[Treatment of Opioid-dependent Inmates - Attitudes and Treatment Practice of medical Staff in Bavarian Prisons]

BACKGROUND

The present study examines the treatment practice and attitudes of medical staff towards opioid-dependent inmates in Bavarian prisons.

METHOD

We interviewed medical staff (n=20) from 18 Bavarian prisons about substitution practice and attitudes by semi-structured interviews.

RESULTS

With regard to the treatment routines and the attitudes of the medical staff, we found mixed results. From the perspective of the medical staff, the treatment decision depends on the patients' wishes, the severity and duration of the dependence, the length of sentence and organizational factors. Problems were discussed in particular with regard to the care situation inside and outside the prisons and difficulties in transition management.

CONCLUSIONS

Substitution therapy is considered a standard treatment method in prisons today. However, our respondents highlighted some disadvantages (e. g. passing on the substitution drug). Although the treatment goal of complete abstinence was generally viewed positively by a part of the medical staff, it was not considered very realistic. From the point of view of the respondents, special attention should be paid to the continuity of the chosen treatment strategy in the context of discharge management.

[First Aid Training for Drug Overdose in Opioid Addicts and Provision of Take-Home Naloxone on Release from Prison: Feasibility Study from the Bavarian Model Project]

INTRODUCTION

Between 22 and 30% of prisoners in Germany are reported to be intravenous drug users. There is a 12-fold increase in mortality, mostly as a result of opioid overdose in the first weeks after release from prison. We evaluated the feasibility of first aid training for drug overdose, including take-home naloxone in incarcerated opioid addicts.

METHODOLOGY

Within the Bavarian Take-Home Naloxone Model Project (BayTHN), a subsample of imprisoned opioid addicts was recruited in 5 Bavarian correctional facilities. Manualized first aid training for drug overdose, including take-home naloxone was provided. All surveys were conducted with standardized questionnaires or semi-structured interviews.

RESULTS

Sixty-two long-term opioid addicts were included (age: 36 years (22-53 years); 53.2% women; age at first opioid use: 19.2 years (10-31 years). On average, 3.9 (1-10) opioid addicts participated per training session. At the time of training, the opioid addicts had been in prison on average for 42 (1-228) weeks and expected their release from prison in about 10 (1-64) weeks. 68% of participants reported having experienced a drug overdose by themselves. 84% had already experienced at least one drug emergency with another person, 36% more than once. Nearly one-third had not offered helped in the last emergency they had experienced, mostly out of fear of doing something wrong. Only 50% of participants had called emergency services. 25% tried to help, however, by not very effective means. 75% often consumed in the presence of other persons, such as partners and/or friends. The incarcerated opioid addicts were well motivated to participate and showed a significant increase in knowledge and skills for effective first aid in an opioid overdose situation.

CONCLUSION

The feasibility study carried out among imprisoned opioid addicts shows that manualized first aid training in handling opioid overdose, including take-home naloxone can be successfully implemented. A best-practice model for reducing initial caveats, organization, and prescribing take-home naloxone at release from prison was established. The high rate of drug overdoses and drug use in the presence of others (potential first responders) proves that the target group for successful use of first aid training along with take-home naloxone could be reached. However, a broad roll-out is needed to achieve a relevant reduction in mortality in opioid addicts after release from prison.

German Guidelines on Screening, Diagnosis, and Treatment of Alcohol Use Disorders: Update 2021

INTRODUCTION

Alcohol consumption in Germany is associated with considerable health and economic consequences. In addition to prevention, the early detection and differential treatment of those affected play an important role. The guideline "Screening, Diagnosis, and Treatment of Alcohol Use Disorders" forms the basis of this care for people suffering from alcohol use disorders. Regular updates integrate the current state of research evidence and clinical expertise.

METHODS

Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology and the German Society for Addiction Research and Addiction Therapy e.V. (DG-Sucht), the 2019-2020 S3 guideline on alcohol was revised by eight working groups. Thirty-five professional societies participated in a structured consensus process to deliberate the recommendations. Potential conflicts of interest were examined in advance, documented, and taken into account during the voting on the recommendations.

RESULTS

The guideline provides recommendations on screening and brief interventions for different groups of people, as well as on treatment of individuals in the acute and post-acute phases of withdrawal. Special emphasis was placed on the treatment of comorbid somatic and psychological disorders. In addition, recommendations for specific groups of people (e.g., children and adolescents, pregnant women) have been made and adapted to the German care landscape.

Beratung Angehöriger pathologischer Glücksspieler/-innen: Status quo und Unterstützungsbedarf

Ziel Angehörige von Menschen mit Glücksspielproblemen sind mit gesundheitlichen, sozialen und emotionalen Belastungen konfrontiert. Bis dato existiert jedoch kein etabliertes Konzept zur Unterstützung für diese Zielgruppe. Deshalb sollen in dieser Studie zum einen relevante Rahmenbedingungen und inhaltliche Aspekte der Arbeit mit Angehörigen von Menschen mit Glücksspielproblemen geklärt und zum anderen die Grundlage für die Entwicklung einer Kurzintervention geschaffen werden.

Methodik Onlinegestützte deutschlandweite Befragung von Suchthilfe-Mitarbeitenden (n=102) sowie Gruppendiskussion mit Angehörigen (n=4) im Herbst 2019.

Ergebnisse Die befragten Mitarbeitenden in der Suchthilfe nannten als die wichtigsten Themen für die Beratung von Angehörigen von Menschen mit Glücksspielproblemen das Verhalten Angehöriger gegenüber Betroffenen, Geldmanagement, den Umgang mit Emotionen, Beziehungsberatung und Psychoedukation. Die meisten Befragten gaben an, die Angehörigen im Einzelsetting (68%) in durchschnittlich 3 Sitzungen (Median 2,5; Min=1; Max=15) zu beraten. Der Abstand zwischen den Sitzungen beträgt durchschnittlich 3 Wochen (Median 2 Wochen). Für die zu entwickelnde Kurzintervention wurden Verantwortungsrückgabe und Selbstfürsorge (69%), Problem-/Belastungsexploration (42%) und Tipps zur finanziellen Existenzsicherung (28%) als die drei wichtigsten Themen ausgewählt. Sowohl als Erfolgsfaktor für eine gelingende Angehörigenberatung als auch für die Adhärenz der Angehörigen wurde eine positive bzw. wertschätzende Beziehungsgestaltung am häufigsten genannt. Die Ergebnisse aus der Gruppendiskussion mit Angehörigen deuten in eine ähnliche Richtung: Die Themen Verhalten als Angehörige gegenüber Betroffenen, Abgrenzung/Verantwortlichkeiten und konkrete Verhaltenstipps wurden als wichtig erachtet; jedoch ging es den Angehörigen eher darum, sich „richtig“ zu verhalten, während der Fokus der Suchthilfe auf der Abgrenzung und Selbstfürsorge lag.

Schlussfolgerungen Die Studie liefert wichtige Hinweise auf relevante Themen und Inhalte für die Beratung Angehöriger von Menschen mit Glücksspielproblemen. Auf Basis dieser Ergebnisse soll im nächsten Schritt eine Kurzintervention entwickelt werden. Hinsichtlich der Beratungsmethoden herrscht jedoch weiterer Forschungsbedarf. Zum anderen sollte untersucht werden, wie der Zugang der Angehörigen zum Hilfesystem und dessen Bekanntheit optimiert sowie bestehende Barrieren vermindert werden können.

S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“

Zusammenfassung. Zielsetzung: Alkoholkonsum ist in Deutschland mit erheblichen gesundheitlichen und wirtschaftlichen Folgen assoziiert. Neben der Prävention spielen die Früherkennung und differentielle Behandlung von Betroffenen eine bedeutende Rolle. Die Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“ bildet die Grundlage für die Versorgung betroffener Personen. Die regelmäßigen Updates implementieren evidenzbasiert den aktuellen Forschungsstand von Literatur und klinischer Expertise. Methodik: Unter Federführung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und der Deutschen Gesellschaft für Suchtforschung und Suchttherapie e. V. (DG-Sucht) wurde die S3-Leitlinie Alkohol von 2019–2020 in acht Arbeitsgruppen überarbeitet. Am strukturierten Konsensprozess zur Beratung der Empfehlungen beteiligten sich 35 Fachgesellschaften. Potentielle Interessenskonflikte wurden im Vorfeld erfragt, dokumentiert und in der Abstimmung der Empfehlungen berücksichtigt.: Die Leitlinie gibt Empfehlungen zu Screening und Kurzintervention für verschiedene Personengruppen, sowie zur Behandlung von Betroffenen in der akuten und postakuten Phase des Entzugs. Besondere Bedeutung kommt der Behandlung von komorbiden somatischen und psychischen Störungen zu. Außerdem wurden Empfehlungen für bestimmte Personengruppen (z. B. Kinder und Jugendliche, Schwangere) ausgesprochen und auf die deutsche Versorgungslandschaft adapiert.

[Weighing the benefits and harms of psychotropic and analgesic substances - A perspective of German addiction medicine experts]

BACKGROUND

In Europe, there have been several addiction-expert rankings of harms related to the use of psychotropic substances in the last 15 years. Among them, only one expert ranking took into account the potential benefits of these drugs. Non-Opioidergic Analgesics (NOAs), such as gabapentinoids and NSAIDs, which have been increasingly the subject of abuse / misuse reports, have not been considered in such expert rankings. Likewise, there is currently no multi-substance comparison as to whether the valuation rank of the harmfulness of an illegal drug may change along with an imagined change in legal status in Germany.

OBJECTIVES AND METHODS

Using a questionnaire, 101 experienced addiction physicians (first cohort) evaluated 33 psychoactive substances including analgesics with regard to their health and social harms as well as potential usefulness for the consumer and their environment / society ('others'). In addition, this cohort investigated whether the harmfulness assessment of an illegal substance changes if it would be legalized. In order to obtain the average overall harmfulness (overall risk) of a substance, the percentage contribution of each dimension to the overall harmfulness was determined in a second survey (second cohort, 36 experienced addiction medicine experts). Finally, the average benefit and overall risk ratings of each substance were related to each other.

RESULTS

Prescription psychoactive substances such as analgesics, NOAs (including gabapentinoids) and opioidergic maintenance medications to treat opiate dependence were judged to have a favorable benefit-harm profile. Cannabis and ketamine were placed in the midfield of both, the harm and benefit rankings. Together with most illicit narcotic drugs, alcohol and nicotine, have been ranked among the most harmful and least useful substances, whereby alcohol was judged on average to be more harmful but also more useful than nicotine. In the event of potential legalization, the overall harm of the traditional illegal drugs methamphetamine, heroin, cocaine and cannabis was estimated to be reduced. This was mainly due to a more favorable valuation of the harm to others under these virtual conditions.

CONCLUSION

Prescription substances including opioidergic and non-opioidergic analgesics as well as opioid maintenance therapy medications (methadone and buprenorphine) were assigned a favorable benefit-harm profile. Alcohol, nicotine and traditional illicit drugs (with the exception of cannabis and ketamine) were determined to have an unfavorable profile. The overall harm of traditional illicit drugs was assessed to decrease along with legalization, mainly by decreasing the harm to others in this virtual event.

[Scientific Rationale for the Directive on Opioid Substitution Treatment of the German Medical Association: A Summary]

BACKGROUND

According to the Narcotic Drugs Prescription Ordinance (BtMVV), the German Medical Association was commissioned to issue a directive on opioid substitution treatment (OST) based on the current state of scientific medical knowledge.

METHOD

For the publication of the initial version of the German Medical Association's directive in 2002, an extensive literature research had been conducted, categorizing the results by levels of evidence. Subsequent revisions in 2010 and 2017 included recent systematic reviews, studies of evidence levels I-III and international guidelines.

RESULTS

OST showed its potential in the pursuit of health- and addiction-related as well as psychological and social goals. There was a decline in the rate of mortality, and high risk consumption of illegally acquired opioids was eliminated in 70 to 80% of patients in OST. Psycho-social assistance was found to enhance treatment outcome. Scientific evidence was lacking for the identification of patient groups suitable for different duration of take-home prescription.

CONCLUSIONS

With its 2017 amendment, the guideline of the German Medical Association was revised on the basis of the current state of science on substitution treatment. This creates more legal certainty for doctors, and treatment can be delivered in accordance with the existing scientific knowledge. Whether the effects of OST observed in this study have an impact on the care of opioid addicts by attracting more doctors to participate in their treatment needs further evaluation.

Prävalenz und Relevanz der Medikamentenabhängigkeit

Dr. Gallus Bischof und PD Dr. Friedrich Wurst im Gespräch mit Prof. Dr. Norbert Wodarz, Chefarzt des Zentrums für Suchtmedizin, sowie stellvertretender Ärztlicher Direktor der Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum medbo.

Sensation seeking, alcoholism and dopamine activity

Sensation seeking scale (SSS) scores were determined in 15 alcohol dependent men with a positive family history for alcoholism (FHP), in 15 alcohol dependent men with a negative family history for alcoholism (FHN) and in 15 well-matched healthy male controls (CONTR). Both FHPs and FHNs suffered from longlasting alcohol dependence meeting ICD-10 and DSM-III-R diagnostic criteria. Dopamine activity was neuroendocrinologically assessed by measuring the amount of growth hormone released after stimulation with the dopamine receptor agonist apomorphine. Planned comparisons within a one-way ANOVA yielded significantly elevated levels of boredom susceptibility (BOS) in both FHPs and FHNs against CONTRs. SSS total scores, while approaching statistical significance, were elevated in FHPs only. Partial correlations (controlling for age, body weight, alcohol intake and duration of dependence) were calculated to examine the relationship between SSS and dopamine activity. Among the SSS subtraits, BOS revealed the highest correlation in each group. However, only in CONTRs did the relationship between BOS and dopamine activity reach statistical significance.

Ranking the Harm of Psychoactive Drugs Including Prescription Analgesics to Users and Others-A Perspective of German Addiction Medicine Experts

Background: Over the past 15 years, comparative assessments of psychoactive substance harms to both users and others have been compiled by addiction experts. None of these rankings however have included synthetic cannabinoids or non-opioid prescription analgesics (NOAs, e.g., gabapentinoids) despite evidence of increasing recreational use. We present here an updated assessment by German addiction medicine experts, considering changing Western consumption trends-including those of NOAs. Methods: In an initial survey, 101 German addiction medicine physicians evaluated both physical and psychosocial harms (in 5 dimensions) of 33 psychoactive substances including opioids and NOAs, to both users and others. In a second survey, 36 addiction medicine physicians estimated the relative weight of each health and social harm dimension to determine the overall harm rank of an individual substance. We compared our ranking with the most recent European assessment from 2014. Results: Illicit drugs such as methamphetamine, heroin, cocaine and also alcohol were judged particularly harmful, and new psychoactive drugs (cathinones, synthetic cannabinoids) were ranked among the most harmful substances. Cannabis was ranked in the midrange, on par with benzodiazepines and ketamine-somewhat more favorable compared to the last European survey. Prescribed drugs including opioids (in contrast to the USA, Canada, and Australia) were judged less harmful. NOAs were at the bottom end of the ranking. Conclusion: In Germany, alcohol and illicit drugs (including new psychoactive substances) continue to rank among the most harmful addictive substances in contrast to prescribed agents including opioid analgesics and NOAs. Current laws are incongruent with these harm rankings. This study is the first of its kind to include comparative harm rankings of several novel abused substances, both licit/prescribed and illicit.

Heterozygous carriage of the alpha1-antitrypsin Pi*Z variant increases the risk to develop liver cirrhosis

OBJECTIVE

Homozygous alpha1-antitrypsin (AAT) deficiency increases the risk for developing cirrhosis, whereas the relevance of heterozygous carriage remains unclear. Hence, we evaluated the impact of the two most relevant AAT variants ('Pi*Z' and 'Pi*S'), present in up to 10% of Caucasians, on subjects with non-alcoholic fatty liver disease (NAFLD) or alcohol misuse.

DESIGN

We analysed multicentric case-control cohorts consisting of 1184 people with biopsy-proven NAFLD and of 2462 people with chronic alcohol misuse, both cohorts comprising cases with cirrhosis and controls without cirrhosis. Genotyping for the Pi*Z and Pi*S variants was performed.

RESULTS

The Pi*Z variant presented in 13.8% of patients with cirrhotic NAFLD but only in 2.4% of counterparts without liver fibrosis (p<0.0001). Accordingly, the Pi*Z variant increased the risk of NAFLD subjects to develop cirrhosis (adjusted OR=7.3 (95% CI 2.2 to 24.8)). Likewise, the Pi*Z variant presented in 6.2% of alcohol misusers with cirrhosis but only in 2.2% of alcohol misusers without significant liver injury (p<0.0001). Correspondingly, alcohol misusers carrying the Pi*Z variant were prone to develop cirrhosis (adjusted OR=5.8 (95% CI 2.9 to 11.7)). In contrast, the Pi*S variant was not associated with NAFLD-related cirrhosis and only borderline with alcohol-related cirrhosis (adjusted OR=1.47 (95% CI 0.99 to 2.19)).

CONCLUSION

The Pi*Z variant is the hitherto strongest single nucleotide polymorphism-based risk factor for cirrhosis in NAFLD and alcohol misuse, whereas the Pi*S variant confers only a weak risk in alcohol misusers. As 2%-4% of Caucasians are Pi*Z carriers, this finding should be considered in genetic counselling of affected individuals.

Methamphetamine-Related Disorders

BACKGROUND

Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad.

METHODS

A systematic literature search was performed on the treatment of methamphetamine-related disorders. Based on this literature review, a multidisciplinary expert panel developed recommendations using the nominal group technique.

RESULTS

The evidence base for the treatment of methamphetamine-related disorders is sparse. The efficacy of psychotherapeutic techniques such as cognitive behavioral therapy and contingency management and the efficacy of complex, disorder-specific treatment programs have been proven in ran - domized controlled trials, but it remains unclear which method is best. Persons carrying a diagnosis of substance abuse should be offered psychotherapy. Structured exercise programs, whether self-directed or professionally led, can improve addiction-specific endpoints as well as comorbid disorders and should, therefore, be offered as well. Pharmacotherapy has shown little to no effect in relatively low-quality clinical trials with low case numbers and high dropout rates, and therefore only a few weak recommendations were made. These include tranquilizers for the short-term treatment of agitation and atypical antipsychotics if necessary. Attempts to substitute other substances, such as methylphenidate or dexamphetamine, for methamphetamine have not yielded any robust evidence to date. Sertraline should not be administered due to serious adverse events.

CONCLUSION

Many of the recommendations in the guideline are made with a weak grade of recommendation because of the poor evidence base and the modest size of the reported therapeutic effects. In acute situations, symptomoriented treatment is recommended. Psychotherapy and exercise should be offered as well.

Transancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders

Liability to alcohol dependence (AD) is heritable, but little is known about its complex polygenic architecture or its genetic relationship with other disorders. To discover loci associated with AD and characterize the relationship between AD and other psychiatric and behavioral outcomes, we carried out the largest genome-wide association study to date of DSM-IV-diagnosed AD. Genome-wide data on 14,904 individuals with AD and 37,944 controls from 28 case-control and family-based studies were meta-analyzed, stratified by genetic ancestry (European, n = 46,568; African, n = 6,280). Independent, genome-wide significant effects of different ADH1B variants were identified in European (rs1229984; P = 9.8 × 10-13) and African ancestries (rs2066702; P = 2.2 × 10-9). Significant genetic correlations were observed with 17 phenotypes, including schizophrenia, attention deficit-hyperactivity disorder, depression, and use of cigarettes and cannabis. The genetic underpinnings of AD only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and nonpathological drinking behaviors.

Genome-wide association study identifies inversion in the CTRB1-CTRB2 locus to modify risk for alcoholic and non-alcoholic chronic pancreatitis

OBJECTIVE

Alcohol-related pancreatitis is associated with a disproportionately large number of hospitalisations among GI disorders. Despite its clinical importance, genetic susceptibility to alcoholic chronic pancreatitis (CP) is poorly characterised. To identify risk genes for alcoholic CP and to evaluate their relevance in non-alcoholic CP, we performed a genome-wide association study and functional characterisation of a new pancreatitis locus.

DESIGN

1959 European alcoholic CP patients and population-based controls from the KORA, LIFE and INCIPE studies (n=4708) as well as chronic alcoholics from the GESGA consortium (n=1332) were screened with Illumina technology. For replication, three European cohorts comprising 1650 patients with non-alcoholic CP and 6695 controls originating from the same countries were used.

RESULTS

We replicated previously reported risk loci CLDN2-MORC4, CTRC, PRSS1-PRSS2 and SPINK1 in alcoholic CP patients. We identified CTRB1-CTRB2 (chymotrypsin B1 and B2) as a new risk locus with lead single-nucleotide polymorphism (SNP) rs8055167 (OR 1.35, 95% CI 1.23 to 1.6). We found that a 16.6 kb inversion in the CTRB1-CTRB2 locus was in linkage disequilibrium with the CP-associated SNPs and was best tagged by rs8048956. The association was replicated in three independent European non-alcoholic CP cohorts of 1650 patients and 6695 controls (OR 1.62, 95% CI 1.42 to 1.86). The inversion changes the expression ratio of the CTRB1 and CTRB2 isoforms and thereby affects protective trypsinogen degradation and ultimately pancreatitis risk.

CONCLUSION

An inversion in the CTRB1-CTRB2 locus modifies risk for alcoholic and non-alcoholic CP indicating that common pathomechanisms are involved in these inflammatory disorders.

Hilfe aus dem Netz für Angehörige von Menschen mit gestörtem Glücksspielverhalten – Nutzung und Ergebnisse des E-Mental-Health-Programms EfA

Ziel Angehörige von Personen mit einer Störung durch Glücksspielen sind häufig durch Stress belastet; viele benötigen Unterstützung. Daher wurde mit „Verspiel nicht mein Leben“ – Entlastung für Angehörige (EfA) ein webbasiertes Angebot entwickelt. Berichtet werden Teilnehmenden-Charakteristika, ihre Lebenssituation, belastende Themen, Hilfesuchverhalten, Selbstwirksamkeitserwartung und Beanspruchung.

Methodik Onlinegestützte Befragung der Teilnehmenden von Juni 2013 bis Juni 2016, u. a. KPD-38 und SQFM-AA.

Ergebnisse Primär nahmen Frauen teil (89,1%). Die meisten Teilnehmenden waren Partner/innen (68,2%). Das Belastungserleben war erhöht, dennoch hatten 2 Drittel bislang keine Hilfen genutzt. Durch die Teilnahme an EfA konnte das Selbstwirksamkeitserleben verbessert und die allgemeine Lebenszufriedenheit gesteigert werden.

Schlussfolgerungen EfA ist ein niedrigschwelliges Angebot, dass Angehörigen den Einstieg in professionelle Hilfen ermöglicht und ihnen erste Hilfen gibt.

Recovery from alcohol dependence: Do smoking indicators predict abstinence?

BACKGROUND AND OBJECTIVES

There is inconsistent evidence about the potential influence of smoking on recovery from alcohol dependence. Our study aimed at assessing the impact of smoking-behavior on relapse during a 12 months follow-up period following a detoxification in patients with Alcohol Use Disorder (AUD).

METHODS

Three hundred Patients with AUD (74.9% smoking) were recruited from two inpatient detoxification units in psychiatric hospitals in Germany and their alcohol consumption was prospectively followed for 1 year. Data on different indicators of smoking behavior was gathered. Cox regression model was used to evaluate potential risk factors on time to relapse of alcohol consumption. Two hundred seventy-nine participants (n = 279) were included in the final analysis.

RESULTS

Smoking increased the risk for alcohol relapse (hazard ratio = 3.962, 95% CI 1.582-9.921). However, this increased risk is slightly reduced with higher numbers of daily consumed cigarettes (hazard ratio per cigarette = .986, 95% CI .976-.995).

CONCLUSION

Smoking reduced the probability of maintaining alcohol abstinence significantly, whereas higher number of cigarettes smoked daily diminished the increased risk of alcohol relapse in alcohol-dependent patients.

SCIENTIFIC SIGNIFICANCE

Coordinated psychiatric and substance abuse interventions for different subgroups of patients with AUD in the post-acute treatment phase are necessary. Individualized treatment planning is especially important in smoking patients with AUD who are vulnerable for a relapse to alcohol drinking and for somatic complications. Our findings might support individualized treatment plans. (Am J Addict 2017;26:366-373).

Genomewide Association Study of Alcohol Dependence Identifies Risk Loci Altering Ethanol-Response Behaviors in Model Organisms

BACKGROUND

Alcohol dependence (AD) shows evidence for genetic liability, but genes influencing risk remain largely unidentified.

METHODS

We conducted a genomewide association study in 706 related AD cases and 1,748 unscreened population controls from Ireland. We sought replication in 15,496 samples of European descent. We used model organisms (MOs) to assess the role of orthologous genes in ethanol (EtOH)-response behaviors. We tested 1 primate-specific gene for expression differences in case/control postmortem brain tissue.

RESULTS

We detected significant association in COL6A3 and suggestive association in 2 previously implicated loci, KLF12 and RYR3. None of these signals are significant in replication. A suggestive signal in the long noncoding RNA LOC339975 is significant in case:control meta-analysis, but not in a population sample. Knockdown of a COL6A3 ortholog in Caenorhabditis elegans reduced EtOH sensitivity. Col6a3 expression correlated with handling-induced convulsions in mice. Loss of function of the KLF12 ortholog in C. elegans impaired development of acute functional tolerance (AFT). Klf12 expression correlated with locomotor activation following EtOH injection in mice. Loss of function of the RYR3 ortholog reduced EtOH sensitivity in C. elegans and rapid tolerance in Drosophila. The ryanodine receptor antagonist dantrolene reduced motivation to self-administer EtOH in rats. Expression of LOC339975 does not differ between cases and controls but is reduced in carriers of the associated rs11726136 allele in nucleus accumbens (NAc).

CONCLUSIONS

We detect association between AD and COL6A3, KLF12, RYR3, and LOC339975. Despite nonreplication of COL6A3, KLF12, and RYR3 signals, orthologs of these genes influence behavioral response to EtOH in MOs, suggesting potential involvement in human EtOH response and AD liability. The associated LOC339975 allele may influence gene expression in human NAc. Although the functions of long noncoding RNAs are poorly understood, there is mounting evidence implicating these genes in multiple brain functions and disorders.

Evidence-Based Guidelines for the Pharmacological Management of Acute Methamphetamine-Related Disorders and Toxicity

Consumption of methamphetamine (“crystal”) has spread dramatically over several European countries. The management of methamphetamine-induced acute disorders has become a growing challenge to the health system. Pharmacological treatment strategies for methamphetamine-induced intoxication syndromes, acute withdrawal symptoms, and methamphetamine-induced psychosis are particularly important.

The development of interdisciplinary and evidence- and consensus-based (S3) German Guidelines was based on a systematic literature and guideline search on therapeutic interventions in methamphetamine-related disorders (April, June 2015). Consideration was given to 9 guidelines and 103 publications. Recommendations on pharmacological treatment strategies were drawn up using the nominal group technique.

Overall, only limited evidence is available. Benzodiazepines are first-line medication for methamphetamine-induced intoxication syndromes, particularly when they present with acute agitation and aggressive behavior. There is no evidence-based medication for the treatment of methamphetamine-related withdrawal symptoms and cravings. When treating methamphetamine-induced psychosis, second-generation antipsychotics should be favored, given their more favorable side-effect profile. The indication for continuation of antipsychotic medication must be reviewed regularly. In most cases, the antipsychotic should be tapered off within 6 months.

[Psychometric Evaluation of the German Version of the Short Questionnaire for Family Members-Affected by Addiction SQFM-AA (Gambling)]

INTRODUCTION

Affected others of disordered gamblers are often heavily impacted because of the illness. Up till now, there is no standardized German instrument to assess this impact. Internationally, the Short Questionnaire for Family Members-affected by addiction (SQFM-AA) is often used which is based on the Stress-Strain-Coping-Support-Modell. That is why we translated this questionnaire into the German Kurzfragebogen für suchtbelastete Familienmitglieder SQFM-AA (Version Glücksspiel) to be able to assess the impact on affected others and to compare our results internationally.

METHODS

The SQFM-AA was translated and retranslated and tested in an online convenience sample of affected others. Essential psychometric properties, discriminatory power, and internal consistency were calculated. Factor structure was analysed using an exploratory factor analysis (principal axis analysis, varimax rotation).

RESULTS

Data collected from 122 affected others (87% female; 67% partners; 61% joint household) were analysed. Discriminatory power ranges between 0.30-0.94, Cronbach's alpha between 0.61-0.95. Factor analysis shows that 69% of variance can be explained in a solution with 9 factors.

DISCUSSION

Due to the methods used when translating and back-translating the SQFM-AA, it can be assumed that both versions are comparable. Internal consistency of all scales is in an acceptable to good range. In our sample, the postulated 11 sub-scales cannot be reproduced. The 9 factors found here can be derived based on theoretical preliminary considerations. 4 of the scales are reflected well in the analysis, 3 more factors show a relevant load on other scales. Furthermore, one item each does not load on the proposed factor for the 2 remaining scales. All in all, the factors can be interpreted well regarding their content. A modification of the questionnaire would improve some of the statistical values, but the international comparability would no longer be possible.

CONCLUSION

With the adaptation presented here, impact on affected others of disordered gamblers can be assessed and relevant areas for therapy and counselling can be identified.

XRCC5 as a risk gene for alcohol dependence: evidence from a genome-wide gene-set-based analysis and follow-up studies in Drosophila and humans

Genetic factors have as large role as environmental factors in the etiology of alcohol dependence (AD). Although genome-wide association studies (GWAS) enable systematic searches for loci not hitherto implicated in the etiology of AD, many true findings may be missed owing to correction for multiple testing. The aim of the present study was to circumvent this limitation by searching for biological system-level differences, and then following up these findings in humans and animals. Gene-set-based analysis of GWAS data from 1333 cases and 2168 controls identified 19 significantly associated gene-sets, of which 5 could be replicated in an independent sample. Clustered in these gene-sets were novel and previously identified susceptibility genes. The most frequently present gene, ie in 6 out of 19 gene-sets, was X-ray repair complementing defective repair in Chinese hamster cells 5 (XRCC5). Previous human and animal studies have implicated XRCC5 in alcohol sensitivity. This phenotype is inversely correlated with the development of AD, presumably as more alcohol is required to achieve the desired effects. In the present study, the functional role of XRCC5 in AD was further validated in animals and humans. Drosophila mutants with reduced function of Ku80-the homolog of mammalian XRCC5-due to RNAi silencing showed reduced sensitivity to ethanol. In humans with free access to intravenous ethanol self-administration in the laboratory, the maximum achieved blood alcohol concentration was influenced in an allele-dose-dependent manner by genetic variation in XRCC5. In conclusion, our convergent approach identified new candidates and generated independent evidence for the involvement of XRCC5 in alcohol dependence.

Association of functional DBH genetic variants with alcohol dependence risk and related depression and suicide attempt phenotypes: results from a large multicenter association study

OBJECTIVE

Dopamine-beta-hydroxylase (DBH) metabolizes the conversion of dopamine to noradrenaline. DBH, located on chromosome 9q34.2 has variants with potential functional consequences which may be related to alterations of neurotransmitter function and several psychiatric phenotypes, including alcohol dependence (AD), depression (MD) and suicidal behavior (SA). The aim of this association study in a large multicenter sample of alcohol-dependent individuals and controls is to investigate the role of DBH SNPs and haplotypes in AD risk and associated phenotypes (AD with MD or SA).

METHOD

1606 inpatient subjects with DSM-IV AD from four addiction treatment centers and 1866 control subjects were included. Characteristics of AD, MD and SA were obtained using standardized structured interviews. After subjects were genotyped for 4 DBH polymorphisms, single SNP case-control and haplotype analyses were conducted.

RESULTS

rs1611115 (near 5') C-allele and related haplotypes were significantly associated with alcohol dependence in females. This association with female alcohol dependence also accounts for the significant relationship between this variant and comorbid conditions and traits.

CONCLUSIONS

This study presents evidence for a potentially functional DBH variant influencing the risk for alcohol dependence while other comorbid conditions are not independently influenced by this SNP. However, the study also supports the possible role of the dopamine system in the etiology of female alcohol dependence.

Results of a double-blind, placebo-controlled pharmacotherapy trial in alcoholism conducted in Germany and comparison with the US COMBINE study

The results of placebo-controlled trials (RCTs) with acamprosate or naltrexone vary substantially. Those differences have been attributed to differing patient characteristics, recruitment strategies, treatment settings and remuneration systems. We tested these assumptions by comparing a new double-blind, placebo-controlled randomized trial conducted in Germany (called PREDICT Study) with data from the US COMBINE Study. PREDICT was designed according to the protocol of the COMBINE Study. A total of 426 alcohol-dependent patients were compared to 459 COMBINE Study patients corresponding to the treatment cells in PREDICT. All patients received acamprosate, naltrexone or placebo for 3 months (PREDICT) or 4 months (COMBINE). Biweekly manualized 'medical management' to enhance compliance was delivered in both studies. Time until the first occurrence of heavy drinking was the main outcome measure. PREDICT found neither acamprosate nor naltrexone to supply any additional benefit compared with placebo, which is at variance with a positive naltrexone effect being reported in the COMBINE Study. A secondary comparison between both studies showed better overall treatment outcomes in PREDICT, although these patients had been more severely affected than their COMBINE counterparts. The divergence in results may be attributable to basic differences in the treatment environments (such as in-patient pre-treatment versus primary outpatient care). We suggest that identically designed RCTs conducted in different parts of the world may help improve the external validity of RCTs. This approach could be called 'comparative efficacy research'.

αCaMKII autophosphorylation controls the establishment of alcohol drinking behavior

The α-Ca(2+)/calmodulin-dependent protein kinase II (αCaMKII) is a crucial enzyme controlling plasticity in the brain. The autophosphorylation of αCaMKII works as a 'molecular memory' for a transient calcium activation, thereby accelerating learning. We investigated the role of αCaMKII autophosphorylation in the establishment of alcohol drinking as an addiction-related behavior in mice. We found that alcohol drinking was initially diminished in αCaMKII autophosphorylation-deficient αCaMKII(T286A) mice, but could be established at wild-type level after repeated withdrawals. The locomotor activating effects of a low-dose alcohol (2 g/kg) were absent in αCaMKII(T286A) mice, whereas the sedating effects of high-dose (3.5 g/kg) were preserved after acute and subchronic administration. The in vivo microdialysis revealed that αCaMKII(T286A) mice showed no dopamine (DA) response in the nucleus accumbens to acute or subchronic alcohol administration, but enhanced serotonin (5-HT) responses in the prefrontal cortex. The attenuated DA response in αCaMKII(T286A) mice was in line with altered c-Fos activation in the ventral tegmental area after acute and subchronic alcohol administration. In order to compare findings in mice with the human condition, we tested 23 single-nucleotide polymorphisms (SNPs) in the CAMK2A gene for their association with alcohol dependence in a population of 1333 male patients with severe alcohol dependence and 939 controls. We found seven significant associations between CAMK2A SNPs and alcohol dependence, one of which in an autophosphorylation-related area of the gene. Together, our data suggest αCaMKII autophosphorylation as a facilitating mechanism in the establishment of alcohol drinking behavior with changing the DA-5-HT balance as a putative mechanism.

[It's not only the gamblers who need help - a pilot study on a family training programme]

Relatives of problematic and pathological gamblers are seriously affected by the illness comparable to relatives of substance abusers. Therefore they might need support. Hence the psycho-educational training programme ETAPPE was developed and tested in an explorative pilot study in cooperation with counselling services. The participants got several questionnaires concerning amongst others: self-assessment of stress, psychological distress and taxing subjects. Results show that families of problematic and pathological gamblers are highly stressed. ETAPPE addresses the topics that are a burden for families. Taking into consideration the limitations, there are positive trends: Through this training, self-assessment of stress, psychological distress and actual situative perceived stress are reduced significantly. Chronic stress remains unchanged. A conclusive evaluation of the effectiveness of this manualized programme is still pending.

Possible association between OPRM1 genetic variance at the 118 locus and alcohol dependence in a large treatment sample: relationship to alcohol dependence symptoms

BACKGROUND

Several lines of evidence from previous research indicate that opioid receptors play an important role in ethanol reinforcement and alcohol dependence (AD) risk. Conflicting results were reported on the role of the mu-opioid receptor (OPRM1) polymorphism A118G (Asn40Asp, rs1799971) in the development of alcoholism.

METHODS

We investigated a total number of 1,845 alcohol-dependent subjects recruited from inpatient facilities in Germany and 1,863 controls for the mu-opioid receptor (OPRM1) polymorphism using chi-square statistics.

RESULTS

An association between the OPRM variant and AD was detected (p = 0.022), in recessive (AA vs. GA/GG) and co-dominant (AA vs. GA) models of inheritance. An association between the OPRM variant and the DSM-IV criterion "efforts to cut down or could not" (p = 0.047) was found, but this did not remain significant after the correction for multiple testing.

CONCLUSIONS

The results indicate that this functional OPRM variant is associated with risk of AD and these findings apply to more severe AD, although the association is only nominally significant.

Genome-wide significant association between alcohol dependence and a variant in the ADH gene cluster

Alcohol dependence (AD) is an important contributory factor to the global burden of disease. The etiology of AD involves both environmental and genetic factors, and the disorder has a heritability of around 50%. The aim of the present study was to identify susceptibility genes for AD by performing a genome-wide association study (GWAS). The sample comprised 1333 male in-patients with severe AD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and 2168 controls. These included 487 patients and 1358 controls from a previous GWAS study by our group. All individuals were of German descent. Single-marker tests and a polygenic score-based analysis to assess the combined contribution of multiple markers with small effects were performed. The single nucleotide polymorphism (SNP) rs1789891, which is located between the ADH1B and ADH1C genes, achieved genome-wide significance [P = 1.27E-8, odds ratio (OR) = 1.46]. Other markers from this region were also associated with AD, and conditional analyses indicated that these made a partially independent contribution. The SNP rs1789891 is in complete linkage disequilibrium with the functional Arg272Gln variant (P = 1.24E-7, OR = 1.31) of the ADH1C gene, which has been reported to modify the rate of ethanol oxidation to acetaldehyde in vitro. A polygenic score-based approach produced a significant result (P = 9.66E-9). This is the first GWAS of AD to provide genome-wide significant support for the role of the ADH gene cluster and to suggest a polygenic component to the etiology of AD. The latter result may indicate that many more AD susceptibility genes still await identification.

Multiple polymorphisms in genes of the adrenergic stress system confer vulnerability to alcohol abuse

Environmental factors such as stress influence both the predisposition to and development of alcoholism, as well as have significant implications for alcoholism relapse. One predominant biological response to acute stress is the release of norepinephrine, which activates the peripheral stress response and also the hypothalamic-pituitary-adrenal axis. We aimed to examine the role of two genes of the adrenergic system (SLC6A2 and ADRA2A) in alcoholism by genotyping 21 SNPs in 785 adult alcohol-dependent patients and 1237 controls. Two single nucleotide polymorphisms (SNP) (rs36020 and rs36029) in SLC6A2 were significantly associated with alcoholism [false discovery rate corrected P-value (FDR) P = 0.007]. Two SNPs in ADRA2A (rs521674 and rs602618) were associated with a positive family history of alcoholism (FDR P ≤ 0.05). A combined SNP-set analysis was also carried out to determine the risk of harbouring multiple alcohol risk alleles across SLC6A2 and ADRA2A. Logistic regression analysis revealed that an increase in the number of alcohol risk alleles increased the risk for alcoholism (P = 0.000567, odds ratio = 1.75, 95% confidence interval 1.26-2.44). A three-SNP haplotype consisting of rs187715, rs36020 and rs40147 alleles, AGC, was also found, which was significantly over-represented in cases compared with controls (61% versus 56%). We therefore demonstrate an association of SLC6A2 and ADRA2A with adult alcoholism. These data confirm the relevance of the adrenergic stress system when considering genetic predisposition to alcohol dependence and suggest that SLC6A2 and ADRA2A should be studied in additional alcohol-dependent cohorts.

Effects of the circadian rhythm gene period 1 (per1) on psychosocial stress-induced alcohol drinking

OBJECTIVE

Circadian and stress-response systems mediate environmental changes that affect alcohol drinking. Psychosocial stress is an environmental risk factor for alcohol abuse. Circadian rhythm gene period 1 (Per1) is targeted by stress hormones and is transcriptionally activated in corticotropin releasing factor-expressing cells. The authors hypothesized that Per1 is involved in integrating stress response and circadian rhythmicity and explored its relevance to alcohol drinking.

METHOD

In mice, the effects of stress on ethanol intake in mPer1-mutant and wild-type mice were assessed. In humans, single nucleotide polymorphisms (SNPs) in hPer1 were tested for association with alcohol drinking behavior in 273 adolescents and an adult case-control sample of 1,006 alcohol-dependent patients and 1,178 comparison subjects. In vitro experiments were conducted to measure genotype-specific expression and transcription factor binding to hPer1.

RESULTS

The mPer1-mutant mice showed enhanced alcohol consumption in response to social defeat stress relative to their wild-type littermates. An association with the frequency of heavy drinking in adolescents with the hPer1 promoter SNP rs3027172 and with psychosocial adversity was found. There was significant interaction between the rs3027172 genotype and psychosocial adversity on this drinking measure. In a confirmatory analysis, association of hPer1 rs3027172 with alcohol dependence was shown. Cortisol-induced transcriptional activation of hPer1 was reduced in human B-lymphoblastoid cells carrying the risk genotype of rs3027172. Binding affinity of the transcription factor Snail1 to the risk allele of the hPer1 SNP rs3027172 was also reduced.

CONCLUSIONS

The findings indicate that the hPer1 gene regulates alcohol drinking behavior during stressful conditions and provide evidence for underlying neurobiological mechanisms.

[Pathological gambling--what do we know?]

According to epidemiological studies, there are 103 000-290 000 people in Germany afflicted by pathological gambling. In many cases the disorder remains hidden for a long time with only a few of the problematic or pathological gamblers seeking help in the professional helping network. Focussing on the relevant results for Germany, this review summarizes the recent research concerning "pathological gambling". The main topics are diagnosis, nosological status, epidemiology, gender-related differences and common screening instruments. Furthermore, the increasing probability for the development of pathological gambling upon existing other psychiatric disorders, e. g. personality disorder, mood and anxiety disorders, substance-related disorders or ADHD, is discussed as well as the current approaches in treatment.

Sex-specific role for adenylyl cyclase type 7 in alcohol dependence

BACKGROUND

Alcohol has been shown to critically modulate cyclic adenosine-3',5' monophosphate (cAMP) signaling. A number of downstream effectors that respond to the cAMP signals (e.g., protein kinase A, cAMP response element binding protein) have, in turn, been examined in relation to alcohol consumption. These studies did not, however, delineate the point at which the actions of alcohol on the cAMP cascade might translate into differences in drinking behavior. To further understand the role of cAMP synthesis in alcohol drinking and dependence, we investigated a specific adenylyl cyclase isoform, adenylyl cyclase (AC) Type 7, whose activity is selectively enhanced by ethanol.

METHODS

We measured alcohol consumption and preference in mice in which one copy of the Adcy7 gene was disrupted (Adcy7(+/-)). To demonstrate relevance of this gene for alcohol dependence in humans, we tested the association of polymorphisms in the ADCY7 gene with alcohol dependence in a sample of 1703 alcohol-dependent individuals and 1347 control subjects.

RESULTS

We show that Adcy7(+/-) female mice have higher preference for alcohol than wild-type mice, whereas there is little difference in alcohol consumption or preference between Adcy7(+/-) male mice and wild-type control subjects. In the human sample, we found that single nucleotide polymorphisms in ADCY7 associate with alcohol dependence in women, and these markers are also associated with ADCY7 expression (messenger RNA) levels.

CONCLUSIONS

These findings implicate adenylyl cyclase Type 7 as a critical component of the molecular pathways contributing to alcohol drinking and the development of alcohol dependence.

What works for patients in outpatient treatment for alcohol addiction? An explorative study into clients' evaluation of subjective factors and therapy satisfaction

This explorative survey investigated clients' evaluation of therapy elements and other supportive factors within a randomized controlled trial. The treatment of patients with alcohol dependence consisted of pharmacotherapy (acamprosate/naltrexone/placebo) and biweekly medical management (MM). Forty-nine study participants were surveyed with a questionnaire to measure both the patients' satisfaction with the therapy and the subjective assessment of treatment elements and supportive factors.Study participants were highly satisfied with the treatment. The supportive factors previously identified by Orford et al1 were confirmed. 'Pharmacotherapy' was rated significantly less effective than 'MM' and 'global study attendance' (P < 0.001). The significant differences in the evaluation of treatment elements point to a preference for regular low-key contacts rather than for medication. Such contacts based on MM could be a useful intervention in clinical care, and its effectivity should be examined more closely in further research.

KCNJ6 is associated with adult alcohol dependence and involved in gene × early life stress interactions in adolescent alcohol drinking

Alcohol abuse and dependence have proven to be complex genetic traits that are influenced by environmental factors. Primate and human studies have shown that early life stress increases the propensity for alcohol abuse in later life. The reinforcing properties of alcohol are mediated by dopaminergic signaling; however, there is little evidence to indicate how stress alters alcohol reinforcement. KCNJ6 (the gene encoding G-protein-coupled inwardly rectifying potassium channel 2 (GIRK2)) is a brain expressed potassium channel with inhibitory effects on dopaminergic tone. The properties of GIRK2 have been shown to be enhanced by the stress peptide corticotrophin-releasing hormone. Therefore, we sought to examine the role of KCNJ6 polymorphisms in adult alcohol dependence and stress-related alcohol abuse in adolescents. We selected 11 SNPs in the promoter region of KCNJ6, which were genotyped in 1152 adult alcohol dependents and 1203 controls. One SNP, rs2836016, was found to be associated with alcohol dependence (p=0.01, false discovery rate). We then assessed rs2836016 in an adolescent sample of 261 subjects, which were characterized for early life stress and adolescent hazardous drinking, defined using the Alcohol Use Disorders Identification Test (AUDIT), to examine gene-environment interactions. In the adolescent sample, the risk genotype of rs2836016 was significantly associated with increased AUDIT scores, but only in those individuals exposed to high levels of psychosocial stress in early life (p=0.01). Our findings show that KCNJ6 is associated with alcohol dependence and may moderate the effect of early psychosocial stress on risky alcohol drinking in adolescents. We have identified a candidate gene for future studies investigating a possible functional link between the response to stress and alcohol reinforcement.

Association of ADH4 genetic variants with alcohol dependence risk and related phenotypes: results from a larger multicenter association study

Genetic variants of the alcohol-metabolizing enzyme ADH4, located on chromosome 4q22-4q23, have been related to alcohol dependence (AD) risk in previous research. The aim of this association study in a large multicenter sample of alcohol-dependent individuals and controls is to confirm ADH4 single nucleotide polymorphism (SNP) and haplotype association with AD and relevant related phenotypes. One thousand, six hundred and twenty-two (1622) inpatient subjects and 1469 control subjects with DSM-IV. AD from four addiction treatment centres were included. Characteristics of AD and related phenotypes including alcohol withdrawal, Cloninger's type I and II and first ages of drinking, regular drinking and AD onset were obtained using standardized structured interviews. After subjects were genotyped for 2 ADH4 polymorphisms, single SNP case-control and haplotype analyses were conducted. Both variants--rs1800759 and rs1042364--and the A-A and C-G haplotypes were significantly related to AD across samples. Furthermore, associations with AD-related phenotypes and subtypes revealed a potential protective influence of this haplotype. This study confirms the significant relationship of ADH4 variants with AD and related phenotypes. While the rs1800759 and rs1042364 A-A haplotype had a potential protective influence on the risk for several AD-related phenotypes, this effect is rather small compared to functional variants of other alcohol or acetaldehyde-metabolizing enzymes like ALDH2*2 or ADH1B*2.

Genetic variation in the PNPLA3 gene is associated with alcoholic liver injury in caucasians

A recent genome-wide study revealed an association between variation in the PNPLA3 gene and liver fat content. In addition, the PNPLA3 single-nucleotide polymorphism rs738409 (M148I) was reported to be associated with advanced alcoholic liver disease in alcohol-dependent individuals of Mestizo descent. We therefore evaluated the impact of rs738409 on the manifestation of alcoholic liver disease in two independent German cohorts. Genotype and allele frequencies of rs738409 (M148I) were determined in 1,043 alcoholic patients with or without alcoholic liver injury and in 376 at-risk drinkers from a population-based cohort. Relative to alcoholic patients without liver damage (n = 439), rs738409 genotype GG was strongly overrepresented in patients with alcoholic liver cirrhosis (n = 210; OR 2.79; P(genotype) = 1.2 × 10(-5) ; P(allelic) = 1.6 × 10(-6) ) and in alcoholic patients without cirrhosis but with elevated alanine aminotransferase levels (n = 219; OR 2.33; P(genotype) = 0.0085; P(allelic) = 0.0042). The latter, biochemically defined association was confirmed in an independent population-based cohort of at-risk drinkers with a median alcohol intake of 300 g/week (OR 4.75; P(genotype) = 0.040; P(allelic) = 0.022), and for aspartate aminotransferase (AST) levels. Frequencies of allele PNPLA3 rs738409(G) in individuals with steatosis and normal alanine aminotransferase (ALT) and AST levels were lower than in alcoholics without steatosis and normal ALT/AST (P(combined) = 0.03). The population attributable risk of cirrhosis in alcoholic carriers of allele PNPLA3 rs738409(G) was estimated at 26.6%.

CONCLUSION

Genotype PNPLA3 rs738409(GG) is associated with alcoholic liver cirrhosis and elevated aminotransferase levels in alcoholic Caucasians.

Genetic variation in the PNPLA3 gene is associated with alcoholic liver injury in caucasians

A recent genome-wide study revealed an association between variation in the PNPLA3 gene and liver fat content. In addition, the PNPLA3 single-nucleotide polymorphism rs738409 (M148I) was reported to be associated with advanced alcoholic liver disease in alcohol-dependent individuals of Mestizo descent. We therefore evaluated the impact of rs738409 on the manifestation of alcoholic liver disease in two independent German cohorts. Genotype and allele frequencies of rs738409 (M148I) were determined in 1,043 alcoholic patients with or without alcoholic liver injury and in 376 at-risk drinkers from a population-based cohort. Relative to alcoholic patients without liver damage (n = 439), rs738409 genotype GG was strongly overrepresented in patients with alcoholic liver cirrhosis (n = 210; OR 2.79; P(genotype) = 1.2 × 10(-5) ; P(allelic) = 1.6 × 10(-6) ) and in alcoholic patients without cirrhosis but with elevated alanine aminotransferase levels (n = 219; OR 2.33; P(genotype) = 0.0085; P(allelic) = 0.0042). The latter, biochemically defined association was confirmed in an independent population-based cohort of at-risk drinkers with a median alcohol intake of 300 g/week (OR 4.75; P(genotype) = 0.040; P(allelic) = 0.022), and for aspartate aminotransferase (AST) levels. Frequencies of allele PNPLA3 rs738409(G) in individuals with steatosis and normal alanine aminotransferase (ALT) and AST levels were lower than in alcoholics without steatosis and normal ALT/AST (P(combined) = 0.03). The population attributable risk of cirrhosis in alcoholic carriers of allele PNPLA3 rs738409(G) was estimated at 26.6%.

CONCLUSION

Genotype PNPLA3 rs738409(GG) is associated with alcoholic liver cirrhosis and elevated aminotransferase levels in alcoholic Caucasians.

No association of alcohol dependence with HOMER 1 and 2 genetic variants

Several lines of evidence indicate that alterations of the central cortico-accumbens glutamate pathway are involved in the development and maintenance of alcohol- and substance-use disorders. The HOMER protein family is encoded by 3 genes HOMER (1-3) which are components of the excitatory postsynaptic density complex and function to modulate synaptic activity by the regulation of glutamate signaling. HOMER 1 and 2 have been reported to contribute to chronic alcohol-induced long-term neurochemical changes in the endogenous reward system. Data from animal models suggest a potential role of the Homer protein family in the development of alcohol and substance use. The aim of this study is to assess potential associations between HOMER 1 and 2 genetic variants in a larger sample of alcohol-dependent individuals and unrelated controls. Five genetic variants of HOMER 1 and 3 of HOMER 2 were genotyped in a multi-site sample of 1,923 German healthy controls and 2,039 alcohol-dependent subjects. Neither single SNP nor haplotype analysis could detect significant associations with alcohol dependence (AD) and related phenotypes. While most of the HOMER 1 and 2 SNPs are in low-to-moderate linkage disequilibrium, three major haplotypes of HOMER 1 and 4 haplotypes of HOMER 2 are present in the majority of alcohol-dependent and control subjects. In conclusion, our results suggest that single SNPs, respectively, haplotypes of the HOMER 1 and 2 genes are unlikely to play a major role in the pathophysiology of AD.

Analysis of monocyte chemotactic protein-1 gene polymorphism in patients with spontaneous bacterial peritonitis

AIM: To investigate a genetic polymorphism of the monocyte chemotactic protein-1 (MCP-1) gene in patients with spontaneous bacterial peritonitis (SBP).

METHODS: MCP-1 genotyping was performed in 23 patients with SBP and 83 cirrhotic control patients with non-infected ascites.

RESULTS: The frequency of carriers of the G-allele was lower in SBP patients but this difference did not reach statistical significance. However, in the subgroup of patients with alcoholic cirrhosis (n = 80), carriers of the G-allele were significantly less frequent in SBP-patients (38.1%) than in cirrhotic controls (67.8%, P = 0.021).

CONCLUSION: In patients with alcoholic liver cirrhosis, the -2518 MCP-1 genotype AA is a risk factor for the development of SBP.

Genome-wide association study of alcohol dependence

CONTEXT

Alcohol dependence is a serious and common public health problem. It is well established that genetic factors play a major role in the development of this disorder. Identification of genes that contribute to alcohol dependence will improve our understanding of the mechanisms that underlie this disorder.

OBJECTIVE

To identify susceptibility genes for alcohol dependence through a genome-wide association study (GWAS) and a follow-up study in a population of German male inpatients with an early age at onset.

DESIGN

The GWAS tested 524,396 single-nucleotide polymorphisms (SNPs). All SNPs with P < 10(-4) were subjected to the follow-up study. In addition, nominally significant SNPs from genes that had also shown expression changes in rat brains after long-term alcohol consumption were selected for the follow-up step.

SETTING

Five university hospitals in southern and central Germany.

PARTICIPANTS

The GWAS included 487 male inpatients with alcohol dependence as defined by the DSM-IV and an age at onset younger than 28 years and 1358 population-based control individuals. The follow-up study included 1024 male inpatients and 996 age-matched male controls. All the participants were of German descent.

MAIN OUTCOME MEASURES

Significant association findings in the GWAS and follow-up study with the same alleles.

RESULTS

The GWAS produced 121 SNPs with nominal P < 10(-4). These, together with 19 additional SNPs from homologues of rat genes showing differential expression, were genotyped in the follow-up sample. Fifteen SNPs showed significant association with the same allele as in the GWAS. In the combined analysis, 2 closely linked intergenic SNPs met genome-wide significance (rs7590720, P = 9.72 x 10(-9); rs1344694, P = 1.69 x 10(-8)). They are located on chromosome region 2q35, which has been implicated in linkage studies for alcohol phenotypes. Nine SNPs were located in genes, including the CDH13 and ADH1C genes, that have been reported to be associated with alcohol dependence.

CONCLUSIONS

This is the first GWAS and follow-up study to identify a genome-wide significant association in alcohol dependence. Further independent studies are required to confirm these findings.

Serotonin transporter gene polymorphism and personality traits in primary alcohol dependence

We tested the hypothesis of an association between the serotonin transporter (5-HTT) gene regulatory region polymorphism and the Temperament and Character Inventory (TCI) personality dimension of Harm Avoidance. For the study, 124 subjects seeking inpatient treatment for primary alcohol dependence were grouped by their 5-HTT genotype and assessed with the TCI. Genotypes differed statistically significantly in Harm Avoidance but not in any other personality trait. This gives support to the hypothesis that the TCI temperament Harm Avoidance is associated with serotonergic neurotransmission in primary alcohol dependence.

[The impact of attachment styles and ADHD on alcohol dependence]

BACKGROUND

Insecure attachment (IA) and attention-deficit/hyperactivity disorder (ADHD) are discussed as risk factors for increased alcohol intake and the development of alcoholism.

METHODS

Among a sample of 517 consecutively admitted German inpatients with alcohol dependence we investigated the contribution of IA to alcoholism phenotypes, taking into consideration comorbid ADHD.

RESULTS

IA was significantly associated with increased alcohol consumption, increased frequency of withdrawal symptoms, increased frequency of physical or psychological problems that are likely to have been worsened by alcohol, and reduced social activities because of alcohol use. ADHD has no significant effect on these parameters.

CONCLUSIONS

IA developed as a result of social interactions during childhood long before alcohol dependence. The results point to an important effect of IA on the severity and acceleration of alcohol dependence. Therefore, it might be helpful to improve efforts in primary prevention and psychotherapy of alcohol dependence by considering the specific needs of subjects with an IA.