Severity Of Alcohol Dependence Research Articles

Economic burden associated with alcohol dependence in a German primary care sample: a bottom-up study.

BackgroundA considerable economic burden has been repeatedly associated with alcohol dependence (AD) – mostly calculated using aggregate data and alcohol-attributable fractions (top-down approach). However, this approach is limited by a number of assumptions, which are hard to test. Thus, cost estimates should ideally be validated with studies using individual data to estimate the same costs (bottom-up approach). However, bottom-up studies on the economic burden associated with AD are lacking. Our study aimed to fill this gap using the bottom-up approach to examine costs for AD, and also stratified the results by the following subgroups: sex, age, diagnostic approach and severity of AD, as relevant variations could be expected by these factors.MethodsSample: 1356 primary health care patients, representative for two German regions. AD was diagnosed by a standardized instrument and treating physicians. Individual costs were calculated by combining resource use and productivity data representing a period of six months prior to the time of interview, with unit costs derived from the literature or official statistics. The economic burden associated with AD was determined via excess costs by comparing utilization of various health care resources and impaired productivity between people with and without AD, controlling for relevant confounders. Additional analyses for several AD characteristics were performed.ResultsMean costs among alcohol dependent patients were 50 % higher compared to the remaining patients, resulting in 1836 € excess costs per alcohol dependent patient in 6 months. More than half of these excess costs incurred through increased productivity loss among alcohol dependent patients. Treatment for alcohol problems represents only 6 % of these costs. The economic burden associated with AD incurred mainly among males and among 30 to 49 year old patients. Both diagnostic approaches were significantly related to the economic burden, while costs increased with alcohol use disorder severity but not with other AD severity indicators.ConclusionsOur study confirms previous studies using top-down approaches to estimate the economic burden associated with AD. Further, we highlight the need for efforts aimed at preventing adverse outcomes for health and occupational situation associated with alcohol dependence based on factors associated with particularly high economic burden.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3578-8) contains supplementary material, which is available to authorized users.

Associations Between Posttraumatic Stress Disorder, Emotion Dysregulation, and Alcohol Dependence Symptoms Among Inner City Females.

ObjectiveThe purpose of this study was to examine how emotion dysregulation (ED) might help explain the relationship between posttraumatic stress disorder (PTSD) and alcohol dependence (AD) symptoms in females.MethodParticipants included 260 women from primary, diabetes, and gynecological clinics of an urban public hospital. This is a primarily African American sample (96.9%), including individuals reporting exposure to at least 1 traumatic event. We examined the associations and predictability patterns between severity of PTSD symptoms, ED, and AD symptoms.ResultsUsing linear regression analyses, PTSD avoidance and numbing symptoms and ED were significant predictors of AD symptoms. When looking at specific dimensions of ED, one's inability to engage in goal‐directed behavior under strong emotional influences showed a full indirect effect on the relationship between PTSD avoidance and numbing symptoms and AD symptoms.ConclusionOur findings suggest that having poor emotion regulation skills may help explain why females with PTSD become dependent on alcohol.

Readiness to Change Predicts Drinking: Findings from 12-Month Follow-Up of Alcohol Use Disorder Outpatients.

To test whether measures of readiness to change (RTC) re-assessed every 3 months had predictive value for change in alcohol use over 12 months in a sample of adult outpatients with alcohol use disorder (AUD). Of the case, 78 outpatients were followed monthly over one year and averaged 9.0 interviews each (total observations=704). Alcohol abstinence days and heavy drinking days were assessed monthly using a 30-day timeline follow-back procedure. RTC was assessed using 3 'readiness rulers' (importance, readiness, and confidence to change, measured on a 0-10 visual analog scale). The effect of RTC on alcohol use over time was tested every 3 months using negative binomial generalized estimating equations (GEE), controlling for gender, age, baseline alcohol dependence severity and AUD treatment status (ongoing vs. ceased). GEE models showed highly significant effects of readiness and confidence to change on respective alcohol outcomes. Effects of importance to change were weaker. As hypothesized, higher RTC scores were associated with improved alcohol use outcomes in this longitudinal study. The strongest effects were for confidence to change. Finding significant predictive validity prospectively is consistent with a theoretical view of RTC as a dynamic construct. Further research might clarify how AUD treatment could actually elicit or increase RTC.

Consumo de álcool no padrão binge e suas consequências em usuários de drogas em tratamento

O objetivo foi avaliar o uso de álcool no padrão binge e suas consequências em usuários de drogas. Estudo descritivo, de abordagem quantitativa, desenvolvido com 140 indivíduos de um Centro de Atenção Psicossocial – Álcool e Drogas. Foram aplicados: um formulário de informações sociodemográficas, a escala de gravidade de dependência de álcool e escala de severidade do uso de drogas. A amostra caracterizou-se por serem adultos do sexo masculino (76,4%), solteiros (77,1%), de cor negra/parda, com baixo nível de escolaridade (57,1%) e religião católica (55,8%). Eram usuários de crack (38,6%), de múltiplas drogas (32,1%) e de cocaína (29,3%), a maioria (80,7%) fez uso de álcool no padrão binge e apresentou níveis severos de dependência alcoólica (93,8%). Ameaça, agressividade e brigas foram evidenciadas na amostra. Os resultados indicam a necessidade de oferecer estratégias interventivas mais intensivas para controle do uso de álcool nesse segmento vulnerável da população, visando minimizar danos.

Disease burden attributed to alcohol: How methodological advances in the Global Burden of Disease 2013 study have changed the estimates in Sweden.

The Global Burden of Disease (GBD) study continuously refines its estimates as new data and methods become available. In the latest iteration of the study, GBD 2013, changes were made related to the disease burden attributed to alcohol. The aim of this study was to briefly present these changes and to compare the disease burden attributed to alcohol in Swedish men and women in 2010 using previous and updated methods. In the GBD study, the contribution of alcohol to the burden of disease is estimated by theoretically assessing how much of the disease burden can be avoided by reducing the consumption of alcohol to zero. The updated methods mainly consider improved measurements of alcohol consumption, including less severe alcohol dependence, assigning the most severe injuries and removing the protective effect of drinking on cardiovascular diseases if combined with binge drinking. The overall disease burden attributed to alcohol in 2010 increased by 14% when using the updated methods. Women accounted for this overall increase, mainly because the updated methods led to an overall higher alcohol consumption in women. By contrast, the overall burden decreased in men, one reason being the lower overall alcohol consumption with the new methods. In men, the inclusion of less severe alcohol dependence resulted in a large decrease in the alcohol attributed disease burden. This was, however, evened out to a great extent by the increase in cardiovascular disease and injuries. CONCLUSIONS WHEN USING THE UPDATED GBD METHODS, THE OVERALL DISEASE BURDEN ATTRIBUTED TO ALCOHOL INCREASED IN WOMEN, BUT NOT IN MEN.

Czynniki ryzyka majaczenia alkoholowego u osób leczonych stacjonarnie w Polsce z powodu uzależnienia od alkoholu

IntroductionDelirium tremens (DT) is a life-threatening complication that occurs in 5–33% of patients treated for alcohol withdrawal syndrome. The aim of the present study was to analyse the risk factors for delirium tremens among patients treated for alcohol dependence. MethodsMedical data of 1027 patients hospitalised in Alcohol Detoxification and Rehabilitation Units of Nowowiejski Hospital in Warsaw were analysed. The relationships between variables that are thought to be related to the prevalence of delirium tremens in this population were evaluated. The relevant psycho-social and demographic data as well as information on alcohol use and treatment history were included. Results262 patients (25.5%) confirmed delirium tremens in the past. Among the variables included in the logistic regression model, previous episodes of consciousness loss, suicide attempts and episodes of alcohol withdrawal syndrome, as well as harmful use of other psychoactive substances, proved to be significant risk factors for delirium tremens. DiscussionThe higher prevalence of DT among patients with previous suicide attempts confirms the relationship between the severity of alcohol dependence and suicide attempts and DT. Additionally, higher risk of DT in patients with previous episodes of consciousness loss can be explained by an increased number of head injuries in individuals with severe addiction. Presumably, the higher prevalence of DT among patients with previous episodes of alcohol withdrawal syndrome and other substance abuse can be attributed to the kindling model. ConclusionsPrevious episodes of alcohol withdrawal syndrome are the risk factors of delirium tremens attributable to the severity of alcohol dependence. In our opinion, the other risk factors, such as loss of consciousness, suicide attempts in the past and harmful use of other psychoactive substances, are nonspecific to alcohol dependence.

PTH-159 Alcohol Detoxification Drug Chart Audit

Introduction Alcohol misuse is a rising problem and alcohol related admissions are common. Alcohol detoxification (DETOX) regimes vary and frequently confuse the prescribers and nurses leading to administration errors, compromising the patient’s care and possibly contributing to early readmissions, by not achieving maximum detoxification. In order to improve that, we have developed and trialled a chlordiazepoxide prescription drug chart in our emergency assessment unit. Following the introduction of the chart there was a significant reduction in prescription and administration errors. The chart is now the standard means of prescribing alcohol detoxification regimes in our hospital. Methods We reviewed 43 patient’s notes with respect to chlordiazepoxide prescription and identified errors in the prescribed DETOX schedule, timing and missed doses. We then developed a drug chart, which was intended to guide the clinician to assess the severity of alcohol dependence using the severity of alcohol dependency questionnaire (SADQ) and then prescribing the correct chlordiazepoxide schedule, bypassing possible prescription errors. We then reviewed 56 medical notes following the introduction of the drug chart and statistically compared the prescription errors (2 population proportion test). We also compared the median total chlordiazepoxide dose given in milligrams and the duration of regimes in days (t test for 2 independent means) in order to identify a possible impact of those elements to alcohol related early ( Results The chart has led to significant (p Conclusion Our experience suggests that DETOX regimes can be cumbersome to prescribe leading to prescription errors, thus compromising patient’s care. The idea of introducing a chlordiazepoxide drug chart was to achieve better care for these patients, by simplifying the prescription process. Our results imply that this was achieved with a suggestion that early readmissions were reduced. The chart is now established as part of alcohol DETOX management at Ipswich Hospital. References 1 Alcohol Misuse Management Guideline Version 1.0 – 2014, Ipswich Hospital 2 Emergency Medicine Journal, 2014. 3 Alcohol use disorders: sample chlordiazepoxide dosing regimens for use in managing alcohol withdrawal, NICE Feb. 2010. 4 Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, NICE 2011. Disclosure of Interest None Declared

Finding safety: a pilot study of managed alcohol program participants' perceptions of housing and quality of life.

BackgroundThere is a higher prevalence of alcohol use and severe alcohol dependence among homeless populations. The combination of alcohol use and lack of housing contributes to increased vulnerability to the harms of substance use including stigma, injury, illness, and death. Managed alcohol programs (MAPs) administer prescribed doses of alcohol at regular intervals to people with severe and chronic alcohol dependence and homelessness. As a pilot for a larger national study of MAPs, we conducted an in-depth evaluation of one program in Ontario, Canada. In this paper, we report on housing and quality of life outcomes and experiences of the MAP participants and staff.MethodsWe conducted a pilot study using mixed methods. The sample consisted of 38 people enrolled in or eligible for entry into a MAP who completed a structured quantitative survey that included measures related to their housing and quality of life. All of the participants self-identified as Indigenous. In addition, we conducted 11 in-depth qualitative interviews with seven MAP residents and four program staff and analyzed the interviews using constant comparative analysis. The qualitative analysis was informed by Rhodes’ risk environment framework.ResultsWhen compared to controls, MAP participants were more likely to retain their housing and experienced increased safety and improved quality of life compared to life on the streets, in jails, shelters, or hospitals. They described the MAP as a safe place characterized by caring, respect, trust and a nonjudgmental approach with a sense of family and home as well as opportunities to reconnect with family members.ConclusionsThe MAP was, as described by participants, a safer environment and a home with feelings of family and a sense of community that countered stigma, loss, and dislocation with potential for healing and recovery. The MAP environment characterized by caring, respect, trust, a sense of home, “feeling like family”, and the opportunities for family and cultural reconnections is consistent with First Nations principles for healing and recovery and principles of harm reduction.

Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study.

BackgroundManaged alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. MAPs provide controlled access to alcohol usually alongside accommodation, meals, and other supports. Patterns of alcohol consumption and related harms among MAP participants and controls from a homeless shelter in Thunder Bay, Ontario, were investigated in 2013.MethodsStructured interviews were conducted with 18 MAP and 20 control participants assessed as alcohol dependent with most using non-beverage alcohol (NBA). Qualitative interviews were conducted with seven participants and four MAP staff concerning perceptions and experiences of the program. Program alcohol consumption records were obtained for MAP participants, and records of police contacts and use of health services were obtained for participants and controls. Some participants’ liver function test (LFT) results were available for before and after MAP entry.ResultsCompared with periods off the MAP, MAP participants had 41 % fewer police contacts, 33 % fewer police contacts leading to custody time (x2 = 43.84, P < 0.001), 87 % fewer detox admissions (t = −1.68, P = 0.06), and 32 % fewer hospital admissions (t = −2.08, P = 0.03). MAP and control participants shared similar characteristics, indicating the groups were broadly comparable. There were reductions in nearly all available LFT scores after MAP entry. Compared with controls, MAP participants had 43 % fewer police contacts, significantly fewer police contacts (−38 %) that resulted in custody time (x2 = 66.10, P < 0.001), 70 % fewer detox admissions (t = −2.19, P = 0.02), and 47 % fewer emergency room presentations. NBA use was significantly less frequent for MAP participants versus controls (t = −2.34, P < 0.05). Marked but non-significant reductions were observed in the number of participants self-reporting alcohol-related harms in the domains of home life, legal issues, and withdrawal seizures. Qualitative interviews with staff and MAP participants provided additional insight into reductions of non-beverage alcohol use and reductions of police and health-care contacts. It was unclear if overall volume of alcohol consumption was reduced as a result of MAP participation.ConclusionsThe quantitative and qualitative findings of this pilot study suggest that MAP participation was associated with a number of positive outcomes including fewer hospital admissions, detox episodes, and police contacts leading to custody, reduced NBA consumption, and decreases in some alcohol-related harms. These encouraging trends are being investigated in a larger national study.

A Randomized Controlled Trial of Extended Brief Intervention for Alcohol-Dependent Patients in an Acute Hospital Setting.

To determine whether alcohol-dependent patients in a hospital setting benefit from extended brief interventions (EBI) delivered by an Alcohol Specialist Nurse. Alcohol-dependent patients recruited via screening at the emergency department (ED) (n=267), whether or not admitted to hospital, were randomized to EBI (up to six counselling sessions offered) or control. At 6 months, 84.2% of patients were assessed by a researcher blinded to the intervention. The primary outcome was a fall in Severity of Alcohol Dependence Questionnaire. There was no difference between groups in the primary outcome [odds ratio (OR) 1.02; 95% confidence interval (CI): 0.38, 2.75, P =0.97]. Secondary outcomes including alcohol consumption and readiness to change did not show a significant difference between groups. However, all secondary outcome measures improved, on average, in both arms. Although EBI can be delivered in an ED or inpatient setting, it was not shown to be an advantage over screening and usual management (which included advice on alternative services), with patients in both groups showing an average improvement. ISRCTN78062794.

Cognitive Dysfunctions in Patients with Alcohol Dependence Syndrome in a Tertiary Hospital in Kathmandu

Alcohol dependence is a chronic disorder, accompanied by neuropsychological deficits. Patients with alcohol dependence were evaluated to identify the cognitive dysfunctions. The study followed descriptive design and recruited participants (N=62) from inpatient services of the Department of Psychiatry and Mental Health by convenient sampling. Participants were evaluated with the Severity of Alcohol Dependence Questionnaire, Frontal Assessment Battery and PGI Memory Scale for the severity of alcohol dependence, executive impairments and memory dysfunctions respectively once they had completed alcohol detoxification. Total duration of alcohol consumption was 13.93 ± 8.74 years, period of dependence was 2.97 ± 2.23 years and 56.5% had moderate level of dependence. 33.9% of the participants had executive impairments particularly in conceptualization, programming and mental flexibility. 38% of variance in executive dysfunction was explained by illness variables, where period of alcohol dependence and education were significant predictors. 54.8% had significant memory dysfunction particularly in visual retention, remote memory, verbal retention of dissimilar pairs and delayed recall. Memory dysfunction differed significantly among the age groups (F=10.22, p<0.01) and age was a significant predictor (β=.542, p<0.001). 19% variance in memory dysfunction was explained by illness variables, where duration of alcohol consumption was a significant predictor (β = .485, p<0.01). Findings indicate that cognitive dysfunctions are prevalent among patients with alcohol dependence. Hence, routine neuropsychological assessment is of particular importance for early detection and remediation of underlying deficits, which completes the treatment of alcohol dependence.

Characterization of comorbid PTSD in treatment-seeking alcohol dependent inpatients: Severity and personality trait differences

BackgroundPost-traumatic stress disorder (PTSD) is often comorbid with alcohol dependence (AD), but little is known about the characteristics of AD treatment-seeking inpatients with PTSD. We examined differences between treatment-seeking alcohol dependent inpatients with and without comorbid PTSD. We hypothesized that those with AD and PTSD would have higher levels of: (1) alcohol use and AD severity; (2) anxiety and mood disorders; (3) neuroticism. MethodsIndividuals (N=411, mean age=41.7±10.0years) with AD were monitored over 30days in a suburban inpatient alcohol treatment setting. Patients were evaluated to identify AD and comorbid PTSD, mood and anxiety disorders, alcohol use and dependence severity, personality, and aggression. ResultsThose with PTSD (19% of the sample) did not differ in the amount of alcohol consumed, but had greater: (1) severity of AD (p=0.001, d=0.44); (2) diagnosis of anxiety (p=0.000, OR=3.64) and mood (p=0.000, OR=4.83) disorders; and (3) levels of neuroticism (p<0.001, d=0.67) and aggression (p<0.001, d=0.81). ConclusionsAD patients with comorbid PTSD present a more severe phenotype across AD severity, frequency of anxiety and mood disorders, and levels of neuroticism and aggression. This group may benefit from concurrent treatment of both AD and PTSD. Future research can investigate neuroticism as a potential treatment target.

Temperament and resilience of children of alcohol dependent individuals

IntroductionChildren of alcohol dependent individuals are affected by disturbed parent-child relationship and exhibit externalizing symptoms, arrhythmicity, negative mood and low persistence.ObjectivesTo assess the temperament and resilience of children of alcohol dependent individuals and to study their relationship with the father's severity and problems of alcohol intake.AimsTo assess the psychological profile of children of alcohol dependent individuals.MethodsCross-sectional study conducted in a tertiary care centre from January to August 2015. Severity of alcohol dependence in father and problems related to it was assessed using ‘short alcohol dependence data’ and ‘alcohol problems questionnaire’; the temperament and resilience of their children (n = 31) was assessed using ‘temperament measurement schedule’ and ‘strengths and difficulties questionnaire’ respectively.ResultsThe sample comprised of 48% boys and 52% girls with mean age (SD) of 9.32 (3.02) years. Eighty-one percent belonged to lower socioeconomic status. Their fathers’ mean age (SD) was 37.13(4.9) years and duration of alcohol dependence being 16.32 (5.7) years, average use/day being 19.19 (14.9) units with moderate (45.2%) to high (41.9%) dependence. Significant association was observed between severity of alcohol dependence and temperamental domain-threshold of responsiveness (χ2 = 17.272, P value = 0.002) (Fig. 1). The average units of alcohol consumed/day were a significant predictor for the presence of emotional problems in the child (OR = 30.12; 95%CI 1.33–677.86).ConclusionThere's a significant association between father's alcohol use and child's psychopathology which indicates the need for preventive and curative mental health measures.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Calcium as a treatment option for alcohol dependence

In the last couple of decades anti-craving drugs have been developed. Acamprosate was described as an effective treatment option to support alcohol abstinence with a low side effect profile. Moreover its molecular mode of action is highly controversial. Recently, calcium salt was described to be the active part of Acamprosate.Using a clinical sample of placebo (n = 10) vs. Acamprosate-treated (n = 19) abstinent alcohol-dependent patients, we measured calcium plasma concentrations after the 1st, 2nd and 3rd month after the treatment commenced. Before treatment, the same physiological calcium concentration of about 2.4 mmol/l was found in both groups respectively. We found significant correlations in the Acamprosate group while no correlations in the placebo group were observed.The very well regulated extracellular calcium serum concentration seems to get out of balance in association with the severity of alcohol dependence in inpatients during withdrawal.Accordingly, in another clinical sample (n = 57) we found a negative correlation between calcium serum concentration and craving (r2= 0.125; P = 0.011) on day 1 of detoxification. The measurement of craving was carried out by a self-rating scale, the Obsessive Compulsive Drinking Scale (OCDS). Furthermore a low calcium level correlated with high breathalyser readings and the number of alcohol inpatient detoxification's.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The impact of appetite regulating peptides on substance use disorders

BackgroundPreclinical and clinical data suggest modulating effects of the appetite regulating peptide ghrelin on food intake. Recent data suggest that in food intake the “endostatic” energy-homeostatic systems of the lateral hypothalamus (LH) and the motivational, mesolimbic reward system operate in dynamic interplay with each other. Ghrelin receptors have been detected in the ventral tegmentum of the midbrain (VTA), where they modulate the activity of dopaminergic neurons projecting to the NAc. Assuming that Ghrelin modulate mesolimbic reactivity, the question remains: is this only the case in response to food cues? Or is this the case in response to reward-associated cues in general (including those related to nicotine and alcohol)?MethodsStudy 1: a consecutive sample of 61 alcohol-dependent male inpatients was included. Blood was drawn at onset of withdrawal 12-24 hours after admission, and following 14 days of controlled abstinence in order to assess plasma concentrations of both active and total ghrelin. In parallel, we assessed alcohol craving applying the Obsessive Compulsive Drinking Scale (OCDS) as well as symptoms of depression (Beck Depression Inventory [BDI]) and anxiety (State Trait Anxiety Inventory [STAI]). The severity of alcohol dependence was assessed with the Alcohol Dependence Scale (ADS). Study 2: 54 non-treatment seeking smokers and 30 healthy controls with normal eating behavior, as measured by the Three Factor Eating Questionnaire (TFEQ) participated in this study. We measured plasma concentrations of both active and total ghrelin, using a blood sample taken two hours after a standardized meal during early nicotine abstinence in the smoking group. Additionally we quantified severity of addiction in the smoking group using the number of cigarettes smoked per day, cotinine plasma concentration and the Fagerström Test for Nicotine Dependence (FTND).ResultsStudy1: we found a significant positive correlation between the plasma concentration of active ghrelin and alcohol craving in both blood samples. Plasma concentrations of active ghrelin increased significantly during early abstinence. In a linear regression model, the plasma concentration of active ghrelin on day one, the scores of the ADS, and the BDI explained 36% of the variance in OCDS sum score (P &lt; 0001). By day 14, these same factors accounted for 54% (P &lt; 0.0001). We did not detect any association between the plasma concentration of total ghrelin and patients’ alcohol cravings. Study 2: plasma concentration of acetylated ghrelin but not total ghrelin was significantly higher in smokers than in non-smokers. Moreover, we found significant negative correlations between acetylated ghrelin and all measures of the severity of nicotine dependence.DiscussionIn conclusion, both studies supports the general idea that ghrelin's central effects go beyond the endostatic regulation of energy homeostasis, also involving pathways underlying reward expectation and craving. Physiologic factors modulating the reactivity of mesolimbic pathways represent an important research topic for developing pharmacologic treatments for disorders characterized by altered reward-related behaviors, such as substance use disorders and behavioral addictions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Molestowanie seksualne przed uzyskaniem pełnoletności a stan zdrowia i funkcjonowanie społeczne osób uzależnionych od opioidów leczonych substytucyjnie

IntroductionA number of previous studies confirmed worse health and social conditions among opioid-dependent individuals with a childhood history of sexual abuse. To the best of our knowledge, this issue has not been investigated in the Polish population. We aimed to analyse the prevalence of sexual abuse in opioid-dependent individuals undergoing therapy in the methadone maintenance clinic and to assess the association of clinical and social characteristics with a history of sexual abuse. MethodThe study included a sample of 240 opioid-dependent patients. Participants were interviewed using self-reported questionnaire and standardised measures on experience of childhood and adulthood abuse, physical and mental health, addictions, social functioning and family history. ResultsAbout 35% of women reported sexual violence in childhood. Sexual abuse in this period was associated with family dysfunction, physical abuse, current more intensive depressive symptoms and pain, as well as suicide attempts with stronger morbid desires. DiscussionThe present findings are consistent with previous research of other authors. Interestingly, the present study did not confirm the relationship between sexual abuse and severity of opioid or alcohol dependence and poor social functioning. ConclusionThe results of our study suggest the potential benefit to multifaceted treatment approach, which should specifically address sexual abuse and suicidal behaviour in opioid-dependent patients.

The Reasons for Heavy Drinking Questionnaire: Factor Structure and Validity in Alcohol-Dependent Adults Involved in Clinical Trials.

People consume alcohol at problematic levels for many reasons. These different motivational pathways may have different biological underpinnings. Valid, brief measures that discriminate individuals' reasons for drinking could facilitate inquiry into whether varied drinking motivations account for differential response to pharmacotherapies for alcohol use disorders. The current study evaluated the factor structure and predictive validity of a brief measure of alcohol use motivations developed for use in randomized clinical trials, the Reasons for Heavy Drinking Questionnaire (RHDQ). The RHDQ was administered before treatment to 265 participants (70% male) with alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, in three pharmacotherapy randomized clinical trials. Principal components analysis was used in half the sample to determine the RHDQ factor structure. This structure was verified with confirmatory factor analysis in the second half of the sample. The factors derived from this analysis were evaluated with respect to alcohol dependence severity indices. A two-factor solution was identified. Factors were interpreted as Reinforcement and Normalizing. Reinforcement scores were weakly to moderately associated with severity, whereas normalizing scores were moderately to strongly associated with severity. In all cases in which significant associations between RHDQ scores and severity indices were observed, the relationship was significantly stronger for normalizing than for reinforcing. The RHDQ is a promising brief assessment of motivations for heavy alcohol use, particularly in the context of randomized clinical trials. Additional research should address factor structure stability in non-treatment-seeking individuals and the RHDQ's utility in detecting and accounting for changes in drinking behavior, including in response to intervention.

Associations Between Recent Heavy Drinking and Dorsal Anterior Cingulate N-Acetylaspartate and Glutamate Concentrations in Non-Treatment-Seeking Individuals with Alcohol Dependence.

Proton magnetic resonance spectroscopy ((1) H-MRS) studies have consistently found abnormal brain concentrations of N-acetylaspartate (NAA) and glutamate in individuals with alcohol use disorders (AUD) relative to light drinkers. However, most such studies have focused on individuals in treatment for severe alcohol dependence (AD), and few studies have investigated associations between neurochemical concentrations and recent alcohol consumption. This study focused on associations between recent drinking and prefrontal neurometabolite concentrations in nonsevere, non-treatment-seeking individuals with AUD. Nineteen treatment-naïve alcohol-dependent individuals aged 21 to 40 completed a (1) H-MRS scan. Single-voxel (1) H-MRS spectra were acquired in dorsal anterior cingulate cortex (dACC) using a 2-dimensional J-resolved point resolved spectroscopy sequence. Associations between recent heavy drinking, assessed using the Timeline FollowBack, and dACC metabolite concentrations were estimated via regression controlling for within-voxel tissue composition. Participants provided a negative breathalyzer reading and reported between 1 and 5days (M=2.45, SD=1.23) since their last drink. Number of heavy drinking days in the 14days preceding the scan (M=4.84, SD=3.32) was significantly inversely associated with both glutamate/water (β=-0.63, t(17)=-3.37, p=0.004) and NAA/water concentrations (β=-0.59, t(17)=-2.98, p=0.008). This study extends the literature by demonstrating inverse associations between recent heavy drinking and dACC glutamate and NAA concentrations in a sample of nonsevere, non-treatment-seeking individuals with AD. These findings may support the hypothesis that amount of recent alcohol consumption may account for differences in neuronal metabolism, even in nonsevere, non-treatment-seeking alcoholics.

Effects of an Exercise Program on Physical Activity Level and Quality of Life in Patients with Severe Alcohol Dependence

ABSTRACTThis study evaluates the feasibility of an exercise program for patients with severe alcohol dependence in a long-term residential setting and the ability of such a program to improve their level of physical activity and quality of life. Forty-four (44) participants were assigned to two groups, an intervention group experiencing the exercise program and a control group which did not participate in the program. Another matched control group, without the health issues of the other two groups, was also used as a basis of comparison. The study was designed as a year-long longitudinal controlled study with a pre-post design. Measures used to determine the effectiveness of the intervention were attendance records, the SF-36 questionnaire, and monitoring devices of daily activity. Active participants in the exercise program showed a significant improvement in physical activity and an enhanced quality of life.

μ-Opioid Receptor Gene (OPRM1) Polymorphisms A118G and C17T in Alcohol Dependence: A Turkish Sample

Previous investigations on opioid system genetics have identified polymorphisms of the OPRM1 gene expressing μ-opioid receptors to be significantly associated with some features of alcohol dependence (AD). In the present study, we evaluated the relationship between single nucleotide polymorphisms (SNP) in the OPRM1 gene, A118G (rs1799971, Asn40Asp) and C17T (rs1799972, Arg6Val), and AD diagnosis, level of alcohol consumption, and AD severity in a Turkish sample. 121 AD patients and 117 healthy male subjects were included in the study. OPRM1 A118G (N40D) and C17T (A6V) polymorphisms were evaluated using PCR - RFLP (polymerase chain reaction - restriction fragment length polymorphism) method. We evaluated the association between the presence of SNPs and AD diagnosis, family history of AD, AD severity evaluated via the Michigan Alcoholism Screening Test (MAST), the daily average and maximum quantity of alcohol consumed. There was no significant difference in OPRM1 A118G genotype frequencies between the AD and control groups. T allele frequency for the OPRM1 C17T SNP was very low (0.006) in the sample population. OPRM1 A118G SNP G118 allele carriers showed significantly higher levels of AD severity as indicated by the MAST. The OPRM1 G118 allele was significantly associated with more severe AD in the Turkish population. Similar to other European populations, the frequency of the OPRM1 T17 allele was very low.