Alcohol Reduction Strategies Research Articles

Psychological processes and alcohol reduction in patients with chronic hepatitis C: Results from the HepART trial.

There is a lack of randomized controlled trials of behavioral interventions and process-level research related to alcohol reduction among patients with chronic liver disease (e.g., hepatitis C viral (HCV) infection). We conducted a process-level, secondary analysis of the Hepatitis C-Alcohol Reduction Treatment (HepART) trial to investigate the association between change in psychological processes posited by the Integrated Behavioral Model (IBM) and change in World Health Organization (WHO) drinking risk levels. Patients with HCV who consume alcohol were recruited from hepatology clinics and received provider-delivered SBIRT (Screening, Brief Intervention, Referral to Treatment) or SBIRT+ 6 months of co-located alcohol counseling. Treatment arms were combined for this analysis because no between-group differences were found. At baseline and 6 months, the timeline followback method was used to determine alcohol risk levels according to the 2000 WHO risk categories (based on average grams of alcohol per day). Changes in alcohol consumption and WHO risk levels were quantified and regressed on change in individual psychological processes (e.g., readiness, self-efficacy, motives, attitudes, and strategies) from baseline to 6 months. At the baseline assessment, 162 participants were classified as abstinent (5%), low (47%), moderate (16%), high (19%), or very high (13%) WHO risk levels. At 6 months, 38% remained at the same risk level and 48% decreased by at least one level. In univariate analyses, changes in 7 of 12 psychological processes were associated with change in risk levels. Adjusted multivariate analyses demonstrated that change in four processes were significantly associated with change in risk levels, including SOCRATES Taking Steps, Ambivalence, and Recognition scores and alcohol reduction strategies. These findings demonstrate significant reductions in quantitative indices of alcohol consumption following opportunistic alcohol interventions in patients with HCV. However, results provided mixed support for associations between change in IBM psychological processes and alcohol consumption.

Preliminary Efficacy of a Web-Based Alcohol and Emotion Regulation Intervention on Sexual Risk Behaviors Among College Women.

Using substances before sex may affect sexual decision-making among young women and increase their risk for a variety of negative consequences, including sexual victimization, sexually transmitted infections, and unintended pregnancies. A brief, web-based intervention combining alcohol reduction strategies with emotion regulation skills demonstrated initial efficacy at reducing heavy drinking and improving emotion regulation abilities among college women with sexual victimization histories. The present study represents a secondary analysis of this intervention to evaluate its preliminary efficacy in reducing sexual risk behaviors, specifically alcohol and other drug use before sex. The sample comprised 200 heavy-drinking college women with histories of sexual victimization randomized to an assessment-only control or the intervention consisting of 14 brief online alcohol reduction and emotion regulation skill-building modules administered daily over a 2-week period. The analytic sample included 173 women who reported their substance use before sex at baseline and at least one of two (1-month and/or 6-month) follow-up surveys. Repeated-measures mixed models revealed significant time-by-intervention interaction effects on alcohol use. Women who received the intervention had a significant decrease in alcohol use before sex from baseline to 1-month follow-up. Although levels of alcohol use before sex continued to be lower at the 6-month follow-up relative to baseline, differences did not reach statistical significance. Time-by-intervention interaction effects on drug use before sex were not statistically significant. Skills to reduce alcohol use and improve emotion regulation skills may be beneficial in helping women make adaptive decisions surrounding their sexual well-being.

Bad Break-Up Behavior: Break-Up Characteristics, Emotional Dysregulation, and Alcohol Use as Risk Factors for Cyber Dating Abuse Among Sexual Orientation Diverse College Students.

Cyber dating abuse (CDA) is a growing public health concern among college students. CDA includes monitoring and abusive behaviors perpetrated toward an ex-partner via technology. Little is known about the predictors of CDA, particularly among sexual minority (SM) college students. Some theorized but relatively untested predictors include break-up characteristics, emotional regulation deficits, and alcohol use. The current study investigates what factors are associated with an increased risk for CDA toward an ex-partner (i.e., break-up characteristics, emotional dysregulation, and alcohol use) and the differences in associations with CDA between heterosexual and SM college students. Participants (N = 661) self-reported their CDA perpetration following their worst romantic break-up. They also answered questions about the break-up, their emotional regulation skills, and their current alcohol use. While SM students (n = 191) reported greater emotion regulation difficulties and alcohol use, they did not significantly differ from heterosexual participants (n = 470) in their reported CDA perpetration post-break-up. Hierarchical regressions were conducted to determine the impact of break-up characteristics and individual factors on CDA perpetration. Break-up characteristics, emotional dysregulation, and alcohol use significantly predicted heterosexual participants' CDA perpetration and accounted for 17% of the variance. Conversely, for SM students, only alcohol use was predictive of CDA, accounting for 5% of the variance. Although SM students report similar break-up experiences and levels of CDA as heterosexual students, additional, unmeasured factors may drive perpetration. However, given the generally high rates of alcohol use and CDA, and their robust association, interventions targeting alcohol reduction and healthy relationship dissolution strategies may be beneficial.

In Case You Haven't Heard…

Nobody on social media with a substance use presence has missed the many ads for various alcohol reduction strategies — applications to put on your phone that remind you how to cut back on drinking. These are valuable, but not free. Typical charges are $80/month. You can get the same thing, but better, from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Go to https://www.rethinkingdrinking.niaaa.nih.gov/ and you will find worksheets and more. There are quizzes to help you and your patients make choices. What you don't get is a personal “counselor,” which the apps provide, but this is not a counselor, it's a marketer to make sure you keep up your monthly payments. You may feel there is a personal connection, but there isn't. We can't be sure if it's even a marketer, or just a robot, artificial intelligence‐fashion. No criticism there, that is the way of apps. But it's not necessary. By the way, if you do want real person support, there are mutual support groups: Alcoholics Anonymous, Smart Recovery, and more. But the key is that many people are not ready to stop drinking and telling them [that] they have to may discourage them from even trying, as researcher Katie Witkiewitz, Ph.D. has proven (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33179). In fact, Witkiewitz is quoted in the current NIAAA's Spectrum article online entitled “Incorporating Harm Reduction Into Alcohol Use Disorder Treatment and Recovery,” (see https://www.spectrum.niaaa.nih.gov/fall2023feature). NIAAA said it does not want to be seen as “competing” with apps, but we have no problem seeing them that way. And they win the contest.

Preliminary Efficacy of a Web-Based Alcohol and Emotion Regulation Intervention on Intimate Partner Aggression Among College Women.

Intimate partner aggression (IPA), encompassing psychological and physical aggression, is a public health concern due to its high rates among young adults. Research and theory connect heavy drinking and emotion regulation (ER) difficulties to IPA and highlight their potential role in reducing IPA. A web-based intervention combining alcohol reduction strategies with ER skills demonstrated initial efficacy at reducing heavy drinking and improving ER abilities among college women with sexual assault victimization histories. The present study represents a secondary analysis of this brief web-based intervention to evaluate its preliminary efficacy on IPA. The sample comprised 200 heavy drinking college women with histories of sexual assault victimization randomized to an assessment only control or the intervention consisting of 14 brief online alcohol reduction and ER skill building modules administered daily over a two-week period. The analytic sample included 103 women who reported their psychological and physical IPA at both the 1- and 6-month follow-up surveys. After controlling for alcohol use, repeated measures mixed models examining changes from baseline to 6-month follow-up by condition revealed a significant time-by-intervention interaction effect on psychological IPA. Women who received the intervention had a significant decrease in psychological IPA from baseline to 6-month follow-up; there was no change in psychological IPA among women in the control condition. There was no significant effect of the intervention on physical IPA. Reducing alcohol use and improving ER skills may be beneficial in helping women cope with relational conflict, thereby decreasing their use of psychological IPA.

Unhealthy Alcohol Use Is Associated With Suboptimal Adherence to Isoniazid Preventive Therapy in Persons With HIV in Southwestern Uganda.

Unhealthy alcohol use is associated with increased progression to tuberculosis (TB) disease, but its effect on adherence to isoniazid (INH) preventive therapy is not known. This was a prospective study of persons with HIV with latent TB in southwestern Uganda reporting any current (previous 3 months) alcohol use or no alcohol consumption in the previous year (2:1 ratio). All received INH. We defined suboptimal adherence as <90% of days with at least 1 Medication Event Monitoring System cap opening, over the previous 90 days. Alcohol use was categorized as follows: none: no self-report and phosphatidylethanol (PEth) <8 ng/mL; moderate: Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) 1-2 (women) or 1-3 (men) and/or PEth 8 ≥ 50 ng/mL; and unhealthy: AUDIT-C ≥3 (women) or ≥4 (men) and/or PEth ≥50 ng/mL. We used generalized estimating equation logistic regression analyses to assess the association between the level of alcohol use and suboptimal INH adherence. Three hundred two persons were enrolled; 279 were on INH for 3 or more months. The prevalence of suboptimal INH adherence was 31.3% at 3 months and 43.9% at 6 months. The odds of suboptimal INH adherence were higher for unhealthy (adjusted odds ratio, 2.78; 95% confidence interval: 1.62 to 4.76) and moderate (adjusted odds ratio, 1.59; 95% confidence interval: 0.94 to 2.71) compared with no alcohol consumption. Suboptimal adherence to INH at 3 and 6 months was high among prospective study of persons with HIV and associated with unhealthy alcohol use. Adherence support and alcohol reduction strategies are needed for this group at high risk for active TB.

Posttraumatic stress symptoms and substance use among college students: Exploring interactions with sleep quality and assigned sex

Substance use is widely recognized as a negative outcome following traumatic events and is tied to symptoms of posttraumatic stress (PTS). Sleep quality may influence the PTS and substance use association, particularly among college students who are at risk for poor sleep. The purpose of the present study was to examine the moderating effect of sleep quality on the relationship between PTS and substance use in a cohort of college students, with an exploratory aim of examining potential differences by assigned sex. A screening survey was completed by 2,767 students enrolled in a larger RCT examining various brief college student alcohol reduction strategies. Results found a significant two-way interaction between PTS symptoms and subjective sleep quality on weekly number of drinks and peak drinking occasion, where the significant positive association between PTS symptoms to weekly drinks and peak drinking occasion was only found for those who reported poor sleep quality. A similar pattern emerged for the significant two-way interaction between PTS symptoms and subjective sleep quality on cannabis use frequency. A significant three-way interaction (i.e., PTS Symptoms × Poor Subjective Sleep Quality × Assigned Sex) indicated the two-way interaction between PTS symptoms and sleep quality for both weekly drinks and cannabis use frequency was stronger among male compared to female participants. Study findings suggest sleep quality is an important factor contributing to the relation between PTS symptom severity and substance use among college students. Strategies for assessing and improving sleep quality and PTS symptoms can be incorporated into prevention and intervention efforts targeting substance use related harm for college students.

Benefits of temporary alcohol restriction: a feasibility randomized trial

BackgroundParticipation in temporary alcohol abstinence campaigns such as ‘Dry January’ may prompt enduring reductions in alcohol consumption. A randomized controlled trial (RCT) is required to establish any long-term benefits or negative consequences of temporary abstinence. In the present study, we randomized heavy drinkers to complete or intermittent alcohol abstinence for 4 weeks, in order to evaluate the feasibility of conducting a large-scale RCT.MethodsThis was a mixed methods feasibility study in which we explored recruitment and retention to a randomized trial, compliance with alcohol abstinence instructions and barriers to compliance, and acceptability of study procedures (primary feasibility outcomes). A community sample of women aged between 40 and 60 who drank in excess of 28 alcohol units per week were randomized to abstain from alcohol for 4 weeks either completely or intermittently (at least four abstinent days per week). To monitor compliance, both groups provided regular breath samples on a cellular breathalyser. A subsample completed a semi-structured interview that probed barriers to compliance with abstinence instructions and acceptability of study procedures.ResultsWithin 5 months, we recruited, screened and randomized 25 participants (20% of participants who responded to advertisements: 14 in the complete abstinence group, 11 in the intermittent abstinence group), 24 of whom were retained throughout the 28-day intervention period. Participants in both groups tended to comply with the instructions: the median number of breathalyser-verified abstinent days was 24 (IQR = 15.5–25.0; 86% of target) in the complete abstinence group versus 12 (IQR = 10–15; 75% of target) in the intermittent abstinence group. Semi-structured interviews identified some barriers to compliance and methodological issues that should be considered in future research. No adverse events were reported.ConclusionsIt is feasible to recruit heavy drinking women from community settings and randomize them to either complete or intermittent abstinence from alcohol for 4 weeks. The majority of participants were retained in the study and compliance with the abstinence instructions was good, albeit imperfect. A comprehensive RCT to compare temporary alcohol abstinence with other alcohol reduction strategies on long-term alcohol consumption is feasible. Findings from such a trial would inform implementation of alcohol campaigns and interventions.

Poly-Strengths and Peer Violence Perpetration: What Strengths Can Add to Risk Factor Analyses

Adolescence is a high-risk time for perpetration of different forms of peer-based violence including harassment, bullying, and sexual assault. Research documents a number of important risk factors but less understood are protective factors like sense of mattering or how combinations of strengths may reduce perpetration risk. The current study examined how protective factors (i.e., positive social norms), including a diversity of strengths (termed poly-strengths), influenced the perpetration of harassment, bullying, and sexual assault for young people, while accounting for the use of alcohol both cross-sectionally and over time. Youth (N = 2232, 52.6% female) in grades 7-10 enrolled in a study using active parental consent (53% response rate) and completed online surveys in school that asked about bullying and harassment, alcohol use, positive social norms related to violence prevention, and a composite of intra-personal strengths. Follow-up surveys took place 6 months later (N = 2150). Logistic regression analyses examined how social norms and poly-strengths influenced odds of perpetration after accounting for demographic variables and the risk factor of alcohol use. Use of alcohol increased the odds of perpetrating all forms of violence. Strengths were significantly related to lower perpetration at Time 1 but not Time 2. Positive social norms reduced perpetration at both time points. The findings suggest adolescent perpetration of bullying, harassment, and sexual violence is lower in the presence of positive social norms over time and more proximally, in the presence of a diverse strengths portfolio. Prevention efforts that incorporate positive social norms and alcohol reduction strategies may reduce peer violence.

Alcohol reduction in red wines by technological and microbiological approaches: a comparative study

Background and Aims The aim of this work was to assess and compare the chemical composition and colour characteristics of Barbera red wines obtained after partial alcohol reduction using three promising methodologies for implementation at the industrial level. Methods and Results Alcohol reduction was achieved by: (i) pre-fermentation addition of liquid derived from grape must (reverse osmosis by-product); (ii) mixed fermentations with strains of Starmerella bacillaris and Saccharomyces cerevisiae; and (iii) dealcoholisation of wine post-fermentation with a polypropylene membrane. The microbiological approach enabled the production of wines with a slightly lower alcohol concentration (−0.2 to −0.3% v/v), while facilitating the release of anthocyanin and some esters of fatty acids (ethyl hexanoate and ethyl dodecanoate) that could contribute positively to wine aroma with pleasant nuances. The low impact of the partial replacement of grape juice on the chemical composition and chromatic characteristics of Barbera wines makes this technique a good option for reducing the ethanol concentration by up to 1.0–2.0% v/v. In contrast, the use of a polypropylene membrane influenced negatively the composition of red wines by reducing significantly the concentration of esters (−60%) and anthocyanin (−17%), independently of the dealcoholisation level (up to −2% v/v). Conclusions The alcohol reduction strategies can greatly influence the volatile and phenolic composition of the wine. The choice of either a technological or microbiological approach in the wine industry is dependent on the alcohol reduction required. Significance of the Study This is the first comparative study of three strategies to reduce the alcohol concentration on the same batch of must/wine.

Effects of Exercise on Liver Fat and Metabolism in Alcohol Drinkers

Exercise is an important component of obesity-associated disorders and has been shown to reduce markers of nonalcoholic fatty liver disease (NAFLD). However, little is known about how these effects are influenced by alcohol intake. The authors performed a randomized controlled trial to investigate the effects of exercise on hepatic triglyceride content (HTGC) and metabolism in overweight or obese patients who consume alcohol. The authors performed a prospective study of 27 patients (mean 54 ± 11 years of age, body mass index [BMI] 31 ± 4 kg/m2) with >5% HTGC in the United Kingdom, consuming alcohol (mean 221 ± 75 g/week). Anthropometry, body composition, HTGC, and abdominal fat were measured using plethysmography and magnetic resonance imaging. Subjects were assigned to groups that exercised (3 times/week on nonconsecutive days) for 12 weeks (n= 14) or continued standard care (control group, n= 13), maintaining baseline weight and alcohol consumption. The exercise program consisted of aerobic exercise (static cycling) and a circuit of resistance exercise (free weights and machines). Patients were examined at baseline and at 12 weeks; data collected on HTGC, body composition, metabolic control, circulating inflammatory, and fibrosis markers were assessed at baseline and at 12 weeks. Between-group differences were evaluated using an unpaired t test and within-group differences using a paired t test. The primary outcomes for this study were changes in HTGC between baseline and 12 weeks. After 12 weeks, there was no significant difference between the exercise and control groups in HTGC (reduction of 0.1% ± 2.1% in exercisers vs increase of 0.5 ± 2.1% in control group; P>.05). At week 12, the exercise group had significant reductions in subcutaneous fat (loss of 23 ± 28 cm2 in the exercisers vs increase of 12 ± 19 cm2 in the control group; P < .01), and whole body fat (loss of 2.1 ± 1.1 kg in the exercisers vs increase of 0.2 ± 2.1 kg; P < .01). The exercise group also had a significantly greater increase in lean body mass (increase of 1.9 ± 1.4 kg for the exercisers vs increase of 0.7 ± 1.5 kg for the control group; P < .01) and a significantly greater reduction in level of cytokeratin 18 (reduction of 49 ± 82 U/L in exercisers vs increase of 17 ± 38 U/L in control group; P < .05). There were no differences between groups in changes in metabolic factors or markers of inflammation. In a randomized controlled trial of obese individuals who consume alcohol, exercise significantly improved body composition and reduced hepatocyte apoptosis (cytokeratin 18), but did not reduce HTGC. This finding could indicate that alcohol consumption reduces the effects of exercise on NAFLD observed in previous studies. Clinical care teams should look to use exercise as part of the management strategy for people consuming alcohol, but optimal benefit may be as an adjunct to alcohol reduction and weight management strategies. (ISRCTN.com, Number: ISRCTN90597099).

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Exercise is an important component of obesity-associated disorders and has been shown to reduce markers of nonalcoholic fatty liver disease (NAFLD). However, little is known about how these effects are influenced by alcohol intake. The authors performed a randomized controlled trial to investigate the effects of exercise on hepatic triglyceride content (HTGC) and metabolism in overweight or obese patients who consume alcohol.The authors performed a prospective study of 27 patients (mean 54 ± 11 years of age, body mass index [BMI] 31 ± 4 kg/m2) with >5% HTGC in the United Kingdom, consuming alcohol (mean 221 ± 75 g/week). Anthropometry, body composition, HTGC, and abdominal fat were measured using plethysmography and magnetic resonance imaging. Subjects were assigned to groups that exercised (3 times/week on nonconsecutive days) for 12 weeks (n = 14) or continued standard care (control group, n = 13), maintaining baseline weight and alcohol consumption. The exercise program consisted of aerobic exercise (static cycling) and a circuit of resistance exercise (free weights and machines). Patients were examined at baseline and at 12 weeks; data collected on HTGC, body composition, metabolic control, circulating inflammatory, and fibrosis markers were assessed at baseline and at 12 weeks. Between-group differences were evaluated using an unpaired t test and within-group differences using a paired t test. The primary outcomes for this study were changes in HTGC between baseline and 12 weeks.After 12 weeks, there was no significant difference between the exercise and control groups in HTGC (reduction of 0.1% ± 2.1% in exercisers vs increase of 0.5 ± 2.1% in control group; P > .05). At week 12, the exercise group had significant reductions in subcutaneous fat (loss of 23 ± 28 cm2 in the exercisers vs increase of 12 ± 19 cm2 in the control group; P < .01), and whole body fat (loss of 2.1 ± 1.1 kg in the exercisers vs increase of 0.2 ± 2.1 kg; P < .01). The exercise group also had a significantly greater increase in lean body mass (increase of 1.9 ± 1.4 kg for the exercisers vs increase of 0.7 ± 1.5 kg for the control group; P < .01) and a significantly greater reduction in level of cytokeratin 18 (reduction of 49 ± 82 U/L in exercisers vs increase of 17 ± 38 U/L in control group; P < .05). There were no differences between groups in changes in metabolic factors or markers of inflammation.In a randomized controlled trial of obese individuals who consume alcohol, exercise significantly improved body composition and reduced hepatocyte apoptosis (cytokeratin 18), but did not reduce HTGC. This finding could indicate that alcohol consumption reduces the effects of exercise on NAFLD observed in previous studies. Clinical care teams should look to use exercise as part of the management strategy for people consuming alcohol, but optimal benefit may be as an adjunct to alcohol reduction and weight management strategies. (ISRCTN.com, Number: ISRCTN90597099).

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Exercise is an important component of obesity-associated disorders and has been shown to reduce markers of nonalcoholic fatty liver disease (NAFLD). However, little is known about how these effects are influenced by alcohol intake. The authors performed a randomized controlled trial to investigate the effects of exercise on hepatic triglyceride content (HTGC) and metabolism in overweight or obese patients who consume alcohol.The authors performed a prospective study of 27 patients (mean 54 ± 11 years of age, body mass index [BMI] 31 ± 4 kg/m2) with >5% HTGC in the United Kingdom, consuming alcohol (mean 221 ± 75 g/week). Anthropometry, body composition, HTGC, and abdominal fat were measured using plethysmography and magnetic resonance imaging. Subjects were assigned to groups that exercised (3 times/week on nonconsecutive days) for 12 weeks (n = 14) or continued standard care (control group, n = 13), maintaining baseline weight and alcohol consumption. The exercise program consisted of aerobic exercise (static cycling) and a circuit of resistance exercise (free weights and machines). Patients were examined at baseline and at 12 weeks; data collected on HTGC, body composition, metabolic control, circulating inflammatory, and fibrosis markers were assessed at baseline and at 12 weeks. Between-group differences were evaluated using an unpaired t test and within-group differences using a paired t test. The primary outcomes for this study were changes in HTGC between baseline and 12 weeks.After 12 weeks, there was no significant difference between the exercise and control groups in HTGC (reduction of 0.1% ± 2.1% in exercisers vs increase of 0.5 ± 2.1% in control group; P > .05). At week 12, the exercise group had significant reductions in subcutaneous fat (loss of 23 ± 28 cm2 in the exercisers vs increase of 12 ± 19 cm2 in the control group; P < .01), and whole body fat (loss of 2.1 ± 1.1 kg in the exercisers vs increase of 0.2 ± 2.1 kg; P < .01). The exercise group also had a significantly greater increase in lean body mass (increase of 1.9 ± 1.4 kg for the exercisers vs increase of 0.7 ± 1.5 kg for the control group; P < .01) and a significantly greater reduction in level of cytokeratin 18 (reduction of 49 ± 82 U/L in exercisers vs increase of 17 ± 38 U/L in control group; P < .05). There were no differences between groups in changes in metabolic factors or markers of inflammation.In a randomized controlled trial of obese individuals who consume alcohol, exercise significantly improved body composition and reduced hepatocyte apoptosis (cytokeratin 18), but did not reduce HTGC. This finding could indicate that alcohol consumption reduces the effects of exercise on NAFLD observed in previous studies. Clinical care teams should look to use exercise as part of the management strategy for people consuming alcohol, but optimal benefit may be as an adjunct to alcohol reduction and weight management strategies. (ISRCTN.com, Number: ISRCTN90597099).

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Exercise is an important component of obesity-associated disorders and has been shown to reduce markers of nonalcoholic fatty liver disease (NAFLD). However, little is known about how these effects are influenced by alcohol intake. The authors performed a randomized controlled trial to investigate the effects of exercise on hepatic triglyceride content (HTGC) and metabolism in overweight or obese patients who consume alcohol.The authors performed a prospective study of 27 patients (mean 54 ± 11 years of age, body mass index [BMI] 31 ± 4 kg/m2) with >5% HTGC in the United Kingdom, consuming alcohol (mean 221 ± 75 g/week). Anthropometry, body composition, HTGC, and abdominal fat were measured using plethysmography and magnetic resonance imaging. Subjects were assigned to groups that exercised (3 times/week on nonconsecutive days) for 12 weeks (n = 14) or continued standard care (control group, n = 13), maintaining baseline weight and alcohol consumption. The exercise program consisted of aerobic exercise (static cycling) and a circuit of resistance exercise (free weights and machines). Patients were examined at baseline and at 12 weeks; data collected on HTGC, body composition, metabolic control, circulating inflammatory, and fibrosis markers were assessed at baseline and at 12 weeks. Between-group differences were evaluated using an unpaired t test and within-group differences using a paired t test. The primary outcomes for this study were changes in HTGC between baseline and 12 weeks.After 12 weeks, there was no significant difference between the exercise and control groups in HTGC (reduction of 0.1% ± 2.1% in exercisers vs increase of 0.5 ± 2.1% in control group; P > .05). At week 12, the exercise group had significant reductions in subcutaneous fat (loss of 23 ± 28 cm2 in the exercisers vs increase of 12 ± 19 cm2 in the control group; P < .01), and whole body fat (loss of 2.1 ± 1.1 kg in the exercisers vs increase of 0.2 ± 2.1 kg; P < .01). The exercise group also had a significantly greater increase in lean body mass (increase of 1.9 ± 1.4 kg for the exercisers vs increase of 0.7 ± 1.5 kg for the control group; P < .01) and a significantly greater reduction in level of cytokeratin 18 (reduction of 49 ± 82 U/L in exercisers vs increase of 17 ± 38 U/L in control group; P < .05). There were no differences between groups in changes in metabolic factors or markers of inflammation.In a randomized controlled trial of obese individuals who consume alcohol, exercise significantly improved body composition and reduced hepatocyte apoptosis (cytokeratin 18), but did not reduce HTGC. This finding could indicate that alcohol consumption reduces the effects of exercise on NAFLD observed in previous studies. Clinical care teams should look to use exercise as part of the management strategy for people consuming alcohol, but optimal benefit may be as an adjunct to alcohol reduction and weight management strategies. (ISRCTN.com, Number: ISRCTN90597099).

The association between substance use and sub-optimal HIV treatment engagement among HIV-infected female sex workers in Lilongwe, Malawi

ABSTRACTFemale sex workers (FSW) have a high prevalence of substance use and HIV, but the impact of substance use on HIV treatment engagement is not well established. We evaluated the association between alcohol and marijuana use and sub-optimal HIV treatment engagement outcomes among HIV-infected FSW in Lilongwe, Malawi. We enroled FSW using venue-based recruitment into a cross-sectional evaluation assessing substance use and HIV treatment engagement. Seropositive FSW, identified through HIV rapid testing, received rapid CD4 count and viral load testing. We used Poisson regression with robust variance estimates to ascertain associations of alcohol and marijuana use with sub-optimal HIV treatment outcomes: (1) lack of ART use among previously diagnosed, ART-eligible FSW and (2) viral nonsuppression among FSW on ART. Of previously diagnosed, ART-eligible FSW (n = 96), 29% were not using ART. Patterns of hazardous drinking were identified in 30%, harmful drinking in 10%, and alcohol dependence in 12%. ART-eligible FSW with harmful drinking or alcohol dependency were 1.9 (95% CI: 1.0, 3.8) times as likely to not use ART compared to FSW without harmful or dependent drinking. Among those on ART, 14% were virally nonsuppressed. The prevalence ratio for viral nonsuppression was 2.0 (95% CI: 0.6, 6.5) for harmful drinkers and alcohol-dependent FSW. Over 30% of ART-eligible FSW reported using marijuana. Marijuana-using FSW were 1.9 (95% CI: 0.8, 4.6) times as likely to not use ART compared to FSW who were not using marijuana. Given the high prevalence of alcohol use and its association with lack of ART use, ART uptake and alcohol reduction strategies should be tailored for alcohol-using FSW in Malawi.

Substance use and HIV infection awareness among HIV-infected female sex workers in Lilongwe, Malawi

BackgroundHIV diagnosis, the first step in HIV care and treatment engagement, may be inhibited by substance use among female sex workers (FSW). We assessed the relationship between alcohol and cannabis use and lack of HIV infection awareness among HIV-infected FSW in Lilongwe, Malawi. MethodsFrom July to September, 2014, 200 FSW aged ≥18 years were enrolled using venue-based sampling to examine substance use, HIV testing history, and serostatus ascertained by HIV rapid test. We used Poisson regression with robust variance estimates to estimate the associations of alcohol and cannabis use and lack of HIV infection awareness. ResultsOf the 138 HIV-infected FSW, 20% were unaware of their HIV infection, with 70% not testing within 6 months prior. According to the Alcohol Use Disorder Identification Tests (AUDIT), 55% of FSW unaware of their HIV infection reported hazardous, harmful, or dependent alcohol consumption. We observed a dose–response relationship between alcohol use and lack of HIV infection awareness, with alcohol dependency significantly associated with lack of HIV infection awareness (adjusted prevalence ratio: 3.0, 95% CI: 1.3, 6.8). Current cannabis use was uncommon (26%) among unaware HIV-infected FSW and weakly associated with lack of HIV infection awareness adjusted prevalence ratio: 1.1, 95% CI: 0.5, 2.5). ConclusionIncreased levels of alcohol use is associated with lack of HIV infection awareness among HIV-infected FSW in Malawi. Frequent, consistent HIV testing integrated with alcohol reduction strategies could improve the health and infection awareness of substance-using FSW.

Stages and Processes of Change Utilized by Female Sex Workers Participating in an Alcohol-Reduction Intervention in Mombasa, Kenya

Background: According to the transtheoretical model (TTM) behavior change occurs through a series of steps when an individual becomes aware of a behavior, prepares to change, and executes those changes using certain processes. This model has not yet been used to describe alcohol-reduction behavior change processes in resource-limited settings. Objective: This qualitative analysis aimed to describe and characterize the stages and processes of change employed by female sex workers in Mombasa, Kenya during the course of their participation in a 6-month alcohol reduction intervention. Methods: In 2011–2012, clinical interviews were conducted with 45 female sex workers. One interview was conducted each month during the intervention period, resulting in a total of six transcripts per participant. During each interview, the counselor noted the participant's stage of change and recent alcohol use. The clinical notes were analyzed via qualitative coding techniques and organized into matrices to classify alcohol reduction strategies discussed by participants. Results: Participants discussed using the stage-specific processes of change described by the TTM to reduce their alcohol use and maintain the behavior change. Participants who were HIV-positive at the start of the intervention seemed to progress to the action/maintenance stage more quickly than HIV-negative participants. Conclusions/Importance: Results suggest that the TTM constructs may be relevant in understanding the alcohol reduction behavior change process of an at-risk population in a resource-limited setting. Future quantitative research should seek to validate the TTM's application internationally. Alcohol interventions should consider tailoring content to participants’ stages of change and HIV-status for increased effectiveness.

Stosunek lekarzy rodzinnych do interwencji związanych z używaniem alkoholu – polskie wyniki międzynarodowego projektu badawczego ODHIN

BackgroundBrief interventions for alcohol use are considered an effective method of reducing alcohol drinking and alcohol-attributable mortality. The aim of the study was to document the attitudes of Polish general practitioners (GPs) to alcohol and alcohol problems, and examine how these attitudes are associated with self-reported activity in managing patients for alcohol use and alcohol-related problems. MethodsA total of 276 GPs were surveyed. The questionnaire included items on the GP's reported education and training on alcohol, attitudes and self-confidence in managing alcohol problems and self-reported estimates of patient numbers managed for alcohol and alcohol problems during the previous year. In addition, potential barriers and facilitators for conducting brief interventions in GP setting were investigated. ResultsMore than half of GPs (55.3%) reported 6 or less patients managed for alcohol and alcohol problems during the previous year. GPs reporting higher levels of education for alcohol problems declared more emphasis on disease prevention, felt more secure in managing patients with alcohol problems and delivered a higher number of brief interventions. DiscussionQualifications and positive experiences rather than declarations about importance and preparation towards conducting brief interventions are associated with higher number of patients managed for drinking alcohol. ConclusionGeneral practitioners in Poland very rarely manage patients for alcohol use and alcohol-related problems. Complex interventions, with special emphasis on training on alcohol reduction strategies, are needed to improve this situation.

A population-based study of premature mortality in relation to neighbourhood density of alcohol sales and cheque cashing outlets in Toronto, Canada

ObjectiveAlcohol overuse and poverty, each associated with premature death, often exist within disadvantaged neighbourhoods. Cheque cashing places (CCPs) may be opportunistically placed in disadvantaged neighbourhoods, where customers abound. We explored...

Patient preferences and perspectives regarding reducing alcohol consumption: role of nalmefene.

Alcohol use disorder is a major public health issue. The absolute mortality burden of alcohol-attributable death has increased over the last 20 years. However, access to care remains very poor and many people with alcohol use disorder are untreated. The main limiting factor for access to care in alcohol use disorder appears to be the reluctance to engage in abstinence. Risk reduction is a developing approach in the treatment of alcohol use disorders, drawing its inspiration, with quite a delay, from the decades-long dominant approach in other substance use disorders. A paradigm shift has recently occurred that places more of an emphasis on reducing alcohol as a therapeutic strategy for patients with alcohol use disorder, to better meet the patients’ preferences and needs. The development and recent approval of nalmefene, in alcohol-dependent adults with a high drinking risk level, contributes to enlarging the therapeutic arsenal for alcohol dependence, strengthening the legitimacy of alcohol reduction strategies.