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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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2
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Powell A, Sumnall H, Smith J, Kuiper R, Montgomery C. Recovery of neuropsychological function following abstinence from alcohol in adults diagnosed with an alcohol use disorder: Systematic review of longitudinal studies. PLoS One 2024; 19:e0296043. [PMID: 38166127 PMCID: PMC10760842 DOI: 10.1371/journal.pone.0296043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/05/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Alcohol use disorders (AUD) associate with structural and functional brain differences, including impairments in neuropsychological function; however, reviews (mostly cross-sectional) are inconsistent with regards to recovery of such functions following abstinence. Recovery is important, as these impairments associate with treatment outcomes and quality of life. OBJECTIVE(S) To assess neuropsychological function recovery following abstinence in individuals with a clinical AUD diagnosis. The secondary objective was to assess predictors of neuropsychological recovery in AUD. METHODS Following the preregistered protocol (PROSPERO: CRD42022308686), APA PsycInfo, EBSCO MEDLINE, CINAHL, and Web of Science Core Collection were searched between 1999-2022. Study reporting follows the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis, study quality was assessed using the JBI Checklist for Cohort Studies. Eligible studies were those with a longitudinal design that assessed neuropsychological recovery following abstinence from alcohol in adults with a clinical diagnosis of AUD. Studies were excluded if participant group was defined by another or co-morbid condition/injury, or by relapse. Recovery was defined as function reaching 'normal' performance. RESULTS Sixteen studies (AUD n = 783, controls n = 390) were selected for narrative synthesis. Most functions demonstrated recovery within 6-12 months, including sub-domains within attention, executive function, perception, and memory, though basic processing speed and working memory updating/tracking recovered earlier. Additionally, verbal fluency was not impaired at baseline (while verbal function was not assessed compared to normal levels), and concept formation and reasoning recovery was inconsistent. CONCLUSIONS These results provide evidence that recovery of most functions is possible. While overall robustness of results was good, methodological limitations included lack of control groups, additional methods to self-report to confirm abstinence, description/control for attrition, statistical control of confounds, and of long enough study durations to capture change.
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Affiliation(s)
- Anna Powell
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
| | - Harry Sumnall
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jessica Smith
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rebecca Kuiper
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
| | - Catharine Montgomery
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
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3
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Petit G, Leclercq S, Quoilin C, Poncin M, Starkel P, Maurage P, Rolland B, Dricot L, De Timary P. Links between psychopathological symptoms and cortical thickness in men with severe alcohol use disorder: A Magnetic Resonance Imaging study. Neuropsychopharmacol Rep 2023; 43:513-520. [PMID: 37013368 PMCID: PMC10739149 DOI: 10.1002/npr2.12331] [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: 09/07/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Anxiety and depression are psychopathological states frequently co-occurring with severe alcohol use disorder (SAUD). These symptoms generally disappear with abstinence but may persist in some patients, increasing the relapse risk. METHODS The cerebral cortex thickness of 94 male patients with SAUD was correlated with symptoms of depression and anxiety, both measured at the end (2-3 weeks) of the detoxification treatment. Cortical measures were obtained using surface-based morphometry implemented with Freesurfer. RESULTS Depressive symptoms were associated with reduced cortical thickness in the superior temporal gyrus of the right hemisphere. Anxiety level was correlated with lower cortical thickness in the rostral middle frontal region, inferior temporal region, and supramarginal, postcentral, superior temporal, and transverse temporal regions of the left hemisphere, as well as with a large cluster in the middle temporal region of the right hemisphere. CONCLUSIONS At the end of the detoxification stage, the intensity of depressive and anxiety symptoms is inversely associated with the cortical thickness of regions involved in emotions-related processes, and the persistence of the symptoms could be explained by these brain deficits.
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Affiliation(s)
- Géraldine Petit
- Psychiatric Emergency Unit, Department of Adult PsychiatryCliniques Universitaires Saint LucBrusselsBelgium
- Institute of Neuroscience, UCLouvainBrusselsBelgium
| | - Sophie Leclercq
- Laboratory of Nutritional PsychiatryInstitute of Neuroscience, UCLouvainBrusselsBelgium
| | | | - Marie Poncin
- Institute of Neuroscience, UCLouvainBrusselsBelgium
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute (IPSY)UCLouvainLouvain‐la‐NeuveBelgium
| | - Peter Starkel
- Laboratory of Hepato‐GastroenterologyUCLouvainBrusselsBelgium
- Department of Hepato‐GastroenterologyCliniques Universitaires Saint LucBrusselsBelgium
| | - Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute (IPSY)UCLouvainLouvain‐la‐NeuveBelgium
| | - Benjamin Rolland
- CH Le Vinatier, Service Universitaire d'Addictologie de Lyon (SUAL)BronFrance
| | | | - Philippe De Timary
- Institute of Neuroscience, UCLouvainBrusselsBelgium
- Laboratory of Hepato‐GastroenterologyUCLouvainBrusselsBelgium
- Department of Adult PsychiatryCliniques Universitaires Saint LucBrusselsBelgium
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4
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Savage SA, Suárez-González A, Stuart I, Christensen I. Successful word retraining, maintenance and transference of practice to everyday activities: A single case experimental design in early onset alcohol-induced brain damage. Neuropsychol Rehabil 2023; 33:1488-1511. [PMID: 35984770 DOI: 10.1080/09602011.2022.2107545] [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: 11/15/2021] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Word retraining programs have been shown to improve naming ability post-stroke and in progressive aphasias. Here, we investigated benefits for a 22-year-old Danish man (DJ), whose difficulties followed brain damage from heavy alcohol misuse. Using a multiple baseline-across-behaviours design (target behaviour: retrieval of word list items), DJ completed a 4-week "Look, Listen, Repeat" program on a computer. Ninety personally relevant target words were selected to create three matched lists. List 1 was trained for 10 sessions over 2 weeks, followed by 9 sessions for List 2 over 2 weeks, while the third list remained untrained. Naming performance was evaluated at baseline, during the intervention, and at 1 and 4 months post-training. Naming improved following each intervention block (p < .001), with only one data point overlapping between the baseline and treatment phases for trained items. Untrained words remained unchanged (p = 1.00), with 50% of data points non-overlapping across baseline to treatment phases. Performance was maintained over time, and appeared to generalize, with DJ naming more trained objects in their natural setting (85%) than untrained items (64%). While more evidence is needed, brief (20-minute), intensive (5-day/week) word retraining programs may assist word retrieval for people with brain damage associated with alcohol misuse.
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Affiliation(s)
- Sharon A Savage
- School of Psychological Sciences, The University of Newcastle, Newcastle, Australia
- Psychology Department, University of Exeter , Exeter, UK
| | - Aida Suárez-González
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - Ida Stuart
- Neurorehabilitation Selma Marie, Ølstykke, Denmark
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5
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Staudt J, Kok T, de Haan HA, Walvoort SJW, Egger JIM. Neurocognitive Recovery in Abstinent Patients with Alcohol Use Disorder: A Scoping Review for Associated Factors. Neuropsychiatr Dis Treat 2023; 19:2039-2054. [PMID: 37790802 PMCID: PMC10544223 DOI: 10.2147/ndt.s424017] [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: 06/25/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Objective Studies have reported inconsistent results regarding the extent to which neurocognitive recovery occurs in abstinent patients with alcohol use disorder (AUD). In addition to abstinence, other factors may have influenced this process and contributed to the inconsistencies. This review examines the factors investigated in this regard and describes the possible influence of each factor based on the evidence collected. Methodology PubMed was systematically searched for articles published between January 2000 and July 2023. Longitudinal humane studies investigating neurocognitive recovery in abstinent adult AUD patients were included. Studies with a cross-sectional design were excluded, as were studies that did not classify AUD according to the DSM-IV or 5 criteria, only examined binge use, did not report neuropsychological outcomes or duration of abstinence, or where neurological disorders were present. Results Sixteen categories of factors were distinguished from 31 full-text articles. Consistent patterns were found, indicating an association between neurocognitive recovery and the "smoking" and 'brain volume" factors. Consistent patterns were also found indicating that there is no relationship with "quantities of alcohol used" and "education level." A similar consistent pattern was also found for "polysubstance use", "gender" and "verbal reading", but the number of studies is considered limited. The association with "age" is studied frequently but with inconsistent findings. The remaining eight factors were regarded as understudied. Conclusion The clearest patterns emerging from the evidence are a predominantly negative influence of smoking on neurocognitive recovery, associations between changes in brain area volume and neurocognitive recovery, and no association between neurocognitive recovery and the amount of alcohol consumed, as measured by self-report, nor with educational attainment. Future research on the understudied factors and factors with inconsistent evidence is needed, preferably through longitudinal designs with multiple assessment periods starting after at least two weeks of abstinence.
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Affiliation(s)
- Jeroen Staudt
- Tactus Addiction Treatment, Deventer, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Tim Kok
- Tactus Addiction Treatment, Deventer, the Netherlands
| | - Hein A de Haan
- Tactus Addiction Treatment, Deventer, the Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction, Radboud University, Nijmegen, the Netherlands
| | | | - Jos I M Egger
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Centre of Excellence for Korsakoff and Alcohol Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
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6
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Fiabane E, Scarpina F, Ottonello M, Pistarini C. Spontaneous Changes in Attentional Capabilities and Reasoning After an Alcohol Rehabilitation Treatment: Evidence About the Role of Age and Alcohol Use. Neuropsychiatr Dis Treat 2023; 19:1321-1329. [PMID: 37284250 PMCID: PMC10239759 DOI: 10.2147/ndt.s403217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/30/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose In this study, we evaluated changes in attentional capabilities and reasoning among early abstinent alcohol-dependent individuals after a 28-day residential rehabilitation program (not including cognitive treatment). Furthermore, we explored the role of individual characteristics and disease-related factors (i.e., length of alcohol use, history of polysubstance dependence, severity of alcohol use) on spontaneous cognitive recovery. Patients and Methods Fifty-five patients with a diagnosis of Alcohol Use Disorder (AUD) were consecutively recruited from a residential rehabilitation hospital in Northern Italy. The majority were male (67.3%) with a mean age of 47.83 years (SD = 8.21). The computerized Psychology Experiment Building Language Test Battery was used to assess the performance at the Posner Cueing Test, Go/no-go Task, Trail Making Test (TMT), Tower of London (TOL), and Balloon Analog Risk Scale. The evaluation was performed twice: at the beginning (T0) and at its end (T1, before the hospital discharge). Results We observed statistically improvements over time in the performance at the: 1) TOL in the time amount required to solve the task (p < 0.001); and 2) TMT in the indexes relative to the number of errors (p = 0.003) and the total time required to solve the task (p < 0.001). Age played a significant role on the changes observed in the score relative to the time amount used by participants to solve the task in TMT (test (p = 0.03) and in TOL (p = 0.02). Moreover, the length of alcohol dependence had an effect on the change observed for the time amount to solve the TMT (time) (p = 0.01). Conclusion We found spontaneous recovery after alcohol detoxification on some, but not all, cognitive functions assessed in our study. The neuropsychological assessment and the identification of patients with cognitive impairment and specific risk factors (e.g., older age and longer history of alcohol use) is important to orient cognitive rehabilitation and increase the efficacy of AUD treatments.
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Affiliation(s)
- Elena Fiabane
- Istituti Clinici Scientifici Maugeri IRCCS, Psychology Unit of Pavia Institute, Pavia, Italy
| | - Federica Scarpina
- Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale S. Giuseppe, Piancavallo, VCO, Italy
| | - Marcella Ottonello
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Physical and Rehabilitation Medicine of Pavia Institute, Pavia, Italy
| | - Caterina Pistarini
- Istituti Clinici Scientifici Maugeri IRCCS, Department of Neurorehabilitation of Pavia Institute, Pavia, Italy
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7
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Wang J, Deane FP, Kelly PJ, Robinson L. A narrative review of outcome measures used in drug and alcohol inpatient withdrawal treatment research. Drug Alcohol Rev 2023; 42:415-426. [PMID: 36633552 PMCID: PMC10108086 DOI: 10.1111/dar.13591] [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: 08/24/2022] [Revised: 11/20/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
ISSUES Assessing drug and alcohol inpatient withdrawal treatment programs is important, as these represent a first step of treatment among people with alcohol and drug problems. However, there are many ways of measuring outcomes making it difficult for service providers to decide which domains and methods to use. This narrative review aims to clarify frequencies of the domains and methods used to assess withdrawal treatment outcomes. APPROACH We reviewed published studies that examined outcomes of inpatient drug and alcohol withdrawal treatment. The types of outcome measures used and the frequency of use were summarised. KEY FINDINGS The review showed that assessment of withdrawal treatment outcomes goes beyond traditional abstinence measures. Outcomes mainly focus on biological and psychological outcomes, with social outcomes rarely measured. Even within outcome domains (e.g., cravings), there were many assessment methods. IMPLICATIONS The review provides service providers with an outline of common outcome domains and measures. Given the importance of social functioning to recovery from alcohol and drug problems, greater emphasis on such measures is desirable. Future research could develop greater consensus on outcome measures for use in withdrawal management services to facilitate clarity around factors associated with treatment success. CONCLUSION Outcome assessment in withdrawal treatment goes beyond abstinence to include holistic measurement of biological, psychological and some social outcomes; but more work needs to be done to cohere the different assessment methods and broaden the scope to include social functioning.
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Affiliation(s)
- Jing Wang
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Laura Robinson
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
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8
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Powell A, Tommerdahl M, Abbasi Y, Sumnall H, Montgomery C. A pilot study assessing the brain gauge as an indicator of cognitive recovery in alcohol dependence. Hum Psychopharmacol 2021; 36:e2782. [PMID: 33682954 DOI: 10.1002/hup.2782] [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: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/11/2022]
Abstract
UNLABELLED Alcohol dependence (AD) is associated with multiple cognitive deficits, which can affect treatment outcomes. Current measures of tracking brain recovery (e.g., functional magnetic resonance imaging) can be less accessible for practitioners. This study pilots a novel device (the brain gauge; BG) to assess its utility, and track recovery of cognitive function in residential alcohol treatment. METHODS A repeated measures design assessed changes in cognitive function during detoxification. Twenty-one participants with AD (16 Male; Mean age 43.85 ± 6.21) completed a battery of alcohol and memory questionnaires and BG tasks at two time-points (∼days 4 and 10) during a single managed detoxification episode. RESULTS Repeated measures ANCOVA revealed that some BG metrics significantly improved, with medium to large effect sizes - processing speed, focus, temporal order judgement and overall cortical metric. However, differences in subjective cognitive function were non-significant after controlling for depression and anxiety change scores. Anxiety change emerged as a significant factor in subjective cognitive function. CONCLUSIONS We conclude it is possible that the prefrontal cortex (PFC) recovers more slowly compared to other brain areas, and there are compounding effects of improvements in anxiety and depression, and metacognitive deficits on subjective EF assessments. Future research should seek to validate the clinical utility of the BG by comparing against established neuroimaging methods.
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Affiliation(s)
- Anna Powell
- Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Mark Tommerdahl
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yasir Abbasi
- Maudsley Health - Al Amal Psychiatric Hospital, Dubai
| | - Harry Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Alcohol Research, Liverpool, UK
| | - Catharine Montgomery
- Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, UK.,Liverpool Centre for Alcohol Research, Liverpool, UK
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9
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Britton MK, Porges EC, Bryant V, Cohen RA. Neuroimaging and Cognitive Evidence for Combined HIV-Alcohol Effects on the Central Nervous System: A Review. Alcohol Clin Exp Res 2021; 45:290-306. [PMID: 33296091 PMCID: PMC9486759 DOI: 10.1111/acer.14530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022]
Abstract
Alcohol use disorder (AUD) among people living with HIV (PLWH) is a significant public health concern. Despite the advent of effective antiretroviral therapy, up to 50% of PLWH still experience worsened neurocognition, which comorbid AUD exacerbates. We report converging lines of neuroimaging and neuropsychological evidence linking comorbid HIV/AUD to dysfunction in brain regions linked to executive function, learning and memory, processing speed, and motor control, and consequently to impairment in daily life. The brain shrinkage, functional network alterations, and brain metabolite disruption seen in individuals with HIV/AUD have been attributed to several interacting pathways: viral proteins and EtOH are directly neurotoxic and exacerbate each other's neurotoxic effects; EtOH reduces antiretroviral adherence and increases viral replication; AUD and HIV both increase gut microbial translocation, promoting systemic inflammation and HIV transport into the brain by immune cells; and HIV may compound alcohol's damaging effects on the liver, further increasing inflammation. We additionally review the neurocognitive effects of aging, Hepatitis C coinfection, obesity, and cardiovascular disease, tobacco use, and nutritional deficiencies, all of which have been shown to compound cognitive changes in HIV, AUD, and in their comorbidity. Finally, we examine emerging questions in HIV/AUD research, including genetic and cognitive protective factors, the role of binge drinking in HIV/AUD-linked cognitive decline, and whether neurocognitive and brain functions normalize after drinking cessation.
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Affiliation(s)
- Mark K. Britton
- University of Florida, Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program; 1225 Center Drive, Gainesville, Florida 32607
| | - Eric C. Porges
- University of Florida, Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program; 1225 Center Drive, Gainesville, Florida 32607
| | - Vaughn Bryant
- University of Florida, Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program; 1225 Center Drive, Gainesville, Florida 32607
- University of Florida, Department of Epidemiology, 2004 Mowry Road, Gainesville, FL 32610
| | - Ronald A. Cohen
- University of Florida, Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program; 1225 Center Drive, Gainesville, Florida 32607
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10
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Preuss UW, Bender M, Franz M, Rechlin T, Roll SC, Scherk H, Klimke A. [Quality of treatment outcomes in alcohol- and substance-related disorders: an evaluation of inpatients from ten psychiatric hospitals]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:154-161. [PMID: 33440454 DOI: 10.1055/a-1128-0356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM OF THE STUDY Alcohol and substance-related disorders (ICD 10 F1x.x) are among the most frequent diagnoses made in hospitalized patients requiring somatic and psychiatric care. In order to assess the success of treatment, it is important to establish and implement outcome indicators in practice. METHOD In 2016, global treatment indicators for admission and at discharge were collected at 10 Vitos clinics in Hesse (CGI and GAF). More than 10,000 patients with ICD10 F1x diagnoses were included in the evaluation. RESULTS The evaluations show significant improvements of the clinical status as well as differences in treatment duration, remissions and gender differences. CONCLUSION The study suggests that global indicators of outcome quality are useful in the assessment of treatment success of alcohol and substance-related disorders. Limitations of the study design, instruments and sample are critically reviewed.
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Affiliation(s)
- Ulrich W Preuss
- Vitos Klinikum Herborn.,Martin-Luther-Universität Halle-Wittenberg
| | - Martina Bender
- Vitos Klinik für Psychiatrie und Psychotherapie Kassel, Bad Emstal, Hofgeismar und Melsungen
| | - Michael Franz
- Vitos Klinik Gießen-Marburg.,Justus-Liebig-Universität Gießen
| | | | | | | | - Ansgar Klimke
- Vitos Klinik Hochtaunus.,Heinrich-Heine-Universität Düsseldorf
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11
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Abstract
Alcohol use disorder (AUD) commonly is associated with compromise in neurobiological and/or neurobehavioral processes. The severity of this compromise varies across individuals and outcomes, as does the degree to which recovery of function is achieved. This narrative review first summarizes neurobehavioral, neurophysiological, structural, and neurochemical aberrations/deficits that are frequently observed in people with AUD after detoxification. Subsequent sections review improvements across these domains during recovery, taking into account modulators of recovery to the extent permitted. Where appropriate, the discussion includes work integrating outcomes across domains, leveraging the strengths of diverse experimental methods. Interventions to ameliorate neurobiological or neurobehavioral deficits do not constitute a primary objective of this review. However, their consideration is a logical inclusion. Therefore, a limited introduction to existing methods is also presented.
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Affiliation(s)
- Sara Jo Nixon
- Department of Psychiatry, University of Florida, Gainesville, Florida.,Center for Addiction Research & Education, University of Florida, Gainesville, Florida
| | - Ben Lewis
- Department of Psychiatry, University of Florida, Gainesville, Florida.,Center for Addiction Research & Education, University of Florida, Gainesville, Florida
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12
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Petit G, Deschietere G, Loas G, Luminet O, de Timary P. Link Between Anhedonia and Depression During Early Alcohol Abstinence: Gender Matters. Alcohol Alcohol 2020; 55:71-77. [PMID: 31825493 DOI: 10.1093/alcalc/agz090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/21/2019] [Accepted: 10/21/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of the present study was to evaluate the relation between anhedonia and depression in alcohol use disorders (AUD) during detoxification: Is trait anhedonia measured at the beginning of detoxification predictive of depressive symptoms observed at the end? Does state anhedonia recover during detoxification as depression does? Gender differences that have been previously observed for depression in AUD were also explored. METHODS 81 AUD inpatients were tested at T1 (day 1) and T2 (day 14-18) of withdrawal with the trait Physical Anhedonia Scale, the state anhedonia Snaith-Hamilton Pleasure Scale, the Beck depression inventory and the Spielberger State Anxiety Inventory and compared to 34 control participants, matched for age and gender. RESULTS AUD patients scored significantly higher than controls on depression, anxiety and state and trait anhedonia when they just entered the detoxification unit. Depression, anxiety and state anhedonia decreased between T1 and T2 in AUD patients. In women, state anhedonia at T1 was predictive of depressive symptoms at T2 over and above anxiety and depression at T1. CONCLUSION In AUD, state anhedonia recovers during detoxification, concurrently to other affective-related symptoms. However, in women, trait anhedonia predicts the level of depression at the end of detoxification, above and beyond anxiety. This finding stresses the importance of addressing anhedonia in the treatment of AUD and emphasizes the need for targeted interventions within clinical settings in this gender. Clinical consequences are discussed.
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Affiliation(s)
- G Petit
- Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, Brussels, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Avenue Mounier 53, boîte B1.53.02, 1200, Bruxelles, Belgium
| | - G Deschietere
- Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, Brussels, Belgium.,Institut of Health and Society (IRSS-UCLouvain), Clos Chapelle-aux-champs,30 bte 30.15 - 1200 Bruxelles, Belgium
| | - G Loas
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB), Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Bruxelles, Belgium
| | - O Luminet
- Research Institute for Psychological Sciences, Université catholique de Louvain, Voie du Roman Pays 20, bte L1.04.01 B-1348 Louvain-la-Neuve, Belgium
| | - P de Timary
- Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, Brussels, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Avenue Mounier 53, boîte B1.53.02, 1200, Bruxelles, Belgium.,Laboratory for Experimental Psychopathology (LEP), Psychological Science Research Institute, Université Catholique de Louvain, Voie du Roman Pays 20, bte L1.04.01 B-1348 Louvain-la-Neuve, Belgium
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Risky decision-making in individuals with substance use disorder: A meta-analysis and meta-regression review. Psychopharmacology (Berl) 2020; 237:1893-1908. [PMID: 32363438 DOI: 10.1007/s00213-020-05506-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND This review aims to identify whether risky decision-making is increased in substance users, and the impact of substance type, polysubstance use status, abstinence period, and treatment status on risky decision-making. METHODS A literature search with no date restrictions was conducted to identify case-control studies or cross-sectional studies that used behavioral tasks to measure risky decision-making in substance users. A random-effects model was performed. GRADE criteria was used to assess the quality of evidence. RESULTS 52 studies were enrolled. The result showed that the difference in risky decision-making performance between user groups and control groups was significant (SMD = - 0.590; 95%CI = - 0.849 to - 0.330; p < 0.001; I2 = 93.4%; Pheterogeneity < 0.001). Subgroup analysis showed that users in the subgroups of alcohol (p < 0.001), tobacco (p < 0.01), cocaine (p < 0.001), opioid (p < 0.001), mixed group (p < 0.01), adult users (p < 0.001), small sample size (p < 0.001), large sample size (p < 0.01), low education (p < 0.001), high education (p < 0.001), short-abstinence period (p < 0.001), long-abstinence period (p < 0.001), without current polysubstance dependence (p < 0.001), and with treatment (p < 0.001) had increased risky decision-making when compared to the controls. On the other hand, elderly substance users with short-abstinence period showed increased risky decision-making. Moreover, current treatment status and polysubstance use may not influence the level of decision-making in substance users. CONCLUSIONS The results show that substance use is associated with impaired risky decision-making, indicating that interventions targeting risky decision-making in substance users should be developed for relapse prevention and rehabilitation.
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Maillard A, Poussier H, Boudehent C, Lannuzel C, Vicente A, Vabret F, Cabe N, Pitel AL. Short-term neuropsychological recovery in alcohol use disorder: A retrospective clinical study. Addict Behav 2020; 105:106350. [PMID: 32070907 DOI: 10.1016/j.addbeh.2020.106350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuropsychological impairments found in recently detoxified patients with alcohol use disorder (AUD) can limit the benefit of psychosocial treatments and increase the risk of relapse. These neuropsychological deficits are reversible with abstinence. The aim of this retrospective clinical study was to investigate whether a short-term stay as inpatients in a convalescent home enables neuropsychological deficits observed in recently detoxified AUD patients to recover and even performance to return to normal. METHODS Neuropsychological data were collected in 84 AUD patients. Five neuropsychological components were assessed before and after a three-week stay in a convalescent home offering multidisciplinary support. Baseline and follow-up performance were compared in the entire group of patients and in subgroups defined by the nature and intensity of the therapy (OCCASIONAL: occasional occupational and physical therapy; INTENSIVE: intensive occupational and physical therapy and neuropsychological training). RESULTS In the entire group of patients, neuropsychological performance significantly improved between baseline and follow-up for all 5 components and even returned to a normal level for 4 of them. The ratio of patients with impaired performance was significantly lower at follow-up than baseline examination for 3 components in the INTENSIVE group only. CONCLUSION Recently detoxified AUD patients with cognitive deficits benefit from a short-term stay in an environment ensuring sobriety and healthy nutrition. Cognitive recovery may be enhanced by intensive care including neuropsychological training. Alcohol programs could be postponed in patients with cognitive deficits in order to offer psychosocial treatment when patients are cognitively able to benefit from it.
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Seemiller LR, Gould TJ. The effects of adolescent alcohol exposure on learning and related neurobiology in humans and rodents. Neurobiol Learn Mem 2020; 172:107234. [PMID: 32428585 DOI: 10.1016/j.nlm.2020.107234] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 12/11/2022]
Abstract
Adolescent alcohol use is a widespread problem in the United States. In both humans and rodents, alcohol can impair learning and memory processes mediated by forebrain areas such as the prefrontal cortex (PFC) and hippocampus (HC). Adolescence is a period in which alcohol use often begins, and it is also a time that can be uniquely sensitive to the detrimental effects of alcohol. Exposure to alcohol during adolescence can cause persisting alterations in PFC and HC neurobiology that are linked to cognitive impairments, including changes in neurogenesis, inflammation, and various neurotransmitter systems in rodent models. Consistent with this, chronic adolescent alcohol exposure can cause PFC-dependent learning impairments that persist into adulthood. Deficits in adult HC-dependent learning after adolescent alcohol exposure have also been reported, but these findings are less consistent. Overall, evidence summarized in this review indicates that adolescent exposure to alcohol can produce long-term detrimental effects on forebrain-dependent cognitive processes.
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Affiliation(s)
- Laurel R Seemiller
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Thomas J Gould
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA.
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Tang WK, Lau CG, Ungvari GS, Lin SK, Lane HY. Recovery of cognitive functioning following abstinence from ketamine. Addict Behav 2019; 99:106081. [PMID: 31470241 DOI: 10.1016/j.addbeh.2019.106081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute and adverse effects of ketamine on cognitive functioning have been documented. No longitudinal study has examined whether cognitive deficits can be reversed following ketamine abstinence although it has been suggested in some cross-sectional studies. This study aimed to investigate the changes in cognitive functioning among ketamine users following a 12-week abstinence from ketamine. METHODS In this longitudinal study, 114 ketamine users completed clinical and cognitive assessments at both baseline and 12-week follow-up with the following instruments: Severity of Dependence Scale, Beck Depression Inventory (BDI), Anxiety Subscale of the Hospital Anxiety Depression Scale (HADSA), and a cognitive battery. RESULTS BDI (p < 0.001) and HADSA (p = 0.044) scores were significantly reduced at the 12-week follow-up. Significant improvements were found in Wechsler Adult Intelligence Scale (Third edition) immediate recall (p < 0.001) and delayed recall (p < 0.001) on the Rey-Osterrieth Complex Figure Test, and in delayed recall (p < 0.001), and immediate recall (p = 0.001) on the Logical Memory component of the Wechsler Memory Scale (Third Edition) at the 12-week follow-up. Participants completed the Stroop Inference Test significantly faster (p < 0.001); and required fewer number of attempts (p < 0.001) and produced fewer perseverative errors (p < 0.001) on the Wisconsin Card Sorting Test at the 12-week follow-up. CONCLUSION Chronic ketamine users' verbal and visual memory and executive functions improved after 12 weeks of ketamine abstinence.
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Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
| | - Chieh Grace Lau
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Gabor S Ungvari
- Division of Psychiatry, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia; Section of Psychiatry, University Notre Dame Australia, Fremantle, Australia
| | - Shih-Ku Lin
- Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Psychiatry, Taipei City Hospital, Taipei, Taiwan
| | - Hsien-Yuan Lane
- Department of Psychiatry, China Medical University Hospital, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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Abstract
OBJECTIVE To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research. METHOD First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed. RESULTS Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition). CONCLUSIONS The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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18
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Sullivan EV, Pfefferbaum A. Brain-behavior relations and effects of aging and common comorbidities in alcohol use disorder: A review. Neuropsychology 2019; 33:760-780. [PMID: 31448945 PMCID: PMC7461729 DOI: 10.1037/neu0000557] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Alcohol use disorder (AUD) is a complex, dynamic condition that waxes and wanes with unhealthy drinking episodes and varies in drinking patterns and effects on brain structure and function with age. Its excessive use renders chronically heavy drinkers vulnerable to direct alcohol toxicity and a variety of comorbidities attributable to nonalcohol drug misuse, viral infections, and accelerated or premature aging. AUD affects widespread brain systems, commonly, frontolimbic, frontostriatal, and frontocerebellar networks. METHOD AND RESULTS Multimodal assessment using selective neuropsychological testing and whole-brain neuroimaging provides evidence for AUD-related specific brain structure-function relations established with double dissociations. Longitudinal study using noninvasive imaging provides evidence for brain structural and functional improvement with sustained sobriety and further decline with relapse. Functional imaging suggests the possibility that some alcoholics in recovery can compensate for impairment by invoking brain systems typically not used for a target task but that can enable normal-level performance. CONCLUSIONS Evidence for AUD-aging interactions, indicative of accelerated aging, together with increasing alcohol consumption in middle-age and older adults, put aging drinkers at special risk for developing cognitive decline and possibly dementia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Edith V. Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
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Chen WY, Zhang H, Gatta E, Glover EJ, Pandey SC, Lasek AW. The histone deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA) alleviates depression-like behavior and normalizes epigenetic changes in the hippocampus during ethanol withdrawal. Alcohol 2019; 78:79-87. [PMID: 30851364 PMCID: PMC6612300 DOI: 10.1016/j.alcohol.2019.02.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 12/27/2022]
Abstract
Withdrawal from chronic alcohol drinking can cause depression, leading to an inability to function in daily life and an increased risk for relapse to harmful drinking. Understanding the causes of alcohol withdrawal-related depression may lead to new therapeutic targets for treatment. Epigenetic factors have recently emerged as important contributors to both depression and alcohol use disorder (AUD). Specifically, acetylation of the N-terminal tails of histone proteins that package DNA into nucleosomes is altered in stress-induced models of depression and during alcohol withdrawal. The goal of this study was to examine depression-like behavior during alcohol withdrawal and associated changes in histone acetylation and expression of histone deacetylase 2 (HDAC2) in the hippocampus, a brain region critical for mood regulation and depression. Male Sprague-Dawley rats were treated with the Lieber-DeCarli ethanol liquid diet for 15 days and then underwent withdrawal. Rats were treated with the HDAC inhibitor, suberoylanilide hydroxamic acid (SAHA), during withdrawal and were tested for depression-like behavior. In a separate group of rats, the hippocampus was analyzed for mRNA and protein expression of HDAC2 and levels of histone H3 lysine 9 acetylation (H3K9ac) during chronic ethanol exposure and withdrawal. Rats undergoing ethanol withdrawal exhibited depression-like behavior and had increased HDAC2 and decreased H3K9ac levels in specific structures of the hippocampus. Treatment with SAHA during withdrawal ameliorated depression-like behavior and normalized changes in hippocampal HDAC2 and H3K9ac levels. These results demonstrate that ethanol withdrawal causes an altered epigenetic state in the hippocampus. Treatment with an HDAC inhibitor can correct this state and alleviate depression-like symptoms developed during withdrawal. Targeting histone acetylation may be a novel strategy to reduce ethanol withdrawal-induced depression.
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Affiliation(s)
- Wei-Yang Chen
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, United States
| | - Huaibo Zhang
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, United States; Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue, Chicago, IL 60612, United States
| | - Eleonora Gatta
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, United States
| | - Elizabeth J Glover
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, United States
| | - Subhash C Pandey
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, United States; Jesse Brown Veterans Affairs Medical Center, 820 South Damen Avenue, Chicago, IL 60612, United States
| | - Amy W Lasek
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, Chicago, IL 60612, United States.
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Role of Patient Sex in Early Recovery from Alcohol-Related Cognitive Impairment: Women Penalized. J Clin Med 2019; 8:jcm8060790. [PMID: 31167412 PMCID: PMC6617550 DOI: 10.3390/jcm8060790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/13/2019] [Accepted: 05/31/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The objective was to explore the role of patient sex in cognitive recovery and to identify predictive factors for non-recovery in alcohol use disorder (AUD). METHODS All patients with AUD admitted to a residential addictions treatment center were systematically assessed at admission and after 6 weeks of abstinence in a controlled environment. The inclusion criteria were that patients were admitted for AUD with baseline alcohol-related cognitive impairment (baseline total Montreal Cognitive Assessment (MoCA) score < 26) and reassessed at 6 weeks (n = 395). A logistic regression model was built to determine the influence of sex on recovery status (MoCA < or ≥ 26) taking into account the interaction effect of sex with alcohol consumption on cognitive function. RESULTS The mean age was 50.10 years (SD = 9.79), and 27.41% were women. At baseline, the mean MoCA scores were 21.36 (SD = 3.04). Participants who did not achieve recovery (59.3% of women vs 53.8% of men) had lower total MoCA scores at baseline. The 2 factors that was significantly and independently associated with non-recovery and with a non-zero coefficient was being a woman and initial MoCA score (respective adjusted odds ratios (AOR) = 1.5 and 0.96, p-values < 0.05). CONCLUSIONS These results could influence the time required in a controlled environment to maintain abstinence and the duration of in-care for women.
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Rochat L, Khazaal Y. Cognitive remediation therapy of working memory in addictive disorders: An individualized, tailored, and recovery-oriented approach. Expert Rev Neurother 2019; 19:285-287. [DOI: 10.1080/14737175.2019.1591950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Lucien Rochat
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
- Research Center, Montreal University, Institute of Mental Health, Montreal, Canada
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