Alcohol-dependent Inpatients Research Articles

The Effect of Eye Movements on Craving in Alcohol-Dependent Inpatients: A Randomized Controlled Experiment

The Effect of Eye Movements on Craving in Alcohol-Dependent Inpatients: A Randomized Controlled Experiment

ALCOHOL-DEPENDENT INPATIENTS IN NORTHERN VIETNAM: A PROSPECTIVE STUDY ON FACTORS RELATED TO RELAPSE

Alcohol-dependent patients face a risk of relapse after detoxification and alcohol dependence relapse is affected by many factors in different countries. The study aims to analyze some of the factors associated to the relapse in alcohol-dependent inpatients in northern Vietnam. Methods: A prospective study that monitored alcohol-dependent inpatient in northern Vietnam for six months. Results: Patients with education from high school and higher had a relapse rate of 0.65 times as compared to patients with education below high school (IRR=0.65; 95% CI: 0.43-0.99). Patients with four or more times of alcohol withdrawal had a relapse rate of 1.76 times compared with patients with less than four times of alcohol withdrawal (IRR=1.76; 95% CI: 1.09-2.84). Patients with severe and very severe depressive disorders on the Hamilton depression rating scale at one month after being discharge from hospital had a relapse rate of 4.27 times that of non-depressed patients. (IRR=4.27; 95% CI: 1.08-16.97). Conclusion: Alcohol-dependent patients had many previous alcohol withdrawal times, the co-occurrence of depressive disorder increased alcohol dependence relapse and relapse soon after recovering from alcohol dependence. In particular, higher education was a protective factor against relapse. These factors were depended on economic, medical, cultural and social characteristics in different countries. ASEAN Journal of Psychiatry, Vol. 24 (7) September, 2023; 1-8

Effects of Transcranial Direct-Current Stimulation (tDCS) Treatment Sessions on Neuropsychological ‎Functioning Among Detoxified Inpatients with Alcohol Dependence: A Randomized Sham-Controlled Clinical Trial

ABSTRACT Individuals with alcohol dependence often experience cognitive dysfunction after detoxification, which can persist even after sustained abstinence. Transcranial direct current stimulation (tDCS) has shown promise in improving cognitive functioning in these patients. The main objective of this research was to assess the impact of ten sessions of transcranial direct-current stimulation (tDCS) targeting the dorsolateral prefrontal cortex (DLPFC) on the neuropsychological functioning of hospitalized individuals with alcohol dependence who have undergone detoxification. This single-center, parallel, and single-blind randomized controlled trial assessed the effects of ten sessions of add-on tDCS treatment on neuropsychological functions. 44 recently detoxified alcohol-dependent inpatients were randomly assigned to either treatment as usual (TAU) plus ten sessions of active tDCS over left DLPFC, or TAU plus ten sessions of sham tDCS and assessed the effect of tDCS sessions and time on neuropsychological functions. Neuropsychological functions were evaluated in inpatients undergoing treatment for alcohol dependence at T1 (9.95 + 2.42 days abstinence) and T2 (19 ± 1.48 days abstinence), and while time had a significant impact on mean scores of various neuropsychological tests, neither active tDCS treatment nor its interaction with time displayed a significant effect on neuropsychological functioning, as revealed by two-way ANOVAs with repeated measurements. In detoxified inpatients with alcohol dependence, tDCS treatment was not found to have a significant impact on neuropsychological functioning when compared to sham treatment, whereas abstinence from alcohol for approximately three weeks resulted in significant improvements in various cognitive domains including mental speed, verbal learning & memory, visual memory, verbal fluency, and response inhibition.

FRI-455 - Opportunistic cirrhosis casefinding in alcohol dependent inpatients through alcohol specialist nurse assessment and transient elastography: early detection in a high risk group

FRI-455 - Opportunistic cirrhosis casefinding in alcohol dependent inpatients through alcohol specialist nurse assessment and transient elastography: early detection in a high risk group

Does selective inhibition training reduce relapse rates when added to standard treatment of alcohol use disorder? A randomized controlled trial.

Alcohol-dependent individuals tend to selectively approach alcohol cues in the environment, demonstrating an alcohol approach bias. Because approach bias modification (ApBM) training can reduce the approach bias and decrease relapse rates in alcohol-dependent patients when added to abstinence-focused treatment, it has become a part of regular treatment. Moreover, in selective inhibition (SI) training, responses to one category of stimuli (i.e., alcohol stimuli) are selectively inhibited in an adapted Go/No-Go task. SI-Training has been found to effectively devalue the inhibited category and to reduce consumption of alcohol among social drinkers. This study investigated whether SI-Training can further improve the effects of treatment as usual that includes ApBM, and if so, whether the effect is mediated by a devaluation of the inhibited alcohol stimuli. Abstinent alcohol-dependent inpatients (N=434) were randomly assigned to receive 6 sessions of either active (n=214, 32% female) or sham (n=220, 38% female) SI-Training, in addition to standard treatment that includes active ApBM. Ratings were used to assess changes in the evaluation of alcohol stimuli after the training. Relapse rates were assessed 3 and 12 months after treatment discharge. Alcohol stimuli were rated negatively before and after the training, and the training did not influence these ratings. Evaluation of nonalcoholic drinks became more positive after active SI-Training. Both ApBM and SI-Training showed the expected training effects on reaction times. Contrary to expectations, SI-Training conditions did not yield different abstinence rates 3 or 12 months after treatment. We found no evidence supporting the hypothesis that SI-Training amplifies the relapse-preventing effect of ApBM. Moreover, alcohol stimuli were rated negatively before and after treatment and were not influenced by SI-Training.

Association of Functional Polymorphism in TPH2 Gene with Alcohol Dependence and Personality Traits: Study in Cloninger's Type I and Type II Alcohol-Dependent Inpatients.

Alcohol dependence (AD) is a complex disorder with a poorly understood etiology. In this study, we investigated the relationship between genetic variation in the TPH2 gene, which encodes the enzyme responsible for serotonin synthesis in the brain, and both AD and personality traits, with attention to Cloninger's types of AD. The study included 373 healthy control subjects, 206 inpatients with type I AD, and 110 inpatients with type II AD. All subjects were genotyped for the functional polymorphism rs4290270 in the TPH2 gene, and AD patients completed the Tridimensional Personality Questionnaire (TPQ). The AA genotype and the A allele of the rs4290270 polymorphism were more frequent in both patient groups compared with the control group. In addition, a negative association was found between the number of A alleles and TPQ scores for harm avoidance in patients with type II, but not type I, AD. These results support the involvement of genetic variations of the serotonergic system in the pathogenesis of AD, especially type II AD. They also suggest that in a subset of patients, genetic variation of TPH2 could potentially influence the development of AD by affecting the personality trait of harm avoidance.

Combining Metabolomics and Interpretable Machine Learning to Reveal Plasma Metabolic Profiling and Biological Correlates of Alcohol-Dependent Inpatients: What About Tryptophan Metabolism Regulation?

Alcohol dependence (AD) is a condition of alcohol use disorder in which the drinkers frequently develop emotional symptoms associated with a continuous alcohol intake. AD characterized by metabolic disturbances can be quantitatively analyzed by metabolomics to identify the alterations in metabolic pathways. This study aimed to: i) compare the plasma metabolic profiling between healthy and AD-diagnosed individuals to reveal the altered metabolic profiles in AD, and ii) identify potential biological correlates of alcohol-dependent inpatients based on metabolomics and interpretable machine learning. Plasma samples were obtained from healthy (n = 42) and AD-diagnosed individuals (n = 43). The plasma metabolic differences between them were investigated using liquid chromatography-tandem mass spectrometry (AB SCIEX® QTRAP 4500 system) in different electrospray ionization modes with scheduled multiple reaction monitoring scans. In total, 59 and 52 compounds were semi-quantitatively measured in positive and negative ionization modes, respectively. In addition, 39 metabolites were identified as important variables to contribute to the classifications using an orthogonal partial least squares-discriminant analysis (OPLS-DA) (VIP > 1) and also significantly different between healthy and AD-diagnosed individuals using univariate analysis (p-value < 0.05 and false discovery rate < 0.05). Among the identified metabolites, indole-3-carboxylic acid, quinolinic acid, hydroxy-tryptophan, and serotonin were involved in the tryptophan metabolism along the indole, kynurenine, and serotonin pathways. Metabolic pathway analysis revealed significant changes or imbalances in alanine, aspartate, glutamate metabolism, which was possibly the main altered pathway related to AD. Tryptophan metabolism interactively influenced other metabolic pathways, such as nicotinate and nicotinamide metabolism. Furthermore, among the OPLS-DA-identified metabolites, normetanephrine and ascorbic acid were demonstrated as suitable biological correlates of AD inpatients from our model using an interpretable, supervised decision tree classifier algorithm. These findings indicate that the discriminatory metabolic profiles between healthy and AD-diagnosed individuals may benefit researchers in illustrating the underlying molecular mechanisms of AD. This study also highlights the approach of combining metabolomics and interpretable machine learning as a valuable tool to uncover potential biological correlates. Future studies should focus on the global analysis of the possible roles of these differential metabolites and disordered metabolic pathways in the pathophysiology of AD.

Cognitive Impairments in Early-Detoxified Alcohol-Dependent Inpatients and Their Associations with Socio-Demographic, Clinical and Psychological Factors: An Exploratory Study.

PurposeCognitive impairment is common among patients with alcohol use disorder (AUD). However, neuropsychological assessment is not usually included as routine practice in alcohol rehabilitation programs. The aim of this study was to describe qualitatively the cognitive deficits in early-detoxified AUD patients undergoing rehabilitation and to explore relevant associations with socio-demographic, clinical and psychological factors.Patients and MethodsForty-one patients with a diagnosis of AUD were consecutively recruited from a residential rehabilitation hospital in Northern Italy. Cognitive impairment was assessed using the Brief Neuropsychological Examination 2 (ENB-2). Anxiety, depression and severity of alcohol dependence were also evaluated using validated self-report questionnaires. Alcohol relapse was investigated 1 month after discharge.ResultsOverall, 31.7% of AUD patients showed cognitive impairments according to the global score scale. However, 70.7% had an impaired performance on at least one test of the ENB-2, with particular regard to executive function, visuospatial and memory domains. Age, education and abstinence at admission were the most relevant factors associated with cognitive deficits in this clinical population.ConclusionThe detection of cognitive impairments is essential in order to adapt alcohol rehabilitation treatment to patients with cognitive deficits and enhance clinical outcomes.

PPARγ activation by pioglitazone does not suppress cravings for alcohol, and is associated with a risk of myopathy in treatment seeking alcohol dependent patients: a randomized controlled proof of principle study.

Proinflammatory processes have been implicated in alcohol addiction, craving, and relapse, while studies in experimental animals have suggested that activation of peroxisome proliferator-activated receptor gamma (PPARγ) inhibits proinflammatory signaling. Accordingly, it is hypothesized that medications with PPARγ activity may have therapeutic potential in alcohol dependence. We conducted a double-blind, placebo-controlled mechanistic proof of principle study in alcohol-dependent inpatients to investigate the effect of pioglitazone on alcohol craving. Participants were treated for withdrawal, if needed, and then randomized to pioglitazone (target dose 45 mg/day) or placebo. Once at target dose, they completed two experimental manipulations: guided imagery, which used personalized auditory scripts to induce alcohol cravings, and a low-dose challenge with i.v. lipopolysaccharide (LPS; 0.8 ng/kg) or placebo, on two separate sessions, in counterbalanced order. Behavioral and endocrine responses as well as CSF levels of proinflammatory cytokines were evaluated. The study was prematurely terminated after randomization of 16 subjects, following an independent review that established a high risk of myopathy in the active treatment group. Analysis of those who completed the study indicated that pioglitazone was associated with elevated, rather than suppressed alcohol cravings in response to alcohol-associated stimuli. LPS did not induce cravings for alcohol and thus did not lend itself to evaluating pioglitazone effects; however, pioglitazone increased the neuroendocrine stress response to LPS. CSF levels of IL-6, TNF-α, or MCP-1 were unaffected by pioglitazone treatment. Both safety and efficacy biomarker data suggest that pioglitazone lacks potential as a medication for the treatment of alcohol dependence. NCT01631630.

Serum lipids, leptin, and soluble leptin receptor in alcohol dependence: A cross-sectional and longitudinal study

ObjectiveAlcohol dependence affects metabolic processes. Further research is needed to apply this knowledge clinically. In this study, possible differences in serum lipids and/or leptin activities between alcohol-dependent in-patients and healthy controls and possible associations with alcohol-related blood parameters and with prospective outcomes in alcohol dependence were assessed sex-specifically. MethodWe measured and compared (median) serum lipids (triglycerides and total, HDL, and LDL cholesterol) and leptin activities (leptin, soluble leptin receptor [ObRe], and free leptin index) in 200 (males 56.5 %) early-abstinent alcohol-dependent in-patients and 240 (males 55.4 %) healthy controls and assessed alcohol-related readmissions during a 24 -month post-inclusion period. ResultsMale patients showed higher HDL cholesterol (61 versus 48 mg/dl), lower LDL/HDL ratios (2.06 versus 3.04), and lower free leptin index (0.30 versus 0.59) at study inclusion compared to healthy controls. In patients, ObRe levels were higher than in controls and decreased from inclusion to the second study-visit (at median 5 days later; males: 16.7–13.8 versus 11.0 ng/ml; females: 17.0–13.4 versus 12.1 ng/ml). The free leptin index increased between the two time points in females (0.80 versus 1.20). Lipids and leptin activities correlated with carbohydrate-deficient transferrin levels and liver enzyme activities. None of the serum parameters were significantly associated with alcohol-related readmissions. ConclusionOur data support that serum lipid levels and leptin activities are involved in alcohol dependence. The parameters appear as possible indirect biomarkers for alcohol dependence.

Alcohol-Dependent Inpatients in Northern Vietnam : A Follow-Up Study on Relapse and Co-Occurring Psychiatric Disorders

Background: The prevalence of alcohol dependence has been increasing in several countries in the world as well as in Vietnam. This study aims to describe relapse among alcohol-dependent inpatients in Northern Vietnam and some co-occurring psychiatric disorders in these patients. Methods: This study followed 53 alcohol-dependent patients who were treated for six months at the Vietnam National Institute of Mental Health. At the point of one month, three months, and six months after being discharged from the hospital, the patients were monitored for their alcohol consumption, relapse into alcohol dependence, and co-occurring psychiatric disorders by clinical psychiatrists, using the International Classification of Diseases, the 10th edition, Hamilton depression rating scale, Hamilton anxiety rating scale, Pittsburgh Sleep Quality Index, and the EQ-5D-5L Life Quality Assessment. Results: The prevalence of relapse into alcohol dependence was 81.1%. The highest relapse rate was found in the first month after alcohol withdrawal (46.5%), then it decreased gradually. 53.9% of the relapsed patients had at least four alcohol withdrawals; they mainly used home-brewed alcohol. The average daily alcohol intake was fairly high: 14.4 ± 8.5 standard drinks. Mental disorders such as depression, anxiety, and sleep disorder were very prevalent among patients with relapsed alcohol dependence. Conclusions: The rate of relapsed alcohol dependence in Northern Vietnam was very high. It is important to detect and treat psychiatric disorders simultaneously with alcohol dependence to achieve better treatment effectiveness and reduce relapse rates.

Basic Human Body Dimensions Relate to Alcohol Dependence and Predict Hospital Readmission.

Alcohol dependence is a severe mental illness and there is a need for more effective preventive and therapeutic strategies. Translational research suggests that intrauterine sex hormone exposure modulates the risk and course of alcohol dependence during adulthood. During development, sex hormones permanently shape sexually dimorphic body dimensions. Thus, these dimensions may provide insight into sex hormone organization. Here, we compared body measurements (absolute, relative to, and residualized on height) between 200 alcohol-dependent in-patients and 240 age-matched healthy control subjects and investigated how these measurements associate with the patients’ prospective 12- and 24-month outcome. The results show that alcohol dependence is related to lower absolute, relative, and residualized body measurements for height and weight, head circumference, bitragion head arc, lip-chin distance, hip, thigh, and calf circumference, and foot length and breadth. In male alcohol-dependent in-patients, higher risk, shorter latency, and more alcohol-related readmissions were predicted by higher absolute, relative, and residualized thigh and calf circumferences. The second-to-fourth finger length ratio, a putative proxy for prenatal sex hormone organization, was not convincingly correlated with the body dimensions, suggesting that the results represent pubertal (or later) effects. The study’s findings have implications for further research. The body measurements’ high accessibility may facilitate the future transition into clinical settings.

Neurophysiological markers of cue reactivity and inhibition subtend a three-month period of complete alcohol abstinence

ObjectiveFinding new tools for conventional management of alcohol disorders is a challenge for psychiatrists. Brain indications related to cognitive functioning could represent such an add-on tool. MethodsForty alcohol-dependent inpatients undertook two cognitive event-related potential (ERP) tasks at the beginning and at the end of a 4-week detoxification program. These comprised a visual oddball task investigating cue reactivity and a Go/No-go task tagging inhibition using oddball P3d and No-go P3d ERP components. Three months after discharge, the patient group (N = 40) was split into two subgroups: patients who remained abstinent during this post-treatment period (90 days; n = 15), and patients who relapsed (mean time: 28.5 ± 26.2 days; n = 25). Pattern changes of both ERP markers (oddball P3d and No-go P3d) during the detoxification were compared to differentiate these populations. ResultsAbstinent patients exhibited similar P3d responses devoted to alcohol cues in Sessions 1 and 2, but an increased No-go P3d devoted to No-go trials in alcohol-related contexts in Session 2 compared to Session 1. ConclusionsSpecific cue-reactivity and inhibitory neurophysiological markers subtend a further three-months of complete abstinence. SignificanceMonitoring these ERP changes during detoxification may provide important clues regarding patients’ future abstinence vs. relapse.

Crossed Eye/Hand Laterality and Left-Eyedness Predict a Positive 24-Month Outcome in Alcohol-Dependent Patients.

Available predictors of hospital readmission following withdrawal in alcohol-dependent patients are limited. However, such parameters are needed to optimize individualized treatment strategies. This study investigated whether crossed eye/hand laterality, eyedness, and handedness may predict outcomes in alcohol dependence. The prospective study included 200 early-abstinent alcohol-dependent inpatients (n[males]=113, n[females]=87) and 240 control subjects (n[males]=133, n[females]=107). We assessed eyedness and handedness using the hole-in-the-card and Shimizu tests and documented alcohol-related readmissions over 12 and 24months. Crossed eye/hand laterality and left-eyedness were associated with a reduced risk for alcohol-related readmission (12-month: odds ratios [OR]=0.41, p=0.008, OR=0.42, p=0.004; 24-month: OR=0.57, p=0.097, OR=0.47, p=0.016), fewer median readmissions (12-month: 0 vs. 1, p=0.005, 0 vs. 1, p=0.005; 24-month: 1 vs. 2, p=0.014, 1 vs. 2, p=0.006), and more mean days to the first readmission (12-month: 270 vs. 209, p=0.007, 269 vs. 207, p=0.003; 24-month: 462 vs. 335, p=0.039, 461 vs. 323, p=0.005). They also interacted with treatment and alcohol drinking history to predict the outcome. In sex-specific analyses, most of these effects remained significant in males but not in females. Handedness alone did not significantly predict outcome. Moreover, the laterality markers did not significantly differ between alcohol-dependent patients and control subjects. Determining crossed eye/hand laterality and eyedness may help to individualize relapse prevention in the future. Both are easily accessible predictors of alcohol-related readmission following inpatient withdrawal treatment.

Estrogen receptor 1 gene variants and estradiol activities in alcohol dependence

ObjectiveAlcohol use disorders inflict a great individual and societal burden. Although sex hormone effects have been implicated in alcohol dependence, research has mostly neglected estrogen activities and female alcohol-dependent patients. Here, we investigated associations of estrogen receptor 1 (ESR1) genetics and serum estradiol activities with aspects of alcohol dependence. MethodSerum estradiol activities of early-abstinent alcohol-dependent in-patients (n[♂] = 113, n[♀] = 87) were followed for at median 5 days and compared with healthy controls (n[♂] = 133, n[♀] = 107). All participants were genotyped for five ESR1 single nucleotide polymorphisms (rs6902771, rs11155819, rs6557171, rs2982683, rs2982712). ResultsBioavailable estradiol levels decreased during withdrawal treatment (P[♂] < .001, P[♀] = .011). Male patients with an increase of bioavailable estradiol during withdrawal showed fewer days to (P = .033) and more alcohol-related readmissions (P < .05) during the 12-month follow-up. Higher estradiol and estradiol-to-testosterone activities were significantly related to liver, muscle, and cell count damage in male patients. Estradiol-to-testosterone activities in female patients were lower compared to female controls (total P = .013, bioavailable P = .009). Moreover, the ESR1 genotypes jointly separated alcohol-dependent patients from controls (P = .037). ConclusionOur findings support the role of ESR1 genetics in alcohol dependence and show for the first time that estradiol activities may sex-specifically predict alcohol-related sequelae and outcome following in-patient withdrawal treatment.

Peripheral Acid Sphingomyelinase Activity Is Associated with Biomarkers and Phenotypes of Alcohol Use and Dependence in Patients and Healthy Controls.

By catalyzing the hydrolysis of sphingomyelin into ceramide, acid sphingomyelinase (ASM) changes the local composition of the plasma membrane with effects on receptor-mediated signaling. Altered enzyme activities have been noted in common human diseases, including alcohol dependence. However, the underlying mechanisms remain largely unresolved. Blood samples were collected from early-abstinent alcohol-dependent in-patients (n[♂] = 113, n[♀] = 87) and matched healthy controls (n[♂] = 133, n[♀] = 107), and analyzed for routine blood parameters and serum ASM activity. We confirmed increased secretory ASM activities in alcohol-dependent patients compared to healthy control subjects, which decreased slightly during detoxification. ASM activity correlated positively with blood alcohol concentration, withdrawal severity, biomarkers of alcohol dependence (liver enzyme activities of gamma-glutamyl transferase, alanine aminotransferase, aspartate aminotransferase; homocysteine, carbohydrate-deficient transferrin; mean corpuscular volume, and creatine kinase). ASM activity correlated negatively with leukocyte and thrombocyte counts. ASM and gamma-glutamyl transferase were also associated in healthy subjects. Most effects were similar for males and females with different strengths. We describe previously unreported associations between ASM activity and markers of liver damage and myelosuppression. Further research should investigate whether this relationship is causal, or whether these parameters are part of a common pathway in order to gain insights into underlying mechanisms and develop clinical applications.

Body mass index and craving predict 24-month hospital readmissions of alcohol-dependent in-patients following withdrawal

ObjectiveAddictive alcohol drinking, craving, and overeating share common etiopathological mechanisms. We investigated whether body mass index (BMI) and craving predict outcome of alcohol-dependent in-patients. MethodThe prospective study included 101 male and 72 female early-abstinent alcohol-dependent in-patients. Craving was quantified by Obsessive-Compulsive Drinking Scale (OCDS) scores. We documented alcohol-related readmissions over 24 months. ResultsIn males, a higher BMI was associated with alcohol-related hospital readmission (median 26.1 vs. 23.1 kg/m2, P = .007) and correlated with more (ρ = 0.286, P = .004) and earlier readmissions (ρ = −0.256, P = .010). These associations were stronger in the subgroup of active smokers (n = 79; median 25.9 vs. 22.3 kg/m2, P = .005; ρ = 0.350, P = .002; ρ = −0.340, P = .002). BMI did not significantly predict outcome in females. Males with at least one readmission reported higher OCDS scores than those without (OCDS-total, OCDS-obsessive, OCDS-compulsive, P < .040), and the OCDS scores correlated with more readmissions (males: OCDS-total, OCDS-obsessive, OCDS-compulsive, ρ > 0.244, P < .014; females: OCDS-compulsive, ρ = 0.341, P = .003) and fewer days to first readmission (males: OCDS-total, OCDS-compulsive, ρ < −0.195, P < .050; females: OCDS-compulsive, ρ = −0.335, P = .004). The OCDS scores explained 9 to 19% of the relationship between BMI and outcome in males. ConclusionBMI and craving are easily accessible outcome predictors of alcohol-related readmission following in-patient withdrawal treatment. They might be used to individualize relapse prevention in the future.

Protocol for a randomised controlled trial of cognitive bias modification training during inpatient withdrawal from alcohol use disorder

BackgroundPeople with alcohol use disorders often exhibit an “alcohol approach bias”, the automatically triggered action tendency to approach alcohol. Approach bias is likely to persist following withdrawal from alcohol, and contribute to the high rate of relapse following withdrawal treatment. Cognitive bias modification (CBM) training has been shown to attenuate approach biases and lead to reduced relapse rates. However, no large multisite trial of CBM specifically within a residential withdrawal treatment setting has previously been conducted. This study aims to test whether CBM delivered during residential withdrawal treatment leads to reduced relapse rates and reduced use of acute health services following discharge, and to test possible moderators of CBM’s effect on alcohol use.MethodsThree hundred alcohol-dependent inpatients are being recruited from three withdrawal treatment units in the Melbourne metropolitan area. Participants complete baseline measures of alcohol approach bias and cue-evoked desire for alcohol, followed by four daily sessions of computerised CBM training (or sham training if randomised to the control group). Approach bias and cue-evoked desire are re-assessed following the fourth training session. Follow-up assessments administered 2 weeks and 3, 6, and 12 months following discharge from the withdrawal treatment unit compare abstinence rates and acute and emergency healthcare service use between conditions. Pre-admission and follow-up substance use is derived from the timeline follow-back method, and approach bias towards alcohol with a computerised Approach Avoidance Task.DiscussionThis study is the first multisite randomised controlled trial of cognitive bias modification delivered during acute alcohol withdrawal treatment. Withdrawal is theoretically an ideal period to deliver neurocognitive interventions due to heightened neuroplasticity and cognitive recovery. If effective, the low cost and easy implementation of CBM training means it could be widely used as a standard part of alcohol withdrawal treatment to improve treatment outcomes. Moderation analyses may help better determine whether certain subgroups of patients are most likely to benefit from it and therefore should be prioritised for CBM during alcohol withdrawal treatment.Trial RegistrationVersion 4 of the protocol (dated 1 August 2017) is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12617001241325. Registered on 25 August 2017 (retrospectively registered).

Primary psychopathic traits are associated with reduced subjective and cortical reactivity to unpleasant emotional movies

Addictive alcohol drinking, craving, and overeating share common etiopathological mechanisms. We investigated whether body mass index (BMI) and craving predict outcome of alcohol-dependent in-patients.The prospective study included 101 male and 72 female early-abstinent alcohol-dependent in-patients. Craving was quantified by Obsessive-Compulsive Drinking Scale (OCDS) scores. We documented alcohol-related readmissions over 24 months.In males, a higher BMI was associated with alcohol-related hospital readmission (median 26.1 vs. 23.1 kg/m2, P = .007) and correlated with more (ρ = 0.286, P = .004) and earlier readmissions (ρ = −0.256, P = .010). These associations were stronger in the subgroup of active smokers (n = 79; median 25.9 vs. 22.3 kg/m2, P = .005; ρ = 0.350, P = .002; ρ = −0.340, P = .002). BMI did not significantly predict outcome in females. Males with at least one readmission reported higher OCDS scores than those without (OCDS-total, OCDS-obsessive, OCDS-compulsive, P < .040), and the OCDS scores correlated with more readmissions (males: OCDS-total, OCDS-obsessive, OCDS-compulsive, ρ > 0.244, P < .014; females: OCDS-compulsive, ρ = 0.341, P = .003) and fewer days to first readmission (males: OCDS-total, OCDS-compulsive, ρ < −0.195, P < .050; females: OCDS-compulsive, ρ = −0.335, P = .004). The OCDS scores explained 9 to 19% of the relationship between BMI and outcome in males.BMI and craving are easily accessible outcome predictors of alcohol-related readmission following in-patient withdrawal treatment. They might be used to individualize relapse prevention in the future.

Religiosity, Guilt, Altruism and Forgiveness in Alcohol Dependence: Results of a Cross-sectional and Prospective Cohort Study.

To compare religious denomination, religiosity, guilt, altruism and forgiveness between alcohol-dependent patients and healthy control subjects and to prospectively investigate their relationship to the disorder's 24-month course following in-patient withdrawal treatment. This study in Franconia (a mainly Christian protestant region of southern Germany) applied six questionnaires to evaluate religiosity, guilt, altruism and forgiveness in 166 alcohol-dependent in-patients during withdrawal and compared findings with that of 240 healthy controls. Compared to controls religious denomination was more frequently reported by the patients (OR = 1.72, P = 0.014) and patients showed higher guilt (P < 0.001). The subjective attainability of altruism was lower in patients than in controls (P = 0.015). Higher scores on scale of inter-religious private practice predicted earlier (Rho = -0.184, P = 0.021) and more frequent alcohol-related readmissions during the follow-up (Rho = 0.207, P = 0.009). Higher religious affiliation was related to earlier (Rho = -0.214, P = 0.008) and more frequent alcohol-related readmissions (Rho = 0189, P = 0.020). Lower values of subjective attainability of altruism predicted a worse outcome (earlier [Rho = 0.231, P = 0.003] and more frequent readmissions [Rho = -0.223, P = 0.004]). The sex-specific analyses show that some of the associations are stronger in women and others are stronger in men; however, these gender differences are small and possibly biased by multiple hypothesis testing. We identified religious denomination, private religious practice, religious affiliation, guilt and reduced attainability of altruism as risk factors for alcohol dependence and a worse follow-up outcome. Our findings may help to establish future preventive and therapeutic strategies.