The clinical and demographic profile of male patients with alcohol dependence syndrome

Alcohol Abstinence, Adherence, and Attitudes toward Disulfiram Treatment for Alcohol Dependence among Patients Attending a Tertiary Care Setting in North India

Background

Disulfiram is the first Food and Drug Administration (FDA)-approved drug for the treatment of alcohol dependence, primarily acting as a deterrent agent. The available literature on disulfiram treatment for alcohol dependence among individuals in low-income and middle-income countries is scarce, while numerous factors impact the acceptance and adherence to such treatment.

Methods

The study utilized a purposive sampling methodology. The participants were contacted by telephone at 4 weeks, 12 weeks, and 24 weeks after the initiation of disulfiram treatment. Alcohol abstinence was calculated using the self-reported total alcohol-free days, and adherence and attitudes toward disulfiram treatment were measured using the Treatment Compliance Assessment Scale (TCAS).

Findings

The participants had a mean age of 39.30±7.7 years. Nearly 62% and 46% of the subjects reported maintenance of alcohol abstinence after initiation of 12 and 24 weeks of disulfiram treatment, respectively. The proportion of non-adherent subjects increased from 36.3% to 57.2% during the 12-week and 24-week follow-up periods. Attitudes toward disulfiram treatment varied significantly across different time points. A strong positive correlation was observed in the alcohol abstinence, adherence, and attitude scores at different time points (P<0.01).

Conclusion

The present study's findings unveiled that nearly 60% and 40% of the study subjects were maintaining alcohol abstinence and adherence at 12 weeks and 24 weeks after initiation of disulfiram treatment, respectively. Disulfiram could be a viable psychological tool for alcohol abstinence, but objective measurements are required to underpin its utility in this setting.

Alcohol use disorder research in India: An update

Background

Despite alcohol use being a risk factor for numerous health-related conditions and alcohol use disorder (AUD) recognized as a disease, there was limited research in India until 2010. This narrative review aims to evaluate AUD-related research in India from 2010 to July 2023.

Methods

A PubMed search used key terms for AUD in India after 2010. Indian and international journals with regional significance that publish alcohol-related research were searched by each author individually. These were then collated, and duplicates were removed. In addition, we also conducted a gray literature search on focused areas related to AUD.

Results

The alcohol-related research in India after 2010 focused on diverse areas associated with alcohol use. Some areas of research have received more attention than others. Two major epidemiological surveys conducted in the past decade reveal that around 5% have a problematic alcohol use pattern. Factors associated with alcohol use, like genetic, neurobiological, psychological, and sociocultural, were studied. The studies focused on the clinical profile of AUD, including their correlates, such as craving, withdrawal, alcohol-related harm, and comorbid psychiatric and medical illnesses. During this period, minimal research was conducted to understand AUD's laboratory biomarkers, course, and prognosis. While there was a focus on generating evidence for different psychological interventions for alcohol dependence in management-related research, pharmacological studies centered on anticraving agents like baclofen. Research on noninvasive brain stimulation, such as rTMS, has shown preliminary usefulness in treating alcohol dependence. Very little research has been conducted regarding alcohol policy.

Conclusion

In the past decade, Indian research on alcohol has focused on diverse areas. Epidemiological and psychological management-related research received maximum attention. Considering the magnitude of the alcohol-related burden, it is essential to prioritize research to other less studied areas like pharmacological management of alcohol dependence and alcohol policy.

Relation between age at first alcohol drink & adult life drinking patterns in alcohol-dependent patients

Background & objectives:

Age at first drink has its influence on later life drinking patterns. The association between age at first drink and adult alcohol consumption has not been studied in clinical population. This study was aimed to determine the age at first drink and its correlation with adult life drinking patterns in alcohol-dependent patients.

Methods:

Adult participants with alcohol dependence were included from the inpatient and outpatient wards of a tertiary care de-addiction facility in India. Questionnaires administered were National Institute on Alcohol Abuse and Alcoholism-Quantity Frequency for alcohol and the Fagerstrom Test for Nicotine Dependence for tobacco.

Results:

Of the 99 participants (92% males) with mean age 37±8.36 yr, mean age at first drink was 21.14±5.33 yr. After controlling for age, satisfaction with life scores and smoking, age at first drink showed a significant negative correlation with drinking days per week (r=-0.259, P=0.012), typical drink per day (r=-0.218, P=0.035) and maximum drinks in the previous month/year (r=-0.233, -0.223 and P=0.024, 0.031, respectively).

Interpretation & conclusions:

Our study suggested that earlier age of first drink correlated with chronic heavy drinking patterns in later adult life in alcohol-dependent patients. This may have implications for alcohol control policies determining the age for legal consumption.