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Peltier MR, Verplaetse TL, Altemus M, Zakiniaeiz Y, Ralevski EA, Mineur YS, Gueorguieva R, Picciotto MR, Cosgrove KP, Petrakis I, McKee SA. The role of neurosteroids in posttraumatic stress disorder and alcohol use disorder: A review of 10 years of clinical literature and treatment implications. Front Neuroendocrinol 2024; 73:101119. [PMID: 38184208 DOI: 10.1016/j.yfrne.2023.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/08/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
Rates of alcohol use disorder (AUD) are increasing in men and women and there are high rates of concurrent posttraumatic stress disorder (PTSD) and AUD. AUD and PTSD synergistically increase symptomatology and negatively affect treatment outcomes; however, there are very limited pharmacological treatments for PTSD/AUD. Neurosteroids have been implicated in the underlying neurobiological mechanisms of both PTSD and AUD and may be a target for treatment development. This review details the past ten years of research on pregnenolone, progesterone, allopregnanolone, pregnanolone, estradiol, testosterone and dehydroepiandrosterone/dehydroepiandrosterone-sulfate (DHEA/DHEA-S) in the context of PTSD and AUD, including examination of trauma/alcohol-related variables, such as stress-reactivity. Emerging evidence that exogenous pregnenolone, progesterone, and allopregnanolone may be promising, novel interventions is also discussed. Specific emphasis is placed on examining the application of sex as a biological variable in this body of literature, given that women are more susceptible to both PTSD diagnoses and stress-related alcohol consumption.
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Affiliation(s)
- MacKenzie R Peltier
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; VA Connecticut Healthcare System, Mental Health Service, West Haven, CT 06516, USA; National Center for PTSD, Clinical Neuroscience Division, West Haven, CT 06516, USA.
| | | | - Margaret Altemus
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; VA Connecticut Healthcare System, Mental Health Service, West Haven, CT 06516, USA
| | - Yasmin Zakiniaeiz
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
| | - Elizabeth A Ralevski
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; VA Connecticut Healthcare System, Mental Health Service, West Haven, CT 06516, USA
| | - Yann S Mineur
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
| | - Ralitza Gueorguieva
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - Marina R Picciotto
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
| | - Kelly P Cosgrove
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; National Center for PTSD, Clinical Neuroscience Division, West Haven, CT 06516, USA; Department of Radiology and Biomedical Imaging, School of Medicine, Yale University, New Haven, CT, USA
| | - Ismene Petrakis
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA; VA Connecticut Healthcare System, Mental Health Service, West Haven, CT 06516, USA; National Center for PTSD, Clinical Neuroscience Division, West Haven, CT 06516, USA
| | - Sherry A McKee
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, USA
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Verplaetse TL, Hillmer AT, Bhatt S, Rusowicz A, Li S, Nabulsi N, Matuskey D, Huang Y, McKee SA, Cosgrove KP. Imaging a putative marker of brain cortisol regulation in alcohol use disorder. Neurobiol Stress 2024; 29:100609. [PMID: 38304303 PMCID: PMC10832501 DOI: 10.1016/j.ynstr.2024.100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/19/2023] [Accepted: 01/14/2024] [Indexed: 02/03/2024] Open
Abstract
Background Stress is a potent activator of the hypothalamic-pituitary-adrenal (HPA) axis, initiating the release of glucocorticoid hormones, such as cortisol. Alcohol consumption can lead to HPA axis dysfunction, including altered cortisol levels. Until recently, research has only been able to examine peripheral cortisol associated with alcohol use disorder (AUD) in humans. We used positron emission tomography (PET) brain imaging with the radiotracer [18F]AS2471907 to measure 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), a cortisol-regenerating enzyme, in people with AUD compared to healthy controls. Methods We imaged 9 individuals with moderate to severe AUD (5 men, 4 women; mean age = 38 years) and 12 healthy controls (8 men, 4 women; mean age = 29 years). Participants received 93.5 ± 15.6 MBq of the 11β-HSD1 inhibitor radiotracer [18F]AS2471907 as a bolus injection and were imaged for 150-180 min on the High-Resolution Research Tomograph. 11β-HSD1 availability was quantified by [18F]AS2471907 volume of distribution (VT; mL/cm3). A priori regions of interest included amygdala, anterior cingulate cortex (ACC), hippocampus, ventromedial PFC (vmPFC) and caudate. Results Individuals with AUD consumed 52.4 drinks/week with 5.8 drinking days/week. Healthy controls consumed 2.8 drinks/week with 1.3 drinking days/week. Preliminary findings suggest that [18F]AS2471907 VT was higher in amygdala, ACC, hippocampus, vmPFC, and caudate of those with AUD compared to healthy controls (p < 0.05). In AUD, vmPFC [18F]AS2471907 VT was associated with drinks per week (r = 0.81, p = 0.01) and quantity per drinking episode (r = 0.75, p = 0.02). Conclusions This is the first in vivo examination of 11β-HSD1 availability in individuals with AUD. Our data suggest higher brain availability of the cortisol-regenerating enzyme 11β-HSD1 in people with AUD (vs. controls), and that higher vmPFC 11β-HSD1 availability is related to greater alcohol consumption. Thus, in addition to the literature suggesting that people with AUD have elevated peripheral cortisol, our findings suggest there may also be heightened central HPA activity. These findings set the foundation for future hypotheses on mechanisms related to HPA axis function in this population.
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Affiliation(s)
| | - Ansel T. Hillmer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
| | - Shivani Bhatt
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Songye Li
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
| | - Nabeel Nabulsi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
| | - David Matuskey
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
| | - Yiyun Huang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kelly P. Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Yale PET Center, Yale School of Medicine, New Haven, CT, USA
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Zakiniaeiz Y, Gueorguieva R, Peltier MR, Verplaetse TL, Roberts W, McKee SA, Cosgrove KP. Sex steroid hormone levels associated with dopamine D 2/3 receptor availability in people who smoke cigarettes. Front Behav Neurosci 2023; 17:1192740. [PMID: 37358969 PMCID: PMC10288103 DOI: 10.3389/fnbeh.2023.1192740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Sex differences exist in tobacco smoking. Women have greater difficulty quitting smoking than men. Tobacco smoking is driven by the reinforcing effects of nicotine, the primary addictive component in cigarettes. Nicotine binds to nicotinic acetylcholine receptors, facilitating dopamine release in striatal and cortical brain regions. Dysregulated dopamine D2/3 receptor signaling in the dorsolateral prefrontal cortex (dlPFC) is associated with cognitive deficits such as impairments in attention, learning, and inhibitory control that impede quit attempts. Sex steroid hormones, such as estradiol and progesterone, influence drug-taking behaviors, through dopaminergic actions, suggesting that their influence may explain sex differences in tobacco smoking. The goal of this study was to relate dlPFC dopamine metrics to sex steroid hormone levels in people who smoke and healthy controls. Methods Twenty-four (12 women) people who smoke cigarettes and 25 sex- and age-matched controls participated in two same-day [11C]FLB457 positron emission tomography scans, one before and one after amphetamine administration. D2R availability (BPND) at baseline and after amphetamine administration was calculated. On the same day, plasma samples were collected for the analysis of sex steroid hormone levels: estradiol, progesterone, and free testosterone. Results Women who smoke had trending lower levels of estradiol than their sex-matched counterparts. Men who smoke had higher levels of estradiol and trending higher levels of free testosterone than their sex-matched counterparts. Among women only, lower estradiol levels were significantly associated with lower pre-amphetamine dlPFC BPND. Discussion/conclusion This study demonstrated that lower estradiol levels are associated with lower dlPFC D2R availability in women which may underlie difficulty resisting smoking.
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Affiliation(s)
- Yasmin Zakiniaeiz
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Ralitza Gueorguieva
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, United States
| | - MacKenzie R. Peltier
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
- Psychology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States
| | - Terril L. Verplaetse
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Walter Roberts
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Sherry A. McKee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Kelly P. Cosgrove
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
- Yale Positron Emission Tomography (PET) Center, School of Medicine, Yale University, New Haven, CT, United States
- Department of Radiology and Biomedical Imaging, School of Medicine, Yale University, New Haven, CT, United States
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Zakiniaeiz Y, Gueorguieva R, Peltier MR, Roberts W, Verplaetse TL, Burke C, Morris ED, McKee SA, Cosgrove KP. Lower Dopamine D2/3 Receptor Availability is Associated With Worse Verbal Learning and Memory in People Who Smoke Cigarettes. Nicotine Tob Res 2023; 25:1047-1051. [PMID: 36107715 PMCID: PMC10077933 DOI: 10.1093/ntr/ntac215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Tobacco smoking is a major public health burden. The mesocortical dopamine system-including the dorsolateral prefrontal cortex (dlPFC)-plays an important role in cognitive function. Dysregulated dopamine signaling in dlPFC is associated with cognitive deficits such as impairments in attention, learning, working memory, and inhibitory control. We recently showed that dlPFC dopamine D2/3-type receptor (D2R) availability was significantly lower in people who smoke than in healthy-controls and that dlPFC amphetamine-induced dopamine release was lower in females who smoke relative to males who smoke and female healthy-controls. However, we did not examine whether the smoking-related dopamine deficits were related to cognitive deficits. AIMS AND METHODS The goal of this study was to relate dopamine metrics to cognitive performance in people who smoke and healthy-controls. In total 24 (12 female) people who smoke cigarettes and 25 sex- and age-matched healthy-controls participated in two same-day [11C]FLB457 positron emission tomography (PET) scans before and after amphetamine administration. Two outcome measures were calculated-D2R availability (non-displaceable binding potential; BPND) and amphetamine-induced dopamine release (%ΔBPND). Cognition (verbal learning and memory) was assessed with a computerized test from the CogState battery (International Shopping List). RESULTS People who smoke had significantly worse immediate (p = .04) and delayed (p = .03) recall than healthy-controls. Multiple linear regression revealed that for people who smoke only, lower D2R availability was associated with worse immediate (p = .04) and delayed (p < .001) recall. %ΔBPND was not significantly related to task performance. CONCLUSION This study demonstrated that lower dlPFC D2R availability in people who smoke is associated with disruptions in cognitive function that may underlie difficulty with resisting smoking. IMPLICATIONS This is the first study to directly relate dopamine metrics in the prefrontal cortex to cognitive function in people who smoke cigarettes compared to healthy-controls. The current work included a well-characterized subject sample with regards to demographic and smoking variables, as well as a validated neurocognitive test of verbal learning and memory. The findings of this study extend previous literature by relating dopamine metrics to cognition in people who smoke, providing a better understanding of brain-behavior relationships.
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Affiliation(s)
- Yasmin Zakiniaeiz
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - MacKenzie R Peltier
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Psychology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Walter Roberts
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Terril L Verplaetse
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Catherine Burke
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Evan D Morris
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Yale Positron Emission Tomography (PET) Center, School of Medicine, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, School of Medicine, Yale University, New Haven, CT, USA
- Department of Biomedical Engineering, School of Medicine, Yale University, New Haven, CT, USA
| | - Sherry A McKee
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Kelly P Cosgrove
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
- Yale Positron Emission Tomography (PET) Center, School of Medicine, Yale University, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, School of Medicine, Yale University, New Haven, CT, USA
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Burke C, Ellis JD, Peltier MR, Roberts W, Verplaetse TL, Phillips S, Moore KE, Marotta PL, McKee SA. Adverse Childhood Experiences and Pathways to Violent Behavior for Women and Men. J Interpers Violence 2023; 38:4034-4060. [PMID: 35978533 PMCID: PMC9852029 DOI: 10.1177/08862605221113012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Childhood maltreatment is associated with risk for committing future violence, but the relationship between subgroups and biological sex is unknown. The relationship between adverse childhood experiences (ACEs), violence, and sex was examined using a nationally representative sample. Results from a latent class analysis suggested a four-class model (low adversity; moderate maltreatment with high household dysfunction; severe maltreatment with moderate household dysfunction; severe multi-type adversities). When compared to low adversity, all typology groups were at significantly higher risk to engage in violence (odds ratio > 2.10, ps < .013). The data supported a linear trajectory, meaning increased childhood trauma was associated with increased risk for violence. Although men endorsed more violent behavior, the relationship between ACEs and violence was significantly stronger among women. Prior findings identify that women are more negatively impacted by ACEs and the current findings newly identify that this extends to violent crime.
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Verplaetse TL, Roberts W, Peltier MR, Zakiniaeiz Y, Burke C, Pittman B, McKee SA. Liquor consumption is associated with other medical conditions in females who consume alcohol. Drug and Alcohol Dependence Reports 2023; 6:100132. [PMID: 36994369 PMCID: PMC10040322 DOI: 10.1016/j.dadr.2023.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023]
Abstract
Background Our group previously identified that females with AUD and females engaging in heavy or extreme binge drinking were more likely to report cancers and other medical conditions compared to their male counterparts. This analysis aimed to extend our previous findings to examine relationships between sex and consumption of alcohol by type on past year medical condition diagnoses. Methods Data from the U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n = 36,309) was used to evaluate associations between sex (female vs. male) and alcohol type (liquor, wine, beer, coolers) on past year self-reported doctor-confirmed medical conditions, controlling for frequency of alcohol consumption. Results A significant interaction demonstrated that females who consumed liquor were more likely to have other medical conditions (OR=1.95) compared to males who consumed liquor. Females who consumed wine in the past year were less likely to have cardiovascular conditions (OR=0.81) compared to males who consumed wine. Those who consumed liquor had increased odds of pain, respiratory, and other conditions (OR=1.11 - 1.21). Females were 1.5 times more likely to have cancers or pain, respiratory, and other medical conditions compared to males (OR=1.36 - 1.81). Conclusions Results identify that consumption of higher alcohol content drinks (i.e., liquor) is associated with past year self-reported doctor- or health-professional confirmed medical conditions in females compared to males consuming the same high alcohol content beverage. Not only should AUD status and risky drinking be considered in the clinical care of individuals with poorer health but also alcohol type, especially higher alcohol content beverages.
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Affiliation(s)
- Terril L. Verplaetse
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, USA
- Corresponding author.
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, USA
| | - MacKenzie R. Peltier
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, USA
- Psychology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, USA
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT 06519, USA
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McKee SA, Verplaetse TL. A novel human laboratory alcohol self-administration paradigm for medication screening: Modeling the ability to resist drinking and heavy drinking. Drug Alcohol Depend Rep 2022; 4:100085. [PMID: 36120181 PMCID: PMC9481061 DOI: 10.1016/j.dadr.2022.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Human laboratory analogues of drinking behavior provide an efficient, cost-effective mechanistic evaluation of a medication signal on drinking. We developed a novel alcohol self-administration paradigm which models the ability to resist drinking and heavy drinking. Methods We compared a de-escalating schedule of monetary reinforcement (n=16, 50% female) to no schedule (n=16, 50% female) on the ability to resist drinking (i.e., latency to start drinking) and subsequent ad-libitum alcohol consumption of preferred alcoholic beverage in participants with alcohol use disorder (AUD). Participants completed two laboratory sessions designed to model the ability to resist drinking using stress (versus neutral imagery, within-subject factor) as a prime for drinking. Results Participants consumed more alcohol with no schedule (74.2%) versus with the de-escalating reinforcement schedule (40.3%,). The de-escalating schedule reduced alcohol consumption by 49%. Eighty-one percent of participants drank heavily with no schedule and this was reduced with the schedule. Use of the de-escalating schedule also increased the latency to pour and sip the first drink. Participants poured and sipped alcohol faster following stress imagery (vs. neutral), had greater craving, and consumed more alcohol in the first 30 minutes. Conclusions Our novel alcohol self-administration model generated heavy drinking. Over 80% of participants without reinforcement consumed more than 2/3 of their preferred alcoholic beverage designed to increase blood alcohol levels to 0.12 mg% within a 2-hour window. Our model was sensitive to stress, and the de-escalating schedule highlighted stress effects on drinking. Thus, this model is ideal for a cross-over design to test medications for AUD.
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Peltier MR, Roberts W, Verplaetse TL, Burke C, Zakiniaeiz Y, Moore K, McKee SA. Licit and illicit drug use across trimesters in pregnant women endorsing past-year substance use: Results from National Survey on Drug Use and Health (2009-2019). Arch Womens Ment Health 2022; 25:819-827. [PMID: 35737132 PMCID: PMC9359119 DOI: 10.1007/s00737-022-01244-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Given the health consequences, perinatal substance use is a significant public health concern, especially as substance use rates increase among women; ongoing data regarding the rates of substance use across trimesters of pregnancy is needed. METHODS The present study utilized cross-sectional population-based data from the National Survey of Drug Use and Health (NSDUH) between 2009 and 2019. We aimed to explore both licit and illicit substance use assessed within each trimester among women endorsing past-year substance use. The NSDUH sample included 8,530 pregnant women. RESULTS Perinatal substance use was less prevalent among women in later trimesters; however, past-month substance use was observed for all substances across trimesters. The prevalence of past-month licit substance use among pregnant women ranged from 5.77 to 22.50% and past-month illicit substance use ranged from 4.67 to 14.81%. In the second trimester, lower odds of past-month substance use were observed across tobacco, alcohol, and marijuana (odds ratios [ORs] ranging from 0.29 to 0.47), when compared to the first trimester. A similar lower rate of past-month substance use was observed in the third trimester compared to the first trimester, across tobacco, alcohol, and marijuana use, as well as cocaine, prescription pain medication, and tranquilizer use (ORs ranging from 0.02 to 0.42). The likelihood of polysubstance use was lower among women in the second and third trimesters compared to the first trimester (ORs ranging from 0.09 to 0.46). CONCLUSION Findings indicate that a minority of women continue to use substances across all trimesters. This is especially true among women using licit substances and marijuana. These results highlight the need for improved interventions and improved access to treatment for these women.
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Affiliation(s)
- MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA.
- Psychology Section, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Terril L Verplaetse
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Kelly Moore
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
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Peltier MR, Roberts W, Verplaetse TL, Zakiniaeiz Y, Burke C, Moore KE, McKee SA. Sex Differences across Retrospective Transitions in Posttraumatic Stress and Substance Use Disorders. J Dual Diagn 2022; 18:11-20. [PMID: 34965199 PMCID: PMC9086923 DOI: 10.1080/15504263.2021.2016027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives: Concurrent substance use disorder (SUD) and posttraumatic stress disorder (PTSD) occur at high rates and are typically associated with poor treatment outcomes in both sexes. However, women have a propensity to cope with increased negative affect via substance use in comparison to men; thus, it is important to elucidate the sex-specific bidirectional relationships between SUD and PTSD to improve our understanding of concurrent SUD/PTSD in men and women. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-Wave 3; n = 36,309), the present study evaluated the impact of sex on the relationship between past-year SUDs (new, remitted, ongoing), including alcohol and drug use, and retrospective transitions in new vs. absent and ongoing vs. remitted diagnoses of PTSD. Additionally, the impact of sex was explored in models examining past year PTSD (new, remitted, ongoing) and retrospective transitions in new vs. absent and ongoing vs. remitted diagnosis of SUDs. Diagnostic transitions were based on retrospective reporting. Results: Results indicated that new, remitted, and ongoing SUDs increase the likelihood of new PTSD diagnoses (OR range = 2.53-8.11; p < 0.05). Among individuals with ongoing drug use disorders (DUD), there were greater odds of ongoing PTSD (OR = 2.10, p < 0.01). When examining the relationship reciprocally, new, remitted, and ongoing PTSD increased the likelihood of new SUDs (OR range = 2.50-8.22; p < 0.05), and ongoing PTSD increased the likelihood of ongoing SUD and DUD (OR = 1.40, 1.70, respectively; p < 0.05). Sex-specific analyses revealed that the relationship between PTSD and SUDs varies between sexes, particularly among women. For instance, women with new PTSD had higher odds of SUDs, and women with ongoing PTSD were almost 2.5 times more likely to have an ongoing DUD. Women with a new PTSD diagnosis were more likely to be diagnosed with a new SUD (OR = 3.27) and an ongoing DUD (OR = 3.08). Conclusions: Results indicate a bidirectional relationship between PTSD and SUD that is in many instances larger in women. Thus, illustrating potential sex-specific differences in underlying mechanisms implicated in SUD/PTSD, warranting additional research.
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Affiliation(s)
- MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terril L Verplaetse
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kelly E Moore
- Department of Psychology, Eastern Tennessee State University, Johnson City, Tennessee, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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Verplaetse TL, Roberts W, Peltier MR, Zakiniaeiz Y, Burke C, Moore KE, Pittman B, McKee SA. Risk drinking levels and sex are associated with cancer and liver, respiratory, and other medical conditions. Drug Alcohol Depend Rep 2021; 1:100007. [PMID: 36843909 PMCID: PMC9948833 DOI: 10.1016/j.dadr.2021.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 06/18/2023]
Abstract
BACKGROUND Heavy alcohol use is associated with increased risk of alcohol-related health consequences. Alcohol consumption has increased in females in the last fifteen years and females are more likely to experience exacerbated health risks due to drinking. Our group identified that females with AUD were more likely to report respiratory conditions or cancers compared to their male counterparts. This analysis sought to further examine relationships between sex and alcohol use on medical conditions by using the new 2020 U.S. Dietary Guidelines risk drinking levels. METHODS Data from the U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n = 36,309) was used to evaluate associations between sex (female vs. male) and alcohol risk drinking levels (abstainer, binge, heavy, extreme binge vs. moderate drinking) on past year self-reported doctor-confirmed medical conditions). RESULTS Females were 1.5 to 2 times more likely to have pain, respiratory, or other medical conditions in the past year (odds ratio [OR]=1.46-2.11) vs. males. Significant interactions demonstrated that heavy drinking females or extreme binge drinking females were 2 to 3 times more likely to have cancers or other conditions (OR=1.95-2.69) vs. males at the same risk drinking level. Female abstainers were more likely than male abstainers to have other medical conditions (OR=1.77). CONCLUSIONS Consistent with our previous findings, results identify that higher risk drinking levels are associated with the presence of past year self-reported doctor-confirmed medical conditions spanning organ systems, particularly in females. Treatment for high-risk drinking should be considered in the clinical care of individuals with significant medical conditions.
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Affiliation(s)
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - MacKenzie R. Peltier
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Psychology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kelly E. Moore
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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11
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Verplaetse TL, Peltier MR, Roberts W, Burke C, Moore KE, Pittman B, McKee SA. Sex and alcohol use disorder predict the presence of cancer, respiratory, and other medical conditions: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Addict Behav 2021; 123:107055. [PMID: 34311184 PMCID: PMC8419091 DOI: 10.1016/j.addbeh.2021.107055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/23/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Women experience greater health consequences of alcohol compared to their male counterparts. In recent years, rates of drinking and heavy alcohol use have increased in women while remaining relatively steady in men. Thus, our aim was to newly examine associations between sex, AUD, and the presence of medical conditions in a large nationally representative, cross-sectional dataset. METHODS Using data from the U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n = 36,309), we evaluated relationships among sex and DSM-5 AUD, and their association with past year clinician-confirmed medical conditions. RESULTS Women were 1.5 to 2 times more likely to be diagnosed with a past year cancer, pain, respiratory, or other significant medical condition compared to men (odds ratio [OR] = 1.331-2.027). Individuals with an ongoing DSM-5 AUD were nearly 1.5 to 2 times more likely to report a confirmed past year liver, cardiovascular, cancer, or other significant medical condition compared to those without an AUD (OR = 1.437-2.073). Interactive effects demonstrated that women with an ongoing AUD were 2 to 3 times more likely to report a past year doctor- or health professional-confirmed medical condition compared to men; specifically, respiratory conditions and cancers (OR = 1.767-2.713). CONCLUSIONS Results identify that AUD is a critical factor associated with disease that spans organ systems. Associations between AUD and respiratory conditions or cancers are particularly robust in women. Effective interventions for a broad spectrum of medical conditions should consider the role of problematic alcohol use, especially given that rates of drinking in women are increasing.
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Affiliation(s)
- Terril L Verplaetse
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
| | - MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; Psychology Service, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
| | - Kelly E Moore
- Department of Psychology, East Tennessee State University, Johnson City, TN, United States.
| | - Brian Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States.
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12
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Roberts W, Moore KE, Verplaetse TL, Zakiniaeiz Y, Burke C, Peltier MR, McKee SA. Prospective Associations of Pain Intensity and Substance Use in the United States Population: A Cross-Lagged Panel Analysis. J Stud Alcohol Drugs 2021. [DOI: 10.15288/jsad.2021.82.576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Walter Roberts
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Kelly E. Moore
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee
| | - Terril L. Verplaetse
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Yasmin Zakiniaeiz
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Catherine Burke
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - MacKenzie R. Peltier
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Sherry A. McKee
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee
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13
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Peltier MR, Verplaetse TL, Mineur YS, Gueorguieva R, Petrakis I, Cosgrove KP, Picciotto MR, McKee SA. Sex differences in progestogen- and androgen-derived neurosteroids in vulnerability to alcohol and stress-related disorders. Neuropharmacology 2021; 187:108499. [PMID: 33600842 DOI: 10.1016/j.neuropharm.2021.108499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
Stress and trauma exposure disturbs stress regulation systems and thus increases the vulnerability for stress-related disorders which are characterized by negative affect, including major depressive disorder, anxiety disorders and posttraumatic stress disorder. Similarly, stress and trauma exposure results in increased vulnerability to problematic alcohol use and alcohol use disorder, especially among women, who are more likely to drink to cope with negative affect than their male counterparts. Given these associations, the relationship between stress-related disorders and alcohol use is generally stronger among women leading to complex comorbidities across these disorders and alcohol misuse. This review highlights the therapeutic potential for progestogen- and androgen-derived neurosteroids, which affect both stress- and alcohol-related disorders, to target the overlapping symptoms related to negative affect. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'
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Affiliation(s)
- MacKenzie R Peltier
- Yale School of Medicine, New Haven, CT, 06519, USA; VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
| | | | | | - Ralitza Gueorguieva
- Yale School of Medicine, New Haven, CT, 06519, USA; Yale School of Public Health, New Haven, CT, 06519, USA
| | - Ismene Petrakis
- Yale School of Medicine, New Haven, CT, 06519, USA; VA Connecticut Healthcare System, West Haven, CT, 06516, USA
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14
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Verplaetse TL, Peltier MR, Roberts W, Moore KE, Pittman BP, McKee SA. Associations Between Nicotine Metabolite Ratio and Gender With Transitions in Cigarette Smoking Status and E-Cigarette Use: Findings Across Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study. Nicotine Tob Res 2020; 22:1316-1321. [PMID: 32152625 DOI: 10.1093/ntr/ntaa022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/20/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Nicotine metabolite ratio (NMR), the ratio of trans 3'-hydroxycotinine to cotinine, is a biomarker of nicotine metabolism. Discrepant findings among clinical trials and population-based studies warrant replication on whether higher NMR, or faster nicotine metabolism, is associated with quitting cigarette smoking. Associations of NMR and e-cigarette use are largely unknown, as well as the relationship between NMR and gender on quitting cigarette smoking or e-cigarette use. METHODS The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative, longitudinal cohort study assessing tobacco use in the US population. In the current study, the PATH (waves 1 and 2; adult interviews) was used to evaluate longitudinal predictions in relationships among NMR and gender and their association with transitions (quit vs. current stable) in cigarette smoking status and e-cigarette use status across waves 1 and 2 of the PATH study. RESULTS NMR and gender were not significantly associated with quit behavior for combustible cigarettes. Regarding e-cigarettes, a significant two-way interaction demonstrated that women with higher NMR were less likely to quit e-cigarette use compared to women with lower NMR (odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.02-0.57; p = .01). CONCLUSIONS Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism across waves 1 and 2 of the PATH study. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. IMPLICATIONS Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. Establishing parameters for NMR collection and for the use of NMR as a biomarker for cigarette smoking behavior and e-cigarette use is an important next step, and may have implications for early intervention and treatment for cessation.
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Affiliation(s)
| | | | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Kelly E Moore
- Department of Psychology, East Tennessee State University, Johnson City, TN
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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15
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Roberts W, Verplaetse TL, Ramchandani VA, McKee SA. A Critical Review of Alcohol Administration Guidelines in Laboratory Medication Screening Research: Is It Time to Include Treatment Seekers? Alcohol Clin Exp Res 2020; 45:15-24. [PMID: 33190310 DOI: 10.1111/acer.14514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023]
Abstract
Human laboratory studies play an important role in alcohol use disorder (AUD) medication development. Medications that are found to be safe and effective during human laboratory screening will then move to more expensive clinical trials in patient populations. Given the gatekeeping role of human laboratory studies in the medication development pipeline, it is critical that these studies accurately forecast how pharmacotherapies will perform under true-to-life clinical conditions. On the other hand, the design of these studies also must adhere to ethical guidelines: certain aspects of clinical reality cannot be incorporated into screening studies because doing so might place the participant at risk for harm or breach other ethical guidelines. Conventions exist that guide the resolution of these conflicting ideals. This article considers the practice of recruiting non-treatment-seeking heavy drinkers to participate in laboratory screening studies. By convention, volunteers are excluded from laboratory screening studies that involve alcohol administration if they are deemed "treatment seeking," meaning that they recently stopped drinking or are motivated to do so. Although this common practice may reduce risk to participants, findings may not accurately predict medication effects on treatment seekers. Indeed, there is empirical evidence that treatment seekers differ from nontreatment seekers in their responses to medications (Neuropsychopharmacology 2017a; 42: 1776; Am J Drug Alcohol Abuse 2017b; 43: 703; J Psychiatr Res 2006; 40: 383). Here, we argue for the importance of recruiting treatment seekers for this research due to their qualitative difference from nontreatment seekers. We argue that these individuals should be the default population in human laboratory medication screening studies. We conclude by discussing 2 case examples of medication experiments led by our research groups that involved administering medications to treatment seekers.
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Affiliation(s)
- Walter Roberts
- From the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terril L Verplaetse
- From the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - Sherry A McKee
- From the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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16
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Roberts W, Marotta PL, Verplaetse TL, Peltier MR, Burke C, Ramchandani VA, McKee SA. A prospective study of the association between rate of nicotine metabolism and alcohol use in tobacco users in the United States. Drug Alcohol Depend 2020; 216:108210. [PMID: 32805549 PMCID: PMC7609495 DOI: 10.1016/j.drugalcdep.2020.108210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Rate of nicotine metabolism has been identified as a biochemical risk factor for nicotine use and dependence; however, its role in alcohol consumption and related outcomes is not well understood. The current research examined nicotine metabolism rate as a risk factor for alcohol use among current tobacco users. We also examined sex differences in these associations. METHOD Data were taken from Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study, a national longitudinal study of tobacco use and associated health outcomes. The nicotine metabolite ratio (NMR) was calculated as the ratio of trans-3' hydroxycotinine to cotinine in urine samples provided at wave 1. Alcohol use outcomes included past 30-day NIAAA-defined hazardous drinking status, total drinks, and alcohol-related consequences. All analyses controlled for alcohol use at Wave 1. RESULTS NMR at Wave 1 predicted increased odds of meeting hazardous drinking criteria, adjusted odds ratio (aOR) = 1.14, 95 % CI = 1.06; 1.23, p = 0.001, greater total alcohol consumption amount, adjusted rate ratio (aRR) = 1.21, 95 % CI = 1.12; 1.30, p < 0.001, and more alcohol consequences, aRR = 1.07, 95 % CI = 1.01; 1.13, p = 0.018, at wave 2. No significant sex differences were identified. NMR remained a significant predictor of alcohol use in models controlling for severity of nicotine exposure in cigarette smokers. CONCLUSIONS NMR may be a shared risk factor for harmful nicotine and alcohol use that contributes to their co-occurrence.
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Affiliation(s)
- Walter Roberts
- Department of Psychiatry, Yale School of Medicine, United States.
| | | | | | - MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, United States; Veterans Affairs Connecticut Healthcare System, United States
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, United States
| | - Vijay A Ramchandani
- Section on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, United States
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, United States
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17
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Peltier MR, Verplaetse TL, Roberts W, Moore K, Burke C, Marotta PL, Phillips S, Smith PH, McKee SA. Changes in excessive alcohol use among older women across the menopausal transition: a longitudinal analysis of the Study of Women's Health Across the Nation. Biol Sex Differ 2020; 11:37. [PMID: 32665024 PMCID: PMC7362573 DOI: 10.1186/s13293-020-00314-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/02/2020] [Indexed: 01/14/2023] Open
Abstract
Background Recent data suggest that excessive alcohol use is increasing among women and older adults. Such trends are concerning, as women are more vulnerable to alcohol-related health consequences, and such health problems may be exacerbated with age. Furthermore, there are sex-specific factors that may influence alcohol consumption among women, including the hormonal changes associated with the menopausal transition and negative affect. The present study sought to investigate transitions in excessive drinking among women across the menopausal transition and included exploration of sex hormones (estradiol; testosterone) and depression. Methods The present study utilized publicly available data from the Study of Women Across the Nation (SWAN) and included 3302 women (42–52 years old at baseline), who completed 10 years of annual assessments. National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria were used as guidance when defining excessive drinking within the present dataset. At year 1, 170 women were identified as drinking excessively. Random-effect logistic regressions were used to examine transitions in excessive drinking. Results Women identified as excessive drinkers were more likely to transition to non-excessive drinking across all menopausal transition stages (ORs range = 3.71–5.11), while women were more likely to transition from non-excessive to excessive drinking during the early peri- and postmenopausal stages (OR = 1.52 and 1.98, respectively). Higher testosterone levels were associated with a decreased likelihood of transitioning to non-excessive drinking (OR = 0.59). Depression and estradiol levels were not related to transitions in drinking. Conclusions The present study demonstrates that the menopausal transition marks a period of instability in alcohol use among women. Further research is warranted to understand factors related to transitioning in and out of excessive drinking.
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Affiliation(s)
- MacKenzie R Peltier
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA.,Psychology Service, VACT Healthcare System, West Haven, CT, 06510, USA
| | - Terril L Verplaetse
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Kelly Moore
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Catherine Burke
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Phillip L Marotta
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Sarah Phillips
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Philip H Smith
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519, USA.
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Peltier MR, Flores JM, Smith PH, Roberts W, Verplaetse TL, Moore KE, Hacker R, Oberleitner LM, McKee SA. Smoking Across the Menopausal Transition in a 10-Year Longitudinal Sample: The Role of Sex Hormones and Depressive Symptoms. Nicotine Tob Res 2020; 22:872-877. [PMID: 31058288 PMCID: PMC7249927 DOI: 10.1093/ntr/ntz069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/26/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Current cigarette smoking rates among older women remain problematic, especially given that this population experiences increased smoking-related health consequences. Despite these increased health concerns, little research to date has explored smoking patterns across the menopausal transition (pre-, early-peri-, late-peri-, and postmenopausal) or the effect of unique factors such as sex hormones and depression during this transition. METHODS This study used 10 yearly waves of data from the Study of Women's Health Across the Nation, a longitudinal dataset. Data included 1397 women endorsing ever smoking regularly at baseline. Random-effects logistic regression models were used to examine smoking transitions. RESULTS Although there were no associations between menopausal transition stage and smoking behavior, increased estradiol was associated with an increased likelihood of quitting regular smoking (eg, transitioning from regular smoking to non-regular or no smoking; odds ratio [OR] = 1.28), whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking (eg, transitioning from former or nonregular smoking to regular smoking OR = 2.56). Depression was associated with increased likelihood of continued smoking (OR = 0.97) and relapse (OR = 1.03). CONCLUSIONS The results emphasize the need to develop interventions to target initiated or continued smoking among women across the menopausal transition and specifically highlight the importance of developing treatments that target depressive symptoms in this population. In addition, although singular hormone measures were associated with smoking behavior, there is a need for future study of dynamic changes in hormones, as well as the impact of progesterone on smoking behaviors across the menopausal transition. IMPLICATIONS To date, no studies have examined smoking behaviors across the menopausal transition. In this study, although menopausal transition status was not significantly related to transitions in smoking behavior, important relationships between sex hormones and depression were observed. Increased estradiol was associated with an increased likelihood of quitting regular smoking, whereas increased testosterone was associated with an increased likelihood of relapsing to regular smoking behavior. Higher depression scores were related to continued smoking and relapse to regular smoking behavior. These results highlight the need to develop interventions to target smoking cessation among women across the menopausal transition.
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Affiliation(s)
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Philip H Smith
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | - Kelly E Moore
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Robyn Hacker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Verplaetse TL, Moore KE, Pittman BP, Roberts W, Oberleitner LM, Peltier MKR, Hacker R, Cosgrove KP, McKee SA. Intersection of E-Cigarette Use and Gender on Transitions in Cigarette Smoking Status: Findings Across Waves 1 and 2 of the Population Assessment of Tobacco and Health Study. Nicotine Tob Res 2020; 21:1423-1428. [PMID: 30239953 DOI: 10.1093/ntr/nty187] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/05/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cigarette smokers report using electronic cigarettes (e-cigarettes) to reduce or quit smoking, but findings are mixed regarding the benefit and risk of e-cigarettes in this population, and effects of gender are unknown. METHODS The Population Assessment of Tobacco and Health (PATH; waves 1 and 2; adult interviews) was used to evaluate relationships among wave 1 e-cigarette use (daily, nondaily, never) and gender and their association with transitions (quit vs. current; relapse vs. former) in cigarette smoking status across waves 1 and 2 of the PATH study. RESULTS Daily e-cigarette users had higher odds of quitting smoking (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.12 to 2.18) compared with never e-cigarette users. Conversely, daily and nondaily e-cigarette users were at greater risk of smoking relapse (OR = 1.84, 95% CI = 1.15 to 2.94 and OR = 1.85, 95% CI = 0.99 to 3.46, respectively) compared with never e-cigarette users. Women were less likely to quit smoking compared with men independent of e-cigarette use (OR = 0.76, 95% CI = 0.59 to 0.99). In stratified analyses, daily or nondaily e-cigarette use did not increase the likelihood of quitting or relapse in women. In men, daily and nondaily e-cigarette users were at greater risk of smoking relapse (OR = 2.96, 95% CI = 1.49 to 5.86 and OR = 3.05, 95% CI = 1.29 to 7.17, respectively) compared with men who were never e-cigarette users. CONCLUSIONS Findings identify e-cigarettes as a potential aid for smoking cessation but also as a potential risk for smoking relapse in men only. Overall, women were less likely to quit smoking, and e-cigarette use did not impact their ability to quit or to stay quit. IMPLICATIONS Cigarette smokers report using e-cigarettes to reduce or quit smoking, but findings are mixed regarding the benefit and risk of e-cigarettes in this population. Using data from the newly available PATH (waves 1 and 2; adult interviews), our findings identify e-cigarettes as a potential aid for smoking cessation but also identify e-cigarettes as a potential risk for smoking relapse in men only. These findings may have implications for the regulation of e-cigarettes by the Food and Drug Administration and the benefit-cost ratio of e-cigarette use in smokers.
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Affiliation(s)
| | - Kelly E Moore
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | | | | | - Robyn Hacker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Kelly P Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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20
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Verplaetse TL, Cosgrove KP, Tanabe J, McKee SA. Sex/gender differences in brain function and structure in alcohol use: A narrative review of neuroimaging findings over the last 10 years. J Neurosci Res 2020; 99:309-323. [PMID: 32333417 DOI: 10.1002/jnr.24625] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/03/2020] [Accepted: 03/18/2020] [Indexed: 12/22/2022]
Abstract
Over the last 10 years, rates of alcohol use disorder (AUD) have increased in women by 84% relative to a 35% increase in men. Rates of alcohol use and high-risk drinking have also increased in women by 16% and 58% relative to a 7% and 16% increase in men, respectively, over the last decade. This robust increase in drinking among women highlights the critical need to identify the underlying neural mechanisms that may contribute to problematic alcohol consumption across sex/gender (SG), especially given that many neuroimaging studies are underpowered to detect main or interactive effects of SG on imaging outcomes. This narrative review aims to explore the recent neuroimaging literature on SG differences in brain function and structure as it pertains to alcohol across positron emission tomography, magnetic resonance imaging, and functional magnetic resonance imaging modalities in humans. Additional work using magnetic resonance spectroscopy, diffusion tensor imaging, and event-related potentials to examine SG differences in AUD will be covered. Overall, current research on the neuroimaging of AUD, alcohol consumption, or risk of AUD is limited, and findings are mixed regarding the effect of SG on neurochemical, structural, and functional mechanisms associated with AUD. We address SG disparities in the neuroimaging of AUD and propose a call to action to include women in brain imaging research. Future studies are crucial to our understanding of the neurobiological underpinnings of AUD across neural systems and the vulnerability for AUD among women and men.
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Affiliation(s)
| | - Kelly P Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale PET Center, New Haven, CT, USA
| | - Jody Tanabe
- Department of Radiology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Moore KE, Oberleitner L, Pittman BP, Roberts W, Verplaetse TL, Hacker RL, Peltier MR, McKee SA. The Prevalence of Substance Use Disorders among Community-based Adults with Legal Problems in the U.S. Addict Res Theory 2019; 28:165-172. [PMID: 32952490 PMCID: PMC7500665 DOI: 10.1080/16066359.2019.1613524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 05/29/2023]
Abstract
BACKGROUND Current national prevalence estimates of DSM-5 diagnosed substance use disorders (SUDs) among adults with justice system involvement are lacking. METHODS This study drew from NESARC-III data (n = 36,309; 2012-2013), a nationally representative U.S. sample, to examine current and lifetime alcohol use disorder (AUD) and drug use disorder (DUD) diagnoses among adults reporting current or prior drug-related, alcohol-related, and general legal problems. RESULTS Adults reporting current alcohol-related legal problems were 22 times more likely to have a current AUD diagnosis (AOR = 22.0, 95% CI = 12.1; 40.1) and 15 times more likely to have had a lifetime AUD diagnosis (AOR = 15.2, 95% CI = 7.5; 30.9) than adults without alcohol-related legal problems. Adults with lifetime drug-related legal problems were 3-5 times more likely to have a current (AOR = 2.6, 95% CI = 2.1; 3.2) and lifetime (AOR = 5.1, 95% CI = 4.3; 6.1) DUD diagnosis, with stimulant use disorder being the most prevalent (AOR = 5.4, 95% CI = 4.5; 6.5). Adults with general legal problems were around 3 times more likely to have a current AUD (AOR = 3.2, 95% CI = 2.6; 4.0) or DUD (AOR = 3.5, 95% CI = 2.8; 4.4). Women with any type of legal problem were more likely to have SUD diagnoses than men. CONCLUSIONS SUD diagnoses are prevalent among adults reporting legal problems, particularly those involving alcohol. There is a continued need for community-based addiction prevention and intervention efforts, especially for women with justice system involvement.
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Affiliation(s)
- Kelly E. Moore
- East Tennessee State University, Department of Psychology, 420 Rogers-Stout Hall, P.O. Box 70649, Johnson City, TN 37614
| | - Lindsay Oberleitner
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Brian P. Pittman
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Walter Roberts
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Terril L. Verplaetse
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Robyn L. Hacker
- Center for Dependency, Addiction, and Rehabilitation, University of Colorado Boulder, 1693 N. Quentin St., Aurora, CO 80045
| | - MacKenzie R. Peltier
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
| | - Sherry A. McKee
- Yale University School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven, CT 06519
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Verplaetse TL, Ralevski E, Roberts W, Gueorguieva R, McKee SA, Petrakis IL. Alcohol Abstainer Status and Prazosin Treatment in Association with Changes in Posttraumatic Stress Disorder Symptoms in Veterans with Comorbid Alcohol Use Disorder and Posttraumatic Stress Disorder. Alcohol Clin Exp Res 2019; 43:741-746. [PMID: 30698839 DOI: 10.1111/acer.13969] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The noradrenergic system has been implicated in alcohol use disorder (AUD) and posttraumatic stress disorder (PTSD), with adrenergic agents reducing drinking in individuals with AUD and improving sleep disturbances in individuals with PTSD. In a recent clinical trial, prazosin, an α1-adrenergic antagonist, was not superior to placebo in reducing PTSD symptoms, sleep problems, or alcohol consumption in a comorbid population; however, patients in both treatment conditions improved in all symptom domains over the course of treatment. It remains unknown whether alcohol abstinence is related to changes in PTSD symptoms and medication effects in individuals with this comorbidity. METHODS Veterans with comorbid alcohol dependence and PTSD (n = 96) were randomized to prazosin (16 mg) or placebo in a 12-week outpatient, double-blind clinical trial. In this secondary data analysis, we examined main effects of alcohol abstainer status (abstainer vs. nonabstainer), treatment, and their interaction on changes in PTSD symptoms over time using linear mixed models. RESULTS There was a main effect of alcohol abstainer status on symptoms of PTSD (p = 0.03), such that nonabstainers had lower total Clinician-Administered PTSD Scale (CAPS) scores than abstainers. There was a significant treatment by alcohol abstainer status interaction (p = 0.01); specifically, among placebo-treated individuals, those who did not abstain from alcohol had lower total CAPS scores compared to alcohol abstainers. Within the prazosin-treated group, abstainers and nonabstainers did not differ on total CAPS scores. Results were similar for the avoidance (p = 0.02), reexperiencing (p = 0.01), and hyperarousal (p = 0.04) subscales, such that placebo-treated nonabstainers had lower CAPS scores overall. CONCLUSIONS Overall, prazosin treatment was not significantly related to changes in PTSD symptoms over the course of the 12-week clinical trial in a comorbid population. Interestingly, placebo-treated alcohol nonabstainers had a significant reduction in PTSD symptoms. Whether placebo-treated individuals continued to use alcohol because of ongoing symptoms of PTSD is not known.
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Affiliation(s)
| | - Elizabeth Ralevski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ralitza Gueorguieva
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Ismene L Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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23
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Moore KE, Oberleitner LMS, Zonana HV, Buchanan AW, Pittman BP, Verplaetse TL, Angarita GA, Roberts W, McKee SA. Psychiatric Disorders and Crime in the US Population: Results From the National Epidemiologic Survey on Alcohol and Related Conditions Wave III. J Clin Psychiatry 2019; 80:18m12317. [PMID: 30758921 PMCID: PMC7826201 DOI: 10.4088/jcp.18m12317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Current knowledge regarding the intersection of psychiatric disorders and crime in the United States is limited to psychiatric, forensic, and youth samples. This study presents nationally representative data on the relationship of DSM-5 psychiatric disorders, comorbid substance and mental health disorders, and multimorbidity (number of disorders) with criminal behavior and justice involvement among non-institutionalized US adults. METHODS Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III; 2012-2013; N = 36,309). Logistic regressions were used to examine the association of specific disorders (eg, mood, anxiety, eating, posttraumatic stress, substance use), comorbid substance use and mental health disorders, and multimorbidity with lifetime criminal behavior, incarceration experience, and past-12-month general, alcohol-related, and drug-related legal problems. RESULTS Overall, 28.5% of participants reported a history of criminal behavior, 11.4% reported a history of incarceration, 1.8% reported current general legal problems, 0.8% reported current alcohol-related legal problems, and 2.7% reported current drug-related legal problems. The presence of any disorder was associated with a 4 to 5 times increased risk of crime outcomes. Drug use disorders were associated with the highest risk of lifetime crime (adjusted odds ratio [AOR] = 6.8; 95% CI, 6.1-7.6) and incarceration (AOR = 4.7; 95% CI, 4.1-5.3) and current legal problems (AOR = 3.3; 95% CI, 2.6-4.2). Multimorbidity and comorbid substance use and mental health disorders were associated with additional risk. Controlling for antisocial personality disorder did not change the findings. CONCLUSIONS Community adults with substance use disorders, comorbid substance use and mental health disorders, and increasing multimorbidity are most at risk of crime and justice involvement, highlighting the importance of community-based addiction treatment.
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Affiliation(s)
- Kelly E Moore
- Department of Psychology, East Tennessee State University, 420 Rogers-Stout Hall PO Box 70649, Johnson City, TN 37614.
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Lindsay M S Oberleitner
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Howard V Zonana
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alec W Buchanan
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian P Pittman
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Terril L Verplaetse
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gustavo A Angarita
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Walter Roberts
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sherry A McKee
- Department of Psychiatry, Division of Law and Psychiatry, Division of Substance Abuse, Yale University School of Medicine, New Haven, Connecticut, USA
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Peltier MR, Verplaetse TL, Mineur YS, Petrakis IL, Cosgrove KP, Picciotto MR, McKee SA. Sex differences in stress-related alcohol use. Neurobiol Stress 2019; 10:100149. [PMID: 30949562 PMCID: PMC6430711 DOI: 10.1016/j.ynstr.2019.100149] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 01/12/2023] Open
Abstract
Rates of alcohol use disorder (AUD) have increased in women by 84% over the past ten years relative to a 35% increase in men. This substantive increase in female drinking is alarming given that women experience greater alcohol-related health consequences compared to men. Stress is strongly associated with all phases of alcohol addiction, including drinking initiation, maintenance, and relapse for both women and men, but plays an especially critical role for women. The purpose of the present narrative review is to highlight what is known about sex differences in the relationship between stress and drinking. The critical role stress reactivity and negative affect play in initiating and maintaining alcohol use in women is addressed, and the available evidence for sex differences in drinking for negative reinforcement as it relates to brain stress systems is presented. This review discusses the critical structures and neurotransmitters that may underlie sex differences in stress-related alcohol use (e.g., prefrontal cortex, amygdala, norepinephrine, corticotropin releasing factor, and dynorphin), the involvement of sex and stress in alcohol-induced neurodegeneration, and the role of ovarian hormones in stress-related drinking. Finally, the potential avenues for the development of sex-appropriate pharmacological and behavioral treatments for AUD are identified. Overall, women are generally more likely to drink to regulate negative affect and stress reactivity. Sex differences in the onset and maintenance of alcohol use begin to develop during adolescence, coinciding with exposure to early life stress. These factors continue to affect alcohol use into adulthood, when reduced responsivity to stress, increased affect-related psychiatric comorbidities and alcohol-induced neurodegeneration contribute to chronic and problematic alcohol use, particularly for women. However, current research is limited regarding the examination of sex in the initiation and maintenance of alcohol use. Probing brain stress systems and associated brain regions is an important future direction for developing sex-appropriate treatments to address the role of stress in AUD.
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Affiliation(s)
| | | | - Yann S. Mineur
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Ismene L. Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
- VA Connecticut Healthcare System, West Haven, CT, 06516, USA
| | - Kelly P. Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Marina R. Picciotto
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
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25
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Roberts W, Moore K, Peltier MR, Verplaetse TL, Oberleitner L, Hacker R, McKee SA. Electronic Cigarette Use and Risk of Harmful Alcohol Consumption in the U.S. Population. Alcohol Clin Exp Res 2018; 42:2385-2393. [PMID: 30222189 PMCID: PMC6286236 DOI: 10.1111/acer.13889] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/05/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use is an increasingly common method of nicotine delivery in the general population. It is well-established that tobacco users are at increased risk to engage in hazardous drinking and meet criteria for alcohol use disorder (AUD) relative to nonusers. Less is known, however, about the risk of harmful alcohol use among people who use e-cigarettes. The current study reports on the association between e-cigarette and alcohol use in the U.S. population using a nationally representative sample. METHODS Data from 36,309 adults who participated in the National Epidemiologic Survey on Alcohol and Related Conditions-Wave III were included in the study. The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) measured past-year e-cigarette and alcohol use outcomes. Based on past-year e-cigarette use, respondents were categorized as nonusers, nondaily users, or daily users. Alcohol use outcomes were drinking quantity/frequency, binge drinking frequency, AUD diagnostic status, and National Institute on Alcohol Abuse and Alcoholism-defined hazardous drinking status. RESULTS Controlling for demographic characteristics, daily and nondaily e-cigarette users showed increased risk of harmful alcohol use compared to e-cigarette nonusers, including hazardous drinking (adjusted odds ratios [AORs] = 1.69; 2.48), AUD (AORs = 1.89; 2.44), and binge drinking frequency (AORs = 1.30 to 3.30). Nondaily e-cigarette use was associated with higher levels of risk than was daily use. Secondary analyses examined alcohol use outcomes according to participants' patterns of dual tobacco cigarette/e-cigarette use. These analyses confirmed that e-cigarette use alongside tobacco cigarette use is associated with additive risk of harmful alcohol consumption, particularly among nondaily users. CONCLUSIONS E-cigarette users, particularly those who engage in nondaily and dual use, show elevated rates of harmful alcohol use. Heavy drinking may constitute a source of health risk among e-cigarette users.
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Affiliation(s)
- Walter Roberts
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - Kelly Moore
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - MacKenzie R. Peltier
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - Terril L. Verplaetse
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - Lindsay Oberleitner
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - Robyn Hacker
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - Sherry A. McKee
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
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26
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Verplaetse TL, McKee SA. Targeting Stress Neuroadaptations for Addiction Treatment: A Commentary on Kaye et al. (2017). J Stud Alcohol Drugs 2018; 78:372-374. [PMID: 28499101 DOI: 10.15288/jsad.2017.78.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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Verplaetse TL, Weinberger AH, Ashare RL, Pittman BP, Shi JM, Tetrault JM, Lavery M, McKee SA. Pilot investigation of the effect of carvedilol on stress-precipitated smoking-lapse behavior. J Psychopharmacol 2018; 32:1003-1009. [PMID: 29692206 PMCID: PMC6258014 DOI: 10.1177/0269881118767647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Separate α1- and β-adrenergic antagonists have shown efficacy in reducing nicotine-motivated behaviors in rodents and humans, supporting a role for the noradrenergic system in mediating the reinforcing properties of drugs of abuse. However, the effect of the combined α1- and β-adrenergic antagonist, carvedilol, on stress-related smoking is unknown. METHODS Using a well-established human laboratory model of stress-precipitated smoking-lapse behavior, we examined whether carvedilol (0 or 50 mg/day; between subject, n=17 per group), administered to steady-state, would attenuate the ability to resist smoking following stress imagery (vs. neutral imagery) and reduce subsequent smoking self-administration in nicotine-deprived smokers ( n = 34 total). Tobacco craving, withdrawal, and physiologic reactivity were also assessed. RESULTS Latency to start smoking and number of cigarettes smoked during the self-administration period did not differ by medication condition. Counter to our hypothesis, tobacco craving demonstrated a medication × time effect, with greater craving in the carvedilol condition. Systolic blood pressure and heart rate demonstrated lower values in the carvedilol versus placebo group, consistent with known effects of carvedilol. CONCLUSION While carvedilol attenuated physiologic reactivity consistent with its clinical indication, beneficial effects on smoking outcomes were absent in this preliminary investigation and may suggest possible worsening. Future work may benefit from discerning the single versus combined effects of α1- and β-adrenergic antagonism on smoking outcomes.
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Affiliation(s)
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Rebecca L. Ashare
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Brian P. Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Julia M. Shi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeanette M. Tetrault
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Meaghan Lavery
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Sherry A. McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Correspondence to: Sherry McKee, PhD, 2 Church Street South, Suite 109, Yale University School of Medicine, New Haven, CT 06519; Tele: 203.737.3529 Fax: 203.737-4243
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28
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Roberts W, Verplaetse TL, Moore K, Oberleitner LM, McKee SA. A preliminary investigation into the effects of doxazosin on cognitive functioning in tobacco-deprived and -satiated smokers. Hum Psychopharmacol 2018; 33:e2660. [PMID: 29878501 PMCID: PMC5995328 DOI: 10.1002/hup.2660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/02/2018] [Accepted: 04/17/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To test the effects of doxazosin, an α1 antagonist, on cognitive functioning during tobacco withdrawal in smokers. METHODS Participants (n = 35) were randomly assigned to receive placebo, 4-mg/day, or 8-mg/day doxazosin. They completed a continuous performance task and self-reported their withdrawal symptoms at baseline and twice following a medication titration period: once in a tobacco-deprived state and again in a nondeprived state. Ability to resist smoking was assessed using a laboratory smoking-lapse paradigm. RESULTS Participants showed poorer cognitive performance on most measures taken from the continuous performance task when tobacco deprived. Eight-mg/day doxazosin improved inhibitory control during the nondeprivation session but did not affect sustained attention or reaction time. Participants receiving doxazosin reported fewer withdrawal symptoms during deprivation than those on placebo. Those showing the greatest improvement of inhibitory control under doxazosin were better able to resist smoking (i.e., latency to smoke) during a smoking lapse task. Self-reported withdrawal symptoms also were negatively associated with time to smoking. CONCLUSIONS Doxazosin reduced symptoms of tobacco withdrawal according to self-report and cognitive assessment and improved inhibitory control above predrug levels. This research identifies potential mechanisms by which doxazosin might improve smoking outcomes.
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Affiliation(s)
- Walter Roberts
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519,Corresponding author: Telephone: (203) 737-3529 Fax: (203) 737-4243,
| | - Terril L. Verplaetse
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - Kelly Moore
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - Lindsay M. Oberleitner
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
| | - Sherry A. McKee
- Yale School of Medicine, Department of Psychiatry, 2 Church Street South, Suite 109, New Haven CT, 06519
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29
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Verplaetse TL, Morris ED, McKee SA, Cosgrove KP. Sex differences in the nicotinic acetylcholine and dopamine receptor systems underlying tobacco smoking addiction. Curr Opin Behav Sci 2018; 23:196-202. [PMID: 31341936 DOI: 10.1016/j.cobeha.2018.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Converging lines of evidence suggest that men generally smoke for nicotine-related reinforcement, whereas women smoke for non-nicotine factors. Women have more difficulty quitting smoking and are less responsive to nicotine replacement therapies than men, underscoring the importance of examining sex differences in the neurochemical mechanisms underlying nicotine-motivated behavior. We review the recent imaging literature on sex differences in the nicotinic acetylcholine receptor system and in the dopaminergic system in response to nicotine administration and tobacco smoking. We offer an explanation to unify imaging findings related to the dopamine system. We then propose a course of action for future medication development for tobacco smoking addiction.
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Affiliation(s)
| | - Evan D Morris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.,Yale PET Center, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06519, USA.,Department of Biomedical Engineering, Yale University, New Haven, CT 06519, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA
| | - Kelly P Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519, USA.,Yale PET Center, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06519, USA
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30
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Verplaetse TL, Moore KE, Pittman BP, Roberts W, Oberleitner LM, Smith PH, Cosgrove KP, McKee SA. Intersection of stress and gender in association with transitions in past year DSM-5 substance use disorder diagnoses in the United States. Chronic Stress (Thousand Oaks) 2018. [PMID: 29527591 PMCID: PMC5841251 DOI: 10.1177/2470547017752637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Stress contributes to the development and maintenance of substance use disorders (SUD), with some research suggesting that the impact of stress on SUD is greater in women. However, this has yet to be evaluated in a national dataset, across major substances of abuse. Methods Using data from the newly available U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3; n=36,309) we evaluated relationships among past year stressful life events (0 or 1 vs. 2+ events, range 0-16) and gender, and their association with transitions (new vs. absent cases; ongoing vs. remitted cases) in Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) alcohol use disorder (AUD), tobacco use disorder (TUD), cannabis use disorder (CUD), and nonmedical prescription opioid use disorder (OUD) diagnoses. Results Having 2 or more stressful life events in the past year increased the odds of having a new AUD, TUD, CUD, and OUD (OR=3.14, 2.15, 5.52, and 3.06, respectively) or ongoing AUD, TUD, and CUD (OR=2.39, 2.62, and 2.95, respectively) compared to 0 or 1 stressful life event. A stress by gender interaction for new vs. absent AUD demonstrated that having 2 or more stressful life events was associated with increased odds of new AUD in men (OR=2.51) and even greater odds of new AUD in women (OR=3.94). Conclusions Results highlight that stress is a robust factor in both men and women with new or ongoing substance use disorders, and that effective treatments for substance use should consider the role of stress in addiction etiology and maintenance. There was little evidence for gender differences in the role of stress on transitions in substance use disorders, except for the onset of alcohol use disorders. Given that rates of alcohol use disorders are increasing in women; the impact of stress needs to be considered.
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Affiliation(s)
| | - Kelly E Moore
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519
| | - Brian P Pittman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519
| | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519
| | | | - Philip H Smith
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY 10031
| | - Kelly P Cosgrove
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519
| | - Sherry A McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06519
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31
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Verplaetse TL, McKee SA, Petrakis IL. Pharmacotherapy for Co-Occurring Alcohol Use Disorder and Post-Traumatic Stress Disorder: Targeting the Opioidergic, Noradrenergic, Serotonergic, and GABAergic/Glutamatergic Systems. Alcohol Res 2018; 39:193-205. [PMID: 31198658 PMCID: PMC6561397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are highly comorbid, and treatment outcomes are worse in individuals with both disorders. Several neurobiological systems have been implicated in the development and maintenance of AUD and PTSD, and pharmacologic interventions targeting these systems for singular diagnoses of AUD or PTSD have proven effective. However, there are no established treatments for co-occurring AUD and PTSD, and relatively few studies have examined potential pharmacotherapy for treating symptoms of both AUD and PTSD in comorbid populations. This review provides a brief overview of the studies to date on pharmacotherapeutic treatment interventions for comorbid AUD and PTSD and highlights future directions for promising targets that have potential in the treatment of individuals with this dual diagnosis. Clinical implications of these findings are also discussed. While current medications targeting the opioidergic, noradrenergic, serotonergic, and GABAergic/glutamatergic brain systems are only modestly efficacious in improving symptoms in individuals with comorbid AUD and PTSD, novel targets within these neurobiological systems may be clinically useful for treating alcohol use outcomes and PTSD symptom severity. More work is needed to optimize pharmacologic treatment strategies that target both alcohol-motivated behavior and PTSD-related symptoms in individuals with co-occurring AUD and PTSD.
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Verplaetse TL, Weinberger AH, Oberleitner LM, Smith KM, Pittman BP, Shi JM, Tetrault JM, Lavery ME, Picciotto MR, McKee SA. Effect of doxazosin on stress reactivity and the ability to resist smoking. J Psychopharmacol 2017; 31:830-840. [PMID: 28440105 PMCID: PMC5823502 DOI: 10.1177/0269881117699603] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Preclinical findings support a role for α1-adrenergic antagonists in reducing nicotine-motivated behaviors, but these findings have yet to be translated to humans. The current study evaluated whether doxazosin would attenuate stress-precipitated smoking in the human laboratory. Using a well-validated laboratory analogue of smoking-lapse behavior, this pilot study evaluated whether doxazosin (4 and 8 mg/day) versus placebo attenuated the effect of stress (vs neutral imagery) on tobacco craving, the ability to resist smoking and subsequent ad-libitum smoking in nicotine-deprived smokers ( n=35). Cortisol, adrenocorticotropin, norepinephrine, epinephrine, and physiologic reactivity were assessed. Doxazosin (4 and 8 mg/day vs placebo) decreased cigarettes per day during the 21-day titration period. Following titration, doxazosin (4 and 8 mg/day vs placebo) decreased tobacco craving. During the laboratory session, doxazosin (8 mg/day vs placebo) further decreased tobacco craving following stress versus neutral imagery. Doxazosin increased the latency to start smoking following stress, and reduced the number of cigarettes smoked. Dosage of 8 mg/day doxazosin increased or normalized cortisol levels following stress imagery and decreased cortisol levels following neutral imagery. These preliminary findings support a role for the noradrenergic system in stress-precipitated smoking behavior, and support further development of doxazosin as a novel pharmacotherapeutic treatment strategy for smoking cessation.
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Affiliation(s)
| | - Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Kathryn M.Z. Smith
- Division on Substance Abuse, Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY
| | - Brian P. Pittman
- Departments of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Julia M. Shi
- Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Meaghan E. Lavery
- Departments of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Marina R. Picciotto
- Departments of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Sherry A. McKee
- Departments of Psychiatry, Yale University School of Medicine, New Haven, CT
- Correspondence to: Sherry A. McKee, PhD, 2 Church St South, Suite 109, Yale University School of Medicine, New Haven, CT 06519; Tele: 203.737-3529 Fax: 203.737-4243
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Roberts W, Verplaetse TL, Moore K, Oberleitner L, Picciotto MR, McKee SA. Effects of varenicline on alcohol self-administration and craving in drinkers with depressive symptoms. J Psychopharmacol 2017; 31:906-914. [PMID: 28351203 PMCID: PMC5823265 DOI: 10.1177/0269881117699618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Varenicline (VAR) is approved to aid in smoking cessation and has been shown to be effective for reducing alcohol consumption in heavy drinkers. Little is known, however, about treatment moderators that may influence efficacy. The current study reanalyzed data from a human laboratory study (Verplaetse et al., 2016) to determine whether VAR was more effective at reducing alcohol use among drinkers reporting symptoms of depression. Participants were 60 adults meeting DSM-IV criteria for alcohol use disorders ( n = 60) who were randomly assigned to receive VAR (1 mg/day, 2 mg/day) or placebo. Following 7 days of medication pretreatment, participants attended a laboratory testing session. They provided self-reported ratings of alcohol craving and performed an ad libitum alcohol consumption task after receiving a priming dose of alcohol (target blood alcohol concentration = 0.030 g/dL). Higher blood VAR plasma levels were associated with less alcohol craving and less drinking among participants with more depressive symptoms. Among participants with fewer depressive symptoms, VAR was associated with more drinking during the ad libitum drinking task. These findings show that depression symptoms may be a moderator of VAR efficacy in alcohol users and provides evidence for the role of nAChRs in depression and alcohol use.
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Affiliation(s)
- Walter Roberts
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | | | - Kelly Moore
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | | | | | - Sherry A McKee
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
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Verplaetse TL, Smith PH, Smith KM, Oberleitner LM, McKee SA. Guanfacine alters the effect of stress and smoking on heart rate variability in regular daily smokers. Psychopharmacology (Berl) 2017; 234:805-813. [PMID: 28028603 PMCID: PMC5309140 DOI: 10.1007/s00213-016-4517-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/16/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND We had previously demonstrated that guanfacine, an α2a-adrenergic agonist, attenuated the effect of stress on smoking-lapse behavior in regular daily smokers. Heart rate variability (HRV), a measure of vagal activity, may be a potential mechanism underlying the relationship between stress, smoking, and relapse. METHODS We examined whether guanfacine (0 mg/day vs. 3 mg/day; n = 26) altered changes in high-frequency heart rate variability (HF-HRV) following stress and ad-lib smoking using a validated laboratory analogue of smoking-lapse behavior. All participants completed a parent study evaluating the effects of guanfacine on stress-precipitated smoking. Each subject completed two laboratory sessions assessing the effects of guanfacine on HF-HRV following stress imagery (vs. neutral imagery; order counterbalanced) and smoking. RESULTS Results demonstrated that guanfacine did not increase tonic levels of HF-HRV relative to placebo. Following the stress versus neutral imagery manipulation (prior to ad-lib smoking), there were no significant changes in HF-HRV in the placebo group. In contrast, guanfacine increased phasic HF-HRV following stress imagery and decreased HF-HRV following neutral imagery. Ad libitum smoking following both the stress and neutral conditions decreased HF-HRV in the placebo group across both imagery conditions. In contrast, guanfacine attenuated stress- and smoking-related decreases in phasic HF-HRV relative to the neutral imagery condition. CONCLUSIONS This is the first demonstration that a noradrenergic target altered dynamic changes in HF-HRV in response to stress and smoking, suggesting that guanfacine alters HF-HRV response to stress. Findings support current theories which suggest that phasic changes in HRV are an important marker of the stress response.
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Affiliation(s)
- Terril L. Verplaetse
- Department of Psychiatry, Yale School of Medicine, New Haven, CT,Corresponding Author: Terril L. Verplaetse, Ph.D., Department of Psychiatry, Yale University School of Medicine, 2 Church Street South, Suite 201, New Haven, CT, 06519 USA, phone: 203.737.6496, fax: 203.737.4243,
| | - Philip H. Smith
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY
| | - Kathryn M.Z. Smith
- Division on Substance Abuse, Department of Psychiatry, Columbia University Medical Center/New York State Psychiatric Institute, New York, NY
| | | | - Sherry A. McKee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
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Abstract
BACKGROUND Alcohol use disorders and tobacco use contribute significant risk to the global burden of disease, and each are major public health concerns. Together, alcohol and tobacco use are highly comorbid and have multiplicative health risks when used concurrently, underscoring the importance of examining alcohol-tobacco interactions in the human laboratory. OBJECTIVE The aims of this review were to summarize the state of research examining alcohol-tobacco interactions in the human laboratory. METHODS We reviewed human laboratory evidence for alcohol and tobacco/nicotine interactions, including 1) craving in drinkers and smokers exposed to smoking or drinking cues, 2) fixed-dosing of alcohol or nicotine in smokers and drinkers, and 3) smoking and alcohol influences on self-administration behaviors. The interactive effects of tobacco/nicotine with other drugs of abuse are also briefly discussed. RESULTS Overall, results identified that alcohol and tobacco have reciprocal influences on potentiating craving, subjective responses to fixed-dose alcohol or nicotine administration, and self-administration. The literature identified that alcohol increases craving to smoke, decreases time to initiate smoking, and increases smoking self-administration. Similarly, tobacco and nicotine increase alcohol craving, decrease subjective effects of alcohol, and increase alcohol consumption. CONCLUSION Future studies should continue to focus on alcohol and tobacco/nicotine interactions in individuals with a wide scope of drinking and smoking histories, different states of alcohol and nicotine deprivation, and influences of either drug on craving, subjective responses, and consumption over the course of the blood alcohol curve. This work could have important implications for the impact of alcohol-tobacco interactions on guiding clinical practice, as well as in the changing landscape of addiction.
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Affiliation(s)
| | - Sherry A McKee
- a Department of Psychiatry , Yale School of Medicine , New Haven , CT , USA
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Verplaetse TL, Smith PH, Pittman BP, Mazure CM, McKee SA. Associations of Gender, Smoking, and Stress with Transitions in Major Depression Diagnoses. Yale J Biol Med 2016; 89:123-9. [PMID: 27354839 PMCID: PMC4918874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Using data from the newly available U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; Wave 3; n = 36,309), we evaluated relationships among gender, cigarette smoking status (current, former, non-smoker), life event stress (0-1 vs. 2+ events), and their impact on transitions in major depression diagnosis (MDD; new vs. absent cases; ongoing vs. remit cases). Women who were both current and former cigarette smokers with more than two stressful events had higher rates of new MDD diagnosis compared to men who were current or former smokers with two or more stressful events. Current smoking and experiencing two or more stressful events increased the odds of having an ongoing MDD diagnosis, while being a former smoker decreased these odds. Results suggest that smoking and stress are markers for depression risk in women and should help guide clinical assessment as well as gender-difference research on the biological underpinnings of these conditions.
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Affiliation(s)
- Terril L. Verplaetse
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine,To whom all correspondence should be addressed: Terril L. Verplaetse, PhD, 2 Church Street South, Suite 201, Yale University School of Medicine, New Haven, CT 06519; Fax: 203.737.4243
| | - Philip H. Smith
- Department of Community Health and Social Medicine, CUNY School of Medicine
| | - Brian P. Pittman
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
| | - Carolyn M. Mazure
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
| | - Sherry A. McKee
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine
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Verplaetse TL, Pittman BP, Shi JM, Tetrault JM, Coppola S, McKee SA. Effect of Varenicline Combined with High-Dose Alcohol on Craving, Subjective Intoxication, Perceptual Motor Response, and Executive Cognitive Function in Adults with Alcohol Use Disorders: Preliminary Findings. Alcohol Clin Exp Res 2016; 40:1567-76. [PMID: 27246567 DOI: 10.1111/acer.13110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Varenicline has been found to decrease alcohol-motivated behaviors. Recent warnings regarding aversive events associated with varenicline used in conjunction with alcohol warrant further investigation into the safety of the drug when combined with alcohol. The purpose of this preliminary investigation was to examine the effect of combining varenicline with a high, fixed dose of alcohol on subjective reactivity and cognitive function in adults with alcohol use disorders (AUDs). METHODS This double-blind, placebo-controlled preliminary investigation examined the effects of varenicline (0, 1, 2 mg/d) on subjective reactivity, cognition, perceptual motor function, and physiologic reactivity to a fixed dose of alcohol (vs. nonalcohol control beverage) using an established laboratory paradigm in smokers and nonsmokers meeting criteria for AUDs (n = 44). All participants had completed a parent varenicline study evaluating alcohol self-administration. Each subject completed 2 fixed-dose laboratory sessions assessing reactivity to a high-dose alcohol (0.08 g/dl) or a nonalcoholic control beverage, order counterbalanced. RESULTS Varenicline attenuated alcohol-related increases in subjective intoxication and alcohol-related decreases in executive cognitive function. At baseline, varenicline reduced alcohol craving and diastolic blood pressure, and increased associative learning, working memory, and perceptual motor function. Varenicline produced nonspecific effects on diastolic blood pressure and heart rate. Overall, there were few differences in effects between 1 and 2 mg/d varenicline versus placebo. CONCLUSIONS These preliminary results continue to support the safety and use of varenicline in combination with alcohol in individuals meeting criteria for AUDs.
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Affiliation(s)
- Terril L Verplaetse
- Department of Psychiatry , Yale University School of Medicine, New Haven, Connecticut
| | - Brian P Pittman
- Department of Psychiatry , Yale University School of Medicine, New Haven, Connecticut
| | - Julia M Shi
- Department of Internal Medicine , Yale University School of Medicine, New Haven, Connecticut
| | - Jeanette M Tetrault
- Department of Internal Medicine , Yale University School of Medicine, New Haven, Connecticut
| | - Sabrina Coppola
- Department of Psychiatry , Yale University School of Medicine, New Haven, Connecticut
| | - Sherry A McKee
- Department of Psychiatry , Yale University School of Medicine, New Haven, Connecticut
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Verplaetse TL, Czachowski CL. Low-dose prazosin alone and in combination with propranolol or naltrexone: effects on ethanol and sucrose seeking and self-administration in the P rat. Psychopharmacology (Berl) 2015; 232:2647-57. [PMID: 25743758 PMCID: PMC4504773 DOI: 10.1007/s00213-015-3896-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/19/2015] [Indexed: 12/29/2022]
Abstract
RATIONALE Evidence suggests that the noradrenergic system mediates ethanol reinforcement. However, preclinical studies suggest that noradrenergic antagonists block other oral reinforcers indicating possible unwanted secondary medication effects. METHODS This study examined combinations of low-dose prazosin with propranolol or naltrexone using a behavioral paradigm that separately assesses reinforcer seeking and self-administration. Male alcohol-preferring (P) rats (n = 20/experiment) were trained to complete a response requirement (RR) resulting in access to 1 % sucrose (n = 10) or 10 % ethanol (n = 10) for 20 min. Rats received vehicle, prazosin alone (0.125, 0.25, 0.5, and 1.0 mg/kg, intraperitoneally (IP)), or prazosin in combination with propranolol (5 mg/kg (IP); Exp. 1) or in combination with naltrexone (0.03 mg/kg, subcutaneously (SC); Exp. 2). RESULTS For Exp. 1, prazosin alone effectively decreased sucrose seeking more than ethanol seeking, but decreased ethanol self-administration only. Propranolol alone effectively decreased ethanol seeking more than sucrose seeking and decreased ethanol intake only. At some dose combinations, there was a greater attenuation of ethanol and sucrose intake relative to either drug alone. For Exp. 2, prazosin alone and naltrexone alone were effective in decreasing ethanol seeking and intake only. Combination treatment was more effective than either drug alone at decreasing ethanol seeking and consumption and sucrose intake, but not sucrose seeking. CONCLUSIONS Propranolol and naltrexone alone were specific to ethanol indicating that low doses of either medication may be beneficial in treating alcohol use disorders. Prazosin in combination with propranolol or naltrexone was more effective than either drug alone and also reduced sucrose-reinforced behaviors. These data suggest that the noradrenergic system is a viable target for developing treatment approaches for problem drinkers.
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Affiliation(s)
- Terril L Verplaetse
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA,
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Verplaetse TL, Weinberger AH, Smith PH, Cosgrove KP, Mineur YS, Picciotto MR, Mazure CM, McKee SA. Targeting the noradrenergic system for gender-sensitive medication development for tobacco dependence. Nicotine Tob Res 2015; 17:486-95. [PMID: 25762760 DOI: 10.1093/ntr/ntu280] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Tobacco use remains the leading cause of morbidity and mortality for both women and men in the United States, and women often experience poorer smoking cessation outcomes than men. Preliminary evidence suggests there are sex differences in medication effectiveness for smoking cessation. However, current medications do not take into account gender-sensitive treatment development and efficacy, underscoring the importance of this underdeveloped area of research. METHODS We reviewed preclinical and clinical evidence for gender differences in the inability to quit smoking by examining (a) the effect of increased negative affect and stress reactivity on smoking outcomes in women and (b) smoking for nicotine reinforcement in men. We also reviewed the current literature targeting the noradrenergic system as a novel gender-sensitive treatment strategy for tobacco dependence. RESULTS We hypothesize that noradrenergic agents that normalize noradrenergic activity may differentially attenuate stress reactivity in women and nicotine-related reinforcement in men, indicating that targeting the noradrenergic system for smoking cessation may be effective for both genders, with benefits operating through sex-specific mechanisms. CONCLUSIONS Converging lines of preclinical and clinical evidence suggest that gender-sensitive approaches to medication development for smoking cessation are a critical next step for addressing low quit rates and exacerbated health risks among women. Evidence reviewed indicates that smoking activates different brain systems modulated by noradrenergic activity in women versus men, and noradrenergic compounds may preferentially target these gender-sensitive systems.
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Affiliation(s)
- Terril L Verplaetse
- Department of Psychiatry and Women's Health Research, Yale University School of Medicine, New Haven, CT
| | | | - Philip H Smith
- Department of Psychiatry and Women's Health Research, Yale University School of Medicine, New Haven, CT
| | - Kelly P Cosgrove
- Department of Psychiatry and Women's Health Research, Yale University School of Medicine, New Haven, CT; Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT
| | - Yann S Mineur
- Department of Psychiatry and Women's Health Research, Yale University School of Medicine, New Haven, CT
| | - Marina R Picciotto
- Department of Psychiatry and Women's Health Research, Yale University School of Medicine, New Haven, CT
| | - Carolyn M Mazure
- Department of Psychiatry and Women's Health Research, Yale University School of Medicine, New Haven, CT
| | - Sherry A McKee
- Department of Psychiatry and Women's Health Research, Yale University School of Medicine, New Haven, CT;
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Verplaetse TL, Rasmussen DD, Froehlich JC, Czachowski CL. Effects of prazosin, an α1-adrenergic receptor antagonist, on the seeking and intake of alcohol and sucrose in alcohol-preferring (P) rats. Alcohol Clin Exp Res 2011; 36:881-6. [PMID: 21981346 DOI: 10.1111/j.1530-0277.2011.01653.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies show that prazosin, an α(1) -adrenergic receptor antagonist, decreases alcohol drinking in animal models of alcohol use and dependence [Rasmussen et al. (2009) Alcohol Clin Exp Res 3:264-272; Walker et al. (2008) Alcohol 42:91-97] and in alcohol-dependent men [Simpson et al. (2009) Alcohol Clin Exp Res 33:255-263]. This study extended these findings by using a paradigm that allows for separate assessment of prazosin on motivation to seek versus consume alcohol or sucrose in selectively bred rats. METHODS Alcohol-preferring (P) rats were trained to complete an operant response that resulted in access to either 2% sucrose or 10% alcohol. A 4-week Seeking Test Phase examined responding in single, weekly extinction sessions when no reinforcer could be obtained. A 4-week Drinking Test Phase consisted of rats lever-pressing to "pay" a specified amount up front to gain access to unlimited alcohol (or sucrose) for a 20-minute period. On Seeking and Drinking test days, prazosin (0.0, 0.5, 1.0, and 1.5 mg/kg) was administered intraperitoneally 30 minutes prior to behavioral sessions. RESULTS Rats were self-administering an average of 0.9 (±0.09) g/kg alcohol on vehicle test day and had pharmacologically relevant blood ethanol concentrations. Prazosin significantly decreased alcohol seeking at all doses tested. The highest dose of prazosin also increased the latency to first response for alcohol and decreased alcohol intake. While sucrose-seeking and intake were similarly affected by prazosin, the high dose of prazosin did not increase response latency. CONCLUSIONS These findings are consistent with and extend previous research and suggest that prazosin decreases motivation to initiate and engage in alcohol consumption. The specificity of prazosin in attenuating the initiation of alcohol- but not sucrose-seeking suggests that this effect is not because of prazosin-induced motor-impairment or malaise. Together with previous findings, these data suggest that prazosin may be an effective pharmacotherapy, with specific application in people that drink excessively or have a genetic predisposition to alcohol abuse.
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