1
|
Valyear MD, LeCocq MR, Brown A, Villaruel FR, Segal D, Chaudhri N. Learning processes in relapse to alcohol use: lessons from animal models. Psychopharmacology (Berl) 2023; 240:393-416. [PMID: 36264342 DOI: 10.1007/s00213-022-06254-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/02/2022] [Indexed: 11/29/2022]
Abstract
RATIONALE Alcohol use is reliably preceded by discrete and contextual stimuli which, through diverse learning processes, acquire the capacity to promote alcohol use and relapse to alcohol use. OBJECTIVE We review contemporary extinction, renewal, reinstatement, occasion setting, and sex differences research within a conditioning framework of relapse to alcohol use to inform the development of behavioural and pharmacological therapies. KEY FINDINGS Diverse learning processes and corresponding neurobiological substrates contribute to relapse to alcohol use. Results from animal models indicate that cortical, thalamic, accumbal, hypothalamic, mesolimbic, glutamatergic, opioidergic, and dopaminergic circuitries contribute to alcohol relapse through separable learning processes. Behavioural therapies could be improved by increasing the endurance and generalizability of extinction learning and should incorporate whether discrete cues and contexts influence behaviour through direct excitatory conditioning or occasion setting mechanisms. The types of learning processes that most effectively influence responding for alcohol differ in female and male rats. CONCLUSION Sophisticated conditioning experiments suggest that diverse learning processes are mediated by distinct neural circuits and contribute to relapse to alcohol use. These experiments also suggest that gender-specific behavioural and pharmacological interventions are a way towards efficacious therapies to prevent relapse to alcohol use.
Collapse
Affiliation(s)
- Milan D Valyear
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada. .,Department of Psychology, McGill University, 1205 Ave. Dr. Penfield, Room N8/5, Montréal, QC, H3A 1B1, Canada.
| | - Mandy R LeCocq
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Alexa Brown
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Franz R Villaruel
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Diana Segal
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Nadia Chaudhri
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, Montréal, QC, Canada
| |
Collapse
|
2
|
Witkiewitz K, Pearson MR, Hallgren KA, Maisto SA, Roos CR, Kirouac M, Wilson AD, Montes KA, Heather N. Who achieves low risk drinking during alcohol treatment? An analysis of patients in three alcohol clinical trials. Addiction 2017; 112:2112-2121. [PMID: 28511286 PMCID: PMC5673549 DOI: 10.1111/add.13870] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/08/2017] [Accepted: 05/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS There is evidence that low-risk drinking is possible during the course of alcohol treatment and can be maintained following treatment. Our aim was to identify characteristics associated with low-risk drinking during treatment in a large sample of individuals as they received treatment for alcohol dependence. DESIGN Integrated analysis of data from the Combined Pharmacotherapies and Behavioral Intervention (COMBINE) study, Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) and the United Kingdom Alcohol Treatment Trial (UKATT) using repeated-measures latent class analysis to identify patterns of drinking and predictors of low-risk drinking patterns during treatment. SETTING United States and United Kingdom. PARTICIPANTS Patients (n = 3589) with alcohol dependence receiving treatment in an alcohol clinical trial were primarily male (73.0%), white (82.0%) and non-married (41.7%), with an average age of 42.0 (standard deviation = 10.7). MEASUREMENTS Self-reported weekly alcohol consumption during treatment was assessed using the Form-90 and validated with biological verification or collateral informants. FINDINGS Seven patterns of drinking during treatment were identified: persistent heavy drinking (18.7% of the sample), increasing heavy drinking (9.6%), heavy and low-risk drinking (6.7%), heavy drinking alternating with abstinence (7.9%), low-risk drinking (6.8%), increasing low-risk drinking (10.5%) and abstinence (39.8%). Lower alcohol dependence severity and fewer drinks per day at baseline significantly predicted low-risk drinking patterns [e.g. each additional drink prior to baseline predicted a 27% increase in the odds of expected classification in heavy drinking versus low-risk drinking patterns; odds ratio = 1.27 (95% confidence interval (CI) = 1.10, 1.47, P = 0.002]. Greater negative mood and more heavy drinkers in the social network were significant predictors of expected membership in heavier drinking patterns. CONCLUSIONS Low-risk drinking is achievable for some individuals as they undergo treatment for alcohol dependence. Individuals with lower dependence severity, less baseline drinking, fewer negative mood symptoms and fewer heavy drinkers in their social networks have a higher probability of achieving low-risk drinking during treatment.
Collapse
|
3
|
Witkiewitz K, Roos CR, Pearson MR, Hallgren KA, Maisto SA, Kirouac M, Forcehimes AA, Wilson AD, Robinson CS, McCallion E, Tonigan JS, Heather N. How Much Is Too Much? Patterns of Drinking During Alcohol Treatment and Associations With Post-Treatment Outcomes Across Three Alcohol Clinical Trials. J Stud Alcohol Drugs 2017; 78:59-69. [PMID: 27936365 DOI: 10.15288/jsad.2017.78.59] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE This secondary data analysis examined patterns of drinking during alcohol treatment and associated drinking outcomes during the first year following treatment. The goal was to provide clinicians with guidance on which patients may be most at risk for negative long-term outcomes based on drinking patterns during treatment. METHOD This study was an analysis of existing data (N = 3,851) from three randomized clinical trials for alcohol use disorder: the COMBINE Study (n = 1,383), Project MATCH (n = 1,726), and the United Kingdom Alcohol Treatment Trial (n = 742). Indicators of abstinence, non-heavy drinking, and heavy drinking (defined as 4/5 or more drinks per day for women/men) were examined during each week of treatment using repeated-measures latent class analysis. Associations between drinking patterns during treatment and drinking intensity, drinking consequences, and physical and mental health 12 months following intake were examined. RESULTS Seven drinking patterns were identified. Patients who engaged in persistent heavy drinking throughout treatment and those who returned to persistent heavy drinking during treatment had the worst long-term outcomes. Patients who engaged in some heavy drinking during treatment had better long-term outcomes than persistent heavy drinkers. Patients who reported low-risk drinking or abstinence had the best long-term outcomes. There were no differences in outcomes between low-risk drinkers and abstainers. CONCLUSIONS Abstinence, low-risk drinking, or even some heavy drinking during treatment are associated with the best long-term outcomes. Patients who are engaging in persistent heavy drinking are likely to have the worst outcomes and may require a higher level of care.
Collapse
Affiliation(s)
| | - Corey R Roos
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Kevin A Hallgren
- Center for the Study of Health and Risk Behaviors, University of Washington, Seattle, Washington
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Megan Kirouac
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Alyssa A Forcehimes
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Adam D Wilson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Charles S Robinson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Elizabeth McCallion
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - J Scott Tonigan
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Nick Heather
- Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| |
Collapse
|
4
|
Gueorguieva R, Wu R, Fucito LM, O'Malley SS. Predictors of Abstinence From Heavy Drinking During Follow-Up in COMBINE. J Stud Alcohol Drugs 2016; 76:935-41. [PMID: 26562602 DOI: 10.15288/jsad.2015.76.935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Although the primary focus of clinical trials is on between-group comparisons during treatment, these studies can also yield insights into which patient characteristics predict longer term outcomes. Our goal was to identify predictors of good outcome during the 1-year follow-up in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study. METHOD We constructed classification trees and a deterministic forest to predict no heavy drinking days during the last 8 weeks of the 1-year follow-up in COMBINE, based on more than 100 baseline predictors and drinking outcomes during the treatment phase of the study. The COMBINE sample was randomly split into a training and a validation data set. Logistic regression models were fit to compare the predictive performance of tree-based methods and classical methods. RESULTS A small tree with only two splits and four nodes based on abstinence and good clinical outcome during treatment had fair classification accuracy in the training and the validation samples: area under the curve (AUC) of 71% and 70%, respectively. Drinking outcomes during treatment were the strongest predictors in the deterministic forest. Logistic regression analyses based on four main effects (good clinical outcome, level of drinking during treatment, age at onset of alcohol dependence, and feeling more energetic) had slightly better classification accuracy (AUC = 74%). CONCLUSIONS End-of-treatment outcomes were the strongest predictors of long-term outcome in all analyses. The results emphasize the importance of optimizing outcomes during treatment and identify potential subgroups of individuals who require additional or alternative interventions to achieve good long-term outcome.
Collapse
Affiliation(s)
- Ralitza Gueorguieva
- Department of Biostatistics, School of Public Health, Yale University, New Haven, Connecticut
| | - Ran Wu
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Stephanie S O'Malley
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
5
|
Landheim AS, Bakken K, Vaglum P. Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties. BMC Psychiatry 2006; 6:44. [PMID: 17054775 PMCID: PMC1626456 DOI: 10.1186/1471-244x-6-44] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 10/20/2006] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Most help-seeking substance abusers have comorbid psychiatric disorders. The importance of such disorders for the long-term course of substance abuse is, however, still unclear. The aim of this paper is to describe six-year outcomes regarding death and relapse among alcoholics and poly-substance abusers and to analyse the predictive value of lifetime psychiatric disorders on relapse. METHODS A consecutive sample of substance-dependent patients who received treatment in two counties in Norway (n = 287) was followed up after approximately six years. Information on socio-demographics, Axis I (CIDI) and II disorders (MCMI-II) and mental distress (HSCL-25) was gathered at baseline. At follow-up, detailed information regarding socio-demographics, use of substances (AUDIT and DUDIT) and mental distress (HSCL-25) was recorded (response rate: 63%). RESULTS At six-year follow-up, 11% had died, most often male alcoholics (18%). Among the surviving patients, 70% had drug or alcohol related problems the year prior to follow-up. These patients were, classified as "relapsers". There were no significant differences in the relapse rate between women and men and among poly-substance abusers and alcoholics. The relapsers had an earlier onset of a substance use disorder, and more frequently major depression and agoraphobia. Multivariate analysis indicated that both psychiatric disorders (major depression) and substance use factors (early onset of a substance use disorder) were independent predictors of relapse. CONCLUSION For reducing the risk of long-term relapse, assessment and treatment of major depression (and agoraphobia) are important. In addition, we are in need of a comprehensive treatment and rehabilitation program that also focuses on the addictive behaviour.
Collapse
Affiliation(s)
- Anne Signe Landheim
- Centre for Addiction Issues, Department for Substance Abuse, Innlandet Hospital Trust, Norway
| | - Kjell Bakken
- Centre for Addiction Issues, Department for Substance Abuse, Innlandet Hospital Trust, Norway
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Norway
| |
Collapse
|
6
|
de Bruijn C, van den Brink W, de Graaf R, Vollebergh WAM. The three year course of alcohol use disorders in the general population: DSM-IV, ICD-10 and the Craving Withdrawal Model. Addiction 2006; 101:385-92. [PMID: 16499511 DOI: 10.1111/j.1360-0443.2006.01327.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine the course of alcohol use disorders (AUD) in a prospective general population study using three different classification systems: Diagnostic and Statistical Manual version IV (DSM-IV), International Classification of Diseases version 10 (ICD-10) and the craving withdrawal model (CWM). The latter is an alternative classification, which requires craving and withdrawal for alcohol dependence and raises the alcohol abuse threshold to two criteria. DESIGN, SETTING AND PARTICIPANTS Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large (n=7,076) representative general population study with a baseline and 1- and 3-year follow-up assessments. MEASUREMENTS Diagnostic status according to DSM-IV, ICD-10 and CWM at baseline and at follow-up was established using a structured interview (Composite International Diagnostic Interview: CIDI). FINDINGS DSM-IV abuse, ICD-10 harmful use and CWM abuse all showed a favourable course with remission rates of 81, 89 and 71%, respectively, at 1-year follow-up and 85, 92 and 79% at 3-year follow-up. Dependence according to DSM-IV, ICD-10 and CWM had a somewhat less favourable course, with remission rates (no dependence) of 67, 67 and 57% at 1-year follow-up and 74, 69 and 73% at 3-year follow-up, respectively. Subjects who were remitted at 1-year follow-up showed relapse-rates of 0-14% for dependence and 4-12% for abuse at 3-year follow-up. Although CWM diagnoses tended towards greater diagnostic stability than DSM-IV and ICD-10, most differences were not significant. CONCLUSION The conviction that addiction is a chronic relapsing disease may apply to treatment-seeking alcoholics, but our data show a far more favourable course of alcohol use disorders in the general population.
Collapse
Affiliation(s)
- Carla de Bruijn
- University Medical Centre Untrecht, Department of Psychiatry, Utrecht, the Netherlands.
| | | | | | | |
Collapse
|
7
|
Bottlender M, Soyka M. Outpatient alcoholism treatment: predictors of outcome after 3 years. Drug Alcohol Depend 2005; 80:83-9. [PMID: 15878808 DOI: 10.1016/j.drugalcdep.2005.03.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Revised: 03/25/2005] [Accepted: 03/27/2005] [Indexed: 10/25/2022]
Abstract
AIMS This prospective study investigated predictors for relapse 3 years after completion of an intensive outpatient treatment programme for alcoholism. DESIGN As previous studies mainly revealed that severity of alcohol dependence, and comorbid psychopathology were predictive for subsequent relapses, the impact of these and other pre-treatment variables on the 36-month outcome was evaluated in a logistic regression analysis. A structured interview was used to assess the variables. Patients were personally interviewed at entry to, and the end of, an outpatient treatment programme, and 6, 12, 24 and 36 months after the end of treatment. One hundred and three alcohol-dependent participants who were taking part in an outpatient treatment were consecutively recruited. RESULTS Seventy-four patients completed the treatment programme. At the follow-up after 36 months, 2 patients had died (after heavy alcohol relapse) and 88 (88%) of the remaining patients could be located and personally re-interviewed. Forty-four (43%) patients were abstinent, 46 (45%) had relapsed and 12 (12%) were classified as improved for the total follow-up period according to the classification proposed by Feuerlein and Küfner. Based on a logistic regression analysis, significant variables for prediction of relapse were treatment drop-outs, female sex and sum of positive life events prior to treatment (relapsers had significantly fewer positive life events). CONCLUSIONS In contrast to previous studies we could not confirm the importance of determinants known as risk factors for relapse like severity of alcohol dependence. The strongest predictor for relapsing after treatment is treatment drop-out. Since women were at an increased risk for relapse gender-specific treatment approaches should be considered. In summary, the effectiveness of the studied intensive outpatient treatment programme, with an abstinence rate of 43% for the total follow-up period of 3 years, is favourable although selection criteria of must be taken into account.
Collapse
Affiliation(s)
- Miriam Bottlender
- Department of Psychiatry, Ludwig-Maximilians University, Munich, Nussbaumstr. 7, 80336 Munich, Germany.
| | | |
Collapse
|
8
|
Powell BJ, Landon JF, Cantrell PJ, Penick EC, Nickel EJ, Liskow BI, Coddington TM, Campbell JL, Dale TM, Vance MD, Rice AS. Prediction of drinking outcomes for male alcoholics after 10 to 14 years. Alcohol Clin Exp Res 1998; 22:559-66. [PMID: 9622432 DOI: 10.1111/j.1530-0277.1998.tb04293.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study reports on the long-term outcomes of 360 men who were hospitalized for alcoholism during 1980 to 1984 and followed at 12 months and again 10 to 14 years later. At the 10/14-year follow-up, 96 (26.7%) men were confirmed as deceased; 255 (70.8%) men participated in the assessment/interview battery completed during baseline hospitalization. The battery consisted of psychosocial, alcohol-related, and psychiatric measures. Two distinct but highly correlated outcome measures were selected: a clinical rating scale and a factor score. Overall, predictors from baseline and 12-month follow-up included age at intake hospitalization, alcoholism severity, social stability, drinking days, and antisocial personality disorder. Approximately 37% of the assessed survivors were either totally abstinent or drinking nonabusively throughout the 10/14-year follow-up, whereas another 37% continued to drink abusively. Men who abstained or reduced alcohol intake reported better physical health at follow-up than those who continued to drink. Although our findings did not directly link alcoholism to death, they strongly indicate that chronic alcohol abuse may lead to premature death.
Collapse
Affiliation(s)
- B J Powell
- Department of Veterans Affairs Medical Center, Kansas City, Missouri 64128, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|