Alcohol Treatment Response Research Articles

Differential alcohol treatment response by gender following use of VetChange

ObjectiveProportionally more women use online alcohol interventions but also report less robust treatment outcomes compared to men. Less is known about outcome disparities among veteran women, who are a growing demographic nationally. The current study examined gender differences among returning veteran men and women who used VetChange, a web-based intervention for hazardous drinking and posttraumatic stress symptoms (PTSS). MethodUsing data from a nationwide implementation study of returning combat veterans (n = 222), we performed hierarchical linear modeling to examine gender differences in alcohol and PTSS outcomes over six months following VetChange registration. Additional analyses examined gender differences in proportional changes in hazardous drinking and at each assessment point. ResultsReturning veterans reported significant decreases in alcohol use and PTSS over time, yet men evidenced significantly greater reduction in average weekly drinks and drinks per drinking day compared to women. Follow up analyses indicated that women were significantly less likely than men to achieve low-risk drinking by one month post-registration. Proportional change in alcohol use yielded marginal and non-significant trends that were, nonetheless, consistent with the overall pattern of gender differences. ConclusionThese results contribute to emerging literature suggesting that women use online alcohol use interventions at proportionately higher rates than do men, but do not reduce their drinking as much as men. There are a number of potential content changes that could improve outcomes for returning veteran women using online interventions, and data-driven adaptations based on stakeholder input are recommended.

Effects of a GABA-ergic medication combination and initial alcohol withdrawal severity on cue-elicited brain activation among treatment-seeking alcoholics

Many studies have reported medication effects on alcohol cue-elicited brain activation or associations between such activation and subsequent drinking. However, few have combined the methodological rigor of a randomized clinical trial (RCT) with follow-up assessments to determine whether cue-elicited activation predicts relapse during treatment, the crux of alcoholism. This study analyzed functional magnetic resonance imaging (fMRI) data from 48 alcohol-dependent subjects enrolled in a 6-week RCT of an investigational pharmacotherapy. Subjects were randomized, based on their level of alcohol withdrawal (AW) at study entry, to receive either a combination of gabapentin (GBP; up to 1,200 mg for 39 days) and flumazenil (FMZ) infusions (2 days) or two placebos. Midway through the RCT, subjects were administered an fMRI alcohol cue reactivity task. There were no main effects of medication or initial AW status on cue-elicited activation, but these factors interacted, such that the GBP/FMZ/higher AW and placebo/lower AW groups, which had previously been shown to have relatively reduced drinking, demonstrated greater dorsal anterior cingulate cortex (dACC) activation to alcohol cues. Further analysis suggested that this finding represented differences in task-related deactivation and was associated with greater control over alcohol-related thoughts. Among study completers, regardless of medication or AW status, greater left dorsolateral prefrontal cortex (DLPFC) activation predicted more post-scan heavy drinking. These data suggest that alterations in task-related deactivation of dACC, a component of the default mode network, may predict better alcohol treatment response, while activation of DLPFC, an area associated with selective attention, may predict relapse drinking.

Translating Effective Web‐Based Self‐Help for Problem Drinking Into the Real World

Drinking Less (DL) is a 24/7 free-access anonymous interactive web-based self-help intervention without therapeutic guidance for adult problem drinkers in the community. In a randomized controlled trial (referred to here as DL-RCT), DL has been shown effective in reducing risky alcohol consumption. To assess whether the findings of DL-RCT are generalizable to a naturalistic setting (DL-RW) in terms of ability to reach the target group and alcohol treatment response. Pretest-posttest study with 6-month follow-up. An online survey was conducted of 378 of the 1,625 people who used DL-RW from May to November 2007. Primary outcome measures were (1) problem drinking, defined as alcohol consumption in the previous 4 weeks averaging >21 or >14 standard units (male/female) per week or >or=6 or >or=4 units (m/f) on 1 or more days per week; and (2) mean weekly alcohol consumption. DL-RW and DL-RCT data were compared and pooled. Intention-to-treat (ITT) analysis was performed to analyze and compare changes in drinking from baseline to follow-up. In the DL-RW group, 18.8% (n = 71) were drinking successfully within the limits of the Dutch guideline for low-risk drinking (p < 0.001) 6 months after baseline (ITT). The DL-RW group also decreased its mean weekly alcohol intake by 7.4 units, t(377) = 6.67, p < 0.001, d = 0.29. Drinking reduction in DL-RW was of a similar magnitude to that in the DL-RCT condition in terms of drinking within the guideline [chi(2)(1) = 1.83, CI: 0.82-3.00, p = 0.18, RD = 0.05, OR = 1.55] and mean weekly consumption (a negligible difference of d = 0.03 in favor of DL-RW group). The results from DL-RCT and DL-RW were similar, and they demonstrate that web-based self-help without therapeutic guidance is feasible, well accepted, and effective for curbing adult problem drinking in the community.

COMBINE genetics study: the pharmacogenetics of alcoholism treatment response: genes and mechanisms.

Partial efficacy of treatment and differences in adverse events across individuals are a challenge and an opportunity in the treatment of alcoholism. Individuation of therapy and understanding origins of differential treatment response may require identification of inherited functional variants of genes. The neurobiology of reward, executive cognitive function, anxiety and dysphoria have been identified as critical domains that may have a genetic basis that could predict treatment response. The COMBINE Study presents a unique opportunity to evaluate specific genetic loci (markers) that affect neurobiology central to addiction and extended withdrawal. The study also addresses variation in drug metabolism and action. Candidate genetic markers are selected for study based on functionality and abundance. COMT Vall58Met is a common (minor allele frequency 0.42), functional, catecholamine-metabolizing enzyme polymorphism with threefold relevance. Vall58Met alters executive cognitive function, stress and anxiety responses and brain endogenous opioid function. OPRM1 Asn40Asp is a common (minor allele frequency 0.10), functional polymorphism of the mu-opioid receptor, which may serve as a gatekeeper molecule in naltrexone's actions and was recently reported to affect naltrexone response. HTTLPR (minor allele frequency 0.40) alters serotonin transporter function to affect anxiety, dysphoria and obsessional behavior, which are assessed in COMBINE and may be related to relapse and addictive behavior. All genetic testing is consented through a separate human research protocol, and the testing is conducted nonclinically, confidentially and apart from the clinical record to protect human research participants who have volunteered for this aspect of COMBINE.

Unaided smoking cessation among smokers in treatment for alcohol dependence

To investigate the possible impact of treatment of alcohol dependence on smoking, we studied 144 smokers in an alcohol treatment center for whom 6-month data were available. Of those, 18 reported not smoking at 6 months. No significant differences in age, gender, or race were observed between quitters and continuing smokers. Quitters at 6 months were significantly more likely to be low dependent smokers than were continuing smokers and were significantly more likely to report no drinking during the past 28 days at the end of 1 month's treatment (93%) than continuing smokers (62%). These findings suggest that quitting smoking may be associated with low levels of nicotine dependence and favorable alcohol treatment response in alcoholic smokers.

Developmental level as a predictor of alcoholism treatment response: An attempted replication

Over 12 years ago, a developmental level (DL) cognitive measure derived from the Rorschach was found to be a powerful predictor of alcohol-related outcomes following behaviorally oriented inpatient alcoholism treatment. These findings represent the strongest evidence of a relationship between cognitive functioning and treatment response. The current pilot study attempted to determine whether the large effects previously obtained with the DL measure could be replicated. The Rorschach was administered during the first week of treatment to 20 male alcoholic patients attending a 1-month day hospital rehabilitation program. The Addiction Severity Index (ASI) was administered upon entry into treatment and a follow-up ASI was also administered 7 months after treatment entry. A higher DL was found to be significantly related to less recent drinking and intoxication at baseline as well as to lower alcohol-related problem levels in general. However, all of the relationships between DL and alcohol-related behaviors at follow-up were found to be either small or in a direction opposite to that hypothesized. Some of the reasons for the discrepancy between the findings of the current study and the earlier study are discussed.

References Cited

References Cited

Stake theory as an explanatory device in Navajo alcoholism treatment response.

The usefulness of "stake in society" theory, a form of transactional theory employed by John J. and Irma Honigmann to explain abandonment of frontier-type norms regarding alcohol use by modern Arctic townsmen, is tested in conjunction with differential response to treatment by a group of 110 Navajo alcoholic men. In a modified usage, "stake" is operationally defined by type. It is postulated that many of the men had suffered initial loss of stake in the context of lack of negative sanctions regarding heavy alcohol use in Navajo culture. Navajos who regained a stake in the old society during treatment tended to conform to new norms in the family context, while those who acquired concurrent stakes in both old and modern society were even more outstanding in their adherence to new norms. The failure of those with modern stake alone to acquire new norms regarding alcohol use is tentatively explained in terms of lack of a reference group other than the drinking fellowship, suggesting that what appears to be a preferable stake may not be regarded as such when it is in the context of what the Cornell study (Leighton et al. 1963) refers to as interference with essential striving sentiments of love and recognition, hence in such cases new norms will not take precedence over old. A model for the wider use of stake theory is presented.

Underemployment in Rural South Vietnam

Previous articleNext article No AccessUnderemployment in Rural South VietnamRobert H. Stroup, and Richard E. GiftRobert H. Stroup Search for more articles by this author , and Richard E. Gift Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Economic Development and Cultural Change Volume 19, Number 3Apr., 1971 Article DOIhttps://doi.org/10.1086/450496 Views: 2Total views on this site Citations: 3Citations are reported from Crossref Copyright 1971 The University of ChicagoPDF download Crossref reports the following articles citing this article:Masahiko Shintani Underemployment in the Agricultural Sector of Vietnam: A Production Function Approach, The Japanese Journal of Rural Economics 3, no.00 (Jan 2001): 26–35.https://doi.org/10.18480/jjre.3.26Frances Ferguson Stake Theory as an Explanatory Device in Navajo Alcoholism Treatment Response, Human Organization 35, no.11 (Mar 1976): 65–78.https://doi.org/10.17730/humo.35.1.a47387941v8g1441 James A. Brown, Jr. , and Jay S. Salkin Underemployment in Rural South Vietnam: A Comment and a Discussion of Family Labor, Economic Development and Cultural Change 23, no.11 (Oct 2015): 151–160.https://doi.org/10.1086/450775