Concurrent Alcohol Dependence Research Articles

The Interaction Between POMC rs2071345 Polymorphism and Alcohol Dependence in Anxiety Symptoms Among Chinese Male Problem Drinkers.

ObjectiveAlcohol dependence can increase the level of anxiety. A growing body of research has identified a link between anxiety symptoms of problem drinkers and their genetic or environment factors, respectively. However, to date few studies have directly examined gene-environment (G × E) interaction on their anxiety symptoms during the acute alcohol withdrawal. The present study aims to examine the interaction between the proopiomelanocortin (POMC) rs2071345 polymorphism and alcohol dependence on anxiety symptoms of male problem drinkers, and further test the exact form of interaction on two competing models: the diathesis-stress model vs. the differential susceptibility model.MethodsA total of 440 male problem drinkers (Mage = 44.5 years, SD = 9.45) were recruited from nine main psychiatric hospitals of northern China during acute alcohol withdrawal. Blood samples were collected for genotyping, self-reported anxiety symptoms, and levels of alcohol dependence were assessed.ResultsResults indicated that the POMC rs2071345 polymorphism significantly moderated anxiety symptoms associated with alcohol dependence. A region of significance (RoS) test showed that male problem drinkers with T allele were more likely to experience more anxiety symptoms than those with CC homozygote when the standardized score of concurrent alcohol dependence was above 0.31. Confirmatory model evaluation indicated that the interaction effect involving POMC gene polymorphism conformed to the diathesis-stress model rather than differential-susceptibility model of person × environment interaction.ConclusionsThis study suggested that the SNP in POMC rs2071345 was associated with alcohol dependence in anxiety symptoms of male problem drinkers and further provided evidence in support of the diathesis-stress hypothesis of alcohol dependence in terms of anxiety symptoms.

Early Outcomes of the Integrated Care Pathway for Concurrent Major Depressive Disorder and Alcohol Dependence

Both Major Depressive Disorder (MDD) and Alcohol Dependence (AD) are highly prevalent, comorbid and have significant impact on morbidity, mortality and socioeconomic burden. Several studies have suggested that these concurrent conditions lead to suboptimal treatment outcomes. Combined psycho- and pharmacotherapies for both conditions promise better outcomes than treatment as usual. We developed and implemented an Integrated Care Pathway (ICP) specifically for concurrent MDD and AD. The aim of the study is to assess the clinical effectiveness of the ICP approach. 1. To compare treatment completion rates between the ICP and historical controls 2. To describe the changes in patterns of drinking and severity of depressive symptoms in ICP patients. Review of clinical charts of ICP patients (n=28) and historical controls (n=92). The ICP patients had significantly higher treatment completion rates compared to historical controls (53.8% vs 21.7%; Fig. 1) Data on patterns of drinking (reduction of percent heavy drinking days from 51.4% to 34.5%), and severity of cravings and depressive symptoms (Fig. 2) were not sufficient for proper statistical testing due to small sample size and multiple missing data points, but showed a tendency for improvement. 2 ICP patients showed a tendency for improvement and significantly greater treatment completion rates than historical controls. Larger sample size and further data collection are needed to corroborate these findings.

Cognitive-Behavior Therapy for Concurrent Anxiety and Alcohol Use Disorder: A Randomized Control Trial

Alcohol dependent individuals also diagnosed with an anxiety disorder were treated with one of two cognitive-behavioral treatments. Treatment ALC, consisting of 6 sessions of alcohol-specific treatment was compared to treatment ALCANX consisting of 6 sessions of alcohol-specific treatment followed by 4 anxiety-specific sessions. At the end-of-treatment no significant differences were found on measures of alcohol consumption or psychiatric (including anxiety) symptoms. Both groups improved to a significant degree. Implications for the cognitive-behavioral treatment of concurrent alcohol dependence and anxiety disorder are discussed.

English

Concurrent alcohol dependence poses a significant burden to health and wellbeing of people with established opioid dependence. Although previous research indicates that both genetic and environmental risk factors contribute to the development of drug or alcohol dependence, the role of genetic determinants in development of concurrent alcohol and opioid dependence has not been scrutinised. To search for genetic pre-determinants of concurrent alcohol and opioid dependence, electronic literature searches were completed using MEDLINE (PubMed) and EBSCO (Academic Search Complete) databases. Reference lists of included studies were also searched. In this discussion paper, we provide an overview of the genes (n=33) which are associated with the opioid, serotonergic, dopaminergic, GABA-ergic, cannabinoid, and metabolic systems for each dependency (i.e., alcohol or opioid) separately. The current evidence base is inconclusive regarding an exclusively genetic pre-determinant of concurrent alcohol and opioid dependence. Further search strategies and original research are needed to determine the genetic basis for concurrent alcohol and opioid dependency.

Stress Reactivity, Social Anxiety, and Alcohol Consumption in People With Alcoholism: A Laboratory Study

Objective: Social anxiety may maintain alcohol dependence through increased reactivity to stressful events, a propensity to drink to cope with stressful events, or both. The current study is a secondary analysis of an existing data set that examined differences between individuals with alcohol dependence and concurrent high and low social anxiety in objective and subjective stress reactivity to a laboratory stressor (Trier Social Stress Test [TSST]), as well as consumption of alcohol following the stressor. Methods: Forty participants with alcohol dependence (20 women) were randomly assigned to the TSST condition as part of the parent study. Post hoc analysis of social anxiety measures yielded high (n = 19) and low (n = 21) social anxiety groups. Participants completed the TSST, followed by a small dose of their favorite alcoholic beverage (target blood alcohol concentration 0.03 g/dL) to prime subsequent laboratory drinking. Participants received a sham beer taste test of 2 glasses (710 mL total) of beer. Differences between high and low social anxiety groups were assessed via subjective and objective (mean arterial pressure, serum cortisol) reactivity to the TSST and consumption of alcohol during the taste test (total mLs consumed, mLs/kg of body weight, and likelihood of consuming all the beer available). Results: No differences emerged in either objective or subjective measures of stress reactivity between high and low social anxiety groups. There were also no differences between social anxiety groups in amount of alcohol consumed during the taste test. Conclusions: No differences were observed between high and low social anxiety participants with concurrent alcohol dependence on stress reactivity or alcohol consumption following a stressor. Given that all participants in this study had alcohol dependence, negative results may suggest that heightened stress reactivity and drinking to cope are more relevant to the development of alcohol dependence and that other factors may maintain alcohol use once dependence has developed.

Gender-specific associations between trauma cognitions, alcohol cravings, and alcohol-related consequences in individuals with comorbid PTSD and alcohol dependence.

The current study examined gender-specific associations between trauma cognitions, alcohol cravings and alcohol-related consequences in individuals with dually diagnosed PTSD and alcohol dependence (AD). Participants (N = 167) had entered a treatment study for concurrent PTSD and AD; baseline information was collected from participants about PTSD-related cognitions in three areas: (a) Negative Cognitions About Self, (b) Negative Cognitions About the World, and (c) Self-Blame. Information was also collected on two aspects of AD: alcohol cravings and consequences of AD. Gender differences were examined while controlling for PTSD severity. The results indicate that Negative Cognitions About Self are significantly related to alcohol cravings in men but not women, and that interpersonal consequences of AD are significantly related to Self-Blame in women but not in men. These findings suggest that for individuals with comorbid PTSD and AD, psychotherapeutic interventions that focus on reducing trauma-related cognitions are likely to reduce alcohol cravings in men and relational problems in women.

Concurrent alcohol dependence among methadone-maintained cocaine abusers is associated with greater abstinence.

Concurrent alcohol dependence (AD) among polysubstance abusers has been associated with negative consequences, although it may not necessarily lead to poor treatment outcomes. One of the most efficacious treatments for cocaine abuse is contingency management (CM), but little research has explored the impact of AD on abstinence outcomes, particularly among patients in methadone maintenance. Using data from three trials of CM for cocaine use, we compared baseline characteristics and posttreatment and follow-up cocaine outcomes between methadone-maintained, cocaine-dependent patients (N = 193) with and without concurrent AD, randomized to standard care (SC) with or without CM. Patients with and without concurrent AD had similar baseline characteristics, with the exception that AD patients reported more alcohol use. AD patients achieved longer durations of cocaine abstinence and were more likely to submit a cocaine-negative sample at follow-up than non-AD patients. Patients randomized to CM achieved better outcomes than those randomized to SC, but there was no interaction between treatment condition and AD status. These findings suggest that cocaine-using methadone patients with AD achieve greater cocaine abstinence than their non-AD counterparts and should not necessarily be viewed as more difficult to treat.

Comorbid disorders in patients with bipolar disorder and concomitant substance dependence

Objective Substance dependence is common in bipolar disorder and is associated with an increase in Axis I and II comorbidity. Little research has compared the relative rates of comorbidity among bipolar patients with dependence on different substances. Methods The Mini International Neuropsychiatric Interview (MINI) was used to assess 166 outpatients involved in one of three clinical trials of medications for bipolar disorder and substance dependence. Patients had concurrent alcohol dependence, cocaine dependence, or both conditions. Results Generalized anxiety disorder and current depressed mood were significantly more common in bipolar patients with alcohol dependence than bipolar patients with cocaine dependence. Those with cocaine dependence had significantly higher rates of post-traumatic stress disorder and antisocial personality disorder and were more likely to present in a mixed mood state than patients dependent on alcohol. Cocaine ENC dependent patients were more likely than alcohol dependent patients to have Bipolar I relative to Bipolar II. Limitations This is a retrospective, cross-sectional data analysis using the MINI for diagnosis. Conclusions Cocaine dependence and alcohol dependence were associated with different clinical features and comorbid disorders in bipolar patients. The results may help confirm the validity of integrative models of mood, behavioral, anxiety, and personality disorders. Further studies on the causal relationship between substance dependence and concurrent and lifetime Axis I disorders for patients with bipolar disorders are indicated.

Risk factors for cocaine-induced paranoia in cocaine-dependent sibling pairs

Objective Cocaine-induced paranoia (CIP), an irrational intense suspicion of others, is a common manifestation of cocaine dependence. Both environmental and genetic factors are thought to play a role, but the specific nature of such contributions is poorly understood. Methods Demographic, diagnostic, and cocaine-use data were obtained from 420 cocaine-dependent, genetically confirmed, full-sibling pairs ( N = 840 subjects) interviewed with the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). Probands with and without CIP were compared; then, factors associated with sibling CIP status were analyzed by logistic regression. Alcohol dependence, a known heritable phenotype, was analyzed as a positive control. Results Of 420 probands, 273 (65%) experienced CIP. Probands with CIP were more severely dependent upon cocaine, had an earlier age of onset, were more likely to smoke cocaine, and used cocaine less frequently during the preceding year. Independent analyses of siblings replicated two of the former (i.e., dependence severity and age of onset). Probands with CIP also had a non-significantly higher proportion of siblings with the trait (66% versus 59%). Probands with concurrent alcohol dependence were confirmed to have significantly higher rates of alcoholism among their siblings. Conclusions Severity of cocaine dependence and age of onset appear to be important risk factors for CIP. Concordance for CIP between siblings did not emerge as significant in our analyses.

Cognitive versus behavioral treatment of concurrent alcohol dependence and agoraphobia: A pilot study

With the growing awareness of the prevalence of anxiety disorders among alcohol abusers there is a need for effective cognitive–behavioral treatments (CBTs). This study is a pilot investigation comparing two treatments for concurrent alcohol dependence and panic disorder with agoraphobia. A 10-session behavioral treatment (BT), consisting of five sessions treating alcohol dependence and five sessions treating panic disorder with agoraphobia, was compared to a 10-session cognitive treatment (CT) that addressed the dysfunctional cognitions mediating the alcohol problem and anxiety symptoms. There were no group differences in frequency or quantity of alcohol consumption or in anxiety symptoms posttreatment or at a 1-year follow-up in a sample of 14 subjects who completed the study. Both groups showed within-group improvements on measures of both alcohol and anxiety symptomatology. Approximately one-third of the subjects made clinically relevant gains on both alcohol and anxiety symptoms. A brief BT for concurrent alcohol dependence and agoraphobia appears encouraging.

Social Support in Alcohol Dependence and Social Phobia: Treatment Comparisons

Objective: This study investigated whether different alcoholism treatment approaches differentially impact social support scores in individuals with concurrent alcohol dependence and social phobia. Method: Individuals (N = 397) were selected retrospectively from a larger pool of participants enrolled in a multisite randomized clinical trial on treatment matching. Three standard treatments were delivered over 12 weeks: Cognitive-Behavioral Therapy (CBT), Twelve Step Facilitation Therapy (TSF), and Motivational Enhancement Therapy (MET). Social support measures were analyzed to test the effects of treatment group and gender. Results: For men, there was significant improvement on two measures of social support regardless of treatment group. Women who received CBT or TSF had better support outcomes than women who received MET. Conclusions: These data suggest that social support can be improved through alcohol treatment in individuals with coexisting social phobia, particularly if social workers emphasize skills training and facilitating involvement in 12-step groups.

Treatment outcome of cocaine-alcohol dependent patients

Cocaine dependent patients (n=27) with and without concurrent alcohol dependence disorder were compared on measures of substance use, addiction severity (ASI), coping, and psychopathology taken before, during, and after outpatient relapse prevention treatment for cocaine dependence. At pre-treatment, the cocaine–alcohol (CA) group reported more frequent alcohol use, and more severe alcohol and family/social problems compared to the cocaine-only (CO) group. By the end of treatment, both groups reported significantly fewer days of alcohol and cocaine use, with sustained reductions observed at 24 weeks following treatment. On most of the addiction severity and psychiatric symptomatology scales, results indicated overall improvement as a function of time, however scores remained relatively `worse' in the CA group. Implications of these findings and the need for specific programming in the treatment of dual drug use are explored.