and improving treatment effectiveness of people with an alcohol use disorder. The key message is that policy-makers unjustifiably focus on the harm of illicit drugs, whereas they underestimate the harm of alcohol use. Policy makers should therefore consider alcohol to be at least as harmful as illicit drugs and invest more in prevention and harm reduction strategies for alcohol abuse and dependence.
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Affiliation(s)
- Jan van Amsterdam
- Laboratory for Health Protection Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
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21
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Joos L, Glazemakers I, Dom G. Alcohol use and hazardous drinking among medical specialists. Eur Addict Res 2013; 19:89-97. [PMID: 23128570 DOI: 10.1159/000341993] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/17/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alcohol use among medical specialists remains a delicate topic. However, the number of prevalence studies remains very limited in Western European countries. AIMS To explore alcohol use and hazardous drinking among male and female medical specialists. METHODS All medical specialists in Belgium--a typical Western European country regarding alcohol use--were invited to participate. Alcohol use and abuse were measured using the Alcohol Use Disorder Identification Test (AUDIT) and the CAGE screen (acronym based on the four items it contains: 'Cut down drinking', 'Annoyed by criticism', 'Guilty feelings' and 'Eye opener'). RESULTS A sample of 1,501 specialists completed the survey. The composition of the sample was comparable with that of the overall population of specialists in Belgium regarding gender, age and specialties. A proportion of 18% of the specialists could be classified as hazardous drinkers and 16.8% reported binge drinking at least once a month. Female medical specialists drank less than their male counterparts; however, a substantial proportion of female specialists (14.9%) displayed higher risk levels of hazardous drinking. Significant differences were found between specialties on the CAGE screen. Finally, younger medical specialists tended to display healthier alcohol use patterns compared with their older counterparts. CONCLUSION Medical specialists tend to indulge in more hazardous drinking compared with the general population (10%). The alcohol use patterns of female doctors tend to move towards those of males.
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Affiliation(s)
- Leen Joos
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Wilrijk, Belgium.
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22
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Copeland WE, Angold A, Shanahan L, Dreyfuss J, Dlamini I, Costello EJ. Predicting persistent alcohol problems: a prospective analysis from the Great Smoky Mountain Study. Psychol Med 2012; 42:1925-1935. [PMID: 22153225 PMCID: PMC3411932 DOI: 10.1017/s0033291711002790] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Rates of alcohol disorders peak in late adolescence and decrease substantially into the mid-20s. Our aim was to identify risk factors that predict alcohol problems that persist into the mid-20s. METHOD Data are from the prospective, population-based Great Smoky Mountains Study (GSMS; n=1420), which followed children through late adolescence and into young adulthood. Alcohol persisters were defined as subjects with an alcohol disorder (abuse or dependence) in late adolescence (ages 19 and 21 years) that continued to meet criteria for an alcohol disorder at the mid-20s assessment. RESULTS The 3-month prevalence of having an alcohol disorder (abuse or dependence) decreased markedly from late adolescence into the mid-20s. A third of late adolescents with an alcohol disorder continued to meet criteria for an alcohol disorder in young adulthood (37 of 144 who met criteria in late adolescence). Risk factors for persister status included multiple alcohol abuse criteria during late adolescence but no alcohol dependence criteria. Risk factors for persister status also included associated features of alcohol dependence such as craving alcohol and drinking to unconsciousness. Persister status was also associated with depression, cannabis dependence and illicit substance use, but not with other psychiatric disorders. More than 90% of late adolescents with three or more of the risk factors identified met criteria for a young adult alcohol disorder. CONCLUSIONS Symptoms of alcohol abuse, not dependence, best predict long-term persistence of alcohol problems. The set of risk factors identified may be a useful screen for selective and indicated prevention efforts.
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Affiliation(s)
- W E Copeland
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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23
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Boschloo L, Vogelzangs N, van den Brink W, Smit JH, Beekman ATF, Penninx BWJH. Predictors of the 2-year recurrence and persistence of alcohol dependence. Addiction 2012; 107:1639-40. [PMID: 22372473 DOI: 10.1111/j.1360-0443.2012.03860.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS To identify independent risk factors of the recurrence of alcohol dependence (AD) in people with a remitted disorder at baseline and persistence of AD in people with a current disorder at baseline. DESIGN Prospective cohort study with assessments at baseline and 2-year follow-up. SETTING Recruitment from the general population, primary care and out-patient mental health-care services. PARTICIPANTS People with remitted AD (n = 253) and current AD (n = 135). MEASUREMENTS Recurrence and persistence of AD during 2-year follow-up were established using the Composite International Diagnostic Interview (CIDI) interview based on DSM-IV. Logistic regression analyses were performed to explore the role of potential risk factors (i.e. baseline severity of alcohol problems, measures for depression and anxiety, socio-demographics, vulnerability factors and addiction-related factors) as independent predictors of a negative course. FINDINGS Overall recurrence and persistence rates of AD were 14.6 and 40.7%, respectively, and were highly conditional on the severity of alcohol problems [adjusted odds ratio (OR) per standard deviation (SD) increase: OR = 3.64, 95% confidence interval (CI): 2.21-6.01 and OR = 2.12, 95% CI: 1.32-3.40, respectively). Severity of depressive/anxiety symptoms was an additional independent predictor of the recurrence of AD, whereas male gender and high education were significant independent risk factors of the persistence of AD. CONCLUSIONS Alcohol dependence has a dynamic course, with only moderate levels of diagnostic stability. Both recurrence and persistence of alcohol dependence are highly dependent on severity of baseline alcohol problems, whereas severity of depressive/anxiety symptoms predicts only the recurrence of alcohol dependence. Both measures may be useful in identifying people at an increased risk of a negative course and who could be targeted by prevention strategies.
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Affiliation(s)
- Lynn Boschloo
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
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24
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Cunningham JA, McCambridge J. Is alcohol dependence best viewed as a chronic relapsing disorder? Addiction 2012; 107:6-12. [PMID: 21981681 PMCID: PMC3272223 DOI: 10.1111/j.1360-0443.2011.03583.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 03/07/2011] [Accepted: 06/29/2011] [Indexed: 11/28/2022]
Abstract
This 'For Debate' paper starts by recognizing the growing trend towards considering alcohol dependence as a chronic relapsing disorder. We argue that the adoption of this model results from focusing on those in treatment for alcohol dependence rather than considering the larger number of people in the general population who meet criteria for alcohol dependence at some point in their lives. The majority of the general population who ever experience alcohol dependence do not behave as though they have a chronic relapsing disorder: they do not seek treatment, resolve their dependence themselves and do not relapse repeatedly. We suggest that caution is therefore needed in using the chronic relapsing disorder label. Our primary concerns are that this formulation privileges biological aspects of dependence to the detriment of psychological and social contributions, it inhibits much-needed developments in understanding alcohol dependence and leads to inefficient distributions of public health and clinical care resources for alcohol dependence. We invite debate on this issue.
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Stecker T, McGovern MP, Herr B. An intervention to increase alcohol treatment engagement: a pilot trial. J Subst Abuse Treat 2011; 43:161-7. [PMID: 22138200 DOI: 10.1016/j.jsat.2011.10.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 09/26/2011] [Accepted: 10/25/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Previous research has documented the difficulty individuals with alcohol use disorders have initiating alcohol treatment. This study assessed the feasibility of a brief, cognitive-behavioral intervention designed to increase treatment initiation among individuals with alcohol use disorders. METHODS This randomized controlled trial included 196 participants who screened positive for a possible alcohol use disorder on the alcohol use disorders identification test. Randomly assigned intervention participants were administered a brief cognitive-behaviorally-based intervention by telephone designed to modify beliefs that may interfere with treatment-seeking behavior. Beliefs about treatment and treatment-seeking behavior were assessed postintervention. RESULTS Participants receiving the intervention had significantly improved their attitudes toward addiction treatment (p < .002) and increased their reported intention-to-seek treatment (p < .000) postintervention. Further, intervention participants were almost three times more likely to attend treatment within a 3-month period (odds ratio = 2.60, p < .025) than participants in the control group. CONCLUSIONS A brief, cognitive-behavioral intervention delivered by telephone and focused on modifying treatment-interfering beliefs holds promise for increasing alcohol treatment seeking among individuals in need.
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Affiliation(s)
- Tracy Stecker
- Psychiatric Research Center, Dartmouth Medical School, Lebanon, NH 03766, USA.
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26
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Abstract
AIMS To determine the prevalence of past 12-month DSM-5 alcohol use disorders (AUDs), to quantify and characterize individuals who remain stably unaffected or affected and those who 'switch' diagnostically between DSM-IV and DSM-5 classifications. DESIGN Data from the nationally representative wave 2 of the National Epidemiological Survey of Alcohol and Related Conditions (NESARC) collected in 2004-05. SETTING General population survey. PARTICIPANTS All surveyed participants (n=34,653, aged 21 years and older) and 29,993 individuals reporting life-time alcohol use across both waves of NESARC. MEASUREMENTS DSM-IV and DSM-5 criteria were coded using proposed guidelines. FINDINGS The prevalence of DSM-5 AUDs was 10.8% with the corresponding prevalence of DSM-IV abuse/dependence being 9.7%, implying a modest 11.3% increase. Those who switched diagnostically from affected to unaffected (19.6% of DSM-IV affected) were most likely to have endorsed hazardous use, due particularly to drinking and driving, while those who transitioned from unaffected to affected (3.3% of DSM-IV unaffected) were primarily DSM-IV diagnostic orphans reporting larger/longer and quit/cut-back. Dropping the legal criterion did not affect the prevalence significantly, while the addition of craving also had a relatively modest impact on prevalence. CONCLUSION The proposed DSM-5 revisions eliminate successfully individuals diagnosed previously with DSM-IV alcohol abuse due primarily to hazardous use alone and incorporate diagnostic orphans into the diagnostic realm. Definitions of craving and importantly, hazardous use require considerable attention as it is likely that they will contribute to variations in reports of increased prevalence of alcohol use disorders between DSM-IV to DSM-5.
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Affiliation(s)
- Arpana Agrawal
- Washington University School of Medicine, Department of Psychiatry, Saint Louis, MO 63110, USA.
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27
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Mewton L, Slade T, McBride O, Grove R, Teesson M. An evaluation of the proposed DSM-5 alcohol use disorder criteria using Australian national data. Addiction 2011; 106:941-50. [PMID: 21205055 DOI: 10.1111/j.1360-0443.2010.03340.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS To evaluate the proposed revisions to the DSM-IV alcohol use disorder criteria using epidemiological data. DESIGN, SETTING AND PARTICIPANTS Data came from the 1997 Australian National Survey of Mental Health and Well-Being. The sample consisted of 10, 641 participants aged 18 years and over. MEASUREMENTS Alcohol use disorders were assessed using a revised version of the CIDI version 2.0. Alcohol use disorders were assessed in all respondents who indicated that they had used alcohol more than 12 times in the previous 12 months (n = 7746). FINDINGS The proposed introduction of a single alcohol use disorder was supported by confirmatory factor analysis (CFA). DSM-5 criteria were all indicators of a single underlying disorder. Under DSM-5, the prevalence of alcohol use disorders would increase by 61.7% when compared with those diagnosed under DSM-IV. When investigating the most appropriate diagnostic threshold, the 3+ threshold maximized agreement between DSM-IV and DSM-5 diagnoses, and produced similar prevalence estimates to those yielded by DSM-IV. Item response theory (IRT) analyses supported the removal of the legal criterion while provided equivocal results for the craving criterion. CONCLUSIONS Under the proposed DSM-IV revisions for alcohol use disorders, estimates of the prevalence in the general population would increase substantially. Whereas evidence supports some of the revisions such as a single underlying disorder, others such as the 2+ threshold for diagnosis of alcohol use disorder and the inclusion of a 'craving' criterion may be problematic.
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Affiliation(s)
- Louise Mewton
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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28
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Lopez-Quintero C, Hasin DS, de los Cobos JP, Pines A, Wang S, Grant BF, Blanco C. Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addiction 2011; 106:657-69. [PMID: 21077975 PMCID: PMC3227547 DOI: 10.1111/j.1360-0443.2010.03194.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To estimate the general and racial/ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances. DESIGN Data were collected from structured diagnostic interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. SETTING The 2001-2002 National Epidemiological Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample from US adults (n = 43,093) selected in a three-stage sampling design. PARTICIPANTS The subsamples of individuals with life-time DSM-IV diagnosis of dependence on nicotine (n = 6937), alcohol (n = 4781), cannabis (n = 530) and cocaine (n = 408). MEASUREMENTS Cumulative probability estimates of dependence remission for the general population and across racial/ethnic groups. Hazard ratios for remission from dependence. FINDINGS Life-time cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively. Males, Blacks and individuals with diagnosis of personality disorders and history of substance use comorbidity exhibited lower hazards of remission for at least two substances. CONCLUSIONS A significant proportion of individuals with dependence on nicotine, alcohol, cannabis or cocaine achieve remission at some point in their life-time, although the probability and time to remission varies by substance and racial/ethnic group. Several predictors of remission are shared by at least two substances, suggesting that the processes of remission overlap. The lower rates of remission of individuals with comorbid personality or substance use disorders highlight the need for providing coordinated psychiatric and substance abuse interventions.
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Affiliation(s)
- Catalina Lopez-Quintero
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Deborah S. Hasin
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - José Pérez de los Cobos
- Addictive Behaviors Unit of Psychiatry Department, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
| | | | - Shuai Wang
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD 20892
| | - Carlos Blanco
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032
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de Graaf R, Ten Have M, van Dorsselaer S. The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods. Int J Methods Psychiatr Res 2010; 19:125-41. [PMID: 20641046 PMCID: PMC6878518 DOI: 10.1002/mpr.317] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The psychiatric epidemiological population study NEMESIS-2 (Netherlands Mental Health Survey and Incidence Study-2) replicates and expands the first Netherlands Mental Health Survey and Incidence Study (NEMESIS-1) conducted from 1996 to 1999. The main objectives of the new study are to provide up-to-date figures on the prevalence, incidence, course and consequences of mental disorders, and to study trends in mental disorders and service use, with the use of a new sample. New topics not included in NEMESIS-1 were added, e.g. impulse-control disorders, and genetic correlates of mental disorders through gathering DNA from saliva samples. This paper gives an overview of the design of NEMESIS-2, especially of its recently completed first wave. NEMESIS-2 is a prospective study among Dutch-speaking subjects aged 18-64 years from the general Dutch population. Its baseline wave included 6646 subjects. Three waves are planned with three year-intervals between the waves. A multistage, stratified random sampling procedure was applied. The baseline wave of NEMESIS-2 was performed between November 2007 and July 2009. Face-to-face interviews were administered with the Composite International Diagnostic Interview (CIDI) 3.0. The response rate was 65.1%, and 76.4% of the respondents donated saliva. The sample was reasonably nationally representative, but younger subjects were somewhat underrepresented. In conclusion, we were able to build a comprehensive dataset of good quality, permitting several topics to be studied in the future.
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Affiliation(s)
- Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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Foa EB, Williams MT. Methodology of a randomized double-blind clinical trial for comorbid posttraumatic stress disorder and alcohol dependence. ACTA ACUST UNITED AC 2010; 3:131-147. [PMID: 22942892 DOI: 10.1080/17523281003738661] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION: Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are each associated with profound disruptions in psychological, social, and physical functioning, and these disruptions are compounded in individuals with both disorders. Comorbidity between the two disorders is high, with the risk for AD increasing substantially among individuals with PTSD and, conversely, PTSD is highly prevalent among people experiencing AD. AIMS: Given the increased impairment associated with this comorbidity, it is imperative to develop effective treatments for individuals who experience both disorders. METHODS: This paper describes the methodology of a study that examines the efficacy of prolonged exposure therapy alone, naltrexone alone, and their combination compared to pill placebo in reducing the severity of PTSD and alcohol use in individuals with comorbid AD and PTSD. DISCUSSION: Issues related to design, assessment, treatment choice, and challenges posed by the study population are discussed.
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Affiliation(s)
- Edna B Foa
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
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Heinberg LJ, Ashton K. History of substance abuse relates to improved postbariatric body mass index outcomes. Surg Obes Relat Dis 2010; 6:417-21. [PMID: 20655025 DOI: 10.1016/j.soard.2010.04.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 03/29/2010] [Accepted: 04/11/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent clinical guidelines have identified current alcohol or substance abuse as contraindications for weight loss surgery. Past research has indicated that a lifetime history of any substance use disorder is significantly greater in those seeking weight loss surgery than the population base rate. However, current substance abuse has been reported to be remarkably low (<1%). The objective was to examine whether a history of substance abuse/dependence is associated with differing weight loss outcomes after bariatric surgery. METHODS A total of 413 patients who had undergone weight loss surgery (75.8% women, 77.7% white, mean age 47.72 years, mean body mass index 50.27 kg/m(2)) at the Cleveland Clinic Bariatric and Metabolic Institute completed a psychological evaluation before surgery, and a history of substance abuse and/or dependence was determined. RESULTS A series of analyses of covariance examining group differences in the percentage of excess weight loss (%EWL) at 1, 3, 6 , 9, and 12 months after surgery were conducted comparing a history of substance abuse/dependence (SA+; n = 45) with the absence of a substance abuse/dependence history (SA-; n = 368), controlling for the baseline body mass index. The groups did not differ in the type of surgery or %EWL at 1 and 3 months of follow-up. However, after adjusting for the baseline body mass index, the patients with a substance abuse history had a significantly greater %EWL at 6 and 9 months postoperatively, with a trend toward significance at the 12-month follow-up visit. CONCLUSION Patients with a substance abuse/dependence history had a greater %EWL from 6 months postoperatively onward. Future research should examine longer term outcomes among SA+ patients and the possible explanations for their short-term improved outcomes compared with SA- patients.
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Affiliation(s)
- Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio 44195, USA.
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Billieux J, der Linden MV. Addictions et mécanismes d'autorégulation : pour une approche multifactorielle et dynamique. ACTA ACUST UNITED AC 2010. [DOI: 10.3917/psyt.161.0045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Dawson DA, Goldstein RB, Grant BF. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcohol Clin Exp Res 2008; 31:2036-45. [PMID: 18034696 DOI: 10.1111/j.1530-0277.2007.00536.x] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is little information on the stability of abstinent and nonabstinent remission from alcohol dependence in the general U.S. population. The aim of this study was to examine longitudinal changes in recovery status among individuals in remission from DSM-IV alcohol dependence, including rates and correlates of relapse, over a 3-year period. METHODS This analysis is based on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of U.S. adults aged 18 years and older originally interviewed in 2001 to 2002 and reinterviewed in 2004 to 2005. The Wave 1 NESARC identified 2,109 individuals who met the DSM-IV criteria for full remission from alcohol dependence. Of these, 1,772 were reinterviewed at Wave 2, comprising the analytic sample for this study. Recovery status at Wave 2 was examined as a function of type of remission at Wave 1, with a focus on rates of relapse, alternately defined as recurrence of any alcohol use disorder (AUD) symptoms and recurrence of DSM-IV alcohol dependence. Logistic regression models were used to estimate the odds of relapse among asymptomatic risk drinkers and low-risk drinkers relative to abstainers, adjusted for a wide range of potential confounders. RESULTS By Wave 2, 51.0% of the Wave 1 asymptomatic risk drinkers had experienced the recurrence of AUD symptoms, compared with 27.2% of low-risk drinkers and 7.3% of abstainers. Across all ages combined, the adjusted odds of recurrence of AUD symptoms relative to abstainers were 14.6 times as great for asymptomatic risk drinkers and 5.8 times as great for low-risk drinkers. The proportions of individuals who had experienced the recurrence of dependence were 10.2, 4.0, and 2.9%, respectively, and the adjusted odds ratios relative to abstainers were 7.0 for asymptomatic risk drinkers and 3.0 for low-risk drinkers. Age significantly modified the association between type of remission and relapse. Differences by type of remission were not significant for younger alcoholics, who had the highest rates of relapse. CONCLUSIONS Abstinence represents the most stable form of remission for most recovering alcoholics. Study findings highlight the need for better approaches to maintaining recovery among young adults in remission from alcohol dependence, who are at particularly high risk of relapse.
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Affiliation(s)
- Deborah A Dawson
- Laboratory of Epidemiology and Biometry, Division of Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland 20892-9304, USA.
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The 14-year course of alcoholism in a community sample: do men and women differ? Drug Alcohol Depend 2008; 93:1-11. [PMID: 17935914 PMCID: PMC2324065 DOI: 10.1016/j.drugalcdep.2007.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 08/02/2007] [Accepted: 08/12/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the course of alcoholism in males and females in a 14-year follow-up of persons with DSM-III alcoholism compared to very heavy drinkers and unaffected controls in a community sample. METHODS Case-control study based on data from the 1997 Health Services Use and Cost study, a 14-year follow-up survey of 442 individuals who participated in two waves of the 1981-1983 St. Louis Epidemiologic Catchment Area study. Cases met criteria for DSM-III alcohol abuse (AA) or dependence (AD) at both waves of the ECA: "Two-times Alcohol Use Disorder Positives (ECA 2t-AUDPs)." Two comparison groups were frequency matched to 2t-AUDPs: (1) ECA Very Heavy Drinkers/One-time Alcohol Use Disorder Positives (ECA VHD/1t-AUDPs) and (2) ECA alcohol-unaffecteds. Lifetime and past year alcohol use disorders, patterns of drinking and recovery among males and females are reported. RESULTS 84.6% of 2t-AUDPs again met lifetime DSM-III criteria at 14-year follow-up. At follow-up, only 9.3% male 2t-AUDPs and 20.7% female 2t-AUDPs met past year DSM-IV AUD criteria. Past year drinking patterns, however, revealed higher rates of DSM-IV AA or AD, problem or risk drinking among 2t-AUDPs (61.7%) compared to both ECA VHD/1t-AUDPs (41.2%) and ECA alcohol-unaffecteds (22.1%). CONCLUSIONS In a community sample, the rate of past year DSM-IV alcohol dependence was lower among male 2t-AUDPs than females, though both groups showed past year rates substantially lower than lifetime rates. However, less than half of ECA 2t-AUDPs exhibited low-risk or abstinent alcohol use behaviors, indicating that while remission from diagnosis is common, clinical relevance persists.
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LaPlante DA, Nelson SE, LaBrie RA, Shaffer HJ. Stability and progression of disordered gambling: lessons from longitudinal studies. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:52-60. [PMID: 18286872 DOI: 10.1177/070674370805300108] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Few studies have explicitly examined the stability (that is, the tendency for individuals to stay at one diagnostic level as opposed to moving to another improved or worsened level) or progression of disordered gambling; however, conventional wisdom holds that disordered gambling is intractable and escalating. The objective of this study was to examine these assumptions. METHOD We reviewed 5 recent prospective studies of gambling behaviour among nontreatment samples for evidence related to the stability and progression of disordered gambling. RESULTS Our review found no evidence to support the assumption that individuals cannot recover from disordered gambling (that is, the persistence assumption), no evidence to support the assumption that individuals who have more severe gambling problems are less likely to improve than individuals who have less severe gambling problems (that is, the selective-stability assumption), and no evidence to support the assumption that individuals who have some gambling problems are more likely to worsen than individuals who do not have gambling problems (that is, the progression assumption). CONCLUSION Contrary to professional and conventional wisdom suggesting that gambling problems are always progressive and enduring, this review demonstrates instability and multidirectional courses in disordered gambling.
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Affiliation(s)
- Debi A LaPlante
- Research Faculty, Division on Addictions, Cambridge Health Alliance, Harvard Medical School, Medford, Massachusetts, USA.
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Haberstick BC, Timberlake D, Smolen A, Sakai JT, Hopfer CJ, Corley RP, Young SE, Stallings MC, Huizinga D, Menard S, Hartman C, Grotpeter J, Hewitt JK. Between- and within-family association test of the dopamine receptor D2 TaqIA polymorphism and alcohol abuse and dependence in a general population sample of adults. J Stud Alcohol Drugs 2007; 68:362-70. [PMID: 17446975 PMCID: PMC2507866 DOI: 10.15288/jsad.2007.68.362] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Dopaminergic dysfunction has been hypothesized to play an important role in the etiology of alcohol-use disorders. A restriction fragment length polymorphism (RFLP) in the 3' untranslated region (3'UTR) of the DRD2 gene affects gene expression and has been implicated as a risk factor for alcohol dependence. This polymorphism (TaqIA) has been reported as positively associated with alcohol-use disorders in case-control samples, but these results have not been replicated in family-based association studies. The mixed results of association between the DRD2 TaqIA polymorphism and alcohol-use disorders may be the result of differences in sample size, phenotype definition, heterogeneity of the samples, and genetic admixture. METHOD We conducted tests of association in a sample of 838 adults participating in the National Youth Survey Family Study (NYSFS). We examined whether the DRD2 TaqIA polymorphism was associated with a symptom-count measure of alcohol abuse and dependence derived from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the Craving Withdrawal Model. RESULTS Tests of association were nonsignificant across each classification system examined. Power calculations suggested that these results were despite the ability to detect an effect size of 1%. CONCLUSIONS This study supports other family-based association tests that have reported no association between the DRD2 TaqIA polymorphism and alcohol abuse and dependence.
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Affiliation(s)
- Brett C Haberstick
- Institute for Behavioral Genetics, University of Colorado at Boulder, Boulder, CO 80309-0447, USA.
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