Effectiveness of Naltrexone and Baclofen Combination in Reducing Craving among Patients with Alcohol Dependence: An Open-label Trial.

Predictors of Clinical Failure after Endoscopic Lumbar Spine Surgery During the Initial Learning Curve

the 14-item Obsessive Compulsive Drinking Scale (OCDS) is a quick and reliable self-rating instrument that provides a total and two subscale scores that measure some cognitive aspects of alcohol "craving". This study validated further its utility as an alcoholism severity and treatment outcome instrument. Alcoholism severity and analogue craving scales were administered at baseline, and the OCDS was given at baseline and weekly to 41 alcohol-dependent individuals who participated in a 12-week pharmacologic and cognitive-behavioral treatment trial. Repeated-measures analysis of variance was used to examine group differences in the OCDS scores of those individuals who remained abstinent or drank during the trial. At baseline, the OCDS was correlated with the alcohol composite score of the addiction severity index (r=.48), the alcohol dependence scale (r=.42), the analogue craving measures (range r=.40 to .57), and prestudy alcohol consumption (r=.60). Most importantly the OCDS total and subscale scores were significantly different between individuals who had relapse drinking, who had "slip" drinking, and who remained abstinent, with relapsers showing the highest scores. The OCDS scores appear to be sensitive to alcoholism severity and change during abstinence and relapse drinking. Since the shared variance with analogue craving measures is only about 20% to 30%, it appears to be measuring a largely independent dimension of alcohol dependence. Its ease of use (5 minutes per self-rating), reliability, validity, and analytic capabilities support its utility as a tool to measure severity and improvement during alcoholism treatment trials.

Drop-out, relapse and abstinence in a cohort of alcoholic people under detoxification

It has been suggested that a crucial dimension of alcohol "craving" includes the concept of both obsessive thoughts about alcohol use and compulsive behaviors toward drinking. An interview-based rating scale, the Yale-Brown Obsessive Compulsive Scale-heavy drinkers (YBOCS-hd), has been found useful in quantifying this concept in alcohol-dependent individuals. A self-rating scale, the Obsessive Compulsive Drinking Scale (OCDS) has been developed by us as a modification of the YBOCS-hd. The YBOCS-hd showed excellent interrater reliability in our hands. The correlation between the YBOCS-hd and the OCDS total scores obtained on 60 alcohol-dependent individuals was 0.83. The test-retest correlation for the OCDS total score was 0.96, and the obsessive and compulsive subscales test-retest correlations were 0.94 and 0.86, respectively. The internal consistency of the items in the OCDS was high (0.86) and did not improve significantly with removal of individual items. The shared variance between the OCDS scores and alcohol consumption during the period of evaluation was only approximately 20%, indicating that the dimension measured by the scale was somewhat independent of actual drinking. As such, it might act as an independent measure of the "state of illness" for alcohol-dependent individuals. When used during a prospective 12-week treatment research study, initial results indicate that the OCDS seems to validly measure a dimension of alcohol dependence, because it decreased from baseline during alcohol reduction and increased in relationship to relapse drinking.(ABSTRACT TRUNCATED AT 250 WORDS)

The Obsessive-Compulsive Drinking Scale (OCDS) is a self-rating questionnaire that measures cognitive and behavioral aspects of craving for alcohol. The OCDS consists of two subscales: the obsessive thoughts of drinking subscale (OS) and the compulsive drinking subscale (CS). This study aims to validate the Japanese version of the OCDS. First, internal consistency and discriminant validity were evaluated. Second, a prospective longitudinal 3-month outcome study of 67 patients with alcohol dependence who participated in a relapse prevention program was designed to assess the concurrent and predictive validity of the OCDS. The OCDS demonstrated high internal consistency. The OS had high discriminant validity, while the CS did not. Twenty-three patients (34.3%) dropped out of treatment. These patients had significantly higher OS scores than those who completed the program. At 3 months, the relapse group had significantly higher OCDS scores than the no relapse group. Also, the OCDS score was higher in subjects who had early-onset alcohol dependence than late-onset dependence. The OCDS is useful for evaluating cognitive aspect of craving and predicts dropout and relapse.

BackgroundThe correlates and consequences of stigma surrounding alcohol use are complex. Alcohol use disorder (AUD) is typically accompanied by self-stigma, due to numerous factors, such as shame, guilt and negative...

ABSTRACTBackground: 5-Hydroxytryptamine (5-HT) 3 receptor plays a crucial role in craving of alcohol dependence. Recent evidence shows that chronic alcohol exposure causes changes in gene expression and induces behavioral changes. However, the relationship between gene expression of 5-HT3 receptor and craving in alcohol-dependent patients is not fully understood. Objectives: The aim of this preliminary study was to investigate the relationship between gene expression of the 5-HT3 receptor and craving in alcohol-dependent patients and the epigenetic mechanism. Methods: We recruited 50 male Han Chinese alcohol-dependent patients and 46 male Han Chinese healthy controls. We investigated the changes of HTR3A mRNA, which encodes the 5-HT3 receptor A subunit, and H3K9 acetylation in HTR3A promoter region. Obsessive Compulsive Drinking Scale (OCDS) was used to assess the craving of alcohol-dependent patients relative to controls. Results: HTR3A mRNA expression levels and acetylation levels of H3K9 in the HTR3A promoter region were significantly higher in the alcohol-dependent patients. HTR3A mRNA expression levels were positively correlated with OCDS scores. Moreover, HTR3A mRNA expression levels were positively correlated with acetylation levels of H3K9 in HTR3A promoter region. Conclusion: The current findings suggest that HTR3A mRNA expression levels were positively correlated with craving in Han Chinese alcohol-dependent patients. The regulation of H3K9 histone acetylation in HTR3A promoter region may offer a target for the treatment of alcohol dependence.

Background: The trunk muscles are vital for the maintenance of spinal stability. Training of specific muscles surrounding the lumbar spine, which provide dynamic and segmental stability, is one of the major goals in the management of patients with chronic low back pain (LBP). However, more investigation of lumbar stabilization training using a ball is required before making any strong conclusions about its ecacy . Objectives: The aim of this study was to compare the eect of trunk stabilization exercises and conventional back care exercises for patients with chronic LBP. Patients and Methods: Thirty male subjects with chronic LBP were randomly assigned to two groups. The experimental group received trunk stabilization exercise using a gym ball whereas the control group received conventional back care exercises for six weeks. The abdominal muscle endurance, pain intensity, and functional disability were measured using pressure biofeedback, vi- sual analogue scale (VAS), and modified Oswestry disability questionnaire (MODQ), respectively. All the measurements were taken at baseline and during week two, four and six. Results: The results of the study demonstrated significant improvements in abdominal muscle endurance and reduction in VAS and MODQ score of both groups (P = 0.001). The trunk stabilization exercise group showed greater gains in abdominal muscle endurance during weeks two to six compared to the conventional back care exercise group (P < 0.05). In addition, the trunk stabi- lization exercise group showed greater reduction in the VAS score (P = 0.035) and MODQ score (P = 0.001) at week six compared to the conventional back care exercise group. Conclusions: The trunk stabilization exercises are more eective than conventional back care exercises in the rehabilitation of

A relationship between some hypothalamic-pituitary-related hormones and craving for alcohol has been suggested, leading to hypothesize a role of some hormones in the neurobiology of alcohol dependence. Investigating this association in alcohol-dependent (AD) patients was the aim of this preliminary and exploratory study. Cortisol, adrenocorticotropic hormone, prolactin, thyroid-stimulating hormone (TSH), free T3, free T4, growth hormone, follicle-stimulating hormone, luteinizing hormone as well as administering the Obsessive-Compulsive Drinking Scale (OCDS) and Penn Alcohol Craving Scale (PACS) were assessed at baseline and after 12 weeks in 25 current AD patients. Patients were treated with baclofen (10 mg t.i.d.) for these 12 weeks. Sixteen patients remained totally abstinent for 12 weeks. At baseline, a significant inverse correlation was found between TSH and PACS (r = -0.46; p = 0.022) and OCDS scores (r = -0.53; p = 0.007). A significant direct correlation was found between free T3 and OCDS score (r = 0.44; p = 0.026). In the 16 abstinent patients, craving scores were significantly decreased at 12 weeks (p < 0.01). At 12 weeks, no significant correlation was found between TSH and craving, but free T3 remained directly correlated with OCDS score (r = 0.60; p = 0.013). A relationship between alcohol craving and free T3 and TSH was demonstrated in AD patients, suggesting the potential involvement of the hypothalamic-pituitary-thyroid axis in the neurobiology of alcohol craving.

Background: Many clinicians and researchers believe that “craving” an abusable substance is a central phenomenon related to addiction. Craving for alcohol appears to be intimately related to the loss of control over consumption and to compulsive alcohol use. Aim: To compare the scores of obsessive compulsive drinking scale with visual analogue scale, severity of alcohol dependence questionnaire and addiction severity index. Materials and methods: Literate patients who met DCR-ICD-10 criteria for alcohol dependence syndrome were taken in the study. They must have been drinking alcohol daily till 1 week ago and the subjects were required to consume at least 6 standard drinks per day over the last month. Instruments used in this study were Obsessive Compulsive Drinking Scale – OCDS, Severity of Alcohol Dependence Questionnaire - SADQ, Addiction Severity Index - ASI , Visual Analogue Scale - VAS, Mini Mental Status Examination - MMSE, Timeline Method - TL Result: Among 40 patients, the mean age of these patients was 38 years (38.55+9.60). 95% of them were Hindus and 5% Christians. 82.5% were married. 50% of patients has the income between Rs.15000-20000 per month. The correlation matrix of OCDS variables (OCDS-T, OCDS-O, OCDS-C), ASI-A, SADQ, VAS variables (G, F, I) and TL on all four follow-ups were measured. All correlations were positive and significant at p<0.001 obsessive compulsive drinking scale total score in 2 drinking outcome groups during 8 week treatment period was seen in which there is a difference between in two patient groups at baseline i.e. abstinent group had lower score than relapse group. This difference was consistently observed between the groups over the entire period of follow-up. Conclusion: Craving was higher among those who relapsed than those who did not. Craving did predict high alcohol consumption and high index of severity at baseline and all through the follow up.

Childhood maltreatment, cognitive emotion regulation strategies, and alcohol craving and dependence in alcohol-dependent males: Direct and indirect pathways

Background: Chronic cervical pain is a common musculoskeletal complication among the people of all ages, especially in middle ages of life. Objectives: The present study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) combined with therapeutic ultrasound (TUS) in managing chronic cervical pain. Materials and Methods: To achieve this objective, a total of 102 individuals aged between 20 and 70 years, all diagnosed with chronic cervical pain, were randomly selected from various physiotherapy clinics located in and around Ropar, Punjab, India. These participants were then randomly assigned to two groups for treatment. Group-A received a comprehensive intervention including TENS and TUS, followed by hot pack application, massage therapy, therapeutic exercises (such as shoulder circumduction and pectoral stretching), cervical stretching, isometric exercises for the cervical region, along with guidance on recommended activities for daily living. In contrast, Group-B underwent a similar physiotherapeutic protocol but without the use of TENS and TUS. To measure outcomes, the Visual Analogue Scale (VAS) was used to assess pain levels, while the Neck Disability Index (NDI) was employed to evaluate the degree of functional disability. Results: The statistical analysis demonstrated a significant reduction (p&lt;0.001) in both VAS and NDI scores from pre- to post-treatment in both groups. However, the improvement was notably greater in Group-A, which experienced an 82.88% reduction in NDI and a 71.62% reduction in VAS, as compared to the results observed in Group-B. Conclusion: In summary, the findings suggest that incorporating TENS and therapeutic ultrasound into the treatment regimen yields more substantial improvements in pain relief and functional recovery than conventional physiotherapy methods alone for individuals suffering from chronic cervical pain.

Aim: This cohort study examined how predictors of alcohol dependence treatment outcomes work together over time by comparing pretreatment and posttreatment predictors. Methods: A sample of 274 alcohol-dependent patients was recruited and assessed at baseline, 6 months after treatment initiation (end of the active intervention phase), and 18 months after treatment initiation (end of the 12-month research follow-up phase). At each assessment point, the participants completed a battery of standardized tests [European Addiction Severity Index (EuropASI), Obsessive Compulsive Drinking Scale (OCDS), Alcohol Timeline Followback (TLFB), Fagerström, and International Personality Disorder Examination (IPDE)] that measured symptom severity and consequences; biological markers of alcohol consumption were also tested at each assessment point. A sequential strategy with univariate and multivariate analyses was used to identify how pretreatment and posttreatment predictors influence outcomes up to 1 year after treatment. Results: Pretreatment variables had less predictive power than posttreatment ones. OCDS scores and biological markers of alcohol consumption were the most significant variables for the prediction of posttreatment outcomes. Prior pharmacotherapy treatment and relapse prevention interventions were also associated with posttreatment outcomes. Conclusions: The findings highlight the positive impact of pharmacotherapy during the first 6 months after treatment initiation and of relapse prevention during the first year after treatment and how posttreatment predictors are more important than pretreatment predictors.

BackgroundAlcohol dependence (AD) is a complex addictive disorder with a high relapse rate. Previous studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioral therapy (CBT) may be effective for AD, and we aim to explore more effective treatment options to reduce relapse rates for AD.Materials and methodsA total of 263 AD patients were recruited. They were divided into six groups according to the location and the type of rTMS: left dorsolateral prefrontal cortex (DLPFC), right DLPFC, sham stimulation, and whether they received CBT treatment: with a fixed schedule (C1) and without a fixed plan (C0). There were included in sham rTMS + C0 group (n = 50), sham rTMS + C1 group (n = 37), right rTMS + C0 group (n = 45), right rTMS + C1 group (n = 42), left rTMS + C0 group (n = 49), left rTMS + C1 group (n = 40). We used obsessive compulsive drinking scale (OCDS), visual analogue scale (VAS), alcohol dependence scale (ADS), montreal cognitive assessment (MoCA), generalized anxiety disorder-7 (GAD-7), patient health questionnaire-9 items (PHQ-9), and Pittsburgh sleep quality index (PSQI) to assess alcohol cravings, alcohol dependence, cognition, anxiety, depression, and sleep quality. They were followed up and evaluated for relapse.ResultsThe sham rTMS + C0 group relapse rate was significantly higher than the right rTMS + C1 group (P = 0.006), the left rTMS + C0 group (P = 0.031), the left rTMS + C1 group (P = 0.043). The right rTMS + C0 group showed significantly higher relapse rate compared to the right rTMS + C1 group (P = 0.046). There was no significant difference in relapse rates between other groups. The repeated-measures ANOVA showed an interaction effect between group and time was significant in the rate of patient health questionnaire-9 items (PHQ-9) scale reduction (P = 0.020). Logistic analysis indicated that smoking and alcohol consumption were independent determinants of relapse (P < 0.05). At 24 weeks of follow-up, Kaplan–Meier survival analysis reveal that there is statistically significant relapse rate between six groups (P = 0.025), left rTMS + C1 group has the best treatment effect for alcohol dependent patients. Cox regression analysis confirmed that current smoking, total cholesterol, and total bilirubin (TBIL) level were risk factors of relapse (P < 0.05).ConclusionThis study is the first to suggest that the combination of rTMS and CBT may be a potentially effective treatment for reducing relapse.

Background: Many clinicians and researchers believe that “craving” an abusable substance is a central phenomenon related to addiction. Craving for alcohol appears to be intimately related to the loss of control over consumption and to compulsive alcohol use. Aim: To compare the scores of obsessive compulsive drinking scale with visual analogue scale, severity of alcohol dependence questionnaire and addiction severity index. Materials and Methods: Literate patients who met DCR-ICD-10 criteria for alcohol dependence syndrome were taken in the study and they must have been drinking alcohol daily till 1 week ago and the subjects were required to consume at least 6 standard drinks per day over the last month. Instruments used in this study were Obsessive Compulsive Drinking Scale– OCDS, Severity of Alcohol Dependence Questionnaire– SADQ, Addiction Severity Index– ASI, Visual Analogue Scale– VAS, Mini Mental Status Examination– MMSE, Timeline Method– TL Results: Among 40 patients, the mean age of these patients was 38 yrs (38.55 ± 9.60). 95% of them were Hindus and 5% christians. 82.5% were married. And 50% of patients has the income between Rs.15000-20000 per month. The correlation matrix of OCDS variables (OCDS-T,OCDS-O,OCDS-C),ASI-A,SADQ,VAS variables (G,F,I) and TL on all four follow-ups were measured. All correlations were positive and significant at p<0.001. Obsessive compulsive drinking scale total score in 2 drinking outcome groups during 8 week treatment period was seen in which there is a difference between in two patient groups at baseline i.e., abstinent group had lower score than relapse group. This difference was consistently observed between the groups over the entire period of follow-up. Conclusion: Craving was higher among those who relapsed than those who did not. Craving did predict high alcohol consumption and high index of severity at baseline and all through the follow up.