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Richards DK, Tuchman FR, Hallgren KA, Kranzler HR, Aubin HJ, O'Malley SS, Mann K, Aldridge A, Anton RF, Witkiewitz K. Reductions in World Health Organization Risk Drinking Level Are Associated With Reductions in Alcohol Use Disorder Diagnosis and Criteria: Evidence From an Alcohol Pharmacotherapy Trial. J Addict Med 2024:01271255-990000000-00308. [PMID: 38606854 DOI: 10.1097/adm.0000000000001303] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVES This study aimed to evaluate the validity of World Health Organization (WHO) risk drinking level reductions as meaningful endpoints for clinical practice and research. This study examined whether such reductions were associated with a lower likelihood of a current alcohol use disorder (AUD) diagnosis and fewer AUD criteria. METHODS We conducted a secondary data analysis to address these objectives using data from a multisite randomized controlled trial of gabapentin enacarbil extended release in treating moderate to severe AUD among adults (N = 346). Participants received gabapentin enacarbil extended release or placebo for 6 months. The timeline follow-back was used to assess WHO risk drinking level reductions, and the Mini-International Neuropsychiatric Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis and criteria at baseline (past year) and end of treatment (past month). RESULTS Most participants (80.1%) achieved at least a 1-level reduction in the WHO risk drinking levels from baseline to end of treatment, and nearly half of participants (49.8%) achieved at least a 2-level reduction. At least a 1-level reduction or at least a 2-level reduction in WHO risk drinking level predicted lower odds of an active AUD diagnosis (1-level: odds ratio, 0.74 [95% confidence interval (CI), 0.66-0.84]; 2-level: odds ratio, 0.71 [95% CI, 0.64-0.79]) and fewer AUD criteria (1-level: B, -1.66 [95% CI, -2.35 to -0.98]; 2-level: B, -1.76 [95% CI, -2.31 to -1.21]) at end of treatment. CONCLUSIONS World Health Organization risk drinking level reductions correlate with Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis and criteria, providing further evidence for their use as endpoints in alcohol intervention trials, which has potential implications for broadening the base of AUD treatment.
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Affiliation(s)
- Dylan K Richards
- From the Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM (DKR, KW); Department of Psychology, University of New Mexico, Albuquerque, NM (FRT, KW); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA (KAH); Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania and VISN4 MIRECC, Crescenz VAMC, Philadelphia, PA (HRK); French Institute of Health and Medical Research, Paris, Île-de-France, France (H-JA); Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT (SSO); Zentralinstitut für Seelische Gesundheit, Mannheim, Baden-Württemberg, DE (KM); Behavioral Health Financing, Economics and Evaluation Department, Research Triangle Institute International, Durham, NC (AA); and Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (RFA)
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Garcia CC, Richards DK, Tuchman FR, Hallgren KA, Kranzler HR, Aubin HJ, O’Malley SS, Mann K, Aldridge A, Hoffman M, Anton RF, Witkiewitz K. Reductions in World Health Organization risk drinking level are associated with improvements in sleep problems among individuals with alcohol use disorder. Alcohol Alcohol 2024; 59:agae022. [PMID: 38606931 PMCID: PMC11010310 DOI: 10.1093/alcalc/agae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 10/26/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS Among individuals with alcohol use disorder (AUD), sleep disturbances are pervasive and contribute to the etiology and maintenance of AUD. However, despite increased attention toward the relationship between alcohol use and sleep, limited empirical research has systematically examined whether reductions in drinking during treatment for AUD are associated with improvements in sleep problems. METHODS We used data from a multisite, randomized, controlled trial that compared 6 months of treatment with gabapentin enacarbil extended-release with placebo for adults with moderate-to-severe AUD (N = 346). The Timeline Follow-back was used to assess WHO risk drinking level reductions and the Pittsburgh Sleep Quality Index was used to assess sleep quality over the prior month at baseline and the end of treatment. RESULTS Sleep problem scores in the active medication and placebo groups improved equally. Fewer sleep problems were noted among individuals who achieved at least a 1-level reduction (B = -0.99, 95% confidence interval (CI) [-1.77, -0.20], P = .014) or at least a 2-level reduction (B = -0.80, 95% CI [-1.47, -0.14], P = .018) in WHO risk drinking levels at the end of treatment. Reductions in drinking, with abstainers excluded from the analysis, also predicted fewer sleep problems at the end of treatment (1-level: B = -1.01, 95% CI [-1.83, -0.20], P = .015; 2-level: B = -0.90, 95% CI [-1.59, -0.22], P = .010). CONCLUSIONS Drinking reductions, including those short of abstinence, are associated with improvements in sleep problems during treatment for AUD. Additional assessment of the causal relationships between harm-reduction approaches to AUD and improvements in sleep is warranted.
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Affiliation(s)
- Christian C Garcia
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
| | - Dylan K Richards
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
| | - Felicia R Tuchman
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, United States
| | - Kevin A Hallgren
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, 98195, United States
| | - Henry R Kranzler
- Center for Studies of Addiction, Perelman School of Medicine, University of Pennsylvania and Mental Illness Research, Education and Clinical Center, Crescenz VAMC, Philadelphia, PA, 19104, United States
| | - Henri-Jean Aubin
- Université Paris-Saclay, Unive Paris-Sud, Université de Versailles Saint-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, Institut national de la santé et de la recherche médicale, Villejuif, France
- APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, 94800, France
| | - Stephanie S O’Malley
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, 06511, United States
| | - Karl Mann
- Zentralinstitut für Seelische Gesundheit (ZI), Mannheim, Baden-Württemberg, 68159, Germany
| | - Arnie Aldridge
- Behavioral Health Financing, Economics and Evaluation Department, Research Triangle Institute International (RTI), Research Triangle Park, NC, 27709, United States
| | - Michaela Hoffman
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Raymond F Anton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, United States
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions (CASAA), University of New Mexico, Albuquerque, NM, 87106, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, 87131, United States
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Wielders JPM, Porpiglia NM, Schellenberg F, Deenmamode J, Delanghe J, Anton RF, Bortolotti F, Siebelder C, Tagliaro F, Weykamp C, Helander A. Recommendations on the measurement and use of the alcohol consumption biomarker CDT. A position paper from the IFCC Working Group on CDT standardisation. Clin Chim Acta 2024; 555:117800. [PMID: 38309557 DOI: 10.1016/j.cca.2024.117800] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Carbohydrate deficient transferrin (CDT) is a biomarker for excessive alcohol consumption utilized in clinical and forensic medicine and workplace testing. Previously, many different analytical methods for CDT were used and the measurand varied considerably, making direct comparison of test results difficult. To end this confusion, the IFCC established a working group on CDT standardisation (WG-CDT) which completed its tasks in 2017. METHODS This IFCC position paper by the WG-CDT summarizes state of the art information about the measurand and the analytical methods and gives concise recommendations for its utilization. RESULTS The results achieved by the CDT standardisation process led to accuracy improvements in national external quality assessment schemes over the years. A brief review of ROC based comparison studies with the traditional biomarkers (GGT, MCV, ALT and AST) discusses the bias resulting from inadequate study populations. In large groups of the general population the superior diagnostic performance of CDT is confirmed. CONCLUSION The relationship between alcohol intake versus resulting CDT is discussed as well as the cutoff and measurement uncertainty. Concerning the application in practice, potential pitfalls are considered and recommendations handling both analytical and preanalytical caveats are given. Finally, some examples of serious misunderstandings in publications about CDT are addressed.
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Affiliation(s)
- J P M Wielders
- Joseph Peter Marie Wielders, Amersfoort, the Netherlands.
| | - N M Porpiglia
- Nadia Maria Porpiglia, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy.
| | | | | | - J Delanghe
- Joris Delanghe, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - R F Anton
- Raymond Francis Anton, Medical University of South Carolina, Charleston, SC, USA
| | - F Bortolotti
- Federica Bortolotti, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - C Siebelder
- Carla Siebelder, MCA Laboratory, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - F Tagliaro
- Franco Tagliaro, Department of Diagnostics and Public Health, Unit of Forensic Medicine, University of Verona, Verona, Italy
| | - C Weykamp
- Cas Weykamp, MCA Laboratory, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - A Helander
- Anders Helander, Karolinska Institutet, Karolinska University Laboratory, Stockholm, Sweden
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Schacht JP, Kubicki M, Anton RF. A randomized trial of the effects of COMT inhibition on subjective response to alcohol: Moderation by baseline COMT activity and mediation of alcohol self-administration. Alcohol Clin Exp Res (Hoboken) 2024; 48:178-187. [PMID: 38206282 DOI: 10.1111/acer.15227] [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] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Poor inhibitory control and enhanced subjective response to alcohol are interrelated risk factors for alcohol use disorder (AUD) that share underlying neural substrates, including dopamine signaling in the right prefrontal cortex, a potential target for pharmacological intervention. Cortical dopamine inactivation is primarily regulated by catechol-O-methyltransferase (COMT), an enzyme with large variation in activity as a function of the COMT rs4680 (val158met) single nucleotide polymorphism. In a previous randomized, placebo-controlled trial of the COMT inhibitor tolcapone (200 mg TID) in non-treatment-seeking participants with AUD, we found that tolcapone, relative to placebo, reduced alcohol self-administration only among rs4680 val-allele homozygotes, whose COMT activity is higher than in met-allele carriers. METHODS We conducted secondary analyses of the effects of tolcapone and baseline COMT activity, as indexed by both rs4680 genotype and an enzymatic activity assay, on the subjective response to alcohol in a bar-laboratory paradigm among 60 participants in the previous trial. RESULTS Tolcapone did not affect alcohol-induced stimulation or sedation more than placebo. However, baseline COMT activity moderated the effects of the drug on both outcomes, such that tolcapone-treated participants with higher baseline COMT activity had less stimulation (p = 0.008) and sedation (p = 0.053) than participants with lower baseline COMT activity and those treated with placebo. Additionally, alcohol-induced stimulation significantly mediated the interacting effects of baseline COMT activity and tolcapone on bar-laboratory self-administration. CONCLUSIONS Tolcapone may reduce subjective response to alcohol more effectively among individuals with preexisting high COMT activity an effect that could account for the drug's reduction of alcohol consumption among these individuals.
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Affiliation(s)
- Joseph P Schacht
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Matthew Kubicki
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Mellick WH, Tolliver BK, Brenner HM, Anton RF, Prisciandaro JJ. Alcohol Cue Processing in Co-Occurring Bipolar Disorder and Alcohol Use Disorder. JAMA Psychiatry 2023; 80:1150-1159. [PMID: 37556131 PMCID: PMC10413222 DOI: 10.1001/jamapsychiatry.2023.2726] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/04/2023] [Indexed: 08/10/2023]
Abstract
Importance Reward circuitry dysfunction is a candidate mechanism of co-occurring bipolar disorder and alcohol use disorder (BD + AUD) that remains understudied. This functional magnetic resonance imaging (fMRI) research represents the first evaluation of alcohol cue reward processing in BD + AUD. Objective To determine how alcohol cue processing in individuals with BD + AUD may be distinct from that of individuals with AUD or BD alone. Design, Setting, and Participants This cross-sectional case-control study (April 2013-June 2018) followed a 2 × 2 factorial design and included individuals with BD + AUD, AUD alone, BD alone, and healthy controls. A well-validated visual alcohol cue reactivity fMRI paradigm was administered to eligible participants following their demonstration of 1 week or more of abstinence from alcohol and drugs assessed via serial biomarker testing. Study procedures were completed at the Medical University of South Carolina. Analysis took place between June and August 2022. Main Outcomes and Measures Past-week mood symptoms were rated by clinicians using the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. The Alcohol Dependence Scale, Obsessive-Compulsive Drinking Scale, and Barratt Impulsiveness Scale were included questionnaires. Functional MRI whole-brain data were analyzed along with percent signal change within a priori regions of interest located in the ventral striatum, dorsal striatum, and ventromedial prefrontal cortex. Exploratory analyses of associations between cue reactivity and select behavioral correlates (alcohol craving, impulsivity, maximum number of alcohol drinks on a single occasion, and days since last alcohol drink) were also performed. Results Of 112 participants, 28 (25.0%) had BD + AUD, 26 (23.2%) had AUD alone, 31 (27.7%) had BD alone, and 27 (24.1%) were healthy controls. The mean (SD) age was 38.7 (11.6) years, 50 (45.5%) were female, 33 (30%) were smokers, and 37 (34.9%) reported recent alcohol consumption. Whole-brain analyses revealed a BD × AUD interaction (F = 10.64; P = .001; η2 = 0.09) within a cluster spanning portions of the right inferior frontal gyrus and insula. Region of interest analyses revealed a main association of BD (F = 8.02; P = .006; η2 = 0.07) within the dorsal striatum. In each instance, individuals with BD + AUD exhibited reduced activation compared with all other groups who did not significantly differ from one another. These hypoactivations were associated with increased impulsivity and obsessive-compulsive alcohol craving exclusively among individuals with BD + AUD. Conclusion and Relevance The findings of this study suggest conceptualizing reward dysfunction in BD + AUD by the potential interaction between blunted reward responsivity and deficient inhibitory control may help guide treatment development strategies. To this end, reduced right inferior frontal gyrus and insula alcohol cue reactivity represents a novel candidate biomarker of BD + AUD that may respond to pharmacological interventions targeting impulsivity-related neural mechanisms for improved executive control.
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Affiliation(s)
| | - Bryan K. Tolliver
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Helena M. Brenner
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Raymond F. Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - James J. Prisciandaro
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Schacht JP, Yeongbin Im, Hoffman M, Voronin KE, Book SW, Anton RF. Effects of pharmacological and genetic regulation of COMT activity in alcohol use disorder: a randomized, placebo-controlled trial of tolcapone. Neuropsychopharmacology 2022; 47:1953-1960. [PMID: 35523943 PMCID: PMC9073504 DOI: 10.1038/s41386-022-01335-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/08/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022]
Abstract
Alcohol Use Disorder (AUD) is characterized by loss of control over drinking. Behavioral control is mediated, in part, by cortical dopamine signaling. Inhibition of catechol-O-methyltransferase (COMT), the enzyme primarily responsible for cortical dopamine inactivation, may increase cortical dopamine, especially among individuals with genetically mediated lower dopaminergic tone, such as COMT rs4680 (val158met) val-allele homozygotes. This study was a randomized, placebo-controlled, pharmacogenetic trial of the COMT inhibitor tolcapone. Ninety non-treatment-seeking AUD individuals were prospectively genotyped for rs4680 and randomized to tolcapone (200 mg t.i.d.) or placebo for 8 days. At baseline and on day 7, peripheral COMT activity was assayed, and participants completed an fMRI alcohol cue-reactivity task; on day 8, they completed a bar-lab paradigm. Primary outcomes were: (1) natural drinking during the medication period; (2) alcohol self-administration in the bar lab; and (3) alcohol cue-elicited cortical (right inferior frontal gyrus [rIFG]) and ventral striatal activation. At baseline, the rs4680 val-allele had an additive effect on COMT activity. Tolcapone, relative to placebo, reduced COMT activity in all genotype groups. COMT genotype moderated tolcapone's effect on drinking during the medication period and in the bar lab, such that tolcapone, relative to placebo, reduced drinking only among val-allele homozygotes. Tolcapone did not affect cue-elicited ventral striatal activation but reduced rIFG activation; less rIFG activation on day 7 was associated with less drinking during the medication period. Taken together, these data suggest that COMT inhibition may reduce drinking specifically among individuals genetically predisposed to excessive COMT activity and potentially low cortical dopamine tone.ClinicalTrials.gov identifier: NCT02949934 https://clinicaltrials.gov/ct2/show/NCT02949934.
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Affiliation(s)
- Joseph P. Schacht
- grid.430503.10000 0001 0703 675XDepartment of Psychiatry, University of Colorado School of Medicine, Aurora, CO 80045 USA ,grid.259828.c0000 0001 2189 3475Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Yeongbin Im
- grid.259828.c0000 0001 2189 3475Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Michaela Hoffman
- grid.259828.c0000 0001 2189 3475Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Konstantin E. Voronin
- grid.259828.c0000 0001 2189 3475Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Sarah W. Book
- grid.259828.c0000 0001 2189 3475Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Raymond F. Anton
- grid.259828.c0000 0001 2189 3475Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425 USA
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Aldridge AP, Zarkin GA, Dowd WN, Witkiewitz K, Hasin DS, O'Malley SS, Isenberg K, Anton RF. The Relationship Between Reductions in WHO Risk Drinking Levels During Treatment and Subsequent Healthcare Costs for the ACTIVE Workgroup. J Addict Med 2022; 16:425-432. [PMID: 34864785 PMCID: PMC9163210 DOI: 10.1097/adm.0000000000000925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 01/03/2023]
Abstract
BACKGROUND Abstinence has historically been considered the target outcome for alcohol use disorder (AUD) treatment, yet recent work has found drinking reductions after AUD treatment, as measured by World Health Organization (WHO) risk drinking levels, are associated with meaningful improvements in functioning, physical health, and quality of life. OBJECTIVES This study extends previous analyses of AUD treatment outcomes by estimating the association between changes in WHO risk drinking levels (very high, high, medium, and low, based on average daily alcohol consumption) and healthcare costs. METHODS Secondary data analysis of the COMBINE study, a multisite randomized clinical trial of acamprosate, naltrexone and behavioral interventions for AUD. Generalized gamma regression models were used to estimate relationships between WHOrisk drinking level reductions over the course of treatment and healthcare costs in the year after treatment (N = 964) and up to 3 years following treatment (N = 651). RESULTS SustainedWHOrisk drinking reductions of 2 or more levels throughout treatment were associated with 52.0% lower healthcare costs ( P < 0.001) in the year following treatment, and 44.0% lower costs ( P < 0.0025) over 3 years. A reduction of exactly 1 level was associated with 34.8% lower costs over 3 years, which was not significant ( P = 0.05). Cost reductions were driven by lower inpatient behavioral health and emergency department utilization. CONCLUSIONS Reduction in WHO risk drinking levels of at least 2 levels was associated with lower healthcare costs over 1 and 3 years. Our results add to literature showing drinking reductions are associated with improvement in health.
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Affiliation(s)
- Arnie P Aldridge
- From the Behavioral Health Research Division, RTI International, NC (APA, GAZ, WND), Department of Psychology, University of NewMexico, 2650 Yale SE MSC11-6280, Albuquerque, NM (KW), Department of Epidemiology, Columbia University, New York, NY (DSH), Department of Medicine, Yale University, Connecticut Mental Health Center, New Haven, CT (SSO), Anthem Inc., Indianapolis, IN (KI), Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (RFA)
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Ekhtiari H, Zare-Bidoky M, Sangchooli A, Janes AC, Kaufman MJ, Oliver JA, Prisciandaro JJ, Wüstenberg T, Anton RF, Bach P, Baldacchino A, Beck A, Bjork JM, Brewer J, Childress AR, Claus ED, Courtney KE, Ebrahimi M, Filbey FM, Ghahremani DG, Azbari PG, Goldstein RZ, Goudriaan AE, Grodin EN, Hamilton JP, Hanlon CA, Hassani-Abharian P, Heinz A, Joseph JE, Kiefer F, Zonoozi AK, Kober H, Kuplicki R, Li Q, London ED, McClernon J, Noori HR, Owens MM, Paulus MP, Perini I, Potenza M, Potvin S, Ray L, Schacht JP, Seo D, Sinha R, Smolka MN, Spanagel R, Steele VR, Stein EA, Steins-Loeber S, Tapert SF, Verdejo-Garcia A, Vollstädt-Klein S, Wetherill RR, Wilson SJ, Witkiewitz K, Yuan K, Zhang X, Zilverstand A. A methodological checklist for fMRI drug cue reactivity studies: development and expert consensus. Nat Protoc 2022; 17:567-595. [PMID: 35121856 PMCID: PMC9063851 DOI: 10.1038/s41596-021-00649-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/21/2021] [Indexed: 12/23/2022]
Abstract
Cue reactivity is one of the most frequently used paradigms in functional magnetic resonance imaging (fMRI) studies of substance use disorders (SUDs). Although there have been promising results elucidating the neurocognitive mechanisms of SUDs and SUD treatments, the interpretability and reproducibility of these studies is limited by incomplete reporting of participants' characteristics, task design, craving assessment, scanning preparation and analysis decisions in fMRI drug cue reactivity (FDCR) experiments. This hampers clinical translation, not least because systematic review and meta-analysis of published work are difficult. This consensus paper and Delphi study aims to outline the important methodological aspects of FDCR research, present structured recommendations for more comprehensive methods reporting and review the FDCR literature to assess the reporting of items that are deemed important. Forty-five FDCR scientists from around the world participated in this study. First, an initial checklist of items deemed important in FDCR studies was developed by several members of the Enhanced NeuroImaging Genetics through Meta-Analyses (ENIGMA) Addiction working group on the basis of a systematic review. Using a modified Delphi consensus method, all experts were asked to comment on, revise or add items to the initial checklist, and then to rate the importance of each item in subsequent rounds. The reporting status of the items in the final checklist was investigated in 108 recently published FDCR studies identified through a systematic review. By the final round, 38 items reached the consensus threshold and were classified under seven major categories: 'Participants' Characteristics', 'General fMRI Information', 'General Task Information', 'Cue Information', 'Craving Assessment Inside Scanner', 'Craving Assessment Outside Scanner' and 'Pre- and Post-Scanning Considerations'. The review of the 108 FDCR papers revealed significant gaps in the reporting of the items considered important by the experts. For instance, whereas items in the 'General fMRI Information' category were reported in 90.5% of the reviewed papers, items in the 'Pre- and Post-Scanning Considerations' category were reported by only 44.7% of reviewed FDCR studies. Considering the notable and sometimes unexpected gaps in the reporting of items deemed to be important by experts in any FDCR study, the protocols could benefit from the adoption of reporting standards. This checklist, a living document to be updated as the field and its methods advance, can help improve experimental design, reporting and the widespread understanding of the FDCR protocols. This checklist can also provide a sample for developing consensus statements for protocols in other areas of task-based fMRI.
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Affiliation(s)
- Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, OK, USA. .,Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Mehran Zare-Bidoky
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Shahid-Sadoughi University of Medical Sciences, Yazd, Iran.,These authors contributed equally: Mehran Zare-Bidoky, Arshiya Sangchooli
| | - Arshiya Sangchooli
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,These authors contributed equally: Mehran Zare-Bidoky, Arshiya Sangchooli
| | - Amy C. Janes
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Marc J. Kaufman
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Jason A. Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.,TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA.,Department of Psychiatry & Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - James J. Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Torsten Wüstenberg
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick Bach
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Alex Baldacchino
- Division of Population Studies and Behavioural Sciences, St Andrews University Medical School, University of St Andrews, Scotland, UK
| | - Anne Beck
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany.,Faculty of Health, Health and Medical University, Campus Potsdam, Potsdam, Germany
| | - James M. Bjork
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Judson Brewer
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Anna Rose Childress
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eric D. Claus
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - Kelly E. Courtney
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Mohsen Ebrahimi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Francesca M. Filbey
- Center for BrainHealth, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Dara G. Ghahremani
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Peyman Ghobadi Azbari
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Biomedical Engineering, Shahed University, Tehran, Iran
| | - Rita Z. Goldstein
- Departments of Psychiatry & Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna E. Goudriaan
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam and Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Erica N. Grodin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - J. Paul Hamilton
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Colleen A. Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Jane E. Joseph
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Falk Kiefer
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Arash Khojasteh Zonoozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.,Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedy Kober
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - Qiang Li
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
| | - Edythe D. London
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Hamid R. Noori
- International Center for Primate Brain Research, Center for Excellence in Brain Science and Intelligence Technology (CEBSIT)/Institute of Neuroscience (ION), Chinese Academy of Sciences, Shanghai, China.,McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Max M. Owens
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Irene Perini
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marc Potenza
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Connecticut Mental Health Center, New Haven, CT, USA.,Connecticut Council on Problem Gambling, Wethersfield, CT, USA.,Department of Neuroscience, Child Study Center and Wu Tsai Institute, Yale School of Medicine, New Haven, CT, USA
| | - Stéphane Potvin
- Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal, University of Montreal, Montreal, Canada
| | - Lara Ray
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Dongju Seo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rajita Sinha
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Michael N. Smolka
- Department of Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Rainer Spanagel
- Institute of Psychopharmacology, Central Institute of Mental Health, Mannheim, Germany
| | - Vaughn R. Steele
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Elliot A. Stein
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Susan F. Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | | | - Sabine Vollstädt-Klein
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Reagan R. Wetherill
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J. Wilson
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi’an, China
| | - Xiaochu Zhang
- Department of Psychology, School of Humanities and Social Science, University of Science and Technology of China, Anhui, China.,Department of Radiology, First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Science at the Microscale and School of Life Science, Division of Life Science and Medicine, University of Science and Technology of China, Anhui, China
| | - Anna Zilverstand
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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9
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Prisciandaro JJ, Hoffman M, Brown TR, Voronin K, Book S, Bristol E, Anton RF. Effects of Gabapentin on Dorsal Anterior Cingulate Cortex GABA and Glutamate Levels and Their Associations With Abstinence in Alcohol Use Disorder: A Randomized Clinical Trial. Am J Psychiatry 2021; 178:829-837. [PMID: 34256607 PMCID: PMC9161238 DOI: 10.1176/appi.ajp.2021.20121757] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although gabapentin has demonstrated efficacy in mitigating alcohol withdrawal symptoms and preventing relapse drinking in individuals with alcohol use disorder (AUD), the neurobiological mechanisms of action underlying these therapeutic effects remain unknown. The present study evaluated changes in GABA and glutamate levels in the dorsal anterior cingulate cortex (dACC) as candidate mechanisms of action. METHODS In a 16-week randomized clinical trial, 68 adults with AUD, including a history of alcohol withdrawal syndrome, received 1,200 mg/day of gabapentin (N=37) or placebo (N=31) and nine medical management visits after ≥72 hours of abstinence. Proton MR spectroscopy (1H-MRS) estimates of dACC levels of GABA (N=67) and glutamate (N=64) were acquired before start of treatment and again approximately 14 days after randomization. Percent days abstinent was reported via timeline followback interview. RESULTS The effects of gabapentin on GABA and glutamate levels were significantly associated with participants' percent days abstinent during early treatment. Specifically, gabapentin was associated with greater increases in glutamate and greater decreases in GABA levels in participants who remained mostly or entirely abstinent, and yet the opposite in participants who drank on more than half of the days preceding the second scan. Furthermore, gabapentin-treated participants with greater increases in glutamate levels during early treatment had significantly more percent days abstinent across the remainder of the study, relative to placebo-treated participants. CONCLUSIONS In addition to providing insight into the mechanisms through which gabapentin may promote abstinence in individuals with AUD, this study also provides evidence for a biomarker of efficacious treatment that may be used to evaluate other glutamatergic or GABAergic medications for AUD and related conditions.
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Affiliation(s)
- James J. Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of SC, Charleston, SC, Corresponding author,
| | - Michaela Hoffman
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of SC, Charleston, SC
| | - Truman R. Brown
- Department of Radiology, Medical University of SC, Charleston, SC
| | - Konstantin Voronin
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of SC, Charleston, SC
| | - Sarah Book
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of SC, Charleston, SC
| | - Emily Bristol
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of SC, Charleston, SC
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of SC, Charleston, SC
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10
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Shmulewitz D, Aharonovich E, Witkiewitz K, Anton RF, Kranzler HR, Scodes J, Mann KF, Wall MM, Hasin D. The World Health Organization Risk Drinking Levels Measure of Alcohol Consumption: Prevalence and Health Correlates in Nationally Representative Surveys of U.S. Adults, 2001-2002 and 2012-2013. Am J Psychiatry 2021; 178:548-559. [PMID: 33472388 PMCID: PMC8222066 DOI: 10.1176/appi.ajp.2020.20050610] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 01/08/2023]
Abstract
OBJECTIVE Little is known about change over time in the prevalence of World Health Organization (WHO) risk drinking levels (very high, high, moderate, low) and their association with health conditions, overall and by gender. The authors used two sets of nationally representative U.S. survey data to determine whether changes over time varied by gender and to examine whether health conditions related to alcohol were associated with WHO risk drinking level within each survey, and whether these associations differed by gender. METHODS Data on current drinkers from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N=26,655) and the 2012-2013 NESARC-III (N=25,659) were analyzed using logistic regression. Prevalence differences between surveys were estimated for each drinking level overall and by gender. Within each survey, prevalence differences by WHO risk drinking level were estimated for alcohol use disorder (AUD), drug use disorders, functional impairment, liver disease, and depressive and anxiety disorders. RESULTS In the 2012-2013 survey, the prevalences of moderate, high, and very high risk drinking were 5.9%, 3.2%, and 3.5%, respectively, representing significant increases from the prevalences in the 2001-2002 survey, which were 1.0%, 0.6%, and 0.9%, respectively. The increase for very high risk drinking among men (0.5%) was smaller than the increase among women (1.4%). Within both surveys, compared with low risk, health conditions were significantly associated with very high risk (range of prevalence differences, 2.2%-57.8%), high risk (2.6%-41.3%), and moderate risk (0.6%-29.8%) drinking. Associations were similar by gender, except that there were stronger effects for AUD in men and for functional impairment and depressive and anxiety disorders in women. CONCLUSIONS The increase in potentially problematic drinking levels among U.S. adults emphasizes the need for better prevention and treatment strategies. The study results support the validity of the WHO risk drinking levels, which show clinical utility as nonabstinent drinking reduction treatment goals. Such goals could engage more people in treatment, improving public health by decreasing personal and societal consequences of risk drinking.
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Affiliation(s)
- Dvora Shmulewitz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Efrat Aharonovich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | | | - Karl F Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Deborah Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | -
- Department of Psychiatry, Columbia University Irving Medical Center, New York (Shmulewitz, Aharonovich, Wall, Hasin); New York State Psychiatric Institute, New York (Shmulewitz, Aharonovich, Scodes, Wall, Hasin); Department of Psychology, University of New Mexico, Albuquerque (Witkiewitz); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (Anton); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Kranzler); Crescenz Veterans Affairs Medical Center, Philadelphia (Kranzler); Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (Mann); Department of Biostatistics (Wall) and Department of Epidemiology (Hasin), Mailman School of Public Health, Columbia University, New York
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11
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Witkiewitz K, Kranzler HR, Hallgren KA, Hasin DS, Aldridge AP, Zarkin GA, Mann KF, O'Malley SS, Anton RF. Stability of Drinking Reductions and Long-term Functioning Among Patients with Alcohol Use Disorder. J Gen Intern Med 2021; 36:404-412. [PMID: 33180306 PMCID: PMC7878601 DOI: 10.1007/s11606-020-06331-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/18/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The World Health Organization (WHO) categorizes alcohol consumption according to grams consumed into low-, medium-, high-, and very-high-risk drinking levels (RDLs). Although abstinence has been considered the ideal outcome of alcohol treatment, reductions in WHO RDLs have been proposed as primary outcomes for alcohol use disorder (AUD) trials. OBJECTIVE The current study examines the stability of WHO RDL reductions and the association between RDL reductions and long-term functioning for up to 3 years following treatment. DESIGN AND PARTICIPANTS Secondary data analysis of patients with AUD enrolled in the COMBINE Study and Project MATCH, two multi-site, randomized AUD clinical trials, who were followed for up to 3 years post-treatment (COMBINE: n = 694; MATCH: n = 806). MEASURES Alcohol use was measured via calendar-based methods. We estimated all models in the total sample and among participants who did not achieve abstinence during treatment. KEY RESULTS One-level RDL reductions were achieved by 84% of patients at the end of treatment, with 84.9% of those individuals maintaining that reduction at a 3-year follow-up. Two-level RDL reductions were achieved by 68% of patients at the end of treatment, with 77.7% of those individuals maintaining that reduction at a 3-year follow-up. One- and two-level RDL reductions at the end of treatment were associated with significantly better mental health, quality of life (including physical quality of life), and fewer drinking consequences 3 years after treatment (p < 0.05), as compared to no change or increased drinking. CONCLUSION AUD patients can maintain WHO RDL reductions for up to 3 years after treatment. Patients who had WHO RDL reductions functioned significantly better than those who did not reduce their drinking. These findings are consistent with prior reports suggesting that drinking reductions, short of abstinence, yield meaningful improvements in patient health, well-being, and functioning.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, 87131, USA.
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Arnie P Aldridge
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - Gary A Zarkin
- Behavioral Health Research Division, RTI International, Research Triangle Park, NC, USA
| | - Karl F Mann
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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12
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Prisciandaro JJ, Schacht JP, Prescot AP, Brenner HM, Renshaw PF, Brown TR, Anton RF. Intraindividual changes in brain GABA, glutamate, and glutamine during monitored abstinence from alcohol in treatment-naive individuals with alcohol use disorder. Addict Biol 2020; 25:e12810. [PMID: 31373138 PMCID: PMC7953366 DOI: 10.1111/adb.12810] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 03/04/2019] [Revised: 06/13/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
Abstract
Proton magnetic resonance spectroscopy (1 H-MRS) studies have demonstrated abnormal levels of a variety of neurometabolites in treatment-seeking individuals with moderate-severe alcohol use disorder (AUD) following acute withdrawal. In contrast, few studies have investigated neurochemical changes across early abstinence in less severe, treatment-naïve AUD. The present study, which represents the primary report of a research grant from ABMRF/The Alcohol Research Fund, measured dorsal anterior cingulate cortex (dACC) GABA, glutamate, and glutamine levels in treatment-naïve AUD (n = 23) via three 1 H-MRS scans spaced across a planned week of abstinence from alcohol. In addition to AUD participants, 12 light drinkers completed two scans, separated by 48 hours, to ensure that results in AUD were not produced by between-scan differences other than abstinence from alcohol. 1 H-MRS spectra were acquired in dACC at each scan using 2D J-resolved point-resolved spectroscopy. Linear mixed modeling results demonstrated a significant increase in GABA, but not glutamate or glutamine (Ps = .237-.626), levels between scans 1 and 2 (+8.88%, .041), with no difference between scans 2 and 3 (+1.00%, .836), in AUD but not LD (F = 1.24, .290) participants. Exploratory regression analyses tentatively revealed a number of significant prospective associations between changes in glutamine levels and heavy drinking, craving, and withdrawal symptoms. Most notably, the present study demonstrated return from abnormally low to normal GABA levels in treatment-naïve AUD within 3 days of their last drink; the pattern of results was consistent with glutamate and glutamine disturbances being exclusive to relatively more severe AUD.
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Affiliation(s)
- James J. Prisciandaro
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston SC USA
| | - Joseph P. Schacht
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston SC USA
| | | | - Helena M. Brenner
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston SC USA
| | - Perry F. Renshaw
- Department of Psychiatry University of Utah Salt Lake City UT USA
| | - Truman R. Brown
- Department of Radiology Medical University of South Carolina Charleston SC USA
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston SC USA
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13
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Anton RF, Hoffman M. Changed Primary Outcome Between Trial Registration and Publication-Reply. JAMA Intern Med 2020; 180:1551-1552. [PMID: 32677668 DOI: 10.1001/jamainternmed.2020.2173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Raymond F Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Michaela Hoffman
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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14
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Anton RF, Voronin KE, Book SW, Latham PK, Randall PK, Glen WB, Hoffman M, Schacht JP. Opioid and Dopamine Genes Interact to Predict Naltrexone Response in a Randomized Alcohol Use Disorder Clinical Trial. Alcohol Clin Exp Res 2020; 44:2084-2096. [PMID: 32772383 DOI: 10.1111/acer.14431] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND While the opiate antagonist, naltrexone, is approved for treating alcohol use disorder (AUD), not everyone who receives the medication benefits from it. This study evaluated whether the OPRM1 SNP rs1799971 interacts with the dopamine transporter gene DAT1/SLC6A3 VNTR rs28363170 or the catechol-O-methyltransferase (COMT) gene SNP rs4680 in predicting naltrexone response. METHODS Individuals who met DSM-IV alcohol dependence were randomly assigned to naltrexone (50 mg/d) or placebo based on their OPRM1 genotype (75 G-allele carriers and 77 A-allele homozygotes) and also genotyped for DAT1 VNTR (9 vs. 10 repeats) or COMT SNP (val/val vs. met carriers). Heavy drinking days (%HDD) were evaluated over 16 weeks and at the end of treatment. Effect sizes (d) for naltrexone response were calculated based on genotypes. RESULTS Naltrexone, relative to placebo, significantly reduced %HDD among OPRM1 G carriers who also had DAT1 10/10 (p = 0.021, d = 0.72) or COMT val/val genotypes (p = 0.05, d = 0.80), and to a lesser degree in those OPRM1 A homozygotes who were also DAT1 9-repeat carriers (p = 0.09, d = 0.70) or COMT met carriers (p = 0.03, d = 0.63). All other genotype combinations showed no differential response to naltrexone. Diarrhea/abdominal pain was more prominent in OPRM1 A homozygotes who were also DAT 9 or COMT met carriers. CONCLUSIONS These results suggest that individuals with AUD with a more opioid-responsive genotype (OPRM1 G carriers) respond better to naltrexone if they have genotypes indicating normal/less dopamine tone (DAT1 10,10 or COMT val,val), while those with a less responsive opioid-responsive genotype (OPRM1 A homozygotes) respond better to naltrexone if they have genotypes indicating greater dopamine tone (DAT1 9-repeat or COMT met carriers). These results could lead to more personalized AUD treatments.
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Affiliation(s)
- Raymond F Anton
- From the, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Konstantin E Voronin
- From the, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah W Book
- From the, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Patricia K Latham
- From the, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Patrick K Randall
- From the, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Willam Bailey Glen
- From the, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michaela Hoffman
- From the, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph P Schacht
- From the, Department of Psychiatry and Behavioral Sciences, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina, USA
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15
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Witkiewitz K, Heather N, Falk DE, Litten RZ, Hasin DS, Kranzler HR, Mann KF, O'Malley SS, Anton RF. World Health Organization risk drinking level reductions are associated with improved functioning and are sustained among patients with mild, moderate and severe alcohol dependence in clinical trials in the United States and United Kingdom. Addiction 2020; 115:1668-1680. [PMID: 32056311 PMCID: PMC7841874 DOI: 10.1111/add.15011] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 07/26/2019] [Revised: 11/11/2019] [Accepted: 02/10/2020] [Indexed: 02/04/2023]
Abstract
AIMS To examine whether World Health Organization (WHO) risk-level reductions in drinking were achievable, associated with improved functioning and maintained over time among patients at varying initial alcohol dependence severity levels. Design and setting Secondary data analysis of multi-site randomized clinical trials: the US Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study and the UK Alcohol Treatment Trial (UKATT). PARTICIPANTS Individuals with alcohol dependence enrolled in COMBINE (n = 1383; 68.8% male) and seeking treatment for alcohol problems in UKATT (n = 742; 74.1% male). Interventions Naltrexone, acamprosate or placebo, and combined behavioral intervention or medication management in COMBINE. Social behavior network therapy or motivational enhancement therapy in UKATT. MEASUREMENTS WHO risk-level reductions were assessed via the calendar method. Alcohol dependence was measured by the Alcohol Dependence Scale, the Leeds Dependence Questionnaire and the Diagnostic and Statistical Manual of Mental Disorders. Measures of functioning included alcohol-related consequences (Drinker Inventory of Consequences and Alcohol Problems Questionnaire), mental health (Short Form Health Survey) and liver enzyme tests. FINDINGS One- and two-level reductions in WHO risk levels in the last month of treatment were maintained at the 1-year follow-up [adjusted odds ratio (OR), 95% confidence interval (CI) = one-level reduction in COMBINE: 3.51 (2.73, 4.29) and UKATT: 2.65 (2.32, 2.98)] and associated with fewer alcohol-related consequences [e.g. B, 95% CI = one-level reduction COMBINE: -26.22 (-30.62, -21.82)], better mental health [e.g. B, 95% CI = one-level reduction UKATT: 9.53 (7.36, 11.73)] and improvements in γ-glutamyltransferase [e.g. B, 95% CI = one-level reduction UKATT: -89.77 (-122.50, -57.04)] at the end of treatment, even among patients with severe alcohol dependence. Results were similar when abstainers were excluded. Conclusions Reductions in World Health Organization risk levels for alcohol consumption appear to be achievable, associated with better functioning and maintained over time in both the United States and the United Kingdom.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque NM, USA
| | - Nick Heather
- Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Daniel E. Falk
- National Institute on Alcohol Abuse and Alcoholism Bethesda MD USA
| | - Raye Z. Litten
- National Institute on Alcohol Abuse and Alcoholism Bethesda MD USA
| | | | - Henry R. Kranzler
- Department of Psychiatry University of Pennsylvania Philadelphia PA USA
| | - Karl F. Mann
- Central Institute of Mental Health, Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | | | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston SC USA
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16
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Sakran JV, Mehta A, Matar MM, Wilson DA, Kent AJ, Anton RF, Fakhry SM. The Utility of Carbohydrate-Deficient Transferrin in Identifying Chronic Alcohol Users in the Injured Patient: Expanding the Toolkit. J Surg Res 2020; 257:92-100. [PMID: 32818790 DOI: 10.1016/j.jss.2020.07.027] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/21/2020] [Accepted: 07/17/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Alcohol use remains abundant in patients with traumatic injury. Previous studies have suggested that serum carbohydrate-deficient transferrin (%dCDT) levels, relative to blood alcohol levels (BALs), may better differentiate episodic binge drinkers from sustained heavy consumers in admitted patients with traumatic injury. We characterized %dCDT levels and BAL levels to differentiate binge drinkers from sustained heavy consumers in admitted trauma patients and their associations with outcomes. METHODS This prospective, cross-sectional, observational study assessed %dCDT and BAL levels in admitted male and female patients with traumatic injury (≥18 y) at an American College of Surgeons Committee on Trauma level-1 center from July 2014 to June 2016. We designated patients with %dCDT levels ≥1.7% (CDT+) as chronic alcohol users and dichotomized acutely intoxicated patients using three different BAL-level thresholds. Primary outcomes included in-hospital complications, along with prolonged ventilation and intensive care unit length of stay, both defined as the top decile. Secondary outcomes included rates of drug or alcohol withdrawal and all-cause mortality. Analyses were adjusted for clinical factors. RESULTS We studied 715 patients (77.5% men, 60.6% ≤ 40 y of age, median Injury Severity Score: 14, 41.7% motor vehicle crashes, 17.9% gunshot wounds, 11.1% falls). While 31.0% were CDT+, 48.7% were BAL>0. After adjusting for CDT levels, BAL levels >0, >100, or >200 were not associated with adverse outcomes. However, CDT+ relative to patients with CDT were associated with complications (adjusted odds ratio: 1.96 [1.24-3.09]), prolonged ventilation days (3.23 [1.08-9.65]), and prolonged intensive care unit stays (2.83 [1.20-6.68]). CONCLUSIONS In this 2-year prospective, cross-sectional, and observational study, we found that %dCDT levels, relative to BAL levels, may better stratify admitted patients with traumatic injury into acute versus chronic alcohol users, identifying those at higher risk for in-hospital complications.
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Affiliation(s)
- Joseph V Sakran
- Johns Hopkins Hospital, Department of Surgery, Baltimore, Maryland.
| | - Ambar Mehta
- Johns Hopkins University, School of Medicine, Baltimore, Maryland; NewYork-Presbyterian, Columbia University Medical Center, Department of Surgery, New York, New York
| | - Maher M Matar
- The Ottawa Hospital, Department of Surgery, Ottawa, Ontario, Canada
| | - Dulaney A Wilson
- Medical University of South Carolina, Department of Surgery, Charleston, South Carolina
| | - Alistair J Kent
- Johns Hopkins Hospital, Department of Surgery, Baltimore, Maryland
| | - Raymond F Anton
- Medical University of South Carolina, Department of Surgery, Charleston, South Carolina; Charleston Alcohol Research Center, Charleston, South Carolina
| | - Samir M Fakhry
- Reston Hospital Center, Department of Surgery, Reston, Virginia
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Hartwell EE, Feinn R, Morris PE, Gelernter J, Krystal J, Arias AJ, Hoffman M, Petrakis I, Gueorguieva R, Schacht JP, Oslin D, Anton RF, Kranzler HR. Systematic review and meta-analysis of the moderating effect of rs1799971 in OPRM1, the mu-opioid receptor gene, on response to naltrexone treatment of alcohol use disorder. Addiction 2020; 115:1426-1437. [PMID: 31961981 PMCID: PMC7340566 DOI: 10.1111/add.14975] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 08/21/2019] [Revised: 11/07/2019] [Accepted: 01/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS There is wide inter-individual variability in response to the treatment of alcohol use disorder (AUD) with the opioid receptor antagonist naltrexone. To identify patients who may be most responsive to naltrexone treatment, studies have examined the moderating effect of rs1799971, a single nucleotide polymorphism (SNP) that encodes a non-synonymous substitution (Asn40Asp) in the mu-opioid receptor gene, OPRM1. The aims of this study were to: (1) conduct a systematic review of randomized clinical trials (RCTs); (2) assess the bias of the available studies and gauge publication bias; and (3) meta-analyze the interaction effect of the Asn40Asp SNP on the response to naltrexone treatment. METHODS We searched for placebo-controlled RCTs that examined the effect of Asn40Asp on the response to naltrexone treatment of heavy drinking or AUD. We tested the hypothesis that the minor (Asp40) allele was associated with a greater reduction in five alcohol consumption measures (relapse to heavy drinking, abstinence, percentage of heavy drinking days, percentage of days abstinent and drinks per day) in naltrexone-treated participants by meta-analyzing the interaction effects using a random effects model. RESULTS Seven RCTs met the study criteria. Overall, risk of bias was low and we observed no evidence of publication bias. Of the five alcohol consumption outcomes considered, there was a nominally significant moderating effect of the Asn40Asp SNP only on drinks per day (d = -0.18, P = 0.02). However, the effect was not significant when multiple comparisons were taken into account. CONCLUSIONS From the evidence to date, it remains unclear whether rs1799971, the OPRM1 Asn40Asp single nucleotide polymorphism, predicts naltrexone treatment response in individuals with alcohol use disorder or heavy drinking.
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Affiliation(s)
- Emily E. Hartwell
- Mental Illness Research, Education and Clinical Center, Cpl. Michael J. Crescenz VAMC, Philadelphia, PA 19104,Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Richard Feinn
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT 06473
| | - Paige E. Morris
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Joel Gelernter
- Departments of Psychiatry, Genetics, and Neuroscience, Yale University School of Medicine, and VA Connecticut Healthcare, West Haven, CT 06516
| | - John Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
| | - Albert J. Arias
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA 23298
| | - Michaela Hoffman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Ismene Petrakis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
| | - Joseph P. Schacht
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - David Oslin
- Mental Illness Research, Education and Clinical Center, Cpl. Michael J. Crescenz VAMC, Philadelphia, PA 19104,Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425
| | - Henry R. Kranzler
- Mental Illness Research, Education and Clinical Center, Cpl. Michael J. Crescenz VAMC, Philadelphia, PA 19104,Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104,To whom correspondence should be addressed at: Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 500, Philadelphia, PA 19104; Telephone: 215-746-1943;
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18
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Meredith LR, Maralit AM, Thomas SE, Rivers SL, Salazar CA, Anton RF, Tomko RL, Squeglia LM. Piloting of the Just Say Know prevention program: a psychoeducational approach to translating the neuroscience of addiction to youth. Am J Drug Alcohol Abuse 2020; 47:16-25. [PMID: 32687415 DOI: 10.1080/00952990.2020.1770777] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Substance use during adolescence can have a number of negative consequences and interfere with normal brain development. Given limited time and resources, brief group- and school-based prevention programs are an efficient strategy for educating youth about the effects of substance use on health outcomes. OBJECTIVES To determine if a science-based, interactive substance prevention program could improve student knowledge and influence students' attitudes toward future substance use behaviors. METHODS The Just Say Know program was given to 1,594 middle and high school students. The facilitator engaged students in an interactive, hour-long session covering brain basics and effects of substance use. Students completed an eight-item pre- and post-knowledge-based test to measure learning outcomes along with feedback questions about youths' attitudes toward substance use and the program. RESULTS After the program, 94% of students reported that it provided helpful information; 92% reported it may influence their approach to substance use, with 76% specifying that they would delay or cut back on substance use. Knowledge-based test performance increased by 78%, with high schoolers displaying significantly higher scores than middle schoolers, but both showing similar improvements in scores. Students who reported higher levels of friends' substance use had smaller improvements from pre- to posttest. CONCLUSION Results suggest Just Say Know, a scientifically-based prevention program, is effective in increasing adolescents' program based-knowledge, has the potential to affect youths' attitudes toward substance use, and is well-received. These findings provide preliminary evidence that a cost-effective, neuroscience-informed group prevention program might reduce or delay adolescents' future substance use.
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Affiliation(s)
- Lindsay R Meredith
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Anna M Maralit
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Suzanne E Thomas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sylvia L Rivers
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Claudia A Salazar
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel L Tomko
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lindsay M Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Anton RF, Latham P, Voronin K, Book S, Hoffman M, Prisciandaro J, Bristol E. Efficacy of Gabapentin for the Treatment of Alcohol Use Disorder in Patients With Alcohol Withdrawal Symptoms: A Randomized Clinical Trial. JAMA Intern Med 2020; 180:728-736. [PMID: 32150232 PMCID: PMC7063541 DOI: 10.1001/jamainternmed.2020.0249] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Although an estimated 30 million people meet criteria for alcohol use disorder (AUD), few receive appropriate pharmacotherapy. A more personalized, symptom-specific, approach might improve efficacy and acceptance. OBJECTIVE To examine whether gabapentin would be useful in the treatment of AUD, especially in those with the most alcohol withdrawal symptoms. DESIGN, SETTING, AND PARTICIPANTS This double-blind randomized clinical trial conducted between November 2014 and June 2018 evaluated gabapentin vs placebo in community-recruited participants screened and treated in an academic outpatient setting over a 16-week treatment period. A total of 145 treatment-seeking individuals who met Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for AUD and were not receiving other AUD intervention were screened, and 96 who also met recent alcohol withdrawal criteria were randomized to treatment after 3 abstinent days. Daily drinking was recorded, and percentage of disialo carbohydrate-deficient transferrin in the blood, a heavy drinking marker, was collected at baseline and monthly during treatment. INTERVENTIONS Gabapentin up to 1200 mg/d, orally, vs placebo along with 9 medical management visits (20 minutes each). MAIN OUTCOMES AND MEASURES The percentage of individuals with no heavy drinking days and those with total abstinence were compared between treatment groups and further evaluated based on prestudy alcohol withdrawal symptoms. RESULTS Of 96 randomized individuals, 90 were evaluable (44 in the gabapentin arm and 46 in the placebo arm), with a mean (SD) age of 49.6 (10.1) years; 69 were men (77%) and 85 were white (94%). The evaluable participants had 83% baseline heavy drinking days (4 or more drinks/day for women, 5 or more for men) and met 4.5 alcohol withdrawal criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). More gabapentin-treated individuals had no heavy drinking days (12 of 44 participants [27%]) compared with placebo (4 of 46 participants [9%]), a difference of 18.6% (95% CI, 3.1-34.1; P = .02; number needed to treat [NNT], 5.4), and more total abstinence (8 of 44 [18%]) compared with placebo (2 of 46 [4%]), a difference of 13.8% (95% CI, 1.0-26.7; P = .04; NNT, 6.2). The prestudy high-alcohol withdrawal group had positive gabapentin effects on no heavy drinking days (P < .02; NNT, 3.1) and total abstinence (P = .003; NNT, 2.7) compared with placebo, while within the low-alcohol withdrawal group, there were no significant differences. These findings were similar for other drinking variables, where gabapentin was more efficacious than placebo in the high-alcohol withdrawal group only. Gabapentin caused more dizziness, but this did not affect efficacy. CONCLUSIONS AND RELEVANCE These data, combined with others, suggest gabapentin might be most efficacious in people with AUD and a history of alcohol withdrawal symptoms. Future studies should evaluate sleep changes and mood during early recovery as mediators of gabapentin efficacy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02349477.
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Affiliation(s)
- Raymond F Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Patricia Latham
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Konstantin Voronin
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Sarah Book
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Michaela Hoffman
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - James Prisciandaro
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Emily Bristol
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
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Anton RF, Witkiewitz K, Falk D, Litten R, Hasin D, Mann K, O'Malley S. Response to Dr. Mark Litt's Commentary. Alcohol Clin Exp Res 2019; 43:2255-2256. [DOI: 10.1111/acer.14160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Raymond F. Anton
- From the Medical University of South Carolina Charleston South Carolina
| | | | - Daniel Falk
- National Institutes of Health ‐ National Institute on Alcohol & Alcoholism Rockville Maryland
| | - Raye Litten
- National Institutes of Health ‐ National Institute on Alcohol & Alcoholism Rockville Maryland
| | | | - Karl Mann
- University of Heidelberg Mannheim Germany
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21
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Schacht JP, Anton RF, McNamara PJ, Im Y, King AC. The dopamine transporter VNTR polymorphism moderates the relationship between acute response to alcohol and future alcohol use disorder symptoms. Addict Biol 2019; 24:1109-1118. [PMID: 30230123 DOI: 10.1111/adb.12676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/16/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 12/19/2022]
Abstract
Alcohol use disorder (AUD) is a genetically influenced disease with peak onset in young adulthood. Identification of factors that predict whether AUD symptoms will diminish or persist after young adulthood is a critical public health need. King and colleagues previously reported that acute response to alcohol predicted future AUD symptom trajectory. Genes associated with brain dopamine signaling, which underlies alcohol's rewarding effects, might influence this finding. This study analyzed whether variation at a variable number tandem repeat polymorphism in DAT1/SLC6A3, the gene encoding the dopamine transporter, moderated the predictive relationships between acute response to alcohol and future AUD symptoms among participants enrolled in the Chicago Social Drinking Project (first two cohorts). Heavy-drinking young adults (N = 197) completed an alcohol challenge, in which acute response (liking, wanting, stimulation, and sedation) was measured. Alcohol use disorder symptoms were assessed over the following 6 years. DAT1 genotype significantly moderated the interactions between follow-up time and alcohol liking (P = 0.006) and wanting (P = 0.006) in predicting future AUD symptoms. These predictive effects were strongest among participants who carried the DAT1 9-repeat allele, previously associated with enhanced striatal dopamine tone relative to the 10-repeat allele. Exploratory analyses indicated that DAT1 effects on the relationship between alcohol liking and AUD symptoms appeared stronger for females (n = 79) than males (n = 118) (P = 0.0496). These data suggest that heavy-drinking DAT1 9-repeat allele carriers who display high alcohol-induced reward in young adulthood may be predisposed to persistent AUD symptoms and support combining genotypic and phenotypic information to predict future AUD risk.
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Affiliation(s)
- Joseph P. Schacht
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston South Carolina USA
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston South Carolina USA
| | - Patrick J. McNamara
- Department of Psychiatry and Behavioral Neuroscience; University of Chicago; Chicago Illinois USA
| | - Yeongbin Im
- Department of Psychiatry and Behavioral Sciences; Medical University of South Carolina; Charleston South Carolina USA
| | - Andrea C. King
- Department of Psychiatry and Behavioral Neuroscience; University of Chicago; Chicago Illinois USA
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22
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Prisciandaro JJ, Schacht JP, Prescot AP, Brenner HM, Renshaw PF, Brown TR, Anton RF. Evidence for a unique association between fronto-cortical glycine levels and recent heavy drinking in treatment naïve individuals with alcohol use disorder. Neurosci Lett 2019; 706:207-210. [PMID: 31108129 DOI: 10.1016/j.neulet.2019.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/12/2019] [Revised: 05/06/2019] [Accepted: 05/16/2019] [Indexed: 12/26/2022]
Abstract
Although the neurotransmitters/modulators glutamate and, more recently, glycine have been implicated in the development and maintenance of Alcohol Use Disorder (AUD) in preclinical research, human proton magnetic resonance spectroscopy (1H-MRS) studies have focused solely on the measurement of glutamate. The purpose of the present analysis was to examine the relative associations of brain glutamate and glycine levels with recent heavy drinking in 41 treatment naïve individuals with AUD using 1H-MRS. The present study is the first that we are aware of to report in vivo brain glycine levels from an investigation of addiction. Dorsal Anterior Cingulate Cortex (dACC) glutamate and glycine concentration estimates were obtained using Two-Dimensional J-Resolved Point Resolved Spectroscopy at 3 Tesla, and past 2-week summary estimates of alcohol consumption were assessed via the Timeline Followback method. Glutamate (β = -0.44, t = -3.09, p = 0.004) and glycine (β = -0.68, t = -5.72, p < 0.001) were each significantly, inversely associated with number of heavy drinking days when considered alone. However, when both variables were simultaneously entered into a single regression model, the effect of glutamate was no longer significant (β = -0.11, t = -0.81, p = 0.42) whereas the effect of glycine remained significant (β = -0.62, t = -4.38, p < 0.001). The present study extends the literature by demonstrating a unique, inverse association of brain glycine levels with recent heavy drinking in treatment naïve individuals with AUD. If replicated and extended, these data could lead to enhanced knowledge of how glycinergic systems change with alcohol consumption and AUD progression leading to pharmacological interventional/preventative strategies that modulate brain glycine levels.
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Affiliation(s)
- James J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of SC, Charleston, SC, United States.
| | - Joseph P Schacht
- Department of Psychiatry and Behavioral Sciences, Medical University of SC, Charleston, SC, United States
| | - Andrew P Prescot
- Department of Radiology, University of Utah, Salt Lake City, UT, United States
| | - Helena M Brenner
- Department of Psychiatry and Behavioral Sciences, Medical University of SC, Charleston, SC, United States
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Truman R Brown
- Department of Radiology, Medical University of SC, Charleston, SC, United States
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of SC, Charleston, SC, United States
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Witkiewitz K, Falk DE, Litten RZ, Hasin DS, Kranzler HR, Mann KF, O'Malley SS, Anton RF. Maintenance of World Health Organization Risk Drinking Level Reductions and Posttreatment Functioning Following a Large Alcohol Use Disorder Clinical Trial. Alcohol Clin Exp Res 2019; 43:979-987. [PMID: 30951210 PMCID: PMC6502682 DOI: 10.1111/acer.14018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/02/2019] [Indexed: 11/30/2022]
Abstract
Background Reductions in the World Health Organization (WHO) risk drinking levels have been proposed as an alternative primary outcome for alcohol clinical trials. Yet, little is known about whether reductions in WHO risk drinking levels can be maintained over time. The current study examined whether reductions in WHO risk drinking levels were maintained for up to 1 year following treatment, and whether reductions over time were associated with improvements in functioning. Methods Secondary data analysis of individuals with alcohol dependence (n = 1,226) enrolled in the COMBINE study, a multisite, randomized, placebo‐controlled clinical trial. Logistic regression was used to examine the maintenance of end‐of‐treatment WHO risk level reductions and WHO risk level reductions at the 1‐year follow‐up. Repeated‐measures mixed models were used to examine the association between WHO risk level reductions and functional outcomes over time. Results Achieving at least a 1‐ or 2‐level reduction in risk by the end of treatment was significantly associated with WHO risk level reductions at the 1‐year follow‐up assessment (p < 0.001). Among individuals who achieved at least a 1‐level reduction by the end of treatment, 85.5% reported at least a 1‐level reduction at the 1‐year follow‐up. Among individuals who achieved at least a 2‐level reduction by the end of treatment, 77.8% reported at least a 2‐level reduction at the 1‐year follow‐up. WHO risk level reductions were associated with significantly lower alcohol consumption, better physical health (p < 0.01), and fewer alcohol‐related consequences (p < 0.001) up to 1 year following treatment. Conclusions One‐ and 2‐level reductions in WHO risk levels during alcohol treatment were maintained after treatment and associated with better functioning over time. These findings support the use of the WHO risk level reductions as an outcome measure that reflects clinically significant improvement in how individuals seeking treatment for alcohol use disorder feel and function.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Deborah S Hasin
- Department of Epidemiology, Columbia University, New York, New York
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karl F Mann
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | | | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Falk DE, O’Malley SS, Witkiewitz K, Anton RF, Litten RZ, Slater M, Kranzler HR, Mann KF, Hasin DS, Johnson B, Meulien D, Ryan M, Fertig J. Evaluation of Drinking Risk Levels as Outcomes in Alcohol Pharmacotherapy Trials: A Secondary Analysis of 3 Randomized Clinical Trials. JAMA Psychiatry 2019; 76:374-381. [PMID: 30865232 PMCID: PMC6450273 DOI: 10.1001/jamapsychiatry.2018.3079] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE The US Food and Drug Administration recognizes total abstinence and no heavy drinking days as outcomes for pivotal pharmacotherapy trials for alcohol use disorder (AUD). Many patients have difficulty achieving these outcomes, which can discourage seeking treatment and has slowed the development of medications that affect alcohol use. OBJECTIVE To compare 2 drinking-reduction outcomes with total abstinence and no heavy drinking outcomes. DESIGN, SETTING, AND PARTICIPANTS Data were obtained from 3 multisite, randomized, placebo-controlled clinical trials of medications for treating alcohol dependence (naltrexone, varenicline, and topiramate) in adults with DSM-IV-categorized alcohol dependence. MAIN OUTCOMES AND MEASURES Within each trial, the percentage of participants in active and placebo conditions who met responder definitions of abstinence, no heavy drinking days, a WHO 1-level reduction, and a WHO 2-level reduction was computed by month with corresponding effect sizes (Cohen h). RESULTS Across the 3 trials (N = 1169; mean [SD] age, 45 [10] years; 824 [70.5%] men), the percentage of participants classified as responders during the last 4 weeks of treatment was lowest for abstinence (naltrexone, 34.7% [100 of 288]; varenicline, 7.3% [7 of 96]; topiramate, 11.7% [21 of 179]) followed by no heavy drinking days (naltrexone, 51.0% [147 of 288]; varenicline, 24.0% [23 of 96]; topiramate, 20.7% [37 of 179]), WHO 2-level reduction (naltrexone, 75.0% [216 of 288]; varenicline, 55.2% [53 of 96]; topiramate, 44.7% [80 of 179]), and WHO 1-level reduction (naltrexone, 83.3% [240 of 288]; varenicline, 69.8 [67 of 96]; topiramate, 54.7% [98 of 179]) outcomes. Standardized treatment effects observed for the WHO 2-level reduction outcomes (naltrexone, Cohen h = 0.214 [95% CI, 0.053 -0.375]; varenicline, 0.273 [95% CI, -0.006 to 0.553]; topiramate, 0.230 [95% CI, 0.024-0.435]) and WHO 1-level reduction (naltrexone, Cohen h = 0.116 [95% CI, -0.046 to 0.277]; varenicline, 0.338 [95% CI, 0.058-0.617]; topiramate, 0.014 [95% CI, -0.192 to 0.219]) were comparable with those obtained using abstinence (naltrexone, Cohen h = 0.142 [95% CI, -0.020 to 0.303]; varenicline, 0.146 [95% CI, -0.133 to 0.426]; topiramate, 0.369 [95% CI, 0.163-0.574]) and no heavy drinking days (naltrexone, Cohen h = 0.140 [95% CI, -0.021 to 0.302]; varenicline, 0.232 [95% CI, -0.048 to 0.511]; topiramate, 0.207 [95% CI, 0.002-0.413]). CONCLUSIONS AND RELEVANCE WHO drinking risk level reductions appear to be worthwhile indicators of treatment outcome in AUD pharmacotherapy trials. These outcomes may align with drinking reduction goals of many patients and capture clinically meaningful improvements experienced by more patients than either abstinence or no heavy drinking days. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT00006206; NCT01146613; NCT00210925.
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Affiliation(s)
- Daniel E. Falk
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | | | | | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Raye Z. Litten
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | | | | | - Karl F. Mann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany
| | - Deborah S. Hasin
- Department of Psychiatry, Mailman School of Public Health, Columbia University, New York, New York,Department of Epidemiology, Columbia University, New York, New York
| | - Bankole Johnson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | | | - Megan Ryan
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Joanne Fertig
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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Prisciandaro JJ, Schacht JP, Prescot AP, Renshaw PF, Brown TR, Anton RF. Brain Glutamate, GABA, and Glutamine Levels and Associations with Recent Drinking in Treatment-Naïve Individuals with Alcohol Use Disorder Versus Light Drinkers. Alcohol Clin Exp Res 2019; 43:221-226. [PMID: 30537347 DOI: 10.1111/acer.13931] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 08/29/2018] [Accepted: 11/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Proton magnetic resonance spectroscopy (1 H-MRS) studies have demonstrated abnormal levels of a variety of neurometabolites in inpatients/outpatients with alcohol use disorder (AUD) following acute alcohol withdrawal relative to healthy controls. In contrast, few studies have compared neurometabolite levels between less severe, treatment-naïve AUD individuals and light drinkers (LD) or related them to recent alcohol consumption. The present study compared neurometabolite levels between treatment-naïve AUD and LD individuals. METHODS Twenty treatment-naïve individuals with AUD and 20 demographically matched LD completed an 1 H-MRS scan, approximately 2.5 days following their last reported drink. 1 H-MRS data were acquired in dorsal anterior cingulate (dACC) using a 2-dimensional J-resolved point-resolved spectroscopy sequence. dACC neurometabolite levels, with a focus on glutamate, glutamine, and GABA, were compared between AUD and LD participants. The associations between metabolite levels and recent drinking were explored. RESULTS AUD participants had significantly lower concentrations of GABA (Cohen's d = 0.79, p = 0.017) and glutamine (Cohen's d = 1.12, p = 0.005), but not glutamate (Cohen's d = 0.05, p = 0.893), relative to LD. As previously reported, AUD participants' glutamate and N-acetylaspartate concentrations were inversely associated with their number of heavy drinking days. In contrast, neither number of drinking (mean p = 0.56) nor heavy drinking (mean p = 0.47) days were associated with metabolite concentrations in LD. CONCLUSIONS The present study demonstrated significantly lower levels of prefrontal γ-aminobutyric acid and glutamine in treatment-naïve individuals with AUD relative to LD. Whether these findings reflect the neurotoxic consequence and/or neuroadaptive response of alcohol consumption versus a predrinking trait, and therefore a more durable neurochemical disturbance, awaits elucidation from longitudinal studies.
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Affiliation(s)
- James J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph P Schacht
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Andrew P Prescot
- Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Truman R Brown
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Witkiewitz K, Kranzler HR, Hallgren KA, O'Malley SS, Falk DE, Litten RZ, Hasin DS, Mann KF, Anton RF. Drinking Risk Level Reductions Associated with Improvements in Physical Health and Quality of Life Among Individuals with Alcohol Use Disorder. Alcohol Clin Exp Res 2018; 42:2453-2465. [PMID: 30395350 PMCID: PMC6286196 DOI: 10.1111/acer.13897] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [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: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Abstinence and no heavy drinking days are currently the only Food and Drug Administration-approved end points in clinical trials for alcohol use disorder (AUD). Many individuals who fail to meet these criteria may substantially reduce their drinking during treatment, and most individuals with AUD prefer drinking reduction goals. One- and two-level reductions in World Health Organization (WHO) drinking risk levels have been proposed as alternative end points that reflect reduced drinking and are associated with reductions in drinking consequences, improvements in mental health, and reduced risk of developing alcohol dependence. The current study examined the association between WHO drinking risk level reductions and improvements in physical health and quality of life in a sample of individuals with alcohol dependence. METHODS Secondary data analysis of individuals with alcohol dependence (n = 1,142) enrolled in the longitudinal, prospective COMBINE study, a multi site randomized placebo-controlled clinical trial, examining the association between reductions in WHO drinking risk levels and change in blood pressure, liver enzyme levels, and self-reported quality of life following treatment for alcohol dependence. RESULTS One- and two-level reductions in WHO drinking risk level during treatment were associated with significant reductions in systolic blood pressure (p < 0.001), improvements in liver enzyme levels (all p < 0.01), and significantly better quality of life (p < 0.001). CONCLUSIONS One- and two-level reductions in WHO drinking risk levels predicted significant improvements in markers of physical health and quality of life, suggesting that the WHO drinking risk level reduction could be a meaningful surrogate marker of improvements in how a person "feels and functions" following treatment for alcohol dependence. The WHO drinking risk levels could be useful in medical practice for identifying drinking reduction targets that correspond with clinically significant improvements in health and quality of life.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology , University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Department of Psychiatry , University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences , University of Washington, Seattle, Washington
| | | | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
| | - Deborah S Hasin
- Department of Epidemiology , Columbia University, New York, New York
| | - Karl F Mann
- Medical Faculty Mannheim , Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina, Charleston, South Carolina
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Matar MM, Jewett B, Fakhry SM, Wilson DA, Ferguson PL, Anton RF, Sakran JV. Identifying chronic heavy alcohol use in emergency general surgery patients: a pilot study. Trauma Surg Acute Care Open 2018; 2:e000098. [PMID: 29766097 PMCID: PMC5877910 DOI: 10.1136/tsaco-2017-000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 11/23/2022] Open
Abstract
Background Chronic heavy alcohol (CHA) use has been associated with perioperative complications. Emergency general surgery (EGS) patients are not routinely screened for CHA. If screened, it is usually for hazardous use of alcohol, using a survey such as the Alcohol Use Disorders Identification Test (AUDIT). This study screened EGS patients for CHA use using serum carbohydrate-deficient transferrin (%dCDT) level, a biomarker that has been validated as an indicator for CHA use, as well as the AUDIT. The purpose of this study was to determine the percent of EGS patients with CHA (as indicated by elevated %dCDT), and the relationship between %dCDT and AUDIT. Secondary aims included comparing the characteristics of EGS patients with and without CHA use, and evaluating the association of CHA use with negative clinical outcomes. Methods EGS patients aged 21 and older admitted to the general surgery inpatient service of a tertiary hospital from July 2014 to June 2016 were invited to participate in this study. %dCDT levels above 1.7% were considered positive for CHA use, as were AUDIT scores ≥8. Results 195 EGS patients were screened for inclusion and 91 (46.7%) agreed to participate. 14 (15.4%) were positive for hazardous alcohol use on AUDIT and 5 (5.5%) were positive for CHA by %dCDT. Positive predictive value of AUDIT for CHA was 21.4%. There was no correlation between positive scores on AUDIT and %dCDT. Discussion Identifying at risk patients early on in their hospital course may allow clinicians to institute treatments to mitigate and/or circumvent complications in such patients. This pilot study determined that 17.6% of participating EGS patients were positive for some type of alcohol misuse, but only 5.5% had CHA. Further research is needed to determine whether routine use of %dCDT would be beneficial in reducing perioperative complications in this patient population. Level of evidence III (diagnostic test).
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Affiliation(s)
- Maher M Matar
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brent Jewett
- Department of Surgery, Trident Medical Center, Charleston, South Carolina, USA
| | - Samir M Fakhry
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dulaney A Wilson
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pamela L Ferguson
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Raymond F Anton
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,The Charleston Alcohol Center, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joseph V Sakran
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Division of Acute Care Surgery, The Johns Hopkins University, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Stewart SH, Reuben A, Anton RF. Reply: Carbohydrate Deficient Transferrin in Patients with Cirrhosis: A Tale of Bridges. Alcohol Alcohol 2018; 53:351-352. [DOI: 10.1093/alcalc/agy009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Scott H Stewart
- Division of General Internal Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adrian Reuben
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Raymond F Anton
- Addiction Sciences Division, Medical University of South Carolina, Charleston, SC 29425, USA
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Kearney-Ramos TE, Dowdle LT, Lench DH, Mithoefer OJ, Devries WH, George MS, Anton RF, Hanlon CA. Transdiagnostic Effects of Ventromedial Prefrontal Cortex Transcranial Magnetic Stimulation on Cue Reactivity. Biol Psychiatry Cogn Neurosci Neuroimaging 2018; 3:599-609. [PMID: 29776789 DOI: 10.1016/j.bpsc.2018.03.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/14/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Elevated frontal and striatal reactivity to drug cues is a transdiagnostic hallmark of substance use disorders. The goal of these experiments was to determine if it is possible to decrease frontal and striatal reactivity to drug cues in both cocaine users and heavy alcohol users through continuous theta burst stimulation (cTBS) to the left ventromedial prefrontal cortex (VMPFC). METHODS Two single-blinded, within-subject, active sham-controlled experiments were performed wherein neural reactivity to drug/alcohol cues versus neutral cues was evaluated immediately before and after receiving real or sham cTBS (110% resting motor threshold, 3600 pulses, Fp1 location; N = 49: 25 cocaine users [experiment 1], 24 alcohol users [experiment 2]; 196 total functional magnetic resonance imaging scans). Generalized psychophysiological interaction and three-way repeated-measures analysis of variance were used to evaluate cTBS-induced changes in drug cue-associated functional connectivity between the left VMPFC and eight regions of interest: ventral striatum, left and right caudate, left and right putamen, left and right insula, and anterior cingulate cortex. RESULTS In both experiments, there was a significant interaction between treatment (real/sham) and time (pre/post). In both experiments, cue-related functional connectivity was significantly attenuated following real cTBS versus sham cTBS. There was no significant interaction with region of interest for either experiment. CONCLUSIONS This is the first sham-controlled investigation to demonstrate, in two populations, that VMPFC cTBS can attenuate neural reactivity to drug and alcohol cues in frontostriatal circuits. These results provide an empirical foundation for future clinical trials that may evaluate the efficacy, durability, and clinical implications of VMPFC cTBS to treat addictions.
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Affiliation(s)
- Tonisha E Kearney-Ramos
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Logan T Dowdle
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Daniel H Lench
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Oliver J Mithoefer
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - William H Devries
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina
| | - Mark S George
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Raymond F Anton
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina
| | - Colleen A Hanlon
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson VA Medical Center, Charleston, South Carolina.
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Anton RF, Latham PK, Voronin KE, Randall PK, Book SW, Hoffman M, Schacht JP. Nicotine-Use/Smoking Is Associated with the Efficacy of Naltrexone in the Treatment of Alcohol Dependence. Alcohol Clin Exp Res 2018; 42:751-760. [PMID: 29431852 PMCID: PMC5880727 DOI: 10.1111/acer.13601] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/09/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The opioid antagonist naltrexone is not efficacious for every alcohol treatment seeker. However, various individual factors, such as genetic differences and nicotine-use/smoking status, have been suggested as predictors of naltrexone response. In a randomized clinical trial, we previously reported that nicotine-use/smoking status might be a stronger predictor of naltrexone efficacy than OPRM1 A118G single nucleotide polymorphism (SNP) genotype. In this report, we further characterize the nicotine-users in that trial, examine other drinking outcomes, examine the influence of smoking change on naltrexone effects on drinking, and validate the result in smokers with disialo carbohydrate-deficient transferrin (%dCDT) change as an independent biomarker of response. METHODS Individuals (n = 146) meeting DSM-IV criteria for alcohol dependence who were genotyped for the OPRM1 A118G SNP and who did, or did not, use nicotine/cigarettes were randomized, in a balanced fashion, to naltrexone (50 mg/d) or placebo and provided medical management (MM) over a 16-week clinical trial. Alcohol use and smoking during the trial were assessed and analyzed. RESULTS Nicotine-use/smoking status significantly interacted with medication in reducing percent heavy drinking days (PHDD) during the trial (p = 0.003), such that nicotine-users/smokers showed significantly lower PHDD on naltrexone versus placebo (p = 0.0001, Cohen's d = 0.89), while nonusers showed no significant difference between naltrexone and placebo (p = 0.95, Cohen's d = 0.02). Similar effects were shown for drinks per day and percent days drinking. The superiority of naltrexone over placebo on PHDD reduction in nicotine-users/smokers was confirmed with %dCDT (Cohen's d range 0.3 to 0.9 over the study). Naltrexone did not significantly change cigarette use in smokers, and change in use did not influence naltrexone's effect on PHDD. CONCLUSIONS These data confirm past findings that naltrexone is more efficacious in those who use nicotine/cigarettes. Compared to previous work on the OPRM1 A118G SNP, it appears that nicotine-use might be a more salient predictor of naltrexone treatment response. While naltrexone did not change cigarette use during the study, and smoking change was not related to alcohol reduction, it should be noted that participants were not seeking smoking cessation and MM did not address this issue.
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Affiliation(s)
- Raymond F Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Patricia K Latham
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Konstantin E Voronin
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Patrick K Randall
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah W Book
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Michaela Hoffman
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph P Schacht
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Hanlon CA, Dowdle LT, Correia B, Mithoefer O, Kearney-Ramos T, Lench D, Griffin M, Anton RF, George MS. Left frontal pole theta burst stimulation decreases orbitofrontal and insula activity in cocaine users and alcohol users. Drug Alcohol Depend 2017; 178:310-317. [PMID: 28686990 PMCID: PMC5896018 DOI: 10.1016/j.drugalcdep.2017.03.039] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [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] [Received: 01/06/2017] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Preclinical research has demonstrated a causal relationship between medial prefrontal cortex activity and cocaine self-administration. As a step towards translating those data to a neural circuit-based intervention for patients, this study sought to determine if continuous theta burst stimulation (cTBS) to the left frontal pole (FP), would attenuate frontal-striatal activity in two substance-dependent populations. METHODS Forty-nine substance dependent individuals (25 cocaine, 24 alcohol) completed a single-blind, sham-controlled, crossover study wherein they received 6 trains of real or sham cTBS (110% resting motor threshold, FP1) each visit. Baseline evoked BOLD signal was measured immediately before and after real and sham cTBS (interleaved TMS/BOLD imaging: single pulses to left FP; scalp-to-cortex distance covariate, FWE correction p<0.05) RESULTS: Among cocaine users, real cTBS significantly decreased evoked BOLD signal in the caudate, accumbens, anterior cingulate, orbitofrontal (OFC) and parietal cortex relative to sham cTBS. Among alcohol users, real cTBS significantly decreased evoked BOLD signal in left OFC, insula, and lateral sensorimotor cortex. There was no significant difference between the groups. CONCLUSIONS These data suggest that 6 trains of left FP cTBS delivered in a single day decreases TMS-evoked BOLD signal in the OFC and several cortical nodes which regulate salience and are typically activated by drug cues. The reliability of this pattern across cocaine- and alcohol-dependent individuals suggests that cTBS may be an effective tool to dampen neural circuits typically engaged by salient drug cues. Multiday studies are required to determine it this has a sustainable effect on the brain or drug use behavior.
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Affiliation(s)
- Colleen A. Hanlon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Neurosciences, Medical University of South Carolina,Center for Biomedical Imaging, Medical University of South Carolina
| | - Logan T. Dowdle
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Neurosciences, Medical University of South Carolina
| | | | - Oliver Mithoefer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Tonisha Kearney-Ramos
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Neurosciences, Medical University of South Carolina
| | - Daniel Lench
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Neurosciences, Medical University of South Carolina
| | - Millie Griffin
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Neurosciences, Medical University of South Carolina
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Neurosciences, Medical University of South Carolina,Center for Biomedical Imaging, Medical University of South Carolina
| | - Mark S. George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina,Department of Neurosciences, Medical University of South Carolina,Center for Biomedical Imaging, Medical University of South Carolina,Ralph H Johnson Veterans Affairs Medical Center
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Prisciandaro JJ, Tolliver BK, Prescot AP, Brenner HM, Renshaw PF, Brown TR, Anton RF. Unique prefrontal GABA and glutamate disturbances in co-occurring bipolar disorder and alcohol dependence. Transl Psychiatry 2017; 7:e1163. [PMID: 28675386 PMCID: PMC5538121 DOI: 10.1038/tp.2017.141] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 12/25/2022] Open
Abstract
Bipolar disorder (BD) and alcohol dependence (AD) frequently co-occur, and co-occurring BD and AD are associated with devastating public health costs. Minimal neurobiological research exists to guide the development of effective treatments for this treatment-resistant population. We believe the present study represents the first investigation of prefrontal gamma-aminobutyric acid (GABA) and glutamate levels in co-occurring BD and current AD. The participants were 78 individuals who met DSM-IV criteria for BD I/II and current AD (n=20), BD I/II alone (n=19), current AD alone (n=20) or no diagnosis (n=19). The participants completed a baseline diagnostic visit, then returned approximately 4 days later for a two-dimensional J-resolved proton magnetic resonance spectroscopy (1H-MRS) acquisition in dorsal anterior cingulate cortex (dACC). All participants were required to demonstrate ⩾1 week of abstinence from alcohol/drugs via serial biomarker testing before 1H-MRS. A 2 × 2 factorial analysis of variance of cerebrospinal fluid (CSF)-corrected GABA/water concentrations demonstrated a significant BD × AD interaction (F=2.91, P<0.05), signifying uniquely low levels of GABA in BD+AD; this effect doubled when the sample was restricted to individuals who consumed alcohol within 2 weeks of 1H-MRS. There were no overall effects of BD/AD on CSF-corrected glutamate/water levels. However, the BD × AD interaction, signifying uniquely low levels of glutamate in BD+AD, approached statistical significance (F=3.83, P=0.06) in individuals who consumed alcohol within 2 weeks of 1H-MRS. The dACC GABA levels were significantly, negatively associated with Barratt Impulsiveness Scale (r=-0.28, P=0.02) and Obsessive Compulsive Drinking Scale (r=-0.35, P<0.01) scores. If replicated, these results may suggest that future treatment studies should preferentially evaluate therapeutics in BD+AD known to increase prefrontal GABA and glutamate levels.
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Affiliation(s)
- J J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, PO Box 250861, Charleston, SC 29425, USA. E-mail:
| | - B K Tolliver
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - A P Prescot
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - H M Brenner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - P F Renshaw
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - T R Brown
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - R F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Anton RF, Schacht JP, Voronin KE, Randall PK. Aripiprazole Suppression of Drinking in a Clinical Laboratory Paradigm: Influence of Impulsivity and Self-Control. Alcohol Clin Exp Res 2017; 41:1370-1380. [PMID: 28493623 DOI: 10.1111/acer.13417] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Aspects of impulsivity have been implicated in the development, or maintenance, of alcohol use disorder (AUD). The brain dopamine system is implicated in both reward processing/memory (typically subcortical) and in brain inhibitory control mechanisms (typically cortical). Using a validated clinical laboratory paradigm, the dopamine/serotonin "stabilizing" drug, aripiprazole was evaluated in non-treatment-seeking AUD individuals based on their level of impulsivity/self-control. METHODS Ninety-nine individuals (77% male; mean age 27; 7.5 drinks per day; 83% heavy drinking days) meeting DSM-IV criteria for alcohol dependence were randomized to aripiprazole (N = 47 evaluable) or placebo (N = 48 evaluable) based on their Barratt Impulsiveness Scale (BIS-11) score (above or below 68). Aripiprazole, or similar placebo, was titrated to 15 mg over 8 days. Drinking was recorded over 6 days under natural conditions. On Day 8, after 1 day of required abstinence, individuals participated in a bar laboratory paradigm that included a priming drink (breath alcohol concentration [BAC] target 0.02 to 0.03 g/dl) and free-choice consumption of up to 8 drinks (max BAC 0.1 g/dl) in exchange for a "bar credit" of $2 per drink (max $16). End points were drinks per day under natural conditions and drinks consumed in the bar laboratory after the priming drink. RESULTS There was no significant main effect of aripiprazole or interaction with BIS-11 score during the natural drinking period. However, there was a main effect of aripiprazole on bar laboratory drinking (p = 0.04) and aripiprazole reduced the total number of drinks consumed more among individuals with low self-control (p = 0.034) and increased latency to consume those drinks (p = 0.045) more among those with high impulsivity. Relative to placebo, aripiprazole caused more side effects and increased alcohol-induced sedation, but neither significantly influenced its interaction with impulsivity/self-control scores on drinking. CONCLUSIONS This paradigm forced a choice between immediate drinking reward and delayed monetary reward. In those with high impulsivity and/or low self-control, aripiprazole shifts the balance away from immediate drinking toward a later reward. Medications targeting cortical dopamine/serotonin balance might show clinical benefit of reduced drinking, among individuals with impulsivity/low self-control.
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Affiliation(s)
- Raymond F Anton
- Alcohol Research Center, Addictions Science Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph P Schacht
- Alcohol Research Center, Addictions Science Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Konstantin E Voronin
- Alcohol Research Center, Addictions Science Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Patrick K Randall
- Alcohol Research Center, Addictions Science Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Litten RZ, Falk DE, O'Malley SS, Witkiewitz KA, Mann KF, Anton RF. Letter to Editor in Response to Johnson's Commentary (2017) on the Witkiewitz and Colleagues (2017) Article. Alcohol Clin Exp Res 2017; 41:1381-1382. [PMID: 28471501 DOI: 10.1111/acer.13411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
| | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism , Bethesda, Maryland
| | | | | | - Karl F Mann
- Central Institute of Mental Health , Mannheim, Germany
| | - Raymond F Anton
- Medical University of South Carolina , Charleston, South Carolina
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Witkiewitz K, Wilson AD, Pearson MR, Hallgren KA, Falk DE, Litten RZ, Kranzler HR, Mann KF, Hasin DS, O'Malley SS, Anton RF. Temporal Stability of Heavy Drinking Days and Drinking Reductions Among Heavy Drinkers in the COMBINE Study. Alcohol Clin Exp Res 2017; 41:1054-1062. [PMID: 28295414 DOI: 10.1111/acer.13371] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/06/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Recently, the Food and Drug Administration (FDA) proposed to expand the options for primary end points in the development of medications for alcohol use disorder to include either abstinence from alcohol or a nonabstinent outcome: no heavy drinking days (with a heavy drinking day defined as more than 3 drinks per day for women and more than 4 drinks per day for men [>3/>4 cutoff]). The FDA also suggested that 6 months would be the most appropriate length for a clinical trial to demonstrate the stability of this nonabstinent drinking outcome. However, few alcohol clinical trials have examined the stability of nonheavy drinking during and after treatment. METHODS In a secondary analysis of the COMBINE study data (n = 1,383), we examined transitions in heavy drinking days during the course of treatment (months 1 through 4), during the transition out of treatment (months 4 through 7), and up to 12 months afterward (months 13 through 16) using latent variable mixture models. RESULTS Heavy drinking and nonheavy drinking were relatively stable in consecutive months (minimum agreement [kappa] = 0.64 for months 1 to 2). Most individuals were stable low-risk drinkers/abstainers or heavy drinkers by the end of treatment, as characterized by a 10% probability (or less) of transitioning out of either a no heavy drinking state or a heavy drinking state. More than two-thirds of the heavy drinkers who exceeded the heavy drinking threshold during treatment reported, on average, a 64% reduction in drinking frequency and a 38% reduction in drinking intensity from pretreatment drinking levels. CONCLUSIONS The results show stability of no heavy drinking as an outcome within the first 4 months of treatment and that the >3/>4 drink cutoff may mask substantial reductions in alcohol consumption among some patients. Future studies should explore the clinical utility of reduction end points.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Adam D Wilson
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Matthew R Pearson
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karl F Mann
- Central Institute of Mental Health, Mannheim, Germany
| | - Deborah S Hasin
- Departments of Psychiatry and Epidemiology, Columbia University, New York City, New York
| | | | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Witkiewitz K, Hallgren KA, Kranzler HR, Mann KF, Hasin DS, Falk DE, Litten RZ, O'Malley SS, Anton RF. Clinical Validation of Reduced Alcohol Consumption After Treatment for Alcohol Dependence Using the World Health Organization Risk Drinking Levels. Alcohol Clin Exp Res 2016; 41:179-186. [PMID: 28019652 PMCID: PMC5205540 DOI: 10.1111/acer.13272] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Abstract
Background Alcohol use disorder (AUD) is a highly prevalent public health problem associated with considerable individual and societal costs. Abstinence from alcohol is the most widely accepted target of treatment for AUD, but it severely limits treatment options and could deter individuals who prefer to reduce their drinking from seeking treatment. Clinical validation of reduced alcohol consumption as the primary outcome of alcohol clinical trials is critical for expanding treatment options. One potentially useful measure of alcohol treatment outcome is a reduction in the World Health Organization (WHO, International Guide for Monitoring Alcohol Consumption and Related Harm. Geneva, Switzerland, 2000) risk levels of alcohol use (very high risk, high risk, moderate risk, and low risk). For example, a 2‐shift reduction in WHO risk levels (e.g., high risk to low risk) has been used by the European Medicines Agency (2010, Guideline on the Development of Medicinal Products for the Treatment of Alcohol Dependence. UK) to evaluate nalmefene as a treatment for alcohol dependence (AD; Mann et al. 2013, Biol Psychiatry 73, 706–13). Methods The current study was a secondary data analysis of the COMBINE study (n = 1,383; Anton et al., 2006) to examine the association between reductions in WHO risk levels and reductions in alcohol‐related consequences and mental health symptoms during and following treatment in patients with AD. Results Any reduction in WHO risk drinking level during treatment was associated with significantly fewer alcohol‐related consequences and improved mental health at the end of treatment and for up to 1 year posttreatment. A greater reduction in WHO risk drinking level predicted a greater reduction in consequences and greater improvements in mental health. Conclusions Changes in WHO risk levels appear to be a valid end point for alcohol clinical trials. Based on the current findings, reductions in WHO risk drinking levels during treatment reflect meaningful reductions in alcohol‐related consequences and improved functioning.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karl F Mann
- Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany
| | - Deborah S Hasin
- Department of Psychiatry, Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, New York
| | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism, National Insitutes of Health, Rockville, Maryland
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism, National Insitutes of Health, Rockville, Maryland
| | - Stephanie S O'Malley
- Department of Psychiatry, Substance Abuse Treatment Unit, Yale University, New Haven, Connecticut
| | - Raymond F Anton
- Medical University of South Carolina, Charleston, South Carolina
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Adams ZW, Schacht JP, Randall P, Anton RF. The Reasons for Heavy Drinking Questionnaire: Factor Structure and Validity in Alcohol-Dependent Adults Involved in Clinical Trials. J Stud Alcohol Drugs 2016; 77:354-61. [PMID: 26997195 DOI: 10.15288/jsad.2016.77.354] [Citation(s) in RCA: 8] [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] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE People consume alcohol at problematic levels for many reasons. These different motivational pathways may have different biological underpinnings. Valid, brief measures that discriminate individuals' reasons for drinking could facilitate inquiry into whether varied drinking motivations account for differential response to pharmacotherapies for alcohol use disorders. The current study evaluated the factor structure and predictive validity of a brief measure of alcohol use motivations developed for use in randomized clinical trials, the Reasons for Heavy Drinking Questionnaire (RHDQ). METHOD The RHDQ was administered before treatment to 265 participants (70% male) with alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, in three pharmacotherapy randomized clinical trials. Principal components analysis was used in half the sample to determine the RHDQ factor structure. This structure was verified with confirmatory factor analysis in the second half of the sample. The factors derived from this analysis were evaluated with respect to alcohol dependence severity indices. RESULTS A two-factor solution was identified. Factors were interpreted as Reinforcement and Normalizing. Reinforcement scores were weakly to moderately associated with severity, whereas normalizing scores were moderately to strongly associated with severity. In all cases in which significant associations between RHDQ scores and severity indices were observed, the relationship was significantly stronger for normalizing than for reinforcing. CONCLUSIONS The RHDQ is a promising brief assessment of motivations for heavy alcohol use, particularly in the context of randomized clinical trials. Additional research should address factor structure stability in non-treatment-seeking individuals and the RHDQ's utility in detecting and accounting for changes in drinking behavior, including in response to intervention.
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Affiliation(s)
- Zachary W Adams
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph P Schacht
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Patrick Randall
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Raymond F Anton
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Stewart SH, Reuben A, Anton RF. Relationship of Abnormal Chromatographic Pattern for Carbohydrate-Deficient Transferrin with Severe Liver Disease. Alcohol Alcohol 2016; 52:24-28. [PMID: 27998920 DOI: 10.1093/alcalc/agw069] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 01/01/2023] Open
Abstract
AIMS Serum carbohydrate-deficient transferrin (CDT) is a validated test for chronic heavy alcohol drinking, but CDT abnormalities have been associated with liver disease, limiting its use in these patients. We report here on the association between poor chromatographic resolution of disialotransferrin from trisialotransferrin (the so-called 'di-tri bridging') and liver disease severity and etiology. METHODS Subjects were patients in whom detailed clinical data, including histology results, were available on their existing liver diseases (n=139). Percent disialo-CDT (%dCDT) was measured by high-performance liquid chromatography, and the risks for di-tri bridging associated with cirrhosis, with and without adjustment for alcohol use and alcohol-related liver disease, were estimated. RESULTS Di-tri bridging was present in 22/73 (30%) cirrhotic subjects and 7/66 (11%) non-cirrhotic subjects. The unadjusted risk for di-tri bridging in cirrhotics relative to non-cirrhotics was 3.6 (95% confidence interval 1.4-9.2). Adjustment for alcohol-related liver disease and current drinking had little effect on this estimate (adjusted odds ratio 3.4), and neither alcohol-related liver disease nor current drinking were independently associated with di-tri bridging after accounting for the effect of cirrhosis. CONCLUSIONS The presence of di-tri bridging was associated with cirrhosis in individuals with both alcohol-related and non-alcoholic liver disease, although most cirrhotic subjects did not exhibit di-tri bridging. When di-tri bridging is seen in individuals being tested for chronic heavy drinking, investigation for cirrhosis should be considered. SHORT SUMMARY There are known liver-disease-associated abnormalities in CDT. In this study, we found that such abnormalities were strongly associated with cirrhosis rather than less-advanced disease, but were only clinically evident in 30% of cirrhotics. Abnormalities also occurred in severe hepatitis without cirrhosis and were not specific for liver disease etiology.
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Affiliation(s)
- Scott H Stewart
- Division of General Internal Medicine, University at Buffalo , 462 Grider Street, Buffalo, NY 14215, USA
| | - Adrian Reuben
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Raymond F Anton
- Addiction Sciences Division, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
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Hahn JA, Anton RF, Javors MA. The Formation, Elimination, Interpretation, and Future Research Needs of Phosphatidylethanol for Research Studies and Clinical Practice. Alcohol Clin Exp Res 2016; 40:2292-2295. [PMID: 27716960 DOI: 10.1111/acer.13213] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/10/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Judith A Hahn
- Department of Medicine, University of California, San Francisco, California.
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Martin A Javors
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, Texas
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Hallgren KA, Witkiewitz K, Kranzler HR, Falk DE, Litten RZ, O'Malley SS, Anton RF. Missing Data in Alcohol Clinical Trials with Binary Outcomes. Alcohol Clin Exp Res 2016; 40:1548-57. [PMID: 27254113 DOI: 10.1111/acer.13106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/12/2016] [Accepted: 04/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Missing data are common in alcohol clinical trials for both continuous and binary end points. Approaches to handle missing data have been explored for continuous outcomes, yet no studies have compared missing data approaches for binary outcomes (e.g., abstinence, no heavy drinking days). This study compares approaches to modeling binary outcomes with missing data in the COMBINE study. METHODS We included participants in the COMBINE study who had complete drinking data during treatment and who were assigned to active medication or placebo conditions (N = 1,146). Using simulation methods, missing data were introduced under common scenarios with varying sample sizes and amounts of missing data. Logistic regression was used to estimate the effect of naltrexone (vs. placebo) in predicting any drinking and any heavy drinking outcomes at the end of treatment using 4 analytic approaches: complete case analysis (CCA), last observation carried forward (LOCF), the worst case scenario (WCS) of missing equals any drinking or heavy drinking, and multiple imputation (MI). In separate analyses, these approaches were compared when drinking data were manually deleted for those participants who discontinued treatment but continued to provide drinking data. RESULTS WCS produced the greatest amount of bias in treatment effect estimates. MI usually yielded less biased estimates than WCS and CCA in the simulated data and performed considerably better than LOCF when estimating treatment effects among individuals who discontinued treatment. CONCLUSIONS Missing data can introduce bias in treatment effect estimates in alcohol clinical trials. Researchers should utilize modern missing data methods, including MI, and avoid WCS and CCA when analyzing binary alcohol clinical trial outcomes.
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Affiliation(s)
- Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Katie Witkiewitz
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Henry R Kranzler
- Department of Psychiatry and Center for Studies of Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,VISN 4 MIRECC, Crescenz Philadelphia VAMC, Philadelphia, Pennsylvania
| | - Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism, Rockville, Maryland
| | | | - Raymond F Anton
- Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, South Carolina
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McHugh RK, Fitzmaurice GM, Griffin ML, Anton RF, Weiss RD. Association between a brief alcohol craving measure and drinking in the following week. Addiction 2016; 111:1004-10. [PMID: 26780476 PMCID: PMC4861663 DOI: 10.1111/add.13311] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 07/31/2015] [Revised: 10/05/2015] [Accepted: 01/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Craving for alcohol is thought to be a predictor of alcohol use, particularly in the near future. The assessment of craving in clinical practice requires brief, simple measures that can be implemented routinely. This study tested whether greater alcohol craving was associated with a higher likelihood of alcohol use in the subsequent week. DESIGN The COMBINE Study (Combining Medications and Behavioral Interventions for Alcohol Dependence) was a large, multi-site clinical trial of treatment for alcohol dependence. Participants were randomized (stratified by site) to one of nine treatment conditions involving combinations of pharmacotherapy and psychotherapy. Craving was assessed every other week throughout the treatment period. SETTING Substance use disorder treatment settings at 11 academic sites across the United States. PARTICIPANTS Participants from the COMBINE Study (n = 1370) with available craving data. MEASUREMENTS Craving was assessed using the three-item self-report Craving Scale. Drinking was assessed using the Timeline Followback method, and was defined as alcohol use in each study week. FINDINGS There was an average of 5.8 (of a possible seven) observation pairs per participant. Craving was associated strongly with alcohol use in the following week [B = 0.27, standard error (SEB ) = 0.06, Wald χ(2) = 43.34, odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.16, 1.47, P < 0.001]. For each 1-unit increase in the Craving Scale, the likelihood of drinking in the next week was 31% higher. CONCLUSIONS Craving for alcohol is associated strongly with alcohol use in the following week. Clinicians can measure alcohol craving effectively using a brief self-report craving scale.
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Affiliation(s)
- R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Garrett M. Fitzmaurice
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115,Laboratory for Psychiatric Biostatistics, McLean Hospital, 115 Mill Street, Belmont, MA 02478
| | - Margaret L. Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Raymond F. Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA
| | - Roger D. Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, 115 Mill Street, Belmont, MA 02478,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
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Abstract
Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.
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Affiliation(s)
- Bryan K Tolliver
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Raymond F Anton
- Addiction Sciences Division, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Boyd SJ, Schacht JP, Prisciandaro JJ, Voronin K, Anton RF. Alcohol-Induced Stimulation Mediates the Effect of a GABRA2 SNP on Alcohol Self-Administrated among Alcohol-Dependent Individuals. Alcohol Alcohol 2016; 51:549-54. [PMID: 27117237 DOI: 10.1093/alcalc/agw024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/04/2015] [Accepted: 04/05/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A single-nucleotide polymorphism (SNP) in GABRA2 (rs279858) may moderate subjective response (SR) to alcohol. Results of studies in non-dependent drinkers examining this GABRA2 SNP on SR have been equivocal. This study examined this SNP's direct and indirect effects on alcohol self-administration in dependent drinkers. METHOD The sample consisted of 63 Caucasian, non-treatment-seeking individuals with alcohol dependence. Subjective stimulation was assessed using the Biphasic Alcohol Effects Scale following consumption of an alcoholic priming drink (target breath alcohol content = 0.02 g%). Participants were subsequently offered the opportunity to self-administer up to eight additional drinks. RESULTS Controlling for baseline stimulation, T-allele homozygotes, relative to individuals with at least one copy of the C-allele, reported greater initial stimulation, t(58) = 2.011, p = 0.049. Greater stimulation predicted greater subsequent alcohol self-administration, t(57) = 2.522, p = 0.015. Although rs279858 genotype did not directly impact self-administration (t(57) = -0.674, p = 0.503), it did have an indirect effect (95% confidence interval [0.068, 1.576]), such that T-allele homozygotes reported greater stimulation, which in turn predicted greater self-administration. CONCLUSION These results suggest that the influence of this SNP on SR differs depending on dose or stage of dependence. This study is the first to demonstrate an indirect effect of rs279858 genotype on drinking through SR. Although C-allele carriers have been shown to have an increased risk for alcohol dependence, in our dependent sample, greater stimulation was found among T-allele homozygotes, suggesting that the influence of SR on developing and maintaining dependence differs based on rs279858 genotype.This study demonstrates an indirect effect of rs279858 genotype on drinking through SR. Although C-allele carriers have an increased risk for alcohol dependence, in our dependent sample, greater stimulation was found among T-allele homozygotes, suggesting that the influence of SR on developing dependence differs based on rs279858 genotype.
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Affiliation(s)
- Stephen J Boyd
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph P Schacht
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - James J Prisciandaro
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Konstantin Voronin
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Raymond F Anton
- Charleston Alcohol Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Prisciandaro JJ, Schacht JP, Prescot AP, Renshaw PF, Brown TR, Anton RF. Associations Between Recent Heavy Drinking and Dorsal Anterior Cingulate N-Acetylaspartate and Glutamate Concentrations in Non-Treatment-Seeking Individuals with Alcohol Dependence. Alcohol Clin Exp Res 2016; 40:491-6. [PMID: 26853538 DOI: 10.1111/acer.12977] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 09/02/2015] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Proton magnetic resonance spectroscopy ((1) H-MRS) studies have consistently found abnormal brain concentrations of N-acetylaspartate (NAA) and glutamate in individuals with alcohol use disorders (AUD) relative to light drinkers. However, most such studies have focused on individuals in treatment for severe alcohol dependence (AD), and few studies have investigated associations between neurochemical concentrations and recent alcohol consumption. This study focused on associations between recent drinking and prefrontal neurometabolite concentrations in nonsevere, non-treatment-seeking individuals with AUD. METHODS Nineteen treatment-naïve alcohol-dependent individuals aged 21 to 40 completed a (1) H-MRS scan. Single-voxel (1) H-MRS spectra were acquired in dorsal anterior cingulate cortex (dACC) using a 2-dimensional J-resolved point resolved spectroscopy sequence. Associations between recent heavy drinking, assessed using the Timeline FollowBack, and dACC metabolite concentrations were estimated via regression controlling for within-voxel tissue composition. RESULTS Participants provided a negative breathalyzer reading and reported between 1 and 5 days (M = 2.45, SD = 1.23) since their last drink. Number of heavy drinking days in the 14 days preceding the scan (M = 4.84, SD = 3.32) was significantly inversely associated with both glutamate/water (β = -0.63, t(17) = -3.37, p = 0.004) and NAA/water concentrations (β = -0.59, t(17) = -2.98, p = 0.008). CONCLUSIONS This study extends the literature by demonstrating inverse associations between recent heavy drinking and dACC glutamate and NAA concentrations in a sample of nonsevere, non-treatment-seeking individuals with AD. These findings may support the hypothesis that amount of recent alcohol consumption may account for differences in neuronal metabolism, even in nonsevere, non-treatment-seeking alcoholics.
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Affiliation(s)
- James J Prisciandaro
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joseph P Schacht
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Andrew P Prescot
- Department of Radiology, University of Utah, Salt Lake City, Utah
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Truman R Brown
- Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Witkiewitz K, Falk DE, Kranzler HR, Litten RZ, Hallgren KA, O'Malley SS, Anton RF. Methods to analyze treatment effects in the presence of missing data for a continuous heavy drinking outcome measure when participants drop out from treatment in alcohol clinical trials. Alcohol Clin Exp Res 2015; 38:2826-34. [PMID: 25421518 DOI: 10.1111/acer.12543] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 06/14/2014] [Accepted: 08/13/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attrition is common in alcohol clinical trials and the resultant loss of data represents an important methodological problem. In the absence of a simulation study, the drinking outcomes among those who are lost to follow-up are not known. Individuals who drop out of treatment and continue to provide drinking data, however, may be a reasonable proxy group for making inferences about the drinking outcomes of those lost to follow-up. METHODS We used data from the COMBINE study, a multisite, randomized clinical trial, to examine drinking during the 4 months of treatment among individuals who dropped out of treatment but continued to provide drinking data (i.e., "treatment dropouts;" n = 185). First, we estimated the observed treatment effect size for naltrexone versus placebo in a sample that included both treatment completers (n = 961) and treatment dropouts (n = 185; total N = 1,146), as well as the observed treatment effect size among just those who dropped out of treatment (n = 185). In both the total sample (N = 1,146) and the dropout sample (n = 185), we then deleted the drinking data after treatment dropout from those 185 individuals to simulate missing data. Using the deleted data sets, we then estimated the effect of naltrexone on the continuous outcome percent heavy drinking days using 6 methods to handle missing data (last observation carried forward, baseline observation carried forward, placebo mean imputation, missing = heavy drinking days, multiple imputation (MI), and full information maximum likelihood [FIML]). RESULTS MI and FIML produced effect size estimates that were most similar to the true effects observed in the full data set in all analyses, while missing = heavy drinking days performed the worst. CONCLUSIONS Although missing drinking data should be avoided whenever possible, MI and FIML yield the best estimates of the treatment effect for a continuous outcome measure of heavy drinking when there is dropout in an alcohol clinical trial.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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Falk DE, Litten RZ, Anton RF, Kranzler HR, Johnson BA. Cumulative proportion of responders analysis (CPRA) as a tool to assess treatment outcome in alcohol clinical trials. J Stud Alcohol Drugs 2014; 75:335-46. [PMID: 24650828 DOI: 10.15288/jsad.2014.75.335] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Several definitions of treatment response have been proposed for alcohol clinical trials (e.g., abstinence and no heavy drinking). However, each of these outcomes allows only one definition of successful response. In contrast, the cumulative proportion of responders analysis (CPRA) includes all of the possible drinking response cutoff points, providing a more complete picture of the therapeutic effects of a treatment. CPRA has been used to examine the efficacy of analgesics but not alcohol pharmacotherapy. To demonstrate its potential utility, we conducted CPRA in two large alcohol treatment trials: the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) trial (naltrexone) and a multisite topiramate trial. CPRA was used to demonstrate the efficacy of naltrexone and topiramate on continuous measures of in-treatment drinking-heavy drinking days and drinks per day-and their reductions from pretreatment. METHOD All possible cutoff points were portrayed for each measure. We provide graphs to illustrate the effects of the active medications compared with placebo and examined them statistically over a number of salient drinking outcomes to evaluate their efficacy. RESULTS Treatment group responder curves were not parallel across the entire range of cutoff points; rather, they separated only at lower levels of drinking. In general, effect sizes increased by 0.10-0.15 when going from the lowest drinking level cutoff (i.e., abstinence and no heavy drinking) to the cutoff associated with the maximal treatment effect. CONCLUSIONS CPRA may be useful in designing subsequent trials and helping to illustrate for treatment providers the likelihood of treatment success given various definitions of a positive response.
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Affiliation(s)
- Daniel E Falk
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Raye Z Litten
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania and Veterans Integrated Service Network 4, Mental Illness Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Bankole A Johnson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
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Weykamp C, Wielders J, Helander A, Anton RF, Bianchi V, Jeppsson JO, Siebelder C, Whitfield JB, Schellenberg F. Harmonization of Measurement Results of the Alcohol Biomarker Carbohydrate-Deficient Transferrin by Use of the Toolbox of Technical Procedures of the International Consortium for Harmonization of Clinical Laboratory Results. Clin Chem 2014; 60:945-53. [DOI: 10.1373/clinchem.2014.221531] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
The need for equivalent results of routine measurement procedures for the alcohol biomarker carbohydrate-deficient transferrin (CDT) has been recognized by the IFCC. This article describes a project to harmonize CDT as conducted by an IFCC working group initiated for this purpose.
METHODS
We used procedures for achieving harmonization as developed by the Consortium for Harmonization of Clinical Laboratory Results to assess the suitability of a candidate reference measurement procedure (cRMP), candidate reference materials (cRMs), and the success of efforts to achieve harmonization.
RESULTS
CDT measurement procedures in routine use showed good reproducibility (CV 1.1%–2.8%) and linearity (r > 0.990) with variable slopes (0.766–1.065) and intercepts (−0.34 to 0.92) compared to the cRMP. Heterogeneity after simulated harmonization was 4.7%. cRMs of frozen human native sera demonstrated commutability and 3-year stability for routine measurement procedures. The cRMP provided reproducible value assignment to cRMs with an expanded uncertainty (k = 2) of 0.03% at the 1.2% CDT level and 0.06% at the 4.4% CDT level. Harmonization efforts reduced the intermeasurement CV from 8.8% to 3.4%, allowed 99% recovery of the values assigned with the cRMP, and demonstrated 99% of results within the desirable allowable total error. Harmonization was less successful in samples with low CDT and high trisialotransferrin concentrations.
CONCLUSIONS
Harmonization of CDT is possible with frozen human native sera as cRMs with values assigned by use of the cRMP. We propose the cRMP as a candidate international conventional reference measurement procedure and cRMs as candidate international calibrators.
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Affiliation(s)
- Cas Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - Jos Wielders
- Department of Clinical Chemistry, Meander Medical Center, Amersfoort, the Netherlands
| | - Anders Helander
- Department of Laboratory Medicine, Karolinska Institutet, and Karolinska University Laboratory, Clinical Chemistry, Stockholm, Sweden
| | - Raymond F Anton
- The Center for Drug and Alcohol Programs, Medical University of South Carolina, Charleston, SC
| | - Vincenza Bianchi
- Toxicology Reference Laboratory, SS. Antonio e Biagio Hospital, Alessandria, Italy
| | - Jan-Olof Jeppsson
- Department of Laboratory Medicine, Malmö University Hospital, Malmö, Sweden
| | - Carla Siebelder
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, the Netherlands
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Anton RF. Commentary on: ethyl glucuronide and ethyl sulfate assays in clinical trials, interpretation, and limitations: results of a dose ranging alcohol challenge study and 2 clinical trials. Alcohol Clin Exp Res 2014; 38:1826-8. [PMID: 24961935 DOI: 10.1111/acer.12495] [Citation(s) in RCA: 7] [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] [Received: 04/15/2014] [Accepted: 05/23/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Raymond F Anton
- Medical University of South Carolina, Charleston, South Carolina
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Stewart SH, Koch DG, Willner IR, Anton RF, Reuben A. Validation of blood phosphatidylethanol as an alcohol consumption biomarker in patients with chronic liver disease. Alcohol Clin Exp Res 2014; 38:1706-11. [PMID: 24848614 DOI: 10.1111/acer.12442] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [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: 09/19/2013] [Accepted: 03/18/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blood phosphatidylethanol (PEth) is a promising biomarker of alcohol consumption. This study was conducted to evaluate its performance in patients with liver disease. METHODS This study included 222 patients with liver disease. Patient-reported alcohol use was obtained as a reference standard, and PEth was measured by tandem mass spectrometry. Receiver operating characteristic (ROC) and contingency table analyses were used to assess the performance of PEth in detecting any drinking and averaging 4 or more drinks daily in the past 30 days. RESULTS At the limit of quantitation (20 ng/ml), PEth was 73% sensitive (95% confidence interval [CI] 65 to 80) and 96% specific (95% CI 92 to 100) for any drinking in the past month. Subjects who drank but had a negative PEth result were mainly light drinkers. Subjects who reported 30-day abstinence but with quantifiable PEth either reported heavy drinking within the past 6 weeks or had data that suggested underreported drinking. At the optimal cutoff concentration of 80 ng/ml, PEth was 91% sensitive (95% CI 82 to 100) and 77% specific (95% CI 70 to 83) for averaging at least 4 drinks daily. CONCLUSIONS PEth is a useful test for detecting alcohol use in patients with liver disease, but cutoff concentrations for heavy drinking will result in misclassification of some moderate to heavy drinkers.
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Affiliation(s)
- Scott H Stewart
- Division of General Internal Medicine, University at Buffalo, Buffalo, New York
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Greenfield TK, Ye Y, Bond J, Kerr WC, Nayak MB, Kaskutas LA, Anton RF, Litten RZ, Kranzler HR. Risks of alcohol use disorders related to drinking patterns in the U.S. general population. J Stud Alcohol Drugs 2014; 75:319-27. [PMID: 24650826 PMCID: PMC3965685 DOI: 10.15288/jsad.2014.75.319] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 02/13/2013] [Accepted: 09/04/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the relations between drinking (mean quantity and heavy drinking patterns) and alcohol use disorders (AUDs) in the U.S. general population. METHOD Data from three telephone National Alcohol Surveys (in 2000, 2005, and 2010) were pooled, with separate analyses for men and women restricted to current drinkers (ns = 5,922 men, 6,270 women). Predictors were 12-month volume (mean drinks per day), rates of heavy drinking (5+/4+ drinks in a day for men/women), and very heavy drinking (8+, 12+, and 24+ drinks in a day). Outcomes were negative alcohol-related consequences constituting abuse (1+ of 4 DSM-IV-based domains assessed by 13 items) and alcohol dependence (symptoms in 3+ of 7 DSM-IV-based domains), together taken to indicate an AUD. Segmentation analyses were used to model risks of problem outcomes from drinking patterns separately by gender. RESULTS In the general population, men and women who consumed ≤1 drink/day on average with no heavy drinking days did not incur substantial risks of an AUD (<10%). Men who drank from 1 to 2 drinks/day on average but never 5+ incurred a 16% risk of reporting an AUD (3.5% alcohol dependence). At higher volumes, men and women who indicated higher rates of drinking larger amounts per day and/or involving 8+ and 12+ drinks/day (and even 24+ drinks/day for men) showed much higher risks of experiencing AUDs. CONCLUSIONS The findings provide quantitative guidance for primary care practitioners who wish to make population-based recommendations to patients who might benefit by reducing both overall intake and amounts per occasion in an effort to lower their risks of developing AUDs.
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Affiliation(s)
- Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, California
- Department of Psychiatry, Clinical Services Research Training Program, University of California, San Francisco, San Francisco, California
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Jason Bond
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Madhabika B Nayak
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Lee Ann Kaskutas
- Alcohol Research Group, Public Health Institute, Emeryville, California
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Raymond F Anton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Raye Z Litten
- Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Henry R Kranzler
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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