Alcohol Abstinence Research Articles

S1409 Improving Provider Adherence to Nutritional and Metabolic Recommendations in Patients With Acute Alcoholic Hepatitis: A Quality Improvement Initiative

Introduction: Alcoholic hepatitis (AH) is an acute, inflammatory liver disease associated with high morbidity and mortality, both short and long term. Current medical therapy for severe alcoholic hepatitis relies on corticosteroids, which have modest efficacy. Alcohol abstinence is of critical importance but recidivism is high. Efficacious medical treatments for alcoholic hepatitis are lacking. Preliminary and Preclinical studies include use of Antibiotics, IL-1 inhibitors, GCSF and antioxidants. Malnutrition and sarcopenia are common among hospitalized AH patients with negative impact on outcome.[1] Current guidelines generally recommend daily protein intake of 1.2–1.5 g/kg/day and caloric intake of 30- 40 kcal/kg/day in alcoholic hepatitis patients. [2][3] Our objective is to implement methods to facilitate adherence to nutritional recommendations in hospitalized patients with AH. Methods: We conducted a 12-month retrospective study followed by a 3-month prospective interventional study at Presbyterian Medical Center. Chart review was performed to evaluate adherence with nutritional recommendations in patients with AH. A 3-month intervention was performed to improve compliance. This included the creation of a customized best practice advisory alert (BPA) in the Electronic medical record (EMR). The triggers included elevated ALT/AST, bilirubin >3 and documented alcohol use within 8 weeks. Alert encouraged physicians to request a nutrition consult if the diagnosis of AH was appropriate. Results: 105 patients with 82 in the pre- and 23 post-intervention periods were reviewed. No significant difference in patient characteristics and demographics was noted between the 2 groups. The intervention implemented revealed a 79% increase in adherence to nutritional recommendation (P < 0.023). Adherence was quantified as modified diet orders in EMR to include high protein diet ( minimum of 60 grams/daily ) and/or addition of supplemental high protein milk shakes to meals and/or electronic consult to nutritionist. Conclusion: AH has high morbidity and mortality. Current pharmacological options remain limited. Patients with AH are commonly malnourished and sarcopenic. System based auto-generated EMR alerts help increase compliance with the nutritional recommendations as well as enforce evidence-based practices in this select patient population.

Behavioral activation, affect, and self-efficacy in the context of alcohol treatment for women with elevated depressive symptoms.

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).

Development of the motivational thought frequency scale for alcohol abstinence (MTF-A).

For most treatment-seeking patients with severe Alcohol Use Disorder (AUD), abstinence is the clinically indicated goal. Existing AUD motivation scales are non-specific about treatment consumption goals, which limit their effectiveness. Desires and mental imagery are relevant in the motivation for AUD treatment engagement. The Motivational Thought Frequency Scale for an abstinence goal (MTF-A) was adapted from the MTF for controlled drinking (MTF-CD). This study psychometrically evaluated the MTF-A in an alcohol-dependent sample engaged in treatment with a goal of abstinence. To enhance the clinical utility of the scale, a secondary aim was to evaluate a psychometrically equivalent short version of the MTF-A. A sample N of 329 treatment-seeking patients with AUD (mean age of 44.44 years, SD=11.89 years, 72% male) who were undertaking a cognitive behavioral treatment (CBT) program for abstinence completed the Motivational Thought Frequency Scale for Abstinence (MTF-A) and the Severity of Alcohol Dependence Questionnaire (SADQ). The MTF-A measured motivation for abstinence through four factors: intensity, self-efficacy imagery, incentives imagery, and availability. Confirmatory factor analyses (CFAs) were conducted to examine factor structure and model fit. Cronbach's alpha assessed internal consistency. Predictive validity was determined by logistic regression predicting first-session treatment non-attendance and alcohol consumption between baseline assessment andcommencement of treatment, controlling for potential confounds. A four-factor structure provided the best fit for the MTF-A, compared with one- and three-factor models. A shortened 9-item MTF-A scale (S-MTF-A) provided better fit than the 13-item MTF-A scale. Both MTF-A and S-MTF-A displayed good internal consistency. Although both MTF-A and S-MTF-A successfully predicted first-session treatment non-attendance, neither predicted alcohol consumption between the baseline assessment and commencement of treatment. The model fit of the four-factor, 9-item S-MTF-A was superior to the original 13-item MTF-A. Both scales were predictive of participation of AUD treatment. Desires and mental imagery play an important role in AUD treatment motivation.

‘It’s a crutch’: A qualitative exploration of UK police employees’ experiences of at-risk alcohol consumption or abstinence

Abstract One-third of UK police employees drink to at-risk levels, with both at-risk drinking and abstinence being associated with poor mental health. This research aimed to qualitatively explore police employees’ experiences of at-risk alcohol use or abstinence, their motivations for drinking/abstaining, and the organizational culture of drinking. Semi-structured telephone interviews with 16 UK serving police employees (12 at-risk drinkers, four abstainers) were conducted and analysed using thematic analysis. Five themes were identified. Participants described the ‘organizational culture of drinking and changes over time’, outlining a cultural shift. Motivations for drinking were reflected across two themes, ‘alcohol as a coping mechanism’ and ‘alcohol and socializing’, with an additional theme representing ‘motivations for abstinence/cutting down’. The final theme highlighted the ‘contrasting perceptions of available support’. Though the drinking culture is no longer as prominent, using alcohol socially and to cope, is normalized. The implications and recommendations for practice are outlined.

Acceptance and use of web-based interventions for alcohol abstinence

EinleitungDie Prävalenzraten für Alkoholgebrauchsstörungen liegen in Deutschland bei ca. 6 %, alkoholabhängig sind ca. 3 %. Nur ca. 10 % der Patienten befinden sich in suchtmedizinischer Therapie. In der Früherkennung und -intervention besteht zudem eine deutliche Unterversorgung. Eine bislang nicht evaluierte Ergänzung zu bestehenden Interventionsangeboten ist der außerhalb der professionellen Suchthilfe von einer ehemaligen Betroffenen entwickelte Internetauftritt „Ohne Alkohol mit Nathalie“ (OAmN). Die vorliegende Pilotstudie hatte zum Ziel, herauszufinden, ob die Nutzer der OAmN-Angebote zu jenen zählen, die bisher vom Suchthilfesystem nicht erreicht werden konnten.MethodenInnerhalb von vier Wochen wurden Nutzer auf vier verschiedenen OAmN-Kanälen dazu aufgerufen, sich an einer anonymen Befragung zu beteiligen. Ein Link führte jeweils zu einem webbasierten Fragebogen. Dieser umfasste offene, geschlossene sowie Multiple-Choice-Fragen zum Konsummuster von Alkohol und bisherigen Therapiebemühungen.ErgebnisseVon 2022 Teilnehmern gaben 84,3 % (n = 1705) an, ein „Alkoholproblem“ zu haben oder es gehabt zu haben. Davon hatten 17,7 % (n = 302) die Diagnose einer Alkoholabhängigkeit und 21 % (n = 529) Therapieerfahrung. Sistiert hatten ihren Alkoholkonsum zum Zeitpunkt der Befragung 85,5 % (n = 1457) der Betroffenen. Die meisten davon (48,5 %, n = 705) mithilfe von OAmN. 97,5 % (n = 1662) waren während ihrer Konsumzeit berufstätig und haben aus eigener Sicht zu 34,3 % (n = 570) „sehr gut“, zu 43,2 % (n = 718) „gut“ funktioniert.DiskussionDie Pilotstudie zeigt, dass webbasierte Angebote wie OAmN Menschen erreichen können, die durch Angebote des etablierten Suchthilfesystems nicht erreicht werden, obwohl eine alkoholbezogene Störung vorliegt und eine Bereitschaft zur Verhaltensänderung im Hinblick auf den Alkoholkonsum besteht.Zusatzmaterial onlineDie Onlineversion dieses Beitrags (10.1007/s00115-022-01385-0) enthält einen zusätzlichen Fragebogen. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.

Evaluation of Antidepressant Effect of Minocycline in Alcohol Abstinence-Induced Depression Model in Mice.

IntroductionDepression is one of the common comorbidities seen in chronic alcohol use disorder. Also, alcohol withdrawal induces depression and anxiety, which is associated with relapse in alcohol consumption. Minocycline, a tetracycline derivative, has shown an antidepressant effect in preclinical models. However, their effect on alcohol withdrawal-induced depression has not been studied. Therefore, the current study has been undertaken to evaluate the effect of minocycline on alcohol abstinence-induced depression models in mice.MethodWe conducted the study in two models. C57bl/6 mice were given a two-bottle choice (alcohol + water) for 28 days. During alcohol abstinence of 14 days, mice were treated with 10 mg/kg, 30 mg/kg, and 50 mg/kg of minocycline and were evaluated for behavioral changes using the forced swim test (FST) and tail suspension test (TST). A sucrose preference test was carried out where mice were exposed to binge alcohol drinking protocol for 12 days, where a two-bottle choice (alcohol or water) was given. This was followed by exposing the mice to a two-bottle choice paradigm (alcohol + sucrose) and they were divided into groups - no treatment group, vehicle-treated, minocycline 30 mg/kg or minocycline 50 mg/kg treated - and consumption of sucrose was assessed.ResultIn the forced swim test, a significant decrease in immobility time (p<0.05) was observed in the high-dose minocycline group (82.75±19.09) as compared to the vehicle control group (128.12±35.44). In the tail suspension test also, a significant decrease in immobility time (p<0.05) was seen in the high-dose minocycline group (83.75±18.61) as compared to the vehicle control group (122.25±18.51). The water and alcohol intake were comparable among all groups. In the sucrose preference test, it was found that the minocycline 50 mg/kg group had the highest sucrose preference (55%) followed by the minocycline 30 mg/kg group (50%) as compared to 42% in the vehicle control group. Significant reduction in brain-derived neurotrophic factor (BDNF) levels was seen with minocycline 50 mg/kg (p<0.05) and minocycline 30 mg/kg group (p<0.05) in BDNF levels when compared to the normal control group.ConclusionMinocycline in a higher dose (50 mg/kg) has shown an effect in alcohol withdrawal-induced depression in the abstinence-induced two-bottle choice model in mice. Both doses of minocycline have shown an effect in the sucrose preference test in the alcohol withdrawal-induced depression model.

Mechanisms and Therapeutic Opportunities in Atrial Fibrillation in Relationship to Alcohol Use and Abuse.

Excessive drinking has detrimental effects on the cardiovascular system. Atrial fibrillation (AF) after alcohol binge drinking, also named "holiday heart syndrome," is well established. However, chronic lower levels of alcohol intake also may increase AF risk. In this review, we aim to provide a comprehensive overview of the epidemiology and pathophysiology by which alcohol may be responsible for AF and discuss whether alcohol abstinence is required for optimal rhythm control as well as to maintain sinus rhythm in patients with AF. The pathophysiologic mechanisms responsible for the relationship between alcohol consumption and AF may include both direct and chronic effects increasing AF burden. Acute effects may include arrhythmogenic changes (such as shortening in atrial refractoriness, slowing in conduction velocity, and increased atrial ectopy) and an autonomic imbalance. Chronic changes contributing to the development of an arrhythmogenic substrate involve atrial structural and functional remodelling processes due to atrial dilation, elevated pressures, and fibrosis formation. In addition, alcohol consumption contributes to developing concomitant AF risk factors such as obesity, sleep-disordered breathing, and hypertension. Alcohol abstinence is associated with a reduction in AF recurrence and overall burden and moreover improves AF risk factor development such as obesity, hypertension, sleep apnea, and AF-related consequences such as stroke. In conclusion, alcohol consumption is associated with atrial arrhythmia and a wide range of cardiovascular comorbidities. Although further evidence is needed, current knowledge indicates that there might not be a safe level of alcohol consumption that does not increase AF risk.

Quantification of phosphatidylethanol combining dried blood spots sampling with Orbitrap-based LC-HRMS platform: Method validation and proficiency testing

Phosphatidylethanols (PEth) are phospholipids specifically synthetised by an enzymatic reaction in presence of ethanol. PEth is a mid-term direct biomarker for alcohol consumption or abstinence, leading to a growing interest for forensic toxicology purposes. Blood deposition onto a filter paper card as dried blood spots (DBS) allows PEth stabilisation which is otherwise easily degraded at room temperature. The goal of this study was to develop and validate a procedure for the quantification of PEth 16:0/18:1, the most abundant analogue, in DBS samples benefiting from the selectivity brought by Orbitrap-based high-resolution mass spectrometry (HRMS). Calibration samples and quality controls (QCs) are volumetrically spotted (10 μL) onto filter paper card (Whatman 903 protein saver) either using HemaXis DB10™ device, or using laboratory micropipette. The whole DBS is manually punched out and the PEth is then directly extracted using an in vial approach with 100 μL of PEth 16:0/18:1-D5 in methanol. Analyses are then performed by LC-HRMS in PRM mode using a QExactive Orbitrap platform. Validation was carried out on with respect to the Food and Drug Administration (FDA) criteria, using three different QC concentrations (39, 87 and 350 ng/mL) over three non-consecutive days. To assess the robustness of our method, an interlaboratory proficiency testing was carried out using 3 different commercial standards at 4 levels (50, 100, 200, and 300 ng/mL) of quality controls (QCs) provided by ACQ Science (Germany). The method was fully validated according to guidelines set forth by the FDA. Calibration curve was built using a weighting factor of 1/x. Trueness was measured between 100.1 and 103.6% for the tested concentrations. Repeatability and intermediate precision were found to be lower than 5%. Linearity was evaluated between the lower limit of quantification of 20 ng/mL and the upper limit of quantification of 2000 ng/mL with an R2 greater than 0.998. Recovery (RE) and matrix effect (ME) evaluated at 2 concentrations ranged from 76 to 99% and 8 to 10%, respectively. During the proficiency test, precision was evaluated below 8.0%, while the accuracy ranged from 93.8% to 105.9% and from 101 to 104.5% when compared with the expected concentration and the mean measured value of all the labs participating respectively. The validation results demonstrate that the use of Orbitrap-based PRM quantification present an interesting alternative over triple quadrupole platforms considered as the gold standard for LC-MS/MS quantitative approaches. Indeed, multiple reaction monitoring (MRM) and PRM provide comparable performance in terms of sensitivity, linearity, dynamic range, precision and repeatability. Moreover, the use of PRM provides access to the full fragmentation spectra without any preanalytical considerations. The proficiency testing results confirm the suitability of PRM mode showing great quantification performances. In addition, those results and especially the repeatability exhibit the precision of the volume control provided by the use of HemaXis™ device. This tool enables the standardisation of the DBS collection at the fingertip in a non-hospital environment either by minimally-trained medical staff or by the patient himself. A rapid, sensitive, and robust method was developed and fully validated for the detection and quantification of PEth 16:0/18:1 in DBS samples. The results of the validation process and the proficiency testing confirm that the use of DBS associated with HRMS PRM-based analyses does not hinder the analytical performances, while providing full information over the MS-MS spectra. The development of analytical tools enabling the use of DBS microsampling that can be performed in almost every environment opens new opportunities toward clinical and forensic toxicological applications.

Phosphatidylethanol in whole blood: A complementary biomarker to ethyl glucuronide in hair

Establish the importance of interpreting the analyses of two alcohol use biomarkers, with a different detection window, when monitoring long-term alcohol consumption of an individual. In many medico-legal cases, such as liver transplantation and traffic incidents, there is a need to provide a proof of alcohol abstinence. Long-term alcohol consumption, particularly proving abstinence, remains a challenge. Therefore, various alcohol consumption biomarkers are used to gain information about the drinking behaviour of an individual. Ethyl glucuronide in hair (hEtG) is a reliable long-term alcohol use biomarker due to its long detection window, depending on the length of hair, allowing for a retrospective evaluation of alcohol use (Crunelle. Drug and Alcohol Dependence 2014:1–11). Phosphatidylethanol 16:0/18:1 (PEth) in whole blood is a direct alcohol biomarker that has gained increasing interest, due to its detection window of two to four weeks. (Ulwelling. Journal of Forensic Science 2018;63(6):1634–1640) This study explores the usefulness of analysis of PEth as a complementary biomarker to hEtG to evaluate alcohol use more accurately over the last weeks to months. Hair and whole blood samples were obtained over a three-year period in a medico-legal context, from the University Hospital Antwerp and analysed by Toxicological Centre University of Antwerp and the National Institute investigation of Criminalistics and Criminology (NICC), Belgium. Individuals ( n = 952) were assessed for a 3- or 6- month period of alcohol abstinence. Hair samples were taken from the posterior head region (0–3 or 0–6 cm). The sample preparation for hair analysis consisted in solid-phase extraction. At NICC, analysis was performed on an LC-MS/MS (Kummer. Journal of Analytical Toxicology 2015;39(1):17–23). At the Toxicological Centre, the extract was analysed on a GC-MS/MS (Cappelle. Forensic Science International 2015;249:20–24). Whole blood was collected on the same day as the hair sample and analysed for PEth using liquid-liquid extraction. In both laboratories, the analyses were performed on a LC-MS/MS. (Dumitrascu, Drug Testing 2021;13:1219; Van Uytfanghe, Talanta 2021;223:121694). PEth and hEtG results were classified into three groups, according to thresholds for abstinent/low, moderate, or excessive alcohol consumption (Society of Hair Testing, 2016; Van Uytfanghe. Talanta 2021;223:121694). Spearman correlation test (rs = 0.692, P = 0.001) showed a significant and moderate correlation between the two biomarkers. It was found that 341 individuals were classified abstinent according to the hair analysis (hEtG < 5 pg/mg) out of which 82% were also classified abstinent according to the whole blood analysis (Peth < 20 ng/mL). Furthermore, 329 individuals were classified as heavy drinkers through hair analysis (hEtG > 30 pg/mg), of which 57% presented a PEth concentration > 200 ng/mL, confirming the classification. Fifty-two individuals (15%) were categorised as abstinent/low alcohol consumption through hEtG analysis, but as moderate drinkers through PEth analysis (20–200 ng/mL). This might be explained by recent, moderate alcohol consumption. While PEth can be detected if alcohol was consumed in the past two to four weeks, EtG had insufficient time to be incorporated into the cut hair sample. Out of 329 individuals classified as heavy drinkers based on hEtG analysis, 45 were categorised abstinent through PEth analysis, suggesting these subjects stopped drinking two to four weeks prior to sample collection. A moderate agreement of Kappa reliability analysis (k = 0.444) between PEth and hEtG confirms that, for a more accurate overview of the drinking behaviour of an individual, both biomarkers are needed. This study demonstrates the necessity of analysing two alcohol use biomarkers with different detection windows, when investigating alcohol use retrospectively. PEth in whole blood is a complementary biomarker to hEtG, as it captures the last two to four weeks of alcohol consumption, which would be missed when only analysing for hEtG.

Complete alcohol abstinence increases the risk of NAFLD but not severity. A population analysis with transient elastography

Background & Aims As the global prevalence of non-alcoholic fatty liver disease (NAFLD) continues to rise, ubiquity of alcohol use has also prompted discussion regarding the potential interactions between the two. This study aims to examine the effects of modest alcohol consumption on the prevalence and complications of NAFLD in a multi-ethnic population. Methods This study analyses the 2017–2018 cycles of NHANES that examined liver fibrosis and steatosis with vibration controlled transient elastography. A coarsened exact matching was conducted to reduce confounding. Logistic regression was done with a multivariate model to assess the relationship between alcohol consumption (modest drinkers and non-drinkers) and risk of NAFLD and its complications. Results 2,067 individuals were found to have NAFLD and 284 NAFLD patients had a total history of alcohol abstinence. After coarsened exact matching, the prevalence of NAFLD was 49% (CI: 0.41 − 0.58) in non-drinkers and 33% (CI: 0.26 − 0.41) in modest drinkers. Non-drinkers had twice the odds of NAFLD compared to modest drinkers (OR: 1.99, CI: 1.22 − 3.22, p<.01) after adjustment for confounders. There were no significant differences in the odds of significant fibrosis, advance fibrosis, cirrhosis, cardiovascular disease and stroke between non-drinkers and modest drinkers. The odds of malignancy in non-drinkers were almost significantly less than modest drinkers (OR: 0.28, CI:0.08 − 1.02, p=.053). Conclusion Interestingly, modest alcohol consumption is associated with decreased odds of NAFLD. Further investigations are required to examine the relationship between alcohol consumption and NAFLD and subsequently the potential impact on NAFLD management.

Effectiveness of Varenicline and Cytisine for Alcohol Use Reduction Among People With HIV and Substance Use

Cigarette smoking and risky alcohol consumption co-occur and are undertreated. Nicotine receptor partial agonists and nicotine replacement therapy (NRT) treat smoking but are unproven for alcohol, and clinical trials rarely include individuals with HIV, substance use, and mental health conditions. To compare the effects on drinking and smoking of nicotinic acetylcholine receptor partial agonists varenicline and cytisine with those of NRT. This 4-group randomized, double-blinded, placebo-controlled clinical trial was conducted from July 2017 to December 2020 in St Petersburg, Russia. Included participants were 400 individuals with HIV who engaged in risky drinking (≥5 prior-month heavy-drinking days [HDDs]) and daily smoking; they were followed up for 12 months after enrollment. Data were analyzed from May 2021 through June 2022. Participants received alcohol and tobacco counseling, 1 active medication, and 1 placebo in 1 of 4 groups: active varenicline and placebo NRT (group 1), placebo varenicline and active NRT (group 2), active cytisine and placebo NRT (group 3), or placebo cytisine and active NRT (group 4). The primary outcome was number of prior-month HDDs at 3 months. Secondary outcomes included biochemically validated abstinence from alcohol at 3 months and smoking at 6 months. Among 400 participants (263 [65.8%] men; mean [SD] age, 39 [6] years), 97 individuals (24.3%) used opioids and 156 individuals (39.1%) had depressive symptoms. These individuals had a mean (SD) CD4 count of 391 (257) cells/mm3, smoked a mean (SD) of 21 [8] cigarettes/d, and reported a mean (SD) of 9.3 (5.8) HDDs in the prior 30 days. At 3 months, the mean (SD) number of HDDs was decreased vs baseline across all groups (group 1: 2.0 [3.8] HDDs vs. 9.5 [6.1] HDDs; group 2: 2.1 [4.3] HDDs vs 9.3 [5.7] HDDs; group 3: 1.5 [3.3] HDDs vs 8.9 [5.0] HDDs; group 4: 2.4 [5.2] HDDs vs 9.6 [6.3] HDDs). There were no significant differences at 3 months between groups in mean (SD) HDDs, including group 1 vs 2 (incident rate ratio [IRR], 0.94; 95% CI, 0.49-1.79), 3 vs 4 (IRR, 0.60; 95% CI, 0.30-1.18), and 1 vs 3 (IRR, 1.29; 95% CI, 0.65-2.55). There were no significant differences at 6 months between groups in smoking abstinence, including group 1 vs 2 (15 of 100 individuals [15.0%] vs 17 of 99 individuals [17.2%]; odds ratio [OR],0.89; 95% CI, 0.38-2.08), 3 vs 4 (19 of 100 individuals [19.0%] vs 19 of 101 individuals [18.8%]; OR, 1.00; 95% CI, 0.46-2.17), and 1 vs 3 (OR, 0.79; 95% CI, 0.35-1.78). Post hoc analyses suggested lower mean (SD) HDDs (eg, at 3 months: 0.7 [1.8] HDDs vs 2.3 [4.6] HDDs) and higher alcohol abstinence (eg, at 3 months: 30 of 85 individuals [35.3%] vs 54 of 315 individuals [17.1%]) among those who quit vs continued smoking. This study found that among individuals with HIV who engaged in risky drinking and smoking, varenicline and cytisine were not more efficacious than NRT to treat risky drinking and smoking but that behavior change rates were high in all groups. ClinicalTrials.gov Identifier: NCT02797587.

Online randomised factorial trial of electronic Screening and Brief Intervention for alcohol use in pregnancy: a study protocol

IntroductionApproximately 1 in 7 pregnant women in the USA report past-month alcohol use. Strong evidence connects prenatal alcohol exposure with a range of adverse perinatal outcomes, including the spectrum of...

Length of Alcohol Abstinence Predicts Posttransplant Delirium in Living Donor Liver Transplant Recipients with Alcoholic Cirrhosis.

History of alcohol abuse is a predictive factor for posttransplant delirium. We aimed to investigate whether preoperative abstinence was associated with posttransplant delirium in liver transplant recipients with alcohol-related cirrhosis. From January 2014 to December 2019, 84 patients with alcohol-related cirrhosis who received living donor liver transplant were retrospectively reviewed and divided into a delirium group (n = 46, 54.8%) and a nondelirium group (n = 38, 45.2%) using the Richmond Agitation- Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit. In the delirium group versus the nondelirium group, patients were more likely to have preoperative hepatic encephalopathy (58.7% vs 31.6%; P = .013), more likely to have higher Model for End-Stage Liver Disease scores (27.05 ± 10.56 vs 18.85 ± 7.96; P < .001), less likely to have preoperative alcohol abstinence (43.5% vs 68.4%%; P = .022), had longer duration of mechanical ventilation (7.57 ± 7.82 vs 2.50 ± 5.96 days; P = .001), and had longer stays in the intensive care unit (14.85 ± 15.01 vs 8.84 ± 7.84 days; P = .021) and in the hospital (37.89 ± 18.85 vs 27.15 ± 10.43 days; P = .002). Multivariate analysis revealed that preoperative alcohol abstinence (odds ratio 4.953; 95% CI, 1.519-16.152; P = .008) was a significant predictor and that more patients had abstinence durations <3 months (60.9% vs 34.2%; P = .048) in the delirium group. A high incidence of posttransplant delirium in liver transplant recipients with alcohol- related cirrhosis was associated with preoperative abstinence. Abstinence >6 months before living donor liver transplant is suggested to reduce the risk of posttransplant delirium.

Psychological Interventions on Abstinence in Patients with Alcohol Use Disorder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

PurposeAccumulating research suggests that psychotherapy helps improve abstinence but the difference in the efficacy of multiple psychotherapies in alcohol use disorder (AUD) remains to be explored.Patients and MethodsA systematic search of databases (Pubmed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and EBSCO) for studies (published from inception to April 10th.) of adults diagnosed with AUD accepting psychotherapies was conducted. Studies covering 9 countries and regions. The qualitative analysis pooled 2646 individuals from 34 randomized controlled trials (RCTs) and the networks included 1928 participants (23 RCTs). The outcomes included percentage of days abstinent (PDA), change in drinks per drinking day (change in DDD), and change in craving compared among individuals accepting various psychotherapies. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and was registered on the International Prospective Register of Systematic Reviews (PROSPERO).ResultsFor the network of PDA, motivational enhancement treatment (MET) (35.44, 11.78 to 59.09, high-certainty) and couple therapy (CT) (28.89, 13.42 to 44.36, moderate-certainty) were significantly different from treatment as usual (TAU) with the surface under the cumulative ranking curve (SUCRA) mean rank 1.9 and 1.9 respectively. TAU+supportive psychotherapy (SP) was better than TAU for the change in DDD in the high-quality direct comparison.ConclusionThe motivational enhancement and the couple therapy show potential amelioration for alcohol abstinence. Additionally, the preferred interventions are different for improving PDA and change in DDD. The evidence network remains to be strengthened.

Do Personality, Alcohol Abstinence Self-Efficacy, and Depressive Symptomatology Affect Abstinence Status in Treatment-Seeking Patients with Alcohol Use Disorder?

Given the high global incidence and disabling nature of alcohol use disorders, alongside high relapse rates, we sought to investigate potential predictors of abstinence, considered a prerequisite of full remission. With an aim to examine (i) the effect of personality, alcohol abstinence self-efficacy, and depressive symptomatology on abstinence status as our primary objective, and (ii) interactions between these three factors, as well as (iii) their changes over time as two secondary objectives, we recruited 51 inpatients at an alcohol rehabilitation center to complete the International Personality Item Pool, the Alcohol Abstinence Self-Efficacy Scale and the Beck Depression Inventory, and to provide information on abstinence attainment 2 months post-treatment. Although regression analyses revealed no evidence for the effect of the investigated factors (personality, self-efficacy, or depressive symptoms) on post-therapy abstinence, other findings emerged, demonstrating (i) a significant reduction in the severity of depressive symptoms, (ii) the effect of personality and alcohol abstinence self-efficacy on depressive symptom severity, and (iii) the role of personality in predicting the temptation to use alcohol in recovering drinkers. These preliminary indications of links between personality, self-efficacy, and subjective well-being mark a promising area for future research on powerful and relevant cues of relapse and abstinence efficacy.

Adherence to Self-Care among Patients with Hypertension in Ethiopia: A Systematic Review and Meta-Analysis.

Background Self-care adherence for hypertensive patients is a cornerstone for the control of it and prevention of its complications. However, there are inconsistent findings for self-care adherence of hypertensive patients in Ethiopia. Thus, this systematic review and meta-analysis was done to determine the pooled estimate self-care adherence. Methods This systematic review and meta-analysis was reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis guideline. An intensive search of online databases such as PubMed (MEDLINE), CINHAL, Google Scholar, and advanced Google search was made to access both published and unpublished articles that report self-care adherence among hypertensive patients in Ethiopia. The pooled estimate was done with STATA version 11 metan commands in a 95% confidence interval. The presence of heterogeneity and publication bias were detected by I2 and Egger's test, respectively. A random-effect model was obtained, and subgroup analysis was done for the management of heterogeneity. Result A total of 24 articles with a total of 7224 participants were included in the final systematic review and meta-analysis. The pooled estimate of overall self-care adherence among hypertensive patients was 36.98% (95% CI: 27.13–46.83). In subgroup analysis, the highest overall self-care adherence was observed in the Amhara region at 53% (95% CI: 46.54, 59.47). The pooled estimate of self-care dimensions such as medication adherence, low-salt diet, physical activity, smoking abstinence, alcohol abstinence, and weight management was 62.71%, 65.96%, 47.28%, 92.53%, 67.59%, and 52.54%, respectively. Conclusion The pooled estimate of good self-care adherence among hypertensive patients was low. From the dimensions of self-care, the lowest level was in physical activity and the highest level was in smoking abstinence. Comparing all regions, the lowest level of overall self-care adherence was observed in Addis Ababa, Tigray region, and South Nations and Nationalities of Ethiopia. Screening of adherence to self-care and health education should be provided to every patient during every visit.

Alcohol-Induced Oxidative Stress and the Role of Antioxidants in Alcohol Use Disorder: A Systematic Review.

Alcohol use disorder (AUD) is a highly prevalent, comorbid, and disabling disorder. The underlying mechanism of ethanol neurotoxicity and the involvement of oxidative stress is still not fully elucidated. However, ethanol metabolism has been associated with increased oxidative stress through alcohol dehydrogenase, the microsomal ethanol oxidation system, and catalase metabolic pathways. We searched the PubMed and genome-wide association studies (GWAS) catalog databases to review the literature systematically and summarized the findings focusing on AUD and alcohol abstinence in relation to oxidative stress. In addition, we reviewed the ClinicalTrials.gov resource of the US National Library of Medicine to identify all ongoing and completed clinical trials that include therapeutic interventions based on antioxidants. The retrieved clinical and preclinical studies show that oxidative stress impacts AUD through genetics, alcohol metabolism, inflammation, and neurodegeneration.

Neural mechanisms underlying empathy during alcohol abstinence: evidence from connectome-based predictive modeling.

Empathy impairments have been linked to alcohol dependence even during abstinent periods. Nonetheless, the neural underpinnings of abstinence-induced empathy deficits remain unclear. In this study, we employed connectome-based predictive modeling (CPM) by using whole brain resting-state functional connectivity (rs-FC) to predict empathy capability of abstinent alcoholics (n = 47) versus healthy controls (n = 59). In addition, the generalizability of the predictive model (i.e., one group treated as a training dataset and another one treated as a test dataset) was performed to determine whether healthy controls and abstinent alcoholics share common neural fingerprints of empathy. Our results showed that abstinent alcoholics relative to healthy controls had decreased empathy capacity. Although no predictive models were observed in the abstinence group, we found that individual empathy scores in the healthy group can be reliably predicted by functional connectivity from the default mode network (DMN) to the sensorimotor network (SMN), occipital network, and cingulo-opercular network (CON). Moreover, the identified connectivity fingerprints of healthy controls could be generalized to predict empathy in the abstinence group. These findings indicate that neural circuits accounting for empathy may be disrupted by alcohol use and the impaired degree varies greatly among abstinent individuals. The large inter-individual variation may impede identification of the predictive model of empathy in alcohol abstainers.

FRI527 - Impact of alcohol abstinence in patients with alcohol-related cirrhosis and portal hypertension

FRI527 - Impact of alcohol abstinence in patients with alcohol-related cirrhosis and portal hypertension

P119 Mass Media as a Means of Engagement and Reach During Alcohol Free for 40 (AFF40)

<h3>Objective</h3> To report the process evaluation findings as it relates to mass media methods used to recruit and engage participants in Alcohol Free for 40 (AFF40). <h3>Use of Theory or Research</h3> The social marketing theory was used to promote voluntary behavior change and promote health strategies for participant adoption. Effective social marketing campaigns used a variety of medias such as social, mass, and digital. <h3>Target Audience</h3> Adults 21 and older looking to abstain from alcohol to improve their overall health. <h3>Program Description</h3> AFF40 is an annual 40-day voluntary alcohol abstinence challenge that is hosted by the Ochsner Eat Fit^TM team of registered dietitians. Participants are challenged to abstain from alcohol consumption for 40 days to promote better health. Strategic planning is used to develop, implement, and evaluate media content (recruitment and program related) across multiple communication channels. <h3>Evaluation Methods</h3> Process evaluation included the tracking of reach, engagement rates, impressions, reactions, downloads, and pageviews from multiple media sources. <h3>Results</h3> During the four months of recruitment and program implementation, the AFF40 Facebook and Instagram pages published 62 posts, reached 104,080 people, recorded 530 new page follows, and had an engagement rate of 6.97% (engagement/reach*100). The AFF40 Facebook group had 934 active members and 4,189 reactions. The AFF40 website registered 719 unique pageviews and the Ochsner blog resulted in 4,796 unique pageviews across six alcohol related articles. Print media garnered 750,000 impressions across 3 newspaper articles. A 2-month span of radio segments (5 times per day each week) added 276,500 impressions. Six television news segments aired with indeterminable reach. <h3>Conclusions</h3> Using technology in the form of mass media allowed for wide participant reach and program engagement in AFF40. Future community-based program efforts may consider the use of multiple communication channels in recruiting, engaging, and disseminating program information. We believe the use of multiple channels, rather than singular, was key to program success in promoting behavior change. <h3>Funding</h3> Ochsner Health