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Wray TB, Reitzel G, Phelan C, Merrill JE, Jackson KM. What apps and websites do those in treatment for substance-related problems use to help them in their recovery? A cross-sectional study of products and use patterns. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2025; 171:209631. [PMID: 39880287 DOI: 10.1016/j.josat.2025.209631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 11/04/2024] [Accepted: 01/10/2025] [Indexed: 01/31/2025]
Abstract
BACKGROUND Given the global burden of substance use disorders (SUD), innovations in methods to achieve sustained recovery are critical. Digital health products (e.g., websites, smartphone apps) can complement and enhance existing SUD treatments or provide some assistance to those who cannot access formal treatment. One goal of the present study was to obtain descriptive information regarding the use of digital health products during SUD recovery. We also examined demographic and SUD-related correlates (e.g., severity, duration) of digital health product use and whether patterns of app use were related to perceived utility of the apps. METHODS A sample of 255 participants (45 % female, Mage = 41.4 [9.6]) recruited at several outpatient addictions treatment facilities in the northeastern US completed an online survey. RESULTS Forty-five percent of participants reported having used some kind of app or website to help them in recovery during their lifetimes. The most common motivations participants reported for using an app alongside treatment were to increase knowledge about addiction, hear advice from others in recovery, and to find motivation to stay sober. Those in most older age groups (35-40, 50+) had significantly lower odds of having used an app relative to 18-35 year-olds, and odds of reporting having used an app were 90 % higher among female participants versus others. Increased frequency of app use and using an app/website over a longer period of time were associated with higher ratings of perceived app helpfulness. CONCLUSION Future research is needed to determine whether using these products provides clinically meaningful benefits for patients, both in the presence and absence of traditional treatment.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Gage Reitzel
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Chanda Phelan
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer E Merrill
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA; Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI, USA
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Petagine L, Zariwala MG, Somavarapu S, Chan SHY, Kaya EA, Patel VB. Oxidative stress in a cellular model of alcohol-related liver disease: protection using curcumin nanoformulations. Sci Rep 2025; 15:7752. [PMID: 40044747 PMCID: PMC11882943 DOI: 10.1038/s41598-025-91139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 02/18/2025] [Indexed: 03/09/2025] Open
Abstract
Alcohol-related liver disease (ARLD) is a global health issue causing significant morbidity and mortality, due to lack of suitable therapeutic options. ARLD induces a spectrum of biochemical and cellular alterations, including chronic oxidative stress, mitochondrial dysfunction, and cell death, resulting in hepatic injury. Natural antioxidant compounds such as curcumin have generated interest in ARLD due to their ability to scavenge reactive oxygen species (ROS), however, therapy using these compounds is limited due to poor bioavailability and stability. Therefore, the aim of this study was to assess the antioxidant potential of free antioxidants and curcumin entrapped formulations against oxidative damage in an ARLD cell model. HepG2 (VL-17A) cells were treated with varying concentrations of alcohol (from 200 to 350 mM) and parameters of oxidative stress and mitochondrial function were assessed over 72 h. Data indicated 350 mM of ethanol led to a significant decrease in cell viability at 72 h, and a significant increase in ROS at 30 min. A substantial number of cells were in late apoptosis at 72 h, and a reduction in the mitochondrial membrane potential was also found. Pre-treatment with curcumin nanoformulations increased viability, as well as, reducing ROS at 2 h, 48 h and 72 h. In summary, antioxidants and entrapped nanoformulations of curcumin were able to ameliorate reduced cell viability and increased ROS caused by ethanol treatment. This demonstrates their potential at mitigating oxidative damage and warrants further investigation to evaluate their efficacy for ARLD therapy.
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Affiliation(s)
- Lucy Petagine
- Centre for Nutraceuticals, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
| | - Mohammed G Zariwala
- Centre for Nutraceuticals, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
| | | | - Stefanie Ho Yi Chan
- Centre for Nutraceuticals, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
- Department of Pharmaceutics, UCL School of Pharmacy, London, UK
| | - Evrim A Kaya
- Centre for Nutraceuticals, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK
| | - Vinood B Patel
- Centre for Nutraceuticals, School of Life Sciences, University of Westminster, 115 New Cavendish Street, London, W1W 6UW, UK.
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Twohig PA, Balasanova A, Cooper L, Le M, Khoury N, Manatsathit W, Olivera M, Peeraphatdit TB. A Brief Intervention on Alcohol Use Disorder Is Associated With Treatment Access for Inpatients With Alcohol-associated Liver Disease. J Addict Med 2025; 19:35-40. [PMID: 39150074 DOI: 10.1097/adm.0000000000001371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
BACKGROUND Alcohol-associated liver disease (ALD) is the most common indication for liver transplantation in the United States. Alcohol use disorder (AUD) treatment is recommended in all patients with ALD and AUD, but it remains underutilized. AIMS To identify predictors of AUD treatment and to assess 30-day readmission, return to drinking, and 1-year transplant-free survival. METHODS Retrospective single-center cohort study of consecutive patients hospitalized with ALD and AUD between 2018 and 2020. Patients who died or were lost to follow-up at 90 days after hospitalization were excluded. AUD treatment was defined as receiving medication or participating in residential, outpatient, or support groups within 90 days of discharge. RESULTS One hundred nine patients were included. Mean age was 51.7 years, and 63% were male. Fifty-six (51%) patients received AUD treatment, and 23 (21%) patients received more than one treatment. Predictors of AUD treatment were younger age (OR, 1.07 [95% CI, 1.04-1.12]; P < 0.001), gastroenterology/hepatology consult (AOR, 8.54 [95% CI, 2.55-39.50]; P = 0.0002), addiction psychiatry consult (AOR, 2.77 [95% CI, 1.16-6.84]; P = 0.02), and a brief AUD intervention (AOR, 18.19 [95% CI, 3.36-339.07]; P = 0.0001). Cirrhosis decompensation, MELD-Na score, and insurance status were not associated with treatment. Thirty-one patients (28.4%) were readmitted, and 29 (26.6%) remained abstinent 30 days from discharge. Patients who received treatment had improved transplant-free survival (HR, 0.44, P = 0.04). CONCLUSION A brief intervention on AUD had the strongest association with receiving AUD treatment in our cohort. Further efforts to incorporate brief interventions when offering AUD treatment to patients with ALD may be beneficial.
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Affiliation(s)
- Patrick A Twohig
- From the Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE (PAT, LC, ML, NK, WM, MO, TBP); and Department of Psychiatry, University of Nebraska Medical Center, Omaha, NE (AB)
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Tokumitsu K, Sugawara N, Adachi N, Kubota Y, Watanabe Y, Miki K, Azekawa T, Edagawa K, Katsumoto E, Hongo S, Goto E, Ueda H, Kato M, Yoshimura R, Nakagawa A, Kikuchi T, Tsuboi T, Watanabe K, Yasui-Furukori N. Real-world clinical determinants of alcohol dependence in outpatients with bipolar disorder: a multicenter treatment survey for bipolar disorder in psychiatric outpatient clinics with 2,392 participants. Front Psychiatry 2024; 15:1434810. [PMID: 39575198 PMCID: PMC11578974 DOI: 10.3389/fpsyt.2024.1434810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 10/21/2024] [Indexed: 11/24/2024] Open
Abstract
Background Bipolar disorder is a psychiatric disorder characterized by mood swings between manic and depressed states that causes psychosocial problems. Cognitive function deteriorates with each recurrence, making it important to maintain remission through continued treatment. Bipolar disorder often co-occurs with alcohol dependence, which is known to lead to decreased treatment adherence and increased suicide risk. However, the real-world clinical determinants of alcohol dependence in outpatients with bipolar disorder in Japan remain unclear. Methods We conducted an observational study targeting 2392 patients with bipolar disorder using data from the MUSUBI study, a joint project of the Japanese Association of Neuro-Psychiatric Clinics and the Japanese Society of Clinical Neuropsychopharmacology. After determining the prevalence of alcohol dependence and the sociodemographic characteristics of patients with bipolar disorder, multivariate analysis was performed to identify risk factors for alcohol comorbidity. Results The prevalence of alcohol dependence among outpatients with bipolar disorder in this study was 5.7%. The prevalence was 7.6% for males and 3.1% for females. The results of the binomial logistic regression analysis revealed that bipolar I disorder, manic state, comorbidities with other psychiatric disorders, male sex, and suicidal ideation were significantly associated with alcohol dependence. Stratified analysis by gender showed that alcohol dependence was more strongly associated with the presence of suicidal ideation in women than in men. Limitation First, because this was an observational study with a cross-sectional design, causal relationships between factors cannot be determined. In addition, this study included outpatients in Japan but lacked information on inpatients. Therefore, it was considered necessary to conduct the study on a larger population in order to generate more robust evidence. Conclusions We found that outpatients with bipolar disorder, especially men, had higher rates of alcohol dependence overall than the general population in Japan. In addition, the relationship between alcohol dependence and suicidal ideation was stronger in women than in men with bipolar disorder. There was a strong association between manic states and alcohol dependence in outpatients with bipolar disorder. These results are useful to clinicians because they reinforce real-world clinical evidence for the treatment of bipolar disorder and co-occurring alcohol dependence.
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Affiliation(s)
- Keita Tokumitsu
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Norio Sugawara
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Naoto Adachi
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Yukihisa Kubota
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | | | - Kazuhira Miki
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Takaharu Azekawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Koji Edagawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichi Katsumoto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Seiji Hongo
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichiro Goto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Hitoshi Ueda
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Masaki Kato
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Reiji Yoshimura
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Atsuo Nakagawa
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Toshiaki Kikuchi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Tsuboi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
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Lang C, Weisel KK, Saur S, Fuhrmann LM, Schoenleber A, Reichl D, Enewoldsen N, Steins-Loeber S, Berking M. Support after return to alcohol use: a mixed-methods study on how abstinence motivation and app use change after return to alcohol use in an app-based aftercare intervention for individuals with alcohol use disorder. Addict Sci Clin Pract 2024; 19:35. [PMID: 38711152 PMCID: PMC11071226 DOI: 10.1186/s13722-024-00457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation. METHODS Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data. RESULTS Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24-96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants' reported use behavior. CONCLUSIONS The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether. TRIAL REGISTRATION The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).
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Affiliation(s)
- Catharina Lang
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany.
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Sebastian Saur
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Lukas M Fuhrmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Antonie Schoenleber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
| | - Daniela Reichl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Niklas Enewoldsen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Otto Friedrich University of Bamberg, Markusplatz 3, 96047, Bamberg, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nuremberg, Nägelsbachstraße 25a, 91052, Erlangen, Germany
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Venkateswaran S, Thirumalai R. A Follow-up Study on Coping Strategies and its Association with Relapse Among Alcohol-dependent Patients. Indian J Psychol Med 2024; 46:245-252. [PMID: 38699765 PMCID: PMC11062311 DOI: 10.1177/02537176231222968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Background Alcohol Dependence Syndrome is a chronic illness that is relapsing in nature. Past research has shown that coping strategies that are specific to alcohol dependence are useful in preventing long-term relapse. This follow-up study is, therefore, an attempt to understand the coping styles and strategies that are associated with relapse among individuals dependent on alcohol. Methods We aimed to cross-sectionally assess the severity of alcohol dependence and coping styles of Alcohol dependent individuals. One hundred and twenty-seven consecutive patients who satisfied the International Classification of Diseases Tenth Edition (ICD 10) criteria for alcohol dependence and who were above the age of 18 years were included. This study was conducted in the de-addiction outpatient services of a Tertiary care center in South India between April 2019 and June 2020. Our Institutional Ethical Committee granted the approval for this study. We used a self-designed proforma for collecting the socio-demographic details. The Severity of Alcohol Dependence Questionnaire (SADQ) and Coping Orientation to Problems Experienced Inventory (Brief - COPE) were administered. Patients were followed up for six months. Motivation Enhancement Therapy was given to all our participants during their monthly follow-up visit. Descriptive analysis was performed using mean and standard deviation. We used the student t-test and chi-squared test to understand the differences in the coping strategies between relapsed and non-relapsed persons. Spearman's correlation was used to assess the correlation between the severity of alcohol dependence and coping strategies. A p value of <.05 was taken as significant. Results Non-relapsed individuals had significantly higher scores on active coping (p = .008), emotional support (p = .044), informational support (p = .017), planning (p < .001), acceptance (p = .030), and humor (p = .001). Relapsed individuals had statistically significant scores on denial (p = .005), substance use (p = .024), and self-blame (p = .012). We found a positive correlation between the severity of alcohol dependence and maladaptive coping strategies (p < .01). Conclusions Relapsed individuals were found to have significantly higher maladaptive coping strategies. Non-relapsed individuals exhibited greater adaptive coping styles. Maladaptive coping strategies positively correlated with the severity of alcohol dependence.
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Affiliation(s)
- Sabitha Venkateswaran
- Dept. of Psychiatry, Chengalpattu Medical College and Hospital, Chengalpattu, Tamil Nadu, India
| | - Ranganathan Thirumalai
- Dept. of Psychiatry, Chengalpattu Medical College and Hospital, Chengalpattu, Tamil Nadu, India
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Soweid L, Gilbert PA, Maharjan G, Holdefer PJ, Evans S, Mulia N. "Everybody needs to find the best path for them": Insights into recovery strategies of people who have not used specialty treatment for alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:743-754. [PMID: 38522024 DOI: 10.1111/acer.15287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Most people with alcohol use disorder (AUD) do not use treatment services, yet the majority ultimately resolve their AUD. As the phenomenon of untreated recovery remains poorly understood, we investigated the strategies used for recovery without treatment. METHODS We conducted semi-structured interviews with 65 adults (27 women, 37 White) with resolved AUD and no history of using specialty services (e.g., inpatient or outpatient rehabilitation, medication-assisted treatment). Using both inductive and deductive coding, we identified and elaborated themes and meanings. We verified our findings through nine member-check sessions with interviewers and interview participants. RESULTS Majorities of interview participants met criteria for severe lifetime AUD (84.6%), were in long-term recovery (>5 years; 81.5%), and indicated abstinence was their recovery goal (56.9%). Close to half (41.5%) had attended mutual-help groups (e.g., Alcoholics Anonymous). We identified five active strategies (Changing Contexts, Social Connections. Activities, Substitution, and Other Strategies) and four additional factors (Mutual-help Groups, Self-Reliance, Spirituality, and Aging/Maturing) that contributed to their recovery. Most participants employed multiple strategies and were intentional in adopting the ones that best suited them. By far, the two most common strategies were Changing Contexts (reported by 69.2% of participants) whereby people reduced their alcohol exposure by modifying social networks or physical settings and relying on Social Connections (reported by 67.7%), especially connections to people with similar lived experiences and struggles. Notably, Social Connections and Mutual-Help groups were the themes most often discussed jointly. Among other contributing factors mentioned, Spirituality appeared to play an important, but not universal, role as it was invoked by approximately half (49.2%) of participants. CONCLUSIONS Our study confirms that recovery without specialty treatment is possible, and that multiple strategies and contributing factors help to achieve it. These findings may inform novel interventions to support recovery among people unwilling or unable to obtain treatment for AUD.
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Affiliation(s)
- Loulwa Soweid
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Paul A Gilbert
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Gaurab Maharjan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Paul J Holdefer
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Sydney Evans
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
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Balbinot P, Pellicano R, Patussi V, Caputo F, Testino G. Alcohol use disorders, self-help groups as a supplement to pharmacological and psychological therapy? A retrospective study in a population with alcohol related liver disease. Minerva Gastroenterol (Torino) 2023; 69:479-485. [PMID: 36255286 DOI: 10.23736/s2724-5985.22.03292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND According to the new criteria in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V), the prevalence of alcohol use disorders (AUDs) is 20-30% in men and 10-15% in women worldwide.2,3 The anticraving therapy/psychotherapy combination is currently used routinely in clinical practice. However, the results after one year are unsatisfactory. Meta-analytic studies found failure rates of 57 to 75%. These percentages vary in relation to the intensity and length of the treatment. In addition, the abstinence rates gradually decrease over time. In this study, the clinical outcome of alcohol related liver disease (ALD) patients who spontaneously attended self-help groups (SHGs) (club of alcoholics in treatment - multi-family community/ alcoholics anonymous) regularly versus those who did not want to start the path or did not complete it was evaluated. METHODS From January 2005 to December 2010, 1337 alcohol use disorder patients affected by compensated alcohol related liver disease, were prospectively followed and retrospectively assessed. Two hundred thirty-one patients were enrolled: 74 attended self-help groups assiduously, 27 attended sporadically and 130 refused participation in SHGs. RESULTS Constant attendance at SHGs compared to non-attendance allows for a significant increase (<0.0001) in the period of sobriety found in the median of distribution. Frequent attendance at SHGs is effectively "preventive," reducing the fraction of relapses by about 30%. The percentage of cases of cirrhosis is significantly different (P=0.0007) between those who have regularly attended SHG meetings (about 1% of patients) and those who have never attended or only occasionally (various percentages between 21 and 31% of patients); in both groups the incidence of new cases would seem to be 0.014 cases/ year. Similar difference in percentages regarding the onset of hepatocellular carcinomas (HCCs), although with a lower level of significance (P=0.017) among those who attended regularly, 4% of patients with an incidence of 0.006 cases/ year, compared to those who have never attended or only occasionally: over 14% of patients with an incidence of 0.022 cases/year. CONCLUSIONS This study suggests the importance of attending SHGs not only for the long-term achievement of alcoholic abstention, but also in positively influencing the course of alcohol-related diseases.
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Affiliation(s)
- Patrizia Balbinot
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
| | - Rinaldo Pellicano
- Unit of Gastroenterology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy -
| | | | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Translational Medicine, Center for the Study and Treatment of Alcohol-Related Diseases, University of Ferrara, Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, University of Ferrara, Ferrara, Italy
| | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino University Hospital, ASL3 Liguria, Genoa, Italy
- Mutual-Self-Help Study Center, Community Programs and Caregiver Training, ASL3 Liguria, Genoa, Italy
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Skorkovský T, Vevera J, Beniš M, Miovský M, Popov P. Evaluating and comparing success rates for inpatient treatment of alcohol addiction in the Czech Republic. Cent Eur J Public Health 2023; 31:198-203. [PMID: 37934483 DOI: 10.21101/cejph.a7905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/11/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES This systematic review seeks to present and compare data from studies evaluating the success of medium-term inpatient treatment of alcohol-dependent patients in the Czech Republic. Another aim was to identify the problems that make such comparisons difficult. No previous review comparing the efficiency of various therapeutic programmes has been published in the Czech Republic. METHODS Bibliographia medica Čechoslovaca and PubMed were used to find studies published in professional medical journals since 1970 evaluating the abstinence of patients who voluntarily completed medium-term inpatient treatment of alcohol dependence. RESULTS Medium-term inpatient treatment of alcohol addiction leads to one year of abstinence in 34% to 76% of patients. Such variance in value is largely caused by selection bias, differences in the definition of abstinence, and differences in data collection methods. CONCLUSION The comparison of studies presented many challenges. Further steps should be taken to help compare treatment programmes in the future, as the programmes provide different therapeutic interventions of different intensities and lengths to different patients. Adequate demographic and other pretreatment characteristics data collection, detailed descriptions of therapeutic interventions, and identification of effective components of the therapeutic programme could support further research in this area, optimize existing programmes, and increase the overall treatment efficiency.
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Affiliation(s)
- Tomáš Skorkovský
- Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Pilsen, Czech Republic
| | - Jan Vevera
- Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Pilsen, Czech Republic
- Department of Psychiatry, Institute for Postgraduate Medical Education Prague, Prague, Czech Republic
| | - Milan Beniš
- Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University and University Hospital in Pilsen, Pilsen, Czech Republic
| | - Michal Miovský
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Popov
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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van Ruitenbeek P, Franzen L, Mason NL, Stiers P, Ramaekers JG. Methylphenidate as a treatment option for substance use disorder: a transdiagnostic perspective. Front Psychiatry 2023; 14:1208120. [PMID: 37599874 PMCID: PMC10435872 DOI: 10.3389/fpsyt.2023.1208120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
A transition in viewing mental disorders from conditions defined as a set of unique characteristics to one of the quantitative variations on a collection of dimensions allows overlap between disorders. The overlap can be utilized to extend to treatment approaches. Here, we consider the overlap between attention-deficit/hyperactivity disorder and substance use disorder to probe the suitability to use methylphenidate as a treatment for substance use disorder. Both disorders are characterized by maladaptive goal-directed behavior, impaired cognitive control, hyperactive phasic dopaminergic neurotransmission in the striatum, prefrontal hypoactivation, and reduced frontal cortex gray matter volume/density. In addition, methylphenidate has been shown to improve cognitive control and normalize associated brain activation in substance use disorder patients and clinical trials have found methylphenidate to improve clinical outcomes. Despite the theoretical basis and promising, but preliminary, outcomes, many questions remain unanswered. Most prominent is whether all patients who are addicted to different substances may equally profit from methylphenidate treatment.
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Affiliation(s)
- Peter van Ruitenbeek
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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11
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Caudle MM, Klaming R, Fong C, Harlé K, Taylor C, Spadoni A, Bomyea J. Approach avoidance training versus Sham in veterans with alcohol use disorder: protocol for a randomized controlled trial. BMC Psychiatry 2023; 23:499. [PMID: 37438722 PMCID: PMC10337098 DOI: 10.1186/s12888-023-04961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent and commonly co-occurs with other psychiatric disorders among Veterans. Provisional evidence supports the use of Approach Avoidance Training (AAT) - a form of computer-delivered cognitive bias modification designed to target implicit approach bias for alcohol-related cues - as an adjunctive program to treat AUD. However, the extent to which AAT is effective for improving AUD recovery outcomes in outpatient Veteran samples and those with psychiatric comorbidities has been understudied to date. Here we describe a double-blind randomized controlled trial of AAT versus a comparison condition (Sham) being conducted in Veterans with comorbid psychiatric conditions completing outpatient standard care. METHODS One hundred thirty-six Veterans currently receiving outpatient treatment for AUD will be recruited for this randomized controlled trial with parallel group assignment. Participants will be randomized to either 6 weeks of AAT (n = 68) or Sham (n = 68) training in conjunction with usual care. Assessments will occur at baseline and 6 weeks, 3 months, and 6 months post-baseline. Primary outcome variables will include functional consequences of drinking. Secondary outcome variables will include alcohol consumption, and behavioral indicators of alcohol approach bias. A subset of participants (n = 51) will also complete functional magnetic resonance imaging (fMRI) to assess neural response during an alcohol approach bias assessment. DISCUSSION This study is the first randomized controlled trial of AAT administered as an adjunctive treatment to standard care in Veterans with AUD and comorbid psychiatric disorders. Additionally, behavioral and neuroimaging data will be used to determine the extent to which AAT targets approach bias for alcohol cues. If effective, AAT may be a promising low-cost adjunctive treatment option for individuals with AUD. REGISTRY NAME AAT for Alcohol Use Disorder in Veterans. TRIAL REGISTRATION ClinicalTrials.gov: NCT05372029; Date of Registration: 5/9/2022.
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Affiliation(s)
- M M Caudle
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - R Klaming
- Department of Veteran Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - C Fong
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA
| | - K Harlé
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - C Taylor
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
| | - A Spadoni
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - J Bomyea
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, San Diego, CA, 92093, USA.
- VA San Diego Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
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12
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Hobden B, Freund M, Lawson S, Bryant J, Walsh J, Leigh L, Sanson‐Fisher R. The impact of organisational factors on treatment outcomes for those seeking alcohol or other drug treatment: A systematic review. Drug Alcohol Rev 2023; 42:1220-1234. [PMID: 37005012 PMCID: PMC10947488 DOI: 10.1111/dar.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/24/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Organisational factors have been found to be associated with health outcomes in a number of health-care settings. Despite likely being an important influence on the quality of care provided within alcohol and other drug (AOD) treatment centres, the impact of organisational factors on AOD treatment outcomes have not been extensively explored. This systematic literature review examines the characteristics, methodological quality and findings of published studies exploring the association between organisational factors and client AOD treatment outcomes. METHODS Medline, Embase, PsycINFO and the Cochrane database were searched from 2010 to March 2022 for relevant papers. Studies meeting the inclusion criteria underwent quality assessment using the Joanna Brigg's Institute critical appraisal tool for cross-sectional studies, followed by data extraction of key variables pertaining to the aims. A narrative summary was used to synthesise the data. RESULTS Nine studies met the inclusion criteria. Organisational factors examined included cultural competency, organisational readiness for change, directorial leadership, continuity of care practices, service access, service to needs ratios, dual diagnosis training, therapeutic optimism and the funding model/health-care system that treatment was delivered in. Outcome measures included duration, completion or continuation of treatment; AOD use; and patient perceptions of treatment outcomes. Seven out of nine papers found a significant interaction between at least one organisational variable and AOD treatment outcomes. DISCUSSION AND CONCLUSIONS Organisational factors are likely to impact treatment outcomes for patients seeking treatment for AOD. Further examination of the organisational factors that influence AOD outcomes is needed to inform systemic improvements to AOD treatment.
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Affiliation(s)
- Breanne Hobden
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Megan Freund
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Samuel Lawson
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Jamie Bryant
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Justin Walsh
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
| | - Lucy Leigh
- Clinical Research Design and StatisticsHunter Medical Research InstituteNewcastleAustralia
| | - Rob Sanson‐Fisher
- Health Behaviour Research CollaborativeSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of NewcastleNewcastleAustralia
- Equity in Health and Wellbeing Program, Hunter Medical Research InstituteNewcastleAustralia
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13
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Atkinson NS. The Role of Toll and Nonnuclear NF-κB Signaling in the Response to Alcohol. Cells 2023; 12:1508. [PMID: 37296629 PMCID: PMC10252657 DOI: 10.3390/cells12111508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
An understanding of neuroimmune signaling has become central to a description of how alcohol causes addiction and how it damages people with an AUD. It is well known that the neuroimmune system influences neural activity via changes in gene expression. This review discusses the roles played by CNS Toll-like receptor (TLR) signaling in the response to alcohol. Also discussed are observations in Drosophila that show how TLR signaling pathways can be co-opted by the nervous system and potentially shape behavior to a far greater extent and in ways different than generally recognized. For example, in Drosophila, TLRs substitute for neurotrophin receptors and an NF-κB at the end of a TLR pathway influences alcohol responsivity by acting non-genomically.
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Affiliation(s)
- Nigel S Atkinson
- Department of Neuroscience and The Waggoner Center for Alcohol and Addiction Research, The University of Texas at Austin, Austin, TX 78712, USA
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14
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Wang D, Yin Y, Yuan W, Li B, Wang H, Hu J, Chen M, Gong Y, Yuan TF, Yu T. Post-error slowing predicts for relapse in individuals with alcohol use disorder. J Psychiatr Res 2023; 161:441-448. [PMID: 37059028 DOI: 10.1016/j.jpsychires.2023.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Relapse characterizes addiction. The cognitive phenotype underlying relapse in individuals with alcohol use disorder (AUD) remain unelucidated. Here we aimed to investigate the potential changes in behavioral adjustment in AUD, and the association with relapse. METHOD Forty-seven subjects with AUD at Shandong Mental Health Center completed the stop-signal task, the PACS, the Beck Depression Inventory and the State-Trait anxiety questionnaires. Thirty age-matched male healthy subjects served as the control group (HC). In the follow-up, twenty-one subjects remained abstinent, while twenty-six subjects relapsed. Independent sample t-test was applied to measure differences between two groups and logistic regression analysis was conducted to explore the potential predictors on relapse. RESULTS The results showed that there were significant differences in stop signal reaction time (SSRT) and trigger failure between the AUD and HC groups. Relapsed group showed longer post-error slowing (PES) when compared to the non-relapsed group. The PES could predict relapse in alcohol use disorder. CONCLUSION Individuals with AUD showed impaired inhibitory control, which may predict relapse.
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Affiliation(s)
- Duanwei Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Yuanyuan Yin
- School of Mental Healthy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Yuan
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Bin Li
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Hairong Wang
- Shandong Mental Health Center, Jinan, Shandong, China
| | - Ji Hu
- School of Life Sciences, ShanghaiTech University, Shanghai, China
| | - Meng Chen
- Brain and Cognitive Neuroscience Research Center, Liaoning Normal University, Dalian, China
| | - Yuandong Gong
- Shandong Mental Health Center, Jinan, Shandong, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China.
| | - Tiangui Yu
- Shandong Mental Health Center, Jinan, Shandong, China.
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15
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Kamens HM, Flarend G, Horton WJ. The role of nicotinic receptors in alcohol consumption. Pharmacol Res 2023; 190:106705. [PMID: 36813094 PMCID: PMC10083870 DOI: 10.1016/j.phrs.2023.106705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023]
Abstract
The use of alcohol causes significant morbidity and mortality across the globe. Alcohol use disorder (AUD) is defined by the excessive use of this drug despite a negative impact on the individual's life. While there are currently medications available to treat AUD, they have limited efficacy and several side effects. As such, it is essential to continue to look for novel therapeutics. One target for novel therapeutics is nicotinic acetylcholine receptors (nAChRs). Here we systematically review the literature on the involvement of nAChRs in alcohol consumption. Data from both genetic and pharmacology studies provide evidence that nAChRs modulate alcohol intake. Interestingly, pharmacological modulation of all nAChR subtypes examined can decrease alcohol consumption. The reviewed literature demonstrates that nAChRs should continue to be investigated as novel therapeutics for AUD.
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Affiliation(s)
- Helen M Kamens
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, United States.
| | - Geneva Flarend
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, United States
| | - William J Horton
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, United States
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16
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Martinelli TF, Nagelhout GE, Best D, Vanderplasschen W, van de Mheen D. Factors associated with problematic substance use before and during the COVID-19 pandemic among a drug addiction recovery cohort: A prospective study in the Netherlands, Belgium, and UK. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 148:209025. [PMID: 36935065 PMCID: PMC10022465 DOI: 10.1016/j.josat.2023.209025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/15/2022] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND The COVID-19 pandemic and measures have placed various burdens on societies and individuals. Emerging evidence suggests that people in drug addiction recovery were negatively affected. This study investigates whether risk and protective factors associated with return to problematic substance use differed between the periods before and during the pandemic for those in recovery. METHODS A convenience sample of persons in drug addiction recovery for at least three months completed an assessment at baseline before the pandemic (T0, N = 367) and at two consecutive follow-ups 12 months apart (T1, N = 311; T2, N = 246). The final follow-up took place during the pandemic (2020-2021). We analyzed rates and predictors of problematic substance use in both periods, and whether relations between predictors and problematic use differed between the periods. RESULTS Rates of problematic use did not differ significantly before and during the pandemic for those who were followed-up. However, the relationship between problematic use and commitment to sobriety differed between both periods (OR = 3.24, P = 0.010), as higher commitment was only associated with lower odds of problematic use during (OR = 0.27, P < 0.001), but not before, the pandemic (OR = 0.93, P = 0.762). In both periods, persons who were engaged in psychosocial support had lower odds of problematic use. CONCLUSIONS The COVID-19 pandemic was not followed by significant return to problematic substance use in a cohort of people who were already in drug addiction recovery for some time before the pandemic. However, with restricted access to environmental resources, they may have been more dependent on internal motivations. Targeting personal recovery resources with interventions could therefore reduce the chances of return to problematic substance use during a pandemic.
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Affiliation(s)
- Thomas F Martinelli
- IVO Research Institute, Koningin Julianaplein 10, The Hague, the Netherlands; Tranzo Scientific Centre for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Prof. Cobbenhagenlaan 125, Tilburg, the Netherlands.
| | - Gera E Nagelhout
- IVO Research Institute, Koningin Julianaplein 10, The Hague, the Netherlands; Department of Health Promotion, Maastricht University (CAPHRI), P. Debyeplein 1, Maastricht, the Netherlands
| | - David Best
- Faculty of Social and Health Sciences, Leeds Trinity University, Brownberrie Lane, Horsforth, Leeds LS18 5HD, United Kingdom
| | - Wouter Vanderplasschen
- Department of Special Needs Education, Ghent University, Henri Dunantlaan 2, Ghent, Belgium
| | - Dike van de Mheen
- Tranzo Scientific Centre for Care and Wellbeing, School of Social and Behavioural Sciences, Tilburg University, Prof. Cobbenhagenlaan 125, Tilburg, the Netherlands
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17
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Radevski ME, Prendergast MA, Bardo MT, Akins CK. PT150 blocks the rewarding properties of ethanol and attenuates ethanol-induced reduction of egg laying in Coturnix quail. Psychopharmacology (Berl) 2023; 240:295-301. [PMID: 36607385 DOI: 10.1007/s00213-022-06299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
RATIONALE Alcohol use disorder (AUD) has been shown to be associated with a dysregulated stress system. Reducing the stress hormone corticosterone (CORT), that binds to glucocorticoid receptors, may attenuate the rewarding properties of drugs of abuse. However, the effect of blocking corticosterone receptors on ethanol reward has yet to be investigated. OBJECTIVES The current study investigated whether the stress hormone receptor antagonist, PT150, would block the rewarding properties of ethanol via the glucocorticoid receptor system and attenuate other ethanol-induced effects. METHODS A conditioned place preference (CPP) procedure was used to examine the rewarding properties of ethanol in an avian preclinical model. Ethanol was paired with the least preferred chamber. On alternate days, water was paired with the preferred chamber. After eight pairings, a place preference test was given that allowed subjects to have access to both chambers. Half of the subjects received PT150 prior to ethanol administration. The other half received vehicle. Time spent in each chamber during the preference tests, locomotor activity during the pairings, and egg production in female birds was recorded. RESULTS Ethanol treatment resulted in a CPP and pretreatment of PT150 blocked the acquisition of the ethanol-induced place preference. Neither ethanol nor PT150 altered locomotor activity. Pretreatment of PT150 also increased egg production in female quail treated with ethanol. CONCLUSIONS These findings suggest repeated ethanol pairings with visual cues can produce a CPP. Furthermore, pretreatment of PT150 may be a potential pharmacotherapy for blocking the rewarding properties of ethanol and may enhance egg production in female quail treated with ethanol.
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Affiliation(s)
- Mia E Radevski
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA.
| | - Mark A Prendergast
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA
| | - Michael T Bardo
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA
| | - Chana K Akins
- Department of Psychology, University of Kentucky, Lexington, KY, 40506, USA
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18
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Hoffmann S, Gerhardt S, Koopmann A, Bach P, Sommer WH, Kiefer F, Mazza M, Lenz B. Body mass index interacts with sex to predict readmission in in-patients with alcohol use disorder. Addict Biol 2023; 28:e13239. [PMID: 36577723 DOI: 10.1111/adb.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/19/2022] [Accepted: 09/22/2022] [Indexed: 12/23/2022]
Abstract
A previous highly controlled pilot study revealed that body mass index (BMI) predicts outcome of in-patients with alcohol use disorder (AUD) in a sex-specific manner. We here provide translational evidence from a daily clinical routine setting and investigated whether BMI and sex interact to predict 24-month readmission risk in four naturalistic cohorts of a specialized addiction clinic (i.e., all patients admitted to the clinic from 2016 to 2020): (i) in-patients (443 males and 197 females) and (ii) day clinic patients (241 males and 103 females) with a primary diagnosis of AUD; (iii) in-patients (175 males and 98 females) and (iv) day clinic patients (174 males and 64 females) with a primary substance use disorder (SUD) other than alcohol. In the in-patients with AUD, BMI interacted with sex to predict the 24-month readmission risks (p = 0.008; after adjustment for age and liver enzyme activities: p = 0.012); with higher BMI, the risk increases significantly in males, whereas for females, the risk tends to decrease. In the group of overweight in-patients, we found higher readmission rates in males relative to females with an odds ratio of 1.8 (p = 0.038). No such significant effects were found in the other cohorts. This study's findings support previous results, suggesting that the easily accessible BMI may serve as a predictive and sex-sensitive biomarker for outcome in in-patients with AUD. Future studies are necessary to elucidate the underlying aetiopathological mechanisms.
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Affiliation(s)
- Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Biostatistics, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Anne Koopmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang H Sommer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychopharmacology, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Bethanian Hospital for Psychiatry, Psychosomatics and Psychotherapy, Greifswald, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Massimiliano Mazza
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernd Lenz
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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19
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Geuijen P, Schellekens A, Schene A, Atsma F. Substance use disorder and alcohol consumption patterns among Dutch physicians: a nationwide register-based study. Addict Sci Clin Pract 2023; 18:4. [PMID: 36639645 PMCID: PMC9837897 DOI: 10.1186/s13722-022-00356-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Problematic substance use and Substance Use Disorders (SUD) are common in all layers of the population. Several studies suggest higher prevalence rates of problematic substance use among physicians compared to the general population, which is harmful for themselves and potentially impairs quality of care. However, nationwide comparison with a highly educated reference group is lacking. Using nationwide register data, this study compared the prevalence of clinical SUD diagnoses and alcohol consumption patterns between physicians and a highly educated reference population. METHODS A retrospective study was performed using registry data from 2011 up to and including 2019, provided by Statistics Netherlands. From the data, a highly educated reference group was selected and those with an active medical doctor registration were identified as "physicians". Clinical SUD diagnoses were identified by DSM-IV codes in mental healthcare registries. Benchmark analyses were performed, without statistical testing, to compare the prevalence of SUD diagnoses and alcohol consumption patterns between physicians and the reference population. RESULTS Clinical SUD diagnoses were found among 0.3% of the physicians and 0.5% of the reference population, with higher proportions of sedative use disorder among physician patients. Among drinkers, the prevalence rates of heavy and excessive drinking were respectively 4.0% and 4.3% for physicians and 7.7% and 6.4% for the reference population. CONCLUSION Prevalence rates of SUD diagnoses were fairly comparable between physicians and the highly educated reference population, but physicians displayed more favorable alcohol consumption patterns. The use of sedatives by physicians might deserve attention, given the relatively higher prevalence of sedative use disorder among physicians. Overall, we observed relatively low prevalence rates of SUD diagnoses and problematic alcohol use, which may reflect a treatment gap and social desirable answers.
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Affiliation(s)
- Pauline Geuijen
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Arnt Schellekens
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Aart Schene
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Femke Atsma
- grid.10417.330000 0004 0444 9382Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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20
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Meshesha LZ, Emery NN, Blevins CE, Battle CL, Sillice MA, Marsh E, Feltus S, Stein MD, Abrantes AM. Behavioral activation, affect, and self-efficacy in the context of alcohol treatment for women with elevated depressive symptoms. Exp Clin Psychopharmacol 2022; 30:494-499. [PMID: 34110890 PMCID: PMC8660942 DOI: 10.1037/pha0000495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Women with Alcohol use disorder (AUD) are more likely than men to have co-occurring depression, drink to cope with negative affect (NA), and cite negative affect as a contributor to relapse. Among AUD treatment seekers, low behavioral activation, NA, and reduced self-efficacy in abstaining from alcohol (e.g., in tempting situations) are relapse risk factors. This study investigated the association between behavioral activation, affective states, and self-efficacy among treatment-seeking women. Participants were 70 women (M = 40.50, SD = 11.59 years of age) with elevated depressive symptoms seeking AUD treatment. The Behavioral Activation for Depression Scale (BADS) was used to assess environmental engagement. The Alcohol Abstinence Self-Efficacy (AASE) scale was used to assess temptation to drink in contexts of positive and negative affect, and general positive and negative affect were assessed with the Positive and Negative Affect Schedule. Results indicated that behavioral activation was directly correlated with positive affect (PA; r = .62, p < .001) and inversely correlated with depression (r = -.35, p = .004), negative affect (r = -.39, p = .001), and temptation to drink in the context of negative affect (r = -.33, p = .006). After controlling for depressive symptoms, behavioral activation continued to be associated with greater general positive affect (β = .595, p < .001) and lower temptation to drink in the context of negative affect (β = -.348 p = .008). Our results suggest a nuanced association between behavioral activation, negative affect, and temptations to drink that is not accounted by depressive symptoms. Self-efficacy to abstain from drinking in a negative affect context should be considered when designing AUD interventions for women. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Claire E. Blevins
- Butler Hospital, Behavioral Medicine and Addictions Research, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine of Brown University
| | - Cynthia L. Battle
- Butler Hospital, Behavioral Medicine and Addictions Research, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine of Brown University
| | - Marie A. Sillice
- Department of Health Policy and Management, City University of New York
- Department of Health Policy and Management, Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York (CUNY)
| | - Eliza Marsh
- Butler Hospital, Behavioral Medicine and Addictions Research, Providence, Rhode Island, USA
| | - Sage Feltus
- Butler Hospital, Behavioral Medicine and Addictions Research, Providence, Rhode Island, USA
| | - Michael D. Stein
- Butler Hospital, Behavioral Medicine and Addictions Research, Providence, Rhode Island, USA
- Department of Health Law, Policy, and Management, Boston University
| | - Ana M. Abrantes
- Butler Hospital, Behavioral Medicine and Addictions Research, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine of Brown University
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21
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Garel N, McAnulty C, Greenway KT, Lesperance P, Miron JP, Rej S, Richard-Devantoy S, Jutras-Aswad D. Efficacy of ketamine intervention to decrease alcohol use, cravings, and withdrawal symptoms in adults with problematic alcohol use or alcohol use disorder: A systematic review and comprehensive analysis of mechanism of actions. Drug Alcohol Depend 2022; 239:109606. [PMID: 36087563 DOI: 10.1016/j.drugalcdep.2022.109606] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alcohol use disorder is highly prevalent and has important economical, societal, psychiatric, and medical consequences. All currently approved therapeutic approaches targeting alcohol dependence have relatively modest effects and high relapse rates. Recent evidence suggests that ketamine may be an effective intervention to treat alcohol use disorder and alcoholic withdrawal. This systematic review aimed to assess the current level of evidence for this intervention. METHODS This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the international database of systematic reviews PROSPERO. Medline(Ovid), CINAHL Complete(EBSCOhost), PsycINFO(Ovid), EBM Reviews(Ovid), EMBASE(Ovid), and Google Scholar were searched for studies using ketamine to treat harmful alcohol use, craving, or withdrawal states in humans. Studies of any methodology that evaluated ketamine in isolation or combination with other interventions were included. The risk of bias was assessed using specific Cochrane critical appraisal tools. RESULTS Of 1922 abstracts identified, 8 full-text articles were eligible for inclusion, yielding a total sample size of 634 participants. Five studies investigated the impact of ketamine on alcohol use and/or cravings and/or withdrawal in outpatient settings. Three studies looked at the effect of adding ketamine to conventional treatment of withdrawal symptoms in participants admitted to intensive care unit for severe alcohol withdrawal. Results on primary outcomes were mixed within and across trials. CONCLUSIONS Despite promising results, the current evidence does not permit definitive conclusions about the efficacy of ketamine in alcohol use disorders or withdrawal. Future studies are warranted.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Christina McAnulty
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Kyle T Greenway
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Paul Lesperance
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Jean-Philippe Miron
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada; McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada; Douglas Mental Health Research Institute, McGill Group for Suicide Studies, 6875 Boulevard LaSalle, Montréal, Québec H4H 1R3, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada.
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22
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Seesink HJ, Schaap-Jonker H, Ostafin B, Lokman JC, Wiers RW. Protocol for an RCT on cognitive bias modification for alcohol use disorders in a religion-based rehabilitation program. BMJ Open 2022; 12:e060820. [PMID: 36130749 PMCID: PMC9494557 DOI: 10.1136/bmjopen-2022-060820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Alcohol-related cues trigger relapse in patients with alcohol use disorders (AUDs). These cues may automatically activate motivational approach tendencies. Through computerised cognitive bias modification (CBM), the tendencies of patients with AUD to approach alcohol can be reduced. The present protocol describes a training intervention with approach bias modification (ApBM) incorporating religion-related stimuli as an alternative to alcohol to improve the effectiveness of CBM in a religion-based rehabilitation centre. AUD is often related to patients' religious attitudes in this treatment context. The religion-adapted ApBM, therefore, combines training in avoidance of alcohol-related motivational cues and an approach to religion-based motivational cues. This combination's effectiveness will be compared with a standard ApBM and to a sham ApBM. METHODS AND ANALYSIS Using a double-blind multiarm parallel randomised controlled trial procedure (ratio 1:1:1), 120 patients with AUD will be randomised into 1 of 3 conditions (religion-adapted ApBM, standard ApBM or sham ApBM) with personalised stimuli. The interventions are delivered over 4 consecutive days during an inpatient detoxification programme in addition to treatment as usual. Assessments occur before the start of the training and after the fourth training session, with follow-up assessments after 1 and 4 months. A multivariate analysis of variance will be used with the primary outcomes, the percentage of days abstinent and meaning in life 4-month follow-up. Secondary outcomes include differences in reported training satisfaction and symptoms of AUD. ETHICS AND DISSEMINATION This study has been reviewed and approved by the Medical Research Ethics Committee Academic Medical Center Amsterdam (Reference number: 2020_251). Further, study results will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NL75499.018.20.
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Affiliation(s)
- Henk-Jan Seesink
- Department of Research, De Hoop ggz, Dordrecht, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Research and Innovation in Christian Mental Health Care, Eleos/De Hoop, Hoevelaken, The Netherlands
| | - Hanneke Schaap-Jonker
- Centre for Research and Innovation in Christian Mental Health Care, Eleos/De Hoop, Hoevelaken, The Netherlands
- Department of Religion and Theology, Faculteit der Geesteswetenschappen, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Brian Ostafin
- Experimental and Clinical Psychology, Department of Psychology, Rijksuniversiteit Groningen Faculteit Gedrags en Maatschappijwetenschappen, Groningen, The Netherlands
| | - John C Lokman
- Department of Psychiatry, Amsterdam UMC - University Medical Centers, Amsterdam, The Netherlands
| | - Reinout W Wiers
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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23
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Gerhardt S, Lex G, Holzammer J, Karl D, Wieland A, Schmitt R, Recuero AJ, Montero JA, Weber T, Vollstädt-Klein S. Effects of chess-based cognitive remediation training as therapy add-on in alcohol and tobacco use disorders: protocol of a randomised, controlled clinical fMRI trial. BMJ Open 2022; 12:e057707. [PMID: 36691127 PMCID: PMC9454048 DOI: 10.1136/bmjopen-2021-057707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 08/16/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Alcohol and tobacco use disorders (AUD, TUD) are frequent, both worldwide and in the German population, and cognitive impairments are known to facilitate instances of relapse. Cognitive training has been proposed for enhancing cognitive functioning and possibly improving treatment outcome in mental disorders. However, these effects and underlying neurobiological mechanisms are not yet fully understood regarding AUD and TUD. Examining the effect of chess-based cognitive remediation training (CB-CRT) on neurobiological, neuropsychological and psychosocial aspects as well as treatment outcomes will provide insights into mechanisms underlying relapse and abstinence and might help to improve health behaviour in affected individuals if used as therapy add-on. METHODS AND ANALYSIS N=96 individuals with either AUD (N=48) or TUD (N=48) between 18 and 65 years of age will participate in a randomised, controlled clinical functional MRI (fMRI) trial. Two control groups will receive treatment as usual, that is, AUD treatment in a clinic, TUD outpatient treatment. Two therapy add-on groups will receive a 6-week CB-CRT as a therapy add-on. FMRI tasks, neurocognitive tests will be administered before and afterwards. All individuals will be followed up on monthly for 3 months. Endpoints include alterations in neural activation and neuropsychological task performance, psychosocial functioning, and relapse or substance intake. Regarding fMRI analyses, a general linear model will be applied, and t-tests, full factorial models and regression analyses will be conducted on the second level. Behavioural and psychometric data will be analysed using t-tests, regression analyses, repeated measures and one-way analyses of variance. ETHICS AND DISSEMINATION This study has been approved by the ethics committee of the medical faculty Mannheim of the University of Heidelberg (2017-647N-MA). The findings of this study will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION The study was registered in the Clinical Trials Register (trial identifier: NCT04057534 at clinicaltrials.gov).
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Affiliation(s)
- Sarah Gerhardt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gereon Lex
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jennifer Holzammer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Damian Karl
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alfred Wieland
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Roland Schmitt
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | | | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neurosciences (MCTN), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Srivastava K, Prakash J, Bhat PS, Chatterjee K, Chaudhury S, Chauhan V. Cognitive behavior therapy as an adjuvant in management of alcohol dependence syndrome. Ind Psychiatry J 2022; 31:255-261. [PMID: 36419701 PMCID: PMC9678146 DOI: 10.4103/ipj.ipj_267_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Treatment of alcohol dependence is a major challenge due to frequent relapses. Cognitive-behavioral therapy (CBT) has been reported to be useful in the treatment of alcohol dependence. AIM This study aims to evaluate the effect of CBT module in management of Alcohol Dependence and compare it with treatment as usual (TAU). MATERIALS AND METHODS All newly diagnosed alcohol dependence patients during the study period meeting the exclusion and inclusion criteria were included in the study. Patients with a head injury, HIV seropositive status, or any other organic brain disorder and comorbid psychiatric disorders were excluded. The study included 226 patients with alcohol dependence randomly assigned to intervention group (n = 116) and TAU group (n = 110). Demographic and clinical data were recorded and Severity of Alcohol Dependence Questionnaire was applied. Relapse was taken as an outcome variable. Both TAU group and experimental group were followed on standard protocol of treatment. RESULTS The data were analyzed and relative risk (RR) was calculated. Findings revealed the study group receiving CBT had a better outcome and relapse rate was also significantly low in the experimental group as compared to the TAU group. CONCLUSION The RR of relapse is lower in patients of alcohol dependence on CBT within 6 months and within 1 year as compared to cases on TAU. It is recommended that CBT be used as an adjunct to treatment in alcohol dependence cases.
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Affiliation(s)
- Kalpana Srivastava
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Kaushik Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Vinay Chauhan
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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25
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Adachi M, Tamakoshi K, Watai I. Hospital organizational structure factors related to discharge planning activities for alcoholics by nurses in Japan. Jpn J Nurs Sci 2022; 19:e12473. [PMID: 35112492 DOI: 10.1111/jjns.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/13/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
AIM Nurses play a significant role in providing discharge support for alcoholics. We aimed to explore the organizational structures of hospitals that are related to effective discharge planning activities provided by nurses. METHODS We conducted a cross-sectional survey of Japanese hospitals with psychiatric wards that accept alcoholics. The survey questionnaire was administered to one nurse per hospital from August to September 2019. The Discharge Planning Scale for Ward Nurses (DPWN) was used to assess the actual status of the hospital nurse teams' discharge planning activities. The DPWN consists of four subscales: subscale I, "collect information from patients and their families"; subscale II, "supports for decision-making for the patients and families"; subscale III, "utilization of social resources"; and subscale IV, "discharge guidance by cooperating with community support teams and multidisciplinary teams." RESULTS From the valid responses of 116 hospitals, scores on subscale IV were significantly lower than scores on subscales I, II, and III, indicating that medical care guidance through multidisciplinary collaboration between hospitals and the community was inadequate. In addition, multiple regression analysis showed that "hospital management and administrators understanding about nurses' discharge support activities," and "planning discharge schedules, such as using clinical paths" were significantly and independently related to the total DPWN and each of subscale scores, regardless of the hospital's establishment body and size. "Multidisciplinary discharge support" was significantly related to subscale II. CONCLUSIONS These findings have implications for the management of discharge planning activities provided by nurses for alcoholics through multidisciplinary collaboration.
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Affiliation(s)
- Madoka Adachi
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Izumi Watai
- Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
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26
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Cripe CT, Mikulecky P, Sucher M, Huang JH, Hack D. Improved Sobriety Rates After Brain-Computer Interface-Based Cognitive Remediation Training. Cureus 2022; 14:e21429. [PMID: 35106254 PMCID: PMC8785625 DOI: 10.7759/cureus.21429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Up to 80% of individuals seeking treatment fail in their attempts at sobriety. This study investigated whether 1) a cognitive remediation therapy (CRT) program augmented with a brain-computer interface (BCI) to influence brain performance metrics would increase participants' self-agency by restoring cognitive control performance; and 2) that ability increase would produce increased sobriety rates, greater than published treatment rates. The study employed a retrospective chart review structured to replicate a switching replication methodology (i.e., waitlist group) using a pre-test and post-test profile analysis quasi-experimental design. Participants' records were organized into treatment and non-treatment groups. Adult poly-substance users were recruited from alcohol and other drugs (AOD) use outpatient programs and AOD use treatment centers in the United States. Participants volunteered for pre- and post-testing without treatment (n = 121) or chose to enter the treatment program (n = 200). The treatment group engaged in a 48-session BCI/CRT augmented treatment program. Pre- and post-treatment measures comprised 14 areas from the Woodcock-Johnson Cognitive Abilities III Assessment Battery. An 18-month follow-up assessment measured maintenance of sobriety. After testing the difference for all variables across time between test groups, a significant multivariate effect was found. In addition, at 18 months post-treatment, 89% of the treatment group maintained sobriety, compared to 31% of the non-treatment group. Consistent with addiction neurobehavioral imbalance models, traditional treatment programs augmented with BCI/CRT training, focused on improving cognitive control abilities, may strengthen self-control and improve sobriety rates.
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27
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Sasaki J, Matsubara T, Chen C, Fujii Y, Fujita Y, Nakamuta M, Nitta K, Egashira K, Hashimoto T, Nakagawa S. Prefrontal activity during the emotional go/no-go task and computational markers of risk-based decision-making predict future relapse in alcohol use disorder. Front Psychiatry 2022; 13:1048152. [PMID: 36683993 PMCID: PMC9845941 DOI: 10.3389/fpsyt.2022.1048152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
AIM To longitudinally examine if the results of cognitive tasks or brain function during emotional or cognitive tasks can predict relapse in alcohol use disorder. METHODS We selected 41 patients with alcohol use disorder during hospitalization. Functional near-infrared spectroscopy (fNIRS) measured the relative change in oxygenated hemoglobin in the frontotemporal areas during an emotional go/no-go task and verbal fluency task (VFT). They performed the N-back and risk-based decision-making tasks for determining working memory or risk-based decision-making. The presence of relapse 6 months following discharge was the primary outcome. RESULTS Twenty-four patients (21 men, three women) remained abstinent, whereas 17 (14 men, three women) relapsed. Compared with the abstinent group, those with relapse displayed significantly decreased activation in the right frontotemporal region during the emotional go/no-go task, significantly shorter reaction time to non-emotional stimuli, and greater risk preference in the risk-based decision-making task. In the abstinent group, we observed a negative correlation between oxygenated hemoglobin and the craving scale. A logistic regression analysis demonstrated that the risk of relapse increased with smaller oxygenated hemoglobin in the right frontotemporal region (odds ratio = 0.161, p = 0.013) and with greater gambling thoughts (odds ratio = 7.04, p = 0.033). CONCLUSION Decreased activation in the right frontotemporal region in response to an emotional stimulus and risk preference could predict relapse in alcohol use disorder.
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Affiliation(s)
- Jun Sasaki
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Koryo Hospital, Ube, Japan
| | - Toshio Matsubara
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Chong Chen
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yuko Fujii
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | | | | | | | | | | | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, Japan
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28
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Geuijen PM, Pars E, Kuppens JM, Schene AH, de Haan HA, de Jong CAJ, Atsma F, Schellekens AFA. Barriers and Facilitators to Seek Help for Substance Use Disorder among Dutch Physicians: A Qualitative Study. Eur Addict Res 2022; 28:23-32. [PMID: 34192705 DOI: 10.1159/000517043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Substance use disorders (SUDs) among physicians affect their health, quality of life, but potentially also their quality of care. Despite the availability of effective specific Physician Health Programs (PHPs), physicians with SUD often experience barriers when seeking professional help. Therefore, we studied barriers and facilitators when seeking help for SUD among physicians from a multiple perspective approach. METHODS A qualitative design was adopted for 2 sub-studies. First, answers of 2 open-ended questions (about anticipated barriers and facilitators) of an existing questionnaire were analyzed. This questionnaire was filled out by 1,685 general physicians (response rate = 47%). The answers of these open-ended questions were coded inductively. Second, 21 semi-structured interviews (about experienced barriers and facilitators) were performed with physician SUD-patients, significant others, and PHP employees. Themes identified in the first sub-study were used to deductively code the interview transcripts. Results were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Barriers were found at the level of the individual physician (negative feelings and lack of disease awareness), whereas facilitators were found at the level of social relationships (confrontation with SUD and social support) and health services (supportive approach, good accessibility, and positive image of services). The interviews emphasized the importance of nonjudgmental confrontation by social relationships in the process of seeking help for SUD. CONCLUSION Physicians with SUD face barriers when seeking help for SUD mostly at the level of the individual physician. Health services and people around physicians with SUD could facilitate the help-seeking process by offering confidential and nonpunitive support. Future studies should explore whether the barriers and facilitators identified in this study also hold for other mental health issues.
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Affiliation(s)
- Pauline M Geuijen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Esther Pars
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Joanneke M Kuppens
- Physician Health Program ABS-Doctors, Royal Dutch Medical Association (RDMA), Utrecht, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein A de Haan
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.,Tactus Addiction Treatment, Deventer, The Netherlands
| | - Cornelis A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Femke Atsma
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
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29
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Zetterström A, Hämäläinen MD, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. The Clinical Course of Alcohol Use Disorder Depicted by Digital Biomarkers. Front Digit Health 2021; 3:732049. [PMID: 34950928 PMCID: PMC8688853 DOI: 10.3389/fdgth.2021.732049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: This study introduces new digital biomarkers to be used as precise, objective tools to measure and describe the clinical course of patients with alcohol use disorder (AUD).Methods: An algorithm is outlined for the calculation of a new digital biomarker, the recovery and exacerbation index (REI), which describes the current trend in a patient's clinical course of AUD. A threshold applied to the REI identifies the starting point and the length of an exacerbation event (EE). The disease patterns and periodicity are described by the number, length, and distance between EEs. The algorithms were tested on data from patients from previous clinical trials (n = 51) and clinical practice (n = 1,717).Results: Our study indicates that the digital biomarker-based description of the clinical course of AUD might be superior to the traditional self-reported relapse/remission concept and conventional biomarkers due to higher data quality (alcohol measured) and time resolution. We found that EEs and the REI introduce distinct tools to identify qualitative and quantitative differences in drinking patterns (drinks per drinking day, phosphatidyl ethanol levels, weekday and holiday patterns) and effect of treatment time.Conclusions: This study indicates that the disease state—level, trend and periodicity—can be mathematically described and visualized with digital biomarkers, thereby improving knowledge about the clinical course of AUD and enabling clinical decision-making and adaptive care. The algorithms provide a basis for machine-learning-driven research that might also be applied for other disorders where daily data are available from digital health systems.
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Affiliation(s)
| | | | | | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Uppsala Science Park, Uppsala, Sweden
| | - Karl Andersson
- Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Ridgeview Instruments AB, Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
- Fred Nyberg
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30
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Fenollal-Maldonado G, Brown D, Hoffman H, Kahlon C, Grossberg G. Alcohol Use Disorder in Older Adults. Clin Geriatr Med 2021; 38:1-22. [PMID: 34794695 DOI: 10.1016/j.cger.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
As the number of older adults worldwide continues to grow, we observe a proportional growth of substance use. Despite the myriad of complications alcohol use disorder (AUD) has on the body with regards to organ systems and mental health, the topic has been underresearched in the older adult population. Thus, it is important to create awareness about the growing problem of AUD among older adults. In this way, we can mitigate the long-term complications and side effects observed with alcohol abuse in this vulnerable population.
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Affiliation(s)
- Gabriela Fenollal-Maldonado
- Department of Psychiatry and Behavioral Neuroscience, Division of Geriatric Psychiatry, St. Louis University School of Medicine, 1438 South Grand Boulevard, St Louis, MO 63104, US.
| | - Derek Brown
- Department of Psychiatry and Behavioral Neuroscience, Division of Geriatric Psychiatry, St. Louis University School of Medicine, 1438 South Grand Boulevard, St Louis, MO 63104, US
| | - Heidi Hoffman
- Saint Louis University School of Medicine, St. Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, US
| | - Chanchal Kahlon
- Saint Louis University School of Medicine, St. Louis University, 1438 South Grand Boulevard, St Louis, MO 63104, US
| | - George Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Division of Geriatric Psychiatry, St. Louis University School of Medicine, 1438 South Grand Boulevard, St Louis, MO 63104, USA
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Gavriel-Fried B, Izhaki R, Levi O. "My god…how did I miss it?": Women's experiences of their spouses' alcohol-related relapses. J Psychiatr Ment Health Nurs 2021; 28:783-793. [PMID: 33740832 DOI: 10.1111/jpm.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 01/22/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Alcohol addiction is manifested by periods of abstinence and relapse in which the individual returns to previous problematic alcohol use. This may lead to unstable and stressful routines for the family and for women who live with a spouse diagnosed with an AUD. AUD may mentally and physically affect women living with a spouse diagnosed with AUD with respect to relapse. However, most studies have focused on the influence of AUD in general, and the way they cope with it; few have dealt with the experience of relapse as a distinctive stage. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Women's experiences of their spouses' relapses are embedded within their broader life experience in the shadow of alcohol addiction. The pattern of transitions from closeness to distance in the ways women think, feel and actively respond to their spouses' relapses shows similarities with the ways in which individuals cope with repeated trauma. This helps relate these women's experiences of their spouses' repeated relapses to the potential complex trauma these women experience and leads to a better understanding of the internal emotional dynamics of these women's behavioural patterns. WHAT ARE THE IMPLICATIONS FOR PRACTICE These women need a therapeutic solution that can help them cope with longstanding emotional burdens. Therapists should be sensitive to the complexity of their experience. When relevant, therapy should be based on therapeutic strategies from trauma practice, along with Alcohol Behavioural Couples Therapy that can reinforce the couple's mutual efforts to achieve sobriety or reduce AUD severity ABSTRACT: Introduction Alcohol use disorder (AUD) is manifested by periods of remission and relapse which can serve as a source of continuous stressors on the individuals and family. Women living with a spouse diagnosed with AUD can be mentally and physically affected by this behaviour. Most studies have focused on the general influence of AUD on these women and their attempts to cope with AUD; there are scant data on the influences of relapse as a distinctive stage. Aim To better understand how women whose spouses are diagnosed with AUD experience their relapses. Method A qualitative-naturalistic approach was implemented. Semi-structured, in-depth interviews were conducted with 12 women whose spouses were diagnosed with AUD. Results Content analysis revealed three main categories representing the transitions from: a) ignorance to realization, b) emotional opposition to acceptance and c) activity to inactivity. Each category reflects one cognitive, emotional or behavioural dimension of this experience. The overarching theme emerged as shifts from closeness to distance in the way these women think, feel and actively respond to their spouse's relapses and addiction. Discussion The shift from closeness to distance as manifested by the three transitions is argued to reflect the ways these women experience and cope with the chronic nature of AUD. It is suggested that this experience parallels the phenomenology of symptoms of complex trauma. Implications for practice Nurses should be alert to the potential accumulative stressors experienced by these women and implement intervention strategies developed in the trauma field in addition to Alcohol Behavioural Couples Therapy.
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Affiliation(s)
- Belle Gavriel-Fried
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Rotem Izhaki
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Levi
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Petagine L, Zariwala MG, Patel VB. Alcoholic liver disease: Current insights into cellular mechanisms. World J Biol Chem 2021; 12:87-103. [PMID: 34630912 PMCID: PMC8473419 DOI: 10.4331/wjbc.v12.i5.87] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/20/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
Alcoholic liver disease (ALD) due to chronic alcohol consumption is a significant global disease burden and a leading cause of mortality. Alcohol abuse induces a myriad of aberrant changes in hepatocytes at both the cellular and molecular level. Although the disease spectrum of ALD is widely recognized, the precise triggers for disease progression are still to be fully elucidated. Oxidative stress, mitochondrial dysfunction, gut dysbiosis and altered immune system response plays an important role in disease pathogenesis, triggering the activation of inflammatory pathways and apoptosis. Despite many recent clinical studies treatment options for ALD are limited, especially at the alcoholic hepatitis stage. We have therefore reviewed some of the key pathways involved in the pathogenesis of ALD and highlighted current trials for treating patients.
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Affiliation(s)
- Lucy Petagine
- Center for Nutraceuticals, School of Life Sciences, University of Westminster, London W1W 6UW, United Kingdom
| | - Mohammed Gulrez Zariwala
- Center for Nutraceuticals, School of Life Sciences, University of Westminster, London W1W 6UW, United Kingdom
| | - Vinood B Patel
- Center for Nutraceuticals, School of Life Sciences, University of Westminster, London W1W 6UW, United Kingdom
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33
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Ignaszewski MJ. The Epidemiology of Drug Abuse. J Clin Pharmacol 2021; 61 Suppl 2:S10-S17. [PMID: 34396554 DOI: 10.1002/jcph.1937] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/02/2021] [Indexed: 01/12/2023]
Abstract
Many Americans use alcohol and recreational drugs. Some will develop substance use disorders that affect a person's brain and behavior, leading to continued use despite problems caused. We review the epidemiology of addiction in the United States, including changes in use patterns over time, highlighting rates in adolescents and young adults, as well as adults. An overview of the health and societal impacts of substance use is provided alongside the importance of multimodal, evidence-based treatment comprising psychosocial interventions and medication management. The article concludes by exploring the impact of the coronavirus disease 2019 pandemic on people who use drugs and their access to treatment.
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Affiliation(s)
- Martha J Ignaszewski
- Complex Pain and Addiction Service, Vancouver General Hospital, British Columbia Children's Hospital, and Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Henssler J, Müller M, Carreira H, Bschor T, Heinz A, Baethge C. Controlled drinking-non-abstinent versus abstinent treatment goals in alcohol use disorder: a systematic review, meta-analysis and meta-regression. Addiction 2021; 116:1973-1987. [PMID: 33188563 DOI: 10.1111/add.15329] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/20/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The proportion of untreated patients with alcohol use disorder (AUD) exceeds that of any other mental health disorder, and treatment alternatives are needed. A widely discussed strategy is to depart from the abstinence paradigm as part of controlled drinking approaches. This first systematic review with meta-analysis aims to assess the efficacy of non-abstinent treatment strategies compared with abstinence-based strategies. METHODS CENTRAL, PubMed, PsycINFO and Embase databases were searched until February 2019 for controlled (randomized and non-randomized) clinical trials (RCTs and non-RCTs) among adult AUD populations, including an intervention group aiming at controlled drinking and a control group aiming for abstinence. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane Collaboration guidelines, literature search, data collection and risk of bias assessment were carried out independently by two reviewers [International Prospective Register of Systematic Reviews (PROSPERO), registration no. CRD42019128716]. The primary outcome was the proportion of participants consuming alcohol at or below the recommended threshold. Secondary outcomes were social functioning, drinking reductions, abstinence rates and dropouts. Using random-effects models, RCTs and non-RCTs were analyzed separately. Sensitivity and subgroup analyses accounted for methodological rigor, inclusion of goal-specific treatment, length of follow-up and AUD severity. RESULTS Twenty-two studies (including five RCTs) with 4204 patients were selected. There was no statistically significant difference between both treatment paradigms in RCTs [odds ratio (OR) = 1.32, 95% confidence interval (CI) = 0.51-3.39]. Non-randomized studies of free goal choice favored abstinence-orientation (OR = 0.60, 95% CI = 0.40-0.90), unless goal-specific treatment was provided (OR = 0.79, 95% CI = 0.40-1.56), or in studies of low risk of bias (OR = 0.73, 95% CI = 0.49-1.09) or with long follow-up (OR = 1.49, 95% CI = 0.78-2.85). Effect sizes were not clearly dependent upon AUD severity. Abstinence- and controlled drinking interventions did not clearly differ in their effect on social functioning and drinking reductions. CONCLUSIONS Available evidence does not support abstinence as the only approach in the treatment of alcohol use disorder. Controlled drinking, particularly if supported by specific psychotherapy, appears to be a viable option where an abstinence-oriented approach is not applicable.
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Affiliation(s)
- Jonathan Henssler
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Helena Carreira
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tom Bschor
- Department of Psychiatry and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
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Lardier DT, Coakley KE, Holladay KR, Amorim FT, Zuhl MN. Exercise as a Useful Intervention to Reduce Alcohol Consumption and Improve Physical Fitness in Individuals With Alcohol Use Disorder: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:675285. [PMID: 34305729 PMCID: PMC8292965 DOI: 10.3389/fpsyg.2021.675285] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/31/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: This meta-analysis and systematic review examined the effects of exercise interventions on alcohol consumption and binge drinking in individuals with alcohol use disorder (AUD). Data sources: PubMed, Web of Science, Google Scholar, SPORTDiscus, and ERIC databases. Study Inclusion and Exclusion Criteria: Peer-reviewed randomized controlled trials published in English between 1970 and 2021. All studies compared exercise (Ex) and treatment as usual (TAU) to TAU in adults with an alcohol-related diagnosis. All forms of exercise interventions were included (e.g., aerobic exercise, yoga, resistance exercise, etc.). Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols standard and the Meta-Analyses and Systematic Reviews of Observational Studies guidelines were followed. Risk of bias was assessed using the Cochrane risk-of-bias tool as described by the Cochrane Handbook for Systematic Reviews and Interventions. Results: The literature searches retrieved a combined 2527 studies, with 1,034 studies screened after removal of duplicates and 973 (94%) rejected after reviewing titles and abstracts. Full-text review was performed on 61 studies, with seven studies meeting inclusion criteria for qualitative and meta-analysis. Across seven studies (n = 492 participants), a significant effect (Z-value = -3.37; g = -0.30; 95% CI [-0.50--0.09]; p = 0.001) was found for Ex+TAU on drinking volume. There was no effect of Ex+TAU on binge drinking. The effect of Ex+TAU on physical fitness (VO2max, ml•kg-1•min-1) was significant (Z-score = 3.70; g = 0.64; 95% CI [0.19-1.08]; p < 0.001). Conclusions: Exercise interventions may decrease alcohol consumption and improve fitness and can be an effective adjunctive treatment for individuals with alcohol-related diagnoses including AUD.
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Affiliation(s)
- David T. Lardier
- Department of Individual, Family and Community Education, College of Education and Human Sciences, University of New Mexico, Albuquerque, NM, United States
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Kathryn E. Coakley
- Department of Individual, Family and Community Education, College of Education and Human Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Kelley R. Holladay
- Department of Individual, Family and Community Education, University of New Mexico, Albuquerque, NM, United States
- College of Health Sciences, Jacksonville University, Jacksonville, FL, United States
| | - Fabiano T. Amorim
- Department of Health Education and Sports Sciences College of Education and Human Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Micah N. Zuhl
- School of Health Sciences, Central Michigan University, Mount Pleasant, MI, United States
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Trangenstein PJ, Mulia N, Lui CK, Karriker-Jaffe KJ, Greenfield TK, Jones-Webb R. Support for Alcohol Policies in Marginalized Populations. Alcohol Alcohol 2021; 56:500-509. [PMID: 33341875 PMCID: PMC8243274 DOI: 10.1093/alcalc/agaa130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
AIM Kingdon [(2014) Agendas, Alternatives, and Public Policies. Essex. United Kingdom: Pearson Education Limited] argues that windows of opportunity to pass policies emerge when problems, solutions and policy support co-occur. This study aims to identify a set of alcohol policies with the potential to reduce alcohol-related disparities given high levels of support from marginalized groups, such as racial/ethnic minorities and lower-income groups. METHODS This study used data from five US National Alcohol Surveys, which were based on household probability samples of adults in 1995 (n = 4243), 2000 (n = 5736), 2005 (n = 1445), 2010 (n = 4164) and 2015 (n = 4041). We used multiple logistic regression to determine the odds of policy support by racial/ethnic group and income level, considering price, place and marketing policies as well as individual-level interventions. RESULTS Overall a majority of Americans supported banning alcohol sales in corner stores (59.4%), banning alcohol advertisements on television (55.5%), and establishing universal health coverage for alcohol treatment (80.0%). Support was particularly high among Blacks, Hispanics/Latinos and lower-income persons. Multivariate models showed that compared with White people, foreign-born Hispanics/Latinos had the most robust levels of support, including raising alcohol taxes (aOR = 2.40, 95% CI: 2.00, 2.88, P < 0.0001), banning alcohol sales in corner stores (aOR = 2.85, 95% CI: 2.22, 3.65, P < 0.0001) and reducing retail sales hours (aOR = 2.91, 95% CI: 2.38, 3.55, P < 0.0001). CONCLUSION Of the policies examined, banning alcohol sales at corner stores is most likely to be in a "window of opportunity" for reducing alcohol-related disparities. By simultaneously reducing population-level consumption and harms from others' drinking, place-based policies have the potential to reduce harms experienced by marginalized groups.
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Affiliation(s)
- Pamela J Trangenstein
- University of North Carolina at Chapel Hill, Department of Health Behavior, 135 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Nina Mulia
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Camillia K Lui
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Katherine J Karriker-Jaffe
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Rhonda Jones-Webb
- University of Minnesota, Division of Epidemiology and Community Health, 300 West Bank Office Building, Minneapolis, MN 55454, USA
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Miller MB, Metrik J, McGeary JE, Borsari B, McCrae CS, Maddoux J, Arnedt JT, Merrill JE, Carey KB. Protocol for the Project SAVE randomised controlled trial examining CBT for insomnia among veterans in treatment for alcohol use disorder. BMJ Open 2021; 11:e045667. [PMID: 34103317 PMCID: PMC8190049 DOI: 10.1136/bmjopen-2020-045667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION As many as 74% of veterans with alcohol use disorders (AUDS) report symptoms of insomnia. Insomnia represents a barrier to alcohol treatment because insomnia symptoms (1) may lead to relapse among those who use alcohol to help them sleep and may negatively impact (2) executive functions and (3) emotion regulation skills. Cognitive-behavioural therapy for insomnia (CBT-I) is an efficacious first-line treatment for insomnia; however, no research has examined the impact of CBT-I on individuals' response to alcohol treatment. In the Sleep and Alcohol for Veterans (Project SAVE) randomised controlled trial, we hypothesise that CBT-I will enhance the efficacy of alcohol treatment among Veterans with insomnia by enhancing their abilities to attend to treatment, regulate emotions and initiate sleep without alcohol. METHODS AND ANALYSIS Eighty Veterans enrolled in alcohol treatment at the Veterans Administration (VA) hospital will be randomly assigned to receive either CBT-I or single-session sleep hygiene (SH) education. Individuals will be eligible to participate if they meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for moderate to severe AUD and Insomnia Disorder of at least 1-month duration. Participants will complete assessments at baseline, post-treatment and 6-week follow-up. Preliminary process outcomes include retention/recruitment rates and treatment satisfaction (feasibility and acceptability, respectively). Primary outcomes are insomnia severity, percentage of heavy-drinking days and alcohol-related problems. We will assess a variety of secondary clinical and mechanistic outcomes (eg, post-traumatic stress disorder (PTSD) symptoms, attention and working memory). ETHICS AND DISSEMINATION Ethics approval was obtained in October 2018. Data collection began in July 2019 and is planned for completion by July 2021. Trial results will be disseminated at local and national conferences, in peer-reviewed publications and through media outlets, as available. Results will also be shared with interested participants and clinical collaborators at the end of the trial. TRIAL REGISTRATION NUMBER clinicaltrials.gov identifier NCT03806491 (pre-results).
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, MO, USA
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Mental Health & Behavioral Sciences Service, Providence VA Medical Center, Providence, RI, USA
| | - John E McGeary
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
- Mental Health & Behavioral Sciences Service, Providence VA Medical Center, Providence, RI, USA
| | - Brian Borsari
- Mental Health Service, San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Services, University of California San Francisco, San Francisco, CA, USA
| | | | - John Maddoux
- Harry S Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
| | - J Todd Arnedt
- Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer E Merrill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
| | - Kate B Carey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA
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Minnaard AM, Ramakers GM, Vanderschuren LJ, Lesscher HM. Baclofen and naltrexone, but not N-acetylcysteine, affect voluntary alcohol drinking in rats regardless of individual levels of alcohol intake. Behav Pharmacol 2021; 32:251-257. [PMID: 33315615 PMCID: PMC7960148 DOI: 10.1097/fbp.0000000000000615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
In humans, there is profound individual variation in the risk of alcohol use disorder (AUD). Because GABA, opioid and glutamate neurotransmission have been implicated in AUD, functional differences in these neural systems may underlie the individual vulnerability to AUD. We therefore determined the effects of drugs affecting GABA, opioid and glutamatergic neurotransmission on alcohol consumption in rats that differed in baseline alcohol intake. Subgroups of low-, medium- and high-alcohol-drinking rats were selected on the basis of alcohol consumption using an intermittent alcohol access procedure. The subgroups were treated with the GABAB receptor agonist baclofen, the opioid receptor antagonist naltrexone and the cysteine precursor N-acetylcysteine, and the effects on alcohol intake and preference were determined. Both baclofen and naltrexone reduced alcohol consumption, but N-acetylcysteine did not. These effects were comparable for low-, medium- and high-alcohol-drinking rats. However, there was a substantial degree of individual variation in the responsivity to baclofen and naltrexone, across the subgroups. Taken together, these results suggest that variation in alcohol consumption does not predict the responsivity to baclofen and naltrexone. This implies that individual variability in alcohol consumption on the one hand and sensitivity to treatment with these drugs on the other hand represent separate processes that likely involve distinct biological mechanisms.
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Affiliation(s)
- A. Maryse Minnaard
- Department of Population Health Sciences, Unit Animals in Science and Society, Faculty of Veterinary Medicine
| | - Geert M.J. Ramakers
- Department of Translational Neuroscience, University Medical Center Utrecht Brain Center, Utrecht University, The Netherlands
| | - Louk J.M.J. Vanderschuren
- Department of Population Health Sciences, Unit Animals in Science and Society, Faculty of Veterinary Medicine
| | - Heidi M.B. Lesscher
- Department of Population Health Sciences, Unit Animals in Science and Society, Faculty of Veterinary Medicine
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Mejldal A, Andersen K, Behrendt S, Bilberg R, Bogenschutz M, Braun‐Michl B, Bühringer G, Søgaard Nielsen A. Stability of Posttreatment Reductions in World Health Organization (WHO) Drinking Risk Levels and Posttreatment Functioning in Older Adults with DSM‐5 Alcohol Use Disorder: Secondary Data Analysis of the Elderly Study. Alcohol Clin Exp Res 2021; 45:638-649. [DOI: 10.1111/acer.14562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/15/2021] [Indexed: 01/20/2023]
Affiliation(s)
- Anna Mejldal
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
| | - Kjeld Andersen
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- Department of Mental Health Odense Region of Southern Denmark Vejle Denmark
- Brain Research‐Inter‐Disciplinary Guided Excellence (BRIDGE) Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Silke Behrendt
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- Brain Research‐Inter‐Disciplinary Guided Excellence (BRIDGE) Department of Clinical Research University of Southern Denmark Odense Denmark
- Institute of Psychology Faculty of Health University of Southern Denmark Odense Denmark
| | - Randi Bilberg
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- Department of Mental Health Odense Region of Southern Denmark Vejle Denmark
| | - Michael Bogenschutz
- NYU Langone Medical Center New York NY USA
- Health Sciences Center University of New Mexico Albuquerque NM USA
| | | | - Gerhard Bühringer
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- IFT Institut für Therapieforschung Munich Germany
- Institute of Clinical Psychology and Psychotherapy Technische Universität Dresden Dresden Germany
| | - Anette Søgaard Nielsen
- Unit of Clinical Alcohol Research (UCAR) Faculty of Health Institute of Clinical Research University of Southern Denmark Odense Denmark
- Department of Mental Health Odense Region of Southern Denmark Vejle Denmark
- Brain Research‐Inter‐Disciplinary Guided Excellence (BRIDGE) Department of Clinical Research University of Southern Denmark Odense Denmark
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Hansen EM, Mejldal A, Nielsen AS. Predictors of Readmission Following Outpatient Treatment for Alcohol Use Disorder. Alcohol Alcohol 2021; 55:291-298. [PMID: 32166313 DOI: 10.1093/alcalc/agaa018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/14/2020] [Accepted: 02/22/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To identify predictors of readmission to outpatient treatment for alcohol use disorder (AUD) with a view to identifying underlying mechanisms for preventing relapse. METHODS A consecutive clinical cohort of 2130 AUD outpatients treated between 1 January 2006 and 1 June 2016 was studied. Data were collected by means of the Addiction Severity Index upon treatment entry and at discharge. Outcome measures were readmission to outpatient treatment and time to readmission. Potential predictors were tested for significance using Cox Proportional Hazards multivariate analysis. RESULTS A total of 22% were readmitted during the follow-up time. Patients readmitted within 1 year of treatment conclusion differed significantly from those not readmitted on age, cohabitation status and completion status of index treatment. Significant predictors of readmission during follow-up time were younger age (hazard ratio (HR) = 0.99, 95% confidence interval (CI), 0.98-1.00), history of psychiatric illness (HR = 1.24, 95% CI, 1.02-1.50), drop-out from index treatment (HR = 1.41, 95% CI, 1.15-1.72) and length of index treatment (HR = 1.02, 95% CI, 1.00-1.04). CONCLUSION Premature drop-out from treatment, a history of psychiatric illness, younger age and longer treatment episodes appear to be the most important predictors of readmission.
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Affiliation(s)
- Emmanuel Mangkornkaew Hansen
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C
| | - Anna Mejldal
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C
| | - Anette Søgaard Nielsen
- Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C.,Psychiatric Hospital, University section, Region of Southern Denmark, J.B. Winsløws Vej 18, 5000 Odense C
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Hämäläinen MD, Zetterström A, Winkvist M, Söderquist M, Öhagen P, Andersson K, Nyberg F. Breathalyser-Based eHealth Data Suggest That Self-Reporting of Abstinence Is a Poor Outcome Measure for Alcohol Use Disorder Clinical Trials. Alcohol Alcohol 2021; 55:237-245. [PMID: 32118260 DOI: 10.1093/alcalc/agaa004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 11/12/2022] Open
Abstract
AIMS To evaluate the efficacy and monitoring capabilities of a breathalyser-based eHealth system for patients with alcohol use disorder (AUD) and to investigate the quality and validity of timeline follow-back (TLFB) as outcome measure in clinical trials and treatment. METHODS Patients (n = 115) were recruited to clinical trials from a 12-step aftercare programme (12S-ABS) and from hospital care with abstinence (HC-ABS) or controlled drinking (HC-CDR) as goal and randomly divided into an eHealth and a control group. The effect of the eHealth system was analysed with TLFB-derived primary outcomes-change in number of abstinent days (AbsDay) and heavy drinking days (HDDs) compared to baseline-and phosphatidyl ethanol (PEth) measurements. Validity and quality of TLFB were evaluated by comparison with breath alcohol content (BrAC) and eHealth digital biomarkers (DBs): Addiction Monitoring Index (AMI) and Maximum Time Between Tests (MTBT). TLFB reports were compared to eHealth data regarding reported abstinence. RESULTS The primary outcome (TLFB) showed no significant difference between eHealth and control groups, but PEth did show a significant difference especially at months 2 and 3. Self-reported daily abstinence suffered from severe quality issues: of the 28-day TLFB reports showing full abstinence eHealth data falsified 34% (BrAC measurements), 39% (MTBT), 54% (AMI) and 68% (BrAC/MTBT/AMI). 12S-ABS and HC-ABS patients showed severe under-reporting. CONCLUSIONS No effect of the eHealth system was measured with TLFB, but a small positive effect was measured with PEth. The eHealth system revealed severe quality problems with TLFB, especially regarding abstinence-should measurement-based eHealth data replace TLFB as outcome measure for AUD?
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Affiliation(s)
| | | | - Maria Winkvist
- Kontigo Care AB, Påvel Snickares Gränd 12, 753 20 Uppsala, Sweden
| | | | - Patrik Öhagen
- Uppsala Clinical Research Center, Dag Hammarskjölds väg 14 B, Uppsala Science Park, 751 83 Uppsala, Sweden
| | - Karl Andersson
- Department of Immunology, Genetics and Pathology, Rudbeck Laboratory, Uppsala University, 751 85 Uppsala, Sweden.,Ridgeview Instruments AB, Skillsta 4, 740 20 Vänge, Sweden
| | - Fred Nyberg
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, 751 24 Uppsala, Sweden
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Success Rates of Monitoring for Healthcare Professionals with a Substance Use Disorder: A Meta-Analysis. J Clin Med 2021; 10:jcm10020264. [PMID: 33450803 PMCID: PMC7828295 DOI: 10.3390/jcm10020264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022] Open
Abstract
In the past decades, monitoring programs have been developed for healthcare professionals with substance use disorders. We aimed to explore estimates of abstinence and work retention rates after participation in such monitoring programs. A literature search was performed using PubMed, Embase, PsycINFO, and CINAHL. Twenty-nine observational studies reporting on success rates (abstinence and work retention) of monitoring for healthcare professionals with a substance use disorder were included in the meta-analysis. Quality-effects models calculated pooled success rates and corresponding 95%-Confidence Intervals (CI), with subgroup analyses on monitoring elements and patient characteristics. Pooled success rates were 72% for abstinence (95%-CI = 63–80%) and 77% for work retention (95%-CI = 61–90%). Heterogeneity across studies was partly explained by the starting moment of monitoring, showing higher abstinence rates for studies that started monitoring after treatment completion (79%; 95%-CI = 72–85%) compared to studies that started monitoring with treatment initiation (61%; 95%-CI = 50–72%). About three-quarters of healthcare professionals with substance use disorders participating in monitoring programs are abstinent during follow-up and working at the end of the follow-up period. Due to selection and publication bias, no firm conclusions can be drawn about the effectiveness of monitoring for healthcare professionals with SUD.
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Mellentin AI, Cox WM, Fadardi JS, Martinussen L, Mistarz N, Skøt L, Rømer Thomsen K, Mathiasen K, Lichtenstein M, Nielsen AS. A Randomized Controlled Trial of Attentional Control Training for Treating Alcohol Use Disorder. Front Psychiatry 2021; 12:748848. [PMID: 34899419 PMCID: PMC8661535 DOI: 10.3389/fpsyt.2021.748848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: There is consistent evidence that community and clinical samples of individuals with an alcohol use disorder (AUD) have attentional biases toward alcohol cues. The alcohol attentional control training program (AACTP) has shown promise for retraining these biases and decreasing alcohol consumption in community samples of excessive drinkers. However, there is a lack of evidence regarding the effectiveness of ACTP in clinical AUD samples. The main aim of the present study is to investigate whether primary pharmacological and psychological, evidence-based alcohol treatment can be enhanced by the addition of a gamified AACTP smartphone application for patients with an AUD. Design and Methods: The study will be implemented as a randomized controlled trial. A total of 317 consecutively enrolled patients with AUD will be recruited from alcohol outpatient clinics in Denmark. Patients will be randomized to one of three groups upon initiation of primary alcohol treatment: Group A: a gamified AACTP smartphone application + treatment as usual (TAU); Group B: a gamified AACTP sham-control application + TAU; or Group C: only TAU. Treatment outcomes will be assessed at baseline, post-treatment, and at 3- and 6-month follow-ups. Repeated measures MANOVA will be used to compare the trajectories of the groups over time on alcohol attentional bias, alcohol craving, and drinking reductions. It is hypothesized that Group A will achieve better treatment outcomes than either Group B or Group C. Perspectives: Because attentional bias for alcohol cues is proportional to the amount of alcohol consumed, and these biases are not addressed within current evidence-based treatment programs, this study is expected to provide new evidence regarding the effectiveness of the gamified AACTP in a clinical population. Furthermore, due to promising results found using AACTP in community samples of excessive drinkers, there is a high probability that the AACTP treatment in this study will also be effective, thereby allowing AACTP to be readily implemented in clinical settings. Finally, we expect that this study will increase the effectiveness of evidence-based AUD treatment and introduce a new, low-cost gamified treatment targeting patients with an AUD. Overall, this study is likely to have an impact at the scientific, clinical, and societal levels. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05102942?term=NCT05102942&draw=2&rank=1, identifier: NCT05102942.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - W Miles Cox
- School of Human and Behavioral Sciences, Bangor University, Bangor, United Kingdom
| | - Javad S Fadardi
- Cognitive Health Laboratory, Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Laila Martinussen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nicolaj Mistarz
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristine Rømer Thomsen
- Centre for Alcohol and Drug Research, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Kim Mathiasen
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Mia Lichtenstein
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Strong CE, Kabbaj M. Neural Mechanisms Underlying the Rewarding and Therapeutic Effects of Ketamine as a Treatment for Alcohol Use Disorder. Front Behav Neurosci 2020; 14:593860. [PMID: 33362485 PMCID: PMC7759199 DOI: 10.3389/fnbeh.2020.593860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
Alcohol use disorder (AUD) is the most prevalent substance use disorder and causes a significant global burden. Relapse rates remain incredibly high after decades of attempting to develop novel treatment options that have failed to produce increased rates of sobriety. Ketamine has emerged as a potential treatment for AUD following its success as a therapeutic agent for depression, demonstrated by several preclinical studies showing that acute administration reduced alcohol intake in rodents. As such, ketamine's therapeutic effects for AUD are now being investigated in clinical trials with the hope of it being efficacious in prolonging sobriety from alcohol in humans (ClinicalTrials.gov, Identifier: NCT01558063). Importantly, ketamine's antidepressant effects only last for about 1-week and because AUD is a lifelong disorder, repeated treatment regimens would be necessary to maintain sobriety. This raises questions regarding its safety for AUD treatment since ketamine itself has the potential for addiction. Therefore, this review aims to summarize the neuroadaptations related to alcohol's addictive properties as well as ketamine's therapeutic and addictive properties. To do this, the focus will be on reward-related brain regions such as the nucleus accumbens (NAc), dorsal striatum, prefrontal cortex (PFC), hippocampus, and ventral tegmental area (VTA) to understand how acute vs. chronic exposure will alter reward signaling over time. Additionally, evidence from these studies will be summarized in both male and female subjects. Accordingly, this review aims to address the safety of repeated ketamine infusions for the treatment of AUD. Although more work about the safety of ketamine to treat AUD is warranted, we hope this review sheds light on some answers about the safety of repeated ketamine infusions.
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Affiliation(s)
- Caroline E Strong
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, United States
| | - Mohamed Kabbaj
- Program in Neuroscience, Department of Biomedical Sciences, Florida State University, Tallahassee, FL, United States
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45
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Li S, Saviano A, Erstad DJ, Hoshida Y, Fuchs BC, Baumert T, Tanabe KK. Risk Factors, Pathogenesis, and Strategies for Hepatocellular Carcinoma Prevention: Emphasis on Secondary Prevention and Its Translational Challenges. J Clin Med 2020; 9:E3817. [PMID: 33255794 PMCID: PMC7760293 DOI: 10.3390/jcm9123817] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/11/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-associated mortality globally. Given the limited therapeutic efficacy in advanced HCC, prevention of HCC carcinogenesis could serve as an effective strategy. Patients with chronic fibrosis due to viral or metabolic etiologies are at a high risk of developing HCC. Primary prevention seeks to eliminate cancer predisposing risk factors while tertiary prevention aims to prevent HCC recurrence. Secondary prevention targets patients with baseline chronic liver disease. Various epidemiological and experimental studies have identified candidates for secondary prevention-both etiology-specific and generic prevention strategies-including statins, aspirin, and anti-diabetic drugs. The introduction of multi-cell based omics analysis along with better characterization of the hepatic microenvironment will further facilitate the identification of targets for prevention. In this review, we will summarize HCC risk factors, pathogenesis, and discuss strategies of HCC prevention. We will focus on secondary prevention and also discuss current challenges in translating experimental work into clinical practice.
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Affiliation(s)
- Shen Li
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA; (S.L.); (D.J.E.); (B.C.F.)
| | - Antonio Saviano
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg, 67000 Strasbourg, France;
| | - Derek J. Erstad
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA; (S.L.); (D.J.E.); (B.C.F.)
| | - Yujin Hoshida
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Department of Internal Medicine, Dallas, TX 75390, USA;
| | - Bryan C. Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA; (S.L.); (D.J.E.); (B.C.F.)
| | - Thomas Baumert
- Inserm, U1110, Institut de Recherche sur les Maladies Virales et Hépatiques, Université de Strasbourg, 67000 Strasbourg, France;
| | - Kenneth K. Tanabe
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA 02114, USA; (S.L.); (D.J.E.); (B.C.F.)
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46
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White VM, Molfenter T, Gustafson DH, Horst J, Greller R, Gustafson DH, Kim JS, Preuss E, Cody O, Pisitthakarm P, Toy A. NIATx-TI versus typical product training on e-health technology implementation: a clustered randomized controlled trial study protocol. Implement Sci 2020; 15:94. [PMID: 33097097 PMCID: PMC7582427 DOI: 10.1186/s13012-020-01053-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Substance use disorders (SUDs) lead to tens-of-thousands of overdose deaths and other forms of preventable deaths in the USA each year. This results in over $500 billion per year in societal and economic costs as well as a considerable amount of grief for loved ones of affected individuals. Despite these health and societal consequences, only a small percentage of people seek treatment for SUDs, and the majority of those that seek help fail to achieve long-term sobriety. E-health applications in healthcare have proven to be effective at sustaining treatment and reaching patients traditional treatment pathways would have missed. However, e-health adoption and sustainment rates in healthcare are poor, especially in the SUD treatment sector. Implementation engineering can address this gap in the e-health field by augmenting existing implementation models, which explain organizational and individual e-health behaviors retrospectively, with prospective resources that can guide implementation. METHODS This cluster randomized control trial is designed to test two implementation strategies at adopting an evidence-based mobile e-health technology for SUD treatment. The proposed e-health implementation model is the Network for the Improvement of Addiction Treatment-Technology Implementation (NIATx-TI) Framework. This project, based in Iowa, will compare a control condition (using a typical software product training approach that includes in-person staff training followed by access to on-line support) to software implementation utilizing NIATx-TI, which includes change management training, followed by coaching on how to implement and use the mobile application. While e-health spans many modalities and health disciplines, this project will focus on implementing the Addiction Comprehensive Health Enhancement Support System (A-CHESS), an evidence-based SUD treatment recovery app framework. This trial will be conducted in Iowa at 46 organizational sites within 12 SUD treatment agencies. The control arm consists of 23 individual treatment sites based at five organizations, and the intervention arm consists of 23 individual SUD treatment sites based at seven organizations DISCUSSION: This study addresses an issue of substantial public health significance: enhancing the uptake of the growing inventory of patient-centered evidence-based addiction treatment e-health technologies. TRIAL REGISTRATION ClinicalTrials.gov , NCT03954184 . Posted 17 May 2019.
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Affiliation(s)
- Veronica M White
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA.
| | - Todd Molfenter
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Julie Horst
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Rachelle Greller
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - David H Gustafson
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Jee-Seon Kim
- Department of Educational Psychology, University of Wisconsin-Madison, Educational Sciences, 1025 West Johnson St, Madison, WI, 53706-1706, USA
| | - Eric Preuss
- Division of Behavioral Health, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, IA, 50319-0075, USA
| | - Olivia Cody
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Praan Pisitthakarm
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
| | - Alexander Toy
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, USA
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Thompson TP, Horrell J, Taylor AH, Wanner A, Husk K, Wei Y, Creanor S, Kandiyali R, Neale J, Sinclair J, Nasser M, Wallace G. Physical activity and the prevention, reduction, and treatment of alcohol and other drug use across the lifespan (The PHASE review): A systematic review. Ment Health Phys Act 2020; 19:100360. [PMID: 33020704 PMCID: PMC7527800 DOI: 10.1016/j.mhpa.2020.100360] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022]
Abstract
The aim of this review is to systematically describe and quantify the effects of PA interventions on alcohol and other drug use outcomes, and to identify any apparent effect of PA dose and type, possible mechanisms of effect, and any other aspect of intervention delivery (e.g. key behaviour change processes), within a framework to inform the design and evaluation of future interventions. Systematic searches were designed to identify published and grey literature on the role of PA for reducing the risk of progression to alcohol and other drug use (PREVENTION), supporting individuals to reduce alcohol and other drug use for harm reduction (REDUCTION), and promote abstinence and relapse prevention during and after treatment of alcohol and other drug use (TREATMENT). Searches identified 49,518 records, with 49,342 excluded on title and abstract. We screened 176 full text articles from which we included 32 studies in 32 papers with quantitative results of relevance to this review. Meta-analysis of two studies showed a significant effect of PA on prevention of alcohol initiation (risk ratio [RR]: 0.72, 95%CI: 0.61 to 0.85). Meta-analysis of four studies showed no clear evidence for an effect of PA on alcohol consumption (Standardised Mean Difference [SMD]: 0.19, 95%, Confidence Interval -0.57 to 0.18). We were unable to quantitatively examine the effects of PA interventions on other drug use alone, or in combination with alcohol use, for prevention, reduction or treatment. Among the 19 treatment studies with an alcohol and other drug use outcome, there was a trend for promising short-term effect but with limited information about intervention fidelity and exercise dose, there was a moderate to high risk of bias. We identified no studies reporting the cost-effectiveness of interventions. More rigorous and well-designed research is needed. Our novel approach to the review provides a clearer guide to achieve this in future research questions addressed to inform policy and practice for different populations and settings.
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Affiliation(s)
- T P Thompson
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - J Horrell
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - A H Taylor
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - A Wanner
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - K Husk
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - Y Wei
- University of Plymouth, Centre for Mathematical Sciences, School of Engineering, Computing and Mathematics, Drake Circus, Plymouth, PL4 8AA, UK
| | - S Creanor
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - R Kandiyali
- Bristol University, School of Social and Community Medicine, Oakfield Grove, Clifton, Bristol, BS8 2BN, UK
| | - J Neale
- King's College London Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, SE5 8BB, UK
| | - J Sinclair
- University of Southampton, Faculty of Medicine, 4-12 Terminus Terrace, Southampton, SO14 3DT, UK
| | - M Nasser
- Faculty of Health, Medicine, Dentistry & Human Sciences University of Plymouth, Plymouth Science Park Derriford, Plymouth, PL6 8BX, UK
| | - G Wallace
- Plymouth City Council, Public Dispensary, Catherine Street, Plymouth, PL1 2AA, UK
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Winder GS, Shenoy A, Dew MA, DiMartini AF. Alcohol and other substance use after liver transplant. Best Pract Res Clin Gastroenterol 2020; 46-47:101685. [PMID: 33158473 DOI: 10.1016/j.bpg.2020.101685] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
In this article we tackle the controversial subject of alcohol and other substance use following liver transplantation (LT). Most of the literature on and importance of this topic pertains not to recreational use of alcohol or substances but to patients who have alcohol or substance use disorders (AUDs/SUDs). To understand these behaviors after such a lifesaving and resource-intensive procedure as LT necessitates an understanding of these disorders as chronic medical diseases. It also requires an awareness that management of these disorders begins before transplant, so we will briefly touch on considerations to prepare patients for the transplantation. Additionally, we review not only the rates of alcohol and substance use post-LT but strategies clinicians could adopt to identify and manage these events post-LT. Thus, we will summarize approaches for monitoring use and a range of therapeutic treatment options, including pharmacotherapy, to employ once use is discovered. While clinical gastroenterologists may be the primary clinicians responsible for the care of LT recipients, we emphasize a multidisciplinary team approach which, especially for the behavioral health components of the treatment, is likely to be the most successful. This article concludes with a summary of recommendations for clinicians working with these patients and possible future directions for both clinical care and research. While the bulk of the literature is on LT in the context of AUD, we review the smaller body of literature available on non-alcohol substance use.
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Affiliation(s)
- Gerald Scott Winder
- Departments of Psychiatry and Surgery, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University Medical Center, 622 West 168th Street, PH14-105, New York, NY, 10032, USA.
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Nursing, Biostatistics and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
| | - Andrea F DiMartini
- Departments of Psychiatry, Surgery and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
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Turton S, Myers JF, Mick I, Colasanti A, Venkataraman A, Durant C, Waldman A, Brailsford A, Parkin MC, Dawe G, Rabiner EA, Gunn RN, Lightman SL, Nutt DJ, Lingford-Hughes A. Blunted endogenous opioid release following an oral dexamphetamine challenge in abstinent alcohol-dependent individuals. Mol Psychiatry 2020; 25:1749-1758. [PMID: 29942043 PMCID: PMC6169731 DOI: 10.1038/s41380-018-0107-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 01/12/2023]
Abstract
Addiction has been proposed as a 'reward deficient' state, which is compensated for with substance use. There is growing evidence of dysregulation in the opioid system, which plays a key role in reward, underpinning addiction. Low levels of endogenous opioids are implicated in vulnerability for developing alcohol dependence (AD) and high mu-opioid receptor (MOR) availability in early abstinence is associated with greater craving. This high MOR availability is proposed to be the target of opioid antagonist medication to prevent relapse. However, changes in endogenous opioid tone in AD are poorly characterised and are important to understand as opioid antagonists do not help everyone with AD. We used [11C]carfentanil, a selective MOR agonist positron emission tomography (PET) radioligand, to investigate endogenous opioid tone in AD for the first time. We recruited 13 abstinent male AD and 15 control participants who underwent two [11C]carfentanil PET scans, one before and one 3 h following a 0.5 mg/kg oral dose of dexamphetamine to measure baseline MOR availability and endogenous opioid release. We found significantly blunted dexamphetamine-induced opioid release in 5 out of 10 regions-of-interest including insula, frontal lobe and putamen in AD compared with controls, but no significantly higher MOR availability AD participants compared with HC in any region. This study is comparable to our previous results of blunted dexamphetamine-induced opioid release in gambling disorder, suggesting that this dysregulation in opioid tone is common to both behavioural and substance addictions.
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Affiliation(s)
- Samuel Turton
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - James Fm Myers
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - Inge Mick
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
- Institute for Clinical Teratology and Drug Risk Assessment in Pregnancy, Charité Universitätsmedizin, Berlin, Germany
| | - Alessandro Colasanti
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ashwin Venkataraman
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - Claire Durant
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - Adam Waldman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alan Brailsford
- Analytical and Environmental Sciences, King's College London, London, UK
| | - Mark C Parkin
- Analytical and Environmental Sciences, King's College London, London, UK
| | - Gemma Dawe
- Department of Neuroradiology, Imperial College Healthcare NHS Trust, London, UK
| | - Eugenii A Rabiner
- Imanova Limited, London, UK
- Centre for Neuroimaging Sciences, King's College London, London, UK
| | - Roger N Gunn
- Imanova Limited, London, UK
- Centre for Restorative Neuroscience, Division of Brain Sciences, Imperial College London, London, UK
| | - Stafford L Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience & Endocrinology, University of Bristol, Bristol, UK
| | - David J Nutt
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK
| | - Anne Lingford-Hughes
- Neuropsychopharmacology Unit, Centre for Psychiatry, Imperial College London, London, UK.
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Barticevic NA, Poblete F, Zuzulich SM, Rodriguez V, Bradshaw L. Brief motivational therapy versus enhanced usual care for alcohol use disorders in primary care in Chile: study protocol for an exploratory randomized trial. Trials 2020; 21:692. [PMID: 32736578 PMCID: PMC7393703 DOI: 10.1186/s13063-020-04589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Harmful alcohol use is a leading cause of global disability and death. However, increased detection and brief intervention capacity of more severe alcohol use disorders has not been accompanied by increased availability of treatment services. Incorporating treatment for such disorders into primary care is of paramount importance for improving access and health outcomes. This study aims to estimate the effectiveness of a Brief Motivational Treatment (BMT) applied in primary care for treatment of these disorders. METHODS A parallel-group, single-blinded, severity-stratified, randomized clinical trial will test the superiority of BMT over enhanced usual care. Eligible participants will be those seeking treatment and who fulfill DSM-V criteria for alcohol use disorder and criteria for harmful alcohol use. With an estimated a loss to follow-up of 20%, a total of 182 participants will be recruited and equally randomized to each treatment group. The intervention group will receive an adaptation of the motivational enhancement therapy, as manualized in Project MATCH. This treatment consists of four 45-min sessions provided by a general psychologist with at least 3 years of primary care experience. The primary outcome is the change from baseline in the drinks per drinking day during the last 90 days, which will be captured using the Timeline Follow Back method. Secondary outcomes will describe the changes in alcohol use pattern, motivational status, and severity of the disorder. All participants will be analyzed according to the group they were allocated, regardless of the treatment actually received. Mean differences (MD) will be computed for continuous outcomes and relative risks (RR) and RR reductions (RRR) for dichotomous results. Linear models will deliver the subgroup analyses. Missingness is assumed to be associated with the baseline alcohol use pattern and severity, so a multiple imputation method will be used to handle missing data. DISCUSSION This trial aims to test the superiority of BMT over enhanced usual care with a reasonable superiority margin, over which the BMT could be further considered for incorporation into PC in Chile. Its pragmatic approach ultimately aims to inform policymakers about the benefit of including a brief psychosocial treatment into PC. TRIAL REGISTRATION ClinicalTrials.gov NCT04345302 . Registered on 28 April 2020.
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Affiliation(s)
- Nicolas A Barticevic
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile
| | - Fernando Poblete
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile.
| | - Soledad M Zuzulich
- Nursing School, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile
| | - Victoria Rodriguez
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile
| | - Laura Bradshaw
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Alameda 340, PO 8331150, Santiago, Chile
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