Concurrent Alcohol Research Articles

The URICA as a measure of motivation to change among treatment-seeking individuals with concurrent alcohol and cocaine problems.

The original 4-factor structure of the University of Rhode Island Change Assessment (URICA; C. C. DiClemente & S. O. Hughes, 1990) was replicated, and the scale's internal consistency was found to be acceptable in a sample of 106 cocaine- and alcohol-dependent participants receiving either disulfiram or no medication in a psychotherapy trial. In addition, participants categorized as having high Committed Action (CA), a new URICA composite, had a significantly greater percentage of days abstinent from both alcohol and cocaine (85.6%) than low-CA participants (72.7%, p < .01). Furthermore, a significant Treatment x CA interaction emerged, suggesting that low-CA participants had better outcomes than those with high CA when assigned to medication, whereas high-CA participants fared equally well with or without medication.

Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common hepatic malignancy worldwide. The primary risk factor for the development of HCC is cirrhosis. Even patients without cirrhosis who develop HCC are typically found to have some underlying hepatic abnormality, such as steatohepatitis or chronic viral hepatitis. Although cirrhosis of any cause increases the risk of developing HCC, cirrhosis associated with chronic hepatitis B or C virus infection or hemochromatosis carries the greatest risk. Additional factors such as patient age and sex, duration and severity of liver disease, concurrent alcohol or aflatoxin exposure, liver histology, and alpha-fetoprotein levels also contribute to the relative risk of developing HCC. Vaccination programs aimed at preventing hepatitis B virus infection have been very successful in lowering the incidence of HCC in some areas of the world. Interferon-based therapy, which may control the inflammatory activity in chronic hepatitis C, also holds promise in preventing HCC. Other novel chemopreventative agents, such as glycyrrhizin and polyprenoic acid, may also have a role in preventing HCC, but they require further study before they can be recommended for widespread use.

A comparison of African American and non-Hispanic Caucasian cocaine-abusing outpatients

An understanding of how different racial and ethnic groups vary with respect to demographic characteristics and severity of psychosocial problems is necessary to better address the treatment needs of these subgroups. This study evaluated similarities and differences between African American and non-Hispanic Caucasian cocaine users initiating substance abuse treatment at community-based programs. At intake to treatment, patients completed the addiction severity index (ASI). African Americans ( n=161) and Caucasians ( n=86) differed with respect to gender, income and age. After controlling these demographic variables and treatment site, race-related differences were noted in many of the ASI composite scores. While African Americans had more severe employment problems, they had less severe alcohol, legal, family/social and psychiatric difficulties than Caucasians. These differences suggest that African Americans and Caucasians may benefit from treatment emphasizing different aspects of their psychosocial problems. Specifically, for many African American patients, employment-training programs may be particularly useful. Caucasians may be in greater need of treatment that focuses on concurrent cocaine and alcohol problems, as well as family and psychiatric difficulties.

The impact of continuing illegal drug use on teenage pregnancy outcomes--a prospective cohort study.

To evaluate the impact of continuing illegal drug use on teenage pregnancy outcomes. Prospective cohort study. Three Australian obstetric hospitals. Four hundred and fifty-six teenage antenatal patients. Teenage antenatal patients were interviewed and completed questionnaires to establish their pattern of non-prescription drug use before and during pregnancy. Illegal drug use data provided by the participants were validated in a subgroup of 180 who were interviewed six months postpartum. Antenatal, intrapartum and postnatal outcomes were collated independently. Data were analysed using SAS. Antenatal co-morbidity, delivery and newborn outcomes. In the cohort, 20.3% used marijuana throughout their pregnancy. However, 33.5% of these were multidrug users. The remaining 79.6% did not use illegal drugs throughout pregnancy (non-users). However, half the 'non-users' were 'ex-users' who ceased drug use immediately before or during early pregnancy. Illegal drug use was associated with an increased incidence of concurrent cigarette and alcohol use (both OR > 4.1 and P < 0.0001) and social and psychiatric morbidity (all OR > 1.95 and P < 0.001). Multidrug use was associated with a significant increase in the incidence of chlamydial and other endocervical infections (chlamydia: OR = 4.2,95% CI = 1.6-10.9; endocervical infections: OR = 2.6,95% CI = 1.1-5.7). After controlling for significant covariates, and in the setting of good antenatal care, the only difference in outcome was a significant linear trend towards an increased incidence of threatened preterm labour across the three groups (P = 0.02). Of note, there were no effects on birthweight, birthweight ratio or preterm birth. Good antenatal care may be able to ameliorate many adverse pregnancy outcomes in teenagers who use illegal drugs throughout pregnancy. The high levels of coexisting psychosocial morbidity are a concern for future mothercrafting.

The impact of continuing illegal drug use on teenage pregnancy outcomes—a prospective cohort study

Objective To evaluate the impact of continuing illegal drug use on teenage pregnancy outcomes. Design Prospective cohort study. Setting Three Australian obstetric hospitals. Sample Four hundred and fifty-six teenage antenatal patients. Methods Teenage antenatal patients were interviewed and completed questionnaires to establish their pattern of non-prescription drug use before and during pregnancy. Illegal drug use data provided by the participants were validated in a subgroup of 180 who were interviewed six months postpartum. Antenatal, intrapartum and postnatal outcomes were collated independently. Data were analysed using SAS. Main outcome measures Antenatal co-morbidity, delivery and newborn outcomes. Results In the cohort, 20.3% used marijuana throughout their pregnancy. However, 33.5% of these were multidrug users. The remaining 79.6% did not use illegal drugs throughout pregnancy (non-users). However, half the ‘non-users’ were ‘ex-users’ who ceased drug use immediately before or during early pregnancy. Illegal drug use was associated with an increased incidence of concurrent cigarette and alcohol use (both OR > 4.1 and P < 0.0001) and social and psychiatric morbidity (all OR > 1.95 and P < 0.001). Multidrug use was associated with a significant increase in the incidence of chlamydial and other endocervical infections (chlamydia: OR = 4.2, 95% CI = 1.6–10.9; endocervical infections: OR = 2.6, 95% CI = 1.1–5.7). After controlling for significant covariates, and in the setting of good antenatal care, the only difference in outcome was a significant linear trend towards an increased incidence of threatened preterm labour across the three groups ( P = 0.02). Of note, there were no effects on birthweight, birthweight ratio or preterm birth. Conclusion Good antenatal care may be able to ameliorate many adverse pregnancy outcomes in teenagers who use illegal drugs throughout pregnancy. The high levels of coexisting psychosocial morbidity are a concern for future mothercrafting.

Missed Opportunities in the field: Caring for clients with co-morbidity problems

This discussion paper presents key issues associated with caring for people with concurrent alcohol or drug and mental health problems. By way of anecdotal stories and personal experiences, it draws attention to 'missed opportunities' for effective care of clients within a general hospital and community mental health service. As educators, inicians and students, we are concerned our own attempts to improve the care of these clients may have been less than successful due to various factors, and believe such information is important to share with the wider nursing profession. We hope the paper will stimulate interest amongst general, mental health and drug and alcohol nurses, and researchers and educators to better address the issue of alcohol, drug and mental health co-morbidity in our community.

The URICA as a measure of motivation to change among treatment-seeking individuals with concurrent alcohol and cocaine problems.

The URICA as a measure of motivation to change among treatment-seeking individuals with concurrent alcohol and cocaine problems.

'Rich Man's Speed': a qualitative study of young cocaine users

Thirty-four young cocaine users recruited from London, UK, participated in qualitative, in-depth interviews about their cocaine use and related behaviours. None had ever received treatment for a drug- or alcohol-related problem. Findings suggest that cocaine users may be younger and less well educated than previously thought. Some young people may perceive cocaine as a safer, more predictable alternative to ecstasy or amphetamines. There was little awareness of risks associated with cocaine use, particularly regarding concurrent heavy alcohol use. Few were able to describe personal 'harm-reduction' strategies to reduce the risks associated with cocaine use, whereas there was good awareness of appropriate measures to take when using ecstasy. Although crack was regarded very negatively compared with powder cocaine, the data indicated that in practice the boundary between the two forms of the drug might be becoming less well defined for some users. The findings suggest a need for national education and policy to raise awareness about the relationship between cocaine powder and crack, and the risks associated with use of the drug in either form.

Isoniazid preventive therapy, hepatitis C virus infection, and hepatotoxicity among injection drug users infected with Mycobacterium tuberculosis.

Treatment of latent Mycobacterium tuberculosis infection with isoniazid can cause hepatotoxicity, but the risk of isoniazid-associated hepatotoxicity among persons coinfected with hepatitis C virus (HCV) is unknown. We conducted a prospective study among 146 injection drug users with M. tuberculosis infection and normal baseline hepatic transaminase values who were treated with isoniazid. Of 146 participants, 138 (95%) were HCV-seropositive. Thirty-seven participants (25%) were human immunodeficiency virus (HIV)-seropositive. Thirty-two (22%; 95% confidence interval [CI], 16%-30%) of 146 participants developed transaminase value elevations to >3 times the upper limit of normal. Transaminase value elevation was associated with concurrent alcohol use but not with race, age, presence of hepatitis B surface antigen, HIV-1 infection, or current injection drug use. Isoniazid was withdrawn from 11 participants (8%; 95% CI, 4%-13%). Of 8 deaths during follow-up, none were attributed to isoniazid-associated hepatotoxicity. The risk of transaminase value elevation and drug discontinuation for HCV-infected persons receiving isoniazid was within the range reported for populations with lower HCV prevalence.

Effects of cocaine and cocaine metabolites on cardiovascular function in squirrel monkeys

The effects of cocaine and the cocaine metabolites norcocaine, ecgonine methyl ester, benzoylecgonine and cocaethylene were evaluated in conscious squirrel monkeys for their effects on blood pressure and heart rate. Norcocaine, ecgonine methyl ester and benzoylecgonine are produced in vivo following cocaine use. Cocaethylene is produced in vivo following concurrent cocaine and alcohol use. Increases in both blood pressure and heart rate were observed following cocaine doses of 0.3–3.0 mg/kg. Ecgonine methyl ester and benzoylecgonine had no effect on either parameter up to doses of 10.0 mg/kg. Norcocaine increased blood pressure, but was less potent than cocaine. Norcocaine did not affect heart rate at doses up to 3.0 mg/kg. In contrast to the other metabolites, cocaethylene increased blood pressure and heart rate similarly to cocaine. These results suggest that ecgonine methyl ester and benzoylecgonine are devoid of cardiovascular effects at doses comparable to cocaine and would not be expected to contribute to cocaine's overall cardiovascular effects. Norcocaine's effect on blood pressure might contribute to the cardiovascular effects of cocaine, but this metabolite is produced only at low levels in vivo. The one metabolite that might be expected to contribute to cocaine's overall cardiovascular effect is cocaethylene, although the degree of this contribution is not clear.

Separate and interactive effects of cocaine and alcohol dependence on brain structures and metabolites: quantitative MRI and proton MR spectroscopic imaging.

The effects of chronic cocaine and alcohol abuse on human brain structure and metabolites are not fully known. We studied controls (n = 13) and abstinent subjects dependent on cocaine (8), alcohol (12), and cocaine and alcohol (17) using quantitative MRI and proton MR spectroscopic imaging. Talairach-based techniques yielded tissue and CSF volumes and gray- and white-matter concentrations of N-acetylaspartate (NAA), creatine and choline metabolites in multiple brain regions. Alcohol dependents had lower gray-matter NAA concentrations and more sulcal CSF than non-alcohol dependents throughout the brain. They also had less subcortical gray matter and (regionally) less white matter. Cocaine dependents compared with non-cocaine dependents had higher posterior parietal white-matter creatine concentration. They also had less gray and white matter in the prefrontal lobes and in a region encompassing the temporal lobes and cerebellum. Structural white-matter deficits in cocaine dependents were greater with longer duration of cocaine use. Subjects with concurrent cocaine and alcohol dependence had less prefrontal white matter, especially in the anterior cingulate, than subjects dependent on only one substance. Chronically abused cocaine and alcohol each leave multiple metabolic and structural brain defects after long-term abstinence. Concurrent dependence on both substances may aggravate white-matter structural defects, primarily in frontal brain.

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.

Smoking among in‐patients with drug‐related problems in an Australian psychiatric hospital

AbstractDespite the high prevalence of smoking among people with mental illnesses, interventions for tobacco dependence have not typically been offered as part of treatment regimens. Data on the prevalence of smoking among 160 people with coexisting alcohol or other drug problems admitted to acute wards of a public psychiatric hospital are presented. Associations between level of smoking, diagnosis, socio‐demographic variables and readiness to quit smoking are examined. Reasons for smoking are also reported. Over 90% of the sample were regular smokers, with a mean cigarette consumption of 22.09 cigarettes per day, which was not related to type of psychiatric illness, gender or relationship status. Daily cigarette consumption was higher among older smokers and those with a diagnosis of alcohol dependence. It is suggested that interventions for tobacco dependence among people with co‐existing alcohol or other drug problems and mental illnesses should be conducted by mental health staff and aim to increase or consolidate motivation to quit smoking; provide nicotine replacement; address any concurrent alcohol abuse; identify and challenge dysfunctional beliefs about smoking; and address stress management, boredom and lifestyle.

CORRELATES AND 6-MONTH OUTCOMES FOR CO-OCCURRING CANNABIS USE IN RURAL AND URBAN AT-RISK DRINKERS

We know little about the functional correlates of recent cannabis use when such use is additional to an “alcohol disorder” in non-treatment populations. We report on data from a prospective study of a large probability community survey of 733 at-risk drinkers in six Southern U.S. states (Alabama, Arkansas, Georgia, Louisiana, Mississippi, and Tennessee) conducted from 1995 to 1996. Twenty-one percent reported cannabis use during the past six months at the baseline interview. These cannabis users were significantly less likely to be married, employed, or a high school graduate (p<.05). They were also more likely to have a diagnosis of “antisocial personality disorder” or “panic disorder.” Recent cannabis users also reported more negative consequences of their alcohol use, including more frequent recent diagnoses of an “alcohol disorder,” legal difficulties associated with their drinking, and more social consequences attributed to drinking. At the six-month follow-up interview, negative alcohol outcomes were associated with concurrent cannabis use, including higher frequency and quantity of alcohol consumption, greater frequency of recent “alcohol abuse” and “dependence,” and greater social consequences of drinking. These results all point to substantially poorer functioning and experiences of individuals with concurrent at-risk alcohol and cannabis use. We suggest that cannabis use may be a marker for greater impairment associated with at-risk drinking. [Translations are provided in the International s Section of this issue.]

Combined tobacco and alcohol use by pregnant and reproductive-aged women in the United States

Objective: To assess trends in the concurrent use of alcohol and tobacco among pregnant women. Methods: Using behavioral risk factor surveillance system data from 1987 through 1997, we determined the prevalence of concurrent tobacco and alcohol use among women aged 18–44 years by pregnancy status and indirectly estimated pregnancy-related disuse rates. Results: The percentage of women who used alcohol and tobacco decreased significantly from 1987 to 1990 among pregnant (5.4% to 3.0%) and nonpregnant women (17.6% to 14.2%), but thereafter did not change significantly. The estimated pregnancy-related disuse rate of tobacco and alcohol increased insignificantly from 70% in 1987 to 82% in 1997. Among women who used both substances, pregnancy-related disuse was slightly greater for alcohol alone (74%) than for tobacco alone (52%). There was not a significant decline in concurrent use of tobacco and alcohol between 1987 and 1997 among women 18–20 years old (pregnant, 4.4% to 3.6%; nonpregnant, 13.5% to 13.7%). That age group also showed a smaller pregnancy-related disuse rate than older women (1997, 74% versus 83%). Conclusion: The steady trend in concurrent use of tobacco and alcohol by young women emphasizes the need for enhanced efforts to reduce the initiation of tobacco and alcohol use by young people. Women who report abuse of tobacco or alcohol should be evaluated for abuse of both substances, and interventions should address abuse of both substances. (Obstet Gynecol 2000;96:767–71.)

1999 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System

There are 5000–10,000 snake envenomations annually in the United States. Fortunately, few are fatal. In this study we review the epidemiology of fatal snakebites.Native snakebite cases from the American Association of Poison Control Centers (AAPCC) National Poison Data System from 1989 to 2018 were reviewed. Additional cases that were not reported to the AAPCC were identified by reviewing Wikipedia and by searching PubMed and online news outlets using various combinations of relevant keywords.We identified 101 fatal bites from native snakes. Rattlesnakes accounted for 74 (90.2%) of the 82 deaths for which the species was known or which occurred where rattlesnakes are the only native crotalids. There were five fatalities attributed to copperheads, two due to cottonmouths, and one caused by an eastern coral snake. Males were disproportionately affected. The median age for victims was 40 years old. In cases for which data were available, many of the snake interactions were intentional, e.g. religious services, animal husbandry, and attempting to kill the snake.Death following envenomation from a native U.S. snake is unlikely, particularly if medical attention is sought promptly. Rattlesnake envenomations are more likely to be fatal than bites from other species. Intentionally engaging with a venomous snake raises the risk of incurring a fatal bite, as does concurrent alcohol or drug use. Age less than 12 years old does not appear to be a risk factor for a fatal outcome, while elderly patients may have a slightly increased risk of death.

Regular attenders to the accident and emergency department

Objectives—To examine the profile of regular attenders to an accident and emergency (A&E) department, and to estimate the percentage of the overall departmental workload attributed to this group of patients,...

Developmental associations between substance use and violence

This study examined the developmental associations between substance use and violence. We examined the trends in each behavior throughout adolescence, how the behaviors covaried over time, and the symmetry of associations taking into account frequency and severity of each behavior. We also examined whether changes in one behavior affected changes in the other behavior over time. Six years of annual data were analyzed for 506 boys who were in the seventh grade at the first assessment. Concurrent associations between frequency of substance use and violence were relatively strong throughout adolescence and were somewhat stronger for marijuana than alcohol, especially in early adolescence. Type or severity of violence was not related to concurrent alcohol or marijuana frequency, but severity of drug use was related to concurrent violence frequency. Depending, to some degree, on the age of the subjects, the longitudinal relationships between substance use and violence were reciprocal during adolescence and slightly stronger for alcohol and violence than for marijuana and violence. Further, increases in alcohol use were related to increases in violence: however, when early alcohol use was controlled, increases in marijuana use were not related to increases in violence. Only in early adolescence was the longitudinal relationship between marijuana use and later violence especially strong. The strength of the longitudinal associations between violence and substance use did not change when common risk factors for violence and substance use were controlled. Overall, the data lend more support for a reciprocal than for a unidirectional association between substance use and violence. Prevention efforts should be directed at aggressive males who are multiple-substance users in early adolescence.

Rapid induction of behavioral and neurochemical tolerance to cocaethylene, a model compound for agonist therapy of cocaine dependence.

Tolerance to abused drugs may impact on patterns of abuse, and in the case of agonist therapies, may be beneficial in that it reduces the reward value of a given dose of abused drug. Cocaethylene, a psychoactive metabolite resulting from concurrent alcohol and cocaine consumption, was examined because of its use in human research studies of drug reward mechanisms, and its potential as a model compound for an agonist based therapy for cocaine dependence. Comparisons were made between cocaine and cocaethylene in the acute development of tolerance to the neurochemical and behavioral effects of cocaine. With chronic exposure, tolerance to the behavioral effects of cocaine was examined. In awake rats with a microdialysis probe in the nucleus accumbens and a jugular catheter, an IV bolus/3-h infusion of cocaine or cocaethylene and a subsequent cocaine challenge was administered while extracellular dopamine and locomotion were monitored. Chronic IV treatment with cocaine, cocaethylene, and a water control was accomplished for 7 days using osmotic minipumps attached to jugular catheters. Animals were then challenged with an IV bolus of cocaine. With acute treatment, the IV bolus of cocaethylene at the beginning of the infusion period resulted in an initial behavioral activation equivalent to that caused by cocaine, after which there was a striking difference in that the cocaethylene group displayed a return to predrug levels of activity, while the cocaine group showed high levels of activity throughout the 3-h period. Both cocaethylene and cocaine resulted in an initial increase in the extracellular concentration of dopamine. However, after that initial increase, levels of dopamine dropped in the cocaethylene group while the cocaine group levels remained elevated. A 1-week infusion of cocaine or cocaethylene resulted in tolerance to the behavioral activating effects of a subsequent cocaine challenge. These results demonstrate a rapid induction of tolerance to the behavioral and neurochemical properties of cocaethylene, resulting in a diminished behavioral response to a cocaine challenge both acutely, and after 7 days. The relevance of these data for the use of cocaethylene as a model compound for an agonist approach to therapy for cocaine dependence is discussed.

Impact of comorbid affective and alcohol use disorders on suicidal ideation and attempts.

The effect of concurrent affective and alcohol use disorders on suicidal ideation and behavior was investigated. The Diagnostic Interview Schedule Version III-R (DIS) was administered to 307 adult veteran men ranging in age from 23 to 78. Participants were classified into one of four groups based on their final DIS diagnosis-lifetime unipolar depression and lifetime bipolar I disorder with or without a lifetime alcohol use disorder. Logistic regression analyses indicated that veterans with a major affective disorder were at greater risk for suicidality than veterans without an affective disorder. However, veterans with unipolar depression were at no greater risk for suicidality than those with bipolar I disorder. Unipolar and bipolar I disorders with a concurrent alcohol use disorder were always associated with an increased risk for suicidality.