Concurrent Alcohol Use Disorder Research Articles

Opioid agonist therapy and mortality among First Nations and other residents with concurrent alcohol use disorder in British Columbia, Canada: A population-based cohort study

BackgroundDespite the prevalence of alcohol use among people with opioid use disorder (PWOUD) engaged in opioid agonist therapy (OAT), clinical care guidance for concurrent alcohol use disorder (AUD) and OUD is scarce. We assessed the prevalence and risk of mortality for concurrent AUD among PWOUD who accessed OAT in British Columbia (BC). MethodsData were obtained from six linked population-level health administrative datasets to identify PWOUD from January 1996 to March 2020. All-cause age and sex standardized mortality ratios (SMR) were calculated to determine the mortality risk by OAT status (on vs. discontinued), stratified by First Nations and other residents with concurrent AUD and OUD. Adjusted risk ratios compared the relative risk of mortality by AUD status (AUD detected vs. not) among First Nations and other residents. ResultsWe identified 62,110 PWOUD who received OAT, including 6305 (10.2%) First Nations. OAT substantially lowered the SMR among First Nations (SMR=6.6, 95% CI: 5.4–8.1) and other residents (SMR=6.6; 95% CI: 6.2–7.0) with concurrent AUD and OUD, compared to those who discontinued (SMR=22.7, 95% CI: 20.4–25.1, SMR=17.5, 95% CI: 16.8–18.2 respectively). The risk of mortality was 1.9 (95% CI: 1.6–2.2) times higher for First Nations and 2.0 (95% CI: 1.8–2.2) times higher for other residents with concurrent OUD and AUD compared to those without an indication of AUD. ConclusionsThe protective effect of OAT remained despite the presence of a concurrent AUD among both First Nations and other residents with OUD. Findings have implications for clinical care management of concurrent disorders.

Medical Conditions Linked to Atherosclerosis Are Associated With Magnified Cortical Thinning in Individuals With Alcohol Use Disorders.

Magnetic resonance imaging (MRI) studies report widespread cortical thinning in individuals with alcohol use disorder (AUD), but did not consider potential effects of pro-atherogenic conditions such as hypertension, type 2 diabetes mellitus, hepatitis C seropositivity and hyperlipidemia on cortical thickness. The conditions are associated with regional cortical thinning in those without AUD. We predicted that individuals with concurrent AUD and pro-atherogenic conditions demonstrate the greatest regional cortical thinning in areas most vulnerable to decreased perfusion. Treatment-seeking individuals with AUD (n=126) and healthy controls (CON; n=49) completed a 1.5T MRI study. Regional cortical thickness was quantitated via FreeSurfer. Individuals with AUD and pro-atherogenic conditions (Atherogenic+), AUD without pro-atherogenic conditions (Atherogenic-) and CON were compared on regional cortical thickness. Individuals with AUD showed significant bilateral cortical thinning compared to CON, but Atherogenic+ demonstrated the most widespread and greatest magnitude of regional thinning, while Atherogenic- had reduced thickness primarily in anterior frontal and posterior parietal lobes. Atherogenic+ also showed a thinner cortex than Atherogenic- in lateral orbitofrontal and dorso/dorsolateral frontal cortex, mesial and lateral temporal and inferior parietal regions. Our results demonstrate significant bilateral cortical thinning in individuals with AUD relative to CON, but the distribution and magnitude were influenced by comorbid pro-atherogenic conditions. The magnitude of cortical thinning in Atherogenic+ strongly corresponded to cortical watershed areas susceptible to decreased perfusion, which may result in morphometric abnormalities. The findings indicate that pro-atherogenic conditions may contribute to cortical thinning in those seeking treatment for AUD.

1470. Neurocognitively-Acting Potentially Inappropriate Medications, Alcohol, and Community-Acquired Pneumonia Among Patients with and Without HIV

BackgroundAlcohol interactions with neurocognitively-acting potentially inappropriate medications (NC-PIMs) may be more common, more harmful, and associated with lower levels of alcohol use among people living with HIV.MethodsWe conducted a nested case–control study using data from the Veterans Aging Cohort Study (2007–2015). Cases with community-acquired pneumonia (CAP) requiring hospitalization (n = 6,716) were 1:5 matched to controls without CAP (n = 33,253) at the time of event by age, sex, race, HIV status, baseline year, and duration of observation time. Index date was defined as CAP date for cases and match date for controls. Based on pharmacy data in the year prior to index date, NC-PIMs included receipt of at least one prescription of any duration for anticonvulsants, sedatives (including benzodiazepines), prescription opioids, antidepressants, antipsychotics, and muscle relaxants. Among HIV+, NC-PIMs exposure also included ritonavir (RTV), cobicistat (COBI), and efavirenz (EFV). Conditional logistic regression models were used to obtain adjusted odds ratios (OR) and 95% confidence intervals (CI) for NC-PIMs (any and count overall, and by class), alcohol use disorder (AUD) diagnoses in the year prior to index date, and their interaction adjusted for smoking status, VACS Index, steroids, vaccination status (influenza and pneumonia), hepatitis C, previous CAP, and various comorbidities.ResultsAmong 39,989 patients, 17,161 (43%) were HIV+, 98% were male, and median age was 58 years. An increase in number of classes of NC-PIMs was associated with a 17% increase in the odds of CAP among HIV+ and uninfected, and this effect was augmented by contemporaneous AUD. Among HIV+, all classes of NC-PIMs apart from EFV were positively associated with CAP, most notably antipsychotics (OR 1.66, 95% CI 1.43–1.93). Among uninfected, the highest risk of CAP was associated with antipsychotics (OR 1.81, 95% CI 1.61–2.03) and anticonvulsants (OR 1.64, 95% CI 1.49–1.80). AUD positively interacted with sedatives, opioids, antidepressants, and muscle relaxants in both groups, and with RTV/COBI in HIV+ patients.ConclusionNC-PIMs, especially with concurrent AUD, are associated with increased CAP risk among those living with and without HIV. Disclosures All authors: No reported disclosures.

Tobacco and alcohol use disorders: Evaluating multimorbidity

There is growing interest in applying the multimorbidity model for mental health disorders - i.e. the interactive effects of co-occurring diagnoses. Alcohol use disorder (AUD) and tobacco use disorder (TUD) often occur together, but distinctive correlates of their co-occurrence have not been studied. Veterans treated by the Veterans Health Administration (VHA) nationally in FY 2012 with diagnoses of both AUD and TUD were compared to those with only AUD or only TUD on socio-environmental factors, medical and psychiatric diagnoses, and service use. Multimorbid effects were defined as those in which patients with both AUD and TUD had more serious problems greater likelihood of specific co-occurring conditions than those with either AUD alone or TUD alone. Veterans with concurrent AUD and TUD (N=153,397), as compared to those with AUD only (N=191,900) or with TUD only (N=643,377), had significantly higher rates of homelessness [odd ratios (ORs)=1.24, 1.68], hepatic disease (ORs=1.11, 2.18), substance use disorders (ORs=1.42, 3.14), receipt of a VA disability pension (ORs=1.26, 1.30) and use of substance and mental health outpatient services (ORs=1.04, 1.12). Veterans with AUD and TUD appear to have more severe problems in some, but not all, socio-environmental, medical, psychiatric, and service use domains than veterans with either of these diagnoses alone. The combination of AUD and TUD yield generally more adverse effects in diverse areas and thus reflect an emergent phenomenon that may a require a distinctive treatment approach.

A 50-Year-Old Male with Cirrhosis, HCV, Alcohol-Use Disorder, and Unexpected Decline While on DAA Therapy

CME Educational Objectives 1. Review concepts in the terminology, diagnosis, treatment, and prognosis of hepatitis C in the setting of alcohol-use disorder. 2. Understand interactions between telaprevir, a US Food and Drug Administration–approved direct-acting antiviral for the treatment of hepatitis C virus, and commonly used psychotropic medications. 3. Provide strategies for managing hepatitis C virus–infected patients with concurrent alcohol-use disorder. The patient is a 50-year-old white man with a history of chronic hepatitis C virus (HCV) genotype 1b, depression, anxiety, hypertension, and alcohol-use disorder. His HCV infection was acquired 30 years ago. He has been followed at the liver medicine practice at Mount Sinai Hospital for the past 5 years. Despite recommendations from his hepatology team to abstain from alcohol and initiate a trial of treatment for HCV, the patient chose to defer currently available treatments, having heard of promising news about interferon-sparing regimens to be released in the near future.

Pharmacotherapy of Alcohol Use Disorders and Concurrent Psychiatric Disorders: A Review

Alcohol use disorders (AUDs) are among the most prevalent psychiatric disorders. Epidemiologic studies have shown a high prevalence of concurrent psychiatric disorders among people with AUDs as well as a higher prevalence of AUDs in people with psychiatric disorders than in the general population. Though psychiatric patients with concurrent AUDs are at increased risk for morbidity and mortality, they are commonly undertreated for their alcohol-related disorders. The efficacy of pharmacotherapy for AUDs is well documented. Our paper reviews the common pharmacotherapies available for AUDs and focuses on the available research regarding treatment of AUDs among psychiatric populations with mood, anxiety, and psychotic disorders. Despite the high prevalence of concurrent AUDs and psychiatric disorders, very limited information has been collected using a randomized controlled trial design targeting those concurrent conditions. Several prevalent psychiatric disorders have not been studied when co-occurring with AUDs. Further research of pharmacological treatments for concurrent AUDs and psychiatric diagnoses is urgently needed.

Chronic cigarette smoking and heavy drinking in human immunodeficiency virus: consequences for neurocognition and brain morphology

Alcohol use disorders (AUD) and chronic cigarette smoking are common among individuals with human immunodeficiency virus infection (HIV). Concurrent AUD in HIV is related to greater abnormalities in brain morphology and neurocognition than either condition alone. However, the potential influence of chronic smoking on brain morphology and neurocognition in those concurrently afflicted with AUD and HIV has not been examined. The goal of this retrospective analysis was to determine if chronic smoking affected neurocognition and brain morphology in a subsample of HIV-positive non–treatment-seeking heavy drinking participants (HD+) from our earlier work. Regional volumetric and neurocognitive comparisons were made among age-equivalent smoking HD+( n = 17), nonsmoking HD+ ( n = 27), and nonsmoking HIV-negative light drinking controls ( n = 27) obtained from our original larger sample. Comprehensive neuropsychological assessment evaluated multiple neurocognitive domains of functioning and for potential psychiatric comorbidities. Quantitative volumetric measures of neocortical gray matter (GM), white matter (WM), subcortical structures, and sulcal and ventricular cerebral spinal fluid (CSF) were derived from high-resolution magnetic resonance images. The main findings were (1) smoking HD+ performed significantly worse than nonsmoking HD+ on measures of auditory-verbal (AV) learning, AV memory, and cognitive efficiency; (2) relative to controls, smoking HD+ demonstrated significantly lower neocortical GM volumes in all lobes except the occipital lobe, while nonsmoking HD+ showed only lower frontal GM volume compared with controls; (3) in the HD+ group, regional brain volumes and neurocognition were not influenced by viremia, highly active antiretroviral treatment, or Center for Disease Control symptom status, and no interactions were apparent with these variables or smoking status. Overall, the findings suggested that the direct and/or indirect effects of chronic cigarette smoking created an additional burden on the integrity of brain neurobiology and neurocognition in this cohort of HIV-positive heavy drinkers.