Alcohol Disorders Research Articles

The role of recovery housing during outpatient substance use treatment

BackgroundRecovery housing generally refers to alcohol- and drug-free living environments that provide peer support for those wanting to initiate and sustain recovery from alcohol and other drug (AOD) disorders. Despite a growing evidence base for recovery housing, relatively little research has focused on how recovery housing may benefit individuals accessing outpatient substance use treatment. MethodsUsing administrative and qualitative data from individuals attending an outpatient substance use treatment program in the Midwestern United States that provides recovery housing in a structured sober living environment, this mixed methods study sought to: (1) determine whether individuals who opted to live in structured sober living during outpatient treatment (N = 138) differed from those who did not (N = 842) on demographic, clinical, or service use characteristics; (2) examine whether living in structured sober living was associated with greater likelihood of satisfactory discharge and longer lengths of stay in outpatient treatment; and (3) explore what individuals (N = 7) who used the structured sober living during outpatient treatment were hoping to gain from the experience. ResultsFactors associated with the use of recovery housing during outpatient treatment in multivariate models included gender, age, and receiving more services across episodes of care. Living in structured sober housing was associated with greater likelihood of satisfactory discharge and longer length of stays in outpatient treatment. Focus group participants reported needing additional structure and recovery support, with many noting that structure and accountability, learning and practicing life, coping, and other recovery skills, as well as receiving social and emotional support from others were particularly beneficial aspects of the sober living environment. ConclusionsFindings underscore the importance of safe and supportive housing during outpatient substance use treatment as well as the need for future research on how housing environments may affect engagement, retention, and outcomes among individuals accessing outpatient substance use treatment.

Alcohol Disorders in Military Veterans: An Evaluation with the Roy Adaptation Model.

The purpose of this paper was to evaluate a role for the Roy adaptation model (RAM) for the nursing care of military veterans with alcohol use disorder. Parse's criteria were used to critique the RAM. The RAM's humanistic philosophy emphasizes the ability to develop new coping skills and adapt to complex environments. The framework can define physical, emotional, and social responses to stressors faced by veterans. The RAM could guide new research and practice initiatives that optimize the health of military veterans.

Time Devoted to Individual, Collective, and Two-Person Sports: Its Association with Risk of Exercise Addiction and Alcohol Use Disorder

Introduction: Although sport activities have beneficial effects on health, excessive practice can lead to exercise addiction (EA), which can be associated with other addictive behaviors. However, results regarding the comorbidities between EA and alcohol use disorder (AUD) remain heterogeneous. This study aims to investigate the relationship between a proxy of AUD and different sport practices, more specifically focusing on EA. Methods: One thousand nine hundred eighty-five (N = 1,985) participants were recruited online and selected to represent the French adult population. Participants were asked to answer questions regarding sport activity, with the EA inventory questionnaire investigating EA, and alcohol consumption, with the CAGE questionnaire investigating a proxy of AUD (score ≥2). Results: AUD was associated with a higher risk of EA and with more time devoted to collective sports (such as football) and two-person sports (such as tennis). The risk of EA was higher for individual sports (such as running), and the risk of AUD seems to increase with the level of physical activity for collective sport but to decrease for individual sports. The type of sports partly but significantly mediated the relationship between AUD and EA. Conclusions: Results support the hypothesis that different types of sport have different risks for EA (individual sports being more concerned) and AUD (collective sports being more concerned). Results suggest that the type of sports may be a crucial variable to understand how physical activity can be a risk factor for alcohol disorders. The social dimension of collective sports should be further investigated to facilitate preventive approaches.

Influence of psychosocial and sociodemographic factors in the surgical management of traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States.

Socioeconomic factors can bias clinician decision-making in many areas of medicine. Psychosocial characteristics such as diagnosis of alcoholism, substance abuse, and major psychiatric disorder are emerging as potential sources of conscious and unconscious bias. We hypothesized that these psychosocial factors, in addition to socioeconomic factors, may impact the decision to operate on patients with a traumatic cervicothoracic fracture and associated spinal cord injury (SCI). We performed a cohort analysis using clinical data from 2012-2016 in the American College of Surgeons (ACS) National Trauma Data Bank at academic level I and II trauma centers. Patients were eligible if they had a diagnosis of cervicothoracic fracture with SCI. Using ICD codes, we evaluated baseline characteristics including race; insurance status; diagnosis of alcoholism, substance abuse, or major psychiatric disorder; admission drug screen and blood alcohol level; injury characteristics and severity; and hospital characteristics including geographic region, non-profit status, university affiliation, and trauma level. Factors significantly associated with surgical intervention in univariate analysis were eligible for inclusion in multivariate logistic regression. We identified 6,655 eligible patients, of whom 62% underwent surgical treatment (n=4,137). Patients treated non-operatively were more likely to be older; be female; be Black or Hispanic; have Medicare, Medicaid, or no insurance; have been assaulted; have been injured by a firearm; have thoracic fracture; have less severe injuries; have severe TBI; be treated at non-profit hospitals; and be in the Northeast or Western U.S. (all P<0.01). After adjusting for confounders in multivariate analysis, only insurance status remained associated with operative treatment. Medicaid patients (OR=0.81; P=0.021) and uninsured patients (OR=0.63; P<0.001) had lower odds of surgery relative to patients with private insurance. Injury severity and facility characteristics also remained significantly associated with surgical management following multivariate regression. Psychosocial characteristics such as diagnosis of alcoholism, substance abuse, or psychiatric illness do not appear to bias the decision to operate after traumatic cervicothoracic fracture with SCI. Baseline sociodemographic imbalances were explained largely by insurance status, injury, and facility characteristics in multivariate analysis.

Do Alcohol Consequences Serve as Teachable Moments? A Test of Between- and Within-Person Reciprocal Effects From College Age to Adulthood

Several studies find between-person reciprocal relations between adolescent/college drinking and positive expectancies. However, drinking and expectancies from college into adulthood are largely unstudied, as are within-person associations. During these age periods, negative alcohol consequences may represent "teachable moments" via expectancy change. The current study tested the reciprocal effects of drinking, negative consequences, and expectancies from college age to adulthood. Using data from a longitudinal study focused on familial alcohol disorder, age bands were created to model effects from college age (18-22) to young adulthood (23-28) and adulthood (29-34). Participants (N = 420) reported on their drinking, negative consequences, and expectancies across three waves (1995-2010). Negative consequences did not predict negative expectancies, but the random intercepts of the two were highly related. Young adult negative consequences predicted a within-person increase in adult heavy drinking. A within-person increase in college age negative expectancies indirectly predicted a within-person decrease in adult negative consequences through reduced young adult drinking, whereas within-person increases in college age positive expectancies indirectly predicted a within-person increase in adult negative consequences through heavier young adult drinking. Findings suggest that negative consequences were related to trait-level negative expectancies, even though prospective effects were not observed. Findings also suggest that college age negative expectancies were protective against future use and consequences, and this effect was unique to college age.

Combination of s-methyl cysteine and protocatechuic acid provided greater lipid-lowering and anti-inflammatory effects in mice liver against chronic alcohol consumption.

Objective(s):Protective effects of s-methyl cysteine (SMC) alone, protocatechuic acid (PCA) alone, and SMC plus PCA against chronic ethanol consumption induced hepatic steatosis and inflammation were investigated. Materials and Methods:Mice were divided into six groups: normal diet (ND) group, Lieber-DeCarli liquid diet without ethanol (LD diet) group, LD diet with ethanol (LED diet) group, SMC group (LED diet plus 0.25% SMC), PCA group (LED diet plus 0.25% PCA), and SMC+PCA group (LED diet plus 0.125% SMC + 0.125% PCA). After 8 weeks of supplementation, blood and liver were used for analysis. Results:Biochemical and histological data showed that SMC plus PCA led to a greater reduction in lipid droplets in the liver than SMC or PCA treatment alone. SMC plus PCA resulted in greater suppression in hepatic mRNA expression of peroxisome proliferator-activated receptor-gamma, sterol regulatory element-binding protein 1c, stearoyl-CoA desaturase-1, cyclooxygenase-2, and myeloperoxidase than SMC or PCA treatment alone. SMC plus PCA led to a greater decrease in hepatic reactive oxygen species and inflammatory cytokine levels than SMC or PCA treatment alone. Conclusion:These novel findings suggest that the combination of SMC and PCA was a potent remedy for alcoholic liver disorders.

Interrogating the Causes, Effects and Societal Responses to Rape and Child-Defilement in Nigeria

Nigeria’s social landscape has been inundated by an alarming spate of rape and child defilement cases, so much more that there is hardly a week without media reports of rape in the country. Records released by the Nigeria Police Force shows that a total of seven hundred and seventeen cases of rape and child defilement were recorded in the first five months of the year 2020. More alarming is the defilement of minors and underage children by adults. The foregoing raises concerns and the need to interrogate the causes of alarming cases of rape and defilement of minors in Nigeria. The mixed methods research approach was adopted to generate both primary and secondary data. For the primary data, an online questionnaire was designed and administered to a total of two hundred and nine Nigerians across various sectors and regions of the country. Besides, six (6) key informants, each from the Ministry of Women, Legal Department, National Human Rights Commission, NGO, religious leader and media practitioners, were interviewed. On the other hand, government reports, gazettes, journal and newspaper articles were used to generate secondary data. Findings show that defilement of minors in Nigeria is perceived from a socio-cultural perspective as an avenue for money rituals. Other causes include mental disorders of perpetrators, alcoholism and substance abuse. Effects of such acts are physical and psychological. Recommendations on ways of curbing the menace include life sentences, name shame of perpetrators, and strict enforcement of existing laws prohibiting rape and defilement in the country.

Prevalence, comorbidity, and predictors of obsessive-compulsive disorder in Iranian children and adolescents

Background and objectivesObsessive-compulsive disorder (OCD) is a disease that causes personal distress or social dysfunction, especially in childhood. The present study aimed to provide the prevalence, comorbidity, and predictors of OCD among children and adolescents. MethodsThis was a cross-sectional national project conducted on 29,858 children and adolescents using the multi-stage cluster random sampling in Iran. There were both genders in each cluster and three age groups (6–9, 10–14, and 15–18 years) within each cluster. The tools used in this research included a demographic questionnaire and K-SADS-PL. To analyze the data, logistic regression and cross-tab tests were used. ResultsAccording to the results, the prevalence of OCD in children and adolescents was 3.1 in boys and 3.8 in girls. Also, gender, age, place of residence, and history of psychiatric hospitalization of parents could predict OCD. OCD had comorbidity with behavioral disorders (OR = 0.60, 95%CI: 0.39–0.92), elimination disorders (OR = 0.50, 95%CI: 0.30–0.83), mood disorders (OR = 2.92, 95%CI: 1.43–5.94), and smoking and alcohol disorders (OR = 4.33, 95%CI: 1.28-14.63). ConclusionIn the development of the obsessive-compulsive disorder, other disorders and symptoms also environmental factors can play a role and are important. Based on our findings, given the prevalence rate of OCD was higher in the age groups of 10–14 and 15–18 years, are one of the most important stages of development for the prevention and treatment of mental disorders, especially OCD, clinical specialists can design appropriate clinical trials or modify existing interventions based on the results of such research.

Factors Predicting Trial Engagement, Treatment Satisfaction, and Health-Related Quality of Life During a Web-Based Treatment and Social Networking Trial for Binge Drinking and Depression in Young Adults: Secondary Analysis of a Randomized Controlled Trial.

BackgroundMental health and alcohol use problems are among the most common causes of disease burden in young Australians, frequently co-occur (comorbidity), and lead to significant lifetime burden. However, comorbidities remain significantly underdetected and undertreated in health settings. Digital mental health tools designed to identify at-risk individuals, encourage help-seeking, or deliver treatment for comorbidity have the potential to address this service gap. However, despite a strong body of evidence that digital mental health programs provide an effective treatment option for a range of mental health and alcohol use problems in young adults, research shows that uptake rates can be low. Thus, it is important to understand the factors that influence treatment satisfaction and quality-of-life outcomes for young adults who access e–mental health interventions for comorbidity.ObjectiveIn this study, we seek to understand the factors that influence treatment satisfaction and quality-of-life outcomes for young adults who access e–mental health interventions for comorbid alcohol and mood disorders. The aim is to determine the importance of personality (ie, Big Five personality traits and intervention attitudes), affective factors (ie, depression, anxiety, and stress levels), and baseline alcohol consumption in predicting intervention trial engagement at sign-up, satisfaction with the online tool, and quality of life at the end of the iTreAD (Internet Treatment for Alcohol and Depression) trial.MethodsAustralian adults (N=411) aged between 18 and 30 years who screened positive for depression and alcohol use problems signed up for the iTreAD project between August 2014 and October 2015. During registration, participants provided information about their personality, current affective state, alcohol use, treatment expectations, and basic demographic information. Subsequent follow-up surveys were used to gauge the ongoing trial engagement. The last follow-up questionnaire, completed at 64 weeks, assessed participants’ satisfaction with web-based treatment and quality-of-life outcomes.ResultsMultiple linear regression analyses were used to assess the relative influence of predictor variables on trial engagement, treatment satisfaction, and quality-of-life outcomes. The analyses revealed that the overall predictive effects of personality and affective factors were 20% or lower. Neuroticism constituted a unique predictor of engagement with the iTreAD study in that neuroticism facilitated the return of web-based self-assessments during the study. The return of incentivized follow-up assessments predicted treatment satisfaction, and state-based depression predicted variance in quality-of-life reports at study completion.ConclusionsOur findings suggest that traditional predictors of engagement observed in face-to-face research may not be easily transferable to digital health interventions, particularly those aimed at comorbid mental health concerns and alcohol misuse among young adults. More research is needed to identify what determines engagement in this population to optimally design and execute digital intervention studies with multiple treatment aims.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ACTRN): 12614000310662; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365137&isReview=true.International Registered Report Identifier (IRRID)RR2-10.1186/s12889-015-2365-2

Aqueous Mulberry Leaf Extract Ameliorates Alcoholic Liver Injury Associating with Upregulation of Ethanol Metabolism and Suppression of Hepatic Lipogenesis

Excessive alcohol intake is a major cause of chronic liver damage and is highly associated with the development of a spectrum of hepatic disorders, including steatohepatitis, liver cirrhosis, and liver cancer. Thus, we aimed to explore the hepatoprotective effects of an aqueous mulberry leaf extract (AME) on alcoholic fatty liver disorder (AFLD) by using a mouse model fed with excessive ethanol. Compared with the normal diet, the ethanol diet significantly increased the body weight of the mice, while the AME supplement reduced the weight gain caused by the ethanol diet. The ethanol diet also attenuated the activity of alcohol dehydrogenase and antioxidant enzymes but increased lipid peroxidation in the liver, which were reversed by AME supplementation. Additionally, AME supplementation diminished the ethanol diet-induced hepatic leukocyte infiltration and expressions of IL-6 and TNFα. Moreover, AME supplementation also reduced the ethanol-diet-induced lipid accumulation and expression of 1-acylglycerol-3-phosphate acyltransferase, acetyl-CoA carboxylase, low-density lipoprotein receptor, and sterol regulatory element-binding protein-1/2 in the liver. Collectively, AME supplementation improved liver lipid accumulation and proinflammatory response in mice induced by the ethanol diet, which was associated with the upregulation of ethanol-metabolizing enzymes and the downregulation of lipogenesis components.

Substance use disorders in the farming population: Scoping review.

The purpose of this scoping review is to summarize the current knowledge base in order to make recommendations for prevention and treatment of substance use disorders among the farming populations. We conducted a scoping review of peer-reviewed articles published between January 1989 and September 2019. The search yielded 3,426 citations and the final review was conducted on 42 articles. The full review was conducted by 4 authors to extract information about the target population, data collection methods, and main results. There were 21 articles on farmers and 21 articles on farmworkers. The majority of the articles were about alcohol. Overall, farmers had higher prevalence of risky alcohol consumption patterns than nonfarmers. The prevalence of risky alcohol consumption was also high among farmworkers compared to the general population. Risk factors for risky alcohol consumption included male gender, lower socioeconomic status, and psychological problems (eg, depression). Recommendations for prevention and intervention of alcohol disorders included policy development and implementation to curb alcohol access by taxation, screening of alcohol-related problems, and alternative means of recreation instead of alcohol consumption. This review confirmed that alcohol-related problems are prevalent among farmers and farmworkers. More population-based research is called for to understand the additional risk factors of alcohol disorders and the prevalence of other substance-related disorders. Also, interventions should be tailored to the unique culture of farmers and farmworkers.

Alcohol and Psychosis: A Narrative Review of the Prevalence, Clinical Manifestations, and Management of Alcohol-related Psychotic Symptoms

Background: Alcohol use disorders, defined as the maintenance of alcohol use for at least a 12-month period despite negative psychological, biological, behavioral, and social consequences, are frequently associated with psychotic symptoms. Objective: Our aim in this paper is to review alcohol-related clinical conditions that are accompanied by psychotic symptoms, alcohol-induced psychotic disorder, alcohol withdrawal delirium, Wernicke’s encephalopathy, Korsakoff’s dementia, comorbid schizophrenia, or delusional disorder. Methods: This is a non-systematic, narrative review based on the relevant literature indexed in PubMed and Google Scholar databases [2000-2020]. Results: Alcohol-induced psychotic disorder is characterized by the presence of auditory hallucinations or delusions. In the state of alcohol withdrawal, tactile, visual hallucinations and delusions are common. Wernicke-Korsakoff syndrome, caused by malnutrition secondary to chronic alcohol misuse, is characterized by the presence of ataxia, ophthalmoplegia, and a range of mental disturbances. The dual diagnosis of schizophrenia and alcohol use disorder rests on shared biological impairments, as shown by neuroendocrinological and brain imaging studies. The subtype of the delusional disorder called Othello’s syndrome, or delusional jealousy based on false beliefs of infidelity, is often seen in the context of alcohol alone or alcohol and neurological disorder. Treatment for alcoholic disorders with psychotic symptoms are dietary, psychological, and pharmacological. Conclusions: There are a number of alcohol-related psychotic syndromes, each requiring its own specific treatment approach.

The effect of expanded insurance coverage under the Affordable Care Act on emergency department utilization in New York.

One of the proposed benefits of expanding insurance coverage under the Affordable Care Act (ACA) was a reduction in emergency department (ED) utilization for non-urgent visits related to lack of health insurance coverage and access to primary care providers. The objective of this study was to estimate the effect of the 2014 ACA implementation on ED use in New York. We used the Healthcare Cost and Utilization Project State Emergency Department and State Inpatient Databases for all outpatient and all inpatient visits for patients admitted through an ED from 2011 to 2016. We focused on in-state residents aged 18 to 64, who were covered under Medicaid, private insurance, or were uninsured prior to the 2014 expansion. We estimated the effect of the expanded insurance coverage on average monthly ED visits volumes and visits per 1000 residents (rates) using interrupted time-series regression analyses. After ACA implementation, overall average monthly ED visits increased by around 3.0%, both in volume (9362; 95% Confidence Intervals [CI]: 1681-17,522) and in rates (0.80, 95% CI:0.12-1.49). Medicaid covered ED visits volume increased by 23,972 visits (95% CI: 16,240 -31,704) while ED visits by the uninsured declined by 13,297 (95% CI:-15,856 - -10,737), and by 1453 (95% CI:-4027-1121) for the privately insured. Medicaid ED visits rates per 1000 residents increased by 0.77 (95% CI:-1.96-3.51) and by 2.18 (95% CI:-0.55-4.92) for those remaining uninsured, while private insurance visits rates decreased by 0.48 (95% CI:-0.79 - -0.18). We observed increases in primary-care treatable ED visits and in visits related to mental health and alcohol disorders, substance use, diabetes, and hypertension. All estimated changes in monthly ED visits after the expansion were statistically significant, except for ED visit rates among Medicaid beneficiaries. Net ED visits by adults 18 to 64 years of age increased in New York after the implementation of the ACA. Large increases in ED use by Medicaid beneficiaries were partially offset by reductions among the uninsured and those with private coverage. Our results suggest that efforts to expand health insurance coverage only will be unlikely to reverse the increase in ED use.

Predictors of Recurrent High Emergency Department Use among Patients with Mental Disorders.

Few studies have examined predictors of recurrent high ED use. This study assessed predictors of recurrent high ED use over two and three consecutive years, compared with high one-year ED use. This five-year longitudinal study is based on a cohort of 3121 patients who visited one of six Quebec (Canada) ED at least three times in 2014–2015. Multinomial logistic regression was performed. Clinical, sociodemographic and service use variables were identified based on data extracted from health administrative databases for 2012–2013 to 2014–2015. Of the 3121 high ED users, 15% (n = 468) were recurrent high ED users for a two-year period and 12% (n = 364) over three years. Patients with three consecutive years of high ED use had more personality disorders, anxiety disorders, alcohol or drug related disorders, chronic physical illnesses, suicidal behaviors and violence or social issues. More resided in areas with high social deprivation, consulted frequently with psychiatrists, had more interventions in local community health service centers, more prior hospitalizations and lower continuity of medical care. Three consecutive years of high ED use may be a benchmark for identifying high users needing better ambulatory care. As most have multiple and complex health problems, higher continuity and adequacy of medical care should be prioritized.

Neurobiology of alcohol seeking behavior.

Alcohol addiction is a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse consequences. A main challenge of addiction treatment is to prevent relapse, which occurs in more than >50% of newly abstinent patients with alcohol disorder within 3months. In people suffering from alcohol addiction, stressful events, drug-associated cues and contexts, or re-exposure to a small amount of alcohol trigger a chain of behaviors that frequently culminates in relapse. In this review, we first present the preclinical models that were developed for the study of alcohol seeking behavior, namely the reinstatement model of alcohol relapse and compulsive alcohol seeking under a chained schedule of reinforcement. We then provide an overview of the neurobiological findings obtained using these animal models, focusing on the role of opioids systems, corticotropin-release hormone and neurokinins, followed by dopaminergic, glutamatergic, and GABAergic neurotransmissions in alcohol seeking behavior.

Clinical dynamics of anhedonia symptom in mood disorder and in alcohol use disorder

IntroductionAnhedonia is an important transdiagnostic phenotypic characteristic of schizophrenia, mood disorders (MD), alcohol use disorder (AUD) and other mental diseases. This Symptom could reflect the neurochemical abnormalities in addictive and affective disorders when the function of reward system is dysregulated (Koob G.F., 2017).ObjectivesTo compare the severity of Anhedonia in clinic of MD and AUD in dynamic of antidepressant therapyMethods The study enrolled 93 patients under treatment in MHRI Clinics: 45 AUD (F10.2; ICD-10) and 48 MD patients (F31-F34; ICD-10). The evaluation of Anhedonia was provided with the SHAPS modified for clinician administration (SHAPS-C) (Rezvan A., 2014).ResultsDue to statistical analysis, we found the level of anhedonia in the MD group was higher than in the AUD group before the treatment. After four weeks of antidepressant therapy the scrutiny of score difference shows less changes in severity of the Symptom in the AUD group (Table 1) Table 1. Dynamics of Anhedonia in MD and AUD groups by SHAPS-C GroupTotal score upon admissionTotal score after four weeks therapyTotal score upon admission and after four weeks therapyAUD (n=45)24 (22; 27,5)22 (20,25; 28)1 (-3; 4)MD (n=48)30 (23; 38)25 (20; 28)4 (1; 8)р (Mann-Whitney test)0,0030,3730,002ConclusionsAnhedonia in the structure of AUD is less pronounced than in MD, but responds less to antidepressant therapy. The study is supported by RSF Grant no. 19-15-00023 “Clinical features and search of potential biomarkers of comorbidity of alcoholism and affective disorders”.

Параметры когерентности биоэлектрической активности мозга и уровень фосфорилированных нейрофиламентов в сыворотке крови при коморбидном течении алкогольной зависимости и аффективных расстройств

Введение. Наряду со многими психическими расстройствами алкогольная зависимость и аффективные расстройства являются результатом взаимодействия генетических, социальных и экологических факторов, что сопровождается морфофункциональными изменениями в центральной нервной системе. Тем не менее, основные причины и механизмы развития коморбидности алкоголизма и аффективных расстройств остаются не до конца ясны. Цель исследования - определение функциональной связности и уровня фосфорилированных нейрофиламентов у пациентов с алкогольной зависимостью и коморбидностью алкогольной зависимости и аффективного расстройства. Методика. Обследовано 60 пациентов после детоксикации: 30 пациентов с алкогольной зависимостью и 30 пациентов с коморбидным течением алкогольной зависимости и аффективного расстройства. Контрольную группу составили 20 психически и соматически здоровых лиц, сопоставимых по полу и возрасту. Исследование биоэлектрической активности головного мозга проводилось при помощи 16-канального энцефалографа. Анализировались общие усредненные значения внутри - и межполушарной когерентности. В сыворотках крови определяли содержание фосфорилированных нейрофиламентов методом твердофазного иммуноферментного анализа на полистироловых планшетах, предварительно покрытых куриными пoликлональными антителами. Результаты. При межгрупповом анализе были выявлены статистически значимо более низкие значения когерентности в правой гемисфере у пациентов с коморбидностью алкогольной зависимости и аффективного расстройства по сравнению с пациентами, страдающими только алкогольной зависимостью. Были обнаружены также статистически значимо более высокие значения концентрации нейрофиламентов в группе пациентов с коморбидностью алкогольной зависимости и аффективного расстройства по сравнению со здоровой группой контроля. При сравнении групп пациентов между собой были обнаружены боле высокие значения концентрации нейрофиламентов у пациентов с коморбидностью алкогольной зависимости и аффективного расстройства на уровне тенденции. Заключение. Наличие коморбидности алкоголизма и аффективных расстройств приводят к нейрофизиологическим изменениям в виде снижения функциональной связности коры головного мозга, особенно в правой гемисфере, а также увеличению степени нейронального повреждения. Background. Similar to many mental disorders, alcohol dependence and affective disorders result from interaction of genetic, social, and environmental factors associated with morpho-functional alterations in the central nervous system. However, major causes and mechanisms of the development of comorbid alcoholism and affective disorders are not fully clear. The aim of this study was to determine the functional connectivity and levels of phosphorylated neurofilaments in patients with alcohol dependence and comorbid alcohol dependence and affective disorder. Methods. 60 patients were evaluated after detoxification, including 30 patients with alcohol dependence and 30 patients with comorbid alcohol dependence and affective disorder. The control group consisted of 20 sex- and age-matched, mentally and somatically healthy individuals. Brain bioelectric activity was recorded with a 16-channel encephalograph. Overall average values of intra- and inter-hemispheric coherence were analyzed. Blood serum concentration of phosphorylated neurofilaments was measured by solid-phase enzyme immunoassay on polystyrene plates pre-coated with chicken polyclonal antibodies. Results. The intergroup analysis showed that coherence values for the right hemisphere were significantly lower in patients with comorbid alcohol dependence and affective disorder compared to patients with alcohol dependence alone (p=0.018). Also, concentrations of neurofilaments were significantly higher in the patient group with comorbid alcohol dependence and affective disorder compared to the healthy control group (p=0.042). Comparison of patient groups showed that neurofilament concentrations had a tendency toward higher values in patients with comorbid alcohol dependence and affective disorder (p=0.092). Conclusion. The presence of comorbid alcoholism and affective disorders leads to neurophysiological alterations evident as reduced functional connectivity of the cerebral cortex, particularly in the right hemisphere, as well as to the increased degree of neuronal damage.

Alcohol use patterns and disorders among individuals with personality disorders in the Sao Paulo Metropolitan Area.

IntroductionAlcohol Use Disorders are frequently comorbid with personality disorders. However, the heterogeneity of the prevalence estimates is high, and most data come from high income countries. Our aim is to estimate the prevalence and association between alcohol use outcomes and the three DSM-5 clusters of personality disorders in a representative sample of the São Paulo Metropolitan Area.Materials and methodsA representative household sample of 2,942 adults was interviewed using the WHO Composite International Diagnostic Interview and the International Personality Disorder Examination Screening Questionnaire. Lifetime PD diagnoses were multiply imputed, and AUD diagnoses were obtained using DSM-5 criteria. We conducted cross-tabulations and logistic regression to estimate the associations between AUDs and PDs.Results and discussionOur study did not find significant associations of PDs with heavy drinking patterns or mild AUD. Cluster B PD respondents tended to show the highest conditional prevalence estimates of most alcohol use patterns and AUD, including its severity subtypes. When alcohol outcomes were regressed on all PD Clusters simultaneously, with adjustment for sex and age, only cluster B was significantly associated with past-year alcohol use (OR 3.0), regular drinking (OR 3.2), and AUDs (OR 8.5), especially moderate and severe cases of alcohol use disorders (OR 9.7 and 16.6, respectively). These associations between Cluster B PDs and these alcohol outcomes were shown to be independent of other PD Clusters and individuals´ sex and age.ConclusionThe main finding of our study is that AUDs are highly comorbid with PDs. The presence of Cluster B PDs significantly increases the odds of alcohol consumption and disorders and of more severe forms of AUDs. Considering the local context of poor treatment provision, more specific prevention and intervention strategies should be directed to this population.

Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial

BackgroundAlcohol and other drug use disorders contribute substantially to the global burden of illness. The majority of people with substance use disorders do not receive any treatment for their problems, and developing treatments that are attractive and effective to patients should be a priority. However, whether treatment is best delivered in a group format or an individual format has only been studied to a very limited degree. The COMDAT (Combined Drug and Alcohol Treatment) trial evaluates the feasibility, acceptability, and cost effectiveness of MOVE group (MOVE-G) treatment versus MOVE individual (MOVE-I) treatment in four community-based outpatient treatment centres in Denmark.MethodsA two-arm non-inferiority trial comparing MOVE-I (Pedersen et al., Drug Alcohol Depend 218:108363, 2020) with MOVE-G a combined group treatment for both alcohol use disorder and drug use disorder. The primary objective is to examine whether MOVE-G is non-inferior to MOVE-I in relation to abstinence from drug and/or alcohol, number of sessions received, and completion of treatment as planned. All participants will receive treatment based on cognitive behavioral therapy and motivational interviewing, vouchers for attendance and text reminders, as well as medication as needed (MOVE). Participants (n = 300) will be recruited over a one-year period at four public treatment centers in four Danish municipalities. A short screening will determine eligibility and randomization status. Hereafter, participants will be randomized to the two treatment arms. A thorough baseline assessment will be conducted approximately 1 week after randomization. Follow-up assessments will be conducted at 9 months post-randomization. In addition, patients’ use of drugs and alcohol, and patients’ wellbeing will be measured in all sessions. The main outcome measures are drug and alcohol intake at 9 months follow-up, number of sessions attended, and dropout from treatment.DiscussionThe present study will examine the potential and efficacy of combined groups (patients with alcohol and drug disorders in the same group) versus individually based treatment both based on the treatment method MOVE (Pedersen et al., Drug Alcohol Depend 218:108363, 2020).Trial registrationISRCTN88025085, registration date 30/06/2020.

Changes in Drug Use Patterns during the COVID-19 Pandemic in Italy: Monitoring a Vulnerable Group by Hair Analysis.

From 22 March until 18 May 2020, a complete lockdown in Italy was ordered as a countermeasure against the COVID-19 pandemic. Social isolation measures affect some populations more than others, and people with drug and/or alcohol disorders (SUDs) are more likely to be adversely affected. This study presents, for the first time, laboratory data on the use of alcohol and drugs in a high-risk population during Italy’s first wave of the COVID-19 pandemic. Thirty subjects with SUDs were monitored for the use of illicit drugs and alcohol every 3 months before, during and after the lockdown, by hair analysis. The number of samples positive for heroin, cocaine, MDMA and cannabis fell considerably during the lockdown and then resumed to pre-lockdown levels when the period of confinement was over. Interestingly, the consumption of benzodiazepines and alcohol followed the opposite trend; both the number of benzodiazepine-positive samples and the level of alcohol consumption increased and remained high, even at the end of the lockdown. The confinement measures produced significant changes in drug/alcohol use patterns, with a shift toward the use of substances that were more easily accessible, used as self-medication for negative feelings, and used to alleviate the effects of abstinence from drugs that were no longer readily available.