Alcohol Use Dependence Research Articles

Understanding the importance of organizational and system variables on addiction treatment services within criminal justice settings

NIDA's Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) is the primary vehicle for testing emerging treatment interventions and fostering adoption of evidence-based therapies in criminal justice settings. The papers in this issue of Drug and Alcohol Dependence use data from the CJ-DATS National Criminal Justice Treatment Practice Survey to explore the influence of organizational and system variables on access to addiction treatment and the types of services available within correctional settings. This essay provides context for the papers in this issue of Drug and Alcohol Dependence. Systems and organizational interventions that improve the delivery and quality of drug abuse treatment services are described and the potential to apply systems change thinking to addiction treatment services available in the criminal justice system is discussed. Each paper is described briefly. CJ-DATS is evolving to support research at the organizational and systems level that facilitates the implementation and sustainability of research-supported treatments and business practices in criminal justice settings.

Assessment of GABAABenzodiazepine Receptor (GBzR) Sensitivity in Patients with Alcohol Dependence

The aim of this study was to measure GABAA benzodiazepine receptor (GBzR) sensitivity in alcohol-dependent patients and compare with matched non-dependent drinkers. Nine abstinent alcohol-dependent male patients, age matched with nine male non-dependent social drinkers, received an intravenous infusion of midazolam. Objective (saccadic eye movement slowing) and subjective (visual analogue scales) measurements were recorded at 15-min intervals for 2 h. There were no differences in objective or subjective measures. Our hypothesis that patients with alcohol dependence would have less slowing of their eye movements in response to this challenge, reflecting reduced GBzR sensitivity, was not confirmed. The reasons for this could mean that GBzR function returns to normal with abstinence, or that this paradigm is unable to measure the subtle subtype-specific changes in GBzR sensitivity that occur following dependent alcohol use.

S.07.07 Increased opioid receptor binding in early abstinence from dependent opioid and alcohol use and relationship to craving

S.07.07 Increased opioid receptor binding in early abstinence from dependent opioid and alcohol use and relationship to craving

P.3.11 Increased opioid receptor binding in early abstinence from dependent opioid and alcohol use and relationship to craving

Aims: Recent PET studies have reported increased bindingof [11C]carfentanil in early abstinence from cocainedependence that is associated with craving (Zubieta et al.1996). In this study we present data on availability of theopioid receptor using the PET tracer [11C]diprenorphinein opioid and alcohol dependent subjects in earlyabstinence compared to controls. Our hypotheses werethat in both dependent groups, opioid receptor availabilitywould be increased compared with controls and that thiswould be related to craving.Methods: We recruited ten opioid and eleven alcoholdependent patients undergoing detoxification and twentyhealthy control subjects. All completed questionnairesmeasuring clinical variables, including craving.All subjects had one [11C]diprenorphine PET scanfollowing standard protocols. Four of the alcoholdependent subjects had a repeat scan after three monthsof abstinence. The PET scans were analysed to producevolume of distribution images (VD) which are an index ofavailable receptors. We extracted VD data for whole brainand 21 pre-defined regions of interest (ROIs). Subjectswere compared with controls using paired t-tests, andclinical variables were tested for correlations with VD.Results: Global [11C]diprenorphine VD was significantlyhigher in opioid dependent subjects than controls(p = 0.019). This was also found in 15 of the 21 ROIs (t-testpl0.05 uncorrected). Alcohol dependent patients showeda trend towards an increase in global, and no significantchanges were found in the.Although the opioid dependent patients craved at ahigh level there was no association with opioid receptoravailability. However, in the alcohol dependent group,an increase in craving was significantly associated withincreased availability of opioid receptors in the striatumand whole brain.The four subjects that were rescanned showed nosignificant change in VD (paired t-test pg0.05) in wholebrain or the ROIs between the two time points. At thesecond scan their craving score was still significantlypositively correlated with VD.Conclusions: We have shown an increase in opioidreceptors in early abstinence from dependent alcohol andopioid use. Although the results in our alcohol dependentgroup did not reach significance they are consistent withanother recent study (Heinz et al. 2005).This finding is most likely due to an acute increasein receptor number in early abstinence. Previous preclinicaland clinical evidence has shown no increase duringcontinuing dependent substance use. However, on its own,this study cannot exclude a state of upregulation of opioidreceptors in chronic dependence or a trait of high opioidreceptor availability as possible causes for these findings.From the emerging evidence in cocaine, opioid andalcohol dependence, opioid receptor availability seems keyin the addictive process, particularly in early abstinence.An elevation in opioid receptor availability and its positiverelationship to craving is consistent with naltrexonersability to reduce drug seeking or craving in alcoholdependence. Treatments aimed at modulating the opioidreceptor system now have a neurobiological underpinningfor their clinical efficacy.

P.4.02 Localized gray matter deficits in adolescents with first-episode psychosis

an increase in global, and no significant changes were found in the regions of interest studied. Although the opioid dependent patients craved at a high level there was no association with opioid receptor availability. However, in the alcohol dependent group, an increase in craving was significantly associated with increased availability of opioid receptors in the striatum and whole brain. We have shown an increase in opioid receptors in early abstinence from dependent alcohol and opioid use. Although the results in our alcohol dependent group did not reach significance they are consistent with another recent study (Heinz et al., 2005). This finding is most likely due to an acute increase in receptor number in early abstinence.

Heavy nicotine and alcohol use in alcohol dependence is associated with D2 dopamine receptor (DRD2) polymorphism

Cigarette smoking in those who are alcohol dependent is associated with higher morbidity and mortality. The A1 allele of the D 2 dopamine receptor (DRD2) gene has been independently associated with alcohol and nicotine dependence. Whether this polymorphism is associated with nicotine dependence in those who are also alcohol dependent has not been investigated. Subjects were 84 (61 males; 23 females) Caucasian DSM IV diagnosed nicotine- and alcohol-dependent subjects sampled from consecutive admissions to a hospital alcohol detoxification ward. Data were obtained through standardised measures of nicotine and alcohol consumption and dependence severity. A1 + allelic (A1/A1 or A1/A2 genotype) compared to A1 − allelic (A2/A2 genotype only) patients were characterised by higher levels of alcohol and cigarette consumption. A1 + allelic patients reported greater alcohol dependence severity, but not nicotine dependence severity. When the combined nicotine and alcohol dose was examined, A1 + allelic patients consumed significantly more of these drugs than their A1 − allelic counterparts.

Complementary medicine for alcohol dependence in Italian services: A mail questionnaire

It is well known that Complementary Medicine (CM) is extensively used in western countries for the treatment of many afflictions. CM has been recently promoted in addiction treatment. To evaluate CM use in alcohol dependence we planned a mail questionnaire for Italian alcohol services. We sent out 612 questionnaires. Health services that were unable to respond to the questionnaire within a 20-day limit period were contacted by phone and if we obtained agreement to participate in the study the questionnaire was sent by fax. We obtained 312 (51.82%) completed questionnaires. Only 16.50% of Italian services use CM for alcohol dependence treatment and acupuncture is utilized more frequently than other methods (phytotherapy, homeopathy, etc.). In Italian alcohol services CM is identified as an instrument incorporated into traditional alcohol treatments (self-help groups, drug treatment, etc.) and not an alternative method. In fact, health services that use it as a principal method of treatment were a rare event in our study (1%). CM plays an integrated role with traditional forms of alcohol treatment in Italian alcohol services and this utilization could be useful to reduce drop-outs and improve alcohol treatment compliance.

Substance dependence, family history of alcohol dependence and neuropsychological functioning in adolescence.

It was hypothesized that adolescent substance dependence moderates the relationship between family history of alcohol dependence and neuropsychological functioning. This study compared the neuropsychological functioning of non-abusing and alcohol and drug-dependent adolescents with and without a family history of alcohol dependence using hierarchical multiple regressions and general factorial analyses. Substance-dependent adolescents were recruited and tested in inpatient alcohol and drug abuse treatment programs after 3 weeks of abstinence. A matched sample of non-abusing adolescents was recruited from the same San Diego-area communities. Substance-dependent adolescents (n = 101) met DSM-III-R criteria for dependence on alcohol and at least one other substance. Non-abusing adolescents (n = 50) had no substance use disorders. Groups were comparable on socio-economic status. Participants were 44% female, ages 13-18, and had no serious head injuries or neurological disorders. Information was gathered on demographics, family history, substance involvement, and conduct disorder behaviors and adolescents were administered neuropsychological tests covering language, visuospatial, verbal memory, attention and executive functioning domains. The hypothesis was supported for language and attention tests. Substance involvement interacted with family history of alcohol dependence to predict language and attention functioning. Family history negative non-abusers performed better than the other adolescents. The pattern of results suggests that family history of alcohol dependence and adolescent substance use are separate risk factors for poorer neuropsychological performance in youth.

Do Patients with Alcohol Dependence Use More Services? A Comparative Analysis with other Chronic Disorders

Do Patients with Alcohol Dependence Use More Services? A Comparative Analysis with other Chronic Disorders

Do Patients with Alcohol Dependence Use More Services? A Comparative Analysis with other Chronic Disorders

The primary purpose of this research was to compare the service use of patients diagnosed with alcohol dependence to the service use of patients diagnosed with other chronic illnesses. The secondary purpose was to determine the impact of comorbid alcoholism on the service use of patients with chronic illnesses. The sample included 67,878 veterans diagnosed with alcohol dependence, depression, or diabetes who were treated by the Department of Veterans Affairs in 1993. The number of inpatient days and outpatient visits over a 4-year period (1991 to 1995) were compared using regression models to control for differences in casemix. Controlling for casemix, patients treated for alcohol dependence had significantly fewer outpatient visits than patients treated for either depression or diabetes. Patients treated for alcohol dependence also had significantly fewer inpatient days than patients treated for depression, but significantly more inpatient days than patients treated for diabetes. Comorbid alcoholism was prevalent among patients treated for depression and diabetes. Comorbid alcoholism increased the number of inpatient days for patients treated for depression or diabetes and increased the number outpatient visits for patients with depression. However, comorbid alcoholism decreased the number of outpatient visits for patients treated for diabetes. Results suggest that patients with alcohol use disorders should not be singled out as being more costly to treat than patients with other chronic illnesses. These findings are in stark contrast to those from studies comparing individuals with alcohol use disorders to relatively healthy individuals sampled from at-risk populations.

Drug use among primary alcoholic veterans.

Many people with alcohol dependence use other drugs. However, not much is known about the relationship between their past drug use (not necessarily dependence) and their prognosis following treatment. The goal of this study is first to determine the drug use rates among primary alcoholic men and then to evaluate the possible relationship between past drug use and future alcohol or drug use relapse. As a result, 630 primary alcoholic veterans were recruited from a 28-day inpatient Alcohol and Drug Treatment Program at the San Diego VA Medical Center. Among them, almost two-thirds also had a history of drug use. Subjects were divided into the following four groups which were determined by their lifetime drug use histories: Group I (N = 226) consisted of drug abstainers, Group 2 (N = 142) was made up of alcoholics who had used only marijuana, Group 3 (N = 210) contained stimulant users who had never used opiates, and Group 4 (N = 52) included all opiate users. Comparisons of the four groups at a 3-month follow-up revealed that alcoholic men who had a history of stimulant or opiate use (Groups 3 and 4) were more likely to have had a drug use relapse. However, the four groups had similar alcohol relapse rates.

Hyperventilation and anxiety: Alcohol withdrawal symptoms decreasing with prolonged abstinence

We previously presented evidence that hyperventilatory and anxiety symptoms are the result of physically dependent alcohol use rather than a premorbid condition. The purpose of the present study was to examine the effect of prolonged abstinence versus resumption of dependent drinking on those symptoms. Two questionnaires (a hyperventilation complaint checklist and Spielberger's Anxiety Inventory) were presented twice to 15 ss, once during an inpatient treatment and once after a median followup period of 17 months. Six ss were abstinent for the entire period, 3 were abstinent with 1 or 2 slips and 6 ss were drinking in a dependent way again for at least 6 months. In the abstinent or abstinent-with-slips group, a significant decrease over time in hyperventilatory symptoms and trait (but not state) anxiety could be found, whereas in the dependent drinking group there was a significant increase in hyperventilatory symptoms and state (but not trait) anxiety. An extended followup in 5 abstinent ss showed a continued decrease in those symptoms. These results provide further evidence for the hypothesis that hyperventilation and anxiety are part of a subacute alcohol withdrawal syndrome.

Hyperventilation, anxiety, craving for alcohol: A subacute alcohol withdrawal syndrome

Hyperventilation leading to respiratory alkalosis is part of the acute alcohol withdrawal syndrome On the basis of clinical observations and a literature review on withdrawal symptoms the following was hypothesized: (a) hyperventilation is also part of a subacute alcohol withdrawal syndrome and (b) hyperventilation appears together with anxiety and craving for alcohol. These hypotheses were tested in a sample of 37 male alcoholic inpatients, abstinent for periods from several weeks to 9 months. Subjects were administered a questionnaire dealing with drinking history and craving for alcohol during abstinence, the Spielberger Anxiety Inventory and a hyperventilation complaint checklist. Subjects' disposition to hyperventilation was assessed during a physiological measurement session. Results show that hyperventilatory symptoms, anxiety and craving for alcohol appear together. Moreover, the severity of hyperventilatory and anxiety symptomatology is positively correlated with the duration of physically dependent alcohol use but not with the duration of excessive drinking per se, irrespective of age. These results corroborate the hypotheses outlined before.