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Grodin EN, Burnette EM, Rodriguez C, Fulcher JA, Ray LA. The gut microbiome in alcohol use disorder and alcohol-associated liver disease: A systematic review of clinical studies. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1221-1242. [PMID: 38719790 DOI: 10.1111/acer.15338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 07/11/2024]
Abstract
Evidence suggests that a relationship exists between the gut microbiome and the pathogenesis of alcohol use disorder (AUD) and alcohol-associated liver disease (AALD). This systematic review identified studies that investigated the gut microbiome in individuals with an AUD or an AALD. A search was conducted on October 27, 2022, in PubMed, Web of Science, and Embase databases. Fifty studies satisfied eligibility criteria. Most studies found evidence for gut dysbiosis in individuals with AUD and AALD. Microbiome intervention studies have mostly been conducted in AALD patients; fecal microbial transplant interventions show the most promise. Because most studies were conducted cross-sectionally, the causal relationship between the gut microbiome and alcohol use is unknown. Furthermore, almost all studies have been conducted in predominantly male populations, leaving critical questions regarding sex differences and generalizability of the findings. The study summaries and recommendations provided in this review seek to identify areas for further research and to highlight potential gut microbial interventions for treating AUD and AALD.
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Affiliation(s)
- Erica N Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Elizabeth M Burnette
- Brain Research Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Crystal Rodriguez
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Jennifer A Fulcher
- Division of Infectious Diseases, David Gefen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Brain Research Institute, University of California, Los Angeles, Los Angeles, California, USA
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2
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Schwarzinger M, Ferreira-Borges C, Neufeld M, Alla F, Rehm J. Alcohol rehabilitation and cancer risk: a nationwide hospital cohort study in France. Lancet Public Health 2024; 9:e461-e469. [PMID: 38942557 DOI: 10.1016/s2468-2667(24)00107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer incidence is scarce. Our main study aim was to assess the effect of alcohol rehabilitation and abstinence on cancer incidence in people with alcohol dependence. METHODS We conducted a nationwide hospital retrospective cohort study which included all adults residing in mainland France and discharged in 2018-21. Multivariable Cox proportional hazards models were used to estimate the effect of rehabilitation treatment at hospital or a history of abstinence versus alcohol dependence without rehabilitation or abstinence on the risk for incident alcohol-associated cancers by sex, controlled for potential confounding risk factors. FINDINGS 10 260 056 men and 13 739 369 women were discharged from French hospitals in 2018-21. Alcohol dependence was identified in 645 720 (6·3%) men and 219 323 (1·6%) women. Alcohol dependence was strongly related to alcohol-associated cancer sites in both sexes (hepatocellular carcinoma and oral, pharyngeal, laryngeal, oesophageal, and colorectal cancers), except for breast cancer. Rehabilitation treatment or abstinence was associated with significantly lower risks compared with alcohol dependence without rehabilitation or abstinence (adjusted hazard ratios: 0·58, 99·89% CI 0·56-0·60 in men and 0·62, 0·57-0·66 in women). Relative risk reductions were significant for each alcohol-associated cancer site in both sexes and supported by all subgroup and sensitivity analyses. INTERPRETATION Our study results support the clear benefits of alcohol rehabilitation and abstinence in reducing the risk for alcohol-associated cancers. As only two in five patients with alcohol dependence were recorded with a history of rehabilitation treatment or abstinence, a large untapped potential exists for reducing cancer incidence. FUNDING European Union's EU4Health programme.
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Affiliation(s)
- Michaël Schwarzinger
- Department of Prevention, Bordeaux University Hospital, Bordeaux, France; University of Bordeaux, INSERM, BPH, U1219, I-prev/PHARES, certified team under Ligue Contre le Cancer, CIC 1401, Bordeaux, France.
| | - Carina Ferreira-Borges
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, UN City, Copenhagen, Denmark
| | - Maria Neufeld
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, UN City, Copenhagen, Denmark
| | - François Alla
- Department of Prevention, Bordeaux University Hospital, Bordeaux, France; University of Bordeaux, INSERM, BPH, U1219, I-prev/PHARES, certified team under Ligue Contre le Cancer, CIC 1401, Bordeaux, France
| | - Jürgen Rehm
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, UN City, Copenhagen, Denmark; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Science (IMS), University of Toronto, Toronto, ON, Canada; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Program on Substance Abuse & WHO European Region Collaboration Centre, Public Health Agency of Catalonia, Barcelona, Catalonia, Spain
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Tap SC. The potential of 5-methoxy-N,N-dimethyltryptamine in the treatment of alcohol use disorder: A first look at therapeutic mechanisms of action. Addict Biol 2024; 29:e13386. [PMID: 38600715 PMCID: PMC11007263 DOI: 10.1111/adb.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/24/2023] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Alcohol use disorder (AUD) remains one of the most prevalent psychiatric disorders worldwide with high economic costs. Current treatment options show modest efficacy and relapse rates are high. Furthermore, there are increases in the treatment gap and few new medications have been approved in the past 20 years. Recently, psychedelic-assisted therapy with psilocybin and lysergic acid diethylamide has garnered significant attention in the treatment of AUD. Yet, they require significant amounts of therapist input due to prolonged subjective effects (~4-12 h) leading to high costs and impeding implementation. Accordingly, there is an increasing interest in the rapid and short-acting psychedelic 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT). This paper offers a first look at potential therapeutic mechanisms for AUD by reviewing the current literature on 5-MeO-DMT. Primarily, 5-MeO-DMT is able to induce mystical experiences and ego-dissolution together with increases in psychological flexibility and mindfulness. This could decrease AUD symptoms through the alleviation of psychiatric mood-related comorbidities consistent with the negative reinforcement and self-medication paradigms. In addition, preliminary evidence indicates that 5-MeO-DMT modulates neural oscillations that might subserve ego-dissolution (increases in gamma), psychological flexibility and mindfulness (increases in theta), and the reorganization of executive control networks (increases in coherence across frequencies) that could improve emotion regulation and inhibition. Finally, animal studies show that 5-MeO-DMT is characterized by neuroplasticity, anti-inflammation, 5-HT2A receptor agonism, and downregulation of metabotropic glutamate receptor 5 with clinical implications for AUD and psychiatric mood-related comorbidities. The paper concludes with several recommendations for future research to establish the purported therapeutic mechanisms of action.
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Affiliation(s)
- Stephan C. Tap
- Department of PsychiatryGroningen University Medical CenterGroningenThe Netherlands
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4
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Garcia CC, Richards DK, Tuchman FR, Hallgren KA, Kranzler HR, Aubin HJ, O’Malley SS, Mann K, Aldridge A, Hoffman M, Anton RF, Witkiewitz K. Reductions in World Health Organization risk drinking level are associated with improvements in sleep problems among individuals with alcohol use disorder. Alcohol Alcohol 2024; 59:agae022. [PMID: 38606931 PMCID: PMC11010310 DOI: 10.1093/alcalc/agae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Among individuals with alcohol use disorder (AUD), sleep disturbances are pervasive and contribute to the etiology and maintenance of AUD. However, despite increased attention toward the relationship between alcohol use and sleep, limited empirical research has systematically examined whether reductions in drinking during treatment for AUD are associated with improvements in sleep problems. METHODS We used data from a multisite, randomized, controlled trial that compared 6 months of treatment with gabapentin enacarbil extended-release with placebo for adults with moderate-to-severe AUD (N = 346). The Timeline Follow-back was used to assess WHO risk drinking level reductions and the Pittsburgh Sleep Quality Index was used to assess sleep quality over the prior month at baseline and the end of treatment. RESULTS Sleep problem scores in the active medication and placebo groups improved equally. Fewer sleep problems were noted among individuals who achieved at least a 1-level reduction (B = -0.99, 95% confidence interval (CI) [-1.77, -0.20], P = .014) or at least a 2-level reduction (B = -0.80, 95% CI [-1.47, -0.14], P = .018) in WHO risk drinking levels at the end of treatment. Reductions in drinking, with abstainers excluded from the analysis, also predicted fewer sleep problems at the end of treatment (1-level: B = -1.01, 95% CI [-1.83, -0.20], P = .015; 2-level: B = -0.90, 95% CI [-1.59, -0.22], P = .010). CONCLUSIONS Drinking reductions, including those short of abstinence, are associated with improvements in sleep problems during treatment for AUD. Additional assessment of the causal relationships between harm-reduction approaches to AUD and improvements in sleep is warranted.
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Affiliation(s)
- Christian C Garcia
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
| | - Dylan K Richards
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
| | - Felicia R Tuchman
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, United States
| | - Kevin A Hallgren
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, 98195, United States
| | - Henry R Kranzler
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA, 19104, United States
| | - Henri-Jean Aubin
- Université Paris-Saclay, Unive Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, Institut national de la santé et de la recherche médicale, Villejuif, France
- APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, 94800, France
| | - Stephanie S O’Malley
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, United States
| | - Karl Mann
- Zentralinstitut für Seelische Gesundheit (ZI), Mannheim, Baden-Württemberg, 68159, Germany
| | - Arnie Aldridge
- Behavioral Health Financing, Economics and Evaluation Department, Research Triangle Institute International (RTI), Research Triangle Park, NC, 27709, United States
| | - Michaela Hoffman
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Raymond F Anton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, United States
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Flores-Ramirez FJ, Illenberger JM, Pascasio G, Terenius L, Martin-Fardon R. LY2444296, a κ-opioid receptor antagonist, selectively reduces alcohol drinking in male and female Wistar rats with a history of alcohol dependence. Sci Rep 2024; 14:5804. [PMID: 38461355 PMCID: PMC10925033 DOI: 10.1038/s41598-024-56500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/07/2024] [Indexed: 03/11/2024] Open
Abstract
Alcohol use disorder (AUD) remains a major public health concern. The dynorphin (DYN)/κ-opioid receptor (KOP) system is involved in actions of alcohol, particularly its withdrawal-associated negative affective states. This study tested the ability of LY2444296, a selective, short-acting, KOP antagonist, to decrease alcohol self-administration in dependent male and female Wistar rats at 8 h abstinence. Animals were trained to orally self-administer 10% alcohol (30 min/day for 21 sessions) and were made dependent via chronic intermittent alcohol vapor exposure for 6 weeks or exposed to air (nondependent). After 6 weeks, the effect of LY2444296 (0, 3, and 10 mg/kg, p.o.) was tested on alcohol self-administration at 8 h of abstinence. A separate cohort of rats was prepared in parallel, and their somatic withdrawal signs and alcohol self-administration were measured after LY2444296 administration at 8 h, 2 weeks, and 4 weeks abstinence. LY2444296 at 3 and 10 mg/kg significantly reduced physical signs of withdrawal in dependent rats at 8 h abstinence, only. Furthermore, 3 and 10 mg/kg selectively decreased alcohol self-administration in dependent rats at only 8 h abstinence. These results highlight the DYN/KOP system in actions of alcohol during acute abstinence, suggesting KOP antagonism could be beneficial for mitigating acute withdrawal signs and, in turn, significantly reduce excessive alcohol consumption associated with AUD.
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Affiliation(s)
- Francisco J Flores-Ramirez
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, SR-107, La Jolla, CA, 92037, USA.
| | - Jessica M Illenberger
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, SR-107, La Jolla, CA, 92037, USA
| | - Glenn Pascasio
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, SR-107, La Jolla, CA, 92037, USA
| | - Lars Terenius
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Rémi Martin-Fardon
- Department of Molecular Medicine, The Scripps Research Institute, 10550 North Torrey Pines Road, SR-107, La Jolla, CA, 92037, USA
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Smalley Z, Livanou M, Dalton B, Patsalos O, Wilks J, Keeler JL, Treasure J, Schmidt U, Hill G, Himmerich H. Exploring Alcohol-Related Behaviours in an Adult Sample with Anorexia Nervosa and Those in Recovery. Nutrients 2024; 16:732. [PMID: 38474860 DOI: 10.3390/nu16050732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/13/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
While individuals with Bulimia Nervosa (BN) and Binge Eating Disorder (BED) often present with a higher rate of Alcohol Use Disorder (AUD) than the general population, it is unclear whether this extends to AN. This cross-sectional study examined differences in alcohol-related behaviours, measured using the Alcohol Use Identification Test (AUDIT), between AN participants (n = 58), recovered AN (rec-AN) participants (n = 25), and healthy controls (n = 57). Statistical models controlled for age and ethnicity. The relationship between alcohol-related behaviours with ED psychopathology and with depression was also assessed. The findings indicated that acute AN participants were not at greater risk of AUD than healthy controls. However, rec-AN participants displayed greater total audit scores than those with acute AN, and more alcohol-related behaviours than healthy controls. Acute AN participants consumed significantly less alcohol than both the healthy control group and rec-AN group. No associations were found between ED psychopathology and alcohol-related behaviours in the AN group or rec-AN. This highlights alcohol as a potential coping mechanism following AN recovery. Clinicians should consider assessments for AUD and targeted interventions aimed at encouraging healthy coping mechanisms in this group. Future studies should look at alcohol use as a moderating factor for AN recovery.
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Affiliation(s)
- Zara Smalley
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Maria Livanou
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Bethan Dalton
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Olivia Patsalos
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Jessica Wilks
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Johanna Louise Keeler
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BC, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BC, UK
| | - Grace Hill
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BC, UK
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7
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Koens S, Klein J, Scherer M, Strauß A, Härter M, Schäfer I, Lüdecke D, von dem Knesebeck O. Perceived treatment urgency of common mental disorders in the German population. Sci Rep 2023; 13:22711. [PMID: 38123622 PMCID: PMC10733386 DOI: 10.1038/s41598-023-49969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Perceived treatment urgency of mental disorders are important as they determine utilization of health care. The aim was to analyze variations in perceived treatment urgency in cases of psychosis (adolescents), alcoholism (adults), and depression (older adults) with two levels of severity each by characteristics of the case and the respondents. A telephone survey (N = 1200) with vignettes describing cases of psychosis, alcoholism, and depression was conducted in Hamburg, Germany. Vignettes varied by symptom severity and sex. Perceived treatment urgency was assessed by three items. A sum scale was calculated. Linear regression models were computed to analyze differences in perceived urgency by characteristics of the case (severity, sex) and the respondents (sex, age, education, migration background, illness recognition, personal affliction). Perceived treatment urgency was significantly higher in severe cases and varied by education. Additionally, regarding psychosis, estimated urgency varied significantly by correct illness recognition. With regard to depression, perceived urgency differed significantly by age and correct illness recognition. Interaction effects between case severity and sociodemographic characteristics of the respondents, personal affliction, and correct recognition of the disorder were found. The identified differences should be considered in the development of interventions on mental health literacy with regard to adequate urgency assessment.
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Affiliation(s)
- Sarah Koens
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Annette Strauß
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Cao HL, Wei W, Meng YJ, Deng W, Li T, Li ML, Guo WJ. Disrupted white matter structural networks in individuals with alcohol dependence. J Psychiatr Res 2023; 168:13-21. [PMID: 37871461 DOI: 10.1016/j.jpsychires.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/19/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023]
Abstract
Previous diffusion tensor imaging (DTI) studies have demonstrated widespread white matter microstructure damage in individuals with alcoholism. However, very little is known about the alterations in the topological architecture of white matter structural networks in alcohol dependence (AD). This study included 67 AD patients and 69 controls. The graph theoretical analysis method was applied to examine the topological organization of the white matter structural networks, and network-based statistics (NBS) were employed to detect structural connectivity alterations. Compared to controls, AD patients exhibited abnormal global network properties characterized by increased small-worldness, normalized clustering coefficient, clustering coefficient, and shortest path length; and decreased global efficiency and local efficiency. Further analyses revealed decreased nodal efficiency and degree centrality in AD patients mainly located in the default mode network (DMN), including the precuneus, anterior cingulate and paracingulate gyrus, median cingulate and paracingulate gyrus, posterior cingulate gyrus, and medial part of the superior frontal gyrus. Furthermore, based on NBS approaches, patients displayed weaker subnetwork connectivity mainly located in the region of the DMN. Additionally, altered network metrics were correlated with intelligence quotient (IQ) scores and global assessment function (GAF) scores. Our results may reveal the disruption of whole-brain white matter structural networks in AD individuals, which may contribute to our comprehension of the underlying pathophysiological mechanisms of alcohol addiction at the level of white matter structural networks.
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Affiliation(s)
- Hai-Ling Cao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wei Wei
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Ya-Jing Meng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wei Deng
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Tao Li
- Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Ming-Li Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Wan-Jun Guo
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Department of Neurobiology, Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, China; Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-machine Intelligence, Zhejiang University, 1369 West Wenyi Road, Hangzhou, 311121, China.
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9
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Wallhed Finn S, Mejldal A, Baskaran R, Nielsen AS. Effects of media campaign videos on stigma and attitudes towards treatment seeking for alcohol use disorder: a randomized controlled study. BMC Public Health 2023; 23:1919. [PMID: 37794390 PMCID: PMC10552234 DOI: 10.1186/s12889-023-16811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Alcohol Use Disorder (AUD) is one of the most stigmatized diagnosis, and stigma imposes a major barrier to treatment seeking. There is a need to develop interventions that can reduce stigma and increase treatment seeking. Little is known about the effects of video materials. The aim of this study was to investigate effects of different videos. The primary outcome was public stigma, and secondary outcomes were: self-stigma, and motivation to change own alcohol use; talking to someone else about their alcohol use; seeking information about AUD treatment or seeking AUD treatment. METHODS This is a three-armed double blind randomized controlled study. The study included 655 Danish adults. Data was collected at a study webpage, and the survey could be completed anywhere with Internet access. After informed consent and completing baseline measures, participants were randomized, 1:1:1 ratio, to a video (video 1 n = 228; video 2 n = 198; video 3 n = 229). Video 1 and 2 have been used in a national mass media campaign and video 3 was recorded for use in the present study. Immediately after exposure, follow-up measures were completed. Outcomes were analyzed with mixed effects linear regression. RESULTS In total n = 616 completed follow-up (video 1 n = 215; video 2 n = 192; video 3 n = 209). Randomization to video 1 and 3 decreased public stigma measured with "Difference, Disdain & Blame Scales", while video 2 increased stigma. Video 2 compared to 1: 2.262 (95% CI 1.155; 3.369) p < 0.001. Video 3 compared to 1: -0.082 (95% CI -1.170; 1.006) p = 0.882. Video 3 compared to 2: -2.344 (95% CI -3.455; -1.233) p = 0.882. All videos reduced motivation to change own alcohol use. Participants with hazardous alcohol use, were more sensitive to the different videos, compared to low-risk alcohol use. Video 2 decreased motivation to seek information about treatment. No effects were seen on motivation to seek treatment, motivation to talk to someone else or self-stigma. CONCLUSIONS Videos can have an immediate effect on level of public stigma. Other types of interventions are needed to increase motivation and reduce self-stigma. To avoid adverse effects in future interventions, the use of theoretical frameworks and stakeholder involvement is emphasized.
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Affiliation(s)
- Sara Wallhed Finn
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Mejldal
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
| | - Ruben Baskaran
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
- SDU Health informatics and technology, Faculty of engineering, The Maersk Mc-Kinney Moller institute, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 20, entrance. 220 B, Odense, 5000, Denmark
- Psychiatric Hospital, University Function, Region of Southern, Odense, Denmark
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Morris J, Boness CL, Witkiewitz K. Should we promote alcohol problems as a continuum? Implications for policy and practice. DRUGS (ABINGDON, ENGLAND) 2023; 31:271-281. [PMID: 38682086 PMCID: PMC11052541 DOI: 10.1080/09687637.2023.2187681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
The highly heterogeneous nature of alcohol use and problems has presented significant challenges to those attempting to understand, treat or prevent what is commonly termed alcohol use disorder (AUD). However, any attempts to capture this complex phenomenon, including the various current criterion of AUD, come with a number of limitations. One particular limitation has been how alcohol problems are represented or understood in ways which do not capture the broad spectrum of alcohol use and harms and the many potential routes to prevention, treatment, and recovery. One possible response to this has been proposed as more explicitly framing or conceptualizing a continuum model of alcohol use and harms. In this commentary, we attempt to identify the key implications of a continuum model for policy and practice, examining the historical and current context of alcohol problem classifications and models. We argue a continuum model of alcohol use and problems holds a number of advantages for advancing public health goals, but also some potential limitations, both of which require further examination.
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Affiliation(s)
- J Morris
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, United Kingdom
| | - C L Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
| | - K Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico, Albuquerque, New Mexico
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11
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Atmaca M, Tabara MF, Koc M, Gurok MG, Baykara S, Korkmaz S, Mermi O. Cortical Thickness of the Orbitofrontal Cortex in Patients with Alcohol Use Disorder. Brain Sci 2023; 13:brainsci13040552. [PMID: 37190518 DOI: 10.3390/brainsci13040552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Aims: In the present study, it was hypothesised that compared to healthy control subjects, significant differences in the cortical thickness of the orbitofrontal cortex (OFC) region of the brain, which is relevant to both impulsivity and decision making, would be identified. Methods: The subject groups included in the study were composed of 15 individuals who met the criteria for alcohol use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 (SCID), and were admitted to the Firat University School of Medicine Department of Psychiatry or were hospitalised, and 17 healthy control comparisons were made. The volumes of and cortical thickness of the OFC were measured in the subjects. Results: It was found that patients with alcohol use disorder had reduced volumes of the OFC bilaterally and a thinner cortical thickness of the same region bilaterally compared to those of the healthy control comparisons. Conclusions: Consequently, it is suggested that the OFC region of the brain appears to be statistically significantly smaller in patients with alcohol use disorder, both in terms of cortical thickness and volume, compared to healthy controls. Future research should focus on the status of these relationships longitudinally and should assess the causality of the association with the treatment response.
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12
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Jeanblanc J, Sauton P, Houdant C, Fernandez Rodriguez S, de Sousa SV, Jeanblanc V, Bodeau S, Labat L, Soichot M, Vorspan F, Naassila M. Sex-related differences in the efficacy of Baclofen enantiomers on self-administered alcohol in a binge drinking pattern and dopamine release in the core of the nucleus accumbens. Front Pharmacol 2023; 14:1146848. [PMID: 37007041 PMCID: PMC10060511 DOI: 10.3389/fphar.2023.1146848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction: Clinical studies on the effectiveness of Baclofen in alcohol use disorder (AUD) yielded mixed results possibly because of differential effects of the enantiomers and sex-related differences. Here we examined the effect of the different Baclofen enantiomers on alcohol intake and on evoked dopamine release in the core of the nucleus accumbens (NAcc) in male and female Long Evans rats.Methods: Rats were trained to chronically self-administer 20% alcohol solution in daily binge drinking sessions and were treated with the different forms of Baclofen [RS(±), R(+) and S(−)]. The effects on the evoked dopamine release within the core of the nucleus accumbens were measured in brain slices from the same animals and the alcohol naïve animals using the fast scan cyclic voltammetry technique.Results: RS(±)-Baclofen reduced alcohol intake regardless of sex but more females were non-responders to the treatment. R(+)-Baclofen also reduced alcohol intake regardless of sex but females were less sensitive than males. S(−)-Baclofen did not have any effect on average but in some individuals, especially in the females, it did increase alcohol intake by at least 100%. There were no sex differences in Baclofen pharmacokinetic but a strong negative correlation was found in females with a paradoxical effect of increased alcohol intake with higher blood Baclofen concentration. Chronic alcohol intake reduced the sensitivity to the effect of Baclofen on evoked dopamine release and S(−)-Baclofen increased dopamine release specifically in females.Discussion: Our results demonstrate a sex-dependent effect of the different forms of Baclofen with no or negative effects (meaning an increase in alcohol self-administration) in subgroup of females that could be linked to a differential effect on dopamine release and should warrant future clinical studies on alcohol use disorder pharmacotherapy that will deeply analyze sex difference.
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Affiliation(s)
- Jérôme Jeanblanc
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Pierre Sauton
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Charles Houdant
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
| | - Sandra Fernandez Rodriguez
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
| | - Sofia Vilelas de Sousa
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
| | - Virginie Jeanblanc
- Animal Facility of the Université de Picardie Jules Verne, Amiens, France
| | - Sandra Bodeau
- MP3CV Laboratory, Department of Clinical Pharmacology, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France
| | - Laurence Labat
- INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Assistance Publique—Hôpitaux de Paris, Paris, France
| | - Marion Soichot
- Laboratoire de Toxicologie Biologique, Hôpital Lariboisière, Paris, France
| | - Florence Vorspan
- INSERM UMRS1144, Département de Psychiatrie et de Médecine Addictologique, Assistance Publique—Hôpitaux de Paris, GH Lariboisière—Fernand Widal, GHU NORD, Université de Paris, Paris, France
| | - Mickael Naassila
- INSERM UMR-S 1247, Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Amiens, France
- GDR3557 Psychiatrie-Addictions, Institut de Psychiatrie, University Hospital Federation (FHU A2M2P), Caen, France
- *Correspondence: Mickael Naassila,
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13
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Gurok MG, Tabara MF, Koc M, Saritoy S, Baykara S, Atmaca M. Pituitary Volumes Are Reduced in Patients With Alcohol Use Disorder. Alcohol Alcohol 2023; 58:107-112. [PMID: 36458440 DOI: 10.1093/alcalc/agac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/01/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS To determine whether there is a difference in pituitary gland volumes in patients with alcohol use disorder compared to healthy people. METHODS The subjects included in the study consisted of 15 individuals who met the criteria for alcohol use disorder according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5) diagnostic criteria based on the Structured Clinical Interview for DSM 5 and were admitted to Firat University School of Medicine, Department of Psychiatry, or were hospitalized, and 17 healthy controls. The volumes of pituitary were measured in subjects. RESULTS Absolute pituitary gland volumes of patients with alcohol use disorder and healthy controls were compared in the analysis performed using the independent samples t-test. The mean volume of the patient group was significantly smaller than the healthy controls (58.02 ± 7.24 mm3 in patients with alcohol use disorder vs. 83.08 ± 12.11 mm3, P < 0.01), a difference which persisted after controlling for age, gender and total brain size. CONCLUSIONS Patients with alcohol use disorder in this study had smaller pituitary gland volumes compared to those of healthy control subjects. However, this study has limitations including small sample size and not adjusting for previous or current medication use or current anxiety and depression.
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Affiliation(s)
- Mehmet Gurkan Gurok
- Department of Psychiatry, Firat University School of Medicine, Elazig 23100, Turkey
| | | | - Mustafa Koc
- Department of Radiology, Firat University School of Medicine, Elazig 23100, Turkey
| | - Sumeyra Saritoy
- Department of Radiology, Firat University School of Medicine, Elazig 23100, Turkey
| | - Sema Baykara
- Department of Psychiatry, Firat University School of Medicine, Elazig 23100, Turkey
| | - Murad Atmaca
- Department of Psychiatry, Firat University School of Medicine, Elazig 23100, Turkey
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14
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Fortinguerra F, Pierantozzi A, Trotta F. The use of medications approved for alcohol use disorders in Italy. Front Public Health 2023; 11:1110435. [PMID: 36875354 PMCID: PMC9975714 DOI: 10.3389/fpubh.2023.1110435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Background Italy has the highest per capita alcohol consumption among European countries. Several pharmacological treatments for alcohol use disorders (AUDs) are currently available in Italy, but no consumption data are available. A first analysis of national drug consumption, comprising the whole Italian population over a long-term period covering the COVID-19 pandemic, was performed. Methods To analyze the consumption of medications indicated for therapy of alcohol dependence, different national data sources were used. Consumption was measured as a defined daily dose (DDD) per 1,000,000 inhabitants per day. Results In 2020, the total consumption of medicines used in the treatment of AUDs amounted to 310.3 DDD per 1 million inhabitants per day (0.018% of the overall drug consumption in Italy) with a decreasing gradient from the north (373.9 DDD) to the south (250.7 DDD). 53.2% of the overall doses were dispensed by public healthcare facilities and 23.5% by community pharmacies, while the remaining 23.3% were purchased privately. The temporal trend of consumption seemed to be stable across the last few years, although an impact of the COVID-19 pandemic was observed. Disulfiram was the most consumed medicine over years. Conclusion All Italian regions offer pharmacological treatments to patients with AUDs, but differences in the number of dispensed doses suggest a different local organization of patient care, which can be partly explained by the different severity of the clinical condition of residing patients. Pharmacotherapy of alcoholism should be deeply investigated to describe the clinical characteristics of treated patients (i.e., comorbidities) and evaluate the appropriateness of prescribed medications.
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15
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White CA, Quinones A, Tang JE, Butler LR, Duey AH, Kim JS, Cho SK, Cagle PJ. A national analysis of the effect alcohol use disorder has on short-term complications and readmissions following total shoulder arthroplasty. J Orthop 2023; 35:13-17. [PMID: 36338316 PMCID: PMC9633869 DOI: 10.1016/j.jor.2022.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/21/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Alcohol use disorder has been associated with broad health consequences that may interfere with healing after total shoulder arthroplasty. The aim of this study was to explore the impact of alcohol use disorder on readmissions and complications following total shoulder arthroplasty. Methods We used data from the Healthcare Cost and Utilization Project National Readmissions Database (NRD) from 2016 to 2018. Patients were included based on International Classification of Diseases, 10th Revision (ICD-10) procedure codes for anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA). Patients with an alcohol use disorder (AUD) were identified using the ICD-10 diagnosis code F10.20. Demographics, complications, and 30-day and 90-day readmission were collected for all patients. A univariate logistic regression was performed to investigate AUD as a factor affecting readmission and complication rates. A multivariate logistic regression model was created to assess the impact of alcohol use disorder on complications and readmission while controlling for demographic factors. Results In total, 164,527 patients were included, and 503 (0.3%) patients had a prior diagnosis of AUD. Revision surgery was more common in patients with an alcohol use disorder (8.8% vs. 6.2%; p = 0.022). Postoperative infection (p = 0.026), dislocation (p = 0.025), liver complications (p < 0.01), and 90-day readmission (p < 0.01) were more common in patients with a diagnosed AUD. On multivariate analysis, patients with an AUD were found to be at increased odds for liver complications (OR: 46.8; 95% CI: [32.8, 66.8]; p < 0.01). Comparatively, mean age, length of stay, and over healthcare costs were also higher for patients with an AUD. Conclusion Patients with a diagnosis of AUD were more likely to suffer from shoulder dislocation, liver complications, and 90-day readmission, while also being younger and having longer hospital stays. Therefore, surgeons should take caution to anticipate and prevent complications and readmissions following total shoulder arthroplasty in patients with an AUD.
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Affiliation(s)
- Christopher A. White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Addison Quinones
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Justin E. Tang
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Liam R. Butler
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Akiro H. Duey
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Jun S. Kim
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Samuel K. Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
| | - Paul J. Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 425 West 59th Street, New York City, NY, 10019, United states
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16
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Silczuk A, Mańczak M, Owoc J. Alcohol Policies Affect Drinking Patterns-A Potentially New and Harmful Drinking Pattern in Consumers of Small Vodka Bottles (SVB) in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17047. [PMID: 36554939 PMCID: PMC9779443 DOI: 10.3390/ijerph192417047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Drinking alcohol has a vast and diverse impact on many aspects of people's lives around the world. It is a major public health concern and is subject to numerous legal regulations and limitations. So far, little attention has been paid to if and how the volume of alcohol containers may affect drinking patterns. The widespread availability in recent years in Poland of small vodka bottles in various flavors and sizes was the rationale behind investigating whether the phenomenon may affect drinking patterns in any way. This was a 12-month cross-sectional survey study that started in January 2020. It included a total of 217 inpatients and outpatients that met the ICD-10 alcohol dependence criteria. The respondents were asked about their drinking habits and the use of small vodka bottles. It was found that respondents who regularly use small vodka bottles were much more likely to start their drinking early in the morning. The widespread availability and selection of small vodka bottles may encourage and facilitate drinking that starts early in the morning. It also makes it easier to maintain and control intoxication throughout the whole day, which could be considered another drinking pattern different from the other well-established ones, such as binge or continuous drinking. However, the design of this study makes it impossible to draw firm conclusions and further research is necessary.
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Affiliation(s)
- Andrzej Silczuk
- Department of Public Health, Medical University of Warsaw, 02-091 Warsaw, Poland
- Department of Prevention and Treatment of Addictions, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
| | - Małgorzata Mańczak
- National Institute of Geriatrics, Rheumatology, and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
| | - Jakub Owoc
- National Institute of Geriatrics, Rheumatology, and Rehabilitation in Warsaw, 02-637 Warsaw, Poland
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17
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Gatta E, Camussi D, Auta J, Guidotti A, Pandey SC. Neurosteroids (allopregnanolone) and alcohol use disorder: From mechanisms to potential pharmacotherapy. Pharmacol Ther 2022; 240:108299. [PMID: 36323379 PMCID: PMC9810076 DOI: 10.1016/j.pharmthera.2022.108299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Alcohol Use Disorder (AUD) is a multifaceted relapsing disorder that is commonly comorbid with psychiatric disorders, including anxiety. Alcohol exposure produces a plethora of effects on neurobiology. Currently, therapeutic strategies are limited, and only a few treatments - disulfiram, acamprosate, and naltrexone - are available. Given the complexity of this disorder, there is a great need for the identification of novel targets to develop new pharmacotherapy. The GABAergic system, the primary inhibitory system in the brain, is one of the well-known targets for alcohol and is responsible for the anxiolytic effects of alcohol. Interestingly, GABAergic neurotransmission is fine-tuned by neuroactive steroids that exert a regulatory role on several endocrine systems involved in neuropsychiatric disorders including AUD. Mounting evidence indicates that alcohol alters the biosynthesis of neurosteroids, whereas acute alcohol increases and chronic alcohol decreases allopregnanolone levels. Our recent work highlighted that chronic alcohol-induced changes in neurosteroid levels are mediated by epigenetic modifications, e.g., DNA methylation, affecting key enzymes involved in neurosteroid biosynthesis. These changes were associated with changes in GABAA receptor subunit expression, suggesting an imbalance between excitatory and inhibitory signaling in AUD. This review will recapitulate the role of neurosteroids in the regulation of the neuroendocrine system, highlight their role in the observed allostatic load in AUD, and develop a framework from mechanisms to potential pharmacotherapy.
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Affiliation(s)
- Eleonora Gatta
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, Psychiatric Institute, University of Illinois at Chicago, USA
| | - Diletta Camussi
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, Psychiatric Institute, University of Illinois at Chicago, USA
| | - James Auta
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, Psychiatric Institute, University of Illinois at Chicago, USA
| | - Alessandro Guidotti
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, Psychiatric Institute, University of Illinois at Chicago, USA
| | - Subhash C Pandey
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, Psychiatric Institute, University of Illinois at Chicago, USA; Jesse Brown Veterans Affairs Medical Center Chicago, IL 60612, USA.
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18
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Gerhardt S, Hoffmann S, Tan H, Gerchen MF, Kirsch P, Vollstädt-Klein S, Kiefer F, Bach P, Lenz B. Neural cue reactivity is not stronger in male than in female patients with alcohol use disorder. Front Behav Neurosci 2022; 16:1039917. [PMID: 36467741 PMCID: PMC9709253 DOI: 10.3389/fnbeh.2022.1039917] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/20/2022] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Males consume more alcohol than females, and alcohol use disorder (AUD) is more prevalent in males than females. However, females progress faster to AUD. Sex differences in neural alcohol cue reactivity were previously observed in young social drinkers, indicating a role of hypersensitivity to alcohol-related cues in very early stages of addiction. To our knowledge, this is the first study on patients diagnosed with AUD to test sex differences in neural reactivity to alcohol cues in order to widen previous findings. METHODS We analyzed data from previous studies, using a well-established functional magnetic resonance imaging (fMRI) paradigm to compare neural reactivity to alcohol cues between 42 female and 124 male patients with AUD (mean age 45 and 46 years) in predefined regions of interest that were implicated by previous studies (ventral and dorsal striatum as well as caudate, putamen, amygdala, hippocampus, insula, anterior cingulate cortex, and medial prefrontal cortex) using independent samples t-tests. Post-hoc, effect size calculations were performed. RESULTS Throughout all nine regions of interest, we found no statistically significant sex differences in neural reactivity toward alcoholic pictures alone or in comparison to neutral pictures (p > 0.05, FDR-corrected). Post-hoc effect size estimates indicated a magnitude between 0.137 and 0.418 (Hedge's g) on alcohol reactivity to alcohol cues compared to neutral cues and indicate very small to less than medium effect sizes in the direction of higher cue reactivity in female patients. CONCLUSION Previous studies showed sex differences in neural alcohol cue reactivity in younger social and problematic alcohol drinkers, i.e., stronger striatal cue-reactivity in males. After correction for multiple comparisons, we did not observe significant sex differences in a cohort of middle-aged females and males with AUD. Sex differences that are present during early phases of addiction development might disappear at later stages of AUD and might thus be considered as clinically less relevant in patients with more severe AUD.
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Affiliation(s)
- Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Haoye Tan
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Bernstein Center for Computational Neuroscience Heidelberg-Mannheim, Mannheim, Germany
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Bernstein Center for Computational Neuroscience Heidelberg-Mannheim, Mannheim, Germany
- Department of Psychology, Heidelberg University, Heidelberg, Germany
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Feuerlein Center on Translational Addiction Medicine, Heidelberg University, Heidelberg, Germany
| | - Bernd Lenz
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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19
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Christoffersen LAN, Mortensen EL, Sørensen HJ, Becker U, Osler M, Flensborg-Madsen T. Demographic factors and delay of treatment for alcohol use disorders among 6584 Danish men receiving alcohol treatment. Nord J Psychiatry 2022; 76:507-514. [PMID: 34873973 DOI: 10.1080/08039488.2021.2007999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to investigate the time lag between onset and treatment (treatment delay) for alcohol use disorders (AUD) and associations between demographic factors and treatment delay for AUD. METHODS The study included 6,584 men registered in the Copenhagen Alcohol Cohort, containing information on civil status, employment status, estimated age at onset of alcohol problems, and age at first outpatient AUD treatment. Data on year of birth, intelligence, and educational level were obtained from the Danish Conscription Database. Information on first hospital AUD treatment was retrieved from Danish national psychiatric registers. Associations between the demographic factors and treatment delay were analysed in separate linear regression models adjusted for year of birth and in a mutually adjusted model including all demographic factors. RESULTS The mean treatment delay for AUD was 6.9 years (SD = 4.1). After mutual adjustment, an SD increase in intelligence score was associated with 0.17 years increase in treatment delay. Educational level was unrelated to treatment delay. Men with estimated age at onset of alcohol problems at age 20 years or younger had a 5.30 years longer treatment delay than men who had estimated age at onset of alcohol problems at age 51 years or older. Employed men had shorter treatment delays than unemployed men, especially among the oldest birth cohorts. CONCLUSIONS The treatment delay of 6.9 years highlights the necessity to promote access to AUD treatment, perhaps in particular among adolescents and young individuals. Cognitive factors may affect treatment delay more than non-cognitive personal factors.
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Affiliation(s)
- Lea Arregui Nordahl Christoffersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Holger Jelling Sørensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Mental Health Centre Copenhagen, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Merete Osler
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Trine Flensborg-Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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20
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Fredriksson I, Jayaram-Lindström N, Kalivas PW, Melas PA, Steensland P. N-acetylcysteine improves impulse control and attenuates relapse-like alcohol intake in long-term drinking rats. Behav Brain Res 2022; 436:114089. [PMID: 36063970 DOI: 10.1016/j.bbr.2022.114089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
Increasing evidence suggests that individuals with alcohol use disorder (AUD) present with a disrupted glutamatergic system that underlies core components of addictive disorders, including drug relapse and low impulse control. N-acetylcysteine (NAC) is a cystine prodrug that has been found to promote glutamate homeostasis and drug abstinence. However, no studies to date have evaluated NAC's effect on impulsivity in substance use disorders. Here we determined whether NAC would decrease alcohol-intake behaviors, in addition to improving impulse control, in long-term alcohol drinking male Wistar-Han rats. Before the start of the experiments, all rats were exposed to long-term intermittent access to 20% ethanol for at least seven weeks. Next, in different groups of rats, the effect of NAC (60 and/or 90mg/kg) was evaluated on (i) voluntary alcohol drinking using a two-bottle free choice paradigm, (ii) the motivation to self-administer alcohol under a progressive ratio schedule of reinforcement, and (iii) relapse-like drinking using the alcohol deprivation effect model. Finally, (iv) NAC's effect on impulse control was evaluated using the five-choice serial reaction time task. Results showed that NAC administration at 90mg/kg significantly reduced relapse-like drinking and improved impulse control. In contrast, NAC had no effect on levels of alcohol drinking or motivation to drink alcohol. In conclusion, our findings continue to support the use of NAC as an adjuvant treatment for the maintenance of abstinence in AUD. Moreover, we provide evidence for NAC's efficacy in improving impulse control following drinking, which warrants further investigation in substance use settings.
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Affiliation(s)
- Ida Fredriksson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, 11364 Stockholm, Sweden
| | - Nitya Jayaram-Lindström
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, 11364 Stockholm, Sweden
| | - Peter W Kalivas
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA; Ralph Johnson Veterans Administration, Charleston, SC, USA
| | - Philippe A Melas
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, 11364 Stockholm, Sweden; Center for Molecular Medicine, L8:00, Karolinska University Hospital, 17176 Stockholm, Sweden.
| | - Pia Steensland
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, 11364 Stockholm, Sweden
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21
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Rehm J, Shield KD, Bunova A, Ferreira‐Borges C, Franklin A, Gornyi B, Rovira P, Neufeld M. Prevalence of alcohol use disorders in primary health-care facilities in Russia in 2019. Addiction 2022; 117:1640-1646. [PMID: 35072306 PMCID: PMC9305418 DOI: 10.1111/add.15816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
AIMS To estimate prevalence of alcohol use disorders (AUD) and alcohol dependence (AD) for Russia in 2019, based on clients in primary health-care facilities. DESIGN Cross-sectional assessment of AUD and AD. Prevalence estimates were cross-validated using a treatment multiplier methodology. SETTING A total of 21 primary health-care facilities, including dispanserization units (population health preventive care settings). PARTICIPANTS A total of 2022 participants (986 women and 1036 men) 18 years of age and older. MEASUREMENTS Composite International Diagnostic Interview. FINDINGS The prevalence of AD and AUD was 7.0% [95% confidence interval (CI) = 5.9-8.1%] and 12.2% (95% CI = 10.8-13.6%), respectively. Marked sex differences were observed for the prevalence of AD (women: 2.8%; 95% CI = 1.7-3.8%; men: 12.2%; 95% CI = 10.3-14.1%) and AUD (women: 6.1%; 95% CI = 4.6-7.7%; men: 19.5%; 95% CI = 17.2-21.8%). Age patterns of AD and AUD prevalence were sex-specific. Among women, the prevalence of AUD and AD was highest in the youngest age group and decreased with age. Among men, the prevalence of AUD and AD was highest among men aged 45-59 years. Sensitivity analyses indicated that the prevalence of AD as estimated using a treatment multiplier (6.5%; 95% CI = 5.0-8.9%) was similar to the estimates of the main analysis. CONCLUSIONS Even though alcohol use has declined since 2003 in Russia, the prevalence of alcohol use disorders and alcohol dependence remains high at approximately 12 and 7%, respectively.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)TorontoOntarioCanada,Dalla Lana School of Public Health and Department of PsychiatryUniversity of TorontoTorontoOntarioCanada,Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and PsychotherapyUniversity Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany,Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthTorontoOntarioCanada,Faculty of Medicine, Institute of Medical ScienceUniversity of TorontoTorontoOntarioCanada,Program on Substance Abuse and World Health Organization (WHO) CC, Public Health Agency of CataloniaBarcelonaSpain,I. M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Kevin D. Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)TorontoOntarioCanada,Dalla Lana School of Public Health and Department of PsychiatryUniversity of TorontoTorontoOntarioCanada,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthTorontoOntarioCanada
| | - Anna Bunova
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian FederationMoscowRussia
| | - Carina Ferreira‐Borges
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable DiseasesMoscowRussia
| | - Ari Franklin
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)TorontoOntarioCanada
| | - Boris Gornyi
- National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian FederationMoscowRussia
| | - Pol Rovira
- Program on Substance Abuse and World Health Organization (WHO) CC, Public Health Agency of CataloniaBarcelonaSpain
| | - Maria Neufeld
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)TorontoOntarioCanada,Institute of Clinical Psychology and PsychotherapyTechnische Universität DresdenDresdenGermany,World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable DiseasesMoscowRussia
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22
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Safreed-Harmon K, Fuster-RuizdeApodaca MJ, Pastor de la Cal M, Lazarus JV. Problems undermining the health-related quality of life of people living with HIV in Spain: a qualitative study to inform the development of a novel clinic screening tool. Health Qual Life Outcomes 2022; 20:84. [PMID: 35614470 PMCID: PMC9131550 DOI: 10.1186/s12955-022-01978-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background In settings with high antiretroviral therapy coverage, numerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). As part of a larger study to develop and validate a new patient-reported outcome measure for use in HIV clinical care in Spain, we sought to identify the most burdensome health-related issues experienced by PLHIV in order to determine which issues should be addressed in the new instrument. Methods We conducted a literature review and a qualitative study based on four focus group discussions (FGDs) with key informants in Spain. Participants were selected via purposive sampling. Two FGDs convened 16 expert HIV service providers, and two convened 15 PLHIV with diverse epidemiological profiles. FGDs followed semi-structured interview scripts and incorporated an exercise to prioritise the most critical health-related issues among those named in the discussions. Content analysis was conducted using MAXQDA 12. Results The analysis of FGD data identified several broad categories of issues that were perceived to negatively affect PLHIV. The most frequently named issues fell within the categories of social problems; physical symptoms; psychological problems; and sexuality-related problems. Regarding social problems, stigma/discrimination was by far the issue raised the most frequently. In the prioritisation exercise, stigma/discrimination was also ranked as the most burdensome issue by both service providers and PLHIV. Within the physical symptoms category, the issues named most frequently were sleep-related problems, fatigue, physical pain and body fat changes. Regarding psychological problems, FGD participants most commonly spoke of emotional distress in general terms, and also called attention to depression and anxiety. In the prioritisation exercise, both service providers and PLHIV ranked psychological well-being as the second-most important issue following stigma. Sexuality-related problems that were reported included sexually transmitted infections, hormonal problems, lack of libido, and general sexual dissatisfaction. Conclusions PLHIV are negatively affected by a wide range of health-related issues. HIV-related stigma and psychological well-being remain major challenges. Identifying and addressing these and other issues in routine clinical care supports healthy aging and may ultimately contribute to better health and HRQoL outcomes in this population.
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Affiliation(s)
- Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. .,Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Maria J Fuster-RuizdeApodaca
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain.,Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Marta Pastor de la Cal
- Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain.,Bizkaisida, Bilbao, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
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23
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Łowicka-Smolarek M, Kokoszka-Bargieł I, Knapik M, Śmietanka K, Dyrda P, Możdżeń M, Kurczab M, Borkowski J, Knapik P. Analysis of Patients with Alcohol Dependence Treated in Silesian Intensive Care Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5914. [PMID: 35627451 PMCID: PMC9140825 DOI: 10.3390/ijerph19105914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022]
Abstract
Analysis of patients with alcohol dependence (AD) treated in intensive care units has never been performed in Poland. Data from 25,416 adult patients identified in a Silesian Registry of Intensive Care Units were analysed. Patients with AD were identified, and their data were compared with the remaining population. Preadmission and admission variables that independently influenced ICU death in these patients were identified. Among 25,416 analysed patients, 2285 subjects (9.0%) were indicated to have AD among their comorbidities. Patients with AD were significantly younger (mean age: 53.3 ± 11.9 vs. 62.2 ± 15.5 years, p < 0.001) but had a higher mean APACHE II score at admission and were more frequently admitted to the ICU due to trauma, poisonings, acute pancreatitis, and severe metabolic abnormalities. ICU death and unfavourable outcomes were more frequent in these patients (47.8% vs. 43.0%, p < 0.001 and 54.1% vs. 47.0%, p < 0.001, respectively). Multiorgan failure as the primary cause of ICU admission was among the most prominent independent risk factors for ICU death in these patients (OR: 3.30, p < 0.001). Despite the younger age, ICU treatment of patients with AD was associated with higher mortality and a higher percentage of unfavourable outcomes.
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Affiliation(s)
- Małgorzata Łowicka-Smolarek
- Department of Anaesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.Ł.-S.); (M.K.); (K.Ś.); (P.D.); (M.K.); (J.B.)
| | - Izabela Kokoszka-Bargieł
- Department of Anesthesiology and Intensive Therapy, Provincial Specialist Hospital, 43-100 Tychy, Poland;
| | - Małgorzata Knapik
- Department of Anaesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.Ł.-S.); (M.K.); (K.Ś.); (P.D.); (M.K.); (J.B.)
| | - Konstanty Śmietanka
- Department of Anaesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.Ł.-S.); (M.K.); (K.Ś.); (P.D.); (M.K.); (J.B.)
| | - Piotr Dyrda
- Department of Anaesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.Ł.-S.); (M.K.); (K.Ś.); (P.D.); (M.K.); (J.B.)
| | - Mateusz Możdżeń
- Students’ Scientific Society, Department of Cardiac Anesthesia and Intensive Care, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Magdalena Kurczab
- Department of Anaesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.Ł.-S.); (M.K.); (K.Ś.); (P.D.); (M.K.); (J.B.)
| | - Jarosław Borkowski
- Department of Anaesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.Ł.-S.); (M.K.); (K.Ś.); (P.D.); (M.K.); (J.B.)
| | - Piotr Knapik
- Department of Anaesthesiology and Intensive Therapy, Silesian Centre for Heart Diseases in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.Ł.-S.); (M.K.); (K.Ś.); (P.D.); (M.K.); (J.B.)
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24
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SM, Agaltsov MV, Alexandrova LM, Antsiferova AA, Aronov DM, Akhmedzhanov NM, Balanova YA, Balakhonova TV, Berns SA, Bochkarev MV, Bochkareva EV, Bubnova MV, Budnevsky AV, Gambaryan MG, Gorbunov VM, Gorny BE, Gorshkov AY, Gumanova NG, Dadaeva VA, Drozdova LY, Egorov VA, Eliashevich SO, Ershova AI, Ivanova ES, Imaeva AE, Ipatov PV, Kaprin AD, Karamnova NS, Kobalava ZD, Konradi AO, Kopylova OV, Korostovtseva LS, Kotova MB, Kulikova MS, Lavrenova EA, Lischenko OV, Lopatina MV, Lukina YV, Lukyanov MM, Mayev IV, Mamedov MN, Markelova SV, Martsevich SY, Metelskaya VA, Meshkov AN, Milushkina OY, Mukaneeva DK, Myrzamatova AO, Nebieridze DV, Orlov DO, Poddubskaya EA, Popovich MV, Popovkina OE, Potievskaya VI, Prozorova GG, Rakovskaya YS, Rotar OP, Rybakov IA, Sviryaev YV, Skripnikova IA, Skoblina NA, Smirnova MI, Starinsky VV, Tolpygina SN, Usova EV, Khailova ZV, Shalnova SA, Shepel RN, Shishkova VN, Yavelov IS. 2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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25
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Büttner L, Aigner A, Pick L, Brittinger J, Steib CJ, Böning G, Streitparth F. 25 years of experience with transjugular intrahepatic portosystemic shunt (TIPS): changes in patient selection and procedural aspects. Insights Imaging 2022; 13:73. [PMID: 35416547 PMCID: PMC9008097 DOI: 10.1186/s13244-022-01216-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background TIPS is an established treatment for portal hypertension. The aim was to analyze how patient selection for TIPS implantation and procedural aspects have changed over 25 years. Routinely collected demographic, clinical, laboratory, and procedural data of 835 patients treated with TIPS in a single center were used. Time trends over the observational period from 1993 to 2018 were retrospectively analyzed. Descriptive statistical analysis was performed. Results The most common indication for TIPS implantation has changed significantly from secondary prevention of variceal hemorrhage in the early years to treatment of recurrent ascites. During the observation period, increasingly more severely ill patients became TIPS candidates. There was little change in MELD scores over this period (in total median 13.00; IQR 10.00–18.00). The proportion of patients with Child–Pugh C cirrhosis increased. The most frequent underlying diseases in total were alcohol-related liver disease (66.5%) and viral hepatitis (11.9%). However, shares of cryptogenic liver cirrhosis, autoimmune hepatitis, and NASH increased over time. The proportion of patients post liver transplant also increased. While bare metal stents were standard in the past, use of covered stents increased. The success rate of TIPS (defined by successful implantation and a decrease in the portosystemic pressure gradient ≤ 12 mmHg) increased significantly over time. The total success rate according to this definition was 84.9%. Conclusion The results of our analysis reflect technical developments in TIPS, especially in terms of stent material and gains in clinical experience, particularly regarding indications and patient selection for TIPS implantation.
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Affiliation(s)
- Laura Büttner
- Department of Radiology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Annette Aigner
- Institute of Biometry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Pick
- Department of Radiology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Josefine Brittinger
- Department of Radiology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christian J Steib
- Medical Clinic II, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Georg Böning
- Department of Radiology, Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Florian Streitparth
- Department of Radiology, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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26
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, and Campbell Family Mental Health Research Institute, Toronto, ON M5S 2S1, Canada; Institute of Medical Science, Dalla Lana School of Public Health, and Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Robin Room
- Centre for Alcohol Policy Research, Turning Point, Fitzroy, VIC, Australia; School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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27
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Huth KBS, Luigjes J, Marsman M, Goudriaan AE, van Holst RJ. Modeling alcohol use disorder as a set of interconnected symptoms - Assessing differences between clinical and population samples and across external factors. Addict Behav 2022; 125:107128. [PMID: 34655909 DOI: 10.1016/j.addbeh.2021.107128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/19/2021] [Accepted: 08/18/2021] [Indexed: 12/30/2022]
Abstract
Alcohol use disorder is argued to be a highly complex disorder influenced by a multitude of factors on different levels. Common research approaches fail to capture this breadth of interconnecting symptoms. To address this gap in theoretical assumptions and methodological approaches, we used a network analysis to assess the interplay of alcohol use disorder symptoms. We applied the exploratory analysis to two US-datasets, a population sample with 23,591 individuals and a clinical sample with 483 individuals seeking treatment for alcohol use disorder. Using a Bayesian framework, we first investigated differences between the clinical and population sample looking at the symptom interactions and underlying structure space. In the population sample the time spent drinking alcohol was most strongly connected, whereas in the clinical sample loss of control showed most connections. Furthermore, the clinical sample demonstrated less connections, however, estimates were too unstable to conclude the sparsity of the network. Second, for the population sample we assessed whether the network was measurement invariant across external factors like age, gender, ethnicity and income. The network differed across all factors, especially for age subgroups, indicating that subgroup specific networks should be considered when deriving implications for theory building or intervention planning. Our findings corroborate known theories of alcohol use disorder stating loss of control as a central symptom in alcohol dependent individuals.
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Affiliation(s)
- K B S Huth
- Department of Psychology, University of Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands; Centre for Urban Mental Health, University of Amsterdam, The Netherlands.
| | - J Luigjes
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands; Centre for Urban Mental Health, University of Amsterdam, The Netherlands
| | - M Marsman
- Department of Psychology, University of Amsterdam, The Netherlands; Centre for Urban Mental Health, University of Amsterdam, The Netherlands
| | - A E Goudriaan
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands; Centre for Urban Mental Health, University of Amsterdam, The Netherlands; Arkin Mental Health Institute, The Netherlands
| | - R J van Holst
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands; Centre for Urban Mental Health, University of Amsterdam, The Netherlands
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28
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Arnedt JT, Cardoni ME, Conroy DA, Graham M, Amin S, Bohnert KM, Krystal AD, Ilgen MA. Telemedicine-delivered cognitive-behavioral therapy for insomnia in alcohol use disorder (AUD): study protocol for a randomized controlled trial. Trials 2022; 23:59. [PMID: 35057834 PMCID: PMC8771184 DOI: 10.1186/s13063-021-05898-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/30/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is a leading preventable cause of morbidity and mortality, but relapse rates are high even with available treatments. Insomnia is a robust predictor of relapse and pilot studies have shown that CBT for insomnia improves insomnia and daytime functioning in adults with AUD and insomnia. The impact of CBT for insomnia on relapse, however, is unclear. This trial will compare telemedicine-delivered CBT for insomnia (CBT-TM) with sleep hygiene education (SHE-TM) on improving insomnia/sleep, daytime symptom, and drinking outcomes in treatment-seeking AUD adults with insomnia. The study will also determine the effects of treatment on sleep mechanisms and their association with clinical outcomes. METHODS This is a single-site randomized controlled trial with planned enrollment of 150 adults meeting criteria for both AUD and chronic insomnia. Eligible participants will be randomized 1:1 to 6 sessions of telemedicine-delivered Cognitive Behavioral Therapy for Insomnia (CBT-TM) or Sleep Hygiene Education (SHE-TM) with clinical assessments conducted at pre-treatment, post- treatment, and at 3, 6, and 12 months post-treatment. Overnight polysomnography will be conducted before and after treatment. Primary clinical outcomes will include post-treatment scores on the Insomnia Severity Index and the General Fatigue subscale of the Multidisciplinary Fatigue Inventory, and the percent of days abstinent (PDA) on the interview-administered Time Line Follow Back. EEG delta activity, derived from overnight polysomnography, will be the primary endpoint to assess the sleep homeostasis mechanism. DISCUSSION This adequately powered randomized controlled trial will provide clinically relevant information about whether targeting insomnia is effective for improving treatment outcomes among treatment-seeking adults with AUD. Additionally, the study will offer new scientific insights on the impact of an evidence-based non-medication treatment for insomnia on a candidate mechanism of sleep dysfunction in this population - sleep homeostasis. TRIAL REGISTRATION CClinicalTrials.gov NCT # 04457674 . Registered on 07 July 2020.
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Affiliation(s)
- J Todd Arnedt
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA.
| | - M Elizabeth Cardoni
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA
| | - Deirdre A Conroy
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA
| | - Mandilyn Graham
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA
| | - Sajni Amin
- Sleep and Circadian Research Laboratory, Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, USA
| | - Kipling M Bohnert
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, USA
| | - Andrew D Krystal
- UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, USA
| | - Mark A Ilgen
- University of Michigan Addiction Treatment Services, Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA
- VA Center for Clinical Management Research (CCMR) Department of Veterans Affairs Healthcare System, Michigan, Ann Arbor, USA
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29
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Qu X, Liu M, Ke C, Liang J, Du Y, Yao L, Li J, Mu G, Liu S, Wang C. Burden of alcohol use disorders in China and the regions with different income levels over the world. J Glob Health 2022; 11:08011. [PMID: 35003718 PMCID: PMC8710067 DOI: 10.7189/jogh.11.08011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Alcohol use disorders (AUD) has long been one of the most disability mental disorders and a major cause of health loss. Methods Based on open access data from the 2019 Global Burden of Disease (GBD 2019) study, we extracted data of years lived with disability (YLD), years of life lost (YLL) and disability-adjusted life years (DALY) to describe the changes of AUD burden over the period of 1990-2019 stratified by sex in globe, high-income countries (HICs), upper-middle income countries (UMCs), lower-middle income countries (LMCs), low-income countries (LICs) and China. We used Joinpoint regression model to fit the changing trend of years. And pairwise comparison was applied to test the coincidence parallelism and judge whether the difference of the trend among different regions is statistically significant. Results LMCs experienced the largest changes in the YLD rate of AUD from 1990 to 2019 (average annual percent change (AAPC) = -0.7, 95% confidence interval (CI) = -0.8, -0.7, P < 0.05), with China experienced a higher increase in 1990 to 1993 (annual percent change (APC) = 3.8, 95% CI = 3.2, 4.4, P < 0.05) than other regions, and the rate of decline in China from 1996 to 2002 (APC = -3.4, 95% CI = -3.6, -3.1, P < 0.05) was higher than that in other regions. UMCs experienced the largest changes in the YLL rate of AUD from 1990 to 2019 (AAPC = -1.1, 95% CI = -1.6, -0.6, P < 0.05), with a larger decline in 2004 to 2012 (APC = -6.2, 95% CI = -6.7, -5.7, P < 0.05) than other regions, and China experienced a larger increase in the rate of YLL from 1999 to 2004 (APC = 9.2, 95% CI = 8.5, 9.9, P < 0.05) than other regions. LMCs experienced the largest changes in the DALY rate of AUD from 1990 to 2019 (AAPC = -0.9, 95% CI = -1.0, -0.8, P < 0.05), with a larger decline in 2006 to 2010 (APC = -3.3, 95% CI = -3.6, -2.9, P < 0.05) than other regions, and UMCs showed a larger increase in the rate of DALY from 1990 to 1994 (APC = 4.5, 95% CI = 3.8, 5.1, P < 0.05) than other regions. Conclusions Given the large variations in AUD burden of disease by income level, future strategies to prevent and reduce the burden should be developed and implemented based on country-specific development status.
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Affiliation(s)
- Xiang Qu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Mi Liu
- Hospital infection management office, The Second People's Hospital of Lianyungang Lianyungang, China
| | - Changrong Ke
- School of Public Health, Weifang Medical University, Weifang, China
| | - Juanjuan Liang
- School of Public Health, Weifang Medical University, Weifang, China
| | - Yuanze Du
- School of Public Health, Weifang Medical University, Weifang, China
| | - Liqun Yao
- School of Public Health, Weifang Medical University, Weifang, China
| | - Juanjuan Li
- School of Public Health, Weifang Medical University, Weifang, China
| | - Guixian Mu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Shiwei Liu
- Tobacco Control office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunping Wang
- School of Public Health, Weifang Medical University, Weifang, China
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Mo D, Min K, Gluck R, Jiang F, Tao R, Geng F, Xia L, Liu T, Liu Y, Liu H, Tang YL. Alcohol Use and Misuse Among Chinese Psychiatrists During the Early COVID-19 Pandemic. Front Psychiatry 2022; 13:933814. [PMID: 35815044 PMCID: PMC9258332 DOI: 10.3389/fpsyt.2022.933814] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
AIM Survey alcohol use and misuse among Chinese psychiatrists during the Coronavirus diseases 2019 (COVID-19) pandemic. METHODS We conducted a large-scale, nationwide online survey of psychiatrists regarding their alcohol use during the pandemic. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to assess alcohol use and misuse. RESULTS Of 3,815 psychiatrists who completed the survey, alcohol use and misus were 47.5% and 8.2%, respectively, and both were significantly higher in males. The majority (59%) reported no change in alcohol use during the pandemic, one-third (34.5%) reported a decrease, and 6.5% reported an increase. Alcohol misuse was associated with middle-age (OR = 1.418), male sex (OR = 5.089), Northeast China (OR = 1.507), cigarette-smoking (OR = 2.335), insomnia (OR = 1.660), and regular exercise (OR = 1.488). A master's degree (OR = 0.714) and confidence in clinical work (OR = 0.610) were associated with less alcohol misuse. Those who reported a decrease in alcohol use during the pandemic were more likely to be male (OR = 2.011), located in Northeast China (OR = 1.994), and feel confident in their clinical work (OR = 1.624). Increased alcohol use was significantly associated with insomnia (OR = 3.139). CONCLUSIONS During the COVID-19 pandemic, alcohol use and misuse among Chinese psychiatrists declined. While males were more likely to misuse alcohol, they were also more likely to have reduced their intake. Age, location, and lifestyle factors also predicted alcohol use and misuse. Further examination of specific factors that reduced alcohol use and misuse may help guide public health efforts to sustain the lower rates beyond the pandemic.
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Affiliation(s)
- Daming Mo
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, China
| | - Kaiyuan Min
- State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rachel Gluck
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Feng Jiang
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China.,Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Tao
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, China
| | - Feng Geng
- Department of Psychiatry, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lei Xia
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Tingfang Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanzhong Liu
- Department of Psychiatry, Chao Hu Hospital of Anhui Medical University, Hefei, China.,Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.,Atlanta Veterans Affairs Medical Center, Decatur, GA, United States
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Horn AR, Diamond KB, Ng MK, Vakharia RM, Mont MA, Erez O. The Association of Alcohol Use Disorder with Perioperative Complications following Primary Total Hip Arthroplasty. Hip Pelvis 2021; 33:231-238. [PMID: 34938693 PMCID: PMC8654594 DOI: 10.5371/hp.2021.33.4.231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Alcohol use disorder is a leading mental health disorder in the United States. Few studies evaluating the association of alcohol use disorder following primary total hip arthroplasty (THA) have been reported. Therefore, the purpose of this study was to determine whether patients with alcohol use disorder undergoing primary THA have higher rates of: 1) in-hospital lengths of stay (LOS); 2) complications (medical/implant-related); and 3) costs. Materials and Methods Using a nationwide claims database from January 1st, 2005 to March 31st, 2014, patients with alcohol use disorder undergoing primary THA were identified and matched to a comparison group according to age, sex, and various comorbidities, resulting in 230,467 patients who were included in the study (n=38,416) and a matched-cohort (n=192,051). Outcomes of interest included comparison of LOS, 90-day medical and 2-year implant-related complications, and costs. A P-value less than 0.002 was considered statistically significant. Results Patients with alcohol use disorder had longer in-hospital LOS (4 days vs 3 days; P<0.0001) as well as higher frequency and odds ratio (OR) of 90-day medical (45.94% vs 12.25%; OR, 2.89; P<0.0001) and 2-year implant-related complications (17.71% vs 8.46%; OR, 1.97; P<0.0001). Patients in the study group incurred higher 90-day costs of care ($17,492.63 vs $14,921.88; P<0.0001). Conclusion With the growing prevalence of alcohol use disorder in the United States, the current investigation can be utilized to evaluate the need for interventions prior to THA which can potentially minimize the rates of morbidity and mortality within this population.
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Affiliation(s)
- Andrew R Horn
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Keith B Diamond
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Guiraud J, Addolorato G, Aubin HJ, Batel P, de Bejczy A, Caputo F, Goudriaan AE, Gual A, Lesch O, Maremmani I, Perney P, Poulnais R, Raffaillac Q, Soderpalm B, Spanagel R, Walter H, van den Brink W. Treating alcohol dependence with an abuse and misuse deterrent formulation of sodium oxybate: Results of a randomised, double-blind, placebo-controlled study. Eur Neuropsychopharmacol 2021; 52:18-30. [PMID: 34237655 DOI: 10.1016/j.euroneuro.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/20/2023]
Abstract
Sodium oxybate (SMO) has been approved in Italy and Austria for the maintenance of abstinence in alcohol dependent (AD) patients. Although SMO is well tolerated in AD patients, cases of abuse and misuse have been reported outside the therapeutic setting. Here we report on a phase IIb double-blind, randomized, placebo-controlled trial for the maintenance of abstinence in AD patients with a new abuse and misuse deterrent formulation of SMO. A total of 509 AD patients were randomized to 12 weeks of placebo or one of four SMO doses (0.75, 1.25, 1.75 or 2.25 g t.i.d.) followed by a one-week medication-free period. The primary endpoint was the percentage of days abstinent (PDA) at end of treatment. An unexpectedly high placebo response (mean 73%, median 92%) was observed. This probably compromised the demonstration of efficacy in the PDA, but several secondary endpoints showed statistically significant improvements. A post-hoc subgroup analysis based on baseline severity showed no improvements in the mild group, but statistically significant improvements in the severe group: PDA: mean difference +15%, Cohen's d = 0.42; abstinence: risk difference +18%, risk ratio = 2.22. No safety concerns were reported. Although the primary endpoint was not significant in the overall population, several secondary endpoints were significant in the intent-to-treat population and post-hoc results showed that treatment with SMO was associated with a significant improvement in severe AD patients which is consistent with previous findings. New trials are warranted that take baseline severity into consideration.
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Affiliation(s)
- Julien Guiraud
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, Amsterdam, Netherlands; D&A Pharma, Paris, France.
| | - Giovanni Addolorato
- Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy; Internal Medicine Unit, Columbus-Gemelli Hospital, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Henri-Jean Aubin
- French Institute of Health and Medical Research (Inserm), Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Paris, France; Addiction Research and Treatment Center, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Philippe Batel
- Addiction unit of Charente, Camille Claudel Hospital, 16400 La Couronne, France
| | - Andrea de Bejczy
- Section of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; Center for the Study and Treatment of Chronic Inflammatory Bowel Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
| | - Anna E Goudriaan
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands; Arkin, Dept. of Research and Quality of Care, Amsterdam, Netherlands, & Amsterdam Public Health Research Institute, Netherlands
| | - Antoni Gual
- Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Otto Lesch
- Department of Social Psychiatry, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Icro Maremmani
- Santa Chiara University Hospital, University of Pisa, Italy
| | - Pascal Perney
- Addiction Medicine, Hospital Grau-du-Roi, Nimes, France
| | | | | | - Bo Soderpalm
- Section of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Henriette Walter
- Department of Social Psychiatry, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Wim van den Brink
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
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Guo K, Li J, Li J, Chen N, Li Y, Yang K, Li X. The effects of pharmacological interventions on smoking cessation in people with alcohol dependence: A systematic review and meta-analysis of nine randomized controlled trials. Int J Clin Pract 2021; 75:e14594. [PMID: 34228852 DOI: 10.1111/ijcp.14594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pharmacotherapies are widely used for smoking cessation. However, their efficacy for people with alcohol dependence remains unclear. OBJECTIVE This study aimed to explore the effects of pharmacotherapies on smoking cessation for people with alcohol dependence. METHODS Five electronic databases were searched in January 2021 for randomized controlled trials (RCTs) reporting the use of pharmacotherapies to promote smoking cessation in people with alcohol dependence. The risk of bias was assessed using the Cochrane tool. RevMan version 5.3 was used to perform meta-analyses of the changes in smoking behaviour, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of the evidence. RESULTS The search identified nine RCTs involving 908 smokers with alcohol dependence; eight were published in the USA and one in Canada. The risk of bias was low in three studies and unclear in the remaining six. The meta-analysis results showed that, compared with the placebo group, Varenicline had a significant effect on short-term smoking cessation (three RCTs, odds ratio [OR] = 6.27, 95% confidence interval [CI]: [2.49, 15.78], P < .05, very low certainty). Naltrexone had no significant effect on smoking cessation in short-term or long-term observations (three RCTs, OR = 0.99, 95% CI: [0.54, 1.81], P = .97, moderate certainty), and Topiramate had no significant effects (two RCTs, OR = 1.56, 95% CI: [0.67, 3.46], P > .05, low certainty). Only one trial reported that Bupropion did not affect smoking cessation. CONCLUSION Varenicline may promote smoking cessation in people with alcohol dependence. However, Naltrexone, Topiramate and Bupropion have no clear effect on increasing smoking abstinence among drinkers. The small number of studies and the low certainty of evidence indicate that the results should be interpreted cautiously.
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Affiliation(s)
- Kangle Guo
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jingwen Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jieyun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Nan Chen
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yanfei Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Xiuxia Li
- Health Technology Assessment Center/Evidence-based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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Sliedrecht W, Roozen HG, Witkiewitz K, de Waart R, Dom G. The Association Between Impulsivity and Relapse in Patients With Alcohol Use Disorder: A Literature Review. Alcohol Alcohol 2021; 56:637-650. [PMID: 33382416 DOI: 10.1093/alcalc/agaa132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 01/14/2023] Open
Abstract
AIM Impulsivity has been identified as a key relapse risk factor in patients with alcohol use disorder (AUD); however, the inherent characteristics of this relationship have been largely understudied. The heterogeneity of AUD and variation in impulsivity constructs require careful consideration to inform future work examining the relationship. This study sought to review empirical findings examining facets of impulsivity and AUD relapse. METHODS A systematic search strategy was employed to capture studies on impulsivity measures related to AUD relapse. Impulsivity measures were qualitatively organized in terms of 'trait impulsivity'-typically measured by self-report questionnaires-and 'behavioural impulsivity', i.e. 'motor impulsivity', 'impulsive choice' and 'reflection impulsivity, assessed with cognitive-behavioural tasks. RESULTS Seventeen peer-reviewed papers were identified. Relapse outcomes varied substantially in relation to impulsivity measures. Twelve papers included aspects of 'trait impulsivity', and nine studies included 'behavioural impulsivity' measures, from which five studies dealt with the 'impulsive choice' subcategory. The Barratt Impulsivity Scale was the self-report questionnaire that was most frequently used. CONCLUSIONS All three included facets of impulsivity ('trait-, motor- and impulsive choice impulsivity') were associated with AUD relapse, but none seemed to be superior to another. This study confirmed that research on the relation between impulsivity and AUD relapse is relatively scarce. Future research and treatment options are proposed.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, The Netherlands
| | - Hendrik G Roozen
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), The University of New Mexico (UNM), MSC 11 6280, Albuquerque, NM 87106, USA
| | - Katie Witkiewitz
- The University of New Mexico, MSC 03-2220, Albuquerque, NM 87131, USA
| | - Ranne de Waart
- Mentrum/Arkin, Domselaerstraat 126, 1093 MB Amsterdam, The Netherlands
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, Universiteitsplein 1, 2610 Antwerp, Belgium
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Gowin JL, Sloan ME, Morris JK, Schwandt ML, Diazgranados N, Ramchandani VA. Characteristics Associated With High-Intensity Binge Drinking in Alcohol Use Disorder. Front Psychol 2021; 12:750395. [PMID: 34744927 PMCID: PMC8564144 DOI: 10.3389/fpsyg.2021.750395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
High-intensity binge drinking, defined as consuming 2-3 times the level of a binge (4 or 5 drinks for women or men), increases the risks of overdose and alcohol-related cancer relative to lower levels of drinking. This study examined the relationship between high-intensity binge drinking and three domains hypothesized to contribute to alcohol use disorder (AUD): incentive salience, negative emotionality, and executive function. This cross-sectional study at the National Institute on Alcohol Abuse and Alcoholism examined 429 adults with AUD and 413 adults without a history of AUD. Drinking was assessed using the 90-day Timeline Followback interview. The AUD sample was divided into training and testing sets, and a machine learning model was generated in the training set and then applied to the testing set, to classify individuals based on if they had engaged in high-intensity binge drinking. We also conducted regression models for the following dependent variables: the presence of high-intensity binge drinking, frequency of high-intensity binge drinking, and number of drinks per of binge. Independent variables in these regression models were determined by variable selection from the machine learning algorithm and included time thinking about alcohol, depression rating, and positive urgency as representative variables for the three domains. These variables were assessed using self-report measures. The models were applied to the adults without a history of AUD to determine generalizability. The machine learning algorithm displayed reasonable accuracy when classifying individuals as high-intensity binge drinkers (area under ROC=0.74, 95% CI 0.67, 0.80). In adults with AUD, greater depression rating (OR=1.04, 95% CI 1.01, 1.070) and amount of time thinking about alcohol (OR=1.48, 95% CI 1.20, 1.91) were associated with greater likelihood of high-intensity binge drinking. They were also associated with greater frequency of high-intensity binge drinking days and greater number of drinks on binge occasions. Our findings suggest that incentive salience may contribute to high-intensity binge drinking in both controls and individuals with AUD. Negative emotionality was only associated with high-intensity binge drinking in individuals diagnosed with AUD, suggesting that it may be a consequence rather than a cause of high-intensity binge drinking.
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Affiliation(s)
- Joshua L. Gowin
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Laboratory on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Matthew E. Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
- Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - James K. Morris
- Laboratory on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Melanie L. Schwandt
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Nancy Diazgranados
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Vijay A. Ramchandani
- Laboratory on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
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Lundin A, Waern M, Löve J, Lövestad S, Hensing G, Danielsson AK. Towards ICD-11 for alcohol dependence: Diagnostic agreement with ICD-10, DSM-5, DSM-IV, DSM-III-R and DSM-III diagnoses in a Swedish general population of women. Drug Alcohol Depend 2021; 227:108925. [PMID: 34358771 DOI: 10.1016/j.drugalcdep.2021.108925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The proposed ICD-11 classification includes major revisions of alcohol dependence. We aimed to evaluate the presence of, and concordance between the proposed ICD-11 dependence and ICD-10, DSM-5, DSM-IV, DSM-III-R and DSM-III in a general population. We also examine as aspects of validity, including longitudinal stability and how meaningful clinical correlates associated across the systems. METHODS Longitudinal population-based study of women in Gothenburg, Sweden. Participants (n = 1,614) were sampled during 1989-2015 through double-phase stratified random sampling. Alcohol use disorders were assessed through structured diagnostic interviews (CIDI-SAM), at baseline and follow-up 5-10 years later (n = 930). Concordance was examined using contingency tables and Cohen's kappa coefficient. RESULTS At baseline, the prevalence of lifetime alcohol dependence was 10.6 % according to ICD-11. Corresponding figures were ICD-10, 4.0 %; DSM-IV, 4.3 %; DSM-III-R, 7.5 %; and DSM-III, 12.3 %.DSM-5 Alcohol Use Disorder was 14.3 %. Concordance between ICD-11 and other diagnoses ranged from almost perfect agreement (with DSM-5 AUD) to substantial (with DSM-III and DSM-III-R) and moderate (with ICD-10 and DSM-IV). The broadening of the "persistent use despite problems" criteria in ICD-11 had little effect on the prevalence. ICD-11 captured a lower proportion of family history of alcohol problems and treatment-seeking compared to ICD-10 and DSM-IV and showed lower stability. CONCLUSIONS The proposed ICD-11 algorithm yields a higher prevalence than either ICD-10 or DSM-III-R /-IV dependence, as well as lower agreement with previous diagnostic systems, lower longitudinal stability and weaker associations with clinical correlates. This is important for knowing how changes in diagnostic criteria impact prevalence estimates and related research.
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Affiliation(s)
- A Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | - M Waern
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
| | - J Löve
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - S Lövestad
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - G Hensing
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - A-K Danielsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Rim SJ, Jo M, Lee JH, Park S. Analyzing Untreated Alcohol Use Disorder and Factors Related to Help-Seeking Status. Psychiatry Investig 2021; 18:936-942. [PMID: 34619821 PMCID: PMC8542744 DOI: 10.30773/pi.2021.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Alcohol use disorder (AUD) is a global burden but is also one of the most undertreated mental disorders. This study estimates the treatment rate (i.e., help-seeking status) of high-risk drinkers and factors associated with not receiving treatment in Korea using nationally representative National Health Insurance Service-National Sample Cohort (NHIS-NSC) data. METHODS Among 1,025,340 participants, we eliminated those under 20 and those who did not respond to the question regarding alcohol consumption. High-risk drinkers were classified based on their frequency and quantity of alcohol consumption (4 or more drinks for women, 5 or more drinks for men per day on average). In total, 32,225 high-risk drinkers were checked for an actual AUD diagnosis to see their treatment-seeking status. RESULTS Among 32,225 high-risk drinkers, only 1.24% had an AUD diagnosis, showing that over 98% of those who could be diagnosed with AUD are not seeking treatment. Factors associated with not seeking treatment were female sex, BMI higher or equal to 18.6, former smoker, middle-aged, and Charlson Comorbidity Index (CCI). CONCLUSION Our data show that many high-risk drinkers do not seek treatment in Korea. Experts, policymakers, and clinicians should promote help-seeking behavior for AUD and pay close attention to those at risk of not receiving treatment for AUD.
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Affiliation(s)
- Soo Jung Rim
- Department of Research Planning, National Center for Mental Health, Seoul, Republic of Korea
| | - MinKyung Jo
- Department of Research Planning, National Center for Mental Health, Seoul, Republic of Korea
| | - Junghyun H Lee
- National Center for Disaster and Trauma, Seoul, Republic of Korea
| | - Subin Park
- Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
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Christoffersen LAN, Mortensen EL, Becker U, Osler M, Sørensen HJ, Flensborg-Madsen T. Age at onset and age at treatment of alcohol use disorders: Associations with educational level and intelligence. Alcohol 2021; 95:7-14. [PMID: 33940176 DOI: 10.1016/j.alcohol.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 01/02/2023]
Abstract
Associations of educational level and intelligence with age at onset and age at treatment of alcohol use disorders (AUD) are sparsely investigated; however, knowledge about these associations is important for an enhanced understanding of AUD. This study aimed to examine three measures of timing of AUD: estimated age at onset of alcohol problems, age at first registration in an outpatient alcohol clinic, and age at first AUD hospital diagnosis, and to estimate associations of educational level and intelligence with each measure of timing of AUD. The aims were investigated in a register-based study comprising 7,019 Danish men seeking outpatient AUD treatment. Data on educational level and intelligence were obtained from the Danish Conscription Database. Estimated age at onset of alcohol problems and age at first registration in an outpatient alcohol clinic were obtained from the Copenhagen Alcohol Cohort. Age at first AUD hospital diagnosis was retrieved from national Danish psychiatric registers. Among individuals with information on all measures of timing of AUD, 65.8% followed the developmental sequence: estimated age at onset of alcohol problems (M = 32.08 years, SD = 9.3), age at first registration in an outpatient alcohol clinic (M = 39.89 years, SD = 9.5), and age at first AUD hospital diagnosis (M = 42.27 years, SD = 12.4). Adjusted linear regression models revealed significant associations of high educational level and high intelligence with later onset and treatment of AUD, ranging from 0.61 to 0.89 years (p < 0.0001) for educational level and from 0.10 to 0.09 years (p < 0.0001) for intelligence. In conclusion, AUD develops sequentially. High educational level and intelligence were associated with later onset and treatment of AUD, but educational level explained most unique variance. This may indicate that in addition to cognitive factors reflected by both educational level and intelligence, non-cognitive factors only reflected by educational level also are important for the timing of AUD.
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Scherrer B, Guiraud J, Addolorato G, Aubin HJ, de Bejczy A, Benyamina A, van den Brink W, Caputo F, Dematteis M, Goudriaan AE, Gual A, Kiefer F, Leggio L, Lesch OM, Maremmani I, Nutt DJ, Paille F, Perney P, Poulnais R, Raffaillac Q, Rehm J, Rolland B, Simon N, Söderpalm B, Sommer WH, Walter H, Spanagel R. Baseline severity and the prediction of placebo response in clinical trials for alcohol dependence: A meta-regression analysis to develop an enrichment strategy. Alcohol Clin Exp Res 2021; 45:1722-1734. [PMID: 34418121 PMCID: PMC9291112 DOI: 10.1111/acer.14670] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/03/2021] [Accepted: 07/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is considerable unexplained variability in alcohol abstinence rates (AR) in the placebo groups of randomized controlled trials (RCTs) for alcohol dependence (AD). This is of particular interest because placebo responses correlate negatively with treatment effect size. Recent evidence suggests that the placebo response is lower in very heavy drinkers who show no "spontaneous improvement" prior to treatment initiation (high-severity population) than in a mild-severity population and in studies with longer treatment duration. We systematically investigated the relationship between population severity, treatment duration, and the placebo response in AR to inform a strategy aimed at reducing the placebo response and thereby increasing assay sensitivity in RCTs for AD. METHODS We conducted a systematic literature review on placebo-controlled RCTs for AD.We assigned retained RCTs to high- or mild-severity groups of studies based on baseline drinking risk levels and abstinence duration before treatment initiation. We tested the effects of population severity and treatment duration on the placebo response in AR using meta-regression analysis. RESULTS Among the 19 retained RCTs (comprising 1996 placebo-treated patients), 11 trials were high-severity and 8 were mild-severity RCTs. The between-study variability in AR was lower in the high-severity than in the mild-severity studies (interquartile range: 7.4% vs. 20.9%). The AR in placebo groups was dependent on population severity (p = 0.004) and treatment duration (p = 0.017) and was lower in the high-severity studies (16.8% at 3 months) than the mild-severity studies (36.7% at 3 months). CONCLUSIONS Pharmacological RCTs for AD should select high-severity patients to decrease the magnitude and variability in the placebo effect and and improve the efficiency of drug development efforts for AD.
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Affiliation(s)
- Bruno Scherrer
- Bruno Scherrer Conseil, Saint Arnoult en Yvelines, France
| | - Julien Guiraud
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,DA Pharma, Paris, France
| | - Giovanni Addolorato
- Alcohol Use Disorder and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy.,Internal Medicine Unit, Department of Internal Medicine and Gastroenterology, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Henri-Jean Aubin
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), French Institute of Health and Medical Research (Inserm), Paris, France.,Addiction Research and Treatment Center, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Andrea de Bejczy
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Amine Benyamina
- Addiction Research and Treatment Center, Paul Brousse Hospital, Paris-Sud University, Villejuif, France
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Department of Translational Medicine, Center for the Study and Treatment of Alcohol-Related Diseases, University of Ferrara, Ferrara, Italy.,Department of Translational Medicine, Center for the Study and Treatment of Chronic Inflammatory Bowel Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, University of Ferrara, Ferrara, Italy.,Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, Ferrara, Italy
| | - Maurice Dematteis
- Department of Addiction Medicine, Faculty of Medicine, Grenoble Alpes University Hospital, Grenoble Alpes University, Grenoble, France
| | - Anna E Goudriaan
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Research and Quality of Care, Arkin, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Antoni Gual
- Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Falk Kiefer
- Medical Faculty Mannheim, Central Institute of Mental Health, Institute of Psychopharmacology, University of Heidelberg, Heidelberg, Germany.,Bethania Hospital for Psychiatry, Psychosomatics, and Psychotherapy, Greifswald, Germany
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Basic Research, National Institutes of Health, Baltimore and Bethesda, Maryland, USA.,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, Maryland, USA.,Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA.,Division of Addiction Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neuroscience, Georgetown Medical Center, Washington, District of Columbia, USA
| | - Otto-Michael Lesch
- Department of Social Psychiatry, University for Psychiatry and Psychotherapy, Vienna, Austria
| | - Icro Maremmani
- Santa Chiara University Hospital, University of Pisa, Pisa, Italy
| | - David J Nutt
- Centre for Neuropsychopharmacology, Imperial College London, London, UK
| | - François Paille
- Department of Addiction Treatment, University Hospital, Vandoeuvre-lès-Nancy, France
| | - Pascal Perney
- Addiction Medicine, Hospital Grau-du-Roi, Nimes, France
| | | | | | - Jürgen Rehm
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.,Department of Psychiatry, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Benjamin Rolland
- UCBL, INSERM U1028, CNRS UMR5292, Centre de Recherche en Neuroscience de Lyon (CRNL), Univ Lyon, Bron, France
| | - Nicolas Simon
- Department of Clinical Pharmacology, CAP-TV, Aix Marseille Univ, APHM, INSERM, IRD, SESSTIM, Hop Sainte Marguerite, Marseille, France
| | - Bo Söderpalm
- Section of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Wolfgang H Sommer
- Medical Faculty Mannheim, Central Institute of Mental Health, Institute of Psychopharmacology, University of Heidelberg, Heidelberg, Germany.,Central Institute of Mental Health, Institute of Psychopharmacology, Heidelberg University, Mannheim, Germany
| | - Henriette Walter
- Department of Social Psychiatry, University for Psychiatry and Psychotherapy, Vienna, Austria
| | - Rainer Spanagel
- Central Institute of Mental Health, Institute of Psychopharmacology, Heidelberg University, Mannheim, Germany
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Ooms M, Roozen HG, Willering JH, Zijlstra WP, de Waart R, Goudriaan AE. Effects of Multiple Detoxifications on Withdrawal Symptoms, Psychiatric Distress and Alcohol-Craving in Patients with an Alcohol Use Disorder. Behav Med 2021; 47:296-310. [PMID: 32396039 DOI: 10.1080/08964289.2020.1760777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Previous studies have shown an association between the number of withdrawal attempts and increased severity of withdrawal symptoms in patients with an alcohol use disorder (AUD). An underlying allostatic neuroadaptive response may negatively affect the withdrawal pathology after alcohol discontinuation. The objective of the present research is to examine the intensification of psychiatric distress, craving, and post-detoxification drinking outcomes, which may result from these neurobehavioral alternations. Fifty-two AUD inpatients were divided into two groups: <2 previous detoxifications and ≥2 previous detoxifications. Patients completed the Dutch version of the Severity of Withdrawal Scale (SWS), Depression Anxiety Stress Scales (DASS-21), VAS Craving, and Desires for Alcohol Questionnaire (DAQ). Linear mixed effects models were applied, controlling for the number of drinks consumed in the past 30 days and alcohol drinking history (years). Patients who had undergone ≥2 detoxifications reported statistically significantly higher scores on SWS withdrawal and DASS psychiatric symptoms. Also, craving patterns were different between groups, as shown by a statistically significant interaction effect for VAS craving for the time of day factor (morning vs. evening). No statistically significant group differences were found for DAQ scores and post-detoxification drinking outcomes. Due to relatively low 1-month follow-up rates our power was limited to detect such a difference. The present study contributes to the existing body of evidence that multiple detoxifications are associated with aggravated withdrawal/psychiatric pathology, and distinct diurnal patterns of VAS craving. Several clinical implications are discussed and alternative strategies are provided to manage repeated cycles of detoxifications.
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Affiliation(s)
- Martha Ooms
- Centrum voor Transculturele Psychiatrie (CTP) Veldzicht, Balkbrug, ZG, The Netherlands
| | - Hendrik G Roozen
- Center on Alcoholism, Substance Abuse, and Addictions (CASAA), University of New Mexico, The University of New Mexico (UNM), Albuquerque, NM, USA
| | - Juul H Willering
- Altrecht Centrum Psychodiagnostiek, Centrum Psychodiagnostiek, Zeist, WB, The Netherlands
| | - Wobbe P Zijlstra
- CITO, Department of Psychometrics and Research, Arnhem, CM, The Netherlands
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A Matched Control Analysis on the Effects of Alcohol Use Disorder After Primary Total Knee Arthroplasty in Medicare Patients. J Am Acad Orthop Surg 2021; 29:e593-e600. [PMID: 32991387 DOI: 10.5435/jaaos-d-20-00466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/24/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Several studies have found the negative impact of alcohol use disorder (AUD), most notably coagulation derangements. We sought to investigate the effects of AUD after primary total knee arthroplasty (TKA) for (1) postoperative complications, (2) lengths of stay, and (3) costs of care. METHODS This was a retrospective database analysis of Medicare patients with AUD undergoing primary TKA performed between 2005 and 2014. Patients with AUD were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 354,690 TKA patients: 59,126 with AUD and 295,564 without AUD. RESULTS Patients with AUD had significantly greater odds ratio (OR) of medical complications, including venous thromboembolism (VTE) within 90 days (OR: 1.41, P < 0.0001) and at 1 year (OR: 1.51, P < 0.0001) and greater 2-year implant-related complications after primary TKA. Furthermore, patients with AUD had significantly longer lengths of stay (4 versus 3 days, P < 0.0001) and incurred a significantly higher episode of care costs ($15,569.76 versus $13,763.06, P < 0.0001). DISCUSSION The present study demonstrated a significant association between AUD and the development of VTE. We hope this research will aid in risk stratification and tailoring of VTE chemoprophylaxis and postoperative management in this at-risk group after TKA. LEVEL OF EVIDENCE Level III.
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Burdzovic Andreas J, Ask Torvik F, Ystrom E, Skurtveit S, Handal M, Martinez P, Laslett AM, Lund IO. Parental risk constellations and future alcohol use disorder (AUD) in offspring: A combined HUNT survey and health registries study. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 36:375-386. [PMID: 33734784 DOI: 10.1037/adb0000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We examined the risk of developing a future alcohol use disorder (AUD) among offspring of families with different constellations of parental risk factors. METHOD We analyzed a sample of 8,774 offspring (50.2% male) from 6,696 two-parent families who participated in the Nord-Trøndelag Health Study in Norway when offspring were 13-19 years old in 1995-1997 or 2006-2008. Based on population registry information and parental Nord-Trøndelag Health Study self-reports, families were classified via Latent Profile Analysis into fiver risk constellations reflecting parents' education, drinking quantities and frequencies, and mental health. Information about AUD-related diagnoses, treatments, and prescriptions for all offspring in the period between 2008 and 2016 was obtained from 3 national health registries and pooled to reflect any AUD. The likelihood of AUD in offspring was examined with a set of nested logistic regression models. RESULTS Registry records yielded 186 AUD cases (2.1%). Compared with the lowest-risk constellation, offspring from two constellations were more likely to present with AUD in unadjusted analyses. After adjusting for all covariates, including offspring's alcohol consumption and witnessing parental intoxication during adolescence, AUD risk remained elevated and statistically significant (adjusted odds ratio = 2.34, 95% confidence interval = 1.14, 4.85) for offspring from the constellation characterized by at least weekly binge drinking, low education, and poor mental health in both parents. CONCLUSION Weekly binge drinking by both parents was associated with future AUD risk among community offspring in Norway when clustered with additional parental risks such as poor mental health and low educational attainment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Meta-analysis of grey matter changes and their behavioral characterization in patients with alcohol use disorder. Sci Rep 2021; 11:5238. [PMID: 33664372 PMCID: PMC7933165 DOI: 10.1038/s41598-021-84804-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/04/2021] [Indexed: 01/31/2023] Open
Abstract
Alcohol Use Disorder (AUD) is associated with reductions in grey matter (GM) volume which can lead to changes in numerous brain functions. The results of previous studies on altered GM in AUD differ considerably in the regions identified. Three meta-analyses carried out between 2014 and 2017 yielded different results. The present study includes the considerable amount of newer research and delivers a state-of-the art meta-analysis in line with recently published guidelines. Additionally, we behaviorally characterized affected regions using fMRI metadata and identified related brain networks by determining their meta-analytic connectivity patterns. Twenty-seven studies with 1,045 AUD patients and 1,054 healthy controls were included in the analysis and analyzed by means of Anatomical Likelihood Estimation (ALE). GM alterations were identified in eight clusters covering different parts of the cingulate and medial frontal gyri, paracentral lobes, left post- and precentral gyri, left anterior and right posterior insulae and left superior frontal gyrus. The behavioral characterization associated these regions with specific cognitive, emotional, somatosensory and motor functions. Moreover, the clusters represent nodes within behaviorally relevant brain networks. Our results suggest that GM reduction in AUD could disrupt network communication responsible for the neurocognitive impairments associated with high chronic alcohol consumption.
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Echeverry‐Alzate V, Jeanblanc J, Sauton P, Bloch V, Labat L, Soichot M, Vorspan F, Naassila M. Is R(+)-Baclofen the best option for the future of Baclofen in alcohol dependence pharmacotherapy? Insights from the preclinical side. Addict Biol 2021; 26:e12892. [PMID: 32146727 DOI: 10.1111/adb.12892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/16/2022]
Abstract
For several decades, studies conducted to evaluate the efficacy of RS(±)-Baclofen in the treatment of alcohol dependence yielded contrasting results. Human and animal studies recently questioned the use of the racemic drug in patients since a potential important role of the different enantiomers has been revealed with an efficacy thought to reside with the active R(+)-enantiomer. Here we conducted experiments in the postdependent rat model of alcohol dependence to compare the efficacy of R(+)-Baclofen or S(-)-Baclofen to that of RS(±)-Baclofen on ethanol intake, seeking, and relapse. R(+)-Baclofen was more effective than RS(±)-Baclofen in reducing ethanol intake and seeking during acute withdrawal and during relapse after abstinence. We also used an original population approach in order to identify drug responders. We found a significant proportion of responders to S(-)-Baclofen and RS(±)-Baclofen, displaying an increase in ethanol intake, and this increasing effect on alcohol intake was not seen in the R(+)-Baclofen group. At an intermediate dose of R(+)-Baclofen, devoid of any motor side effects, we identified a very large proportion of responders (75%) with a large decrease in ethanol intake (90% decrease). Finally, the response to RS(±)-Baclofen on ethanol intake was correlated to plasma level of Baclofen. R(+)-Baclofen and RS(±)-Baclofen were effective in reducing sucrose intake. Our study has important clinical implication since it suggests that the wide variability in the therapeutic responses of patients to RS(±)-Baclofen may come from the sensitivity to the R(+)-Baclofen but also to the one of the S(-)-Baclofen that can promote an increase in ethanol intake.
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Affiliation(s)
- Victor Echeverry‐Alzate
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
- Instituto de Investigación Biomédica de Málaga (IBIMA) Hospital Regional Universitario de Málaga Spain
- Department of Psychobiology & Behavioral Sciences Methods, School of Psychology Complutense University of Madrid Spain
| | - Jérôme Jeanblanc
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
| | - Pierre Sauton
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
| | - Vanessa Bloch
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Laurence Labat
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Marion Soichot
- Laboratoire de Toxicologie Biologique – Hôpital Lariboisière Paris France
| | - Florence Vorspan
- INSERM UMR‐S 1144 Université de Paris, Optimisation Thérapeutique en Neuropsychopharmacologie Paris France
- Faculté de Médecine Université de Paris Paris France
- Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal Assistance Publique – Hôpitaux de Paris Paris France
| | - Mickael Naassila
- INSERM UMR 1247‐Research Group on Alcohol and Pharmacodependences (GRAP) Université de Picardie Jules Verne Amiens France
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Song Z, Chen J, Wen Z, Zhang L. Abnormal functional connectivity and effective connectivity between the default mode network and attention networks in patients with alcohol-use disorder. Acta Radiol 2021; 62:251-259. [PMID: 32423229 DOI: 10.1177/0284185120923270] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with alcohol-use disorder (AUD) demonstrate dysfunctional cerebral network connectivity. However, limited studies have investigated attention systems in AUD. PURPOSE To assess functional (FC) and effective connectivity (EC) in the dorsal (DAN) and ventral attention networks (VAN) and default mode network (DMN) in patients with AUD using resting-state functional magnetic resonance imaging (rs-fMRI). MATERIAL AND METHODS MRI and rs-fMRI data were obtained from 28 men with AUD and 30 age-matched healthy controls. Independent component analysis was used to identify and extract network data, for comparison between the two groups. Effective connectivity was evaluated using Granger causality analysis (GCA) by selecting significantly different brain areas as regions of interest (ROI). Signed-path coefficients between ROIs were computed in bivariate mode. RESULTS In patients with AUD, FC decreased in the left superior parietal gurus (SPG) and left interparietal sulcus (IPS, in DAN); FC decreased in the right superior frontal gyrus (SPG) and right middle frontal gyrus (MFG, in DMN). GCA values indicated that the DMN exerts a positive causal effect on the DAN (P = 0.007/0.027), which consequently exerts a negative causal effect on the DMN (P = 0.032). Signed-path coefficients from the right MFG to the left IPS correlated negatively with MAST scores (P = 0.015). CONCLUSION We found novel inter-network connectivity dysfunction in patients with AUD, which indicates abnormal causal relations between resting-state DAN and DMN. Thus, patients with AUD may have abnormal top-down attention modulation and cognition.
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Affiliation(s)
- Zhiyan Song
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Zhi Wen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, PR China
| | - Lei Zhang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, PR China
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Bergman D, Hagström H, Capusan AJ, Mårild K, Nyberg F, Sundquist K, Ludvigsson JF. Incidence of ICD-Based Diagnoses of Alcohol-Related Disorders and Diseases from Swedish Nationwide Registers and Suggestions for Coding. Clin Epidemiol 2020; 12:1433-1442. [PMID: 33408530 PMCID: PMC7781026 DOI: 10.2147/clep.s285936] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023] Open
Abstract
Aim To improve consistency between register studies in Sweden and ensure valid comparisons of possible changes in alcohol-related disorders and diseases (ARDDs) over time, we propose a definition of ARDDs. Based on this definition, we examined Sweden’s incidence rates of ARDDs from 1970 to 2018 in non-primary healthcare settings (inpatient and outpatient). Methods Swedish Society of Epidemiology members were invited to give feedback on the International Classification of Disease (ICD) codes with a potential link to alcohol use. We then calculated age-standardised and age-specific incidence of ARDDs over time according to the National Patient Register, and the lifetime prevalence of ARDDs diagnosed in adults alive in Sweden on Dec 31, 2018. Results Sweden’s estimated incidence of ARDDs increased substantially after introducing the new ICD-9 codes in 1987. In the past 10 years (2009–2018), the incidence of ARDDs has been stable (males: 110/100,000 person-years, females: 49/100,000 person-years). Requiring at least two ICD records for diagnosed ARDDs led to a somewhat lower incidence of ARDDs (males: 71 per 100,000 person-years, females: 29 per 100,000 person-years). In Sweden, the lifetime prevalence of diagnosed ARDDs in adults on Dec 31, 2018, was 1.9% (95% CI=1.9–1.9). Conclusion In this nationwide study, we found an incidence of ARDDs of 50–100/100,000 person-years. In 2018, 1 in 52 adults in Sweden had been diagnosed with ARDDs in the National Patient Register.
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Affiliation(s)
- David Bergman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hannes Hagström
- Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Johansson Capusan
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Psychiatry in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karl Mårild
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Pediatric Gastroenterology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Orebro University Hospital, Orebro, Sweden.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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47
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Ceci FM, Ferraguti G, Petrella C, Greco A, Ralli M, Iannitelli A, Carito V, Tirassa P, Chaldakov GN, Messina MP, Ceccanti M, Fiore M. Nerve Growth Factor in Alcohol Use Disorders. Curr Neuropharmacol 2020; 19:45-60. [PMID: 32348226 PMCID: PMC7903493 DOI: 10.2174/1570159x18666200429003239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/19/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
The nerve growth factor (NGF) belongs to the family of neurotrophic factors. Initially discovered as a signaling molecule involved in the survival, protection, differentiation, and proliferation of sympathetic and peripheral sensory neurons, it also participates in the regulation of the immune system and endocrine system. NGF biological activity is due to the binding of two classes of receptors: the tropomyosin-related kinase A (TrkA) and the low-affinity NGF pan-neurotrophin receptor p75. Alcohol Use Disorders (AUD) are one of the most frequent mental disorders in developed countries, characterized by heavy drinking, despite the negative effects of alcohol on brain development and cognitive functions that cause individual’s work, medical, legal, educational, and social life problems. In addition, alcohol consumption during pregnancy disrupts the development of the fetal brain causing a wide range of neurobehavioral outcomes collectively known as fetal alcohol spectrum disorders (FASD). The rationale of this review is to describe crucial findings on the role of NGF in humans and animals, when exposed to prenatal, chronic alcohol consumption, and on binge drinking.
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Affiliation(s)
- Flavio Maria Ceci
- Department of Experimental Medicine, Sapienza University Hospital of Rome, Italy
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University Hospital of Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology, Section of Neurobiology, National Research Council (IBBC-CNR), Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University Hospital of Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University Hospital of Rome, Italy
| | - Angela Iannitelli
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Valentina Carito
- Institute of Biochemistry and Cell Biology, Section of Neurobiology, National Research Council (IBBC-CNR), Rome, Italy
| | - Paola Tirassa
- Institute of Biochemistry and Cell Biology, Section of Neurobiology, National Research Council (IBBC-CNR), Rome, Italy
| | - George N Chaldakov
- Department of Anatomy and Cell Biology, Medical University, Varna, Bulgaria
| | | | - Mauro Ceccanti
- Centro Riferimento Alcologico Regione Lazio, Sapienza University of Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, Section of Neurobiology, National Research Council (IBBC-CNR), Rome, Italy
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48
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Chen K, Hollunder B, Garbusow M, Sebold M, Heinz A. The physiological responses to acute stress in alcohol-dependent patients: A systematic review. Eur Neuropsychopharmacol 2020; 41:1-15. [PMID: 32994116 DOI: 10.1016/j.euroneuro.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/22/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Dysregulation of physiological stress reactivity plays a key role in the development and relapse risk of alcohol dependence. This article reviews studies investigating physiological responses to experimentally induced acute stress in patients with alcohol dependence. A systematic search from electronic databases resulted in 3641 articles found and after screening 62 articles were included in our review. Studies are analyzed based on stress types (i.e., social stress tasks and nonsocial stress tasks) and physiological markers (i.e., the nervous system, the endocrine system, somatic responses and the immune system). In studies applying nonsocial stress tasks, alcohol-dependent patients were reported to show a blunted stress response compared with healthy controls in the majority of studies applying markers of adrenocorticotropic hormone and cortisol. In studies applying social stress tasks, findings are inconsistent, with less than half of the studies reporting altered physiological stress responses in patients. We discuss the impact of duration of abstinence, comorbidities, baseline physiological arousal and intervention on the discrepancy of study findings. Furthermore, we review evidence for an association between blunted physiological stress responses and the relapse risk among patients with alcohol dependence.
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Affiliation(s)
- Ke Chen
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
| | - Barbara Hollunder
- Charité Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany; Movement Disorder & Neuromodulation Unit, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maria Garbusow
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam Sebold
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany; Department for Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
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49
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Guillou Landreat M, Beauvais C, Grall Bronnec M, Le Goff D, Le Reste JY, Lever D, Dany A, Gallopel Morvan K. Alcohol use disorders, beverage preferences and the influence of alcohol marketing: a preliminary study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:90. [PMID: 33256798 PMCID: PMC7706018 DOI: 10.1186/s13011-020-00329-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/10/2022]
Abstract
Background Alcohol Use Disorders (AUD) are among the most prevalent mental disorders in the world. They are the leading risk factor for premature mortality and disability among 15 to 49-year-olds. Links between alcohol marketing and patterns of alcohol consumption are well defined in adolescents but there is few data on the impact of alcohol marketing on a population of drinkers with an AUD and seeking treatment. This study was designed in collaboration among researchers specialising in addictive disorders, in social marketing and primary care. Methods This was a monocentric, cross-sectional, descriptive study. The main objective of this study was to define the type of marketing identified by drinkers with an AUD who were seeking treatment and their beverage preferences. Drinkers aged 18+ with an AUD and seeking treatment were included. A descriptive analysis and a logistic regression were carried out . Results N = 91 patients were included, 73.6% were male, the average age was 46.2 years. 72% said they were not influenced by alcohol marketing, but 76% recalled an alcohol advertisement in the last 6 months. The most frequently reported beverage preferences were wine (39.6%), standard beers (29.6%), spirits (27.5%) and strong beers (16.5%). Conclusions Patients with AUD, defined as vulnerable, reported exposure to alcohol marketing but did not seem to identify it consciously. Marketing influences differed according to beverage preferences. These results need to be confirmed by a larger study. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-020-00329-8.
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Affiliation(s)
- Morgane Guillou Landreat
- EA SPURBO 7479, Université de Bretagne Occidentale, Addictologie de liaison , Pole 3 , 1 étage, Hôpital de la Cavale Blanche , Bld Tanguy Prigent, 29200, Brest, France. .,UMR 1246 SPHERE, University of Nantes / Tours, Tours, France. .,HUGOPSY NETWORK, Rennes, France.
| | | | - Marie Grall Bronnec
- UMR 1246 SPHERE, University of Nantes / Tours, Tours, France.,HUGOPSY NETWORK, Rennes, France.,CHU Nantes, Addictology and Psychiatry Department, Nantes, France
| | - Delphine Le Goff
- EA SPURBO 7479, Université de Bretagne Occidentale, Addictologie de liaison , Pole 3 , 1 étage, Hôpital de la Cavale Blanche , Bld Tanguy Prigent, 29200, Brest, France
| | - Jean Yves Le Reste
- EA SPURBO 7479, Université de Bretagne Occidentale, Addictologie de liaison , Pole 3 , 1 étage, Hôpital de la Cavale Blanche , Bld Tanguy Prigent, 29200, Brest, France
| | - Delphine Lever
- MD, CHRU BREST, Addictology Unit CHRU BREST, Brest, France
| | - Antoine Dany
- EA SPURBO 7479, Université de Bretagne Occidentale, Addictologie de liaison , Pole 3 , 1 étage, Hôpital de la Cavale Blanche , Bld Tanguy Prigent, 29200, Brest, France
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50
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Cano-Cebrián MJ, Fernández-Rodríguez S, Hipólito L, Granero L, Polache A, Zornoza T. Efficacy of N-acetylcysteine in the prevention of alcohol relapse-like drinking: Study in long-term ethanol-experienced male rats. J Neurosci Res 2020; 99:638-648. [PMID: 33063355 DOI: 10.1002/jnr.24736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023]
Abstract
Alcohol use disorders are chronic and highly relapsing disorders, thus alcoholic patients have a high rate of recidivism for drug use even after long periods of abstinence. The literature points to the potential usefulness of N-acetylcysteine (NAC) in the management of several substance use disorders probably due to its capacity to restore brain homeostasis of the glutamate system disrupted in addiction. However, there is little evidence in the case of alcohol. The aim of this study was to explore the potential anti-relapse efficacy of NAC using the alcohol deprivation effect (ADE) model in long-term experienced rats. Two experiments were performed in male Wistar rats to: (a) test the efficacy of NAC to prevent relapse and (b) discriminate the best administration schedule (intermittent vs. continuous) for NAC. In the first experiment, animals were implanted with mini-osmotic pumps delivering 0 or 1 mg/hr NAC during 14 days. In a second experiment, rats received 0, 60, or 100 mg/kg once daily by subcutaneous injection. The efficacy to prevent ADE was evaluated in both experiments. NAC subcutaneously administered, either by continuous infusion or by intermittent injections regimen, is able to block the ADE. The best results were obtained after using 60 mg/kg NAC dose. Our findings support the hypothesis that NAC may represent a valuable therapy in the management of alcohol relapse.
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Affiliation(s)
- María José Cano-Cebrián
- Departament de Farmàcia i Tecnologia Farmacèutica i Parasitologia, Universitat de València, Burjassot, Spain
| | - Sandra Fernández-Rodríguez
- Departament de Farmàcia i Tecnologia Farmacèutica i Parasitologia, Universitat de València, Burjassot, Spain
| | - Lucia Hipólito
- Departament de Farmàcia i Tecnologia Farmacèutica i Parasitologia, Universitat de València, Burjassot, Spain
| | - Luis Granero
- Departament de Farmàcia i Tecnologia Farmacèutica i Parasitologia, Universitat de València, Burjassot, Spain
| | - Ana Polache
- Departament de Farmàcia i Tecnologia Farmacèutica i Parasitologia, Universitat de València, Burjassot, Spain
| | - Teodoro Zornoza
- Departament de Farmàcia i Tecnologia Farmacèutica i Parasitologia, Universitat de València, Burjassot, Spain
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